Journal Pre-proof

A web-based clinical pedagogy program to enhance registered

nurse Preceptors' teaching competencies – An innovative process
of development and pilot program evaluation

Xi Vivien Wu, Yuchen Chi, Yah Shih Chan, Wenru Wang, Emily
Neo Kim Ang, Shengdong Zhao, Vibhor Sehgal, Fong Chi Wee,
Umadevi Panneer Selvam, Kamala M. Devi

PII: S0260-6917(19)30484-8
DOI: https://doi.org/10.1016/j.nedt.2019.104215
Reference: YNEDT 104215

To appear in: Nurse Education Today

Received date: 27 March 2019

Revised date: 8 July 2019
Accepted date: 13 September 2019

Please cite this article as: X.V. Wu, Y. Chi, Y.S. Chan, et al., A web-based clinical
pedagogy program to enhance registered nurse Preceptors' teaching competencies – An
innovative process of development and pilot program evaluation, Nurse Education
Today(2019), https://doi.org/10.1016/j.nedt.2019.104215

This is a PDF file of an article that has undergone enhancements after acceptance, such
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© 2019 Published by Elsevier.

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A web-based clinical pedagogy program to enhance Registered Nurse Preceptors’ teaching

competencies – An innovative process of development and pilot program evaluation

Xi Vivien Wu*, Yuchen Chi, Yah Shih Chan, Wenru Wang, Emily Neo Kim Ang, Shengdong Zhao, Vibhor
Sehgal, Fong Chi Wee, Umadevi Panneer Selvam, Kamala M Devi

Authors Affiliations:

Xi Vivien Wu, Lecturer, PhD, RN

a
Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine,

of
National University of Singapore, Singapore
[email protected]

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Yuchen Chi, Research Assistant, BSc (Nursing), RN
a
Alice Lee Centre for Nursing Studies, -p
re
Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
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[email protected]

Yah Shih Chan, Senior Lecturer, MHSc (Mgt), RN

na

a
Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine,
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National University of Singapore, Singapore

[email protected]
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Wenru Wang, Associate Professor, PhD, RN

a
Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
[email protected]

Emily Neo Kim Ang, Professor, PhD, RN

a
Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
[email protected]
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Shengdong Zhao, Associate Professor, PhD

b
School of Computing
National University of Singapore, Singapore
[email protected]

Vibhor Sehgal, Research Assistant, B. Tech,

a
Alice Lee Centre for Nursing Studies,
Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
[email protected]

of
ro
Fong Chi Wee, Assistant Director of Nursing, M.Ed, RN
c
Department of Education and Practice, Nursing Service,
Tan Tock Seng Hospital, Singapore
[email protected] -p
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Umadevi Panneer Selvam, Nurse Educator, MTD, RN
c
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Department of Education and Practice, Nursing Service,

Tan Tock Seng Hospital, Singapore
[email protected]
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Kamala M Devi, Associate Professor, PhD, RN

a
ur

Alice Lee Centre for Nursing Studies,

Yong Loo Lin School of Medicine,
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National University of Singapore, Singapore

[email protected]

*
Correspondence: Dr Xi Vivien Wu, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of
Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11, 10 Medical
Drive, Singapore 117597
E-mail: [email protected]; Tel: 65-66012756

a
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of
Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Tel: 65-
65165086
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b
School of Computing, National University of Singapore, Singapore 117417, Tel: 65-65168413

c
Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Tel: 63214461

Funding: The study is funded by Ministry of Education (MOE), Singapore; Tertiary Education Research
(TRF) Grant (MOE 2017-TRF-009).

Word count: 4748 words including abstract and keywords, but excluding references

Disclaimer: The authors declare no conflicts of interest.

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Acknowledgement:

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The authors would like to thank Dr. Mark Gan, who provided expert opinions on the education
perspectives and evaluation of the program. The authors would like to thank the nurses who participated

-p
in the research, Tan Tock Seng Hospital, and Alice Lee Centre for Nursing Studies, Yong Loo Lin School
of Medicine, National University of Singapore for providing support for the study. The authors would like
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to thank the National University Health System Medical Publications Support Unit, Singapore, for
assistance in professionally editing the language of this manuscript.
lP

Ethical approval details: Ethical approval for the study was obtained from the National Health Group
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Domain Specific Review Board.

