Mentoring and Enabling Learning in the Practice Setting

Mentoring and en fitting discipline in the Practice SettingIntroductionThe focus of this assignment is on the delivery of mentoring and judging deep d deliver nursing devote. The power is a mental health nurse representing inwardly a home treatment team in East capital of the United Kingdom. The identified education need is that of administration of a term injection, a common element of the nursing intention with patients with mental illness. The target audience is a savant mental health nurse. The team is a multidisciplinary one with bookmans from contrastive professions entirely placed within the team for specified attainment experiences and clipping periods.Mentors be usu exclusivelyy assigned a pupil for the term of their clinical placement. They meet with the student at the beginning of the placement to agree accomplishment out come ons and course of take in nurture needs, and then work with the student for a minimum of 40% of their clinical placement (N MC), and then perform their legal opinion documentation towards the end of the placement. This usually involves passing the student for competence in identified clinical skills. farefountainhead Two The Role of the MentorThe berth of the mentor within the nursing context is complex, because it involves direction, facilitation, support, guidance, sound judgment and feedback1. sound judgment of a student nurse during their training is in coition to key clinical competencies, as defined by the NMC Standards of Proficiency for Pre-Registration nursing nurture2. These competencies are then translated into clinical assessment areas as defined by the students University, and assessed against their definitions. The NMC are clear about the expectations of the nursing character in clinical form, in relation to competence and responsibility the nursing role involves a capacity non notwithstanding to participate actively in occupy provision however overly to accept responsib ility for the effective and efficient solicitude of that care 3. Therefore, mentoring involves not only doctrine discrete clinical skills but the more than complex issues of demonstrating the sort of care for individualist clients according to their needs. Mentoring involves the consolidation of theoretical and practical schooling acquired during the students academic experience within the University teaching and acquireness crashting, and applying that association to practice4. Therefore, it is important that mentors not only act in a way that is appropriate to their master role and the expectations of their employer, but are as well as aware that theirs is the standard against which students will saloon their witness conduct and competence.The role of the mentor is to teach within the clinical setting, at that placefore, all formal teaching which takes place is clinically oriented and clearly relates to the performance of the professional role5. Research by Lloyd-J ones et al6 seems to indicate that not only do students get the surpass out of their clinical placements through the student-mentor affinity, but that the quality of their education and maturement is linked to the amount of time that they spend with their mentors. Therefore, mentors need to run into that their role involves a freight to working with their named student and supporting their go outing through this close working relationship78.The role of the mentor also involves assessing the student, against competency standards defined by the NMC and by the students educational institution. The NMC now requires that whatever mentors are sign-off mentors, which meaning that they sign-off the student as adapted at the end of their training, and share equal responsibility with the awarding institution for that students competence to perform their professional role. In midwifery, all mentors must be sign off mentors. Regardless of this, it is a signifi do-nothingt responsibili ty for any mentor to assess a student and confirm they are competent in key areas of clinical practice, and in that locationfore mentors are educated and supported to understand the teaching and information processes involved, especially in marking how to assess competence. Some research shows that assessment can be carried out in a tripartite agreement between student, mentor and a member of the academic provide of the university (usually the students individualised tutor)9. This kind of close working relationship has many benefits, for the mentor, the student and the academic institution, and in relation to the assessment role of the mentor, provides valuable support10. This also shows that separate role of the mentor is that of close liaison with academic staff in relation to student progress and assessment, student conduct and behaviour. While not all institutions corroborate this three way set up per se, many use this kind of arrangement to address student problems in a chieving