A DISSERTATION ON Qualitative Evaluation of a Hospital-Based Preceptor-Guided Clinical Orientation Program

Table of Contents Section 1: The Problem ........................................................................................................1 The Local Problem .........................................................................................................1 Problem in the Larger Population ..................................................................................3 Rationale ........................................................................................................................5 Evidence of the Problem ......................................................................................... 5 Definition of Terms........................................................................................................6 Significance of the Study ...............................................................................................8 Research Questions ........................................................................................................9 Review of the Literature ..............................................................................................10 Conceptual Framework ......................................................................................... 11 Related Research ................................................................................................... 26 Implications..................................................................................................................35 Summary ......................................................................................................................36 Section 2: The Methodology ..............................................................................................38 Introduction ..................................................................................................................38 Research Design and Approach ...................................................................................38 Generic Qualitative Inquiry .................................................................................. 39 Justification of the Research Design ..................................................................... 40 Program Evaluation Approach .............................................................................. 41 Goal-Free Approach to Program Evaluation ........................................................ 42 Participants ...................................................................................................................45 Participant Selection Criteria ................................................................................ 46 ii Sample Size Justification ...................................................................................... 47 Participant Access ................................................................................................. 48 Participant Rapport ............................................................................................... 49 Confidentiality Considerations ............................................................................. 50 Newly Graduated Nurse Selection Process and Demographics ........................... 51 Preceptor Selection Process and Demographics ................................................... 52 Data Collection ............................................................................................................53 Interviews .............................................................................................................. 54 Observation ........................................................................................................... 56 Documents ............................................................................................................ 57 Data Analysis ...............................................................................................................58 Validity and Reliability ......................................................................................... 60 Limitations ............................................................................................................ 64 Data Analysis Results ..................................................................................................66 Data Analysis of Research Question 1.................................................................. 67 Data Analysis of Research Question 2.................................................................. 92 Summary of Preceptor Data Analysis ................................................................. 110 Cross-Categorical Thematic Summary of RQ1 and RQ2 Findings ...........................111 Preceptor-Guided Clinical Orientation Program Facilitators ............................. 112 Preceptor-Guided Clinical Orientation Program Barriers ................................... 113 Conclusions ......................................................................................................... 116 Program Evaluation ...................................................................................................117 Step I: Learner Preparation ................................................................................. 118 iii Step II: Climate Preparation................................................................................ 118 Step III: Model for Collaborative Planning ........................................................ 120 Step IV: Assessing Learning Needs .................................................................... 121 Step V: Developing Objectives ........................................................................... 122 Step VI: Learning Plans ...................................................................................... 122 Step VII: Conducting the Designed Learning Experience .................................. 123 Step VIII: Evaluating Learning Outcomes and Reassessing Learning Needs....................................................................................................... 123 Conclusions ......................................................................................................... 134 Section 3: The Project ......................................................................................................137 Introduction ................................................................................................................137 Description and Goals ................................................................................................137 Rationale ....................................................................................................................138 Review of the Literature ............................................................................................139 Preceptors ............................................................................................................ 140 Mentors ............................................................................................................... 148 Coaches ............................................................................................................... 152 Conclusion .......................................................................................................... 153 Executive Summary ............................................................................................ 153 Implementation ..........................................................................................................155 Project Evaluation ......................................................................................................155 Social Change Implications of the Study ...................................................................155 Conclusion .................................................................................................................156 iv Section 4: Reflections and Conclusions ...........................................................................158 Introduction ................................................................................................................158 Project Strengths and Limitations ..............................................................................158 Recommendations for Alternative Approaches .........................................................160 Scholarship, Project Development, and Leadership and Change ..............................161 Reflections on the Importance of the Work ...............................................................164 Implications, Applications, and Direction and Directions for Future Research ........165 Conclusion .................................................................................................................166 References ........................................................................................................................168 Appendix A: The Project .................................................................................................187 Appendix B: Interview Question Grid .............................................................................216 Appendix C: NGN Semistructured Interview Tool .........................................................217 Appendix D: Preceptor Semistructured Interview Tool ..................................................220 Appendix E: Sample NGN Interview Transcript .............................................................222 Appendix F: NGN Data Codebook Categories and Subcategory Example .....................234 Appendix G: Preceptor Interview ....................................................................................235 Appendix H: Preceptor Data Codebook Categories and Subcategories Example ...........246 Appendix I: Preceptor Academy Goals ...........................................................................247 Appendix J: Interpretive Summary of NGN1 interview ..................................................248 Appendix K: Interpretive Summary of Preceptor Interview............................................256