equipped for excellence: a theory-based orientation...
TRANSCRIPT
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Equipped for Excellence: A Theory-Based Orientation Plan for Vascular Access Specialists Sheila Hale, RN, CRNI, VA-BC, Judy Smith, MSN, RN, CRNI, Gwen Irwin, RN, CRNI
Seton Family of Hospitals
Abstract
Goal
To equip new members of the Vascular Access Team with knowledge, skills and values for providing high quality, evidence-based vascular access services to the people of Central Texas
The education and training of new clinicians is a crucial topic for leaders in vascular access, yet there is a paucity of published work in this arena. This presentation describes an original orientation plan based upon Patricia Benner’s “Novice to Expert” theory, encompassing all stages of learning and development, as well as the three learning domains. Minimizing the risk of overlooking important content areas during the orientation process, while developing well rounded, highly skilled vascular access clinicians is the expected outcome.
Patricia Benner’s Novice to Expert Learning Theory
Patricia Benner based her Novice to Expert Learning Theory on the Dreyfus model of Skill Acquisition.
Novice
Advanced Beginner
Competent
Proficient Expert
Dreyfus Model (1980)
•Cognitive –Thinking Domain
•Psychomotor –Doing Domain
•Affective –Feeling Domain
Bloom’s Taxonomy
Cognitive • Self-Paced Study • Case Study • Simulation • Concept Mapping
Psychomotor • Demonstration/Return Demonstration • Observation/Modeling • Simulation
Affective • Case Study • Storytelling • Reflective Journaling • Role-Playing
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Novice
• No situational context
• No experience in new area of practice
• Needs concrete rules to govern actions
Advanced Beginner
• Recognizes meaningful elements of cases in context
• Needs preceptor support in the clinical setting
• Needs help setting priorities
• Applies guidelines
Competent
•Feeling of mastery
•Able to manage contingencies and troubleshoot problems
•Effective and organized
•Conscious and deliberate planning
•Needs to develop speed and flexibility
Proficient
•Perceives situations holistically
•Sees what is most important and anticipates needs
•Sets priorities
•Recognizes early warning signals
•Flexible and efficient
Expert
•Broad array of experiences
•Intuitive grasp of situations
•Highly skilled analysis
•Vision of what is possible
Patricia Benner’s Novice to Expert Learning Theory
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Reflections on Theory-Based Vascular Access Orientation
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Lessons Learned
• Weekly meetings with manager and preceptor
– Leadership connection and
support
•Develop relationships
–Communicate confidence in
preceptor and learner
–Solve problems early
–Celebrate wins
Questions we still have: • Would one preceptor throughout be
best? Or several preceptors? • More time spent with US machine? • More time spent on anatomy?
Outcomes
•12 weeks average time to competency
•Less comprehensive
•Longer time to success rate >90%
•$15,000 (orientee salary only)
Former Plan
•8 weeks average time to competency
•More comprehensive
•Shorter time to success rate >90%
•$10,000 (orientee salary only)
Theory-based Plan
Utilization of this orientation method in a network of seven hospitals in Central Texas has • Reduced the time required for
inexperienced clinicians to achieve independent practice by 30%
• Prepared the clinicians to advance to higher levels of vascular access knowledge and skills
• Added value to the organization by reducing training costs.
Conclusion
Anderson, J. (2006). The work-role transition from expert nurse clinician to novice nurse educator in a baccalaureate nursing program. (Doctoral dissertation). Abstract retrieved from CINAHL. (2009711311) Bastable, S. (2008). Nurse as educator: Principles of teaching and learning for nursing practice. Sudbury, MA: Jones and Bartlett. Benner, P. (1984). From Novice to Expert: Excellence and power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall Health. Chinn, P., Kramer, M. (2008). Integrated theory and knowledge development in nursing (7th ed). St. Louis: Mosby Elsevier. Gentile, D. (2012). Applying the novice-to-expert model to infusion nursing. Journal of infusion nursing, 35(2), 101-107. Keating, S. (2006). Curriculum development and evaluation in nursing. Philadelphia: Lippincott Williams & Wilkins. Marble, S. (2009). Five-step model of professional excellence. Clinical journal of oncology nursing, 13(3), 310-315. McEwen, M., Wills, E. (2007). Theoretical basis for nursing (2nd Ed). Philadelphia: Lippincott Williams & Wilkins. Moureau, N., Lamperti, M., Kelly, J., Dawson, R., Elbarbary, M., vanBoxtel, J, Pittiruti, M. (2013). Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. British journal of anesthesia. Advance online publication. doi: 10.1093/bja/aes400
References
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Seton Family of Hospitals Vascular Access Team
Thank you!