Mentoring and Enabling Learning in the Practice Setting

Mentoring and enabling learning in the practice setting A reflective account of my experience of facilitating learning, assessing and teaching a student or co-worker, and how this experience will inform my future development within the mentor or practice teacher role. Student Number: 2930211 Word Count: 3150 Part 1: Introducing the Mentorship role I am a band five registered paediatric nurse based on an orthopaedic and spinal surgical ward in a tertiary paediatric hospital.

I am currently engaging in completing my training to become a qualified mentor. This reflective account details my experiences assessing, teaching and facilitating the learning of a student during their practice based learning, and how this experience may affect my future practice. Throughout the account, in order to protect the identities of people, trust and clinical setting involved confidentiality will be maintained via the use of pseudonyms or omission of names (Nursing and Midwifery Council (NMC), 2008a).

The function of practice based learning is to provide experience, serving an important role in developing the skills of the student in interacting with patients and their families assisting in technical, psychomotor, interpersonal and communication skills (Ali and Panther, 2008). Practice based learning provides an opportunity to link theory and practice, and promotes professional identity development (Fishel and Johnson, 1981). Practice based learning is also crucial in the profession of nursing due to the vocational nature of the work, and necessity of assessing clinical competency and safeguarding the public (Rutowski, 2007).

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By ensuring specific standards are met with assessment in practice, it effectively ensures that students are fit for practice at point of registration (NMC, 2004). My demonstration of demonstrating my eligibility to supervise and assess students in a practice setting and successful completion of the NMC approved mentorship programme will allow me to meet the definition of a mentor (NMC, 2004), and perform an important role that every nurse has to assume formally, sooner or later (Ali and Panther 2008, Figure 1)

Figure 1. (Synthesised using NMC 2008b, Rutowski 2007, Beskine 2009) Part 2 The NMC Standards In order to ensure that there is a set level for supporting learning and assessment in practice, the NMC devised and provided a set of standards for which mentors, practice teachers and teachers are required to meet (NMC 2008b, Ali and Panther, 2008). The agreed mandatory requirements include a developmental framework, the standards, and information regarding application of the standards to assessment in practice.

The competence and outcomes for a mentor are underpinned by eight domains (Figure 2, NMC, 2008b). Figure 2. (NMC, 2008b) Number Domain 1 Establishing effective working relationships 2 Facilitation of learning 3 Assessment and accountability 4 Evaluation of learning 5 Creating an environment for learning 6 Context of practice 7 Evidence-based practice 8 Leadership When considering the eight domains within my own clinical practice area I consider establishing effective working relationships and leadership to be of particular importance.

The establishment of an effective working relationship is vital due to working together with families and providing care for the family as the patient, rather than just the child (Casey, 1988) in order to provide a good standard of care. Establishing effective working relationships also serves to reduce poor student experiences and improve ability to assure competence to practice (Beskine 2009, Dowie 2008). When considering the importance of family centred care, as well as the promotion of an effective working relationship, leadership is a key theme.

Leadership in my clinical setting involves role modeling, improving care and influencing others (Cook, 2001) as well as considering situational forms of leadership (Faugier and Woolnough, 2002) when communicating with different parties in different situations. Leadership in my practice setting could range from working with a difficult family, which may require participative leadership, or a situation where I need to be assertive. I must frequently act as an advocate for the child (Children Act 1989), requiring a more autocratic approach (Bass and Bass 2008).

Both establishing effective relationships and leadership require skill, knowledge and experience and can be central to providing quality care (Department of Health 2004). Key professional challenges surrounding learning and assessment in my practice area include difficulty due to the busyness and staffing levels on my ward, which is known to affect the quality of assessment in practice (Phillips et al, 2000). The pressure of clinical commitments and lack of available time has an affect on the organisation and supervision of students during clinical placement (Caldwell et al 2008).

Other difficulties may include inconsistency in performance influencing assessment of fitness for practice (Duffy and Hardicre 2007a), or students who are not compliant with support available and provided should they be failing (Duffy and Hardicre 2007b). Reluctance to fail a failing student due to poor assessment or finding the failing process too difficult (Duffy 2003) also serves as a professional challenge in my practice area.