the required levels of assessment. Despite there being examples of near(a) practice such as this, however, the demands of the mentorship role mean that there is salvage a deficit between the theory and practice of mentoring, which needs more attention11.The challenges of mentorship from my perspective reflect these issues in the literature. The demands of meeting identified student needs are partly met by the training and support for mentors, but the realities of providing client-centred care whilst supporting student schooling mean that the teaching and learning opportunities are not unceasingly maxmised. Developing a good relationship with students is also usually slowly addressed, but there are times when it is not possible to develop a good relationship with some students and I exact been aware in the past that this impacts on the quality of the learning experience. some other issue is managing students who are not achieving their designated competencies, and thi s process, while supported by the academic staff, is very stressful for all involved. It seems to me that the mentor role is not valued by the employer either, and in a busy workload, the required time for mentors to spend with students to provide the right kind of feedback is not factored in. However, I am also aware that this is an evolving area, and that practice is changing in line with the published standards for the preparation of mentors. Ultimately, as a mentor I have a strong commitment to ensuring the standards of the profession are maintained, and being a mentor allows me to make a valuable contribution to practice and to the profession in this way.Part Three The Assessment PlanThe author set out to assess the students ability to carry out a depot injection, and so set up a teaching plan and assessment plan accordingly (see Appendix). Carrying out this assessment plan involved reviewing the theories of education and learning which are most relevant to the type of assessm ent, some of which will be discussed here. This author is aware of the theories which underpin nurse education and learning, and will address some of these here, believing that these theories still help explain how student nurses come to develop the abilities, knowledge, skills and capabilities which allow them to fulfil the requirements of the nurses role. Therefore, the teaching plan and the assessment plan chassis on this theoretical knowledge in order to maximise the students opportunities to learn and turn competent in the chosen skills12. Behaviourist theories suggest that learning takes place through stimulus response learning, and through operant conditioning, through which students behaviours are changed through observing, and through reactions to their own behaviours13. In order to build on this, the nurse demonstrates the procedure and the kinds of behaviours that are associated with the procedure, including communications behaviours. This would need to be reinforced b y word of these behaviours, and it is argued that basing learning only on behavioural principles is not adequate to meet the challenges of nursing learning. Cognitive theories are those which also underpin the authors approach to teaching and assessment. Within cognitivism, which is orientated towards scientific and positivist principles, the mind of the learner is equated with theories about computing and how computers work, and knowledge is viewed in terms of symbolic mental constructs, or dodging learning can be said to have taken place when there is a change in the learners internal cognitive schema. Therefore, learning is said to have taken place when the individuals behaviour has changed following acquisition of cognitive learning14. Within cognitive theories, learning is establish around the acquisition of factual information, and while there is no requirement for learning to have been processed on a deeper level, it does mean that the relevant knowledge has been assimila ted by the learner 15. Both of these theories, however, underpin much of the assessment process, because the mentor is looking for behaviour change, based on the students demonstration of behaviours, both physical and more interactive, and also looking for the student to be able to demonstrate the acquired knowledge and facts associated with the skill1617.However, having carried out the assessment plan, the author also learned that it is hard to assess students on their attitude and behaviour with clients. The mechanics of a procedure can be easily observed and evaluated, but the effect of being observed and assessed may affect the way the student nurse interacts with the client. The client is another factor which may affect this process as well, because the client/student relationship, particularly within a mental health setting, may not be well developed, and may be more surd to establish. However, it is this authors experience that the mentors approach, manner and preparation of the client and