Promoting Success in First Year Nursing Students K Martin

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Identify factors associated with early departure from a two-year nursing program …

Identify factors associated with early departure from a two-year nursing program
Special attention was placed on factors associated with minority nursing students

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  • Minority students are well represented at FCC with greater than counties % of minorities in the FCC Nursing program…> 16% (current county minority rep.) Program currently averages 20% minority students Increasing numbers of ESOL students…as the diverse population in Montgomery County moves out I 270 in search of affordable housing, good schools and a more rural lifestyle. Early departure is defined as failure or withdrawal failing from one of the three first-year nursing courses.
  • Widely used theoretical model of student departure – over 775 citations noted by Braxton in 2004
  • Longitudinal approach to the “ill structured” problem of student departure from higher education literature. Describes the interaction between Student Pre-entry attributes with student Goals and Commitments, Institutional Experiences, Academic and Social Integration… strong emphasis from Tinto on Academic and Social Integration… Theory will guide the author in the identification of appropriate “Pre-entry Attributes” (Next Slide)
  • Pascarella et al (1983) studied the relationship between student pre-entry characteristics and the outcome of departure from a sample of commuter students (n=579), and found that this relationship had a significant relationship, explaining about 10% of the decision. ( Social Integration may not be as prevalent in commuter students and therefore relationships may differ.) Dispositions will not be studied nor will pre-college educational experiences
  • Began searching literature in Fall 2006…til early spring 2008 (10years)
  • Community College low degree attainment – 28% from 1996 – 2000, highest levels of degree attainment occur at 4-year, Private, Research institutes (Ishitani and Carter) First gen – (Nunez and Cuccaro-Alamin (1998) attend PT, 2-year colleges, older, married (outside commitments), dependents and low income Ishitani (2006) First-generation college students (parents never attended college) 1.3 times more likely to leave college before degree completion High School Curriculum – college prep or honors curriculum had positive effects on persistence (Braxton, Duster and Pascarella, 1988; Carter, 2006; Ishitani, 2006) Type of institution – 2-year lower degree completion/transfer rates (Ishitani, 2006) more affordable, particularly appealing to Hispanic students (Carter) SES – less likely to have had rigorous HS curriculum, female, older, black or Hispanic and be FG college student, single parent and work PT (Engle & O’Brien, 2007) Hispanic – greater financial responsibility for family, delayed enrollment into college, living with family “Pulled Away” (Fry 2004), all lowering degree completion rates compared to white students
  • NET Nurse Entrance Test , ERI – Educational Resources, Inc. NET reading correlated to success on NCLEX RN and program completion (Sayles, Shelton, Powell, 2003) ( Symes, Tart, Travis 2005). Academic background – developmental reading in MD CC increased risk of failure in nursing program (Baker, 1994) More recently, MY ROL – all but one study found science GPA in HS or nursing pre-requisite courses is a positive indicator of success in program and on NCLEX RN 4 studies…Byrd, Garza, Nieswiadomy 1999, Carpio, O’Mara, Hezekiah 1996, Sayles, Shelton, Powell 2003, Wong and Wong 1999) Race/culture – minority race had negative effect on student success in program and on NCLEX RN (Byrd, Garza, Nieswiadomy 1999, Sayles, Shelton, Powell 2003) Conclusion – increasing minority rep is an important public health goal, but we loose many minority students in nursing programs….ROL validated the choices I have made for IV…an improved understanding of what are the risk factors for failure in the first year of the nursing program will provide valuable insight to be used by nursing faculty and administrators.
  • Access assured by FCC VP of Information Services and the FCC PeopleSoft Project Director
  • Transfer transcripts …electronically generated, paper copies
  • Failing - < 75% of available course points or failing clinical component (pass/fail) Withdrawing – student initiated decision to discontinue enrollment in course for whatever reason (illness, family, personal, failing) 3 courses: NU 101 6 credit Introduction to Clinical Nursing, NU 210 3 credits Reproductive Health Nursing, NU 211 7 credits Medical Surgical Nursing I (taken with Reproductive Health Nursing concurrently)
  • Race was collapsed initially (due to low n in cells) to White, African American and Other (Asian, Hispanic and N. Am. Indian) for description of sample….later collapsed to White and Other in order to have dichotomous DV for logistic regression purposes. Number of times Science Prerequisite taken – looked at all student transfer transcripts and FCC PS record…all college transcripts must be sent… Nursing Major RN or PN – in many/most of MD Community College nursing programs PN majors take the same set of clinical nursing courses with the RN majors….no differentiation during courses is made….vast majority go on to second year and graduate on time (therefore have completed all RN and AS degree requirements). SES – proxy for income amount is being a recipient of need-based financial aid ESL or Developmental English - proxy for standardized reading score, such as NET….Baker found that MD CC nursing students who took Developmental English were at increased risk of failing a nursing course. Work during program – outside commitments CNA on admission – skills and abilities that may enhance student performance. Some 4-year institutions requiring student to be prepared as CNA on admission….Catholic University
  • NU 101 6 credit Introduction to Clinical Nursing NU 210 Maternal Child Nursing, 3 credits NU 211 MS I, 7 credits
  • 21 PN majors max. 12 fewer Gen. Eds is only diff…most have taken those to be ready to continue on to RN 2 nd year of program…very similar
  • Typicall Community College student: older, strong minority student representation, financial aid recipient, working… Pg. 31 Table 2
  • These group difference did not result in any significant differences in failing a first-year nursing course (  2 = .322, p=.571), the dependent variable.
  • Two other student characteristics approached significance, but did not meet the rigid criteria of p<.05; students who completed a Developmental English (  2=3.734, p=.053) and male students (  2=2.123, p=.145). Table 3. pg. 33
  • Rule of 10 : 1 parameter for every 10 cases….20 students failed in sample, therefore, 2 parameters entered…
  • male sex approached significance (  2=2.12, p=.145), and after controlling for all other variables male sex became a significant predictive characteristic. Table 4 pg. 35
  • Males n=9

