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Underachievement Of The Nursing Student

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Question:

Discuss about the application of different learning theory to promote effective learning process.
 
 

Answer:

Introduction:

Effective mentorship during prequalified nursing education is considered very important because nursing students spend half of their course in clinical practice. In such situation, it is essential that rich clinical experience is provided to nursing students that supports their ongoing development and learning. It can be summed up by saying that effective mentorship is critical for the development of required clinical competencies in nursing students. Students who find an effective mentor before their placement finds the mentoring support as invaluable for their professional skill development. While a student attempts to learn new nursing skills and interventions, the mentor acts as a gatekeeper to monitor whether expectations in particular task is met by them or not. The supervising mentor guides a failing student to the right direction by summative assessment of their learning and implementation of alternative learning process to improve their practice (Myall et al., 2008). This essay explores the whole process of mentoring and their role in learning, teaching and assessment of students through the discussion on an experience of mentorship with an underachieving student. The essay takes the discussion further by describing the underachievement of the nursing student and identifying the behaviors or action leading to underachievement. Furthermore, the assessment of the student is done through the comparison with different learning styles and using them to teach and improve existing skill of students. The essay also focuses on the application of different learning theory to promote effective learning process. Finally, the essay also provides a reflection on key learning from the experience as a mentor to improve nursing skills of an underachieving student.

Discussion on underachieving student

For a nursing mentor, managing and supporting a nursing student who is failing to meet the standards and proficiencies mentioned by NMC (National Midwifery Council) for registration is the most challenging task. The NMC outlines different competency standards for different practice areas such as adult nursing, mental health nursing, children’s nursing and learning disabilities nursing. The NMC also makes it mandatory for all mentors to support and assess learning of a student on pre-registration nursing education programme (Nursing & Midwifery Council 2017).  Therefore, mentors work with prequalifying nursing students to support, supervise and teach them in the application of theory to practice. However, when a student does not perform at the expected level, the mentoring role becomes difficult. Once such challenging mentoring experience was seen when a second year nursing student came to a mentor for a 5 week placement. The main reason for which she was sent to the mentor was that she was inefficient in administering medications correctly. In her last placement, she was found to make serious error in this area and due to this underacheivement, she was placed under a mentor. She had made many mistakes in last placement as she gave the wrong dose of medication to a patient which lead to adverse drug event.

 


Considering the underachievement of student in medicine administration, the mentor’s role in supporting the student to achieve this competency is important. This is because nurses are the most involved in the medicine administration phase and they play a vital role in the medication process. A small mistake by them can also cost the lives of patient. Wrong dose related error is mostly made by nurse due to complex dosage regimen particularly in the specialty area of ICU, emergency department and intervention area (Smeulers et al., 2015). The common reasons reported by nurses for this kind of error are name confusion, inappropriate drug labeling, miscommunication and knowledge deficits (Feleke, Mulatu, & Yesmaw, 2015). Hence, as a mentor, it is very important for them to identify, intercept and correct errors of the nursing student in placement.

The first step for mentor is to identify the underachieving learner. The mentor can do this by reviewing the previous placement record of the nursing student. This can help to formulate strategy for support and guidance (Melnyk et al., 2014). While trying to assess the behavior of the underachieving learner, the most common problem reported by mentors was that nursing students could not apply theoretical knowledge to nursing practice. In the scenario of the nursing student, she also faced the same problem. She also had attitude because she felt very nervous and displayed very high level of anxiety during clinical actions. Another major issue with her was that she had poor interpersonal skill which increased the likelihood of making medication error. During the observation, the student was found to display high level of anxiety during medicine administration. The student’s behavior is common to other underachieving learner. Rooke, (2014) showed that underachieving learners in nursing practice display diverse range of behaviors like reluctant to ask questions, unenthusiastic attitude, high level of anxiety, inconsistent performance, lack of theory to support learning, lack of response insight, poor judgment and poor professional behavior and development. In this situation, the mentor plays a major role in improving the knowledge, skills and professional attitude required for professional nursing practice.