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A web-based clinical pedagogy program to enhance Registered Nurse Preceptors’ teaching

competencies – An innovative process of development and pilot program evaluation

ABSTRACT

Background: Registered Nurse Preceptors guide students to integrate theory into practice,

assess clinical competencies, and enhance problem-solving skills. Researches have indicated

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that the teaching competencies of nurse preceptors can be transferred to students’ clinical

learning.

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-p
Objectives: The aims of the study are to develop a web-based clinical pedagogy (WCP) program

for Registered Nurse Preceptors and conduct pilot program evaluation.

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lP

Design: A three-step process was applied to integrate the theoretical framework, evidence from

the systematic review, and content validity by the experts and pilot test with the Registered
na

Nurse Preceptors in the content and technical development of the program. The WCP program
ur

has unique features including use of dashboard, interactive videos, consultation with experts,
Jo

discussion forum and backend data analysis.

Results: A committee of six content experts evaluated the comprehensiveness,

appropriateness, and relevancy of the program. The item-Content Validity Index (CVI) score

ranged from 0.83 to 1.00 and the scale-CVI score was 0.87, which indicated that the WCP

program had a strong content validity. Ten nurse preceptors were invited to use the WCP

program. Preceptors shared that the website was easy to use and navigate. They commented

that the videos in each module are beneficial for nurses to understand the real situation in the
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clinical setting. This feature also makes the website more interactive. Feedback from preceptors

was subsequently used to further refine the program.

Discussion and Conclusion: The WCP program is an evidence-based program that provides a

comprehensive coverage on clinical teaching pedagogy and assessment strategies. The unique

web-based technology and interactive features provide a platform for nurse preceptors to

discuss clinical encounters with peers and consult experts. The flexible and resource-rich nature

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of web-based learning encourages nurses to use it for continuing education.

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KEYWORDS

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clinical pedagogy; teaching competency; web-based program; nurse preceptor.
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Introduction

In clinical contexts, nursing students are able to learn in complex care settings, receive

appropriate guidance, and foster the development of clinical competence and professionalism

(AACN, 2008). Registered Nurse Preceptors take on the dual role of being a practitioner and

an educator. Preceptorship is defined as a professional relationship between a student and a

clinician in which they work together in clinical to achieve the student’s learning objectives

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(Yonge, 2007). Nursing leaders and academics have often articulated concerns about

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preceptors’ competence in clinical teaching and assessments (Wu et al., 2017). Preceptors’

levels of competence will impact students’ learning experiences and clinical competence.
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Continuing education for healthcare professionals is an important guideline across the
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world. In Singapore, the Ministry of Health encourages strategies that are innovative and
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promote the professional development of healthcare professionals who feel more motivated
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and dignified to care for the health of the population (2016). The preceptorship course

provided by the hospital in Singapore is a face-to-face workshop. A previous study indicated

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that Registered Nurse Preceptors might not have time to attend the course due to busy work
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schedules (Wu et al., 2016). Faculty’s involvement, appropriate course materials, and

preceptors’ training are identified as the essential elements to the preparation of preceptors

(Bourbonnais and Kerr, 2007). There is definitely a need to look into how we can best provide

professional development for Registered Nurse Preceptors that allows for flexibility in learning

and improves responsiveness to their learning needs. It is paramount that continuing education

courses increase the flexibility and responsiveness of the nursing workforce and offer

alternative means for nurses to take up such courses.

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Literature review

Nursing students’ learning in clinical education

Clinical competence is defined as the integration of nursing knowledge, psychomotor

skills, and problem-solving abilities to offer safe care for patients (Hickey, 2010). Clinical

competence develops over time as nurses progress from a novice level to a proficient level

(Benner, 1982). Achieving clinical competency is a key element in nursing education focusing on

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professional standards and patient safety (Kim, 2007).

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Nursing students encounter several challenges in dynamic clinical environments and

experience significant levels of anxiety during clinical assessments (Wu et al., 2015). Previous
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studies have demonstrated remarkable concerns among nursing students, e.g. variations in
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assessment standards, preceptors’ competence in providing feedback, variations in clinical
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guidance and support by preceptors, and high expectations of students’ clinical competence by
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Registered Nurse Preceptors (Wu et al., 2016; Wu et al., 2015). Students generally appreciate

clinical guidance and seek responsibility and trust from preceptors. However, these students
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may experience frustration, anxiety, fear, and powerlessness periodically in dynamic clinical
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environments (Nabolsi et al., 2012). These unfortunate circumstantial experiences may affect

students’ learning outcomes in clinical education.