Transcript

  • 1. Third Annual Mid-Atlantic Regional Conference of Community College Educators October 23, 2009 Kathleen M. Martin, DNP, RN
  • 2.
    • FCC experiences
      • 15-25% attrition in first year
    • ? Minority students
    • ? ESOL student
    • Identify factors associated with early departure from a two-year nursing program
    • Special attention was placed on factors associated with minority nursing students
  • 3.
    • Vincent Tinto
    • “ A Longitudinal Model of Institutional Departure”
    • Tinto, V. (1993). Leaving college: rethinking the causes and cures of student attrition. (2 nd ed.). Chicago: The University of Chicago Press
  • 4. Departure Decision Departure Decision Time (T) Family Background Skills and Abilities Prior Schooling Intentions Goal and Institutional Commitments External Commitments Pre-entry Attributes Goal & Commitments Academic Performance Faculty Staff Interactions Formal Informal Extracurricular Activities Peer Group Interactions Formal Informal Academic System Social System Institutional Experiences Academic Integration Social Integration Intentions Goal and Institutional Commitment External Commitments Integration Goal & Commitments Outcome External Community
  • 5.
    • Family and community background
      • Social status, parents education, size of community
    • Personal attributes
      • Sex, race, physical handicaps
    • Skills
      • Intellectual and social
    • Financial resources
    • Dispositions
      • Motivations, intellectual, social and political preferences
    • Pre-college educational experiences
      • College prep or AP HS curriculum
      • HS GPA
      • Tinto, V. (1993) Leaving college: Rethinking the causes and cures of student attrition (2 nd Ed) Chicago: The University of Chicago Press
  • 6.
    • Higher Education Literature
      • ERIC database
    • Nursing Education Literature
      • CINAHL database
    • Search terms
      • Education, nursing
      • High risk or At risk student
      • College student
  • 7.
    • Community college students
      • Low degree attainment
    • First-generation college students
      • 1.3 times more likely to not complete college degree
    • High-school curriculum
    • Type of higher education institution
    • Socio-economic status
    • Hispanic
  • 8.
    • Basic knowledge testing
      • Nurse Entrance Test (NET)
    • Academic background
      • Developmental reading
      • GPA
    • Racial and cultural background
      • Minority race
  • 9.
    • “ Which student pre-entry attributes are predictive of nursing student early departure from a two-year nursing program?”
    • Study Design
    • Descriptive, correlational study utilizing administrative data at FCC
  • 10.
    • FCC PeopleSoft: Student database
      • Integrated database
        • Demographic student information
        • Grades
        • Advising notes
        • Billing
      • Accurate
  • 11.
    • FCC Student Financial Aid Records
      • Need-based aid
      • Reliable electronically generated by funding organization
  • 12.
    • Student transfer transcripts
      • Paper copies of official transcripts
      • Electronically stored in PeopleSoft
        • Reliable data
        • Required for admission to program
  • 13.
    • FCC Nursing Student Information Sheet
      • Plan to work during nursing program?
      • CNA prior to admission to program?
      • No missing data
  • 14.
    • IRB approval from SOM (10/29/07)
    • FCC Approval of Use of Human Participants
    • Password protected computer for data storage
    • Identifiers removed
  • 15.
    • Pre-entry attributes
      • Students individual characteristics
    • Goals and commitments
      • External commitments
    • Outcome
      • Early departure – failing or withdrawing from any of the three first-year nursing courses
  • 16. Independent Variables Source Age/Sex PeopleSoft Race/ethnicity PeopleSoft # times science prerequisites taken: A&P I or II, Microbiology: Once/more than once PeopleSoft or student transcript Nursing major: RN or PN PeopleSoft SES: Yes/No Financial Aid Records ESL English: Yes/No PeopleSoft or Student Transcript Developmental English: Yes/No PeopleSoft or Student Transcript Work during program: Yes/No Nursing Student Information Sheet CNA on admission to program: Yes/No Nursing Student Information Sheet
