Mentoring in the Clinical Setting - Essay Example

Running Head: Mentoring in the Clinical Setting Mentoring in the Clinical Setting Practice enhancement and facilitation of learning for nurses is vital. Nurses are optimistic to boost their practice and thus attain professional development. According to- LILLIAN M SIMMS (Professor of Nursing Emeritus of The University of Michigan) "To accelerate the delivery of essential health services to the people of the world, particularly underserved populations, the transformation of the nursing profession is critical, and professional nurses must assume roles as leaders and active participants in change. 'Nurses must master the skills of visionary and strategic thinking to have an impact on institutional and political forces that control health development. The emergence of the phenomenon of transformation is providing a rare opportunity for nursing. Transformation provides a scenario for a new way of interacting, a new way of problem solving, and a means to developing a shared vision among health professionals in various settings". Quality care and cost containment are the expected norms by both providers and consumers in today's health care system. The evident and rapid changes in the past few years demand that hospital management and nurses provide competence in service delivery, in addition to the safe development and learning environment of the nursing graduates in providing nursing care (Mandin, H., Jones, A., Woloschuk, W. and Harasym, P. 1997, 173-179). Nicklin and Kenworthy (2000) stated; that an effective manager is paramount to a good learning environment. Thus, role of mentorship and supervision play very important role for the learning environment. Effective supervision also necessitates quality assurance, clinical governance and proper audits. The term mentoring has become a popular term in a range of professions and has gained escalating use in nursing clinical education (Morton-Cooper A, Palmer A, 2000). Clinical governance can be defined as 'a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish' (DOH 1998). More simply put clinical governance is 'the means by which organizations ensure the provision of quality clinical care by making individuals accountable for setting, maintaining and monitoring performance standards,' (DOH North Thames Regional office 1998). In usual circumstances, nurses are anticipated to use self-awareness and be cautious in monitoring their own behavior; precisely assessing one's own boundaries can be hard. similarly, as peer debriefing (Melia et al., 1998; Rushton et al., 1996) offer opportunities for self-reflection, nurses might be sensitive concerning discussing their clinical "secrets" with peers for fear of being judge. though, while clinical experiences as well as challenges (including secrets) are conversed with an empathic listener within the safe sphere of clinical supervision, nurses are capable to use self-reflection and introspection to full-grown and develop within their professional care giving roles. Talking about issues contiguous boundary crossings as well as infringements takes away the power intrinsic in the secrecy, or as Simon (1999) has inferred, it "bursts the bubble of enthrallment" (p. 45). In this observe, then, clinical supervision is viewed as a primary tool for managing risk. devoid of regular practical supervision, nurses and other clinicians can without difficulty descend into boundary problems (Cindy A. Peternelj-Taylor, Olive Yonge; 2003). Peplau (1952) was an early supporter of clinical supervision in nursing. unluckily, clinical supervision in nursing is hardly ever formalized as in other disciplines, and numerous nurses in practice these days still lack sufficient clinical supervision. Durkin (2000) has suggested that working with managers and the performance-appraisal process can help nurses with supervision boundary issues. conformist wisdom, though, dictates that for supervision to be really effective it must be commenced by someone other than one's direct supervisor, for the power discrepancy that exists robotically places the nurse in a place of susceptibility. Instead, clinical supervision must be undertaken as a formal process whereby the supervisee-supervisor relationship is embraced to help the supervisee in managing the sentiment of care giving and the convolutions of boundary maintenance. Clinical supervision can expect and commence possible boundary infringements by intervening while signs of boundary corrosion appear, and more significant perhaps, to put up on the idea that apparently unimportant acts (i.e., boundary crossings) can show the way to a succession of unethical patterns of behavior through the measured erosion of treatment boundaries (Cindy A. Peternelj-Taylor, Olive Yonge; 2003). Moreover, for quality assurance clinical practice guiding principle that support professional standards and offer guidance concerning clinical, ethical, and legal issues can offer staff and management with control concerning boundary maintenance. though guidelines for each possibility are unlikely, context-specific theoretical situations can be used to arouse exploration and consideration of conflicting views and provide recommendations for practice. Such strategy would replicate a practical approach and take into contemplation the convolutions of the treatment environment, the nature of the clientele, and the capability of the clinicians (Fisher & Goldsmith, 1999; Gallop, 1998b). As a clinical risk-management strategy, Love (2001b) further advocates orientating clients to the rationale of boundaries in curative relationships. Not simply are clients thus informed about what is appropriate and inappropriate within the circumstance of the therapeutic relationship, although nurses and other therapists also are in a place of constantly having to observe the meaning of boundaries from a personal and a professional viewpoint (Cindy A. Peternelj-Taylor, Olive Yonge; 2003). Clinical audit is conceivably the best acknowledged example of the wider group of clinical efficacy activities. It defined as the methodical and vital analysis of the quality of clinical care. This comprises the actions used for diagnosis and