Small Group Mentoring: A Method for Improving Outcomes in Foundations of Nursing Practice

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Small Group Mentoring:

A Method for Improving Outcomes in Foundations of

Nursing Practice

4/14/2013

El Paso Community College Teachership Academy Jose Luis Lopez MSN, RN

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ABSTRACT

The purpose of this study is to determine the effectiveness of small group mentoring in first semester nursing students, aimed at improving outcomes in the Foundations of Nursing Practice course. The conceptual framework is derived from Florence Nightingale’s Environmental Theory in which the main focus was the control of the environment of individuals and families. Through the manipulation of the environment of both negative and positive outcomes, a balance can be maintained. The research design is a descriptive

longitudinal study using a convenience sample of first semester nursing students over the span of four semesters (Spring 2010, Fall 2010, Spring 2011, and Fall 2012). The control group for this study is the first semester nursing students during Spring 2010 where no mentoring took place. Findings in the review of literature suggest that faculty mentoring and support of students have a positive impact on the retention of students. Supportive social networks, community

involvement, as well as family and home involvement play a significant role in the success of first semester nursing students. In conclusion, mentoring of first semester nursing students has been effective in their performance of unit exams. If we are to improve the outcomes of first semester nursing students, a more formal approach to mentoring must be established. Our Nursing Program is bound to face major challenges if we do not continue to provide a network of support to our nursing students.

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INTRODUCTION:

More than four decades ago, John E. Roueche highlighted calls for increased attention to student progress and success in his first book Accountability and The Community College; Directions For The 70’s. Since then numerous reports have been published which suggest that we have seen too little improvement in our public schools and community colleges. In an article published by the Center for Community College Student Engagement in 2010, “The Heart of Student Success”, Mr. Roueche (Director of Community College Leadership Program at The University of Texas at Austin), stated, “It is well known that the great majority of students enrolling in community colleges require remediation in one or more of the basic academic skills and that most community colleges function as ‘emergency rooms’ for many of their entering students. Not only are many students still alarmingly underprepared for college, but they too often have developed an active aversion to mathematics, English, and the educational process more generally.”

Students enrolled in the El Paso Community College (EPCC) Nursing Program are no

exception to the many obstacles faced by students at other community colleges throughout the country. Most of the nursing students at EPCC are of Hispanic origin, with English as their second language. Many come from low income families and must maintain employment in order to pay for school and support their families. Single mothers are not uncommon, and neither is being the first person in their immediate family to attend college. Many lack a solid support system at home to assist them with the rigors of nursing school. Some face social isolation from their friends and family since most of their time is spent playing catch-up with their studies in order to achieve success.

Many nursing students have a difficult time adjusting to the enormous amount of

information presented during their first semester of study, as well as to the question format used in unit and standardized exams. Entering students continue to demonstrate a deficiency in study and test taking skills. The process of critical thinking is an essential

component/requirement in the student’s ability to correctly answer assessment and application type questions.

In her book “Notes on Nursing” Florence Nightingale emphasizes the roles of environmental management and manipulating the environment to prevent diseases. She focuses on a

relationship of cooperation and collaboration. The conceptual framework for this study is derived from Florence Nightingale’s theory. The design of this model, in which the major components are student, environment, and faculty, illustrates how the manipulation of the environment can play a significant role in student success and provides the structure for understanding those external factors which affect the students during their course of study.

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Mentoring students during their first semester of study may very well be the key in improving overall test scores and success rates of first semester nursing students.

PROBLEM STATEMENT:

The vast majority of students admitted into the nursing program are only used to

memorizing information and answering knowledge-based questions. They do not realize that nursing school requires that they understand concepts and apply them to various situations. The unit exam questions and the standardized examination from Assessment/Technologies Institute, LLC (ATI), are of similar format utilized by the NCLEX-RN examination, required by the Texas Board of Nursing for licensure in the State of Texas. Some students are not academically prepared for the rigors of the nursing program while others may lack the discipline, enthusiasm, commitment and motivation to succeed. Their first encounter with reality seems to be when they take their first unit exam, and for some disbelief in their performance is not uncommon. Nursing exams not only test the acquired knowledge of the assigned material, but also the student’s ability to apply that knowledge in real situations.

