ANALYTICAL ARTIFACTS 17
AnalyticalArtifacts: Readiness to Practice and Evaluating Practicum Progress
AnalyticalArtifacts: Readiness to Practice and Evaluating Practicum Progress
Itis important for nurse educators to evaluate practicum progress aswell as readiness to practice among nursing students. Readiness issimply defined as a concept of progressing into the practice ofnursing (Wolff, Pesut & Regan, 2010). Educators usuallycategorize graduates as capable entry level nurses and determinewhether they are ready to enter into practice. Readiness to practiceof novice graduates is different from one educator to the other. Itdepends on the educator’s expectations on certain units of study aswell as what they recognize as readiness (Reising & Devich,2004). The realities of educators are what shape the insightregarding readiness for practice among new graduates. As a result,this should be put into consideration in the framework of what istermed as readiness to practice by nurses in diverse settings. Mostnew graduates consider readiness to practice as having the skills,competence, knowledge, and judgment necessitated to carry out theundersigned responsibilities (Wolff, Pesut & Regan, 2010). Thecurrent paper critically examines and analyzes the responsibilitiesand challenges faced by educators in determining readiness topractice using behaviorist learning theory. In particular the paperlinks behaviorist theory to various aspects including the role ofclinical experience for student, the clinical experience of theeducator, the clinical learning environment, current clinicaleducation program, and educators bias and how practicum progress isevaluated.
Overviewof Behaviorist Learning Theory
Basically,behaviorist learning theory deals with individual’s behaviors whichcan be observed and measured (Parkay& Hass, 2000). Behavioristtheorists stress behavior modifications which are brought about bystimulus-response relationships generated by the student. Accordingto Parkay& Hass (2000), behavior is directed by stimuli. This means thatthe selection of response is based on psychological drives and formerconditioning. The conditioning may be either classical or operantconditioning. Behaviorists put forth that behaviors which can beobserved directly are the ones that should be studied (Parkay &Hass, 2000). This implies that the justifiable items of study areactions but not emotions or thoughts. The theory assumes that humanbehaviors arise from learning habits, and such behaviors may beunlearned as well and substituted by novel ones (Parkay & Hass,2000). To be precise, when an individual’s behaviors turn out to beundesirable, it can be unlearned as substituted with a desirable one.Rewarding response is a major component of behaviorist theory.Learning occurs when the acceptable response is rewarded.
Behavioristtheory has greatly been adopted in the classroom setting. Proponentsof the theory assert that adopting the system of rewarding andpunishing students has yield positive outcomes (Wenger,2009). Instructors reward acceptable behavior and punish undesirableones. For the system to be effective, the educator must explain tothe students for them to understand their significant. Although thisis a good teaching method, various factors such as stimulus,response, as well as the relationships created by every studentdetermine success. In education, behaviorist methods are used toenhance acceptable behaviors and discourage undesirable ones. Varioustechniques are developed from the theory for application in classroomsettings. They encompass reinforcement, contracts, extinction,consequences as well as behavior change (Parkay & Hass, 2000).
Educatorsare the dominant figures in the education setting according tobehaviorist theory. This means that they put in place appropriateprogrammes intended to change behavior. The theory entails aninstructor centered methodology whereby the main responsibility ofthe educator is to maneuver the student’s learning environment inorder to bring forth certain responses. Modification of behavior inthe preferred direction is the key objective of behaviorist approachto learning. The external environment is a major element as it actsas the foundation in which stimuli are arranged. It acts as the mainfocus of learning. Behaviorist learning theory is founded on varioussuppositions, which encompass: behavior is shaped by externalenvironment, the center of learning is behavior that can be observed,and reinforcement is key in the learning procedure (Wenger,2009). Thetheory requires students to master various steps prior to moving tosuccessive ones. The purpose of the learning orientation is toemphasize what the educator requires of the student in order toperform well.
Applicationof Behaviorist Learning Theory to Practice Readiness
Behavioristlearning theory is very applicable to practice readiness. To startwith, while evaluating practicum progress, the educator shouldconsider behavior modifications among graduate students whiledetermining their readiness to practice. Behavior modification inthis case is tied to the acquirement of novel responses to clinicalenvironment stimuli. For instance, during practicum, the educatorshould observe how the student behaves when he/she comes into contactwith a sick person or offensive odors. Initially, the student mayfeel light-headed or queasy but these should change with time. Duringthe course of the practicum, the student should become accustomed tosuch things, implying that his/her behavior modification matches whatan educator may refer as appropriate for practice readiness. Besides,the student should gain the competency and professional skillsrequired for practice. These include confidentiality, communication,knowledge of code of conduct, as well as courtesy.
