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  1. J.Adderton

    The One-Minute Preceptor

    Being a nurse preceptor can be very rewarding, but it’s sometimes a rough gig. If you’ve ever been a preceptor, you probably had a “we’ll get to that when there’s time” task list that seemed to go on forever. A big hurdle for nursing preceptors today is finding enough time to coaching during the busy workday. Imagine if there was a way you could effectively precept even when the only available time is 5 minute blocks (or less) throughout the workday. Enter….The One Minute Preceptor. What Is It? The One-Minute-Preceptor has been a tested and valued teaching tool for over 20 years. Instead of becoming overwhelmed with the “whole” of orientation, the One Minute Preceptor method makes the most out of time-crunched teaching opportunities. The Five Microskills The One Minute Preceptor method focuses on five microskills; skills that also teach clinical reasoning. Get a commitment Probe for supporting evidence Reinforce what they did well Give guidance on any errors or mistakes Teach a general principle It’s Easy (Really) Now, I realize “five microskills” sounds complicated, but the One Minute Preceptor is really easy to use. Let’s take a look at just one snapshot of the precepting day and apply the five microskills. Case Study You are precepting a new graduate nurse on a busy inpatient rehabilitation unit. A nursing assistant reports Mr. V (one of your 7 assigned patients) is asking for assistance to the bathroom for the 3rd time in the past hour. You tell the nursing assistant that you and the student will take Mr. V to the bathroom to assess what’s going on. The patient is 72 and is 3 days post stroke- with left sided weakness. Assessment data Afebrile Urine frequency Voiding only small amounts No burning or itching with urination Pt obese and unable to palpate bladder Denies abdominal pain No history of prostate issues States “my bladder feels full” Microskill 1- Get a commitment to the issue Preceptor Review the assessment findings with the new nurse Ask them what they think the is going on with the patient Examples “What do you think is going on with Mr. V?” “Why do you think Mr. V is experiencing urinary frequency?" Microskill 2- Probe for supporting evidence Preceptor Ask what evidence supports the new nurse’s opinion Ask what other alternatives were considered and why they were rejected Examples "What findings lead you to this conclusion?" "What else did you consider?" Microskill 3- Teach general principles Preceptor Use the opportunity to provide education To make more memorable, phrase as a general rule “when this happens, do this” Example “Mr. V’s symptoms, other than urine frequency, do not suggest a UTI. Some stroke patients experience urinary retention following the event. When patients feel a strong urge to urinate but void little, it could be because they are not emptying the bladder fully. When this happens, the next step is to scan the patient’s bladder.” Microskill 4- Let them know what they did right Preceptor At the first opportunity, tell the new nurse what they did well. Be Specific Share the effect it had Example “You asked the patient great questions and were able to gather helpful subjective data. Mr. V appreciated your interest and concern.” “You didn’t jump straight to the conclusion of a UTI and used deductive reasoning to eliminate what wasn’t the problem. We were able to address the issue faster without unnecessary legwork.” Microskill 5- Correct Any Mistakes Preceptor If a mistake or omission is made by the new nurse, as soon as possible find an appropriate time and place to discuss: Let the new nurse critique their performance Then discuss what was wrong How to correct in the future Example “You may be right that Mr. V’s prostate is enlarged. But, we still need to assess to determine if the patient is retaining urine” “You correctly performed the bladder scan, but you need to be sure to explain the procedure to the patient” Putting it All Together You may be thinking… “This will take forever to get through”. But, the One Minute Preceptor is patient-centered and uses your nursing duties throughout the day to teach. This approach allows you to provide meaningful coaching in five minutes or less. Have you used the One Minute Preceptor method for coaching? If so, what was your experience?
  2. Recently I had an experience that made me pause and eventually want to call every nurse I know to tell them that they are missing out on a chance to partner at a deep level with their patient, families, colleagues, staff, and personally. It all began in December 2009 with my friend's mom. I noticed how everything I had done for the last 30 years came together just in time to learn a life lesson I think you will appreciate. My best friends mother is 81 years old and has a 50 year history of diabetes. You can just imagine the challenges her body faces on a daily bases. After a UTI in December, she was hospitalized and is doing fine now. During this time of illness and healing, we met wonderful nurses, doctors, social workers, and home care aides. This was a relatively good experience for such a difficult time. Of course, there were frustrating times for everyone as we tried to work together with mom and a lifetime of noncompliance. For all of the nurses out there wanting to perfect their skills in their profession, I highly recommend that you take a look at Life Coaching. I've been to many conferences and learned so much about my specialty, lab results, technology, and so forth. I even went to seminars to learn to deal with difficult people. Life Coaching is one of the most effective communication tools available today and is designed to place decisions, responsibility, outcomes, and celebrations with the people they belong too, our patients and their families. I hope this sounds interesting to you. A nurse that has been trained as a coach will have the ability to listen to what is being said at a very different level. You know how we like to fix things, right? When you coach, you are partnering in a unique way with the intent to walk alongside the patient and/or family and help them design the outcome they want. We do this already in different areas of care delivery. The opportunity to do so much more in a way that honors our patient is exciting and easily attainable. My friend encouraged her mom to live with them during the first months of recovery. "Mom" was given a few lessons on how to eat as a diabetic and some basic review of her medications and use of insulin. After 50 years either she has it or she doesn't! I was asked to speak with "Mom" and see if there was anything I could do to help the family in general. As a Professional Coach and RN, I found the real opportunity came when we simply asked her, "What is important to you right now? She answered, "I'd like to feel good enough to visit my kids before I die". The questions begin. Help me understand what it means to "feel good enough". She wanted to have blood sugars that she could predict so she was not feeling scared all the time. This began a dialogue that she described her fears, especially at night. "Then in the morning, I feel like I have a hangover and cannot get out of bed". Looking over her "data" we could back off of the insulin a few units raising the blood sugar while staying within normal limits. Fear at night was a big surprise, the family really had no idea. We did talk about what she was afraid of, but more importantly, what would help her feel safe. Only on occasion did she say, "I do not know". During this process, we found opportunities to establish what was important to "mom" especially since we know that people are likely to do those things that are important to them. According to the family, for the first time in 15 years "mom" was taking action to improve her health as well as in her relationship with her children. As those areas were addressed the family reported she was walking more, using her cane, assisting in her bath, and staying up for a good part of the day. Before she moved to join son, I asked what she thought needed to be communicated to the son and daughter-in-law in preparing to receive her in their home. I loved her response which motivated me to encourage nurses to consider adding coaching to their practice. She said, "Desiree, it was like all of a sudden people understood that I need to be asked what I am willing or wanting to do and respect my answer. That made all the difference. You know, nurses like to tell you what to do because they want you to get better but sometimes our goals do not match". The most natural coaches are nurses indeed. I see people from all professions becoming a Life or Health & Wellness Coach and the trend in nursing seems to be growing slowly. This is our natural next step in meeting the patient and their families where they are, respecting their decisions, yet offering them all that we have to improve their quality of life as they define improvement and quality.

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