ABSTRACT
Clinical learning is a vital component in the curricula of
nursing education, providing an opportunity to student nurses to combine
cognitive, psychomotor, and affective skills. Evaluation is a basic part of
clinical education. There are a number of problems and challenges associated
with evaluation of clinical training of student nurses. Some of these concerns
are subjectivity and variability in the use of effective clinical evaluation
tools to evaluate the psychomotor, affective and cognitive learning domains.
These invariably safeguards patients from unsafe practice. The purpose of the
study is to explore the views and experiences of preceptors and clinical
instructors regarding evaluation of student nurses’ clinical training. The
study utilized a descriptive case study methodology and was conducted at Cape
Coast Teaching Hospital. Ten preceptors and five clinical instructors
participated in the study. The data was collected, using face-to-face
interviews of fifteen participants each. The data was analyzed using thematic
content analysis approach. Several themes emerged from the data analysis.
Examples of these include problems with the evaluation process, subjectivity of
evaluation tool, increased number of students, training needs and inappropriate
clinical placement. It is recommended that preceptors and clinical instructors
need to be professionally trained to fit for their demanding role. Again, the
training should be ongoing to support and improve the quality of students’
evaluation.
CHAPTER ONE
INTRODUCTION
Background to the Study
Clinical learning is an important aspect of pre-registration
nursing programmes. It enables students to acquire skills and knowledge
required for quality care provision. In clinical learning, skills are taught
and the knowledge can be applied in practice to help understand existing
realities. Nursing educators consider clinical skills acquisition as an
important part of nursing education. They also believe, nursing students can
improve their theoretical knowledge by working in real clinical condition
(Elcigil & Sari, 2007; McCarthy & Murphy, 2008).
In United States of America, Australia, New Zealand and
European countries clinical teaching and learning form a significant part of
pre-registration and education programmes (Price, 2007; Cooper, 2014). In these
countries, clinical learning plays an important role in improving the practice
of both healthcare professionals and student nurses, which in turn contributes
to improved care provision. It is probably for this reason that Cassidy (2009)
describes clinical learning as the heart of professional practice.
Acknowledging this, the preceptor or clinical instructor constitutes an
important aspect of students’ learning. Fitzgerald and colleagues (2010)
claimed that students’ knowledge, skills acquisition, and theory-practice
integration can be enhanced through preceptorship activities.
Preceptorship is a model or approach
to teaching and learning that pairs nursing students with experienced
practitioners to assist students in meeting specific learning objectives in the
clinical setting (Myrick, 2005). Carr (2008) defined the preceptorship model as
the act of teaching, assessing, supervising and coaching students.
Preceptorship may also be defined as a one-to-one teaching and learning
relationship between a Registered Nurse (RN) and nursing student whereby the RN
acts as a role model to facilitate student learning and provide evaluation of
learning objectives (Kaviani & Stillwell, 2000; Luhanga, Billay, Grundy,
Myrick & Yonge, 2010). In countries such as United Kingdom, the term
preceptorship is similar to mentorship and these terms are used interchangeably
to indicate the same process of clinical teaching (Myrick, Caplan &
Smitten, 2011). The clinical learning environment is where students learn to
incorporate cognitive, psychomotor and affective skills necessary for
professional development, and in turn become socialized into the profession
(Luhanga et al, 2010). Midgley (2006) posited that most effective climate for
learning and critical thinking is one that is devoid of fear, supportive,
fosters openness and respect for the student as an individual. Myrick (2005)
also asserted that in such an environment students can develop self-confidence,
competence, interpersonal communication and problem-solving skills. These were
further supported by various studies which show that students paired with
preceptors have better learning outcomes (Wieland, Altmiller, Dorr & Wolf,
2007; Luhanga et al, 2010). As such, the responsibility of nurturing and supporting
future nurses lies largely on nurse preceptors (Ohrling & Hallberg, 2000).
In Ghanaian nursing education, in
order to improve effective clinical teaching and learning, preceptors have been
introduced to supervise students in the practice setting. Preceptorship model
was first introduced into a peri-operative nursing program in Ghana (1990s);
this model was subsequently expanded to basic diploma and Bachelors in nursing
education (Opare, 2000). The preceptorship model has proved to be highly useful
strategy for clinical education as it allows education to be individualized.
Classroom knowledge was likened to real patient management problems and
provides for role modeling as the student’s develops standards and strategies
for practice.