Theclinical learning environment, which acts as the external environmentaccording to behaviorism, is vital in this case. Respondentconditioning emphasizes the significant of external environment as itcan either positively or negatively impact self-confidence and moraleof the student. Students formulate relationships due to theirclinical experiences during practicum. This offers the foundation forlong-term attitudes towards health professionals, medicine, as wellas clinical facilities. Behaviorism promotes the scrutiny of studentresponses, environmental stimulus, as well as the impacts ofreinforcements in an objective and clear manner (Wenger, 2009). Usingbehaviorist theory, the educator should exhibit certain acceptablebehaviors the student should examine the technique of performing thebehavior and direct observation should be employed in assessingperformance and in providing the necessary reinforcement.
Roleand Challenges of the Educator
Therole played by the educator is derived from the institution’sphilosophy, procedures, policies, as well as the course expectations(Billings & Halstead, 2012). Effective communication skills arean essential prerequisite for a successful educator. Learning ismotivated when the educator asks thought rousing open ended queries.This can only be achieved through effective communication skills.Such questions enable learners to think critically therefore,developing good thinking skills (Gaberson & Oermann, 2010). Theeducator should also have clinical competency and professionalknowledge required to work in a clinical environment. In order tomeet the learning needs of the student, the educator should also beenthusiastic, patient, courageous, flexible, be a person ofintegrity, honest, readiness to accept mistakes, and give a chance tothe student to convey his/her concerns. Understanding one’s biasesas well as values is also paramount.
Themain role of the educator is facilitation. This means that theeducator assist the student in attaining the projected learningneeds. He/she acts as guide and couch in assisting the student “learnhow to learn” (Allen et al. 2008). The educator must formulate thelearning expectations of the student and ensure that they are wellconveyed. Mostly, such information is communicated through writingand for that it must be precise. It encompasses learning objectivesand goals, learning expectations, preparations, as well as timelinefor meeting the objectives. Another role of the educator isevaluating student’s progress. Evaluation can either be summativeor formative (Allen et al. 2008). Formative evaluation acts as areinforcement to support behavior as stated in the behavioristlearning theory. It offers information which motivates thedevelopment of skills, knowledge, and values among students. Itpoints forward areas necessitating enhancement and providesrecommendations to improve performance. On the other hand, summativeevaluation is used to assess performance of the student and thereforeshould be graded. For instance, summative evaluation should be usedto assess practicum progress.
Therole of a behaviorist educator is to offer stimulus material andencourage the right response. They also view mistakes as not adequateconditioning considering that lack of the appropriate conditioningleads the student in making mistakes. In summary, the role of abehaviorist educator includes the following.
Motivating and facilitating the learning process
Ensuring continuous and active participation of students
Providing positive reinforcement
Indetermining readiness to practice, behaviorist theory can be used bythe educator to develop the required objectives and competencies.Certain behavioral objectives enable students to comprehend theprecise behavior that should be learned and evaluation technique tobe used (Bourke & Ihrke, 2012). This way, the educatorexplicates the degree of competency and expectations required. Theeducator exhibits certain acceptable behaviors, students examine themethod of performing the behavior, and the educator uses directobservation or rating forms to assess performance.
Challengesto Determining Practice Readiness
Indetermining readiness to practice, the educator faces a number ofchallenges which include the following.
Practical and theoretical complexities in evaluation due to speedy development of knowledge in the healthcare setting.
It is difficult to incorporate clinical teaching with competency standards.
Requirement of different evaluation tools to asses students in different settings such as in the laboratory and real-patient settings. Besides, summative and formative evaluations require separate tools.
Clinical courses necessitate the assessment of psychomotor and affective skills of gradually amplifying difficulty.
It is extremely difficult to assess progress in an entire program as compared to evaluating one course.
The competency based syllabus adopted by most healthcare programs necessitates students to exhibit their clinical capability as well as the availability of other significant attributes and this may be difficult for the educator to evaluate.
