Creating an environment conducive to adult learning - Educational Innovations - sugical nusing

AORN Journal,  April, 2003  by Sharon E. Hohler

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How should a nurse preceptor react when a surgeon makes the following request of a preceptee? "Nurse, get me an Otis elevator." An Otis elevator is a passenger or freight elevator that is made by the Otis Elevator Co, and is found in public buildings. This request sends the novice perioperative nurse on an errand for a nonexistent surgical instrument and makes fun of his or her lack of knowledge. The preceptor knows this is an old joke. A joke such as this, made at the new nurse's expense, however, can be a pivotal point in that nurse's career. The nurse preceptor can intervene to protect the preceptee from the surgeon's attempt at humor or keep silent, which will result in the novice nurse's humiliation. Does this really happen? Unfortunately, it does.

Preceptors must create an environment that is friendly to novice nurses and conducive to perioperative nurse education, particularly in light of the current nursing shortage. Effective teachers use principles of adult learning to facilitate the education of new employees. This results in increased satisfaction for preceptors, preceptees, other staff members, and ultimately, patients.

PRINCIPLES OF ADULT LEARNING

Principles of adult learning were described by Malcolm Knowles, PhD, in the mid 1960s. Knowles used the term andragogy to describe "the art and science of helping adults learn." (1) These principles state that adults are self-directed learners, have rich experiences and knowledge on which to draw, desire to learn to better handle real-life situations, and see education as a process that increases competence and leads to achievement of their full potential. (2) Although there have been many adaptations by other educators, Knowles pioneered learning principles that still are used in adult education programs throughout the world.

This article shares strategies used at St Francis Medical Center, Cape Girardeau, Mo, to achieve a friendly environment that is conducive to adult learning. These strategies are based on several of Knowles' conditions of learning, including:

* the environment is characterized by mutual trust and respect,

* the learning process makes use of learners' experience,

* learners participate actively in the learning process, and

* learners have a sense of progress toward their goals. (3)

ENVIRONMENT OF MUTUAL TRUST AND RESPECT

Preceptors should create an environment in which new staff members feel accepted.

   Every nurse in the OR is
   responsible for the success
   of a new nurse, whether it
   be by accepting him or her
   as part of the team or
   teaching a new skill. New
   nurses often feel the difference
   between an OR that
   really cares for new nurses
   and one that does not. (4)

Simple things preceptors and their coworkers can do to show caring include talking with new staff members and offering help when a new nurse looks lost. Include new staff members at lunch and break time. New staff members who feel unwelcome are more likely to leave and find a more welcoming environment in which to work.

Earn trust. Earn a preceptee's trust by providing all the information he or she will need. Nurses have a reputation for being judgmental of new nurses. An insecure preceptor deliberately may cause the preceptee difficulty so that the preceptor then can come to the rescue. For example, since Dr L routinely draws anatomic landmarks with a sterile marking pen before making a surgical incision, he expects the pen to be available and handed to him when needed. If the preceptee does not have this information from the preceptor, a delay will result while the preceptee opens the package. This should never happen, but it does. This behavior undermines the preceptee's self-confidence and may contribute to the loss of a potentially excellent perioperative nurse.

MAKE USE OF LEARNERS' EXPERIENCE

Recognize that a perioperative nurse preceptee has some--maybe years of--nursing experience and knowledge. He or she may have worked in another OR and have that background on which to build. This preceptee just needs to learn the facility's routines and physicians' preferences. Alternatively, a preceptee may not have worked as a perioperative nurse but may have years of experience as a medical/surgical unit nurse or as a community health nurse. Value preceptees' knowledge and skills. It is difficult and humbling for an experienced nurse to leave a job with known routines to undertake a new specialty.

Linking new learning to a preceptee's knowledge and previous experiences can be compared to building a pyramid. New bits of knowledge and experiences are stacked onto preexisting blocks, retained, and used. Ascertain a preceptee's level of experience, and begin at that level. Has the preceptee been a perioperative nurse elsewhere, or has he or she had nursing positions that are unrelated to the OR? A preceptee with no perioperative experience will require a longer orientation period with more repetition of desired practices.

Explain why and how. Reaffirm preceptees' knowledge and skills by explaining why certain actions are taken, as well as how. Although perioperative nursing is based on scientific information, it is very action oriented. New preceptees need to understand the scientific basis behind a practice to adapt those principles to different situations. For example, knowledge of the principles and operating steps for using a steam sterilizer will enable preceptees to correctly operate the sterilizer for both cannulated and noncannulated instruments in a flash cycle and drills in a prevacuum cycle.