Nurse preceptors’ learning and professional development

Registered Nurse Preceptors are appointed by clinical nurse leaders (CNLs), and the

selection is based on clinical experience, job performance, and willingness to teach. The role

and responsibility of nurse preceptors are clearly defined as guiding students to integrate

theory into practice, assessing clinical competencies, and enhancing problem solving skills (Cant
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et al., 2013). Professional competence, interpersonal relationship skills, personality

characteristics, and teaching abilities are highlighted as effective clinical teaching behaviors

(Tang et al., 2005). Interactions with preceptors are positively correlated with increased

competence in organization, collaboration, delegation, initiating nursing care, and

communication for students (Kim, 2007).

Many preceptors experience challenges in managing the dual role of being a registered

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nurse and a preceptor (Jonsén et al., 2013). While struggling to fulfil all their obligations, most

preceptors place a higher priority on patient safety and care due to higher patient acuity and a

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lower priority on the precepting role (Jones, 2005). CNLs and nurse academics have clearly

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acknowledged the key role of preceptors in clinical assessments (Wu et al., 2017). However,
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research has found that there may not be adequate preparation for nurses preceptors to take
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up the essential role to train and educate nursing students (Mitchell et al., 2018). Preceptors

may not be prepared with formal pedagogical education (Wu et al., 2016), resulting in
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inadequate teaching knowledge and experiences. Consequently, they may experience role
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ambiguity and unfamiliarity with clinical teaching and assessments (Benner et al., 2009). Thus,
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the impetus for the educational program and the web-based platform came from previous

studies by Wu et al. (2018; 2016; 2017; 2015).

Most of the organizations always prepare nurse preceptors either using the traditional

face-to-face classes and/or e-learning online modules (Kennedy, 2019). With a preceptor

training program, nurses are able to equip themselves with adequate knowledge of educational

strategies to help them teach the preceptees effectively (Kennedy, 2019). In addition, the

preceptor program also helps nurses to build a clear understanding of their roles as preceptors,
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which will lead to positive outcomes including reduced attrition rate, higher job satisfaction,

and better performance (Painter, 2017).

Web-based professional development for nurse preceptors

Web-based programs have been used widely in preceptorship education. A web-based

program utilises digital platforms for learning, which is recognised as an effective learning

approach for nursing professional development (Lu et al., 2009). Myrick et al. (2011) built an

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online learning community to engage preceptors socially in a virtual workspace and to provide a

platform for interaction. Foronda et al. (2015) facilitated learning for preceptors by applying an

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innovative pedagogy using avatars in a three-dimensional virtual clinical setting. Other studies

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used a virtual world as a medium to illustrate specific examples on student evaluation and a
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dynamic table on key concepts, observe the critical aspects of the behaviors performed by the
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model in the video clips, online storytelling on leadership experiences, and podcast scripts to

present the unsafe practices and the caring approach by the preceptors when dealing with the
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unsafe situations (Blum et al., 2012; Parker et al., 2012; Parsons, 2006; Stutsky and Spence
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Laschinger, 2014; Wilkinson et al., 2015; Zahner et al., 2009). Overall, the findings of these
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studies revealed that web-based programs are informative, supportive, and highly valued.

Qualitative findings revealed a precursor of anxiety and frustration with technical difficulties,

followed by appreciation and learning. The findings of the aforementioned online programs will

be considered and built-in when the WCP program is developed by the team. The usability and

validity of the WCP program will be addressed.

Web-based learning has been widely utilised for nursing professional development in

clinical settings (Chen et al., 2008). Nurses are willing to apply web-based continuing education
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due to flexibility, self-regulated nature, and minimal impact on family lives (Yu et al., 2007).

Learners’ internet attitudes, which are the dispositions toward or the perceptions of using the

internet, may influence willingness and interest in learning (Peng et al., 2006). A previous study

found that learners tend to participate in web-based learning more willingly with positive

internet attitudes (Liang et al., 2011). Nevertheless, nurses’ attitudes are regarded as one of the

most important factors, which may promote web-based learning for professional development

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and continuing education.