student can ameliorate this kind of difficulty considerably.Part Four The Teaching PlanThe teaching plan (see Appendix B) is based on two different theories. The first are the constructivist theories of learning, which suggest that people learn in an active way, and through this process, construct for themselves essential forms of reality, within which the pre-existing knowledge and reality assimilates any new learning18. The second theoretical basis for the learning plan is that of humanism, a theory which supports a more nursing-oriented approach to learning, focusing on self-development and on the individual becoming what they are capable of becoming through the learning process1920. There is, however, some argument that all of the theories discussed so far are eminently applicable to nursing education, because the process is cognitive and behavioural, and combines the acquisition of facts with the competent performance of key nursing skills. Knowledge underpins practice, and helps to develop clinical reasoning, but experience helps students to reconfigure their internal schema and their deeper thought of the world, albeit subjectively. The most important learning theory here which relates to nursing education and, in particular, to the learning which takes place in clinical practice, under the guidance of the clinica mentor, is Bandurafs Social Learning Theory21, because it seems to be the theory which best describes how adults learn within this context22.Banduras social learning theory, suggests that people essentially learn from observing and imitating each other in social situations, and that through this learning process, people model themselves on others, and learn from them not only how to behave, but also acquire attitudes, and an awareness of the probable consequences of the observed behaviours23. What this theory offers in particular to understanding how learning takes place in the clinical nursing context is a model which incor porates other influences on learning, including cognitive processes, the ways in which behaviours are modelled on role models, the effect of the learners personality, and the effect of the learning environment 24. This theory is helps mentors to understand the complexities of nursing competence and its development, which requires the combination of cognitive elements, some of which may be learned in a formal classroom setting, with the modelling of behaviours of student nurses on the mentors who act as their role models25. While it is clear that the clinical learning experiences of student nurses are key to development of a good knowledge base26 and proper professional competence2728,29, the quality of mentorship must be considered, because through social learning theory, students come to model themselves on what they are seeing practice30,31. This can present its own challenges, particularly when the students are not being supervised or taught by their primary mentor but by a blo od brother mentor32 33. There are those who argue that this is necessary, to expose students to different role models and behaviours, so that students can then develop their own critical thinking and judgement3435, through observing different forms of clinical reasoning36.The assessment processes built in to the mentoring relationship are a very important feature of learning and development, because student nurses must learn from any errors and omissions, and this continues on into their professional practice once qualified37. Learning to manage ones own learning and development, identify ways to learn from errors or difficult situations, within the practice setting, reflects the principles of social learning theory38. However, the author is also aware of the need for students to develop a realistic understanding of practice, and how the errors and challenges which can arise during their clinical work may be related to them not having the knowledge and skills needed to meet the need s of the clients39, and thus learning is about identified how to develop to meet those needs nursing l40. Ulitmately, becoming a nurse means the ability to meet the standards of the profession, through knowledge,41 skills, clinical reasoning, critical thinking and application of experiential and theoretical certainty to practice42, which is quite demanding for all those involved in the training of students. Ultimately, student nurses are socialised into their profession as well as being trained how to perform their role, 43, and while this in itself may not always be an ideal, because the organisational culture may not always be positive44, it is important for students to learn all aspects of the profession4546.Although there is always the possibility that nurses may learn good as well as bad behaviours, 47, a good mentor would support such students to develop the critical awareness and reflective skill to be able to identify the positive models and reject the negative models as pa rt of their