Clinical and Classroom Settings Impact On Academic Performance In Nursing Education

 Academic Performance In Nursing Education and Impacts of Clinical and  Classroom Settings

Academic Performance in the Clinical and Classroom settings, Academic Failure in the Clinical Setting In Nursing Education, Assisting the Failing Student in the Clinical Setting In Nursing Education, Academic Failure in the Classroom Setting In Nursing Education, Setting  for Clinical and  Classroom for Academic Performance In Nursing Education.

Academic Performance in the Clinical and Classroom settings

    One major responsibility of nursing faculty is the evaluation of student academic performance. In many circumstances faculty are charged with evaluating students in both classroom (didactic) and clinical settings. Student evaluation is an expectation of faculty at all levels and requires careful consideration for many reasons.

    The outcome of evaluation has a major effect on students, and faculty must always be aware of this. Faculty may have limited preparation in how to evaluate students within the classroom (Morrison, 2010) or the clinical setting (Suplee, Gardner, & Jerome  D'Emilia , 2014). 

    The outcome of an evaluation usually means that students' progress in the program; However, an unsatisfactory evaluation means that students may face having to repeat a course, a delay in their education, or removal from the program. These outcomes have financial, emotional, and other costs for students. 

    In addition, faculty may also experience negative consequences, such as emotional distress, pressure from administration to maintain numbers, and a sense of personal failure when it is necessary to assign a failing grade. In the context of this stressful situation for all involved, faculty must be aware of the legal concepts important to the evaluation process.

Academic Failure in the Clinical Setting In Nursing Education

    Faculty who teach clinical nursing courses are responsible for guiding students in the development of professional nursing skills and values. Faculty must ensure that the learning experiences chosen provide the student with the opportunity to develop those skills that ensure that they will become safe, competent practitioners. 

    Applying a theoretical knowledge base, developing psychomotor skills, using appropriate communication techniques with patients and staff, exhibiting decision-making and organizational skills, and behaving in a professional manner are examples of the types of competencies that nursing students are expected to achieve through their clinical experiences. 

    Faculty are also expected to make judgments and decisions about the ability of students to satisfactorily meet the objectives of the clinical experience. When students are unable to satisfactorily meet the objectives of the clinical experience, faculty have the legal and ethical responsibility to deny academic progression.

    Legal and ethical grounds exist for dismissal of a student who is clinically deficient. Nurse Practice Acts exist in all states to regulate nursing practice and nursing education within a given state.

    Successful graduation from a nursing program should indicate that the student has achieved the minimum competencies required for safe practice. When providing clinical care, nursing students will be held accountable for professionally negligent actions, and are required to come to clinical learning situations prepared and to ask for help when needed (Christensen, 2010). 

    Although nursing practice is regulated by state law, which results in variations in practice standards between states, the prevailing view is that students are practicing on their own “fictitious license” and not the license of their instructor (Christensen, 2010). As a result, students will be held to the same standards of practice as a reasonable, prudent nurse with the same education and experience.     

    Patients should expect that the care provided be safe, quality care at the level that is needed. In addition, students and faculty are expected to follow professional standards of practice and codes of ethics that have been developed to guide the profession, even though the students' educational experiences are not completed.

    When engaged in clinical learning experiences, the nursing student is under the supervision of the clinical faculty, with input from agency staff. The nursing staff in the facility have ultimate control over patient care that is delivered, so there must be constant and appropriate communication between staff, faculty, and students. 

    The clinical agency contract that allows the school to use the facility for learning experiences may also contain a clause stipulating that the school of nursing will provide supervision of students. 

    It is also common for the agency to retain the right to request removal of students and faculty if the level of performance does not meet the standard of care acceptable to the institution, and could result in the loss of the clinical agency as a site for future clinical experiences.

    Faculty must accept responsibility for ensuring that students practice with an acceptable level of competence. Each member of the health care team is liable for his or her own potential negligence related to patient care. If the student does not provide care according to applicable standards, the student is liable for any resulting damage. 

    If the nursing faculty does not adequately assign, monitor, and supervise the student, the nursing faculty is liable for resulting damage. And if the clinical staff who retain ultimate responsibility for the patient's care neglect their duties in overseeing the care, they are liable for resulting damage.