  • 17. Dependent Variable Source Student course failure or withdrawal failing in first year of nursing program PeopleSoft Failure/W in NU 101 PeopleSoft Failure/W in NU 210 PeopleSoft Failure/W in NU 211 PeopleSoft
  • 18.
    • Which first-year nursing student pre-entry attributes predict early departure?
    • Failure in first year course = ƒ (  age) + (  sex) + (  race) + (  #science Pre-requisite) + (  nursing major) + (  CNA) + (  Developmental English) + (  ESL English) + (  plan to work) + (  Financial Aid) +  error
  • 19.
    • Student enrolled in fall 2005 and fall 2006, day option (n=124 students)
    • 26 (21%) minorities
    • 9 (7.3%) men
    • 21 (17%) PN majors/103 (83%) RN majors
  • 20.
    • Sample (n=124)
      • Mean age 32.2 year (SD 9.46)
      • Predominately female (93%)
      • 21% minority race , 79% white
      • 35% received need-based financial aid
      • 66% plan to work during nursing program
      • 25% were CNA’s upon admission
  • 21.
    • Two groups:
      • Fall 2005 (n=63)
      • Fall 2006 (n=61)
    • Fall 2006 significantly younger (t=2.589, p=.011)
    • Fall 2006 repeated Anatomy & Physiology I with greater frequency (  2 =4.689, p=.030)
    • Fall 2006 repeated Anatomy & Physiology II with greater frequency (  2 =5.140, p=.023)
    • Fall 2006 students “Repeated any science prerequisite” with greater frequency (  2 =8.549, p=.003)
  • 22.
    • Three significant relationships:
      • Anatomy & Physiology I more than once (  2 =15.613, p<.001)
      • Anatomy & Physiology II more than once (  2 =13.169, p<.001)
      • Students who repeated any science prerequisite (Anatomy & Physiology I, II or Microbiology) (  2 =15.455, p<.001).
  • 23.
    • First regression:
      • Two parameters (Rule of 10)
      • Predicted 85.5% of cases
      • Students who took Anatomy & Physiology I more than once were 5.24 times more likely to fail a first-year nursing course (CI 1.725,15.975, p=.004)
      • Students who took Anatomy & Physiology II more than once were 5.23 times more likely to fail a first-year nursing course (CI 1.252, 21.849, p=.023)
      • Hosmer & Lemeshow, 2000, p. 347
  • 24.
    • Second regression:
      • Entered all student characteristics of interest at once
        • P < .25 at bivariate level
        • Strongly supported in literature
      • Predicted 83.9% of cases
      • Being a male increased a student’s risk of failure 6.56 times (OR=6.56; CI 1.044, 41.18)
      • Repeating Anatomy & Physiology I or II increased a students risk of failure by about 7 times (A & P I, OR 7.053; CI 1.952, 25.487; A & P II, OR 6.690; CI 1.304, 34.324)
  • 25.
    • Minority status did not influence early departure (OR=0.58; CI 0.108, 3.174)
    • Prerequisite science performance is predictive of early departure
  • 26.
    • Strengthen pool of nursing program candidates
      • Policies and procedures must discourage practice of repeating science prerequisites
        • Average grades when multiple attempts?
        • Accept first attempt grade?
      • Inform high school faculty and counselors about rigors of nursing program
      • Inform student of rigors of nursing program
        • Advisor
  • 27.
    • Increase nursing faculty informal contact with students
      • Initiate collaboration between nursing and science faculty at FCC
        • Speak to students in science prerequisite courses
      • Initiate opportunities for student-faculty interaction outside of class
    • Students
      • Family Orientation
  • 28.
    • Classroom strategies
      • Create “Learning Community”
    • Male students
      • Replicate using larger sample size
  • 29.
    • FCC has initiated cohort scheduling
      • Fall lecture groups maintained in Spring for both courses
      • Maintains student contacts with study partners, psycho-social support
    • FCC has initiated the “Family Orientation” effective June 2008
      • Student and family member speakers for Q & A
      • Very positive student feedback!
    • Allied Health Advisor aware of study findings
  • 30.
    • Currently seeking FT Nursing Tutor/Mentor
      • Currently have Clinical Mentors
    • Will be seeking FT Nursing Recruitment and Retention Specialist – non-nurse position
      • Will evaluate current method for selecting students from pool of applicants
      • May consider mentoring program
      • Will plan time for students and faculty to meet informally
  • 31.