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Whether you are a student in a clinical preceptorship, or precepting in a new position, there are unwritten rules of “etiquette” in place when working with a nursing preceptor. Follow these tips for a more positive and enriching experience. When in doubt, pause and put yourself in the preceptor’s shoes to gain insight into your responses before you respond.
Never act like you know everything upfront. Using expressions akin to “Duh” or “I knew that” do not bode well for a positive preceptorship experience. Allow the preceptor to do his or her job which is to teach you what you need to know. Until he/she assesses your skill and knowledge abilities, he/she may train you at a level below what you think you deserve. Let him/her make the adjustment based on your demonstrated skills and abilities. Do not act like you are better than his/her training or that he/she is wasting your time!
Be a listerner, not a talker. Your preceptor’s job – in addition to his or her regular duties – is to train you to excel in performing in your new nursing position. He/she is giving you a wealth of information. Listen to that information and write it down if you have to. Don’t interrupt when the preceptor is talking with pearls of wisdom such as, “That’s not how I did it at my last job.” You will not win points. Listening is an active and interactive experience.Be there for it.
Ask lots of questions. Remember, there are no dumb questions – just unasked ones. Your preceptor wants you to clarify issues and asks questions. Don’t save the questions for the day you start working on your own. Question instructions for clarification and further information as needed. You do not look dumb by asking a lot of questions. Your preceptor knows you are listening and are engaged in the process when you ask questions.
Allow your preceptor to be your resource. He/she did not just enter the organization as you are doing. A preceptor is chosen by management because of his/her experience in the job position and nursing skills and knowledge. Use this to your advantage and have the preceptor be your resource for everything. You don’t need to limit this resource to on-the-job duties – they even have useful information such as where the closest bathroom is and what time the cafeteria opens.
Thank your preceptor at every opportunity. When I was working at a pediatric ER, I remember a co-worker, whose nursing student was not following the above tips say, “Time for my 13 dollar headache.” She was getting paid an extra dollar an hour to be a nursing preceptor. Even with a positive experience, that is not close to payment enough for the extra mile a preceptor goes every day for you. You do not need to shower this person with compliments or gifts – although he/she would likely not mind. But you do need to thank this person, at least once a day, for his/her attention to your needs. Expressing appreciation is still one of the best cost-free gifts a person can extend to another.
About the Author: Sue Heacock, RN, MBA, COHN-S is the author of Inspiring the Inspirational: Words of Hope From Nurses to Nurses, a compilation of stories from nurses around the country, with a sprinkling of inspirational quotes. Sue is a Certified Occupational Health Nurse Specialist and has worked in a variety of areas of nursing including pediatrics and research. Before entering the nursing profession, Sue worked in human resources and equal employment opportunity.
Click here to read more on Sue Heacock.
History and Orientation
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. The model was developed in response to the failure of a free tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
Core Assumptions and Statements
The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:
|1.||feels that a negative health condition (i.e., HIV) can be avoided,|
|2.||has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and|
|3.||believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence).|
The HBM was spelled out in terms of four constructs representing the perceived threat and net benefits: perceivedsusceptibility, perceived severity, perceived benefits, and perceived barriers. These concepts were proposed as accounting for people’s “readiness to act.” An added concept, cues to action, would activate that readiness and stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one’s confidence in the ability to successfully perform an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or overeating.
Table from “Theory at a Glance: A Guide for Health Promotion Practice” (1997)
|Perceived Susceptibility||One’s opinion of chances of getting a condition||Define population(s) at risk, risk levels; personalize risk based on a person’s features or behavior; heighten perceived susceptibility if too low.|
|Perceived Severity||One’s opinion of how serious a condition and its consequences are||Specify consequences of the risk and the condition|
|Perceived Benefits||One’s belief in the efficacy of the advised action to reduce risk or seriousness of impact||Define action to take; how, where, when; clarify the positive effects to be expected.|
|Perceived Barriers||One’s opinion of the tangible and psychological costs of the advised action||Identify and reduce barriers through reassurance, incentives, assistance.|
|Cues to Action||Strategies to activate “readiness”||Provide how-to information, promote awareness, reminders.|
|Self-Efficacy||Confidence in one’s ability to take action||Provide training, guidance in performing action.|
Source: Glanz et al, 2002, p. 52
Scope and Application
The Health Belief Model has been applied to a broad range of health behaviors and subject populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness. 3) Clinic use, which includes physician visits for a variety of reasons.
This is an example from two sexual health actions. (http://www.etr.org/recapp/theories/hbm/Resources.htm)
|Concept||Condom Use Education Example||STI Screening or HIV Testing|
|1. Perceived Susceptibility||Youth believe they can get STIs or HIV or create a pregnancy.||Youth believe they may have been exposed to STIs or HIV.|
|2. Perceived Severity||Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.||
Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid.
|3. Perceived Benefits||Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.||
Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others.
|4. Perceived Barriers||
Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level).
Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options).
|5. Cues to Action||Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message “no glove, no love”) or reminder messages (such as messages in the school newsletter).||
Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).
|6. Self-Efficacy||Youth confident in using a condom correctly in all circumstances.||
Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment).
Conner, M. & Norman, P. (1996). Predicting Health Behavior. Search and Practice with Social Cognition Models. Open University Press: Ballmore: Buckingham.
Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice.San Fransisco: Wiley & Sons.
