Clinical Mentorship in Nursing - Essay Example

Clinical Mentorship in Nursing Clinical Mentorship in nursing is followed by seven main tasks of supervision ly, the relationship task, the teaching/learning task, the counselling task, the monitoring task, the evaluation task, the consultative task and the administrative task. Training should incorporate elements from the body of research demonstrating the effective ways of teaching skills. By looking at the historical development of clinical nursing and supervision and then by reviewing research literature relevant to the training of supervisors, it is clear that a syllabus for 'clinical guidance/nursing' could probably be constructed from the information presented. Standards for Nursing mentorship includes the question of 'What makes a good nurse' followed by a debate about how such standards can be developed through theory and training. Clinical Setting Teaching and Assessment Traditionally clinical students learn skills through the experience of being supervisees, taking on the model presented to them by their supervisor, or by adapting the therapeutic skills learned in their training as therapists. While these methods have some merit they also have considerable limitations like bad practice can easily be handed down from generation to generation without some new import from an external source. While emphasising on teaching clinical setting, I would focus on one-on-one relationship initiated at the behest of the protege. This relationship is marked by high ethical standards and clear boundaries as both parties experience mutual benefits and personal and/or professional growth. Mentoring functions are carried out within the context of an ongoing, caring relationship between the mentor and the protg so I suggest that mentoring is not a single task or training episode, a group experience, or a preassigned relationship that is unidirectional in benefit. The relationship task would help me to lead the professionals towards engaging in the process of self-assessment. Self-assessment has the potential to empower both the mentor and the protege because each may recognise personal strengths and weaknesses and understand how these characteristics may affect the mentoring relationship. Furthermore, it allows mentors and proteges to appropriately and confidently establishes relationships with other like-minded professionals. (Black et al, 2004) If mentoring is to be successful, faculty members must be willing to participate in the relationship and to be informed about the responsibilities of it. For mentors the matter of concern is that they must balance the demands of their positions e.g., clinical caseloads, program responsibilities, teaching, research and service requirements with their availability to students as the impact of these factors affects the ability and desire of some mentors to form meaningful relationships with students. (Black et al, 2004) An analysis of the environment can alert mentors and proteges to the social and political norms of a setting. Conducting a systematic assessment will empower mentors and proteges to recognise and align their abilities, expectations, and responsibilities. Both can actively gauge their compatibility for this type of relationship based on factual information rather than on speculation. (Black et al, 2004) Clinical psychology graduates were surveyed and 38 per cent of trainees reported a major conflict with their supervisor, which inhibited their ability to learn from supervision. Therapeutic orientation, style of supervision and personality issues were the main areas of conflict. (Fleming & Steen, 2003) The Teaching/Learning Task Mentors need to be clinically competent and knowledgeable, and have good teaching and interpersonal skills, that's why I consider myself helpful in supervisory behaviours by giving direct guidance on clinical work, linking theory and practice, joint problem-solving, offering feedback, reassurance and role models. Trainees need clear feedback about their errors; corrections must be conveyed unambiguously so that trainees are aware of mistakes and weaknesses they may have. Ineffective supervisory behaviours include rigidity, low empathy, failure to offer support, failure to follow the supervisees concerns, being indirect and intolerant and emphasising negative aspects in the evaluation process. Teaching Methods Inskipp and Proctor (200la, 2001b) have produced a comprehensive manual for training that provides a wide range of creative suggestions for experiential learning. Hollo way (1999) offers a framework for supervisor training. Bradley and Whiting's model of supervisor training has four major goals: 1. To provide a theory or knowledge base relevant to supervisory functioning; 2. To develop and refine supervisory skills; 3. To integrate theory