Assessment of student and learning style:

To address the shortcoming of the nursing student in medicine administration, the first critical step for the mentor will be to establish a unique relationship with the learner. A mentor is defined as an individual who manage the potential of a learner, develop their skills and help them achieve their professional goals (Bray & Nettleton, 2007). As part of student-mentor relationship, the role of mentor is to judge the quality of the underachieved student through assessment process. The progress of learner is dependent on unbiased assessment decisions. Marañón & Pera, (2015) also mentions that relationship is the heart of effective mentoring and giving constructive and developmental feedback is the fundamental part of professional mentoring relationship. The following are the important element of effective mentor-student relationship:

  1. Open communication with learner
  2. Identifying goals and challenges
  3. Passion and inspiration
  4. Developing caring relationship, mutual respect and trust
  5. Exchange of knowledge
  6. Independence and collaboration (Eller, Lev, & Feurer, 2014)

Hence, the process starts with open communication with learner and assessment of their unique learning style. Secondly, this is followed by teaching and learning phase in which passion, inspiration and exchange of knowledge occurs. Foster, Ooms & Marks-Maran, (2015) mentions that for students, teaching and knowledge exchange is the most valued behavior for them in the student-mentor relationship. Mentors also work to address the attitude related problem of learners. For instance, they can motivate students to learn by arousing their curiosity level. They always try to correct their clinical action by explaining the relevance of the action for achieving adesired goal. The most important point that must be instilled in unachieved student’s mind is that they must also have the confidence that they can learn anything and achieve satisfactory results. Developing anxiety and lack of confidence is a negative trait for learners.

 


In the context of the nursing student with underachievement in medications administration, her skill and professional development can be planned by mentors by proper assessment strategy. Proper assessment and accountability will only foster professional growth, personal development and nursing competency of the student (Moran & Banks, 2016). Learning style is one of the major factor that influence learning and identifying the preferred learning style of student is important to align the teaching and learning strategies according to the preferred learning style of students. It promotes retention of information and promotes learning too (Leidenfrost et al., 2014). In case of the underachieved student, the mentor can identify her learning style via the VAK questionnaire. The VAK questionnaire is based on the visual-auditory-kinesthetic learning styles model. It is a simple and easily tool that helps mentor to identify preferred learning styles of students and plan specific teaching plan and learning strategies that matches student’s preference (Thakur, Vij, & Shri, 2017).

The VAK learning style model defines three types of learning styles. Visual learners are those who learn best from visual displays and taking notes. They always try to observes things through display, demonstrations, handout and displays. The second learning style is the auditory learning style that involves retention of information through spoken words or sounds. Such learners pays interest to lectures, classroom discussion and role plays. Another learning style is the kinesthetic learning style by which learners learn through physical and practical hands-on experience. This types of learners are explorers who actively participates in activities (Gholami & Bagheri, 2013). The VAK questionnaire helps to identify learning styles by answering 30 questions. The score obtained from the response determines the main preferred learning style of student. Based on the learning style of the underachieved student, the mentor can plan the modes of learning and teaching process for them. If she is a auditory learner, she can use lecture methods for teaching. For visual learners, providing displays will be important. Secondly, for kinesthetic learners, giving them practical hands-on experience will promote their professional development.

Application of learning theories to enhance learning

On the basis of the VAK questionnaire, the preferred learning style identified in the underachieving student was visual learning style. The assigned mentor can plan teaching and assessment strategies according to the visual learning style. In such case, the mentor needs to explain all the concepts related to medicine administration by means of pictures, diagrams and good quality educational videos. They need to integrate all clinical information with visual diagrams. Matching learning style with preferred learning style will ultimately prove beneficial for the underachieved nursing student because this will have a great impact on her ability to acquire the knowledge related to safe medicine administration (Morgan, 2014). All have an individual learning styles that best suits them. Therefore, the underachieved nursing student is expected to take detailed notes and learn fast by means of illustration, graphics and power-point presentation. Hence, visual tools will be used as a teaching tool to improve the skills of the nursing student.