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Methods
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The aims of the study are to develop a web-based clinical pedagogy (WCP) program for
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Registered Nurse Preceptors and conduct pilot program evaluation. To facilitate the content
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and technical development of the program, a three-step process was applied to integrate the
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theoretical framework, evidence from systematic review, and the content validity test by the

experts and pilot test with the nurse preceptors. The pilot evaluation of WCP program was
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conducted through content validity and pilot test. Ethical approval for the study was obtained
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from the National Health Group Domain Specific Review Board.

Step 1: Conceptual framework for the design of the WCP program

The WCP program draws on the conceptual framework of Bandura’s self-efficacy theory

(1977). Self-efficacy is defined as a future-oriented belief that an individual possesses the

requisite skills to reach a successful outcome. The theory suggests that individual behaviors are

determined through continuous interactions between cognitive, behavioral, and environmental

factors (Goldenberg et al., 2005). Bandura (1977) explained self-confidence as the belief of an
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individual about his/her ability to perform the activity. Professional confidence refers to a

professional’s dynamic and maturing personal belief. This includes an understanding of the role

and scope of practice for the profession and the capacity to fulfil the expectations competently,

fostered through a process of affirming experiences. Based on Bandura’s theory (1977), self-

efficacy is achievable through the mastery of experience, vicarious experience through

mentors, social persuasions, and physiological factors. With increased self-efficacy and self-

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confidence in clinical teaching and assessments of preceptors, students will benefit and

enhance their clinical competencies.

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Step 2: Evidence from our systematic review and program development

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The research team conducted a systematic review to obtain evidence to develop the
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WCP program. The systematic review aimed to review and synthesise online learning programs
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for preceptors (Wu et al., 2018). Six electronic databases (CINAHL, Medline OVID, PubMed,

Science Direct, Scopus, and Web of Science) were searched from January 2000 to June 2016.
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The search terms used in the search process included: ‘online learning program’, ‘e-learning’,
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‘online learning’, ‘train*’, ‘educate*’, ‘develop*’, ‘prepar*’, ‘support*’, ‘nurse preceptor’, ‘nurse
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mentor’, ‘nurse educator’, and ‘nurse leader’ (Wu et al., 2018). In the end, 20 studies were

selected from 56 retrieved full-text articles after filtration (Wu et al., 2018). Our systematic

review found that online learning offers accessibility, convenience, and flexibility, which

provides an alternative for preceptors who face challenges of workload and time (Wu et al.,

2018). Therefore, it is paramount that continuing education courses are integrated with

technology to increase the flexibility and responsiveness of the nursing workforce.

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The contents of the program were analysed with the selected (Blum et al., 2012; Bradley

et al., 2007; Foronda et al., 2015; Myrick et al., 2011; Parker et al., 2012; Parsons, 2006; Stutsky

and Spence Laschinger, 2014; Wilkinson et al., 2015; Zahner et al., 2009). Roles and

responsibilities of a preceptor covered contents on what a preceptor is, and policies and

procedures. The adult learning theory included precepting adult learners, learning styles, and

teaching styles. Clinical teaching composed of coaching, facilitating student learning, facilitating

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students' critical thinking skills, clinical teaching and learning strategies, learning cultural

competence, intergenerational workplace settings, and guiding students through assessment,

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communication, and crisis management. Clinical assessments emphasised student evaluation.

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Feedback skills covered giving and receiving feedback, timing and relevancy of giving feedback,
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and effective feedback. Handling challenging situations encompassed precepting unsafe
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students or practices, attitude problems, poor communication skills, inabilities to demonstrate

knowledge and skills, and unprofessional behaviors. Caring attributes of preceptors included
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having a welcoming presence, demonstrating empathy, encouraging growth, patience, building

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relationships, and communicating therapeutically. The recommendations in the systematic

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review have guided the content development of the WCP program.

Step 3: Content validity and pilot test

A committee of six content experts consisting of three nursing academics from different

higher learning institutions, a clinical nurse educator, a hospital nurse administrator, and a

Singapore Nursing Board (SNB) representative was formed. Clinical nursing experts evaluated

the clinical relevance of the program, and academics contributed in the pedagogy and

assessment sections. Furthermore, the SNB representative shared the perspective of Ministry
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of Health on the professional development of nurses. The preliminary program was sent to

content experts for individual evaluations. Content validity was evaluated in three aspects,

including comprehensiveness, appropriateness, and relevancy. The content experts reviewed

the program and completed the Content Validity assessment form by rating each item from 1

(not comprehensive, appropriate, relevant) to 4 (very comprehensive, appropriate, relevant).

