Creating context for critical thinking in practice: the role of the preceptor

Abstract

This paper is a report of a study to determine the impact of the preceptor coaching component of a reflective contextual learning intervention on novice nurses' critical thinking skills during the first 6 months of their practice. The use of preceptors to develop novice nurses' clinical skills has been well documented in the literature. However, there is little literature focused on preceptor involvement to develop novice nurses' critical thinking. This small case study was conducted in the United States of America in 2004 with six nurse/preceptor dyads. Stake's qualitative instrumental case study design was used to evaluate the preceptor component of the contextual learning intervention. Stories of preceptor experiences were analyzed using Stake's phases of data analysis (i.e. description, categorical aggregation, establishing patterns, naturalistic generalizations). Specific questions (e.g. nature of coaching used by the preceptor) guided the analysis. Repeating patterns were coded and isolated and later collapsed as the analysis moved forward. Preceptors use of the contextual learning intervention created a context that stimulated novice nurses' critical thinking. Two main themes describe the novice nurses' critical thinking skills relative to the preceptor coaching: 1) critical thinking as organizing and carrying out tasks; and 2) critical thinking as intentional, reflective thinking. Preceptor education should incorporate the following components: understanding the impact of power and anxiety on critical thinking of novice nurses transitioning into practice; creating dialogue that invites questions in a reflective and critical manner; and challenging thinking through sharing of perspectives.