Background
In the medical field, nursing is a significant profession that requires passion, dedication, sacrifice, and confidence to work on the front foot for the providence of the best possible care to the unhealthy population. However, without any specialized training for the nursing practitioners and the concerned healthcare providers, it is almost impossible to cope with potential eventualities in the healthcare environment. Therefore, nurses are the backbone of the care work environment imbued with care-related knowledge and the right skillsets despite the serious challenges they face while the delivery of the best possible care, handling unhealthy people, and ensuring patient safety. Often, these challenges within the clinical setting turn out to be environmental hazards for the nurses and they are hindered to work. Morton et al (2017) and Hermann et al (2016) highlight the specialized nature of the nursing profession and the challenges healthcare providers face that in every care environment nurses are exposed to potential threats such as physical ailments and infectious diseases from patients as they have to come in contact with a bunch of patients with different disease threats at regular intervals. They add that this hazardous profession is capable to manifest potential harm and hazards for the nurses. Since the outbreak of the Covid-19 pandemic around the world, the responsibilities, as well as potential threats for the nurses, have increased twofold. Indeed, nursing is a dangerous profession for care providers who provide care facilities at the forefront during Covid-19, but dangers and threats can be reduced through protective strategies and pieces of equipment such as gloves, masks, etc., hiring professional preceptors, recruiting an adequate number of nurses, and training programs to ensure the prevention and management of Covid in the urgent care facility. In this regard, the preceptorship training program is considered to be an effective evidence-based solution to cope with the healthcare hazards nurses face on a daily basis due to lack of knowledge and clinical practice during Covid. With that said, this benchmark capstone project will talk about the effectiveness of preceptorship training as an intervention to implement an outcome for the prevention and management of Covid-19 in an urgent care facility.
Clinical Problem Statement
Due to the outbreak of the viral pandemic, nurses are resigning from care environments because of the poorly inclined work, less satisfactory payment conditions, lack of personal safety, and overworked hours due to the severity of the Covid. This results in nurses’ turnover which is a huge concern these days in the healthcare system worldwide as many care providers have complained that their work environments are not providing any training program to tackle the Covid spread and many of their fellow nurses have captured the virus or have left the hospital because of the threat. So, for those remaining their workloads are heavy and a lack of knowledge regarding the strategies and policies to prevent Covid spread has made their ability to deliver quality care not easy. In addition, organizations due to a lack of Covid-related knowledge and resources failed to support nurses’ autonomy which is why nurses were unable to perform their duties at or beyond the nursing practice. Covid is the time when healthcare organizations need more nurses and other care providers to bring in, but nurses leaving due to poor management and inadequate staffing have impacted the performance of those who are still providing the best possible care in the facility. Overworked nurses feel stressed and more fatigued so the delivery of quality care is hard to accomplish in this scenario.
Purpose of Change Proposal
Covid has become a giant for the world and it has affected the healthcare system the most. The main intention of implementing the change proposal is to formally put forward a plan for the management and prevention of Covid to improve the scope of service within the healthcare organization. The practicum site has not found the solution to cope with the nurses’ turnover and Covid prevention issues, but only a preceptorship program to improve the nurses’ and preceptors’ retention as well as patient safety. Thus, to ensure optimal patient care, nurses, preceptors, and other care-providing staff within the urgent care facility must uphold a certain competency to ensure that quality care is being always provided to patients safely and correctly.
PICOT Question
For patients at risk of Covid-19 in the acute care setting, does the implementation of a new preceptorship training program for improving management and prevention of the pandemic help decrease the risk of Covid spread and can impact better patient care outcomes?
PICOT Statement Overview
The purpose of this PICOT question is to develop an awareness of the implementation of a preceptorship program to guide new nurses in the clinical setting in order to address the effectiveness of nurse-to-nurse communication and cooperation while using medical instruments and procedures. A variety of sources provide evidence that adequate preceptorship training in the urgent care setting for the nurses increases the self-care for the healthcare providers, especially nurses as well as patients (Çamveren et al, 2022). In various specific studies during the times of Covid-19 since it has stricken the globe conducted in different regions that are heavily affected by the pandemic, conducting preceptorship programs is associated with better Covid prevention and management. It is evident that the nurses who receive appropriate education and training for tackling patients suffering from acute illnesses due to the Covid pandemic have higher levels of interpersonal and professional skills. Hence, nurse education and training through professional preceptors form one of the evidence-based practices to improve the quality of Covid management and prevention and self-care for outpatients suffering from mild symptoms of Covid (Kelly, 2022).
