Adult learning principles serve as the foundation for most preceptor education programs. Clinical teaching strategies concentrate on approaches that will optimize learning in the clinical arena and are based upon the new nurse's need to know. The preceptor is the facilitator of the learning process guiding the new nurse through the nuances of hospital policies and clinical judgment. Andragogy is a term that preceptors can explain and illustrate, and names such as Tough, Knowles, and Brookefield roll off preceptors' tongues with ease. A name that would elude most preceptors, however, is Maria Montessori. Montessori's unique educational approach will serve as the focus of this month's column.

Maria Montessori was the first female physician in Italy, and she specialized in pediatrics and psychiatry. She became involved in the education of children when she was asked to open a preschool for children in one of the poorest and most crime-ridden areas of Rome. The children's parents often worked 16 hours a day, and as a result, the children were unsupervised, unruly, and uneducated. The year was 1907, and since that time, Montessori's name has been associated with a unique pedagogical approach to learning.

For over 100 years, "Montessori" classrooms have offered an alternative to the standard educational approach of structured, teacher-directed environments, with little or no movement to a prepared environment where the child is given the freedom to select learning activities without constant dependence on the teacher. Learning occurs in a cooperative atmosphere marked by social interaction and peer teaching. The student emerges from a Montessori education as a competent, responsible, adaptive individual who is a lifelong learner and problem solver. Lillard and Else-Quest (2006) found that Montessori education fosters social and academic skills that are equal or superior to those fostered by a pool of other schools when they studied 5 year olds and 12 years olds enrolled in Montessori schools and traditional schools.

Polk-Lillard (1996) in her book Montessori Today describes the Montessori approach as unique among educators because Montessori included all the formative years from birth to adulthood in a comprehensive educational plan. Cameron Camp, PhD, director and senior research scientist at the Myers Institute for Research in Cleveland, has done extensive research engaging people with dementia by applying the Montessori method. Camp and Schneider (2002) have developed training manuals, games, and activities that can be used by caregivers in the home, adult day care centers, or nursing homes. The staff adapts activities for different levels of difficulty and stages of dementia. Performing such tasks on their own gives residents a sense of accomplishment and, by engaging them, helps reduce problem behavior.

Is Montessori's approach to learning the genesis for holistic education regardless of age? It can certainly serve as a model for preceptor education. Let us examine three elements of a Montessori approach that could enhance the quality of the orientation experience: intrinsic motivation, prepared environment, and "sensitive periods."

First and foremost, the orientee is perceived as a motivated learner, anxious to display sound judgment and to provide excellent care. Montessori believed that every child has intelligence, creativity, and imagination. This must be the premise of preceptors about the new nurse assigned to them. If an orientee struggles with a basic concept or skill, it must be the preceptor that gently and empathetically conveys to the orientee that the skill can be mastered. In addition, orientees should be directing the learning activities that will meet the gap in their knowledge base. A new nurse may have never cared for a patient with sepsis, started an IV, or placed a violent patient in seclusion. How revolutionary it would be if the orientee selected the patients or concentrated on one skill to master during a shift. Most orientation programs are crafted by the educator, and the orientee adapts to the patient assignment prescribed by the preceptor.

Montessori advocated for a prepared environment where the child could be safe and engage in a myriad of activities throughout the day. The materials used in a Montessori classroom are self-correcting and allow the child to achieve mastery. Is a prepared environment even a possibility in the chaotic, dynamic, intense world of a nursing unit? The nursing unit is not a classroom, and the new nurse is expected to perform certain basic skills and make inferences about a patient's condition. The new nurse is adapting to a change in roles; the new nurse is no longer a learner who incidentally works but a worker who incidentally learns. For this reason alone, it is imperative that the preceptor be a modulator of the environment. The preceptor can maximize learning by minimizing interruptions, running interference with challenging patients or coworkers, and providing the new nurse with the necessary "tools and rules" to be successful.

Finally, Montessori believed that children experienced sensitive periods. These sensitive periods indicated that the child was receptive to some activities but indifferent to others (Seldin & Epstein, 2006, p. 46). This principle has great applicability for orientation. In many organizations, formalized orientation classes are held during the first several days or weeks of employment, and the variety of activities range from passing a medication test; being assessed for competency; and learning about fall prevention, fire safety, and infection control before the nurse ever steps onto the nursing unit; this is "front-end" teaching. There is no transfer of learning because the orientee is learning in isolation. The rationale behind establishing an orientation program such as this is because of convenience in scheduling. Once nurses arrive on the clinical unit, it can be a logistical nightmare in facilitating their attendance at a subsequent class or classes. Yet, many organizations have committed themselves to a "phased orientation approach" where classroom activities are coordinated with sensitive periods expressed by the orientees. As a result, the orientee has greater interest and energy for learning because it is relevant to the learning need.

Everyone involved in the orientation process is acutely aware of the commitment of resources and time that is necessary to transition a novice nurse from student to worker and an experienced nurse to a new clinical environment. The goal of orientation is to prepare nurses who are intrinsically motivated rather than dependent on extrinsic rewards, who embrace lifelong learning not just surviving orientation, and who stand out rather than fit in. Maria Montessori proposed this learning approach over 100 years ago. It is time we entertained it as a lifelong learning philosophy.

How many of you have a phased approach to orientation? We would love to hear from you.

Mary Beth and Mary

REFERENCES