The NMC Standards to support learning and assessment in practice (2008b) do provide a framework for mentors, but due to the nature of the document it is not comprehensive enough to consider all aspects of competence assessment (Cassidy, 2009). It could be considered that some level of assessment remains subjective despite the framework being provided, due to the inherent nature of the involved profession and the variation of skills to be assessed.

Holistic assessment of competence is difficult to structure a framework, particularly when considering a students reflexive action to utilise their knowledge skills and attitude with emotional intelligence (Freshwater and Stickley 2004, Clibbens et al 2007). These issues may become more prevalent when considering the possibility of a mentors failure to fail a student (Duffy, 2003). These is somewhat rectified by the responsive development of ‘sign off mentors’ who make a final judgement on the fitness for practice of the student at the end of their training (NMC 2008b).

Further support can be given to the NMC standards to support learning and assessment in practice (NMC 2008b) by documents such as ‘Guidance for mentors or nursing students and midwives’ (Royal College of Nursing (RCN), 2007) a toolkit which assists in providing support and strategies for mentors. Part 3: My practice based assessment session Practice based assessment is a core method of assessing the knowledge, skills and attitude of a student (Bloom 1956, Wallace 2003), but is complex to ensure objective management (Carr, 2004).

To accommodate a diversity of patients and needs (Dogra and Wass, 2006), different types of assessment are necessary, all of which are part of the mentor student relationship (Wilkinson et al 2008, Figure 3, NMC 2008b). Figure 3. ( Wilkinson et al, 2008) Type of assessment Description Mini clinical evaluation exercise. Snapshot of student performing core clinical skill. Can be integrated into ward environment or routine patient encounter (e. g gaining a pain score from a patient) Direct observation of procedural skills.

Observing a student carry out a procedure and providing feedback afterwards (e. g performing aseptic non touch technique to prepare a dressings trolley). Case based discussion. A structured interview to explore behaviour and judgement (e. g discussing aspects care of a patient and what a student did or observed). Mini peer assessment. A group of qualified professionals providing feedback on an individuals performance, includes self assessment (e. g feedback from other nurses that supervise a student in their clinical placement).

The method of assessment must be considered in terms of reliability, validity, acceptability, educational impact, and cost effectiveness in order to evaluate the suitability of the assessment itself (Chandratilake et al, 2010). Assessment of formal knowledge allows review of conceptual knowledge, including considering potential risks or other influencing factors. Assessing an individual in practice, or their craft knowledge, allows reflection and development on experiential learning (Price, 2007).

Both formal and craft knowledge are required to be continuously assessed to understand the student in order to understand how the student reads risk situations and uses concepts to address practice requirements (Price, 2007). When assessing students it is important to establish four key areas (Hinchliffe 2009, figure 4). Figure 4. (Hinchliffe 2009) Key area Description Knowledge What do they know? Skill What do they do? Performance How well do they do it? Motivation Why do they do it, and how do they feel about it? Continuous assessment has limitations with regards to validity and reliability for numerous reasons.

There is a requirement for co-ordination between educators and service providers to agree on appropriate assessment pathways for formative and summative assessment, allowing an appropriate level of assessment and practice theory link (Price, 2007). A mentor in a complex clinical setting combined with the pressure of continuous assessment on students in front of patients, family, relatives and other professionals has an impact on performance and may increase the anxiety of the student or the assessor (Price, 2007). Anxiety may also be caused by the mentors eeling of competence to assess, the student feeling ready to be assessed (including contributing personal factors), as well as changes in curriculum causing mentors to feel less competent in assessing certain areas (Price, 2007). My assessment was of the competence of a first year student utilising pain assessment tools appropriately to successfully gain a pain score from a post operative patient. I considered this to be an area of importance due to the integral part of professional training pain assessment is recommended to serve; considering pain as the fifth vital sign (Royal College of Nursing (RCN),2008).

Considering the expectations of first years participation in observing vital signs, competence is important for patient safety (Lomas 2009) . I would consider this assessment a direct observation of a procedural skill (Wilkinson et al 2008). An observing qualified mentor was present and observing at all points of the assessment and feedback. The observing assessor provided written feedback regarding the assessment provided (Appendix 2).

