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Hughes LJ, Alcock J, Wardrop R, Stone R, Pierce B. Remediation in clinical practice for student nurses - A scoping review. NURSE EDUCATION TODAY 2024; 137:106180. [PMID: 38522256 DOI: 10.1016/j.nedt.2024.106180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice. OBJECTIVES A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice. METHODS The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed. RESULTS Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice. CONCLUSIONS This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice.
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Affiliation(s)
- Lynda J Hughes
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia.
| | - Julia Alcock
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Rachel Wardrop
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Renee Stone
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
| | - Beth Pierce
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia
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Alkhelaiwi WA, Traynor M, Rogers K, Wilson I. Assessing the Competence of Nursing Students in Clinical Practice: The Clinical Preceptors' Perspective. Healthcare (Basel) 2024; 12:1031. [PMID: 38786441 PMCID: PMC11121458 DOI: 10.3390/healthcare12101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Nursing students' integration of theoretical knowledge and practical abilities is facilitated by their practice of nursing skills in a clinical environment. A key role of preceptors is to assess the learning goals that nursing students must meet while participating in clinical practice. Consequently, the purpose of this study was to explore the current evidence in relation to competency assessment and assessment approaches, and the willingness of preceptors for assessing nursing students' competency in a clinical setting. The scoping review used the five-stage methodological framework that was developed by Arksey and O'Malley, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Relevant studies were searched by applying a comprehensive literature search strategy up to April 2024 across the following databases: CINAHL, OVID MEDLINE, EMBASE, and PUBMED. A total of 11,297 studies published between 2000 and April 2024 were revealed, and 38 were eligible for inclusion, which the research team categorised into three main themes: definitions of competence, tools for assessing competence and preceptors' and mentors' viewpoints in relation to the assessment of nursing students' competence. This review established that there are a multitude of quantitative instruments available to assess clinical competence; however, a lack of consistency among assessment instruments and approaches between countries and higher education institutions is prevalent. Existing research evidence suggests that the preceptors carried out the assessment process clinically and they found difficulties in documenting assessment. The assessing of nursing students' competency and the complexity of assessment is a concern for educators and mentors worldwide. The main concern centers around issues such as the interpretation of competence and complex measurement tools.
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Affiliation(s)
- Watin Arif Alkhelaiwi
- Nursing Department, Faculty of Applied Medical Science, Jouf University, Sakaka 72388, Aljouf Region, Saudi Arabia
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (M.T.); (K.R.); (I.W.)
| | - Marian Traynor
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (M.T.); (K.R.); (I.W.)
| | - Katherine Rogers
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (M.T.); (K.R.); (I.W.)
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (M.T.); (K.R.); (I.W.)
- College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai P.O. Box 505055, United Arab Emirates
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Carroll AG, Peddle MR, Malik G. Undergraduate paramedicine students' experiences of feedback during clinical placement on-road: A scoping review. Nurs Health Sci 2022; 25:18-29. [PMID: 36369909 DOI: 10.1111/nhs.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
Feedback on performance enhances student confidence and clinical skills and promotes safe clinical practice. Experiences of feedback are well documented across many health disciplines; however, less is known about paramedicine students' experiences of feedback on-road in an emergency ambulance. The aim of this scoping review was to identify what is known about paramedicine students' experiences of feedback during clinical placement on-road in an emergency ambulance. A review of studies between 2000 and 2021 was undertaken, guided by the Joanna Briggs Institute Methodology for JBI Scoping Reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. Databases included CINAHL, EMBASE, EBSCO, MEDLINE, Web of Science, Cochrane, ERIC (ProQuest), ProQuest (Nursing and Allied Health), Trove, and Open Accessd Theses and Dissertations. Three studies were identified. Feedback is valued by paramedicine students; however, it can be personal and destructive in nature. Paramedics are enthusiastic and supportive and provide clear feedback. Paramedics face challenges supervising students and may lack preparation to provide feedback. There is limited evidence on paramedicine students' experiences of feedback during clinical placement. Further exploration is needed to gain further understanding.