(Bourke& Ihrke, 2012)
TheRole of Clinical Experience for Student
Studieshave shown that clinical experience plays a major role in nursingeducation (Candela, 2012). In addition to offering students with therequired experience, the clinical setting provides opportunities forstudents to become accustomed to the environment. During clinicalpractice, the students are able to practice with real patients withvalid health concerns. The clinical environment is the only place inwhich the student can apply theory into practice. This means that thestudents are able to apply the obtained knowledge in the classroominto practice. It also helps in the development of competency andsocialization for entering into actual nursing practice in future.
Clinicalexperience acts as a foundation for preparing students inunderstanding the clinical principles and standards in practice(Kelly& Ahern, 2008). This is vital in nursing educationconsidering that nurses are guided by set principles which they aresupposed to adhere to. Clinical practice motivates students inemploying critical thinking skills to solve problems as well as makedecisions regarding nursing issues. Nursing career is founded onpractice. This means that clinical education forms a fundamental partin the nursing program. Having quality clinical experience is vitalas it dictates the quality of nursing education (Kelly & Ahern,2008). Clinical placements offers a good foundation in which studentscan be able to apply what they have acquired in class into practice.The experiences obtained are significant as they prepare students toenter into the nursing practice as independent and competentpractitioners. Besides, they offer greater insights in developingefficient clinical strategy. Applying behaviorist theory in thiscase, the student receives information responses from clinicalexperience until the required behavioral modification is attained.Behavioral modification can be in form of dealing with difficultpatients and being accustomed to the nursing environment.
Researchhas cited clinical experience to be amongst the key anxietygenerating elements in the nursing curriculum (Candela, 2012). Adescriptive correlational investigation carried out among nursingstudents indicated clinical experience as the main element causingstress in the entire nursing curriculum. During the preliminaryclinical experience, various components are linked with anxietygeneration including unfamiliar environments, panic of making errors,failure to have clinical experience, difficult to deal with patients,as well as evaluation by the faculty (Benner, 1982). According tobehaviorist theory, systematic desensitization is a method rooted inrespondent conditioning which lessens anxiety and fear amongindividuals (Candela, 2012). It assumes that fear or anxiety causedby a certain stimulus or environment is learned and thus, can beunlearned. In this case, the various elements causing stress amongstudents during preliminary clinical experience are learned and canalso be unlearned.
TheClinical Experience of the Educator
Theeducator is a registered nurse with advanced education andexperience. This Includes advanced clinical education in the field ofhealthcare. Nurse educators must have broad clinical experience whichenables them to guide and formulate effective strategies to meettheir student’s learning needs. They are supposed to stayup-to-date with novel nursing techniques as well as technologies asthis assists them in keeping in line with the clinical practice. Theyusually have a masters or doctoral level of education and work invarious settings including hospital-based schools, universities andcolleges among others (Gaberson & Oermann, 2010). The educatorshould demonstrate a dedication of lifelong learning, and exhibitknowledge about learning theories and student evaluation, have thecapacity to design programs which mirror effective educationalstandards, and have the capability to evaluate the needs of students.
Byhaving sufficient experiences, the educator is able to distinguishamongst the same stimuli. This is referred to as discriminationlearning. For example, educators with more experience are also moreacquainted with the clinical environment. Through this, they arecapable of making differentiations thus discriminate amongst stimuli.Clinical practice entails shifting towards discrimination learning.The educator acts as a role model to the student. They have the roleof designing, executing, assessing, and revising clinical educationprograms to ensure they remain current and are up to standard.Through experience, the educator is able to understand the kind ofbehaviors he/she should instill to the student. The educator acts asa reinforcement to the student by supporting them in meeting thelearning needs according to behaviorist theory. The educatoris the dominant figure in the education setting according tobehaviorist theory. This means that they put in place appropriateprogrammes intended to change student’s behavior.
TheClinical Learning Environment
Theclinical learning environment is described as the forces, conditions,as well as external stimuli which impact individuals, and it entailsvarious factors surrounding the individual encompassing the clinicalsetting, patients, and the staff (Duan, 2006). According to Duan(2006) the learning environment is made up of physical, psychosocial,as well as organizational components. It offers a set of externalfactors and forces which engulf the individual. A clinical learningenvironment can either be positive or negative. During a clinicalpracticum, a positive environment offers amplified positive attitudesfor the student, and it turns out to be more worthwhile both for theeducator and the student.
