Mentorship in Professional Practice - Essay Example

Mentorship in Professional Practice Introduction: Health care regularly come up with newer technological advances hence the personnel in it requirelifelong learning to maintain a skilled workforce. The nurses learn from the reflections of the outcomes of the job done. The lifelong learning requires inquiring mind, importance of self-fulfillment, freedom to learn responsibility for self and equality of opportunity (Hinchliff 1998). Lovelady (2000) also found that simply memorising the features and operation of equipment often results in inefficient handling of it in the ward, as the learning is not remembered in longer term. Hence the student should be taught in contextualised manner to develop cognition and comprehension. It is here that the mentor helps, guide and be a role model to a nurse student and facilitates learning through her own practice. The aim of the article is to discuss role of a mentor in assessing the learning abilities and fitness for practice of nursing students. The article is a discussion on developing competencies and accountability to fitness for practice as desired in the code of professional conduct clauses (NMC as in Stuart 2003). Definition and purpose of 'in practice' assessment: Howard and Eaton (2003, p46) refer assessment as "measurement of a candidate's level of competence in theoretical and practical nursing skills. The in practice assessment aims to judge a new nurse for at least minimum competence and skills required for patient care. The mentor/assessor should take care to take whole programme into consideration. The formative assessment is a mock assessment without pass or fail result. It is assessment of ongoing development of skills and applied knowledge where the student's progress is continuously monitored, it in fact is most important type of 'in practice' assessment. It leads to summative assessment, which is the final stage of a learning and assessment process and experience. The summative assessment has clear pass, fail or refer result on the basis of decisions made by formative assessment. The components of 'In practice' assessment are: competence developed, projects, case studies and expert witness testimonials, Objective structured clinical examinations (OSCE), oral assessment etc. The fair assessment requires on part of mentor assessor to provide following opportunities to the student: motivation to learn with enthusiasm,. Good relationship between student and mentor/assessor, The mentor /assessor should be relaxed and comfortable at the time of assessment and ensure that student understands what is required from him/her (Howard & Eaton 2003). The purpose of assessment is to ascertain whether the nurses and midwives are able to take good care of patients in safe and competent manner. The nurses should show fitness for practice and fitness of purpose by relating to changing needs of health care system. They should also develop fitness for award when the education fulfills needs of the profession and finally fitness for responsibility as the health care professional have a social contract between profession and the society. The mentor should keep in mind : In a clinical setting the student works alongside the mentor, she is learning and being assessed at the same time. The clinical assessment is based on direct observation of practice. Human observation has inherent biases and subjectivity, thus the assessment is inconsistent and unreliable. During the clinical practice student has to adapt to diverse settings. She has to interact with multitude of personalities viz. Other nurses doctors many patients differing in illnesses. While she is adapting she is also being assessed. The assessment of behavioural skills is difficult in changing and unpredictable clinical environment. Mentors are overburdened with assessment to many student nurses and clinical duties so only a faction of student's ability is assessed. There is theory- practice gap in nursing since nursing and midwifery are not exact science and health care workers need to modify according to need of the clients (Quinn 2000 & Stuart 2003). Factors determining effectiveness of assessment: The new nurse requires personal support (mentorship) which may also be directed teaching learning (preceptorship). Later they require more space and mentor's role is that of a facilitator, available on request (Jarvis & Gibson 1997). Daloz (1986 in Jarvis & Gibson 1997) defines roles of a mentor as: support by providing positive expectation, challenges by setting tasks with high standards and constructing hypotheses and finally the vision by providing a mirror, being a role model and preserving the tradition. Thus the mentor is a teacher, facilitator, guide, counsellor and also a role mode to her student on a one to one basis. The mentor has to cope up with two professions viz. that of an educator and of a clinical practitioner (Jarvis and Gibson 1997). Factors determining validity and reliability of assessments: The four cardinal criteria of assessment, according to Quinn (2000) are: validity, reliability, feasibility and discriminating power. Validity is measuring what is to be measured. It is important for a mentor to know how to measure and what is to be measured. Validity requires an appropriate method. The validity measures ability to care for patient, it may not do much with student's educational achievement. Reliability is the accuracy with which the test measures