Strategies for Success: A Crisis
Management Model for
Remediation of At-Risk Students
Anita C. Reinhardt, PhD, RN
Teresa Keller, PhD, RN
Linda Summers, PhD, RN
Pamela Schultz, PhD, RN
The start: N490 - Opportunity for
Success: BSN Undergraduates
Anita C. Reinhardt, PhD, RN
Tenna R. Schumacher, MSN, RN
Pamela Schultz, PhD, RN
Project
• Student’s Program success or failure
• Remediation course (N490 - Opportunity for
Success)
• Presentation at Western Institute of Nursing
Conference (Spring 2011)
Rational/Background
• Schools are adopting the HESI exit exam as a
benchmark for progression (Nibert, Young, &
Britt, 2008).
• Students at risk for successful completion in
nursing programs have been shown to benefit
from a focused remediation course.
Nibert, A. T., Young, A., & Britt, R. (2008). The HESI Exit Exam: progression benchmark and remediation guide... reprinted with permission
from Nurs Educ 2003;28(3):141-145. Nurse Educator, 70S-774.
Rational/Background
• Research shows that the content of successful
remediation courses varies, but most feature
common strategies to help students become
successful.
• These strategies include faculty mentoring,
test-taking strategies, and self-directed student
activities.
The Approach
• Crisis Management for At-Risk Students
(Elders, 2008)
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Assess the individual and the problem
Plan the intervention
Implement the intervention
Resolution of the Crisis
Anticipatory planning
Elders, D. (2008). Theory and intervention. In K. Fortinash & P. Holoday Worret (Eds.), Psychiatric/Mental
Health Nursing (4th ed.). St. Louis, MO: Mosby-Elsevier.
Setting
• The BSN program is situated within a college
of a land-grant University in the southwest
southern border of the USA.
• The undergraduate BSN program admits 48
students each semester for a four semester
program and is accredited by CCNE.
• The standardized testing products used for the
program is offered by HESI.
Setting
• Prior to admission to the program, students are
tested to indicate baseline assessment of basic
knowledge gained from prerequisite courses
required of BSN undergraduate students.
• During the program various levels of ongoing
knowledge are accessed and a HESI Exit exam
is required prior to clinical placement in the
preceptorship that is a culminating immersion
clinical experience.
Sample
• Thirteen (13) students in danger of program
dismissal.
• The sample included 7 female, 6 males with a
mean group age of 29 (range 23-41).
• The cohort ethnic mix: 4 Anglo, 7 Hispanic, 1
Asian, and 1 African American.
Sample
• Some students had taken the Exit HESI exam
as many as 9 times without success.
• The minimum passing grade was 850 out of
1200 per HESI guidelines.
• Students took the HESI Exit Exam as part of
their final culminating nursing course while
enrolled in the remediation course.
Planning the Intervention
• Review of the literature; development of
evidence table
• Discussion with course faculty leaders and the
BSN and Program Director
• Discussion with peers
• Assess current practice for at-risk students
Intervention Design
• A retrospective project design was used to
review pre-existing student test data from
HESI exams
• Develop the independent-study outcomes for a
course offered in Spring Semester 2010.
• IRB approval was obtained from NMSU for
post hoc analysis.
The Course
• Students in danger of program dismissal due to
repeated HESI failure were enrolled in a
remediation course designed around
– faculty engagement and mentoring,
– focused reviews and self -assessment,
– self-directed student content assessment with
review plan, and
– student engagement with their own learning
process.
The Course
• In addition, students were provided an
opportunity for individual test-taking
counseling to assess study techniques and
offered alternative study methods.
Course Objectives
Upon successful completion of the course, the
student is expected to be able to:
• Perform a self-evaluation for areas of strength
and challenges in professional performance
• Mobilize areas of emotional and academic
strength to support successful performance
Course Structure
• Duration: 15 weeks
• Class time: 3 hrs per week in face-to-face
classroom
• Engagement:
– Mandatory attendance
– Assessment on-line of self esteem
– Self-developed plan of review based on areas of
weakness found in previous HESI attempts
– Required participation in group discussions
Course Structure
• Instruction format:
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Socratic questioning and discussion
Practice tests
Test reviews
Power Point presentation in weak content area that
included a teaching plan with pre-post test and self
evaluation of the presentation
– Registration and weekly progress reports of an
external review program
Implementing the Intervention
• The N490 course was taught for the first time
in Spring of 2010, with the purpose to
determine if an evidence-based remediation
course lead to improved student outcomes,
including success with a program-required exit
HESI exam and ultimate first-time success on
the NCLEX-RN licensing exam.
Results
• All students successfully completed the
remediation course and passed the HESI Exit
Exam enabling them to complete the
preceptorship and the BSN program.
• NCLEX-RN first-time pass rate was 92% with
12/13 student results reported.
• Only 1 of these student failed the NCLEX-RN on
their first attempt. As last to report, this person
was finally successful on their 2nd attempt. Now,
the cohort has a 100% pass rate.
Anticipatory Planning
• Implement changes to the program
– Pathophysiology became a pre-requisite course
– Curricular review of BSN program objectives
implemented
– Continuation of the N490 course for any student atrisk (having failed a Nursing course).
– Focused support (counseling or referral) of at-risk
students
• Minimum Admission HESI composite score level
set by department
Conclusion
• The Crisis Intervention Model assisted in our
approach to the development of the focused
remediation.
• A focused remediation course with engaged
faculty involvement supports positive student
outcomes and the production of qualified BSN
graduates prepared to take and pass the
NCLEX-RN examination successfully.
What’s next?
• Presentation – WIN 2011 (done)
• Publish – JNE 2012 (done)
• Expand – Ongoing work to analyze data and
present WIN 2012 (done) and another article
this time to Nurse Educator journal about use
of HESI admission scores and student progress
and outcomes (in final draft)
• All scholarly work!
References
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