Accordingto Saarikoski et al. (2002), nursing students join novel environmentsfor learning during clinical placements. The learning is founded on asupportive environment rooted on pedagogical as well as psychologicalcomponents. One of such components is the relationship made betweenthe student and the staff. An effective relationship results in apositive learning environment that constitutes of educationalatmosphere. Levett-Jones et al. (2008) puts forth that a learningenvironment is influenced by various factors including support,excellent interpersonal relationships, as well as feedback. Supportis achieved through supervision whereby the student is taughtpractical skills, evaluated and facilitated in learning, assisted ingetting clinical knowledge, supervisors act as role models, assiststudents in applying theory into practice, and give feedback(Levett-Joneset al. 2008).
Applyingbehaviorist learning theory in this case, clinical learningenvironment acts as a god basis in which students modify theirbehavior in order to achieve the desired ones. The clinical learningenvironment, which acts as the external environment according tobehaviorism, is vital in this case. Respondent conditioningemphasizes the significant of external environment as it can eitherpositively or negatively impact self-confidence and morale of thestudent. The clinical learning environment acts as stimuli tostudent’s response. If the stimulus is positive, then the expectedresponse would also be positive. This means that a positive learningenvironment would result in positive response. Student’s behavioris shaped by the clinical learning environment.
CurrentClinical Education Program
Clinicaleducation program is designed with the aim of offering students withappropriate chances for developing an intellectual approach towardsclinical education. It also helps students to obtain the basicclinical education in the perspective of their educationalresponsibilities, roles, as well as interests (Iwasiw, Goldenberg &Andrusyszyn, 2009). Clinical education forms a major element ofphysical therapy program. The program offers students with clinicaland educational instruction in the broad field of medicine. Theclinical program is organized in a manner that allows students togain a high level of educational exposure in clinical settings. Itassists in developing universal knowledge in different areas such asdiagnosis as well as management. In accordance to behaviorist theory,the current clinical education program is designed in a manner thatinfluences students’ behaviors in a positive way. Modificationof behavior in the preferred direction is the key objective ofbehaviorist approach to learning.
EducatorBias and How Practicum Progress is Evaluated
Whiledetermining readiness to practice, the educator should not be biasedbut should consider using the appropriate techniques in doing so.Bias can be in form of gender, racial, or ethnic bias among others.Bias has bee evidenced in nursing education, and various strategieshave been put in place to make certain that the profession is open toall. In nursing practice, practitioners are required to followvarious principles and standards to guide them. Practice readiness isusually determined by how well as student performed during thepracticum. Therefore, the educator should employ the most effectivetool to evaluate practicum progress. According to Allen et al (2008)the evaluation strategy used should match with educationalmethodologies. The main aim of evaluation is to assess theachievement as well as performance of a student. This acts as a basisfor determining whether a student progresses in the actual practice.
Thereare various tools used by educators in evaluating practicum progress.One such tool is Measurable Performance Objectives (MPO). MPOs aredeveloped by curriculum designers with the aim of evaluating studentsduring their practicum. During this phase, students are able todevelop attitudes and skills which increase their levels ofcompetency and specialization. MPO is a clinical assessment tool(CAT) used in measuring competency (Tolhurst & Bonner, 2000).They are statements and goals which direct teaching and used toassess whether the teaching has been effective. MPO explains andmeasures individual behavior, problem solving, knowledge, as well ascritical thinking (Allen et al. 2008). MPO is made up of threeelements which encompass: conditions, performance, as well ascriteria (Tolhurst & Bonner, 2000). Performance permitsobservation and evaluation. This is in accordance to the behavioristtheory which deals with individual’s behaviors which can beobserved and measured. Conditions acts as the basis of attaining theobjectives and the tools to be used. Through this, objectives arecommunicated to the student in a clear manner. Lastly, the criteriaexhibit the degree of desired performance. It also indicates themanner in which the student should perform or behave with the aim ofattaining the competency. Criteria specification is vital as itpermits the student understand how the evaluation is being carriedout. Evaluating practicum progress is significant for various reasonsincluding the following. The educator is able to compare theperformance of the student with goals and monitor the progress of thestudent.
