Management of a Learner Who is not Achieving the Required Level of Competence - Case Study Example

MANAGEMENT OF A LEARNER WHO IS NOT ACHIEVING THE REQUIRED LEVEL OF COMPETENCE IN PRACTICE IN AN INTENSIVE CARE UNIT ENVIRONMENT Introduction Dyslexiahas a major impact on the working lives of those involved in nursing work (Morris and Turnbull, 2007). Students with on-going health issues like dyslexia may find the educational process exhausting (Waldman, Perlman and Cinotti, 2009) and even struggle with their colleagues’ poor attitudes (Nursing Standard, 2008; 22, 17, p.61). Further, issues like educational success, quality of care, and safety of patients are highly regarded in this concern. In this regard, mentors are accountable to the Nursing and Midwifery Council for their decisions in assessing and confirming that students are capable of safe and effective practice (NMC, 2008, p. 13). In other words, the confirmation by the mentor or practice teacher that the student is capable of safe and effective practice will be considered by the assessment board, along with other criteria and assessed outcomes, in order to determine if the student has successfully accomplished or completed all the requirements for the program (NMC, 2008). In this light, this paper explores a scenario wherein a learner was not achieving a required level of competence to practice in an intensive care unit environment, thereby prompting a considerable attention since the student is in a special unit that requires dexterity in providing safe and effective care for patients (NMC, 2008). Moreover, the succeeding sections of this paper shall provide critical analyses 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 scenario and to provide recommendations and solutions based on reputable concepts from scholarly literatures and journals. The 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 James’s 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. Analysis/Discussion The above scenario reveals James’ disability─ dyslexia. Dyslexia is defined by the British Psychological Society (1999) as a complex neurological condition (quoted in White, 2007) wherein manifestations, or symptoms, are evident in areas of learning and function, which include reading, spelling and written language (British Dyslexic Association, 2009; Crisfield, 1996 quoted in Traylor, 2007, ppt. slides 10-11). Moreover, concentration levels and calculation skills are affected in dyslexic individuals (DfES, 2004 quoted in Aiken & Dale 2007, p. 7). In addition, individuals who experience dyslexia could possibly have a feeling of anxiety and social isolation (Aiken & Dale, 2007, p. 19). As such, James’s poor concentration level, inability to remember more than 2 verbal instructions at once, as well as illegible handwriting and spelling mistakes categorically exemplify the diagnosis of dyslexia. On the other hand, dyslexia tends to be resistant to conventional teaching methods, but its effects can be lessened by specific intervention, which include the application of information technology and supportive counseling (British Dyslexia Association, 2009). [EMERGING ARGUMENT:] Therefore, it is essential for me as a mentor to put anticipatory adjustments to support his learning endeavors and, above all, explore James’s needs (White 2007) because teaching/mentoring is most effective when it responds to the student’s needs (Potter and Perry, 2001). 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. Ethical and Professional Issues Concerning Failure of Students in Practice Looking at a professional standpoint, Duffy (2003) explained that it is inevitable that some students will not be able to meet the required level of practice and in turn, mentors must not “fail to fail” students in order to safeguard professional standards, patients, and the public, in general (Duffy, 2003; RCN, n. d.). In this way, the mentors will definitely 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) (quoted in RCN, 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”. Issues One issue that James’s encountered was that he was told that he could not become a registered nurse/practitioner because of his disability. In regard to this issue, NMC states that “it will need evidence that the registrant is not capable of safe, competent, effective and independent practice” (quoted in Aiken & Dale, 2007, p. 32). Also, James’s will be a subject for assessment and evaluation to ensure that he is fit to provide a safe and effective nursing care to patients (NMC, 2008). Furthermore, 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 (Aiken& Dale, 2007). Integrating the Role of the Mentor in Teaching, Assessing, Feedback and Evaluation of James’s condition As regarded earlier, 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 (NMC, 2008). With regard to 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, 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 (RCN, n. d.), 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 In regard to honour assessment and grading criteria, Corlett (2004, quoted in Traylor 2007, ppt. slide 7) exemplified that “it is NOT expected that educational standards should be lowered to accommodate disabled students”. Moreover, one of the criteria in determining if the adjustment is reasonable and if it can meet the standards of both academic and clinical practice (Corlett 2004, quoted in Traylor 2007, ppt. slide 7). Certainly, these affirmations provide for a clear and logical point of view in relation to the grading criteria for dyslexic students. Thus, it is also certain that though mentors consider the disability of the students, standards must not be compromised (NMC, 2008; Duffy, 2003). Role as a Mentor to James In one study conducted by the University