Although the focus of mentor is to promote professional development of students, however assessment is required in the area of professional values, interpersonal skills, attitudes and reasoning too (Bennett & McGowan, 2014). This is because certain behavior and value also determines the ability to manage risk and remaining persistence with service standards. On the basis of this identification, appropriate action plan can be developed by the mentors. According to the NMC specification, while assessing and documenting the skill of pre-registration nursing student, it is necessary to be factual and non-judgment to identify strength and weakness in particular nursing practice (Nursing & Midwifery Council, 2017). In the context of underachieving nursing student, the mentor can identify weakness in clinical skill by reviewing past placement report. Secondly, her attitudes and behavior towards nursing practices can be evaluated by open communication and interaction with the student. This interaction revealed many efficiencies in student both in terms of professional skills as well as interpersonal skills and professional values. Firstly, the student was found to lack confidence and her communication skill was poor. In the area of medicine administration, determining medicine in different clinical situation was difficult for her. So, the action plan for professional development mainly needs to address the area of competencies in medicine administration and personal attitude towards nursing practice.

Developing an action plan for underachieving nursing student to help them achieve specific professional outcome is a challenging task for mentors. However, it can be made easier by outlining different activities such as-

  1. Identifying areas of development for nursing students
  2. Evaluating how to achieve target learning outcomes.
  3. Listing the criteria to assess achievement of outcome
  4. Planning a date for achievement of action plan
  5. Giving constructive and honest written or verbal assessment feedback to students
  6. Implement teaching plan for the achievement of desired competencies (Brown et al., 2012).

While teaching the nurse about medicine administration safety, the first important teaching will be to make the student crystal clear about the five stages of medication process- prescribing, transcribing, dispensing and delivery, administering and monitoring process (Halbesleben et al., 2010). In helping the nurse to achieve the required competency in this area, the nurse will not focus on the nursing actions in each process. Instead, it will focus on making the student nurse about errors that can occur in different stage. This will be a unique learning opportunity for student because mentors have the experience in these areas and they provided useful knowledge about practice issues occurring in this activity. This process will enhance the learning process and make the nurse aware about mistakes and ways to address them.

 


The most common issue for nursing student when they enter clinical placement is that they struggle to apply theoretical knowledge into practice in different clinical situations. However, mentors facilitate their transition from one learning environment to another through their knowledge and experience in nursing (Button, Harrington, & Belan, 2014). They can also enhance the learning experience of mentors by application of different learning theories in the teaching and mentoring process. Each learning theories can contribute to effective mentorship process. For instance, the behaviorist learning theory focused mainly on change in behavior due to experience or positive reinforcement. It recognizes that behavior can be changes in response to a stimulus. It is relevant to the theories of classical and operant conditioning that focus on reinforcement of rewards to promote change (Montano & Kasprzyk, 2015). Hence, to modify student’s attitudes and response towards an action, the mentor can alter the stimulus condition in clinical environment.

Another theoretical perspective about learning is understood from the cognitive learning theory which focuses on individual’s cognition such as perception, thought, memory and way of processing information to promote learning. It is a highly active process in which individual observe, categorize and form generalization about to environment and then develop new insights and learning (Sternberg & Zhang, 2014). Hence, contrary to behavioral theory, it does not believe in rewards to enhance learning. A mentor trying to teach nursing students by this method will have to influence the learning process by identifying the past perception, expectation and social influence that affect their learning situation. Another adult learning theory is the andragogy learning theory which regards adult learning as problem centred process. It recognizes the fact that experience forms the basis for learning and people are interesting in learning those things which have immediate relevance in their personal life (Merriam, 2015).

In my own personal mentoring practice, I would apply the cognitive learning theory to facilitate better learning in the nursing student. Hence, in relation to the inefficiency of the nursing student in safe medicine administration, the main role of mentor will be to assess the past experience of students in this activity and find out how their own expectation and social influences disrupts from achieving the outcome. This can give insight into the mentees expectation and the reasons for which she could not match them during delivery of the activity. Knowing about her own perception can help the mentor to judge whether she has the right professional value to achieve those competencies or not. Secondly, any knowledge or skills gap and other environmental factors in workplace that causes the student nurse to medication errors.

