Management of a Learner Who Is Not Achieving the Level of Competence in an Intensive Care Unit - Essay Example

MANAGEMENT OF A LEARNER WHO IS NOT ACHIEVING THE REQUIRED LEVEL OF COMPETENCE IN PRACTICE IN AN INTENSIVE CARE UNIT ENVIRONMENT Introduction Teaching is indeed a vital part of every learner’s endeavor. As we all know, the teaching methods and strategies used by teachers, or mentors, could greatly affect the way the learners would understand and retain the knowledge about the lessons that have been presented and imparted to them by their mentors. In the same way, the learner’s ability, or disabilities, can equally have an effect on the extent that they could comprehend and apply the concepts, which have been taught to them in their learning institutions. As such, Potter and Perry (2001) uphold that it is impossible to separate teaching from learning (p. 473) and interpersonal communication is vital for teaching [and learning] to occur. In line with the aforementioned idea, mentorship in nursing is a crucial role in honing the knowledge, skills and attitudes of student nurses in many areas in the broad field of nursing. The clinical preceptors and mentors must determine the needs and abilities of their student nurses because teaching these students is most effective when it responds to their needs (Potter and Perry, 2001). Also, the assessment of their disabilities and difficulties prompts a better understanding and management that are geared towards overcoming hindrances and learning improvements. In this regard, this paper explored a scenario wherein a learner was not achieving a required level of competence to practice in an intensive care unit environment, which definitely requires prompt attention since the student is in a special unit that requires dexterity in providing safe and critical care for the patients. Moreover, the sections of this paper exemplified the critical analysis of the given scenario, ethical and professional issues on failing students, substantial arguments, the role of mentor in nursing students and the grading criteria based on disabilities and established standards. Thus, this paper aims to describe the ways through which effective management shall be applied to the given scenario and to provide recommendations and solutions based on reputable concepts from reliable references. [Given] Scenario Upon mentoring a second year student in his final term, the mentor completed an initial interview wherein he identified some areas for development in the aspects of communication and documentation from the student’s previous placement in the intensive care unit. At this meeting, James, the student, informed him that he was diagnosed with dyslexia. When working with James, the mentor noticed that he appeared to have lost his confidence, with seemingly poor concentration level, and an inability to remember more than 2 verbal instructions at once. The mentor also observed that the written documentation was poor with illegible handwriting and spelling mistakes. In addition, James reported that one of the mentor’s colleagues has told him that he cannot be a registered practitioner if he has dyslexia. Given this situation, the mentor must carry out considerable management to help James make it through and cope with the situation. Critical Analysis With the abovementioned scenario, we can clearly recognize the major cause for the student not achieving the required level of competence in practice and it was obviously because of his dyslexia. Crisfield (1996, quoted in Traylor 2007, ppt. slides 10-11) cited the definition of The British Dyslexic Association for dyslexia as: “…a complex neurological condition ….The symptoms may affect many areas of learning and function, and may be described as a specific difficulty in reading, spelling and written language. One or more of these areas may be affected... ‘Numeracy, notational skills (music), motor function and organizational skills may also be involved. However it is particularly related to mastering written language, although oral language may be affected to some degree.” Another definition of the disorder is the definition in DfES’s (2004, as quoted in Aiken & Dale 2007, p. 7): “…A specific difficulty, typically characterized by an unusual balance of skills. Dyslexia affects information processing (receiving, holding, retrieving and structuring information) and the speed of processing information. It therefore has an impact on skills such as reading, writing, using symbols and carrying out calculations.” The abovementioned definitions can be correlated to the condition of the student (James). We can also say that he was indeed experiencing a certain degree of difficulty in some of his skills and functions such as in writing and ability to concentrate. Undeniably, this condition has affected his confidence and coping with the situation. In this manner, students like James who experience dyslexia could possibly have a feeling of anxiety and social isolation (Aiken & Dale, 2007, p. 19). Role of Mentors in Students with Disabilities According to Traylor (2007, ppt. slide 13), the students with disabilities must perceive their mentors as open and approachable upon disclosure of their underlying conditions. The mentors are expected to respond to the situation in an optimistic manner, wherein they will serve as an instrument to help the students strategize the ways to improve their performance and must be there to support them in every step they take to alleviate their condition. In addition, support organizations like Skill.org provides for information about supporting dyslexic students on clinical practice. Thus, generous and beneficial support mechanism must be undertaken by the mentor in the given scenario, as with the aforementioned concepts. Issues and Arguments The student’s feeling of anxiety was even aggravated by one his mentor’s colleague’s statement that he cannot become a registered practitioner due to his underlying condition. However, this statement by one of the mentors must not be considered as conclusive, as there are still a lot of