Literature Search
The literature search strategy employed for this capstone project change proposal was the database search method to identify relevant research journals within the effectiveness of preceptorship training literature for the development of literature review. Examples of the databases to search potential terminologies related to preceptorship training programs included Medline, EMBASE, and PubMed to identify the relevance of each scholarly work to the research topic.
Evaluation of Literature
Nurses and preceptors are the backbones of any healthcare environment and in an urgent care setting like for Covid-19 management; they work tirelessly to ensure quality care and safety of the patient putting their own needs on the backfoot. However, a lack of knowledge regarding policies and strategies to prevent and manage Covid spread is a prevalent problem in healthcare facilities that negatively impact medical care. The issue is worth investigating and therefore PICOT question was developed for the change proposal that aided in finding evidence-based interventions as a significant model. This model was to improve patient care and safety as well as the intervention would positively portray the nursing practice in the healthcare setting. The main factor in this research project aims at investigating the effectiveness of implementing a preceptorship training program to improve the management and prevention of Covid-19 for better patient outcomes. The literature review section provides a comparison of the research question, population sampling, and limitations of the research studies that were analyzed while reviewing the relevant literature accessed through online databases in relation to the PICOT question. A review of the relevant literature that was researched through a database search strategy is summarized as follows to determine the effectiveness of the preceptorship program for the management and prevention of Covid in the urgent care facility.
Comparison of Research Questions
The research questions of the 8 research studies that were analyzed in the literature evaluation table were in line with the PICOT statement regarding the implementation of the preceptorship program in the Covid urgent care setting. The research questions of 7 articles aimed at evaluating the effectiveness of preceptorship training programs to prevent and manage Covid spread and to improve better patient care outcomes. In the first study, researchers aimed at exploring the needs and perceptions of preceptors to decrease turnover and increased job satisfaction. The first research question of the study also aimed at the tangible functions of preceptors as safety administrators for the nurse practitioners in the care setting (Quek et al, 2019). This research question of 1st research study was also similar to that of the 7th research article as this also aimed at analyzing the roles and responsibilities of a preceptor for the preceptees as competency validators. The research question of the second article aimed at evaluating the role of preceptorship training programs in nursing practice and its 1st research question also aimed at exploring the potential role of preceptorship training for the starter preceptors and the newly graduated nurses to help them manage Covid in the urgent care setting such as within Intensive Care Unit (ICU) of the healthcare facility (Quek et al, 2018). The aims of the 2nd and 8th articles were almost similar as both emphasized the role of preceptorship in developing positive impacts on the retention of new nurse graduates and preceptors. The 3rd and 4th articles had similar research questions that aimed at assessing the role of preceptorship programs in improving the confidence and competencies of the preceptors. The 3rd article’s research question aimed at analyzing how a preceptor team influences the efficacy of preceptorship to improve the abilities and motivation of the preceptors (Irwin, 2018). Similar to this, the research question of the 4th research study focused on assessing preceptors’ competencies in nursing practice (Bartlett et al, 2020). The research question of the 5th article aimed at helping the researchers regarding the preceptorship training to examine what factors optimize the continuing professional development of preceptors (King et al, 2021). The research question of the 6th article aimed at introducing preceptorship intervention in order to prepare preceptors to play their role within the clinical practice (Griffiths et al, 2022). The 7th article had similar research questions as article 1 and aimed at preceptor roles and responsibilities (Strickland, 2020). Finally, the 8th article had a similar research question as that of article 2nd and aimed at the positive impacts of preceptorship training programs on nurses’ retention (Kelly, 2022).