Thewhole learning environment allows for the incorporation of thecompetency procedure which is deemed to be ongoing. In clinicalpracticum, positive environment amplifies student’s success as itallows for positive attitudes. The educator is supposed to guide andrecognize the learning needs of students, and come up with goodstrategies to meet such need. Besides, the educator should abide byprocedures, policies, guidelines and ethics, be accountable tolearning of the student, and file the competency procedure.
Thepaper has criticallyexamined and analyzed the responsibilities and challenges faced byeducators in determining readiness to practice using behavioristlearning theory. Behaviorist learning theory deals with individual’sbehaviors which can be observed and measured. Behaviorist theoristsstress behavior modifications which are brought about bystimulus-response relationships generated by the student. The theoryassumes that human behaviors arise from learning habits, and suchbehaviors may be unlearned as well and substituted by novel ones. Therole of a behaviorist educator in determining practice readinessinclude: motivating and facilitating the learning process, ensuringcontinuous and active participation of students, providing stimulus,providing positive reinforcement. It has also been shown that theeducator faces various challenges which encompass: practical andtheoretical complexities in evaluation due to speedy development ofknowledge in the healthcare setting and difficulty in incorporatingclinical teaching with competency standards. Clinical experience isvital in nursing education and its acts as a foundation for preparingstudents in understanding the clinical principles and standards inpractice. Having quality clinical experience is paramount as itdictates the quality of nursing education. During a clinicalpracticum, a positive environment offers amplified positive attitudesfor the student, and it turns out to be more worthwhile both for theeducator and the student. Evaluating practicum progress issignificant for determining student readiness to practice. In thiscase, MPO has been discussed as the appropriate tool of evaluation.It is used in measuring student competency and it comprises ofconditions, performance, and criteria. By evaluating progress, theeducator is able to compare the performance of the student with goalsand monitor the progress of the student.
Allen,P., Lauchner, K., Bridges, R., Francis-Johnson, P., McBride, S., &Olivarez, A. (2008). Evaluating continuing competency: A challengefor nursing. Journalof Continuing Education in Nursing,39(2), 81-85.
Billings,D., & Halstead, J. (2012). Teachingin nursing: A guide for faculty(4th ed.). St. Louis, MI: Saunders.
Bourke,M., & Ihrke, B. (2012). Theevaluation process: An Overview. Teaching in nursing: A guide forfaculty(4th ed.). St. Louis, MO: Saunders Elsevier.
Candela,L. (2012). Teachingin nursing: A guide for faculty(4th ed., 202-243). St. Louis, MI: Saunders.
Duan,Y. (2006). Selecting and applying taxonomies for learning outcomes: Anursing example. InternationalJournal of Nursing Education Scholarship,3(1), 1-14.
Gaberson,K. B. & Oermann, M. H. (2010). Clinicalteaching strategies in nursing(3rd ed.). New York, NY: Springer Publishing Company, LLC.
Iwasiw,C., Goldenberg, D. & Andrusyszyn, M. (2009). Curriculumdevelopment in nursing education(2nd ed.). Boston, MA: Jones & Bartlett.
Kelly,J. & Ahern, K. (2008). Preparing nurses for practice: Aphenomenological study of the new graduate in Australia. Journalof Clinical Nursing,18(6), 910-918.
Levett-Jones,T., Lathlean, J., Higgins, I. & McMillan, M. (2008) Staff-studentrelationships and their impact on nursing students’ belongingnessand learning. Journalof Advanced Nursing,65, 316-324.
Parkay,F.W. & Hass, G. (2000). CurriculumPlanning(7th ed.). Needham Heights, MA: Allyn & Bacon.
Reising,D. L., & Devich, L. E. (2004). Comprehensive practicum evaluationacross a nursing program. NursingEducation Perspectives,25(3), 114-119.
Saarikoski,M. & Leino-Kilpi H (2002) The clinical learning environment andsupervision by staff nurses: developing the instrument. InternationalJournal of Nursing Studies, 39,259-267.
Tolhurst,G., & Bonner, A. (2000). Development of clinical assessmentcriteria for postgraduate nursing students.Collegian,7(2), 20-25.
Wenger,E. (2009). Contemporarytheories of learning: Learning theorists in their own words.New York: Routledge.
Wolff,A. C., Pesut, B., & Regan, S. (2010). New graduate nurse practicereadiness: Perspectives on the context shaping our understanding andexpectations. NurseEducation Today,30, 187–191.