The experts indicated comments if the rating was 1 or 2 for any item.

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Formative evaluation took the form of multi-modal usability testing (Krug, 2010;

Nielsen, 1994), which sought to elicit feedback on the applicability, content, ease-of-use,

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acceptance, and time to completion of the modules. For the pilot test, ten nurse preceptors

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were invited to use the WCP program and provide feedback.
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Results
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Content development of the WCP program

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The research team consists of five nursing academics and two clinical educators from

the hospitals. The team had many rounds of deliberation on the contents of the WCP program
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and developed the contents based on the systematic review, national guidelines on clinical
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nursing education, and relevant literatures. The WCP program consists of eight modules: 1)

introduction of preceptorship, 2) planning care with preceptee, 3) conducting clinical

assessment, 4) facilitating clinical learning, 5) creating positive clinical learning environment, 6)

providing constructive feedback, 7) handling challenging situations, and 8) managing

underperforming preceptee. A brief summary of each module is provided in Table 1.

(Insert Table 1 here)

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One distinctive feature of the WCP program is that the preceptors can learn through

real scenarios. Scenarios used in the program are pre-recorded as videos that capture the

interaction among the preceptor, the student, and the patient. Interestingly, while situations

evolve, participants need to make certain decisions on clinical teaching and assessment. Such a

feature offers a simulated situation, and the participants feel a real sense that they are actually

in the clinical situations and guiding the students. The WCP program consists of seven scenarios

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(Table 2). Once the participant logs in to the WCP program, he/she is able to access the eight

modules listed on the main page. As a learning process, the participant first watches the

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scenarios in the video, which engages the participant in the process of decision-making.

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Secondly, the participant proceeds with learning theories and concepts in clinical education.
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With the simulated experiences, nurse preceptors can understand and transfer these learning
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theories and concepts into daily practices. Thirdly, the participant is required to complete a quiz

for self-evaluation after each module. Quizzes is utilised to reinforce the key points in the
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modules. In addition, continuous support is provided for the preceptors on clinical teaching and
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assessment skills through the ‘Discussion Forum’ and the ‘Expert Consultation’ sections in the
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WCP program. (Insert Table 2 here)

Technical development of the WCP program

The technology team worked closely with the researchers to streamline and enhance

the key features, i.e. flexibility and ease of use. A general model for planning and implementing

a comprehensive evaluation, as recommended by Cook and Ellaway (2015), was adopted to

evaluate the WCP program. The WCP program is a web-based program that involves the use of

smart devices (laptop, tablet, or smartphone) to facilitate self and peer-learning of preceptors.
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It is built using modern web technologies (React.js, Node.js, and MongoDB) with a dashboard-

like interface. Dashboard interfaces are extremely easy to interact with, even for users with

minimal web experiences. Additionally, every new user is on-boarded using an interactive step-

by-step website walkthrough to reduce user-interface complexities (Figure 1). The participant is

able to view the patients’ clinical histories, vital signs, and radiological examination results on

the WCP program. Subsequently, they can use a device to observe interactions between the

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preceptor, the nursing student, and the patient in the videos. This interface also allows the

nurse preceptor to assess students’ clinical competence and provide feedback.

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(Insert Figure 1 here)

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The WCP program provides flexibility in learning by dividing the entire course into
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smaller modules, which can easily fit into preceptors’ tight work schedules. Although flexible,
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the modules are designed to be completed in a sequential manner. The website ensures that all

modules are completed in a pre-defined order and that no module is skipped. The completion
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time for each module for every preceptor is recorded in the web-program for the research
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study. After the completion of each module, the preceptor has to take a quiz before moving on
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to the next module (Figure 2). Upon the successful completion of the entire course, the

participant is awarded with an e-certificate of course completion, which can be downloaded

and kept as part of professional portfolio.