what it should measure. The reliability is based on consistency of student's performance, consistency of interpretation and agreement of interpretation between assessors (Stuart 2003). For an assessment to be valid and reliable, all assessors to judge in same way. The reliability depends on student factors viz. Lack of confidence, motivation or interest, fatigue, anxiety. The researchers feel that the student older than the mentor, from higher socioeconomic level and those speaking/appearing well were assessed better. Environmental factors such as variability of clinical environments and its busy settings also affect assessment by different assessors. The assessor factors viz. they compensate give allowances, e.g. a student performing difficult and complex task is given allowance as better assessment. Clinical settings are complex and variable and assessor need to make complex judgements. Assessor's negative presence makes student nervous while positive or encouraging presence makes her do the job well. The mentor is accountable to her conduct. She should supervise and assess following: personal standards of practice, standards of care delivery, what is taught, learnt and assessed, standards of teaching and assessing, professional judgement about student's performance code of conduct (NMC as cited in Stuart.2003). Briggs (1999) observed that in clinical practice there are many activities, which can not be measured in an assessment. Such non-assessable activities do not make part of mentor's final assessment and that is a bias against the student. Briggs (1999) also states that the mentor in a reflection of her own professional experience can only appreciate these non-assessable actions. The outcomes of assessment: The assessment is measure of ability of a nurse. Cree & McAulay (2000) emphasise that assessment measures the potential, achievement, attitude, aptitude and motivation of a student reflected as marks, grades or recommendations. Stuart (2003) finds that outcome of a theoretical and practical training should be ability of skilled and competent care to patients by the nurse.. The clinical teaching, learning and assessment are complex and require coordination between mentor and assessor. A mentor is role model for the mentee under her. Students who have worked alongside respected and knowledgeable practitioners developed enthusiasm and commitment. McLean et al (2005) observed that all students doing one given task successfully (reliability) is not sufficient to assessment, as there are always variations in the students' attainment and involvement of a mentor hence inconsistency and unreliability in the assessment. They show agreement with the Redfern et al. (2002) that the training should be judged on validity also whereby every student has to perform a different task individually and successfully, and not on reliability alone (McLean et. al., 2005). Philp (1983 as cited in Stuart 2003) stated that often a prior impression of the assessee affects the assessment. A positive impression gets a better assessment (halo effect) while a previous negative impression brings the student underrated assessment (Horn effect). Neary (2000) pointed out some mentors show authority over the student and a feeling of subordination for new learner comes. In such situation a summative feedback is given without soliciting the opinion of the student. Since the mentor is has accountability to increase competence of a student, she should do so by good interpersonal relations. Critical analysis of challenges: Butterworth, Faugier & Burnard (1998) The supervisor is taken as authoritative figure by the mentee which is a pity since mentoring is much wider and generous than that. It is basically a peer support, which is otherwise also done regularly on informal basis. According to authors supervision is taken as disciplinary act which again is not entirely true. The supervision aims to expand clinical knowledge and develop efficacy. It also helps to develop autonomy and self -esteem as a professional. The mentee has to realise that supervision does not aim for penalties but for personal and professional goals. It is a duty of mentor to develop reflective practice or deep learning (Gibbs 1992). The student should learn to apply knowledge to practice and generate ideas to solve tricky situations rather than feeling nervous or scared. Burns & Bulman (2000) also prefer reflective teaching in practice. The experience gained from current practice should be given critical thinking and open mindedness for application to the future practice. Failing a student: Stuart (2003) found that it is required of a mentor/assessor to legally and professionally set high standards of competence for self if not so it will be reflected in their assessment and pass on to future practitioners as well. They should pass only those students who have shown clinical competence. The mentor has special relationship with the learner but has a professional accountability as well. When the mentor has friendly or not so friendly relationship with her mentee, it may make her biased in assessment. The mentor should realise prior to assessment whether any superficial thought is affecting the assessment since a student's future depends on it. It is frequently advised that thus, mentor and assessor should be different persons. The transcultural nurses may battle with language limitations. They must learn basics of local language and nuances of communication in that