• Subject Name : Nursing

The Underperformance of Mentees/Students in Clinical Learning Environments

Introduction to The Clinical Learning Environment in Nursing Education

The underperformance of the student in the clinical setting is one of the issues that increase the risk concerning patient care (Flott et al., 2015). This review is important to understand the reason behind the underperformance that can be improved to increase the learning that will directly reduce the chances of risk. The scope of the review is to evaluate different pieces of literature that are important to understand the reason behind the underperformance of the student in the clinical setting. The searching strategy that has been utilized for the literature review includes the use of the keywords that will help to retrieve the quality articles that will improve the structure of the review. The last ten year articles are included in the review to understand the perspective of different research over the topic.

Literature Review of The Clinical Learning Environment in Nursing Education

Historical Background

The study presented by Vinales (2015) discussed that clinical learning environment is considered to be a major phase in the nursing profession and the right mentor should be provided to the nurses to improve their performance. The underperformance of the nursing student can be due to their incompatibility or lack of the right mentorship that directly increaser risk in the care. The clinical learning environment should provide the conducive learning environment in which mentor support the student to improve their understanding by facilitating the right learning opportunities. The findings were agreed by Cleland et al. (2017) by adding that nurses are born to be a nurse but there is need to improve their skills by clinical learning as too much of theoretical knowledge can lead to unskilled nurses that can hamper the health care. The nursing students in clinical learning impacted by the learning pattern and the mentor that will directly affect the clinical skills and knowledge.

One of the studies presented by Papastavrou et al. (2016) discussed that the different educational aspect of the clinical learning can differ from the student perspective that leads to decreased satisfaction and lead to the underperformance. The clinical learning experience is important for the nursing student to improve their skills and knowledge but due to incompatibility of the environment or mentor lead to underperformance. The different clinical learning setting that differs from the student perspective which decreases the learning satisfaction that causes the underperformance.

Methodologies of The Clinical Learning Environment in Nursing Education

The research paradigms for the literature review follow the interpretivism approach that state individual create the reality and they are constructed by the individual meaning. The interpretivism follows the social construction process that is specific, unique and deviant. The aim of the interpretivism not to reveal the universal concept but it discovers the individual aspect to understand the social construct (Rehman & Alharthi, 2016). The research design that is preferred is exploratory designs that aim to address the research question that has little research data. The exploratory designs help to provide theoretical data concerning the research topics which is important to conclude the findings. It is utilized to investigate topics that help to identify the gap in the study (Schoonenboom et al., 2017).

The research approach for the study is inductive as it helps to elaborate on the process in which the theory is developed after the observation that is related to the specific research question. The inductive approach data the relevant data to understand the trend related to the topic that is necessary to understand the topic (Rahi, 2017). The sampling technique for the study utilizes the non-probability sampling technique that set particular parameters to improve the retrievals of the data that is relevant for the study. The non-probability sampling utilizes specific keywords to improve the search (Taherdoost, 2016). The journal article will be utilized to review the process as they are high quality that is important to identify the gap in the research (Palmatier et al., 2017).

Previous Studies on The Topic

According to Killam et al. (2013), different challenges have been associated with the underperformance of the nursing student in the clinical learning setting. One of the major reasons behind the underperformances of the nursing student is the lack of time and unenthusiastic mentor that led to detrimental effect over the nursing student performance. The unsupportive settings also increase the chances of the underperformance of the student that directly affect their skill development. Decrease opportunities for the learning also contribute to the underperformances of the student that lead to poor development of skills. The findings are supported by Gemuhay et al. (2018) by adding that not only the surrounding environmental factors but there are the different individual factor that contributes to the underperformances of the student in the clinical learning. Some of the factors are a sociodemographic factor, student individual factor, student response to negative clinical practise and hospital factor. Theses factor increase the chances of underperformance of the nursing student which cause the lack of appropriate clinical practises skills that are important to deliver quality care to the patient.

One of the articles presented by Ekstedt et al., (2019) discussed the student perspective concerning their underperformance and which has directly affected their skill development. Student discussed that the underperformance during the clinical placement is due to many reasons and one of is organizational shortcomings. The lack of relationship between the student and mentor directly decrease the motivation of the student to perform up to the mark. The lack of engagement and feedback directly decrease the nursing student to understand the gap in the clinical practice which leads to underperformance. The student performance directly impacted by the different perspective as it directly affects the mental and physical status of the student. 

Mainstream versus Alternative Viewpoints

The alternative viewpoint discussed by Hunt et al. (2016) discussed that coercive behaviour of the student that occurs due to the negative feedback of the mentor which directly affects the mentor and the student performance. The irrelevant behaviour of the student toward the mentor feedback directly decreases their chances to justify the role which lead to underperformance. The findings are supported by Timmins et al. (2017) by discussing that student reluctant behaviour toward the mentor thought and suggestion also decrease the chances of the student to perform well in the clinical setting. The reluctance behaviour leads to decrease understanding of the clinical practice that will eventually cause underperformance of the student. Another viewpoint presented by Knight (2018) by discussing the importance of the student underperformances assessment helps the mentor to understand the lack in the clinical setting. The student uncooperative behaviour in the assessment is also one of the reasons for undiagnosed underperformance which increases the chances of consistent mistake which again led to underperformance. The disturbances in the assessment hamper the result that can help the mentor to address the specific issue of the student to improve their clinical performance.