Importance of clinical learning environment

The main focus of mentors in nursing practice is to support preregistered nurse to achieve the desired competency to confirm their registration as a practice nurse. Hence, nurses mostly focus on characteristics and attitudes of nurse that prevent them from achieving desired professional outcome. However, it  cannot be denied that shortcomings and weakness in nursing students alone do not lead to underachievement. Sometimes, the clinical environment of process also acts as a barrier in the accomplishing a clinical task in a safe and effective manner. This may have an impact on the student’s learning experience too. The clinical environment is necessary for practical experience and development of nurses. However, sometimes the clinical environment only creates stressful situation for nurses. One study investigating about learning challenges of nursing students in clinical environment revealed that insufficient qualification of nursing instructor and unsupportive learning environment created challenges in learning (Baraz, Memarian, & Vanaki, 2015). In relation to medication errors by nurses, it was also found that clinical environmental also contributed to this issues. Cheragi et al., (2013) revealed that nurses reported medication errors due to noisy environment, heavy workload, tiredness and lack of adequate support. All these factors are linked to clinical environment. Hence, it cannot be denied that providing an appropriate clinical environment is also necessary to enhance the learning process. To facilitate quality acquisition of clinical experience during placement, it is necessary to adjust clinical learning environment. Therefore, when mentors engage in assessment process, they must also assess nursing student’s satisfaction with the clinical environment as this also affects their motivation level as well as clinical performance (Papastavrou et al., 2016).

 


After the identification of the learning style, the appropriate assessment of the nursing student can be done by SWOT analysis. This can help to determine the main priorities of action and utilizing strengths as a motivational factor for mentees. The SWOT analysis can act as a useful tool to identify strength and weakness in nursing students and plan teaching objectives accordingly. It can act as a starting block in the interview. The SWOT analysis can assess students in the following ways:

Strength- Personal strengths and good qualities as a nursing student

Weakness- Areas needing improvement in terms of clinical skill and personal attitude towards nursing

Opportunities- Interesting opportunities for the nursing students to achieve competency in medication administration

Threat- Personal and environment barriers acting as a threat in the learning and skill acquisition process

With SWOT analysis process, objective setting process for learning and skill development will become easier. Reflection on assessment and constructive feedback can provide a positive learning experience to the underachieving student. On basis of identification of weakness and strength, the SMART objectives that can be made by the mentor to train and develop the student includes the following:

  • Helping the student to achieve complete competency in safe medicine administration (Specific)
  • Promoting practice based learning in student through visual aids and exploring past to identify perception, thought and attitude of nursing, evaluation of activities by validation of assessment tools and decisions (Measureable)
  • Full clarity regarding medication administration process will be given through video tutorial and role play (Achievable)
  • Improving communication and interpersonal skills to prevent errors and facilitate collaboration process in nursing practice (Relevant)

Conclusion

The essay gave an understanding about the duties and responsibilities of a mentor for skill development in pre-registration nursing students. The critical discussion regarding the process followed by a mentor to assess and teach an underachieving student gave insight into the importance of alignment with mentee’s learning style to promote learning. Furthermore, application of different learning theory was found to enhance the learning process for nursing students. Apart from focus on personal and professional skill development, the importance of effective clinical environment was also found to be important to support and motivate students to learn clinical skills. Completion of this module gave me very important knowledge and insights regarding the non-judgmental attitude and specific planning needed by mentors. It gave me idea about different dimension of mentor’s role such as that of effective working relationship, evidence-based practice, context of practice, assessment and accountability, evaluation of practice and facilitation of learning. In future, I will use the above elements to support learning and assessment of students

 

References

Baraz, S., Memarian, R., & Vanaki, Z. (2015). Learning challenges of nursing students in clinical environments: A qualitative study in Iran. Journal of education and health promotion, 4.

Bennett, M., & McGowan, B. (2014). Assessment matters—mentors need support in their role. British journal of nursing, 23(9), 454-458.

Bray, L., & Nettleton, P. (2007). Assessor or mentor? Role confusion in professional education. Nurse education today, 27(8), 848-855.