    Clinical faculty have several responsibilities related to the instruction of students. First, clinical faculty must set clear expectations for student performance and communicate these expectations to students before the onset of any learning experience.

    These expectations must be reasonable for students to meet and must be consistently and equitably applied to all of the faculty members' assigned students. Second, faculty must determine the amount of supervision to provide to students. 

    When determining the appropriate level of supervision, faculty should consider the severity and stability of the assigned patient's condition, the types of treatments required by the patient, and the student's competence and ability to adapt to changing situations in the clinical setting. Another responsibility of clinical faculty is to judge the ability of the student to transfer classroom knowledge to the clinical setting.

    Application of theory to nursing care is an important component of safe nursing practice, and faculty must engage in data collection to determine the level of student performance in this area. Faculty may collect data in multiple ways. For example, before providing care, students may be asked to develop written care plans and provide the rationale for their proposed nursing interventions. 

    Faculty may also verbally ask students to explain the significance of patient assessment data they have gathered, or students may be asked to keep a weekly journal that provides insight into their clinical decision making.

    Because faculty retain the legal liability for appropriate student assignments and student monitoring to ensure applicable standards of care are being followed, the faculty has the responsibility to remove students from providing clinical nursing care when the student is unsafe.

    Fearing legal action, faculty may hesitate to fail a student who performs poorly in the clinical setting. However, federal and state courts have frequently upheld the responsibility and right of faculty to evaluate students' clinical performance and dismiss students who have failed to meet the criteria for a satisfactory performance. 

    The courts have long indicated that faculty, as experts in their profession, are best qualified to make decisions about the academic performance of students (Brent, 2001; Christensen, 2014; Guido, 1997; Smith, McKoy , & Richardson, 2001). 

    When teaching a clinical course, faculty must clearly establish and communicate the course and clinical objectives; They must document student performance and effectively communicate with students on an ongoing basis about their progress in the clinical area. 

    As part of this communication, faculty should clearly identify at the beginning of the course, along with the clinical objectives, the level of clinical competence that students will be expected to achieve. These requirements should be stated in the course syllabus, along with information about how the clinical grade will be determined for the course. 

    The clinical syllabus should clearly identify all of the evaluation measures that will be used in determining the clinical grade. Students must receive continuing input through a formative evaluation process, periodically receiving information about progress and suggestions for improvement.

    Students must have time to demonstrate the course competency requirements during the clinical experiences and cannot be required to master those competencies until the end of the course. The consequences of not meeting objectives should also be clearly communicated to students.

    Written records of all clinical experiences and student faculty conferences should be kept for each student during the course. Hall (2013) studied the use of anecdotal notes in the clinical setting and suggested that the use of anecdotal notes can promote accurate student clinical evaluations.

    Written records of a student's learning experience documenting that the student has been provided with adequate opportunity to meet the clinical objectives. If opportunities to meet clinical objectives have not been provided, students cannot be evaluated or failed on unmet objectives.

    Anecdotal records should be objectively written, describe both positive and negative aspects of a student's performance, and address the objectives of the course. Faculty should avoid commenting on the personality of the student but instead should reflect on what the student has or has not accomplished in relation to the course objectives. 

    Notes of the student's daily and weekly assignments should be based on fact and should be nonjudgmental. Documenting both aspects of performance indicates that the student's total performance was taken into account when the final clinical grade was assigned.

    Throughout the clinical experience, faculty should provide consistent, constructive feedback to students. Identifying positive aspects of a student's clinical performance and areas needing improvement will help that student develop self-esteem and confidence as a practitioner. 

    Feedback is best conveyed in privacy, away from peers, staff, and patients, thus maintaining student confidentiality. Persistent clinical deficiencies should be addressed in conferences with the student, ideally away from the clinical setting.

    Written records of student faculty conferences are used to document areas of faculty or student concern that have been discussed, along with the measures that are being taken to correct these deficiencies.

  Information about the progress the student makes toward correcting clinical deficiencies and any lack of progress should be included in follow up notes. Both the faculty member and the student should sign these written records.

    Communicating effectively with a student who is not performing satisfactorily can be difficult. When feedback is given to a student about deficiencies in performance, it is essential for the faculty member to convey to the student a sense of genuine concern about helping the student to improve his or her performance, as well as to convey the faculty member's responsibility for ensuring patient safety in the clinical setting. 