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Affiliation(s)
- Amy G Carroll
- School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Monica R Peddle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Gulzar Malik
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
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Hardie P, Murray A, Jarvis S, Redmond C. Experienced based co design: nursing preceptorship educational programme. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:53. [PMID: 36115973 PMCID: PMC9482750 DOI: 10.1186/s40900-022-00385-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients play a central role in nursing preceptorship relationships, a professional educational relationship between a staff nurse and student nurse that is grounded in providing patient care. Yet the patient experiences and perspectives are largely uncaptured in the literature or represented in current preceptorship education programmes. Furthermore, the lack of student, staff nurse & patient involvement in the design of preceptorship education programmes has been noted. OBJECTIVE To use a co-design process to develop an innovative educational programme for developing interpersonal and communication skills among nurses who act as preceptors. We sought to (a) clarify experiences and events from all three members involved in a preceptorship relationship (student nurse, preceptor, and patient (SPP) in order to develop a shared understanding of nursing preceptorship relationships and (b) identify the key informational and educational needs recommended by SPP for the educational programme. METHODS Using the principles and the iterative process of Experienced Based Co Design (EBCD), data was collected from qualitative interviews and used to inform a series of co-design workshops and the co-production of the new educational programme. RESULTS Twenty-six individuals, including undergraduate student nurses, staff nurses, patients, and a team of nursing, educational and educational technologist experts, contributed to developing a blended learning preceptorship educational programme that consists of three core elements (1) six online reusable learning objects, (2) two role play simulations and (3) a virtual reality storytelling simulated experience. CONCLUSIONS The EBCD process ensured that the educational programme was developed to meet SPP viewpoints associated with fostering positive interpersonal relationships in a nursing preceptorship. EBCD is a valuable framework for developing human-centred educational resources that combine experiential knowledge (experiences) and scientific knowledge (literature-based knowledge). It facilitated the identification and the development of Interpersonal and Communications skills (IP & C skills) training required within a nursing preceptorship relationship, creating an authentic and memorable learning programme. The structure of EBCD harnesses SPP involvement throughout the research and development process, ensuring transparency and continuity of message, scope, and outcomes.
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Affiliation(s)
- Philip Hardie
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Suzi Jarvis
- Innovation Academy, University College Dublin, Dublin, Ireland
| | - Catherine Redmond
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Gingerich A, Sebok-Syer SS, Lingard L, Watling CJ. The shift from disbelieving underperformance to recognising failure: A tipping point model. MEDICAL EDUCATION 2022; 56:395-406. [PMID: 34668213 DOI: 10.1111/medu.14681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Coming face to face with a trainee who needs to be failed is a stern test for many supervisors. In response, supervisors have been encouraged to report evidence of failure through numerous assessment redesigns. And yet, there are lingering signs that some remain reluctant to engage in assessment processes that could alter a trainee's progression in the programme. Failure is highly consequential for all involved and, although rare, requires explicit study. Recent work identified a phase of disbelief that preceded identification of underperformance. What remains unknown is how supervisors come to recognise that a trainee needs to be failed. METHODS Following constructivist grounded theory methodology, 42 physicians and surgeons in British Columbia, Canada shared their experiences supervising trainees who profoundly underperformed, required extensive remediation or were dismissed from the programme. We identified recurring themes using an iterative, constant comparative process. RESULTS The shift from disbelieving underperformance to recognising failure involves three patterns: accumulation of significant incidents, discovery of an egregious error after negligible deficits or illumination of an overlooked deficit when pointed out by someone else. Recognising failure was accompanied by anger, certainty and a sense of duty to prevent harm. CONCLUSION Coming to the point of recognising that a trainee needs to fail is akin to the psychological process of a tipping point where people first realise that noise is signal and cross a threshold where the pattern is no longer an anomaly. The co-occurrence of anger raises the possibility for emotions to be a driver of, and not only a barrier to, recognising failure. This warrants caution because tipping points, and anger, can impede detection of improvement. Our findings point towards possibilities for supporting earlier identification of underperformance and overcoming reluctance to report failure along with countermeasures to compensate for difficulties in detecting improvement once failure has been verified.
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Affiliation(s)
- Andrea Gingerich
- Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | | | - Lorelei Lingard
- Schulich School of Medicine & Dentistry, Centre for Education Research & Innovation, Western University, London, Ontario, Canada
| | - Christopher J Watling
- Schulich School of Medicine & Dentistry, Centre for Education Research & Innovation, Western University, London, Ontario, Canada
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Rodger KS, Juckes KL. Managing at risk nursing students: The clinical instructor experience. NURSE EDUCATION TODAY 2021; 105:105036. [PMID: 34242907 DOI: 10.1016/j.nedt.2021.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/22/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clinical nursing instructors are responsible for providing optimal learning experiences and evaluating student performance, while maintaining patient safety in acute care settings. Our undergraduate Bachelor of Science in nursing program in Canada recently experienced an unusually high number of students who failed a compulsory medical surgical clinical course. Due to these high numbers, additional dedicated clinical groups were arranged for those students who were repeating. METHOD Seven clinical instructors participated in a focus group to share their experiences of managing students at risk. Thematic analysis was conducted on the interview data. RESULTS The results revealed four themes: (a) supporting student learning while ensuring patient safety, (b) balancing responsibilities and professional obligations (c) feeling physically and emotionally drained (d) experiencing self-doubt in making decisions (e) seeking and finding support. CONCLUSION The complexity of supervising at risk for failure nursing students in the clinical setting has an impact on instructors, patients, the educational institution and other students. Findings from this study offer a deeper understanding of the personal and professional impact on instructors when managing at risk nursing students and suggests ideas for future research, including examining the student perspective.