PURPOSE OF STUDY:

The purpose of this study is to determine the efficacy of a small group mentoring

intervention program aimed at improving test scores of first semester students in Foundations of Nursing Practice.

RESEARCH QUESTIONS:

This research is guided by the following research questions:

1) Will small group mentoring improve test scores of first semester nursing students? 2) Is there a correlation between early mentoring intervention and the performance of

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REVIEW OF LITERATURE:

Mentoring

Dorsey and Baker (2004) reviewed 16 studies which support the premise that faculty mentoring and support of students have a positive impact in the retention of students.

Academic Performance

Potolsky (2003) revealed in her study that prerequisite science courses grades have a

relationship to the academic performance of first semester nursing students. Students who had higher prerequisite course grades generally performed better in their first year of nursing school than their counterparts with lower prerequisite course grades. The study also found that students performed better in the prerequisite courses than in the first semester nursing

courses, perhaps due to their lack of understanding and ability to apply complex concepts to a hypothetical patient situation.

Part-Time Employment, Age, Ethnicity

The study conducted by Salamonson and Andrew (2006) found that working more than 16 hours per week during the semester had a detrimental effect on students’ academic

performance. Perhaps the most obvious argument for decreased academic performance in this scenario is less time available for studying. The study also revealed that those students who worked in nursing-related employment did not hold an advantage in academic performance, even for a nursing practice-based subject. Older students achieved better grades than younger students entering college soon after graduating from high school. Non-native English speakers of English are also are more likely to underperform academically, and have disproportionately higher failure rates in their first year of nursing school than native English speakers.

Retention

Baker (2010) found that the highest rated strategies for retention of minority students were those that involved direct interaction of nurse faculty and students. Baker also noted that the most effective strategies used were: timely feedback on test performance, timely feedback on

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clinical performance, and faculty availability. Faculty-student interaction is a vital component in the retention of students, and students view faculty as a key factor in their continued success in nursing programs (Shelton, 2003). Financial support affects access to and continuation of nursing school. Major factors stated by students that influenced graduation from nursing programs included supportive faculty, individual motivation, peer support, and belonging to nursing associations (Amaro, 2005).

CONCEPTUAL FRAMEWORK:

Mentoring Environmental Model

The conceptual framework is based on the mentoring design of a model in which the major components of Mentee/Student, Environment, and Mentor/Faculty form the foundation. The sub-concepts elucidate the major concepts as they relate to the successful outcomes of the student. The threads serve to guide both the student and mentor by ensuring that the common subjects necessary for success are addressed throughout the semester. Foundations of Nursing Practice introduces the role of the professional nurse as a provider of care, coordinator of care, and member of a profession, and emphasizes knowledge, judgment, skills, and professional values within a legal/ethical framework (El Paso County Community College District 2012-2013 Catalog). Communication Knowledge Critical Thinking Accountability Evaluation MENTEE STUDENT Negative Outcomes Poor Performance on Exams MANIPULATION OF ENVIRONMENT (Mission, Family,

Cultural Diversity, Community)

MENTOR

FACULTY

FAMILY

MANIPULATION OF ENVIRONMENT (Mission, Family,

Cultural Diversity, Community)

Positive Outcomes Student-success

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The integration of positive and negative outcomes is essential in the concept of student success. The development of these outcomes guides the student in developing a framework in which he/she can master the subject matter.

The concept of Environment provides the structure for understanding those external factors which affect the students during their course of study. The mission of the institution and student, individual and family relationships, cultural values and beliefs, and the resources available within the home and community bind both mentor and student.

Communication is an active process entailing verbal and nonverbal skills for the purpose of sharing information. This two-way street provides mentor and student the avenue to establish a trusting relationship, allows for greater sharing of knowledge and expertise, and increases interaction and enhanced mentoring, leading to decreased attrition.

Knowledge is the expertise, and skills acquired by a person through experience or education, the theoretical or practical understanding of a subject, what is known in a particular field or in total, facts, and information. The term knowledge is also used to mean the confident

understanding of a subject with the ability to use it for a specific purpose if appropriate (Oxford English Dictionary, 2011).