    McGregor (2007) addressed the importance of the student faculty relationship in which faculty are supportive when helping students cope with a clinical failure while at the same time retaining a sense of their self-worth and dignity. 

    Students should be allowed the opportunity to clarify and respond to the feedback given by the faculty member. Sometimes an objective third party, such as a department chairperson or course coordinator, can assist by providing an objective perspective of the circumstances and serving as an impartial witness to what was said by both the faculty member and the student.

    When notifying a student that course requirements are not being met and failure of the course may result, the faculty member must follow the institutional guidelines that have been established for such situations. Informing a student of unsatisfactory clinical performance can produce a stressful situation for the student. However, it also provides the due process that is the student's right in cases of academic deficiency. 

    It enables the student to understand that his or her performance is unsatisfactory and provides the student with the opportunity to correct deficiencies. It is equally important that the faculty member communicate information about the student's performance to other faculty who are administratively responsible for the course.

Assisting the Failing Student in the Clinical Setting In Nursing Education

    How do clinical faculty determine when a student's clinical performance is unsatisfactory and warrants failure of the course? How many opportunities should the student be given to learn before being evaluated? These are questions that have been debated in nursing education for decades without resolution. 

    Faculty are responsible for evaluating the cognitive, psychomotor, and affective behaviors of students during clinical learning experiences. Even with reliable and valid evaluation tools, it can be difficult to objectively evaluate the behavior of students, especially in the affective domain.

    Clinical evaluation has many inherent challenges for the nurse educator. Clinical evaluation may be subjective, evaluation criteria may be misinterpreted by faculty or students, and clinical nursing practice is very complex ( Krautscheid , Moceri, Stragnell , Manthey, & Neal, 2014).

    Faculty in the clinical setting need to implement clear clinical evaluation measures and provide the student with frequent feedback as to their progress in meeting the clinical expectations. 

    However, once having determined that a student's performance is unsatisfactory and that failure of the course is likely to occur, faculty must implement actions to protect the student's right to due process and assist the student through what will undoubtedly be a stressful experience.

    Faculty may use several guidelines when working with students whose clinical performance is unsatisfactory. For example, as previously mentioned, unsatisfactory clinical behaviors should be identified and discussed with the student as early as possible.

    Documentation of the student's performance and all conferences with the student should be maintained. Working in collaboration with the student, faculty should develop a plan or “learning contract” in which the needed areas of improvement are identified, along with appropriate measures to ensure improvement of performance. 

    The student should be made aware that isolated instances of good or inadequate performance will not lead to a passing or failing grade. Instead, it is essential that the student strive to develop a consistency of behavior that portrays continuing improvement in performance and the delivery of safe patient care.

    The student should also understand that successful completion of any remedial work identified in the plan may not be sufficient to ensure a passing grade for the course; satisfactory completion of the course objectives will be required. After the plan has been detailed in a document, both the student and faculty should sign and date it. The student should be given a copy of the plan for his or her own records and reference.

    Frequent feedback sessions are essential during this time, as the student attempts to make an improvement in performance. The number of sessions depends on the situation, but it is often helpful to agree to meet on a regular basis, for example, weekly. The faculty member should maintain objective and factual records of all sessions held with the student, including a description of strategies for intervention that were developed. Student self-appraisal should be a part of the process.

    The student should also understand that during this period of evaluation, increased supervision and observation by faculty may be necessary to continue to ensure that patient safety is maintained. Then students may report feeling treated unfairly or harassed and indicate that the increased faculty supervision is creating a stressful situation.

    It may be helpful at this time to refer the student to a counselor or other qualified individual for assistance with stress management. Then clinical faculty members should refrain from assuming the role of counselor to the student because a conflict of interest could develop that would interfere with the objective and unbiased judgment of the instructor. 

    Morgan (2001) cautioned that faculty, like counselors and therapists, have a responsibility to avoid assuming dual roles, such as counselor and faculty supervisor, when establishing relationships with students. It is imperative that the nurse educator only act within the boundaries of his or her position and role. 

    At times, a clinical instructor may experience a sense of concern about a student's performance but have difficulty clearly identifying the unsatisfactory behaviors. The instructor may wish to seek input from another faculty member about the student's performance.