The assessment was planned including the criteria and a number of questions developed, to test the learners understanding (appendix 1). The criteria for assessment was structured and at an appropriate level for the student on both a theoretical and practical level (Stuart, 2007). The developed questions were aimed to make the student provide rationale for their choices within and around the assessment, aiming to make the assessed skill less of a series of tasks and provide a more versatile skill applicable in different ways (Cassidy, 2009).

I waited until the ward was quiet to ensure there would not be interruptions and the assessment would not be compromised (Rutowski, 2007). Initially, I introduced myself to the student, as it was the first time we had met, this aimed to familiarise myself with the student and aim to reduce their anxiety (Price, 2007). I went on to tell the student what exactly I wanted them to do, approximately how long it would take and reassured them not to be worried as this was not a formal assessment, aiming to reduce anxiety (Price 2007) and make expectations clear.

It was identified by my observing assessor that I did not enquire as to previous experiences of the learner. Although I knew that the student was a first year and the assessment was appropriate as such, enquiring further into their experiences may have provided a link that would have altered the assessment in some way and perhaps have assisted in supporting further growth (Newman and Pelle, 2002). My assessor also felt that outcomes should have been more clearly identified at the beginning of the assessment.

Though the information was provided, and in an appropriate environment (Price, 2007) a shorter almost bullet point summary at the end of discussing outcomes may help to prepare the student for what is expected of them (Stuart, 2007) and reduce confusion or anxiety (Price, 2007). When the student had completed the first criteria, I asked her my first question. This took into consideration the students approach to communication (Dickson et al, 1997) and their knowledge of basic child development (Sheridan et al 1997), knowledge applicable to core skills in many ways.

The student correctly prioritised the order of pain evaluation, completing the second criteria (International association for the study of pain (IASP) 1994, Broome 2000). I asked the student the second question at this point, the student demonstrated theoretical ability to integrate with the nursing team to provide safe and effective care (Stuart 2007, Lomas 2009). Finally for the assessment the student communicated well with the child and their family demonstrating effective family centred care (Casey 1988) and successfully gained an appropriate pain score (IASP 1994) using the ‘Wong-Baker faces pain rating’ (Wong et al 2001).

After the pain score had been gained I asked my final question which was how often should pain observation be done, which the student correctly responded to in accordance with RCN (2008). My observing assessor felt that at points my speech was too fast and noted that I needed to repeat myself on occasion. Speaking at a slower rate allow a student to digest and understand information given to a better level, and prevents them from becoming overwhelmed with information faster than they can process it (Prozesky 2000).

I provided a feedback session for the student, aiming to develop a sustainable proactive learning relationship with the student (Cassidy, 2009), which included an action plan made with the student (Appendix 3). Considering that the student was essentially competent at the skill, the action plan was focussed on gaining a greater range and experience in order to gain a more reflexive experienced quality regarding the skill and provide more holistic competence (Cassidy, 2009).

The feedback was provided positively and constructively and seemed to help with the students self esteem with regards to the skill, creating a more supportive working relationship and conducive learning environment (Clynes and Raftery, 2008). The student-mentor relationship is crucial to the students learning experience (Ali and Panther 2008, Beskine 2009, Goppee 2008, NMC 2008b, Wilkes 2006, White 2007). Effective communication skills can help identify a student causing concern at an early stage in order to pre-empt failure (Caldwell et al, 2008).

Though feelings of sadness or failure may be felt by the student and mentor from failing assessment, and this provides a challenge, it is important for mentors not to avoid these situations if a student has not met desired outcomes as this may have far reaching implications on student progression (Duffy and Hardicre 2007a, Duffy and Hardicre 2007b, Wilkinson 1999). The feedback was scheduled and provided shortly after the session aiming to give the student prompt support if required and to correct any unsatisfactory behaviour if present (Duffy and Hardicre 2007b).

Considering the feedback, and my own reflections on the assessment, there is need for my future development. I will also endeavor to speak more slowly and learning more about the student prior to assessment. , and provide a more clear identification of outcomes . I would consider gaining feedback on the students performance from the patient and their family in the future. This would allow us to take into account the view of the service user and family to promote clinical excellence and family centred care is of a high quality (Department of Health 2004, Casey 1988).