Principal Questions Being Asked

The question that has been raised concerning the underperformance of the student concerning the clinical learning is only external factors are responsible for the underperformance or any internal factor is also responsible for the lack of justification of the role. Another question that can be raised is what is the effect of the mentor behaviour concerning the performance of the student? These questions can be raised concerning the study to improve the understanding the related to the underperformance in the clinical setting that has directly impacted the clinical skills of the student.

General Conclusion on The Clinical Learning Environment in Nursing Education

The study can be concluded by adding that the underperformance of the student is affected by a bunch of factors that directly causes a decrease in clinical skills. The factor that causes the underperformances are related to organization, mentor and individual these in collaboration cause the underperformance. The alternate viewpoints discuss that irrelevant behaviour of the nursing student concerning the clinical practise and mentor lead to the underperformance which directly affects the clinical skills of the student. Some question that can be raised after this discussing can be “Are only the external factor that leads to the underperformance of the student or internal factor also responsible for poor justification of the role”. Another question that arises concerning the study “How mentor behaviour affect the performance of the student in clinical learning”

Conclusion on The Clinical Learning Environment in Nursing Education

The main agreement that has been concluded by the study is the underperformance of the student is directly impacted by the different factors that led to a negative impact over performance. Some of the disagreement presented in the article is related to the irrelevant behaviour of the student that led to the underperformance. The gap that has been identified in the study is the lack of mentor perceptive concerning the underperformed that need to be addressed. Clinical learning is the main phase in the nursing profession and underperformance of the student can hamper the skills developmental process that important for the clinical practise. There is a need to reduce the barriers associated with learning that lead to the underperformance which can help the student to improve the clinical practice. The individual barriers can be decreased by counselling that will help the student understand the impact of their behaviour over their clinical leaning. 

References for The Clinical Learning Environment in Nursing Education

Cleland, J., Cilliers, F. & van Schalkwyk, S. (2017). The learning environment in remediation: a review. The Clinical Teacher, 15(1), 13–18. DOI:10.1111/tct.12739 

Ekstedt, M., Lindblad, M. & Löfmark, A. (2019). Nursing students’ perception of the clinical learning environment and supervision in relation to two different supervision models – a comparative cross-sectional study. BMC Nursing, 18(1). DOI:10.1186/s12912-019-0375-6 

Flott, E. A. & Linden, L. (2015). The clinical learning environment in nursing education: a concept analysis. Journal of Advanced Nursing, 72(3), 501–513. DOI:10.1111/jan.12861

Gemuhay, H. M., Kalolo, A., Mirisho, R., Chipwaza, B. & Nyangena, E. (2019). Factors affecting performance in clinical practice among preservice diploma nursing students in northern Tanzania. Nursing Research and Practice2019, 3453085. DOI: 10.1155/2019/3453085

Hunt, L. A., McGee, P., Gutteridge, R. & Hughes, M. (2016). Manipulating mentors’ assessment decisions: Do underperforming student nurses use coercive strategies to influence mentors’ practical assessment decisions? Nurse Education in Practice, 20, 154–162. DOI:10.1016/j.nepr.2016.08.007 

Killam, L. A., & Heerschap, C. (2013). Challenges to student learning in the clinical setting: A qualitative descriptive study. Nurse Education Today, 33(6), 684–691. DOI:10.1016/j.nedt.2012.10.008 

Knight, A. W. (2018). How Clinical Instructor Behavior Affects Student Clinical Engagement from a Motivational Perspective. Journal of Nuclear Medicine Technology, 46(2), 99–106. DOI:10.2967/jnmt.118.209320 

Palmatier, R. W., Houston, M. B., & Hulland, J. (2017). Review articles: purpose, process, and structure. Journal of the Academy of Marketing Science, 46(1), 1–5. DOI: 10.1007/s11747-017-0563-4 

Papastavrou, E., Dimitriadou, M., Tsangari, H. & Andreou, C. (2016). Nursing students’ satisfaction of the clinical learning environment: a research study. BMC Nursing, 15(1). DOI: 10.1186/s12912-016-0164-4 

Rahi, S. (2017). Research Design and Methods: A Systematic Review of Research Paradigms, Sampling Issues and Instruments Development. International Journal of Economics & Management Sciences, 06(02). DOI: 10.4172/2162-6359.1000403 

Rehman, A. A., & Alharthi, K. (2016). An introduction to research paradigms. International Journal of Educational Investigations, 3(8), 51-59.

Schoonenboom, J., & Johnson, R. B. (2017). How to construct a mixed methods research design. KZfSS Kölner Zeitschrift Für Soziologie Und Sozialpsychologie, 69(S2), 107–131. DOI:10.1007/s11577-017-0454-1 

Taherdoost, H. (2016). Sampling methods in research methodology; how to choose a sampling technique for research. SSRN Electronic Journal of Academic Research in Management, 5(2), 18-27. DOI: 10.2139/ssrn.3205035 

Timmins, F., Cassidy, S., Nugent, O., Lydon, C., Part, S., Keane, L., & Coffey, M. (2017). Reluctance to fail nursing students in practice-implications for nurse managers. Journal of Nursing Management, 25(7), 489–490. DOI:10.1111/jonm.12508 

Vinales, J. J. (2015). The learning environment and learning styles: a guide for mentors. British Journal of Nursing, 24(8), 454–457. DOI: 10.12968/bjon.2015.24.8.454 

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