    Faculty have the right, but no legal responsibility, to obtain an objective evaluation by another faculty member. If this is done, the faculty member must make the student aware of the purpose of this observation and that the results of the objective evaluation may affect the grade awarded.

    If the student continues to provide unsafe patient care despite the interventions to improve performance, faculty may withdraw the student from the course before the end of the semester. 

    Students who might qualify for removal from the clinical setting are those who demonstrate a consistent lack of understanding of their limitations, those who clearly and repeatedly cannot anticipate the consequences of their actions or lack of action, and those who consistently fail to maintain appropriate communication with faculty and staff about patient care. 

    If a student is dishonest with faculty and staff about the care provided to a patient, serious, legal and ethical implications occur.

    In all of these cases, patient care may be jeopardized and unsafe situations may be created for patients. Clinical faculty can refuse to allow a student to continue to provide care in the clinical setting; however, if the student's performance is safe, the student must be allowed to complete the clinical requirements of the course, even if the student is not meeting course objectives. Students are not required to achieve course objectives until the end of the course.

    Following the mentioned procedures helps ensure that a student's right to due process has been upheld. Maintaining effective communication with the student throughout the experience may be difficult but is essential to achieving a satisfactory resolution to the situation for both faculty and student. 

    When students perceive that they have been treated fairly and objectively, most will accept that they were unable to satisfactorily meet the objectives required of the course. Faculty should avoid excessive self-blame for the clinical failure of a student

Academic Failure in the Classroom Setting In Nursing Education

    Nursing program curricula are by necessity academically rigorous. Academic classroom failure, with subsequent attrition from the nursing program, is not uncommon, and retention of nursing students is a familiar concern of nursing educators. However, faculty have a responsibility to uphold academic standards and must at times assign a failing grade in a course. 

    There are numerous reasons for academic failure in the classroom. First, students may initially underestimate the amount of time they will need to devote to course study to be successful in the pursuit of a nursing degree. Students may be unprepared and lack the study and time management skills necessary to organize their schedules and study time appropriately. 

    Students can quickly become overwhelmed with the academic demand of a nursing program, and the resulting stress serves to further increase anxiety and the inability to deal with course requirements.

    Second, many of today's nursing students are attempting to fulfill numerous roles, simultaneously juggling the responsibilities and demands of work, family, and school. Role overload becomes excessive, and the students' grades are adversely affected. Students are often forced to make difficult decisions and may be ill-equipped to identify appropriate priorities when addressing these issues. 

    Third, some students have difficulty with the level of cognitive ability required in nursing courses. Although adept at memorizing facts and information, they are not able to apply the concepts and develop the appropriate decision-making abilities. 

    This is usually demonstrated by their inability to perform well on tests that demand application, analysis, and synthesis levels of cognition. Students who have never before been required to think on these levels may become frustrated when they spend much time memorizing information but still do not perform well on tests.

    Some students may have learning disabilities that affect their ability to read with comprehension, successfully take tests, memorize information, or maintain concentration. Some students have satisfactory clinical performance but are unable to perform well in the classroom setting. Students for whom English is a second language may also experience these difficulties.

    Faculty have an ethical responsibility to identify students who are considered to be at high risk for academic failure in the classroom. The same examples of high-risk characteristics Donovan identified in 1989 are still pertinent today, and include low grade point average, low standardized test scores, decreased critical thinking skills, and attendance at several universities without achieving a degree. 

    An additional high risk characteristic is difficulty achieving satisfactory grades in required science courses (Wolkowitz & Kelley, 2010). When students who have these characteristics are accepted into a nursing program, academic support services must be provided to increase their chances of success. 

    Students who are working more than 16 hours a week and those who have English as a second language have also been documented to be at increased risk for lower academic performance ( Salamonson & Andrew, 2006).

    Faculty also have the responsibility for developing and providing academic support services that increase students' chances for success and thus increase student retention in the nursing program. 

    There are many services that may be available to assist students academically, such as tutoring programs, individual course study sessions, study skills workshops, faculty student mentoring programs, test-taking support, peer study sessions, and time and stress management training. Faculty should be aware of resources within other departments in the institution that can offer valuable assistance to students in need. 