and skills into a working supervisory style; and 4. To develop and enhance the professional identity of the supervisor. (Bradley and Whiting, 2001:363) Inevitably the range of topics requires a range of teaching and training methods and should start from "Clinical Tools" including topics like Procedures, protocols, Guidelines to clinical practice, Standards of Care, Clinical Pathways and Innovative Practices. Scott et al. (2000) found that methods of conducting training vary across institutions and include didactic instruction, individual supervision, group supervision and assigned reading. They found that reviewing audio or videotapes of supervision sessions were used to a lesser extent. Using audiotapes or videotapes in supervisor training can be a valuable resource when used to explore and enhance relationship skills, given the importance of the relationship to supervisory practice. Supervisor trainers need to be very careful about what they offer in a training programme, with thought given to the model of supervision they are teaching and the way that good teaching mirrors that model. (Fleming & Steen, 2003) Didactic teaching will reinforce the notion that supervision is a didactic experience, modelling a relationship in which one person knows, and the other needs to learn, If supervisees are to become reflective practitioners (Schon, 1986), then both supervisors and trainers need to model those skills. Strategies for Implementation In order to implement the teaching theories of Nursing, these 12 strategies would be useful: 1. Review and assess the extent to which your instruction is evidence based. 2. Review current literature to find support for your belief that the teaching method you have adopted results in better outcomes. 3. Ask questions from the students about your current practice strategies. 4. Identify colleagues at your facility who have the same interest in the clinical question you are trying to solve. 5. Conduct a collaborative search for studies or systematic reviews in the specific area of your clinical question. 6. Analyse the studies from your search to decide if you have the "best evidence" to guide your practice. 7. Develop a practice guideline for your students using the "best evidence". 8. Establish measurable outcomes that can be used to determine the effectiveness of your guideline. 9. Implement the practice guideline. 10. Measure the established outcomes. 11. Evaluate the practice guideline to determine if your facility should continue or change it. 12. Develop a system for routinely sharing evidence-based literature. (Melnyk B., et al, 2000) Failure of Change Often the matter of concern remains the point that why, after introducing nursing theories into practice, nurses lose interest in them with such speed. Time and difficulty are important variables to consider when planning a change to theory-based practice. Hersey and Blanchard's (1977) framework has been adapted to illustrate these issues with regard to theory application. A change in knowledge about nursing theories would be relatively easy to obtain in a short time frame. A change in attitudes takes a little longer and is more difficult to achieve. A change by an individual to theory-based practice is more difficult and is time-consuming to achieve. Factors contributing to a failure to sustain change 1. Incomplete diagnosis 2. Starting off too fast; 3. Missionary zeal for the 'flavour of the month'; 4. Losing the senior sponsor; 5. Lack of steering from the steering group; 6. Proceeding too fast for people to absorb the consequences; 7. Demands for unrealistic short-term results; 8. Failing to evaluate benefits as they occur; 9. Not monitoring the boundaries; 10. Failing to get 'key players' in the right state of commitment and support; 11. Insufficient involvement of the people affected by the changes; 12. Insufficient resources allocated to maintain the change (Fleming & Steen, 2003) Change Process in Applying Nursing Theories Salanders and Dietz-Omar (1991) found that the introduction of a nursing theory represented a change in the philosophical orientation of the nurse. Earlier, Wright (1988) had argued that change would occur in any setting where a nursing theory is being adopted. On the authority of Robinson (1990), the adoption of a nursing theory is essentially a precursor to radical change. It is an explicit call to change practice. That is why, of course, so many of the proponents of the use of theories in practice are those who are at the forefront of change. They care about the nursing practice they offer and are constantly seeking ways to improve it. Therefore, it is not surprising that the literature dealing with the introduction of nursing theories into clinical practice tends to follow the various theories and strategies of change outlined above. However, Robinson's