(Insert Figure 2 here)

The WCP program allows multiple ways of knowledge sharing and active discussions

through an online discussion forum. Forums create discussion environments on certain topics

visible to others at any time. Hence, the discussion forum in the WCP program allows
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preceptors to share their clinical teaching experiences and support each other along their

learning journeys. Apart from peer-to-peer discussions, a panel of clinical education experts is

available online to provide guidance and feedback. At the back-end, the WCP program is able to

generate the demographic data of the participants and conduct certain levels of data analysis

(Figure 3).

(Insert Figure 3 here)

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Content validity test

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The Content Validity assessment forms completed by content experts were consolidated

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for the calculation of the content validity index (CVI). As recommended by literature (Gilbert

and Prion, 2016; Polit et al., 2007), only when both item-CVI and scale-CVI are above 0.80, the
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content of the program is considered valid. There are 8 modules within WCP program. Each
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module has its specific learning points developed based on educational theories and concepts,
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systematic review, and knowledge contributed by the research team. In total, there are 21 learning

points. Every learning point was assessed and scored as one item based on its relevancy,
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appropriateness and comprehensiveness. The learning points are the summary of the contents of
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modules. The content validity test has been conducted to assess the educational contents provided in

the modules. The item-CVI score ranged from 0.83 to 1.00 and the scale-CVI score was 0.87,

which indicated that the WCP program had a strong content validity.

The content experts also shared feedback related to the program. In addition, an

education specialist was invited to review the pedagogical aspects of the WCP program.

Subsequently, the research team discussed the revised contents to finalise the WCP program in

consideration of the comments by the expert panel. The most common feedback by the
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content experts is that some of the learning theories explained in the program might be too

abstract for nurses to understand, in consideration of their various educational background.

Content experts also shared some real situations they have experienced in clinical settings. In

fact, we have used those situations as references when developing case scenarios. Next, the

research team revised the contents of WCP program to ensure all the educational theories and

concepts in the program are relevant and succinct. Meanwhile, real case scenarios were added

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to assist with the understanding of educational theories or concepts. This rigorous review

process enhanced the content validity of the WCP program.

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Pilot test - formative and user-centred evaluation

The main purpose of the pilot study was to evaluate the website in terms of usability,
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navigation, website design, and quality of information. Hence, the pilot study did not evaluate
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outcomes related to clinical teaching competence, self-efficacy, and attitudes towards web-
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based learning. During pilot test, nurse preceptors were given access to the WCP program that

allowed them to navigate the dashboard and review the modules of the program. The nurse
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preceptors were required to rate the website from the 4 aspects as highlighted above. There
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were additional questions on asking users’ likes and dislikes of the website features, and what

are improvements required.

Nurse preceptors shared that the website was easy to use and navigate. They

commented that the videos in each module are beneficial for nurses to understand the real

situation in the clinical setting. This feature also makes the website more interactive.

Preceptors recommended replacing wordy content with graphics and pictures will attract users'

attention. Feedback from nurse preceptors was subsequently used to further refine the
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program. The formative and user-centred evaluation generated input regarding revisions and

modifications (Dick and Carey, 1990) that informed the design and development of the WCP

program. Since nurse preceptors participated in the pilot test provided positive feedback

towards the features including dashboard and interactive videos, no major change was made

after the pilot test. Some minor changes were made based on the feedback of the nurse

preceptors, including replacing wordy content with more attractive graphs and tables, and

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increase font size at certain parts of the website to make the content easier to read. Some

minor issues highlighted by pilot test users including some experienced slow speed of the

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website and system errors of the quiz layout were addressed by the technical assistant.

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Discussion
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The three-step process which integrated the theoretical framework, evidence from
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systematic review, and the content validity test and pilot test, facilitated the content and

technical development of the WCP program.

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The conceptual framework offered an overarching idea of using web-based platform for
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the WCP program (Bandura, 1977). Furthermore, the systematic review supported that online

learning offers accessibility, convenience, and flexibility for preceptors (Wu et al., 2018). The

unique web-based technology and interactive features in WCP program provide a platform for

nurse preceptors to discuss clinical encounters with their peers and to consult experts. The

WCP program provides flexibility in learning that could better fit into preceptors’ busy

schedules.
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The Manpower Minister in Singapore highlighted that fast-changing technology “will

change the way we work, the way we communicate, and the way we do business” (Yong, 2015).

Furthermore, there will be a plunge in employment growth in a few years due to baby boomers

gradually leaving the workforce and smaller cohorts entering the workforce. Therefore, the

existing workforce needs to explore other ways with fewer workers and leverage on new

technology. It has been widely encouraged that the workforce needs to embrace technology to

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keep ahead of the curve (Yong, 2015).

