How do I help students integrate research/evidence into the practice education setting?

Evidence must be used to guide clinical decision-making. Care decisions are grounded in research, not opinion (Mathieson, Grande & Luker, 2018). The AAP expects students to search several sources for data, results, and conclusions of valid, reputable studies. Diligent research on a particular patient presentation is good, however, it holds limited value until the findings are applied to clinical practice (Hagler et al., 2012). Evidence-informed care can be accomplished by ensuring the student:

• • Has thoroughly assessed the patient.
  • Can construct a clinical question derived from subjective and objective data.
  • Can find the best evidence through an appropriate and inclusive search.
  • Appraises the evidence for validity and usefulness.
  • Educates the patient while incorporating the evidence with clinical assurance and considers the patient’s needs.

Students should demonstrate the following while integrating evidence-informed research into practice:

• • Self-directed learning.
  • Use of appropriate evidence in clinical practice.
  • Establishment of a personal library of evidence-based practice resources.

How much supervision should I give the student?

The dilemma of whether to stay with the student or let them practice independently is difficult. The preceptor is encouraged to:

• • Observe the student in a variety of practice education situations to ascertain their overall abilities.
  • Observe the student with complex or new patient presentations until you have confidence in the students’ abilities.
  • Discuss with the student their overall plan for the day and when your observation is needed.
  • As an experienced practitioner, circumstances to include when deciding if student observation is required are:
    • Has the student-managed a similar situation in the past?
    • What are the risks for the student and the patient?
    • What potential errors could be made and what would be the impact to the patient, student, and yourself be?
    • Will the student ask for help when necessary or are they overconfident?
    • Does the student feel overwhelmed with this patient presentation?
    • Does the student ask relevant and pertinent questions for other patient presentations?
• • If the student is having difficulty, do not increase the caseload or preceptor observation, as this can increase student anxiety and hinder clinical confidence (Smith, 2006). Give the student extra time to feel comfortable with the current caseload and observations.

How do I select patients for students?

The selection of patients will reveal the student’s abilities to manage patients in a variety of clinical situations. Consider the following when selecting patients for the students:

• • Understand and know the clinical objectives for the clinical placement.
  • Allow the student to gain confidence before assigning complex patients.
  • Begin with a reduced workload so the student can manage and then quickly increase caseload as they integrate knowledge and gain confidence.
  • Gradually introduce new patients and experiences.
  • Observe how the student manages assigned patient presentations.
  • Consider selecting patients outside of the current caseload to meet the students’ clinical expectations.

How do I evaluate students?

Evaluation can be challenging as it requires you to make a judgment of someone else’s abilities (Smith, 2006). Reflect on your personal values and beliefs when related to what is important in your nursing practice. The following suggestions may assist you in the provision of formative feedback:

• • Collect data on a daily basis throughout the clinical experience. This can be subjective and objective data collected through direct or indirect student observation.
  • Observe how the student interacts with   patients, family members, and other health care professionals.
  • Provide objective and constructive feedback. Frequent positive constructive feedback is essential for student growth. Provide feedback to the student at least once per clinical day. Feedback on areas that the student must strengthen can be difficult but is essential for the student to recognize learning gaps to improve patient care (Smith, 2006).

• The preceptor will provide feedback for each patient and how this is accomplished will vary depending on the location and structure of the practice experience site.

How do I give constructive feedback throughout the clinical day?

When providing feedback, think about what you want to achieve, how you want to achieve this, and develop your own understanding of how the feedback will be perceived (Hardavella, Aamli-Gaagnat, Rosalva, & Streter, 2017). The following are tips for providing feedback:

• • Plan time for feedback
  • Give feedback promptly (e.g., right after the event).
  • Think about what needs to be conveyed (i.e., gaps in health history).
  • One-on-one feedback is preferable.
  • Start lightly.
  • Be specific.
  • Encourage self-reflection.
  • Be aware of nonverbal cues.
  • Self-reflect after you have provided feedback.

How to preceptor an overly confident NP student?

Video: Preceptoring in Primary Health Care Working with Overly Confident, Confrontational and Challenging Student

It is extremely important to recognize an overly confident student. The following should be considered to help facilitate teaching and feedback to an overly confident student:

• • Do not escalate any confrontations.
  • State the objective facts that support your position.
  • Find a common goal on which you can agree.
  • Actively listen to their response.
  • Prior to exiting the conversation, agree on a plan.

How to give feedback to a sensitive NP student?

Video: Preceptor in Primary Health Care Working with a Sensitive Student

Providing feedback and communicating to a sensitive student can be challenging. Approach to feedback is important so the sensitive student maintains their confidence and can continue to grow in the role.  Consider the following when providing feedback to a sensitive student:

• • Identify a private place to have the conversation.
  • State your concerns clearly.
  • Use ‘I’ statement, not “you”r” statements (For example, I am concerned).
  • Actively listen to their response.
  • Prior to exiting the conversation, agree on a plan.