To safeguard patients from unsafe practice, it is important
to evaluate student’s clinical competence. It should not automatically be
assumed that learning is taking place in students’ practice experience. The
preceptor provides constant feedback and support to the student and provides
evaluation data to both the student and faculty (National Organization of Nurse
Practitioner Faculty, 2000). However, this type of teaching is not without
problems. It has been noted that teaching in clinical setting often occurs at a
rapid pace with multiple demands on the preceptors. A variation in teaching and
learning opportunities occurs because cases vary in number, type and complexity
and may lack continuity (Irby, 2001). In a busy setting, there may be limited
time for teaching and feedback from preceptors. Students may not find learning
to be collaborative with the preceptor. Additionally, personal attributes of
the nurse are found to influence preceptors’ role and commitment (Andrews &
Chilton, 2000). These attributes of preceptors have been identified as mainly
patience, non-judgmental, empathic, warm, respectful, fairness and flexibility
(Burns, Beauchesne, Ryan-Krause & Sawin, 2006). It was reported that such
personal attributes can affect nurses’ attitudes and beliefs towards
preceptorship (Vallant & Neville, 2006) in turn affect whether they see
preceptees as an integral part of nursing or a separate additional
responsibility (Atkins & Williams, 1995). When preceptorship is seen as an
integral part of nursing, RNs acknowledge the presence of the model as
beneficial to both themselves and students. This benefit can mold and shape
nursing education (Myrick, 2005). Additionally, it influences how they fulfill their
roles as preceptors (Atkins & Williams, 1995) contributing to a positive
learning environment and outcomes in students during clinical placement
(Vallant & Neville, 2006). Moreover, preceptors who have positive attitude
towards preceptorship are more likely to be committed to their roles, thus they
are less likely to be concerned that precepting will compromise their time with
other nursing activities (Atkins & Williams, 1995).
Assessment of clinical performance involves collecting data
for a better judgment of nursing students. Clinical learning outcomes emphasize
skills related to patient care standards (Billings & Halstead, 2009). The
process of evaluation involves data collection, interpretation and formation of
judgments and conclusions about students’ clinical performance (Mahara, 1998).
Additionally, evaluation helps in the maintenance of professional standards and
the protection of the public by ensuring that those that graduate from nursing
programmes have attained the requisite skills and are safe to practice
(Goldenberg & Dietrich, 2002). Evaluation has two interrelated functions
which are achieved through formative and summative methods.
Formative evaluation is intended to provide feedback on the learning which has
taken place and to identify areas requiring remediation, while summative
evaluation aims at making judgments to determine if the student’s performance
meets academic and professional requirements. (Atkins & Williams, 1995).
Formative and summative evaluations are similarly seamless; there is formative
element in any summative evaluation (Schoenhofer & Coffiman, 1994).
Various authors have revealed that, evaluation of the
clinical performance of nursing and midwifery students has been a long-standing
concern for nurse educators (Andre, 2000; Lasater, 2007). Clinical evaluation
is complex and challenging for both seasoned and novice educators, thereby
raising concerns among students and faculty (Isaacson & Stacy, 2009). Some
of the concerns are the subjectivity and variability involved in evaluating
students’ clinical performance. Much of the discussion have centered on the
thorny issue of subjectivity and a plethora of clinical evaluation tools that
have been devised or abandoned in the quest to overcome this ongoing dilemma.
Wood (1982) proposed that the problem probably persists because clinical
evaluation relies upon the observation of the performance of one individual by
another, which itself is inevitably subjective.
Evaluation is an important component of the preceptor-student
relationships. Evaluation is performed by either a preceptor or clinical
instructor. The preceptor and clinical instructor need to be familiar with the
institution curriculum. There are goals and objectives for the specific
clinical experiences and the evaluation tool that is
required by the institution at the completion of the placement. An evaluation
session at midpoint of the term and at the end of the rotation is essential.
The preceptor’s evaluation also needs to be shared with the faculty person who
is responsible for grading the student’s performance (Khodadadi, 2012)
There are many issues in assessing clinical nursing skills
(Coates & Chambers, 1992). Inconsistency in the use of applied tools and
disagreements in evaluation process by clinical educators are two of the
issues. Most student nurses believe that clinical evaluation cannot distinguish
the level of their theoretical and practice knowledge (Sheikholeslami, Masole,
Rafati, Esmaeili, Vardanjani, Yazdani- Talami, & Khodadadi, 2012).
Statement of the Problem
The quality of nursing education depends largely on the
quality of clinical experience planned in the nursing curriculum. The
evaluation of students’ competency to practice is a worldwide matter of concern
to all practice-based professions (Whiteford, 2007). The multiplicity of
factors influencing evaluation indicates its complexity and difficulty in
ensuring its objectivity and accuracy. It is therefore not surprising to note
that student’s’ clinical skills are sometimes not accurately evaluated
(Roberts, 2011). Acknowledging this, students who perform poorly may slip
through the net of education programmes and subsequently enter professional
practice. Patients encountering these categories of nurses may be at risk of
receiving inadequate care which may have a negative impact on their health.
Evaluation, as a way of determining
the clinical competence, is one of the fundamental principles of development
and measurement of student achievement in nursing education (Wallace, 2003).
The clinical teacher; preceptor’s role is of fundamental importance in shaping
the student nurses’ clinical learning experiences. Competence in clinical
practice is a necessary element of professional nursing practice. Determination
of student’s progress towards the achievement of course objectives is one of
the most important roles of the preceptor and clinical instructor. Competence
is a construct which is not directly measurable but can be inferred from the
evaluation of performance (Stuart, 2003). Despite this, limited studies have
been conducted on factors that may affect clinical performance and evaluation
of students in practice. This is particularly the case in Ghana, although the
preceptorship and clinical instructorship model has been introduced in nursing
education, it has not been fully integrated into the nursing education
curriculum as asserted by Lewallen and DeBrew (2012).
For more Nursing Science Projects Click here
===================================================================Item Type: Ghanaian Topic | Size: 116 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
===================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.