The two books reviewed this month are Mastering Precepting: A Nurse's Handbook for Success by Beth Ulrich and Healthy Places, Healthy People (second edition) by Melanie Dreher and Lisa Skemp. As you can see from the titles alone, these are two very different books but offer useful knowledge for all nurses, regardless of their area of practice or interest.
Sigma Theta Tau International published A Nurse's Handbook for Success by Beth Ulrich in 2011. The book has 13 chapters, an appendix, and an index. It costs U.S.$39.95 and is 268 pages long. A companion website http://www.RNPreceptor.com provides the plans and resources presented in the book. I found this book to contain excellent resources and suggestions for those being precepted, those doing the precepting, and those managing the precepting dyad. The book is directed to the preceptor but the needs of the preceptee are, obviously, continually addressed or referenced. Successful precepting is a result of preceptors and preceptees working together within the context in which they function working to achieve understanding, competence, and confidence.
In the Foreword, Sherwood (2011, p. xxiv) states, "Mastering Precepting does not leave the preceptor preparation to chance but offers a toolkit to effective competency development." Chapter One presents the roles of a preceptor and discusses the context within which the precepting occurs. Figure 1.1 visually demonstrates that the precepting is within the context of safety and quality. This visual, along with the various roles of the preceptor (teacher/coach, leader/influencer, facilitator, evaluator socialization agent protector, and role model) frame the subsequent approaches presented. Chapter One ends with a preceptor development plan for each role.
Chapter Two discusses learning theories, models, and styles. Specifically it offers an overview of adult learning theory, transformative learning theory, social learning theory, Maslow's hierarchy of needs, Benner's novice to expert model, and learning styles. This brief (17-page) overview reminds the preceptor to model the learning for the learner. At the end of the chapter, the preceptor is asked to reflect on how they learn best in preparation for their role.
Precepting strategies are presented in Chapter Three with the goal of clarifying for the preceptor areas of strength and those needing further development to increase the preceptor's knowledge and expertise. Table 3.1 assists the manager and preceptor to clarify role expectations on both sides. Issues such as the priority of the precepting role compared with other duties are addressed prior to beginning precepting, thus reducing the chance of misunderstanding and conflict. The question of whether the precepting will be accomplished through single preceptor or by a team of preceptors is asked, as well as how many preceptees will the preceptor have at one time. This chapter has many other excellent questions and thus is ripe with issues needing clarification prior to beginning precepting.
As stated by the author, "At the heart of any precepting experience is the development of competence, the development of ability and experiences to effectively utilize the competence (critical thinking, clinical reasoning, and clinical judgment) and the confidence to take action when needed" (page 55). Chapter Four discusses these critical elements in the precepting process. Because competence is conceptual in nature, excellent examples of how to recognize competence are given. The ANA Position statement on professional role competence and core critical thinking skills and subskills from the American Philosophical Association are referenced. Characteristics of critical thinkers, clinical reasoning, and clinical judgment are presented and how to help a preceptee develop these characteristics discussed.
As all nurses know, having a plan and clear understanding of the objectives will result in better outcomes, whether it has to do with patient care or precepting. Writing objectives has never been a favorite activity of mine but I have learned over the years that unless everyone knows what the goals or end product should be, knowing whether the goal has been reached is difficult. In addition, unless everyone involved has the same understanding of the outcome or goal, we all may not be moving in the same direction. Chapter Five demonstrates how to develop and use objectives, goals, and outcomes. It contains a great section on how to write objectives and why the verb used is important to the level of success obtained. If the preceptee does not understand from the objective that they are expected to analyze a clinical situation but the objective states they need to know about it, both preceptor and preceptee will be frustrated in not achieving the necessary outcome.
Communication is the topic for Chapter Six. The five skills of effective communication are presented along with a checklist for self-evaluation of dialogue behaviors. Suggestions are made regarding different methods of communication and which methods work best in certain situations. Patient safety and handoffs as well as managing difficult conversations are discussed. The chapter ends with strategies for education and meetings.
Chapter Seven is about coaching. The preceptor as a coach has specific elements that require additional understanding and knowledge about the coaching role. Coaching is helping others find their own answers within themselves through questioning and reflection that result in them taking action to move through their challenges. This chapter reviews how to set up a coaching agreement with the preceptee and use an interactive coaching format. Strategies that assist the preceptee to learn and move through their challenges are presented. As in other chapters, this chapter ends with a preceptor development plan for coaching.
With all the instructional technology available and the fact that the majority of nurses entering the profession have grown up using educational technologies, Chapter Eight identifies various forms of technology and appropriate uses of each one. Use of simulation and high-fidelity patient simulation in developing clinical competence and confidence and facilitating clinical judgment are discussed. An overview of developing simulation experiences is presented.
Chapter Nine looks at the different experiences and needs of specific learner populations such as student nurses on clinical rotations versus experienced nurses or international nurses. Each population has specific needs that must be considered to best meet the precepting goals.