learning journey48.Part five dollar billPersonal Development and Learning as a MentorThe process of learning to become a mentor has opened new vistas of experience and knowledge for me, as a nurse, as a mentor, and as a person. While it is challenging to hold up a mirror to oneself and appraise what kind of role model you are presenting to the students you are working with, this is a positive experience because it allows you to identify your own strengths, and honor them, whilst also identifying your weaknesses, and take steps to address these. In particular, for me it has demonstrated that while my practice is good, my understanding of some issues is not based on the latest evidence available, and working with students who ask about the evidence base for practice really motivates me to seek out that evidence. I have also become aware of my own tendency to make value judgements, labelling students good or bad, and I have examined the qualities which lead to these as we ll as overcoming this unconscious stereotyping. I learned that I wanted to empower students to take charge of their own learning49, but learning how to do this was a longer process for my own development.Learning about learning is also a process of self-discovery which is then applied to mentorship practice. Understanding assessment principles and learning theories has changed the way that I teach students and really given me insight into how assessment can best be carried out. It has also helped me to understand the terminology used within the clinical assessment documents. The need to develop better working relationships with the academic staff has also emerged as a feature to be applied to my future practice.Overall, this experience has shown me that mentorship, which can be onerous and demanding in the current clinical situation, is also an investment, in the future of the profession and in the future wellbeing of clients. It can enhance my own capabilities, and provide me with more opportunities to reflect and to reconsider my professional personal and competence. Ultimately, I aim to be a good mentor, but in order to do this, I must be a competent nurse. Therefore, the process has been a form of reciprocal learning.References 212337Andrews, G.J., Brodie, D.A., Andrews, J.P. et al (2006) Professional roles and communications in clinical placements a qualitative study of nursing students perceptions and some models for practice. internationalist daybook of breast feeding Studies 43 (7) 861-874.Andrews, M. and Wallis, M. (1999) Mentorship in nursing a literature review. journal of travel nursing 29 (1) 201-207.Bandura, A. (1977) Social Learning Theory New York General Learning Press.Bankert, E.G. and Kozel, V.V. (2005) Transforming pedagogy in nursing education a caring learning environment for adult students. nurse Education Perspectives 26 (4) 227-229.Bauer, J. and Mulder, R.H. (2007) model learning from errors in daily work. Learning in wellness an d Social Care 6 (2) 121-133.Brammer, J. (2006) A phenomenographic study of registered nursesf understanding of their role in student learning An Australian perspective. International Journal of breast feeding Studies 43 (8) 963-973.Chambers, D. (2007) Is the modern NHS fit for nursing students? British Journal of Nursing 16 (2) 74 75Chenoweth, L. (1998) Facilitating the process of critical thinking for nursing. she-goat Education immediately. 18(4)281-9Collins, M. (1991). Adult education as vocation. London Routledge.Cope, P., Cuthbertson, P. and Stoddard, B. (2000) Situated learning in the practice placementJournal of Advanced Nursing 31 (4) 850-856.DeCarvalho, R. (1991) The humanist paradigm in education. The Humanistic Psychologist.19 (1) 88-104.Doughty, R., Harris, T., and McClean, M. (2007) Tripartite assessment of learners during practice placements in midwifery pre-registration programmes. Education + fosterageEvans, R.J. and Donnelly, G.W. (2006) A Model to Describe th e Relationship Between Knowledge, Skill, and Judgment in Nursing Practice Nursing Forum 41 (4) , 150157Freeth, D. and Fry, H. (2005) Nursing students and tutors perceptions of learning and teaching in a clinical skills centre. Nurse Education today 25 272-282.Gonczi, A. (1993). Competence and competencies A global perspective. Paper presented at the First field Conference on Competencies in Nursing Adelaide Australian Nursing Federation (SA BrancGray, M.A.,and Smith, L.N. (2000) The qualities of an effective mentor from the student nurses perspective findings from a longitudinal qualitative study Journal of Advanced Nursing 32 (6) ,15421549.Hawks, J.H. (1992) authorization in nursing education concept analysis and application to philosophy, learning and instruction. Journal of Advanced Nursing 17 (5) 609-618.Hutchings, A., Williamson, G.R., and Humphreys, A. (2005) Supporting learners in clinical practice capacity issues. Journal of Clinical Nursing 14 (8) 945955.Jones, M.L., Walt ers, S. and