Effectiveness of Preceptor-Based Orientation to Mentorship-Based Orientation for New Managed Care Nurses

 

One of the most significant issues that have come up in managed care nursing is determining the best orientation programs for individuals in this sector. This is especially considering that preceptor have come to take on an important role in helping in the development of the necessary skills that nurses need in the effective care of patients with complex problems. Mentors, on the other hand, are individuals that possess the required skills to teach ne managed care nurses to handle a diversity of situations. A consequence is that both mentors and preceptors have come to be seen as both mentors and role models. In this study, there will be an attempt to determine the effectiveness of a preceptorship-based orientation when compared to a mentorship-based orientation for new managed care nurses.

Background and Significance of the Problem

Managed care is one of the areas that have come to experience significant shortages in nurses and this is likely to become a serious problem in future if it is not taken care of at resent. Most of the managed care nurses that are available are essentially a part of an aging workforce, which means that there is need to make sure that there is the advancement of means through which new nurses are brought in (Buerhaus, Staiger, & Auerbach, 2000; Phillips & Miltner, 2015). However, the method through which they can be provided with training is a significant issue because it involves a situation where there are those that support preceptorship, while others support mentorship. It is important to ensure that younger nurses turn towards managed care means that it is essential for an effective way to orient them to the field to be developed. This process will ensure that they can become more effective in their tasks while at the same time promoting the retention of experience within the field (Cooney, 1992; Ortaliz, 2014). New nurses are in constant need of being provided with the required teaching and mentoring in the areas of the profession that they choose to specialize. This is especially considering that they are expected to take over and become the providers of safe and efficient care for the patients in their watch. Managed care involves a mix of new nurses and those with experience in various specialties and this means that there will be an increase in demand for competent preceptors and mentors who have the ability to effectively teach the manner through which managed nursing care can be delivered in various areas.

Statement of the Problem and Purpose of the Study

An issue that has come up in nursing in recent years has been the best method of orientation for new managed care nurses. A result has been that preceptorship has been presented as a more effective means of achieving orientation when compared to mentorship. One of the most significant roles that has to be played by preceptors is ensuring that they demonstrate competency in nursing skills while at the same time display effective clinical teaching behaviors so that a positive learning environment can be created. In addition, the orientation process is one that has to be handled with considerable competency, so that it can be possible to impart knowledge and skills to new nurses that are being oriented. A consequence is that orientation has to be handled by individuals that have acquired the necessary skills and training in order to make it possible for those being oriented to achieve safety when it comes to patient care.

Literature Review

The literature selected is aimed at informing the reader concerning the approach that is currently undertaken to ensure that new nurses are oriented. It also intended to impart knowledge concerning the manner through which the quality of orientation can be greatly improved by undertaking strategies that have been designed to advance the effectiveness of nurse preceptors. In this way, it becomes possible to focus all the goals of nursing organizations to the development of their workforce in the managed care field. The literature also deals with a diversity of issues concerning the creation of a healthy work environment that illuminates the need for a smooth professional relationship with the nurses undergoing orientation.

Preceptorship

While this concept originated in the 15^th century, where it was used as a form of tutoring, it came into use in the final quarter of the twentieth century when there was the creation of intensive care units in hospitals (Ryan-Nicholls, 2004). The rise in the use of this term came about because there was need for nurses overseeing these units to be supervised by more experienced individuals, who were known as preceptors (Ryan-Nicholls, 2004). One of the most significant aspects of orientation is that preceptors are required to ensure that they handle a smaller load of cases so that they can have as their main focus the orientation process. The achievement of the objective of advancing the role of preceptors is important because it involves nurse leaders encouraging these individuals to act as both clinicians and tutors (Edwardson, 2011; Prion et al., 2015). Therefore, preceptors have a role as teachers because it is through their actions that it will be possible to make the orientation process as smooth as possible. In addition, nurses undergoing the process will also be able to meet their learning objectives in such a way that they will be able to transition more effectively to their new area of specialization.

Training

Because of their important role in the orientation process, preceptors have to be well trained so that they can effect meaningful change (Sandau & Halm, 2011). Among the biggest failures that many healthcare organizations have is that they tend to cut education costs in a bid to save costs, but this ends up leading to a situation where some functions are hampered. The preceptor-based orientation program is one of those that end up suffering because its benefits are overlooked. Evidence that has been collected over time shows that the availability of constant support for preceptor-based orientation programs can lead to the achievement of the satisfaction of both preceptors and orientees to such an extent that there is a high retention of the latter (Van Patten, 2014).

Research Question, Hypothesis, and Variables

Research Question

How effective is preceptorship-based orientation compared to mentorship-based orientation for new managed care nurses? This research question will look into the preceptor approach to orientation in comparison to the mentorship one in a bid to show its effectiveness in advancing the orientation experience of new nurses.

Hypothesis

The main hypothesis for this study is that the preceptorship-based orientation is more appropriate than mentorship-based orientation because the former is based on experience and guidance that allows orientees the freedom of action needed to become knowledgeable in their fields. Therefore, preceptors have the ability to instill core skills that are critical for new managed care nurses to have.