of Ireland, they learned that students with on-going health issues find educational process exhausting (Waldman, Perlman and Cinotti, 2009). In this regard, mentors must ascertain and attend to the learning needs of the affected students and face the challenge to support them, thereby making effort to promote conducive and favorable learning environments and placement areas (White, 2007). This assumption is supported by the idea that mentors play a vital role in promoting equality of opportunity by treating students with fairness, respect and understanding (NMC, 2008). According to Traylor (2007, ppt. slide 13), 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 the same way, the idea of openness or acceptance is supported by this statement from a related story of a dyslexic student: “it was a great relief for me that my mentor was empathetic” (“I am not stupid, I have dyslexia”, Nursing Standard, 2008; 22, 17, p.61). Thus, the said feeling of relief by the student was brought about by his/her mentor’s understanding of the student’s disability (Nursing Standard, 2008; 22, 17, p. 61). In order a sufficient understanding of the student’s disability, as a mentor, I (as James’s mentor) should have an adequate training in handling students like James, thereby enabling me to support him in his ICU exposure, or placement, and his academic endeavors (NMC, 2008). The literature supports this concept as “NMC advises that all mentors, practice teachers and teachers should receive disability equality training” (NMC, 2008). In this manner, I will be guided to prepare James for the demands in his ICU placement. In addition, I also have to consider allocation of time to meet the special needs of students with disabilities (NMC, 2008), just like James. 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. Moreover, as supported by White (2007), the following are my roles as a mentor to support James, particularly in his ICU placement: 1. Instituting the use of laptop computers to aid James in his spelling difficulties, illegible handwriting (no need to write, just use the laptop), and most of all, to help James in proper documentation of patient care in the ICU. In turn, I must also motivate James to have the interest and dedication to learn the use of this (laptop) technology (White, 2007). 2. Strengthening James’s support network such as friends and families. In a similar manner, as a mentor, I can also act as James’s support in his learning needs and deal with his difficulties (NMC, 2008; White, 2007). 3. Encouraging personal development and challenging James to face up to opportunities and problems and recognize personal strengths and weaknesses (White, 2007). 4. Providing constructive feedback on their performance (Duffy, 2003). 5. Planning of activities (White, 2007) in the ICU. 6. Giving instructions to James one at a time, slowly and clearly, in a quiet location (DDA 1995, quoted in RCN, n. d., pp. 19-20). 7. Giving time to James in order to prepare himself and to accomplish the assigned tasks thereby ensuring more successful and desirable outcomes (Morris and Turnbull, 2007). Conclusion As a result, we were able to provide an extensive discussion pertinent to the issues of particular concern, which were presented in the given scenario. As such, we conclude that thorough assessment, evaluation and support are necessary to help James to succeed in his endeavors. In this manner, beneficial support and acceptance of James’s condition can pave the way to fulfill his potentials quoted in Morris and Turnbull, 2007). 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…” (RCN, n. d., p. 22). Bibliography Aiken, F. & Dale C. (2007) Practice Education Forum A Review of the Literature into Dyslexia in Nursing Practice, pp. 7-8, 19, 32. London, Royal College of Nursing. Blankfield S. (2002) Greatest problem with dyslexia is attitude. Nursing Standard, 16, 42, pp. 30-31. Harrow-on-the-Hill, RCN Publishing Company Ltd. British Dyslexia Association (2009) What is Dyslexia? Available from: [Accessed 30 March 2009]. Clinical experiences of students with dyslexia (2006). Nursing Standard, 20, 37, p. 16. Harrow-on-the-Hill, RCN Publishing Company Ltd. Duffy, K. (2003) Failing students: a qualitative study of factors that influence the decisions regarding assessment of students’ competence in practice. London, Nursing and Midwery Council (NMC). Herrington, M. (2008). Dyslexia Support and Inclusive Practice (University of Wolverhampton ADSHE Network June 18th 2008), p. 8. Available from: [Accessed December 20, 2008]. I am not stupid, I have dyslexia (2008). Nursing Standard, 22, 17; p. 61. Harrow-on-the-Hill, RCN Publishing Company Ltd. 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]. Morris, D. and Turnbull, P. (2007) A survey-based exploration of the impact of dyslexia on career progression of UK registered nurses. Journal of Nursing Management, 15, pp. 97-106. Essex, Blackwell Publishing Ltd. Morris D. and Turnbull, P. (2006) Clinical experiences of students with dyslexia. Journal of Advanced Nursing, 54, 2, 238-247. Nursing and Midwery Council (2004) Standards of proficiency for pre-registration nursing education, p.10. London, The Council. Nursing and Midwery Council (2008) Standards to support learning and assessment in Practice - NMC Standards for mentors, practice teachers and teachers. London, The Council. Potter, P.A, & Perry, A.G. (2001). Fundamentals of Nursing. Fifth Edition. St. Louis/London, Mosby, pp. 473-474. Royal College of Nursing (n. d.). Guidance for mentors of nursing students and midwives (An RCN toolkit), pp. 11, 14, 19-20, 22. London, RCN. Skill.org. (n.d.). Easy Read Welcome to Skill. Available from: [Accessed December 20, 2008]. 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