treatment, the allied use of resources as well as the consequence of care on the outcome and excellence of life for the patient. The major function of mentor also includes clinical audit to develop patient care by notifying healthcare professionals' considerate of their clinical practice. This is typically attained by setting standards, determining current performance against those standards, recognizing shortfalls and putting in place any required action. As standards change, re-audit will become required. Clinical audit must be seen as an incessant process by which clinical practice and patient care can be enhanced. Basically, Mentoring is a process that increasingly used in management development and the skills and techniques learned on the management development programme are put into practice through the support and help of an experienced manager back in the workplace (Allery, L. A., Owen, P. A., & Robling, M. R. 1997, 870-4). Thus, they are also liable to have evidence based health care and efficiently manage changes. Evidence based health care means using scientific rigor to appraise evidence from a wide range of sources to best benefit the patient or delivery of healthcare. Evidence based health care as a discipline will require mentor to understand where to find the best evidence, to be able to critically appraise the evidence and to understand how that evidence is relevant to an individual, and to be able to communicate this knowledge in an appropriate way, to individual patients as well as the wider healthcare team. In the pursuit of accurate decision making, evidence should be taken from all sources: scientific papers (qualitative and quantitative), as well as narrative and clinical experience, appraised for its relevance, and then applied to patients, careers and doctors. And managing change provides current, cutting-edge information to guide nurses who are responsible for managing change in our health care system. Project 2000 was an educational model intended to prepare nursing students to be more able to deal with changing health care demands and provide quality care upon registration. Since it was implemented in 1989, abundant feedback concerning the programme's strengths and weaknesses suggests that practical constraints often meant that the sought after transformation of nurse education has been less radical in operation than planned - especially with regard to its defining attribute student-centeredness. substantial numbers of nursing students in the common foundation programme were being taught in single large groups. Many students, understandably, find the prospect of asking a question in the presence of a sizeable audience too daunting - and are thereby denied the opportunity to participate in their own learning. Similarly on the other side of the equation, teachers 'have to predominantly lecture to large groups rather than being able to use smaller group methods' (Durkin, N. 2000). These observations demonstrate that structure tends to determine function. An obvious example is the way in which the physical structure of a lecture hall is designed to enable everyone in the audience to see and hear the lecturer - not each other. Attempts to insert student-centered functions forcibly into structures which are purpose-built to optimize the traditional educational paradigm of teacher-directed lectures and textbooks are fraught with difficulty. In clinical practice, Care (1996, 27-30) describes importance of supervision and mentorship from three points of view: an organizational phenomenon, a structural role and a type of interpersonal relationship. The organizational phenomenon. The mentor is given the authority to introduce the RN to the culture and operation of the hospital, thereby assisting with socialization of the employee. The hospital culture is unique, and through this process of socialization the RN may be made aware of the prevailing attitudes and values of the organization. Structural role phenomenon. With this aspect, primary emphasis is on the role development of the RN (Freeth, D., Nicol, M. 1998, 455-461). The mentor uses his/her professional experience in the work environment to guide the registered nurses in bridging the gap between theoretical knowledge and clinical practice, thereby increasing his/her level of independent functioning. Interpersonal emphasis. Where the emphasis is interpersonal, the mentor nurtures the nurses. This relationship is described as similar to that of a parent-child relationship. The older adult nurtures and educates the immature, younger individual. The effectiveness of the mentorship program can be related to the kind of relationship the mentor establishes with the nurse (Kerry T, Mayes, 1995). The supervisor has the power and responsibility to judge, evaluate, and influence the status of the clinical settings. Another aspect of supervision becomes highlighted by using its Swedish equivalent, "handledning", which means "to lead by the hand", to help a younger, less experienced, less skilled, less knowledgeable colleague, candidate, or trainee to gain knowledge, skill, and experience (Freeth, D., Reeves, S., Goreham, C., Parker, P., Haynes, S., Pearson, S. 2001, 21, 366-372). Thus in this environment, the supervisor may be perceived as a teacher, tutor, mentor, or someone to relate to, rely upon, and identify with; alternatively he might be experienced as judging or controlling in the interest of the trade or the body of professionals, or as a delegate of the "institution"(Clarke, B., James, C., & Kelly, J. 1996, 171-180). The major task for supervision is to create a setting in which the capacity to learn can develop. To achieve such conditions is not easy and can be complicated by the nurses as well as by the supervisor. How can supervision enhance and safeguard the difficult task of learning, to help the nurses to understand the patient and his own involvement in the intricate interaction that evolves between patient and nurses therapist and between nurse's therapist and supervisor Is there any one way to do it, or are there as many ways as the interactions or even episodes that one studies This uncertainty is further aggravated by the as yet unanswered question of whether