factors to consider, including a thorough assessment of the condition of the individual with the disorder and decision by professional regulating bodies in accordance with established laws. The said statement of the mentor’s colleague can also be subject to ethical consideration with regards to discrimination issues. Moreover, as a common knowledge to everyone, each institution for higher education most probably has its own criteria for evaluating and grading its students with disabilities. Hence, instructors/mentors must be very much careful in giving statements to the students with disabilities to prevent disillusionment and lowering of confidence and morale of students like James. Another issue that needs to be carefully dealt with in the given scenario is the fact that the student’s placement was in an intensive care unit. In this special area in a health care setting, registered nurses and student nurses must be coherent and discerning to the critical needs of the patients admitted therein. These characteristics are vital towards provision of safe nursing care to patients with special needs, as well as early detection of problems and prompt nursing interventions. However, with regards to students and practitioners with disabilities like dyslexia, a careful judgment must be taken into account. In this manner, Aiken & Dale (2007, p. 32) explicated the following ideas in reference with NMC: “The NMC have received referrals of registrants who have been identified as being affected by dyslexia… However, the identification of a particular condition does not, of itself, lead to a conclusion of impaired fitness to practice (NMC, 2006b). In general terms, allegations brought to the NMC centre around issues such as poor record keeping, inadequacy of care plans, difficulties with drug administration, poor provision of care, inability to cope either in stressful environments or when asked to multi-task. The registrant’s dyslexia, if relevant, may be considered to be contributory factors to these matters. However, it is the actual allegation that the fitness to practice panel will consider and it will need evidence that the registrant is not capable of safe, competent, effective and independent practice.” According to MORI (2005, as quoted in Aiken & Dale 2007, p. 32), regulators need to have a criteria to come up with a decision of fitness to practice to a certain individual. Effective records of processes and procedures must also be kept as a reference for the decisions that will be made. Ethical and Professional Issues Concerning Failure of Students in Practice Looking at a professional standpoint, Duffy (2004, as quoted in Guidance for mentors of nursing students and midwives, RCN.org. n. d., p. 14) explained the reason for student’s failure in accordance to professional standards: “Potentially clinical assessment of student nurses can safeguard professional standards, patients and the general public. It is inevitable that some students will not be able to meet the required level of practice and it is essential that mentors do not avoid the difficult issue of having to fail these students.” In this way, the “mentors will require courage and confidence to fail students” who were not able to meet the standards and quality for practice (RCN.org. n. d., p. 14). On the other hand, in reference to the given scenario and in due consideration of students with disability, it would be unethical to simply fail these students who experience some difficulties because of their condition. Definitely, mentors should consider the underlying conditions of students like James. In line with this, The Special Educational Needs and Disability Act ([SENDA] 2001) provides for the guidelines on the special education needs and plans to prevent disability discrimination in education. “This demands that local authorities and schools become more effective in their teaching approaches: it therefore insists that statements of special educational needs are clearly worded, reviewed and that proper amounts and types of teaching are provided” (Johnson, n.d.). This act also takes into consideration the so-called reasonable adjustments. DDA (1995, as quoted in Guidance for mentors of nursing students and midwives, RCN.org. n. d., pp. 19-20) says that “the duty to make reasonable adjustments arises when disabled individuals encounter ‘substantial disadvantage’ and it refers to any actions taken to remove or reduce the disadvantage”. Some of the adjustments include, but not limited to, the following: “the use of coloured overlays to assist in reading text on white paper the use of coloured paper additional training and support giving verbal rather than written instructions allowing plenty of time to read and complete the task giving instructions one at a time, slowly and clearly, in a quiet location reminding the person of important deadlines and reviewing priorities regularly using a wall planner; create a ‘to do’ list the use of modified/specialised equipment provision of a quiet area to write up notes or when specific tasks require intense …concentration… and flexible working hours/frequent breaks.” (DDA 1995, as quoted in Guidance for mentors of nursing students and midwives, RCN.org. n. d., pp. 19-20). Similarly, McCandless-Sugg, Sanderson-Mann, & Wharrad (2006), in their study, concluded that mentors need to have more information and education about dyslexia and that there is no one solution to the challenges that student nurses with dyslexia face in clinical practice, which exemplifies their individuality, thus their learning needs should be assessed and responded to on an individual basis. Thus, with regards to registration of students with disabilities, NMC (2004) provided the following guidelines: “Students who declare on application that they have a disability should submit a formal assessment of their condition and specific needs, from a GP or other medical or recognised authority, to the relevant Occupational Health department... …Where appropriate, the institution’s student support services should also be involved. The NMC would require