Comparison of Sample Populations
The sample population that was used in the majority of the articles that were accessed through online databases and were analyzed was mainly based on reviewing the peer-reviewed research articles that addressed the effectiveness of preceptorship training programs for the management and prevention of Covid. The care setting used in 1st article was an acute tertiary hospital in Singapore, 2nd article used 20 reviewed articles, articles published between 1996 and 2013 were selected for critical review in the 3rd article, and 4th article used a number of research studies through qualitative research method. Furthermore, article 5 was based on a study conducted in an acute care setting in the United Kingdom along with 39 peer-reviewed articles, 21 articles were selected fulfilling the inclusion criteria for article 6, and the participants for article 7 included preceptors working in an acute care setting, and article 8 also consisted of preceptors facilitating within a hospital setting.
Comparison of the Limitations of the Research Studies
The studies analyzed for the development of the literature review for the capstone project had different limitations. The limitation of the first article was that it could use longitudinal and multi-centered studies (Quek et al, 2019), 2nd research article could utilize assessments to extract insight into the experiences and needs of the preceptors and newly graduated nurses (Quek et al, 2018), 3rd and 4th article could explore preceptees’ perceptions to highlight the importance of preceptorship training in Covid care setting, and the limitation of the 5th article was that researchers should analyze the preceptor-nurse and nurse-patient relationship-centered care in the hospital setting study was conducted (King et al, 2021). Moreover, the 6th article has limited the study to just articles that could better be evaluated through the intervention’s hospitals were using in the immediate environment to manage and prevent the Covid spread (Griffiths et al, 2022). The limitation of the 7th article was similar to article 1 as it could use multi-centered studies for better research outcomes (Strickland, 2020). 8th article limited the study of the participant preceptors of the acute care setting however, the study could be conducted through analyzing research studies, nurse-preceptor relationship, and evaluation strategies for assessing the impacts of preceptorship programs on nurses’ and preceptors’ retention (Kelly, 2022).
Change or Nursing Theory
The two change theories that can help to develop nursing intervention related to the effectiveness of preceptorship training to aid nurses in preventing and managing Covid within urgent care settings include the health belief model and the unfreezing-change-refreezing theory. The health belief model is based on the idea that people embark on the motivation to change their behavior according to the recommended positive behavior in a work environment when the perceived susceptibility is so severe (Liu, 2021). In such a situation in relation to the capstone project implementation in an urgent care environment, nurses would be motivated to embark on their behavioral change after having preceptorship training. Such a situation in any work environment is referred to as “readiness to act” according to the behavior motivated by the positive recommended behavior. The other theory that makes sense in implementing a capstone project for the effectiveness of preceptorship training is Kurt Lewin’s theory of the unfreezing-change-refreezing model. Kurt Lewin’s theory depends on how nurses as a driving force within the healthcare system support or oppose the proposed change (Hussain et al, 2018). Deriving from the change model of Kurt, the implementation of the intervention required educational resources as well as human resources such as PowerPoint presentations, handouts, the Internet as well as nurses and preceptors for monitoring and training. The refreezing stage of Kurt’s change theory demands that preceptors, nurses, and stakeholders should adopt a new habit through the intervention implemented within the hospital setting (Wojciechowski et al, 2016). The implementation of the intervention would definitely take time to ensure the success of the change project implementation as a necessary step.
Implementation Plan and Outcome Measures
The solution to the lack of knowledge and professional practices regarding Covid management and prevention is the implementation of preceptorship training to enhance preceptor-preceptor, nurse-nurse, and nurse-patient communication to improve care practices. For that to be implemented, there need to be education initiatives to encourage nurses offering their services in Covid care setting to engage in productive nursing activities and professional practices under the guidance of professional preceptors. Within the healthcare setting, there should be rules and policies strictly implemented for Covid management through education and training programs. Since Covid has stricken the globe, there is not much in the healthcare system in various regions of the world that are implemented to tackle the issue of Covid management and prevention within and out-hospital settings. Resultantly, more people are capturing the virus and care providers in the healthcare system are at risk of Covid-19 the most. The preceptorship program urged preceptors and nurses to take effective immediate actions in detecting Covid and preventing virus spread. The preceptorship program played a positive role in terms of the development of decision-making skills in preceptors to deliver immediate care solutions to the newly qualified nurses. This initiative added preceptees’ engagement, sustainability, and value to the program (Rambod et al, 2018). Through the implementation of the change project, healthcare professionals can effectively participate in the education of the nurses, starter preceptors, volunteers, and other healthcare providers to promote safe and healthy care environment as well as the community.