Brown, L., Douglas, V., Garrity, J., & Shepherd, C. K. (2012). What influences mentors to pass or fail students: Lynn Brown and colleagues describe a study to explore mentorship practices, including whether mentors pass students who are not fit to practise, the reasons for doing so and mentors’ perceptions of the university’s support for their role. Nursing Management, 19(5), 16-21.

Button, D., Harrington, A., & Belan, I. (2014). E-learning & information communication technology (ICT) in nursing education: A review of the literature. Nurse Education Today, 34(10), 1311-1323.

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse's viewpoint. Iranian journal of nursing and midwifery research, 18(3), 228.

Eller, L.S., Lev, E.L. and Feurer, A. (2014) ‘Key components of an effective mentoring relationship: a qualitative study’, Nurse Education Today, vol. 34, no. 5, pp. 815–20.

Feleke, S. A., Mulatu, M. A., & Yesmaw, Y. S. (2015). Medication administration error: magnitude and associated factors among nurses in Ethiopia. BMC nursing, 14(1), 53.

Foster, H., Ooms, A. & Marks-Maran, D. (2015) ‘Nursing students’ expectations and experiences of mentorship’, Nurse Education Today, vol. 35, no. 1, pp. 18–24. Available at: https://dx.doi.org/ 10.1016/ j.nedt.2014.04.019 (Accessed 11 February 2015).

Gholami, S., & Bagheri, M. S. (2013). Relationship between VAK learning styles and problem solving styles regarding gender and students’ fields of study. Journal of Language Teaching and Research, 4(4), 700-706.

Halbesleben, J. R., Savage, G. T., Wakefield, D. S., & Wakefield, B. J. (2010). Rework and workarounds in nurse medication administration process: implications for work processes and patient safety. Health care management review, 35(2), 124-133.

Leidenfrost, B., Strassnig, B., Schütz, M., Carbon, C. C., & Schabmann, A. (2014). The Impact of Peer Mentoring on Mentee Academic Performance: Is Any Mentoring Style Better than No Mentoring at All?. International Journal of Teaching and Learning in Higher Education, 26(1), 102-111.

Marañón, A. A., & Pera, M. P. I. (2015). Theory and practice in the construction of professional identity in nursing students: a qualitative study. Nurse education today, 35(7), 859-863.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.

Merriam, S. B. (2015). Adult Learning Theory: A Review and an Update. Culture, Biography & Lifelong Learning, 1(1), 59-71.

Montano, D. E., & Kasprzyk, D. (2015). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health behavior: Theory, research and practice (.

Moran, M., & Banks, D. (2016). An exploration of the value of the role of the mentor and mentoring in midwifery. Nurse education today, 40, 52-56.

Morgan, H. (2014). Maximizing student success with differentiated learning. The Clearing House: A Journal of Educational Strategies, Issues and Ideas, 87(1), 34-38.

Myall, M., Levett?Jones, T., & Lathlean, J. (2008). Mentorship in contemporary practice: the experiences of nursing students and practice mentors. Journal of clinical nursing, 17(14), 1834-1842.

Nursing & Midwifery Council. (2017). NMC standards for mentors, practice teachers and teachers. Retrieved 11 August 2017, from https://www.ed.ac.uk/files/atoms/files/nmc_standards_to_support_learning_and_assessment_in_practice.pdf

Papastavrou, E., Dimitriadou, M., Tsangari, H., & Andreou, C. (2016). Nursing students’ satisfaction of the clinical learning environment: a research study. BMC nursing, 15(1), 44.

Rooke, N. (2014). An evaluation of nursing and midwifery sign off mentors, new mentors and nurse lecturers' understanding of the sign off mentor role. Nurse education in practice, 14(1), 43-48.

Smeulers, M., Onderwater, A. T., Zwieten, M. C., & Vermeulen, H. (2014). Nurses' experiences and perspectives on medication safety practices: an explorative qualitative study. Journal of nursing management, 22(3), 276-285.

Sternberg, R. J., & Zhang, L. F. (Eds.). (2014). Perspectives on thinking, learning, and cognitive styles. Routledge.

Thakur, D., Vij, A. K., & Shri, C. (2017). Matching Teaching Pedagogy with Learning Styles of Students-Insights through Literature Review.

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