we adjust our working strategies to the particular problems or impose our favorite strategies to confront them. Human understanding and ways of dealing with tasks and problems depend on, are influenced by, and are expressions of mental "structures" (Lichstein, P., & Young, G. 1996, 406-9). A cognitive style, which is a stabilized disposition of perception and cognition; a working style, related to the selective use of basic concepts and theories; and the defensive style, composed of character traits, transferences, counter transferences, counter-resistances, counter identifications, and so forth are a difficult task to depict these structures and to understand how they aid or hamper the process of learning and teaching. The teaching of health care professionals involves training in autonomous function. Mentorship is focused on exhibiting skills in one professional area. Health care professionals are trained to think critically about their profession's segment of a complex problem. This is the way that most schools of health professions have been structured. Perhaps this is because this makes it easier for educators in those schools to assure that "the core body of knowledge" for their discipline is maintained. Educational institutions are not structured to encourage cross-departmental teaching because it involves a potential loss of resources. Also, cross-departmental evaluation often involves a perceived loss of control. The training of health care providers such as (e.g., nursing assistants; licensed practical nurses; associate degree nurses; diet technicians; and activity, occupational, and physical therapy assistant is primarily technical. Because of the technical nature of their training and the fact that they have to learn so many methodologies in such a short time, they learn to accomplish the routine procedures they are expected to perform on a daily basis. In other words, they learn to deal with simple common problems. Clinicians with more training will learn to deal not only with common simple problems, but also with "their part" of a common complex problem. They will not define a complex problem as complex because that would suggest they might have to deal with other disciplines to solve it. They will also see solutions as certain because to imagine the ambiguity would threaten their identity as a practitioner in a specific field. Instead, they are taught to see a portion of a complex problem as their problem, in effect making a complex problem simple so they can address it. There is no time to learn the type of interdisciplinary thought processes that must go into framing and solving uncommon complex problems, especially problems that are also ambiguous. There is no time to learn about the complex decision making that can create a true resolution to such an issue. Thus, It is essential to establish a good "learning alliance" in supervision. This is based on the mutuality of goals in work that are dearly stated as well as experienced by both nurses and supervisor. The supervisor has to be "holding" and "containing" towards the trainee. By holding, I mean the establishment of a phase-specific security in the working relationship; by containing, I mean the provision of an emotional and cognitive "space" to enhance the nurse's recognition and understanding of his conscious and unconscious experiences of interacting with the patient. The keeping of the frame in supervision and observing the consequences of breaking it is of crucial importance to be able to comprehend the complex interaction between patient, analyst, and supervisor. Frame has stationary aspects, such as agreements on goal, payment, and methods, and general rules for supervision as well as for the supervised therapy; and a mobile aspect, which is the continuous reflective review of doing the work together. Among supervisory techniques described in the literature are: - structuring the supervisory and/or therapeutic interaction directly and indirectly; - giving information on principles, dynamics, and technique; - clarifying, by calling the trainee's attention to some gap or ambiguity in his observation and/or understanding; - reformulating and checking preconceptions; - confronting the trainee with misconceptions, distortions, warded-off counter transference reactions; - Exploration in relation to content of the ongoing process, or of the ongoing relationship; - expounding, such as supporting, informing, summarizing; - giving general technical or strategic suggestions; - discussing the formulation of goals for the actual treatment; - directing the trainee, and prescribing strategies for future sessions. (Rudmann, S. V., Ward, K.M., Varekojis, S.M. 1999). The mentor can be questioned about his aims, intentions, and concerns as well. Learning is more subtle: it is difficult to determine if it has occurred, if it is functional, and if it is an illusory "reduction of cognitive dissonances"(Moore, S. M. et al., 1996, 165-187). The following statements can define the main assumptions concerning learning: - According to a basic assumption, humans organize their actions to reach certain goals in accordance with their interpretation of a specific situation; - Learning is directed, or at least strongly influenced, by the existing internal structures; - Conscious and unconscious intentions as well as the security principle and the use of psychological defenses interfere with the processing of information; - Aspects of learning that are related to imitation and identification is influenced by the quality of object relationships. (Rudmann, S. V., Ward, K.M., Varekojis, S.M. 1999, 109-112) The distinctive character of knowledge is organization, dependent on operations belonging to various developmental levels. One expects that trainees learn in two ways: assimilative and accommodative. Assimilative learning means that the new information is added to the previous, thereby increasing already existing knowledge. The therapist can add newly gained experiences, observations, information, and theory to those he already has, which then become enriched, differentiated, and consolidated. Accommodative learning means that encounters with new information result in a fundamental