Glanz, K., Marcus Lewis, F. & Rimer, B.K. (1997). Theory at a Glance: A Guide for Health Promotion Practice.National Institute of Health.
Eisen, M et.al. (1992). A Health Belief Model — Social Learning Theory Approach to Adolescents’ Fertility Control: Findings from a Controlled Field Trial. Health Education Quarterly. Vol. 19.
Rosenstock, I. (1974). Historical Origins of the Health Belief Model. Health Education Monographs. Vol. 2 No. 4.
Becker, M.H. The Health Belief Model and Personal Health Behavior. Health Education Monographs. Vol. 2 No. 4.
Champion, V.L. (1984). Instrument development for health belief model constructs, Advances in Nursing Science, 6, 73-85.
Becker, M.H.,Radius, S.M., & Rosenstock, I.M. (1978). Compliance with a medical regimen for asthma: a test of the health belief model, Public Health Reports, 93, 268-77.
See also Health Communication
By Linda Beattie, contributor
It is just after midnight, your shift is well underway and there is a long list of patients waiting for your help. Who has time to eat? Besides, it’s hard to find nutritious food at work and you’re trying to cut back, right? Don’t fool yourself—skipping a meal is one of the worst things you can do for yourself, and there aresome healthy options.
Nurses usually learn about good nutrition in their undergraduate studies, but the reality of shift work and the hectic pace at the hospital or other health care setting can make it hard to follow even the most common-sense principles. Hospital food service programs haven’t helped much in the past, either.
Thankfully, nutrition experts are teaming up with food service managers to make more healthy and tasty choices available for all hospital food patrons—including patients, visitors and staff—and to offer advice to their health care colleagues.
“At hospital cafeterias, we’ve really made it a point to develop more nutritious hot entrees, grab-and-go options, salad bars and healthy snacks. When we’re talking about nurses eating healthy, it can be a real challenge because of their schedule,” said Dee Sandquist, MS, RD, spokesperson for the American Dietetic Association and director of nutrition, weight managment and diabetes at Southwest Washington Medical Center in Vancouver, Washington.
“Nurses need quick choices,” she continued. “They need good snacks available and they need to be careful not to get over-hungry, because that can cause them to overeat or make less healthy choices.”
By Nancy Deutsch, RN, contributor
A new nurse had a busy night shift on a med-surg unit. At 3 a.m., one of her patients started to crash, so she spent the night working with the patient, skipping her break, not having time to chart or do much with any of the other patients. When it was time to report to the day shift, one of the nurses who had just come on immediately demanded to know why another patient’s pre-op checklist was not complete, without listening to what the night nurse had experienced.“Where’s our compassion for each other?” asked Seattle nurse Kathleen Bartholomew, RN, MSN.Bartholomew said this is not an isolated example of how nurses can be unkind to each other. “I observed these behaviors,” she said. “They were hurtful, but they didn’t mean to hurt each other; it’s frustration.”Troubled by this issue, Bartholomew wrote the book Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young and Each Other, interviewing hundreds of nurses who were upset by the behavior of their peers.Bartholomew, who has a master’s degree in nursing from the University of Washington and still works as a nurse a few days a month at the Swedish Medical Center, said that “at the very core” of the problem is “the fact that we’re not united.“We’re the only profession that can’t seem to get it together on what the entry level should be.”She believes the behavior stems from nurses’ belief that they lack influence. While nurses no longer rush to give up their seats or bring coffee to physicians, “We still show deference in little ways,” she said, adding that when people feel powerless, they often lash out at others—even unconsciously.Bartholomew pointed out that much hostility between nurses is passive-aggressive, and many new nurses witness this when more experienced nurses answer questions abruptly or not at all.An example is during the preceptor relationship when new nurses sometimes feel they are a burden to veteran nurses. Preceptors don’t get a lighter load in order to take time to train a new nurse, and that can cause some conflict, according to Bartholomew.Bartholomew is quick to point out that these issues can be overcome—and that new nurses can take a leadership role in changing the cultural dynamic.“Talking it out is the answer,” she said. “Always respond to the non-verbal, to the feelings. Respond to that nurse. Say, ‘I know you say nothing’s wrong but the tone of your voice says differently. Please tell me what’s wrong.’“If you don’t speak to the truth,” Bartholomew explained, “you can’t fix it.”You Can Fix It (more…)
By Karen Siroky, RN, MSN, and Christina Orlovsky, contributors
“I’ve learned that I need to be patient with myself. As a new nurse, I’m not going to know everything or always do everything exactly right at first. So, my advice would be to give yourself time, learn from everything and don’t sweat the little stuff,” said Kerry Willis, RN, a new critical care nurse at Tampa General Hospital in Florida. “The worst part is feeling like you just are not prepared. Slowly but surely those feelings subside with each and every new experience. As a new nurse you must learn to grow from every experience.”
- Is the means to establish a helping-healing relationship. All behavior communication influences behavior.
- Communication is essential to the nurse-patient relationship for the following reasons:
- Is the vehicle for establishing a therapeutic relationship.
- It the means by which an individual influences the behavior of another, which leads to the successful outcome of nursing intervention.
Basic Elements of the Communication Process
- Sender – is the person who encodes and delivers the message
- Messages – is the content of the communication. It may contain verbal, nonverbal, and symbolic language.
- Receiver – is the person who receives the decodes the message.
- Feedback – is the message returned by the receiver. It indicates whether the meaning of the sender’s message was understood.