Variables

The dependent variable is the effectiveness of preceptors in delivery of skills and knowledge to those nurses receiving orientation. The independent variable of the study is a preceptor-based orientation allows for the development of characteristics that have a positive impact on the learning experience of those undergoing orientation.

Methodology

Sample

One of the most significant aspects of the sample is that they will involve preceptors and orientees of different ages, experiences, and backgrounds. This diversity of individuals will help in coming up with a proper picture of the situation at hand, especially the manner through which orientation takes place under different contexts.

Sampling Strategy

The strategy that will be adopted in this process will involve a random method, where the researcher will seek out those preceptors and orientees willing to participate in the study. However, it will also consider the backgrounds of the participants in order to come up with as much diversity as possible.

Research Design

A quantitative design will be adopted for this study because it is the best means through which to ensure that there is a greater coverage of the sample (Sousa, Driessnack, & Mendes, 2007). In addition, adopting this design will also allow for objectivity in the study because it will be applied to a diversity of contexts.

Extraneous Variables

A possible extraneous variable involves the possibility of some potential participants declining to participate in the study. This is especially the case if it happens in the last minute because it will require that other participants be found to replace them.

Instruments

A diversity of literature on the subject matter, especially those concerning preceptorship and orientation will be the main instruments of the study. This will enable the opinions of various experts concerning the orientation process to be analyzed and applied.

Description of the Intervention

The intervention likely to take place will involve seeking to ensure that there is an improvement in preceptorship-based orientation. This will involve better preceptor training and the creation of a good working environment for orientees.

Data Collection Procedures

These procedures will involve a number of actions the first of which is gaining the consent of the participants. In addition, questionnaires will be developed for both preceptors and orientees that will participate in the study.

Data Analysis Plans

The data collected will be analyzed objectively with the aim of better understanding the subject matter while at the same time answering the research question. Moreover, the data collected will be supplemented by literature which will provide a perspective of previous studies and their outcomes in relation to the current one.

Ethical Issues

It is important to ensure that there is the advancement of the interests of the participants of the study. This process will be conducted in such a way that questionnaires will be only be given to the selected participants after having briefed them concerning the objectives of the study. Furthermore, there will be an attempt to ensure that the identity of participants is kept confidential in order to bring about the establishment of means through which they can maintain their privacy.

Limitations of Proposed Study

One of the most significant limitations of the study is that it is quite difficult to conduct a broader study because of the time limit. Furthermore, there is a potential that the very limited information concerning the research question, this study will be delving into an area that has not been concentrated on by many previous studies. This will mean that it will be going into an area which is only just beginning to be studied; with very little reference.

Implications for Practice

This study is essential in advancing the cause of orientation in the context of managed care nursing. Its importance can be seen through the answering of the research question where there will be an attempt to determine whether preceptorship is a more viable orientation method for new nurses than mentorship.

Infant Mortality in Ethiopia

 

Ethiopia is one of the poorest countries in sub-Saharan Africa, while it also has the distinction of being its second most populous nation. Because it is one of the least developed, this country faces significant economic and social problems. These include a situation where his health care system is still to be fully developed to serve its people effectively. Moreover, due to the low levels of pregnancy, as well as the cultural methods that have come to favor essentially large family sizes, the country has come to face significant high child mortality rates. This is especially the case considering that the people in the country are suffering from a severe scarcity of the basic needs such as food, clothing, housing and protection necessary for the promotion of the interests of the population. The rapid and uncontrolled increase in the population has made it extremely important for the government to change its policies in such a way as to promote the quality of life of its people while at the same time guaranteeing that health care programs have targeted them to create opportunities for treatment. The data on child mortality rates not only in Ethiopia but also in the rest of sub-Saharan Africa are a reflection of the considerable socio-economic problems faced by these countries. The data can be used effectively to ensure that there is a level of monitoring and assessment of the population, as well as health programs that have been set up.

Literature Review

Although the exact size of the decline across data sources is changing, the reduction in infant and child mortality over the past few years has been significant. This article, the main focus is not the absolute gross mortality, but rather the forces that change the gross mortality over a period of time from time to time. Infant and under - five mortality rates in Ethiopia has continued to tilt over the last 25 years with the more pronounced reduction in the last decade. The data show that nearly one out of every ten newborns (97 per 1000) did not survive to celebrate their first birthday, and one of all six children (166 per 1000) before her fifth birthday. In view of the slow pace of improvement in infant and child mortality to reach the child survival millennium development goal before 2015, Ethiopia should be under-five mortality in the ratio of 5.2 per 1000 live births each year since the beginning of 1990. As shown, between 1990 and 2000, the rate of the decrease under-five mortality was only less than 2 per 1000 live births per year. Ethiopia should therefore reduce child mortality by 7.4 per 1000 live births per year between 2003 and 2015 in order to achieve the MDG goal in question.