Overall, my observing assessor thought that my assessment of the student was appropriate for their level of knowledge, skill and attitude (Bloom 1956, Hinchliffe 2009, NMC 2008b) and effective in determining the level of competency in this area. Part 4: My practice based teaching session I prepared a teaching plan (appendix 4), a powerpoint presentation (appendix 7), handout of the presentation and a handout of the various tools for pain assessment (appendix 8) before my teaching session.

This teaching took a mostly behaviourist approach as opposed to a cognitive approach, however, discussion during the learning allows for a more cognitive approach(Figure 5). I arranged for a qualified mentor to observe and assess my teaching and the feedback I provided to the student (appendix 5). They provided written feedback on my session (appendix 6 and appendix 9). My assessor noted positive use of further reading and handouts, to enhance the students personal knowledge and support for further adult learning (Knowles 1990, Beskine 2008).

Provision of printed handouts, particularly with space for notes beside them, may help accommodate students who have dyslexia, and may otherwise struggle to absorb the information provided (White, 2007). Figure 5. (Synthesised from Bullock et al 2008, Goppee 2008, Hinchliffe 2009) Learning theory Description Behaviourist Information provided by teacher, student relatively passive. Cognitive (humanisitic) Student centred. More useful in vocational teaching like nursing. Relates past experience (knowledge or theory).

I booked and prepared the seminar room on the ward to ensure there wouldn’t be disturbances, a formal teaching session with clear aims of what to achieve (Goppee, 2008). Utilising a space like this creates a professional and friendly environment helping create a good learning environment (Beskine 2008, Hand 2006). My assessor observed that I had created a welcoming environment. My assessor commented on the high quality of the evidence based content within the teaching session, my own skill and knowledge in this particular area.

Providing good evidence based information assists in providing excellence in care (Department of Health 2004, Beskine 2008). Using examples from practice also helped describe to the learner applications of the theory to practice (Knowles 1990). My assessor noted my good eye contact and body language, reassuring the student encourages continued attention, interest and a positive relationship (Dickson et al 1997). My assessor commented upon the open questions I asked, keeping the student interested, engaged and relating to practice, encouraging cognitive learning (Figure 5).

Further learning revolved around the student as an adult learner identifying how to best expand their knowledge in this area by approaching it in a more kinaesthetic learning style (Pashler et al 2009, Figure 6). Figure 6. (Synthesised from Dunn et al 1996, Given and Reid 1999) Learning Style Advantages Disadvantages Visual Learns through images, visual tools or imagining events. May need more time to complete tasks. May have decreased interest in theoretical values. Auditory Learns well through talks or lectures.

Absorbs sequenced organised information well. May use checklist. Highly unlikely to be able to multitask. Can focus on one area at a time and neglect ‘the big picture’. May not work well in groups. Kinaesthetic (Tactile) Learns through doing. Tends to enjoy the experience of learning. Finds it easy to demonstrate. May miss instructions or information if presented orally. May find paying attention to detail difficult. My observing assessor noted that at some points the speed of the session was a little too fast.

This may cause the student to become confused or not absorb the information that I am teaching (Prozesky 2000). On reflection I can use this experience to expand my personal knowledge and how to develop further (O’Callaghan 2005). I will speak more slowly so that the learner can gain more from my teaching session, and consider the student as an adult learner with previous experiences, which can be used as a resource (Knowles 1990). I could also have asked how the student learned best and accommodated their learning style effectively (Rassool and Rawaf 2007).

A wider range of learning styles (figure 6) would accommodate all types of learning (Rassool and Rawaf 2007, Pashler et al 2009). I would also put more emphasis on patient safety issues (Beskine 2008). Part 5: The Leadership skills required by a Mentor I am aware that being a mentor is part and parcel of leadership behaviour (Girvin, 1998). Transformational leadership concentrates on the ability to influence situations or people by affecting their methodology of thought and role modelling (Girvin, 1998).