Critical thinking is a framework for problem solving and a way in which an individual can identify and analyze the actions, decisions, values, and judgment of him and others. Critical thinking skills are developed in time through one’s progress in education and experience. Accountability is the responsibility of both the mentor and student, and a concept in ethical and legal boundaries. It is the obligation that mentor and student share, and is essential in setting the standard of responsibility and sustainable development.

Evaluation of self and objectives is an essential component to measure progress. It is the determinant factor that allows one to proceed with or formulate a new approach. Honesty plays a major role in the evaluation of self.

METODOLOGY/ RESEARCH DESIGN:

The purpose of this research design is to determine if an early education intervention program is effective in improving outcomes in the course Foundations of Nursing Practice course. The design is a descriptive longitudinal study using a convenience sample of first

semester nursing students over the span of four semesters (Spring 2010, Fall 2010, Spring 2011, and Fall 2012). The control group for the study is the first semester nursing students during Spring 2010 where no formal mentoring was provided. Information for the study was obtained using test scores on unit exams in Foundations of Nursing Practice and National Council

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Licensure Examination (NCLEX) Pass Rates for El Paso Community College. The intervention site was school based. Students were mentored in small groups of no more than ten students and on an individual basis. Mentoring was provided to all students who performed poorly on unit exams and to those who sought improvement in their performance.

INTERVENTIONS:

The focus of early intervention is to identify those students at risk of not achieving academic success. Initially students were identified as being at risk if they failed any of the unit exams. An Action Counseling Plan was initiated to address the student’s deficiencies and students were required to review their exams with their mentor and attend tutoring sessions for test taking skills, drug dosage calculations, open lab, and clinical sessions before their next scheduled unit exam.

A more formalized process of identifying students at risk was established in the last two years of this study which focused on “Jeffry’s Cultural Competence and Confidence Model” (Jefferys, 2010) which includes academic, environmental, and background variables. Such variables include reading comprehension and math scores, work, family and peer support, first in family to go to college, and English as a second language. This process enabled the

identification of student’s at risk at a much earlier stage. Effective intervention efforts begin early by reaching out to students. Early intervention programs provide students with

information about program requirements and expectations, and serve to widen their options in achieving academic success. Successful retention strategies to improve student outcomes include workshops in the Nursing Process, test taking skills, study techniques, note taking, and educational websites to improve reading comprehension.

Non-cognitive variables appear to be more reliable measures of minority students' ability to succeed in college (Sedlacek, 1996). These non-cognitive variables include positive self-concept, realistic self-appraisal, long-range goal setting and planning, presence of a strong support person, successful leadership experience, demonstrated community service, and the ability to demonstrate experiential knowledge or the application of learning to real-life experience. An institution with comprehensive retention services provides counseling, tutoring, academic support, career planning and placement services, as well as work to improve the social climate on campus and the cultural competency skills of academic advisors and faculty members (Dumas-Hines, 2001).

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RESULTS:

Examination scores for all Foundation of Nursing Practice students were tabulated to obtain unit exam averages. Formal mentoring began during the Fall 2010 semester and continued through the Fall 2012 semester. During the Fall 2011 and Spring 2012 semesters no data was obtained, (see Figure 1). The exclusion of data during the Fall 2011 and Spring 2012 limits the findings during this mentoring period. One can only deduce from the data provided that students during this period benefited in the same way in improving their examination scores.

Figure 1

The percentage of students passing the Foundations of Nursing Practice unit exams and passing the course was obtained by tabulating the number of students taking the exam and completing the course, (see Figure 2). No data was obtained for the Fall 2011 and Spring 2012 semesters. Formalized mentoring, however, was provided during these two semesters.