evidence of how such students would be supported in both academic and practice environments to ensure safe and effective practice sufficient for future registration” (p. 10). Theoretical Models/Concepts that Apply to Dyslexia Aiken & Dale (2007, pp. 7-8) in their paper entitled ‘A Review of the Literature into Dyslexia in Nursing Practice’ explicated two theoretical models that relate to dyslexia. The first model is the traditional medical model, which upholds the concept that people receive a particular service and perceive their disability as a problem. Secondly, the social model of disability perceives the person in the viewpoint of the society, which is geared towards modification of the environment to support the person. Accordingly, the social model of disability is used by the Nursing and Midwifery Council (NMC) and the Disability Discrimination Act (DDA), respectively. On the other hand, according to Herrington (2008, p.8), the focus upon key issues in dyslexic students must include “countering the social construction of disability” and reshaping, redesigning and creating new academic practices”. With this, we can observe that the social model of disability is applicable to the focus formulated by Herrington because the mentor and the student must co-exist in order to find ways to modify the environment and support the needed change for the betterment of the student’s morale and efficiency in his placement. Integrating the Role of the Mentor in Teaching, Assessing, Feedback and Evaluation of Nursing Students Mentors play a pivotal role in the welfare of the students, which requires that their teaching, assessment, feedback, and evaluation measures are appropriate, especially when dealing with students with disability. As regarded earlier in this paper (particularly in the Issues and Argument section), it is necessary to consider the learning conditions and the capacity of the students, which could mean having a ‘reasonable adjustment’ to the teaching methods that will be implemented, as well as the needed teaching aids to provide for mentor’s support and conducive learning environment. With regards to the assessment, determining the stage of training, forming measurable and achievable objectives, introducing learning opportunities, assessing anxieties, fostering for self-assessment of the students and encouraging them to verbalize the necessary support and questions must be anticipated in this phase (Guidance for mentors of nursing students and midwives, RCN.org. n. d., p.11). Equally, giving feedback is essential for the students to provide for support and revitalizes the learning process. According to the Guidance for Mentors of Nursing Students and Midwives (no particular date), feedback must be delivered during, or as soon as possible after, the events surrounding clinical placement and exposure. Furthermore, evaluation phase provides for the judgment whether students pass, or fail, based on the performance they have shown during the activities in the placement. Whatever the result of the evaluation, the mentor must communicate it with each of the concerned students in an honest manner. In addition, documentation of all the findings to these phases is absolutely important, especially in undertaking decisions pertaining to the academic interests and clinical performance of the students. Grading Criteria With regards to honour assessment and grading criteria, Corlett (2004, quoted in Traylor 2007, ppt. slide 7) exemplified the following logical points: “It is NOT expected that educational standards should be lowered to accommodate disabled students and one of the criteria for determining whether an adjustment is reasonable is the maintenance of course standards both academic and in clinical practice.” This statement provides for a clear and logical point of view. It explained that though mentors consider the disability of the students, standards must truly not be compromised. Conclusion As a result, we were able to provide an extensive discussion pertinent to the issues of concern presented in the given scenario. As such, we conclude that thorough assessment, evaluation and support are necessary to help the student (James) succeed in his endeavors. Finally, this paper leaves a remarkable statement as it summarizes the general idea of this paper: “Impairment does not mean incapacity… With support, students with disabilities can work well in clinical as well as academic settings…” (Guidelines, n. d., RCN, p. 22). Bibliography Aiken, F. & Dale C. (2007). Royal College of Nursing. Practice Education Forum A Review of the Literature into Dyslexia in Nursing Practice, pp. 7-8, 19, 32. Available from: [Accessed December 19, 2008]. Herrington, M. (2008). Dyslexia Support and Inclusive Practice (University of Wolverhampton ADSHE Network June 18th 2008), p. 8. Available from: [Accessed December 20, 2008]. Johnson, B. (n.d.) Position Article (by the Dyslexia Action Principal Educational Psychologist). Research. Available from: . [Accessed December 19, 2008]. McCandless-Sugg,F., Sanderson-Mann, J. & Wharrad, H. 2006. DysPEL: Dyslexia and Practice Environment Learning in Nursing, p.1. Available from: [Accessed December 20, 2008]. NURSING & MIDWIFERY COUNCIL (NMC). 2004. Standards of proficiency for pre-registration nursing education, p.10. Available from: [Accessed December 19, 2008]. Potter, P.A, & Perry, A.G. (2001). Fundamentals of Nursing. Fifth Edition. St. Louis/London, Mosby, pp. 473-474. Royal College of Nursing. (no specific date). Guidance for mentors of nursing students and midwives (An RCN toolkit), pp. 11, 14, 19-20, 22. Available from: [Accessed December 19, 2008]. Skill.org. (n.d.). Easy Read Welcome to Skill. Available from: [Accessed December 20, 2008]. Special Educational Needs and Disability Act (SENDA). (2001). Available from: [Accessed December 20, 2008]. Traylor S. (2007). Supporting Students with Dyslexia in Clinical Practice (Powerpoint Presentation). Disability Liaison Officer School of Nursing & Midwifery, Power Point Slides, 7, 10-11. Available from: [Accessed December 19, 2008]. Read More