modification of existing cognitive schemata, so that the new encounter can be dealt with. To deal with the information, the trainee must actively engage himself in warding it off or "accommodating" to it by restructuring previously held knowledge, points of view, and theory (Zwarenstein, M., Reeves, S., Barr, H., Hammick, M., Koppel, I., Atkins, J. 2002). The correct type of learning and orientation environment is extremely important in assisting the RNs adapt to the real world practice of nursing. When the orientation program is not individualized, stressing instead the institution's policies, procedures and formal lines of communication, it neglects the ongoing practice needs of nurses in the workforce with limited unsupervised clinical experience. Following a centralized orientation program, the graduate arrives in the ward where clinical, social and organization learning needs are often undertaken informally and inefficiently by nursing staff. Implementation of a mentorship program will decentralize orientation and provide opportunities for the graduate to integrate theory and practice. Time limits need not be strictly enforced; the mentor and nurse would work together while a need was perceived. The time could vary in length from a few weeks to several months (Freeth, D., Reeves, S., Goreham, C., Parker, P., Haynes, S., Pearson, S. 2001). The unit benefits by a mentortorship since it maintains quality of learning and efficient nursing care. The nurses are assisted, at ward level, by the mentor in his/her role transition from a student to a registered nurse. The integration of theoretical and clinical components of orientation is fostered by the one-to-one nurse and mentor approach. The mentor accomplishes clinical orientation more quickly and less stressfully than traditional methods. Supervision, combined with a support mechanism as offered by the mentor, aids in the consistency of clinical experiences and recognition of individual learning needs of the nurses (Mandin, H., Jones, A., Woloschuk, W. and Harasym, P. 1997). Skills and knowledge are developed by the RNs, while he or she maintains confidence in delivery of care, therefore becoming a more effective member of the ward; the mentor has potential to promote early confidence and to generate the positive, enthusiastic attitudes so essential to good staff morale. The mentor role is one of responsibility. It also has advantages for the nurse, and the hospital. There are rewards and satisfaction in the role of the teacher and model for the nurse when selected as a mentor. The mentor role increases the registered nurse's self-esteem, as he or she is being recognized for clinical expertise, teaching ability and professionalism. Due to this additional challenge of mentoring, it leads to an increase in job satisfaction. Another advantage of the mentor role is that it provides a mechanism for development of senior staff. Mentors reported that the mentoring experience promoted their growth and development by strengthening both their clinical and interpersonal skills. They saw this experience as a means of enhancing their professional practice as a mechanism for clinical advancement without assuming a traditional management role. Finally, a mentor benefits the hospital by acting as a recruitment tool. RNs are attracted for their initial working experience since the scheme offers a thorough clinical orientation. The mentor, when implemented in the hospital, offers the RNs a 'competent role model who is involved on a daily basis in decisions, processes, and protocols of patient and unit management, and who is able to derive satisfaction from the work setting without extensive role deprivation or frustration.' A mentor teaches practice nurses to use a wide variety of skills and techniques to take care of patients. A problem-solving or nursing process approach is generally accepted by professional and educational groups; practice, licensing, and accrediting bodies; and the institutions where nursing is practiced as an appropriate framework for nursing practice and activities (AMH 92, 1992; Holloway, 1993; Hudak, Gallo, and Lohr, 1990). This approach includes assessing and diagnosing patient problems, planning and goal setting for individual patient needs, intervening for each problem, and evaluating results. Pain and anxiety are examples of patient problems for which nurses might intervene. In hospitals, nurses might be involved in direct care of patients, management, teaching, research, or consultation regarding patient care. Nursing roles in hospitals may also encompass coordinating the multiple services involved in patient care. Mentors should provide a supportive environment that enables the nurse to develop his/her advanced clinical practice in the specialty area of nursing, and in relation to the delivery of services to explicit populations. (Burns, Nancy & Grove, Susan K. 1997, 53- 57) Moreover, Supervision generally produces other benefits for the nurses. While the nurse instigates to explore other significant relations in and around the patient's life she mightbecome conscious of other intrusion which would take about societal and personal alteration. Supervisor teaches the nurses the prospect to become aware of numerous things by forming a relationship within which the nurse's impulsiveness and originality can appear as they enthusiastically concretize diverse relationships and instigate to discern through this procedure somewhat of the complication of an individual's life (Bernard, J.M. 1998). Conclusions Thus, in clinical setting supervision or mentorship is for the reason of enhancing professional functioning. There are numerous good descriptions of clinical supervision. The purpose of supervision or Mentors is to provide a supportive learning environment that enables the nurse to develop his/her advanced clinical practice in the specialty area of nursing, and in relation to the delivery of services to explicit populations. Mentors teach nurses how to use a wide variety of skills and techniques to take care of patients. Among them is Problem- based learning that helps nurses to cope different problems in different situation. 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