Figure 2 68 72 74 76 72 78 75 85 76 77 82 78 70 75 82 72 77 77 83 83 86 86 81 84

Exam 1 Exam 2 Exam 3 Exam 4 Exam 5 Final Course Grade

Averages For Unit Exams

Spring '10 Fall '10 Spring '11 Fall '12

32 45 58 39 70 66 42 94 60 65 87 75 40 84 77 66 72 69 71 84 91 94 85 100

Exam 1 Exam 2 Exam 3 Exam 4 Exam 5 Final Course Grade

Percentage of Students Passing

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The NCLEX pass rate results were obtained from the Texas State Board of Nursing web site

www.bne.state.tx.us/nursingeducation/edudocs/RN-5yr-passrate.pdf ,(see Figure 3). Mentoring of all students at El Paso Community College was formalized beginning with the Fall semester of 2010. The majority of the students who graduate in the Spring of 2012 received four semesters of formalized mentoring. Graduates from each year included those students that were off track due to personal or academic circumstances.

NCLEX PASS RATE Year of NCLEX

Exam 2010 2011 2012 Quarter Results) 2013* (First

Percent Pass Rate 78.38% 88.51% 92.37% 97.87%

Ratio of Students Passing NCLEX Examination 116/148 134/148 121/131 46/47 Texas Board Of Nursing 2013 Figure 3 SUMMARY:

Small Group Mentoring of first year nursing students is an effective method for improving outcomes in Foundations of Nursing Practice. There appears to be a direct correlation between early intervention and the success of students. The formal mentoring of students, for the most part, did not take place until after the administration of the first unit exam. Mentoring was also interrupted by the start of clinical rotations during the administration of exams 4 and 5. Review of literature reveals that faculty mentoring and support of students has a significant positive impact on the students’ success. Further, direct interactions are the highest rated strategies to decrease student attrition rates. The most effective strategies were: timely feedback on test performance, timely feedback on clinical performance, and faculty availability. Faculty-student interaction is a critical element in the retention of students, and students view faculty as a key

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factor in their persistence of nursing programs. The vast majority of students admitted into the nursing program use rote learning, verbatim memorization techniques, when answering

knowledge-based questions. This is in contrast to the understanding of concepts, critical thinking and application of nursing principles essential to nursing. The unit exam questions and the NCLEX –RN examination (required by the Board of Nursing for licensure in the State of Texas) are of similar format. Some students are less academically prepared for the rigors of the nursing program, while others may lack discipline and motivation to study and persevere. Still others are lacking the economic or familial support to help them achieve and maintain

academic success.

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REFERENCE:

Amaro, D., Abriam-Yago, K., Yoder,M. (2006). Perceived barriers of ethnically diverse students in nursing programs. Journal of Nursing Education,45(7). 247-254.

Baker, B., (2010). Faculty ratings of retention strategies for minority nursing students. Nursing Education Perspectives, 11(4).216-220.

Dorsey, L., & Baker, C. (2004, July/August). Mentoring undergraduate nursing students: assessing the state of the science. Nurse Educator, 29(6), 260-265.

Dumas-Hines, F. A. (2001) Promoting diversity: Recommendations for recruitment and retention of minorities in higher education. College Student Journal, 33 , 190-96

El Paso County Community College District (2012) 2011-2012 catalog, 41, pg261.

Jeffreys, M.R., (2010). Teaching Cultural Competence in Nursing and Healthcare second edition. New York: Springer Publishing Company, LLC

Nightingale, F., (1992). Notes on Nursing. Philadelphia: J.B Lippincott Company. Oxford English Dictionary, (2011) Oxford University Press

Potolsky, A., Cohen, J., Salor, C., (2003, September/October). Academic performance of nursing students: do prerequisite grades and tutoring make a difference. Nursing Education

Perspectives, 24(5), 246-250.

Salamonson, Y., Andrew, S., (2006) Academic performance in nursing students: influence of part-time employment, age and ethnicity. Issues and Innovations in Nursing Education, 342-349.

Sedlacek, W.E. (1996) Employing non-cognitive variables in admitting students of color. New Directions for Student Services, 74, 79-91.

Shelton, E. (2003). Faculty support and student retention. Journal of Nursing Education, 42(2), 68-76.

Texas Board of Nursing (2013) Texas Board of Nursing NCLEX-RN Pass Rate for Last 5 Years. Retrieved April 12, 2013 from Texas.gov:

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