The content development was guided by the systematic review of the literatures (Wu et

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al., 2018). Therefore, the WCP program is an evidence-based program that provides

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comprehensive coverage on clinical teaching pedagogy and assessment strategies. The findings
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of prior studies further highlight the importance of preparing preceptors to be pedagogically
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ready (Wu et al., 2016; Wu et al., 2017; Wu et al., 2015). In addition, as the systematic review

focused on the preceptorship programs in a wide range of clinical settings, the WCP program
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applied the key analytic results from the systematic review. The evidenced-based nature of the
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WCP program thus can be applied in wide array of the settings, such as, acute care hospitals,
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community hospitals, primary care settings, higher education institutions during clinical

practicum.

The results of the Content Validity Assessment enhanced the quality of the contents.

The content experts are experienced academics and clinicians from various fields of nursing,

ranging from clinical nursing, nursing education, specialist in pedagogy and assessment, and

government sector. The item-CVI and scale-CVI score indicated that the contents of the WCP

program had a good level of validity. The qualitative feedback by the content experts
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contributed to the creation of the clinical scenarios, and ensured the educational theories and

concepts in the WCP program are relevant and succinct.

The Pilot Test reassured the technical features have reasonable level of usability, easy

navigation, desirable website design, and high quality of information. Some pilot test users

stated that they encountered problem in viewing the answers of some quizzes due to incorrect

format. Our technical assistant has changed the format of display and solved the problem.

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There were also comments mentioned that the speed of the website was a bit slow. Hence, the

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research team decided to engage a server which is able to support the website efficiently.

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Subsequently, the speed of the website has been improved.
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Research has indicated that the teaching competency of nurse preceptors can be
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transferred to students’ clinical learning to enhance their clinical competencies (Wu et al.,

2016). Role modelling and adequate support from preceptors can nurture students in
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developing essential resilience traits and enhance their confidence in problem-solving in the
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ever-changing clinical situations (Coşkun et al., 2014). Consequently, the introduction of a

robust online preceptorship program enhances students’ learning outcomes, i.e. clinical
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competence, by preparing and supporting preceptors, particularly in maintaining consistency in

their supervision and guidance, and standard setting of students’ clinical assessments.

Limitations

The limitations of this study include there is one hospital engaged for the development

of WCP program. It is expected that upon the completion of the program development, the

WCP program will be shared with other hospitals and tested further. In addition, the three-step

process of program development is time-consuming. Thus, time lags may occur due to fast-
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paced technological developments. There are also limitations when conducting the pilot test of

the WCP program. The outcomes related to clinical teaching competence, self-efficacy, and

attitudes towards web-based learning were not evaluated. The research team intended to

include the evaluation of these outcomes in the larger-scale experimental study in the

subsequent phase.

Clinical implications

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Nurse preceptors facilitate students’ learning in clinical setting. Researches have

indicated that the teaching competencies of nurse preceptors can be transferred to students’

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clinical learning. Traditionally, nurse preceptors attend preceptorship courses at a face-to-face

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workshop that is provided by the hospital. Nurse educators at the hospital conduct the
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workshop. With the increasing acuity of patients and manpower constraint, it is challenging for
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clinical institutions to release nurses for training and development. The flexible web-based

learning platform offers an alternative for preceptors who are working adults and strive to
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maintain a balance between work and family life.

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Based on the results of a systematic review by the research team (Wu et al., 2018), it
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has been noted that all reviewed studies were conducted in North America. Thus, a relevant

research is especially valuable in the Asia-Pacific region. The team has planned to conduct an

experimental research to examine the effects of the WCP program on the clinical teaching

competence, self-efficacy, and attitudes towards web-based learning of the Registered Nurse

Preceptors in clinical pedagogy and assessments.

Conclusion
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This study has applied an innovative three-step design process to develop the WCP

program for nurse preceptors. The WCP program adopted an evidence-based approach to

develop a comprehensive learning program on clinical teaching and assessments. The WCP

program provides a platform for preceptors with tight work schedules. The flexible learning

platform offers an alternative besides traditional face-to-face learning. The unique features of

the WCP program, e.g. peer-learning, consultation with experts, and interactive features, can

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have great advantages for preceptors who are working adults.