Akehurst, R. (2001) The implications of contact with the mentor for preregistration nursing and midwifery students Journal of Advanced Nursing 35 (2) , 151160Knight, P. (1995) Assessment for Learning in Higher Education London Kogan PageLearning Theories Knowledge Base (2008) www.learning-theories.com Accessed 23-8-08.Letcher, D.C. and Yancey, N.R. (2004) Witnessing change over with Aspiring Nurses A Human Becoming Teaching-Learning Process in Nursing Education Nursing attainment Quarterly 17 (1) 36-41 .Lloyd-Jones, M., Walters, S. and Akehurst, R. (2001) The implications of contact with the mentor for preregistration nursing and midwifery students. Journal of Advanced Nursing 35 (2) 1510160.Mattila, L-R. and Eriksson, e. (2007) Nursing students learning to utilize nursing research in clinical practice. Nurse Education Today 27 568-576.McMillan, D.E., Bell, S., Benson, E.E. et al (2007) From anxiety to enthusiasm facilitating graduate nursing students knowledge develop ment in intuition and theory. Journal of Nurse Education 46 (2) 88-91.Mooney, M. (2007) Professional socialization the key to survival as a newly qualified nurse. International Journal of Nursing Practice 13 75-80.Myall, M., Levett-Jones, T., Lathlean, J. (2008) Mentorship in contemporary practice the experiences of nursing students and practice mentors. Journal of Clinical Nursing 17 (14) 1834-1842.Neary, M. (2000) Responsive assessment of clinical competence. Nursing Standard 15 (10) 35-40.Nehring, V. (1990) Nursing clinical teacher effectiveness inventory a replication study of the characteristics of ebestf and eworstf clinical teachers as perceived by nursing faculty and students. Journal of Advanced Nursing 15 (8) 934-40.Nixon, M., Morgan, L., Forsyth, J. and Ellis, D. (1996).A comparative study of teacher directed and self directed methods of teaching clinical skills to undergraduate nursing students. International Journal of Nursing Practice. 2(2) 88-93NMC (2004) Standards o f Proficiency for Pre-Registration Nursing Education procurable fromwww.nmc.org.uk Accessed 23-8-08.Nolan, C.A. (1998) Learning on clinical placement the experience of six Australian student nurses. Nurse Education Today 18(8) 622-9NMC (2004) Standards of Proficiency for Pre-Registration Nursing Education Available fromwww.nmc.org.uk Accessed 23-8-08.Phillips, R.M., Davies, W.B., and Neary, M. (2008) The practitioner-teacher a study in the introduction of mentors in the preregistration nurse education programme in Wales part 2. Journal of Advanced Nursing 23 (6) 1080-1088.Shin, K.R. (1998) comminuted thinking ability and clinical decision-making skills among senior nursing students in associate and baccalaureate programmes in Korea. Journal of Advanced Nursing 27 (2) 414-418.Stuart, C.C. (2003) Assessment, Supervision and Support in Clinical Practice London Churchill Livingstone.Tucker, K., Wakefield, A., Boggis, C. et al (2003) Learning together clinical skills teaching for medic al and nursing students. Medical Education 37 (7) 630-637Welsh, I. and Lyons, C.M. (2001) Evidence-based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice an empirical contribution to the debate. Journal of Psychiatric and Mental Health Nursing 8 (4) , 299305.Appendix AAssessment PlanCompetence to be assessed administration of depot injectionPlanCheck student knowledge and simulated technique prior to administration fig out student and client for procedure.Observe student and assess stated assessment points.Provide feedback to student.Assessment Points savant has checked prescription is correct pupil has checked prescription against client identity and care plan.Student has discussed procedure correctly and appropriately with client.Student has ensured client confidentiality and privacy during procedure.Student has discussed effect/side effects with clientStudent draws up correct back breaker, checks dr ug properly with qualified staff, and prepares to administer injection in correct site.Student performs injection with correct techniqueStudent communicates with the client appropriatelyStudent records procedure in appropriate records, correctly.Student ensures client is comfortable post-procedure.Student can discuss properties of medication, side effects, route, dose and any contra-indicationsStudent can discuss holistic care of the client.Appendix B11Footnotes1Andrews, M. and Wallis, M. (1999)2 Nursing and Midwifery Council (2004) p 8.3 Nursing and Midwifery Council (ibid) p 8.4 Mattila, L-R. and Eriksson, E. (2007) p 569.5 Phillips, R.M., Davies, W.B., and Neary, M. (2008) p 10806 Lloyd-Jones, M., Walters, S. and Akehurst, R. (2001) p151.7Bankert, E.G. and Kozel, V.V. (2005)8 Lloyd-Jones (Ibid) p 160.9 Doughty, R., Harris, T., and McClean, M. (2007)10Doughty et al (ibid)11 Myall, M., Levett-Jones, T., Lathlean, J. (2008)12Knight, P. (1995)13 Learning Theories Knowledgebase (2008) 14 Learning Theories Knowledge base (ibid).15 Learning Theories Knowledgebase (ibid)