view can only be accepted with certain reservations. I am of the opinion that, without proper understanding and planning, the adoption of theory-based practice will not be a precursor to radical change. Assessing the Need for a Nursing Theory in Practice Applying a nursing theory to practice is a task that should only be undertaken after much preparation. Prior to its introduction, it is important to make sure that the theory is not going to replace a more appropriate one already in use. Therefore, it is essential to find out how good or bad the existing formal or informal theory is. Most of the literature stresses that the introduction of a nursing theory requires considerable time, dedication, commitment and support, both moral and financial. Efforts have to be made to ensure that all those who are going to be affected by the theory, including nurses, patients, their families and multidisciplinary colleagues, understand its philosophy and find it acceptable. It may also be prudent to assess the attitudes of clinical staff and patients towards nursing theories and towards change in general. Sharp (1991) states that attitudes are precursors of behaviour and a person's attitude may constitute a predisposition to respond to something in a negative or positive way. So, a negative attitude towards nursing theories and an unwillingness to change will influence the motivation to change and the acceptance of the change. Careful assessment of the environment is also important, as ward layout can sometimes thwart attempts to implement a nursing theory successfully (McKenna, 1997). However, the resources required to make the environment more receptive to theory-based practice may be difficult to obtain when there are increasing financial restraints and when existing services are stretched to the limit. Implementing the Change to Theory-Based Practice Salanders and Dietz-Omar (1991) maintain that the first major step in implementing a nursing theory is to have formal and informal educational sessions. This will help the ward staff to become familiar with the theory and give them the skills necessary to apply it. According to Dyer (1990), this will make it meaningful to them and help to minimise their fears and anxieties about the new theory. Although there are wide-ranging opinions, there is a dearth of sound research studies available, which have examined how nursing theories affect client care. More studies need to be done and those few which have been done require replication. The use of methods such as action research, phenomenology and quasi-experiments to note the results of implementing theories must be seen as a legitimate use of research funding and researchers' time. From the research that does exist, it would appear that to look favourably on the utilisation of theory is to look favourably on quality of care. It could be argued that one nurse applying theory to improve the quality of client care is of more value than dozens of nurses developing theories, which are not tested and will never be applied in practice. This may appear to some to be heretical, but the mere existence of theories cannot alter client care; they have to be used to be effective. (McKenna, 1997) References Black L. Linda, Medina Sondra & Suarez C. Elisabeth, (2004) Helping Students Help Themselves: Strategies for Successful Mentoring Relationships in Counselor Education and Supervision. Volume: 44. Issue: 1. Bradley, L.J. and Whiting, P.P. (2001) Supervision training: a model, in L.J. Bradley and N. Ladany (eds) Counselor Supervision: Principles, Process, and Practice (3rd edition), Philadelphia, PA: Brunner-Routledge. Dyer, S. (1990), Nursing models: teamwork for personal patient care, Nursing the Elderly, 1(5): 28-30. Fleming Ian & Steen Linda, (2003) Supervision and Clinical Psychology: Brunner-Routledge: New York. Holloway, E.L. (1999) A framework for supervision training, in E.L. Holloway and M. Carroll, Training Counselling Supervisors, London: Sage. Inskipp, F. and Proctor, B. (2001 a) Making the Most of Supervision (2nd edition), London: Cascade Inskipp, F. and Proctor, B. (2001b) Becoming a Supervisor, London: Cascade. McKenna Hugh, (1997) Nursing Theories and Models: Routledge: London. Melnyk ,B et al. "Evidence based practice: The Past, the Present, and Recommendations for the Millenium", Pediatric Nursing 26(1):77-80, January 2000. Scott, K.J., Ingram, K.M., Vitanza, S.A. and Smith, N.G. (2000) Training in supervision: a survey of current practices, Counseling Psychologist 28 (3): 403-422. Schon, D. (1986) Educating the Reflective Practitioner, San Francisco: Jossey-Bass. Sharp, T. (1991), 'Whose problem' Nursing Times, 87(3): 36-8. Salanders, L. and Dietz-Omar, M. (1991), Making nursing models relevant for the practising nurse, Nursing Practice, 4(2): 23-5. Read More