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Affiliation(s)
- Kathleen S Rodger
- University of Saskatchewan College of Nursing, University of Saskatchewan Regina, Canada.
| | - Karen L Juckes
- University of Saskatchewan College of Nursing, University of Saskatchewan Regina, Canada.
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Almalkawi I, Jester R, Terry L. Developing a consensus-based scoring rubric to enhance practice-based assessment of student nurses' clinical competence: A Delphi study. NURSE EDUCATION TODAY 2021; 100:104859. [PMID: 33713987 DOI: 10.1016/j.nedt.2021.104859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Concerns about reliability and validity of practice-based assessment of professional competencies are frequently reported in the literature. Difficulty in understanding competency statements or distinguishing different achievement levels has been found to be a major factor. OBJECTIVES To develop a consensus-based scoring rubric based on stakeholders' interpretations of level descriptors for student nurses' professional values competencies. DESIGN Two rounds of Classic e-Delphi. SETTINGS This study was conducted in a London based university using Bristol Online Survey website as a host. PARTICIPANTS 100 stakeholders with vested interests in undergraduate pre-registration nurse education were purposefully invited to participate. METHOD Round one collected free-text interpretations of the United Kingdom Nursing and Midwifery Council professional values competency statements. Round two used a Likert scale questionnaire to measure the level of agreement to the level descriptor statements generated through round one. Responses were analysed through content analysis in round one and consensus measure in round two. A threshold of 70% agreement to determine consensus was set in advance. RESULTS In round one, 47 participants provided their interpretations of the competency statements. In round two, 51 participants completed the questionnaire. All 24 items achieved a strong consensus with 86%-100% of participants agreeing or strongly agreeing with the statements. CONCLUSIONS A Delphi study was successfully used to develop a consensus-based scoring rubric with clearly stated descriptors for professional values competency statements. This scoring rubric holds the potential to enhance practice-based assessment across all healthcare professional disciplines.
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Affiliation(s)
- Ibraheim Almalkawi
- School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
| | - Rebecca Jester
- University of Wolverhampton, Faculty of Education Health and Wellbeing, Gorway Road WS1 3BD, United Kingdom.
| | - Louise Terry
- School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
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Hughes LJ, Mitchell ML, Johnston ANB. Moving forward: Barriers and enablers to failure to fail - A mixed methods meta-integration. NURSE EDUCATION TODAY 2021; 98:104666. [PMID: 33221050 DOI: 10.1016/j.nedt.2020.104666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many academics and clinicians who assess nursing students as part of their work-integrated learning experiences encounter difficulties with awarding a failing grade to students who do not meet fitness for practice standards. OBJECTIVES The aim of this study was to explore and further our understanding of assessors' experiences of failure-to-fail of nursing students within work-integrated learning. DESIGN This aim was achieved through an exploratory, sequential, mixed methods research project. METHODS Guided by Invitational Theory, this programme of work included an integrated systematic review, one-on-one and focus group interviews, and finished with a survey. RESULTS The results of each of the phases of this mixed methods study were integrated to provide a greater understanding of the enablers and barriers for assessors managing poor performing students to ameliorate failure to fail. Enablers identified included: assessor supports, programme flexibility, and organisational culture. The barriers included grade inflation, in appropriate student responses, organisational processes and workload. CONCLUSIONS This comprehensive integration of a mixed methods study provides new and deeper understanding of the phenomenon of failure to fail. It provides clear recommendations for practical application by tertiary and clinical facilities to enhance the enablers and minimise the barriers to failure where it is warranted.
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Affiliation(s)
- Lynda J Hughes
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, Qld 4111, Australia.
| | - Marion L Mitchell
- Griffith University, School of Nursing and Midwifery, Nathan, Qld 4111, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, Qld 4111, Australia; Princess Alexandra Hospital, Nurse Practice Development Unit, Ipswich Rd, Woolloongabba, Qld 4102, Australia
| | - Amy N B Johnston
- Menzies Health Institute Queensland, Griffith University, Nathan, Qld 4111, Australia; The University of Queensland, School of Nursing, Midwifery and Social Work, Translational Research Institute, Woolloongabba, Qld 4102, Australia; Princess Alexandra Hospital, Department of Emergency Medicine, Ipswich Rd, Woolloongabba, Qld 4102, Australia
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