Language (Bellack and Edlund 1992). The nervousness of these nurses may affect their learning adversely. The mentor in such case should have a friendly and genuine attitude to help her overcome this nervousness. System of support for assessor: The mentor, particularly a new one needs support from a colleague or peer. There must be regular meetings between mentors of different disciplines to gather support. The higher educational institutions also offer support to mentors and a new one should get access to it (ENB 2000 as in Stuart 2003). Jarvis & Gibson (1997) advise that peer assessment is also a good support for reflection on a mentor's work. The mentors assess each other under peer assessment and provide means for improvement. They also advise a new mentor to do self-assessment by putting in learner's place. Such assessment practices also help a mentor to decide future teaching plans. Conflict with the relationship between mentor and student: The conflict arises when there is theory -practice gap or difference of current practice from the earlier practice. A common occurrence in nursing. The mentor in such cases should facilitate the closure of these gaps by supervision and support and make student understand the current clinical practice. She should observe as to how the mentorship has influenced her own practice. In cases of conflicts, which may also be a decision to fail a student, the mentor should take help from Bond and Holland's (1998) Brainstorming or mind mapping. The latter is a very simple yet useful method. It requires you to write the issue in centre of a paper and encircle it. Write all other thoughts around the major issue and enclicle all theses. Connect all the thoughts with straight line to the central issue. Sit back and look at the map. Write wild and silly and connect it to the issue. Now arrange your thoughts on priority, importance basis and discard the ones you think useless. Conclusion: Caldwell and Carter (1993) define 'mentor' as a father or mother figure. Now -a-days mentor performs clinical duty and the new nurse watches her and learns. The mentor also guides students to clinical practice or they may decide a plan jointly. Mentoring or preceptorship is individualised teaching that makes new nurse to do transition from theory to practice and resolve any conflict to such a transition. The mentor socialises the student nurse to culture and operation of the hospital. The Mentor, through her own practice, teaches the student nurse to close the theory and practice gap for independent working in the hospital. It is an interpersonal relationship as well where the mentor guides her according to knowledge, competence and personal characteristics (Stuart 2003; Jarvis & Gibson 1997). REFERENCES Bellack, J. P. & Edlund, B. 1992. Nursing Assessment and Diagnosis, Jones and Bartlett. Biggs, J. (1999) Teaching for Quality Learning at the University, Buckingham: SRHE and Open University Press. Bond, M. and Holland, S. (1998) Skills of Clinical Supervision for Nurse,s Buckingham: Open University Press. Burns, S. and Bulman, C. (Eds.) (2000) Reflective Practice in Nursing: the Growth of the Reflective Practitioner 2nd Ed. Oxford: Blackwell Science Butterworth, T., Faugier, J & Burnard, P. 1998, Clinical Supervision and Mentorship in Nursing, Nelson Thornes. Caldwell, B.J. and Carter, E.M.A. (Eds.) (1993) Return of the Mentor: Strategies for Workbased Learning London: Falmer Press Cree, V. and McAuley, C. (Eds.) (2000) Transfer of Learning in Professional and Vocational Education. London: Routledge Gibbs, G. 1992, Improving the Quality of Student Leaning Plymouth: Technical and Education Services Hinchcliff, S 1998, 'Lifelong learning in context', In: Quinn, FM & Humphrey, J (eds.). Continuing Professional Development in Nursing: A Guide for Practitioners and Educators. Nelson Thorns. Howard, S & Eaton, A 2003, The Practitioner as successor, Elsevier Health Science. Jarvis, P. and Gibson, S. (1997) Teacher, Practitioner and Mentor in Nursing, Midwifery, Health Visiting and the Social Sciences. Cheltenham: Stanley Thornes. Lovelady, B 2000, 'Supervising the development of technical skill in new staff', In: Spouse, J. & Redfern, L. (eds.). Successful Supervision in Health Care Practice: Promoting Professional Development. Blackwell Publishing. McLean, C, Monger, E & Lally, I. 2005, 'Assessment of Practice using National Health Services Knowledge and Skill Framework', Nursing in Critical Care, vol. 10, no. 3. Neary, M. 2000, Teaching, Assessing and Evaluation for Clinical Competence: A Practical Guide for Practitioners and Teachers, Nelson Thornes. Redfern S. et al. 2002, 'Assessing competence to practise in nursing: a review of the Literature', Research Papers in Education Policy and Practice 17 (1), pp.51-77. Stuart, CC 2003, Assessment, supervision and support in clinical practice: A guide for nurses, midwives and other health professionals, Elsevier Health Science. Quinn, F. M. (2000) The Principles and Practice of Nurse Education 4th ed. ,Cheltenham: Stanley Thornes The Teacher Practitioner and Mentor in Nursing, Midwifery, Health Visiting and the Social Services: In Nursing, Midwifery, Health Visiting and the Social Services By Peter Jarvis, Sheila Gibson Published by Nelson Thornes, 1997 Reflective Practice in Nursing: The Growth of the Professional Practitioner By Chris Bulman, Sue Schutz Published by Blackwell Publishing, 2004 Read More

 

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