Learning Skills Clinical
The purpose of research is to improve student's learning and clinical skills by implementing the preceptorship model in army. Army has started baccalaureate and Post RN nursing to meet the challenges of globe, which could be educational, health related issues, faculty shortage, theory practice gap and graduate nurse's demand in the world. These two programs have many challenging tasks at their final term of final year which are difficult to learn without supervision, especially clinical skill building which is integral part of final exam. Stevenson and Shanley (2006) identified that “the supervisee develops greater self confidence, greater insight and greater consistency with clients. He/she has increased ability to reflect on practice afterwards.” (p. 588). Therefore, this study will help to implement the preceptorship model in addition; will bring change at policy level. Consequently, it will help to identify the characteristics of preceptor, and how she/he will facilitate to integrate the theory into practice to enhance the students learning.
Purpose of Literature Review
Literature will help to identify the main variables (constructs, concepts). Relatively, it will guide to get instrument (questionnaire, interview guide) form the different sources by which researcher can measure the main variables. Literature provides the empirical data, conceptual framework, theoretical framework, and importance of research by giving previous research results, and that aids to integrate previous results to the present study. It also support and facilitate to interpret the results of study.
Concepts of Literature Review
Literature review is important to understand the important concepts in research study which derived from the research question. These concepts can formulate the conceptual framework. The entire process of research revolves around the research question which helps to understand the phenomenon.
Research Question
Do baccalaureate nursing students who work with a preceptor during their intensive care rotation nursing experience of their medical surgical course score higher on their medical surgical final exam compared to those to baccalaureate nursing students who do not work with a preceptor?
Preceptor
According to Mantzorou, 2004 (as cited by Peirce, 1991) that word preceptor primarily was introduced in 15th century stands for teacher or lecturer. It is defined by Cooper and Palmer, 2002 (as cited by Cooper, 1993) that preceptor is “a qualified and first level nurse who has agreed to work in partnership with a (newly) registered practitioner colleague in order to assist and support them in the process of learning and adaptation to his or her new role” (p. 98).
Preceptee/Nursing Students
Barrett and Myrick (1998) highlighted that preceptee is person who can be student or new staff nurse work on assign patients under supervision and provide nursing care according to the guidelines given by preceptor.
Preceptorship Model
According to the Myrick and Yonge (2004) it is a model in which preceptee and preceptor work together through an orientation process to build the clinical skills.
Preceptor and students learning
Pakistan army schools/hospitals do not have preceptorship in their setting, although around the globe this model is utilizing, and even in some places of Pakistan. Allen and Simpson (2000) emphasized that if preceptor and preceptee work together they give better environment to the patients. Moreover, Block, Claffey, Korow, and McCaffrey, (2005) identified that mentor or preceptor is important for the organization. Army is struggling for faculty development due to shortage of faculty, and implementation of preceptorship which can reduce the shortage by utilizing them as a faculty or assigning them as a clinical instructor. Relatively, Ross and Clifford (2002) has discussed that transition period from student to staff nurse is more stressful, thus preceptor can guide and support them to handle the different issues. Final year of nursing students becomes very hectic because of electives in their final term of final year and final exams especially clinical skills testing.
Consequently, Lambert, and Glacken (2005) illuminated that “The importance of supporting students on clinical placements is clearly evident in the literature with a variety of clinical support roles developed to succor, guide and teach student nurses in clinical areas” (p.667). However, this is important to look after the nursing students for safe clinical practices and to have the competent nurses for future. Accordingly, Tveiten (2005) stated that “The concept of clinical is usually connected with the concept of supervision related to the nursing discipline…this is connected with the fact that clinical supervision is conducted with reference to clinical practice” (p. 17). Subsequently, Charleston and Goodwin (2004) highlighted that preceptorship as a model has potentials to influence nursing practices, clinical learning enhancement, promote recruitment and retention generate more interaction between nurse student and supervisor whereas, Stevenson and Shanley (2006) asserted that sometimes there is lack of investigating and questioning skills in clinical nurse teacher and preceptors in undergraduate nursing education due to lack of taining therefore, Lambert, and Glacken (2005) stated that “the concept of facilitation emerged congruent with the culture of higher-level education new models of nurse education emphasize a non-prescriptive student-cantered approach promoting self-direction, critical thinking and life-long learning” (p.667).