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Table 1. Modules of the WCP program

Module name Theories/principles/protocols Module des

Introduction of preceptorship Learning theory This module explains the roles and responsib
Learning style learning theories and principles provides
preceptors.

Planning care with preceptee Patient care planning This module elaborates the importance o
Learning contract for goal- preceptee. In addition, the module explains

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setting preceptor and a preceptee in setting goals
beginning of the clinical attachment.

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Conducting clinical assessment Clinical assessment strategy This module provides practical guidance for nu
Clinical evaluation clinical assessment and evaluation. Nurse prec
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assessment and evaluation and learn hands-on
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assessment.
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Facilitate clinical learning Effective clinical teaching and This module provides useful information on fa
learning Nurse preceptors learn how to facilitate learni
Adult learning theory minute learner tool can be used as a guide for
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One-minute learner tool shifts.

Creating positive clinical Positive learning environment This module highlights the benefits of creati
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learning environment addition, the module guides nurse preceptor

environment for their preceptee.
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Providing constructive feedback Constructive feedback In this module, nurses are able to learn the m
Techniques in feedback feedback to preceptee in various circumstanc
offered on the techniques of providing constr

Handling challenging situations Reporting for incident This module offers strategies on how to handl
Emotional support The module provides useful information on ho
emotional support to preceptee who may be u
incident.

Managing underperforming Learning contract This module provides knowledge on how to cr

preceptee Healthcare institution’s are concerns regarding preceptee’s performan
protocol for the escalation of skills to guide preceptees when they are unde
an underperforming preceptors learn the pathways for support and
preceptee situation.
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Table. 2 Description of the scenarios

Scenario name Characters involved Story timeline Description

Planning of shift RN Yuchen Second week of clinical attachment It is the second week of
SN Jun Mr. David: POD 2 of wound attachment. He is familia
Mr. David debridement conditions. How does RN
Mr. Raj Mr. Raj: Newly admitted to the the patients with SN Jun
hospital shift?

Readiness for Clinical RN Yuchen Mr. David: POD 3 of wound SN Wei Wei has an oppo
assessment SN Wei Wei debridement dressing and pre-operat
Mr. David Mr. Raj: Going for laparoscopic David. She needs to com

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cholecystectomy today assessment as well. How
confident to perform the
experience. How will RN

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clinical assessment?

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Wei is trying to change t
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him. How will RN Yuchen
SN Wei Wei continue wi
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or otherwise?

Guiding the student for RN Yuchen Mr. David: POD 5 of wound RN Yuchen notices that S
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administration of SN Jun debridement sufficient knowledge reg

medication Mr. Raj Mr. Raj: POD 2 of laparoscopic of medication. What cou
cholecystectomy him?
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Precious learning RN Yuchen Mr. David: POD 7 of wound RN Yuchen and SN Wei W
opportunity SN Wei Wei debridement, going home today the discharging procedu
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Mr. David Mr. Raj: POD 5 of laparoscopic Wei is looking forward t

Mr. Raj cholecystectomy procedure. However, M
will RN Yuchen delegate

Art of feedback RN Yuchen Mr. David: POD 7 of wound RN Yuchen notices that S
SN Wei Wei debridement, going home today the procedure wrongly i
Mr. David Mr. Raj: POD 5 of laparoscopic How will she react?
cholecystectomy How will RN Yuchen pro
Wei regarding her perfo

Medication error RN Yuchen Mr. David: Discharge to home. SN Jun reports to RN Yuc
SN Jun Mr. Raj: POD 5 of laparoscopic medication error. How w
Mr. Raj cholecystectomy incident?
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What could RN Yuchen d

Jun is in emotional distre

Unexpected result of RN Yuchen Final week of hospital attachment SN Wei Wei gets to know
clinical learning SN Wei Wei Mr. David: Discharged to home upon receiving the final
Mr. Raj: Discharged to home attachment. She feels ve
will RN Yuchen handle th

* POD - post-operative day; RN - registered nurse (preceptor); SN - student nurse (preceptee);

Mr. David - patient, admitted for diabetic foot, underwent wound debridement, going home
with wound dressing; Mr Raj - patient, admitted for abdominal pain, went for ultrasound, going
for cholecystectomy.

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Figure 1
Figure 2
Figure 3