Transformational leadership in nursing encourage autonomy and enable students or staff to reach their potential and promotes good interprofessional rapport (Pollard, 2009). By acting as a role model in my clinical setting and seeking to address obstacles inherent in mentorship on the ward, it is possible that I could not only develop myself and the students that I mentor, but also other mentors on the ward and their behaviour and practice in a positive way (Girvin 1998, Pollard 2009).

Obstacles such as staffing levels, busy ward environment and the pressure of clinical commitments impact upon me damaging the effective working relationship between myself and the student (Beskine 2009, Hurley and Snowden 2008, McBrien 2006). Finding time provide written feedback in a students documentation can be limited (Price, 2007). By e-mailing other mentors evaluations of my shifts with their students it may become common practice providing a greater range of student evaluation and a positive learning environment (Cassidy, 2009).

This feedback can then be sent to the mentor at a quieter time, and discussed with the student prior to, signing and entry into their documentation with time being less of an issue. Despite this being a good use of resources and time management (Beskine 2009) I have already tried this and found often mentors are not interested unless the evaluation bears a particular negative weight with regards to poor performance which must be addressed urgently. Anxiety of the student, or my own as the assessor may effect the reliability, subjectivity or the validity of assessment (Price, 2007).

Effectively facilitating the learning of students requires flexibility and understanding for different learning styles including (Bullock et al 2008, Goppee 2008, Hinchliffe 2009, Dunn et al 1996) including adult learning (Knowles,1990) and students with learning difficulties (White, 2007). Strong links between practice and theory (Stuart, 2007) must be in place to ensure suitability of assessment and teaching. Along with these issues, the student-mentor relationship must be nurtured to provide a quality learning experience (Ali and Panther 2008, Beskine 2009).

Discussing a students preferred learning style in their initial interview may encourage the student to engage in a higher standard of adult learning (Knowles 1990, Rassool and Rawaf, 2007). This can help me alter my strategies to create a better relationship between myself and the student (Beskine, 2009). I am currently supervisor to a first year student on first placement who has studied in school and sixth form, they do not have a great deal of experience with adult learning, and they have needed additional support and provision of resources to facilitate their learning, articularly with practical skills. Orientation is the gateway to a successful placement (Beskine 2009). Students must be assessed fairly and objectively (Ali and Panther 2008, Duffy and Hardicre 2007a), though this may cause unpleasant emotions to both the student and assessor it is important that this is done, to ensure student progression is not damaged (Duffy 2003, Duffy and Hardicre 2007a, Duffy and Hardicre 2007b, Rutowski 2007, Wilkinson 1999) and competence is insured for patient safety (NMC 2008b, Lomas 2009).

I aim to ensure that the students I work with and assess are competent and fit for practice (NMC, 2008b). It is important to regularly work with students and have clear objectives from the initial interview (Duffy and Hardicre, 2007a). I am aware that it is my responsibility to ensure concerns with a students performance are raised by midpoint at latest, so that by final interview, there should be no surprises for the students summative assessment of their progress and level of competence (Duffy and Hardicre, 2007a).

Asking children and parents their opinions on students working with me, and their performance can provide an insight into the family centred care the student is providing (Casey, 1988) and may allow a greater interpretation of holistic reflexive performance (Cassidy, 2009). On the negative side, a parent is not aware of the pressures upon the student (Price, 2007). The parent of a sick child is anxious themselves and will be more subjective than objective.

In conclusion, mentoring is a complex and diverse role, and one I will take on with focus and and knowledge, and endeavor to continue to develop as a practitioner, assessor and teacher in the clinical setting. This reflective process has been incredibly valuable in preparing me to be a mentor, and my personal and professional development. I have gained a much deeper understanding of the mentor student process through investigation of the various aspects of NMC standards, as well as various assessment and teaching strategies. Areas on which I must develop are clear, and in completing this ourse I feel adequately prepared, and look forward to further developing my skills and knowledge within this role. REFERENCES References Ali PA, Panther W (2008), Professional development and the role of mentorship, Nursing Standard, 35-39, Date of acceptance April 3 2008. Bass, B. M. & Bass, R. (2008). The Bass handbook of leadership: Theory, research, and managerial applications (4th ed. ). New York: Free Press. Beskine D (2009), Mentoring students: establishing effective working relationships, Nursing Standard, 23, 30, 35-40.

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