Use of Evidence-Based Practice in Intervention Plan
The implementation of preceptorship training was used as an evidence-based practice (EBP) within the practicum site to ensure the quality management and prevention of Covid-19 in and out of the hospital setting. This strategy was used to improve the clinical decision-making and daily patient care practice within the urgent care system. Professional preceptors were hired to integrate the best available nursing evidence while taking patients’ needs, care, and safety measures into consideration who were suffering from Covid-19 or post-Covid acute illnesses. Through the implementation of preceptorship training, preceptors and nurses within the urgent Covid care system would be enabled through the standardized curriculum and guidelines to integrate the best clinical knowledge and practice to ensure the management and prevention of Covid as well as self-care for the healthcare providers.
Plan for Evaluating Proposed Nursing Intervention
Evaluation of the outcomes to evaluate the effectiveness of the nursing intervention is crucial in the capstone change project so that modifications can be made accordingly to improve the quality of the care offered and to enhance the effectiveness of healthcare teams within the organization. Therefore, a high-quality evaluation of the nursing intervention implemented is required to determine the success and impacts of the intervention to make healthcare providers understand how an intervention transforms the care delivery and patient safety methods. In addressing the issue of prevention and management of Covid-19 within a care delivery system and in the community, preceptorship training intervention was widely implemented. Kurt Lewin’s theoretical insight of the unfreezing-change-refreezing model was used to analyze the effectiveness of the change project in order to evaluate the behaviors of preceptors through a survey instrument. Kurt Lewin’s theory depends on how nurses as a driving force within the healthcare system support or oppose the proposed change (Hussain et al, 2018). The nursing intervention is evaluated through the survey tool to assess the effectiveness of the intervention and the competency of preceptors in managing and preventing Covid within the hospital setting and in the community.
Potential Barriers and Plan to Overcome Barriers
Potential Barriers
Preventive efforts that seek Covid management must take into consideration the potential barriers in order to make the nursing intervention successful. There are numerous potential limitations that hamper the implementation of preceptorship training as a change intervention in the nursing profession during the risk of Covid-19 such as in-person training sessions, educational resources, and human resources. For nurses and other healthcare providers, the implementation of preceptorship training is not enticing in an urgent Covid care setting if they are overly concerned regarding their overworked hours, Covid threat, and lack of knowledge about Covid management and prevention. Another potential barrier is the challenge experienced by nurses and healthcare providers in the retention of the training program as nurses overwork due to the staff shortage and strict work hours due to Covid severity. Many nurses and preceptors require a firm commitment in terms of engagement of the start and finish time of the program and seek this time constraint as a barrier. Thus, the time constraint is the potential barrier due to which preceptorship training program could not be implemented in the long run. So, healthcare providers working within the urgent care environment need to address working and training hours with the stakeholders.
Plan to Overcome Barriers
Taking the time and resource barriers into account, there is a need to improve the possibility that every nurse and care provider would remain in the training program apart from their working part-time hours. Preceptorship training staff are the important enablers for maintaining nurses’ and preceptors’ engagement in the program and for a standardized curriculum integrating clinical guidance and practice should be implemented for making the implementation of the change project more rewarding. It is also significant to get patients involved during the preceptorship training as they are the ones who can ensure self-care in the out-clinic environment in the community. Therefore, to achieve the set objectives of the change project, there is a dire need to establish good stakeholder-preceptor, preceptor-nurse, nurse-nurse, and nurse-patient relationships. Establishing relationships and enhancing communication are the most crucial parts of preceptorship training to improve clinical practice geared toward managing and preventing the potential risks of Covid-19. Moreover, face-to-face training through PowerPoint presentations is significant in promoting behavior change and this strategy as compared to online preceptorship training would be more effective to achieve positive feedback on the intervention.
References
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