    They should also encourage activities that provide a support system for students, such as participation in student clubs and organizations. Peer mentoring can also be an effective educational strategy that benefits both the student serving as the mentor and the student being mentored (Dennison, 2010; Robinson & Niemer, 2010).

    Developing and providing support services for students with academic difficulties helps ensure that students receive the assistance they need at the earliest possible intervention point. Assisting the Failing Student in the Classroom

Setting  for Clinical and  Classroom for Academic Performance In Nursing Education

    When designing intervention programs that will assist students to be academically successful in a nursing program, faculty must consider the academic experience from the perspective of the student because this may have major implications for student retention and success. Faculty should obtain feedback from students in the program about their areas of concern, both academic and nonacademic. 

    For example, if students believe that large class size is interfering with their ability to learn, strategies that provide students with access to faculty in small groups could be implemented. Student focus groups can provide much feedback, and faculty can use this information to develop interventions.

    Faculty also need input about what programs or interventions are working (eg, tutoring services, orientation programs, peer-to-peer study assistance groups) so that these can be continued or eliminated according to their success. Faculty need to know what concerns students have that can be addressed with appropriate resources. 

    Using this information, faculty would be able to develop a retention intervention program designed to maximize students' positive experiences and enhance academic success. More specifically, faculty can implement several proactive strategies that support students' academic efforts in the classroom. 

    First, faculty should remain aware of the changing student population and students' different learning styles. Nurse educators need to develop innovative, flexible programs designed to support the academic needs of the increasing numbers of nontraditional adult learners, graduate students, and culturally diverse students.

    Flexible class scheduling, the use of technology to provide learning at convenient times for students, campus child care , recognition of students' life experiences, and support for students with English as a second language can all help students achieve their educational goals.

    The learning expectations and strategies of today's college students are likely to be different than those of students of the past. Much literature has been published that addresses the varying learning styles of the current generation, and information gained from those studies should be used to provide meaningful learning experiences for students.

    Students who are successfully integrated academically and socially into the academic environment will be more likely to be retained in the system. Institutions must realize that students bring diverse needs to the educational process. 

    The role of the faculty adviser is key in assisting students to successfully adjust to their academic responsibilities. Faculty need to be informed about academic policies that affect student advice so that they are able to provide accurate, timely information.

    Academic advising by faculty plays an essential role in the student's academic success as well as in retention in nursing programs (Harrison, 2012). Rosenberg and O'Rourke (2011) suggested that increasing the diversity and cultural competence of the faculty can be used to improve student retention among students from diverse backgrounds. Nursing associations or organizations can be a source of encouragement for students and can serve as a vehicle for socializing students into the nursing profession.

    Individually, faculty members can take several steps to assist students who are doing poorly in the classroom. When a student demonstrates evidence of a lack of understanding of content of the course, such as failing a test or not completing an assignment properly, the faculty member should meet with the student to identify the student's perspective of the problem. 

    Students are often able to recognize the problem themselves, such as not enough time spent in preparation, lack of understanding of the material, or personal problems. Each of these reasons for poor performance requires the use of different intervention strategies, and the student should be involved in determining what actions are to be taken. 

    Tests should be reviewed to assess the areas of difficulty and to determine whether the problem is potentially related to, for example, lack of knowledge about content, reading difficulties, anxiety associated with test taking, poor study skills, or personal difficulties. Once the potential causes have been identified, intervention strategies can be designed and implemented to help correct the situation. 

    Faculty must realize that it is the student's responsibility to learn as well as the student's responsibility to use the resources available to improve academic performance. Students must take responsibility for carrying out the plan of action developed in conjunction with the faculty member. 

    Faculty cannot assume responsibility for ensuring that all students are successful in the course, but they must make certain that students are active participants in identifying concerns, developing strategies to address deficiencies, and improving performance. Faculty should always be willing to listen to student concerns and make referrals to appropriate program resources when appropriate.

    If, despite various efforts, a student cannot satisfactorily meet the course requirements, faculty have no alternative but to assign a failing grade. At this point, the student will require guidance and support as the available options are reviewed. 

    If this is the first nursing course that the student has failed, it is commonly program policy to allow one retake of the course. If this is the second nursing course failure for the student, the student may be dismissed from the program. The student should receive appropriate academic advice as he or she plans future educational goals.