Key to a successful precepting outcome is the preceptee's behavior and motivation. Chapter Ten looks at how to assess and address preceptee behavior and motivation particularly if the preceptee is struggling. This chapter provides tools to help the preceptee gain insight regarding how their behavior impacts care delivery, patients, and teammates by focusing on observable change. Strategies the preceptor can use are identified. A Just Culture is used as the problem-solving framework enabling preceptors to objectively assess preceptee performance, thus avoiding fundamental attribution errors. By applying Just Culture, the preceptor is able to look at preceptee behavior and work with the preceptee to address the error in an appropriate and helpful manner. Another way to identify preceptee behavioral pattern strengths and developmental opportunities is the Dimensional Model of Behavior tool. This tool is based upon the premise that observed workplace behaviors can result from two dimensions: task accomplishment and relating to others. Preceptees are provided with actionable data based on observations of behavior, not attributions. The emphasis is on how the preceptee approaches their work. Table 10.1 offers tips for using the Dimensional Model of Behavior. Motivation, or why people do what they do, helps the preceptor assist the preceptee to change their behavior based on the preceptee's reasons, not the preceptor's reasons.
The pragmatics of precepting are found in Chapter Eleven. Concrete examples are given of how to assist the preceptee's organization and time management. A section discusses delegation skill development. For the preceptor, strategies are offered to manage challenges with the preceptee's skill development and negative or unproductive preceptee behaviors. This is a very useful chapter.
Chapter Twelve is directed at managers and their role in selecting, supporting, and sustaining preceptors. The development of performance standards for the preceptor is described, including how to establish outcomes for differing levels of preceptee as discussed in Chapter Nine. To assist in selecting the right person to serve as a preceptor, a rubric is provided, which can be used as is or as a model to develop a rubric specific to your organization. Conflict between preceptor and preceptee, communication, education and guidance of the preceptor, and finally evaluation of the preceptor in that role are discussed. The importance of recognition of preceptors is also discussed.
The last chapter, Chapter Thirteen, discusses the importance of self-care on the part of the preceptor to prevent burnout and create the optimal healing environment. Numerous tables provide practical suggestions to prevent and receive help for burnout are given. A self-assessment and planning tool is offered for the preceptor to use in planning ahead to address or avoid burnout.
The Appendix offers suggestions on how each chapter can be best used in a preceptor education course. These appendices and the companion website offer a solid framework from which to function to move to a successful precepting experience for all involved. I highly recommend this book for anyone who is or will be serving as a preceptor.
The second book is Healthy Places, Healthy People (second edition) by Melanie Dreher and Lisa Skemp. Sigma Theta Tau International published this book as well in 2011. The book has seven chapters and an index. It costs U.S.$39.95 and is 288 pages long. This may seem like an unusual book to review for this journal and its readers but with the increased emphasis by the federal government on decreasing the "gap" between the community and the healthcare organization, the principles discussed by these authors are of importance. As stated in the introduction, "this book is designed to help students of public health use the concept of culture to learn how communities work and how to work with communities" (p. XV).
Chapter One explains why culture is the critical organizing concept for community nursing practice. The idea of what is culture and cultural competence are discussed, as well as what is a community and community health. The scientific foundation of community health nursing and related concepts are presented.
Chapter Two discusses culturally informed community health practice that requires a different way of thinking and a different set of skills. Building on Chapter Two, Chapter Three discusses strategies for entering and understanding your community. Assessment is the first of three core public health functions, and this chapter describes how to assess the culture and health of an entire community using two approaches. How to determine commonly used statistical measures, epidemiological studies, and ethnography is explained. The numerous sources for community data are presented including a long list of Internet sites.
Chapter Four presents how to discover the culture of your community. As in previous chapters, suggested activities help the reader understand how to discover the community's culture. All aspects of the community are presented allowing a comprehensive understanding of what constitutes a community. Community cycles and populations are also discussed. Chapter Five presents how to describe and analyze the health of a community. Systematic and comprehensive procedures are detailed as well as how to compare the health of the community with other communities and at other times. The healthcare infrastructure of the community in terms of primary, secondary, and tertiary prevention is examined. Numerous suggested activities once again bring the information provided to a useable and practical level for the reader.
Chapter Six points the reader to the future with the presentation of how to lay the foundation for a healthy community by using the Healthy People agenda as the foundation for the strategic plan. Aspects of planning in community health are discussed. Creating the community constituency and appraising the effectiveness of the plan are discussed with an example of contextual analysis using public high school completion as the basis.
Chapter Seven takes the reader "through the complex process of leading change by putting a culturally informed health community agenda into action" (p. 209). The differences between two models of action as well as their appropriate use are discussed. Coalition building, distinguishing between primary and secondary target groups, is discussed. How to distinguish between a conservative and culturally preservative action plan is presented. Examples and suggested activities assist the reader in using the information presented. The book concludes with an extensive reference list that serves as an excellent resource for further inquiry. I highly recommend this book because it offers the reader a different perspective that results in a broader understanding of the communities within which we work and live.
In conclusion, both books reviewed are well worth the reader's time. Each book looks at quite different content but both offer excellent information the reader will find useful.