However, the official source shows that child mortality in Ethiopia fell by 35 percent between 2000 and 2005; Infant mortality declined by 21 per cent and the under-five mortality rate declined by 26 per cent over the same period. Nevertheless, mortality rates remain high. Data on infant and child mortality rates reflect the level of socioeconomic development and the quality of life of the country and are used to monitor and evaluate population and health programs and policies. In addition, commodity prices have declined considerably in the last fifty years. Another report shows that the infant mortality rate declined from 199 in 1950 to 90 and 77 in 2005. This task would be very difficult, taking into account past trends and large unfulfilled needs for the survival of children in Ethiopia. Therefore, a deep understanding of levels, trends, differentials and determinants of infant mortality is critical to any attempt to achieve the goal of reducing infant and child mortality through appropriate and sustainable interventions. In this article, researchers have updated a number of factors and, above all, on the reduction of mortality problems, a rough estimate of EDHS 2000 and 2005 for Ethiopia and described the relationship between infant mortality and socioeconomic and demographic characteristics in Ethiopia. The subject of research is an exciting subject.

The main objective is to analyze the decline in infant mortality in Ethiopia. In addition, it is very important to generate a discussion on the reduction of infant mortality and promote awareness of the problems related to the interval of birth and duration of breastfeeding. This can be studied in different ways, the demographic and socioeconomic characteristics of the children and the mother. Now the question is how has child mortality in Ethiopia gone? At what level? Is it true or not? For experimental determinations an analysis is limited to two methods such as the Brass and Trussell models of infant mortality. Specifically, this study examined the prevalence, duration of breastfeeding and infant mortality in Ethiopia.

The Trussell model shows child mortality and under-five mortality for a five-year period before the survey. The most recent EDHS 2005 estimates show that the overall infant mortality rate has significantly decreased. The reduction in the mortality rate of children under the age of five declines from 0-14 years preceding the survey. In particular, from 5 to 9 years, the death rate of children under the age of five decreased. A recent news article referring to a United Nations official gave the following assessment: "Ethiopia, the second most populous nation in Africa, has managed to reduce the death rate of children under the age of five by 40 percent over the past 15 years." The report also provided a coordinated death rate, carefully compiled from different sources, to provide a complete picture of the morality trends of children since the 1960s. Despite this, the infant mortality rate also declined to around 50 in the same survey period. As the Ethiopian government has implemented a number of activities aimed at reducing childhood diseases and mortality. The Government has developed a health sector development program and formulated a health policy with an emphasis on disease prevention and control.

It is rare to establish mortality rates with confidence for more than fifteen years before the survey. Even during the last 15-year period considered here, the apparent trends in mortality rates should be interpreted with caution for several reasons. First, there may be differences in the completeness of death reports associated with the length of time before the examination. Secondly, the accuracy of the age message at the time of death and the date of birth may eventually expire. Thirdly, the sample of mortality variability tends to be high, especially for groups with a relatively small number of births. Fourth, mortality rates are declining, as at present women aged 50 and older do not have children in the early periods. In particular, this truncation affects mortality trends. For example, for the period 10-14 years prior to the survey, rates did not include any births for women aged 40-49 because these women were over 50 years old at the time of the survey and they were not able to pass the interview. Since these excluded deliveries for older women are likely to have a higher risk of death than those for younger women, the mortality rates for this period may be somewhat underestimated. Estimates of later periods are less affected by the slope of the truncation, since fewer older women are excluded. The degree of this bias depends on the proportion of genera omitted. The selection of bias for the statistics of child and child mortality for fifteen years before the survey should be negligible.

Results and Conclusion

It is clear that infant mortality is high due to poverty and other social factors or poor medical care. At the same time, demographic factors affecting both mother and child influence infant mortality. In developing countries, low birth weight is due to poor maternal health and nutrition. Inadequate weight gain during pregnancy is particularly important because it accounts for a large part of fetal growth retardation. The birth gap is believed to be associated with infant mortality. The correct spacing of births allows more time for child care to provide more maternal resources for child care and also allow a healthier mother. But the scenario in Ethiopia is very different, for example; Access to health services is limited. In general, the reality is the health problems of mothers and children associated with fertility and birth. The maternal mortality rate of 673 per 100,000 live births and the infant mortality rate of 77 per 1,000 live births are among the highest in the world. There is a growing trend in the incidence of juvenile pregnancy, which accounts for more than 30 percent of fatalities as a result of unsafe abortion. About 90 percent of women in the home provide care, only 28 percent of women receive prenatal care, and skilled staff receive only 7 percent of births. Postnatal care is extremely low in Ethiopia. The low status of women in Ethiopia underlies and often directly undermines any negative reproductive health outcomes. Most Ethiopian women, especially rural women, lack the reproductive and social self-determination necessary for the exercise of their reproductive rights, which in turn reflects their low reproductive health and social status. Therefore, the decline in infant mortality is suspect. According to the results of the study the total rate of infant mortality in Ethiopia is highly rejected.