There are some common issues in private and government sectors in Pakistan, that nursing is based on senior-ship. Nurses do not take much interest in studies because they are in position, and they are teaching students with old strategies which are not appropriate to meet the challenges of to-days education/nursing students they have to go ahead to have the evidence based practices. Moreover, Ferguson and Day (2007) evidence based practice is important for nurse's .Relatively, at some places teaching instructors and clinical instructors are not the same for teaching of theory and clinical skills in wards. Further, they cannot communicate frequently due to lack of resources regarding student's progress. However, Williamson and Webb (2001) identified that ideally nursing instructors and clinical instructors should work together to relate theory into practice. Thus, Leigh, Douglas, Kathlee and Douglas (2005) added that “The competencies of nurses in their operational and administrative duties vary according to the length of service, experience, grade and responsibilities” (p. 508). However, Fox, Henderson, and Nyhan (2006) argued that if preceptors do not feel that they are able to provide effective support, or the preceptee feels unsupported, than this can lead to frustration by both parties, as a result according to Bourbonnais and Kerr (2007) importance of preceptor cannot be denied they play a major role at both sides clinical as well academic side. To get the better affects Hrling and Hallberg (2001) (as cited by Nehls et al. 1997) emphasized that ratio of preceptor and preceptee should be one to one on site of supervision and clinical teaching. Students from the diverse group may be having different concerns. So, Charleston and Happell (2005) supported that “Attitudes and behaviors heavily influenced the degree of change in students' anxiety and confidence levels” (p. 307). In their study on preceptorship Charleston and Happell (2005) acknowledged that preceptor generate the positive learning environment for the preceptee. In addition, Bourbonnais and Kerr (2007) emphasized that preceptors sustain students learning experiences, but at the same time preceptors should be awarded by different motivations and organization or managers should support them to keep up their morale. This is true that lack of support and facilities at working place is one of the major factors of faculty/nurses shortage and turnover in army. Further, assessment of students and staff by asking relevant questions is important to sustain the role of preceptor. Thus, Phillips and Duke, 2001, Myrick and Yonge, 2004 highlighted that questioning is one of the teaching learning strategies which solve queries and enhance the critical thinking skills which is fundamental part of nursing practices. However, McCarthy (2006) alleges that not only student but this is also important to know that how much preceptor is competent and knowledgeable. Students learn form their teachers who are role model for them, if they are lacking certain skills ultimately it affect the students learning. Usher, Nolan, Reser, Owens and Tollefson (1999) highlighted that characteristics of preceptor plays major role to influence student's learning.
Preceptorship and students higher grades
It is generally recognized that nursing schools/colleges manage the development of students' theoretical knowledge, with practice skills through working in health care. Kippenbrock, Stacy and Palmer (2004) added that utilization of multiple educational strategies enhance nursing student's clinical learning. There are factors which affect preceptor and preceptees co-ordination or relation, and in that situation preceptor struggle extra to obtain the maximum outcomes. OÈ hrling and Hallberg (2001) included that ward has a special environment, that is why students take time to adjust there therefore, preceptor plan to provide special learning environment in which students can grasp and apply the clinical skills because it is a different experience from practicing in demonstration room. However, O'Shea and Kelly (2007) revealed that newly qualified nurses face because of less preparedness or lack of competencies. This problem occurred when they do have assistance because of extra responsibilities. Relatively, Salsali (2005) alleges that “The aims of nursing education principally center on the transmission of nursing knowledge, and assisting nursing students to acquire the necessary skills and attitudes associated with nursing practice” (p. 5). Preceptorship will help nurses to handle difficulties they face at clinical as well it will provide comfortable working environment. O'Malley, Cunliffe, Hunter and Breeze (2000) ultimately, nurses will be able to give quality care to the patients, because appropriate supervision leads to good quality patient care. Leons-Perkins, Schnuth, Lipsky (1999) discussed in his study that students increase their grades in final exam if they work with preceptor, as well ratio of preceptor and preceptee may affect preceptee performance. Further, Levy and Merchant (2005) added that gender of preceptor do not affect, but many personnel and teaching qualities e.g. delegation of appropriate responsibility, clear expectations, and providing opportunity for procedures do affect to achieve grades in their final evaluation of clinical skills moreover, they highlighted that diversity of students and place of applying the clinical skills has significant difference in achieving grades.
Exploration of literature
I am searching an extensive literature from library of Aga Khan University, including Medline, online journals, and books. Further, search is continue from different websites especially “google, pubmed, blackwell synergy and yahoo” for my research proposal development. I am trying to get articles and books of last five years especially in English but it is still difficult to find out history and some other essential things therefore; I will be using some old references for literature review. It is continues process which may go till research study over.
References:
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Bourbonnais, F. F., & Kerr, E. (2007). Students and newly qualified nurses:
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Block, M. L., Claffey, C., Korow, M. K., & McCaffrey, R. (2005).The Value of
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