Mentorship in Practice - Nursing - Essay Example

Mentorship in practice – Nursing – level 3 Topic: Reflective Analysis Aim: To enable health professionals to develop a critical understandingof the process of mentoring in practice, and apply knowledge and skills appropriately in order to maximize learning in the practice environment, through a continuous process of quality enhancement. Competencies: 1. Critically reflect on the components of supportive human relationships in order to enable students to adapt to the learning environment and maximize learning. 2. Review the oppurtunities created for the learner to identify and undertake experiences to meet their learning needs. 3. Demonstrate a good learning of the theories underpinning assessment and apply these in the achievement of learning, making judgement about the achievement of learning outcomes. 4. Develop, implement and programmes of learning in the relevant work environment. 5. Reflect on the quality of learning by maintaining an environment where change can be supported. Reflective Analysis Preparing nurses to work in highly technical and demanding environments is a challenge today. The need for experienced nurses far exceeds the supply. This calls for continuous coaching and mentoring of nurses. Nurses are confronted with the need to remain updated with the latest technical skills. They are faced with anxiety and remain under pressure to keep up with the changes. Classroom lectures are insufficient and lack interaction. Learning should be an active process with active participation of both the student and the mentor alike. The mentor has to, at all times, urge and motivate the learner to participate in the process of education; to make the learner responsible for their own learning. Knowles defines contract learning thus: "Contract learning is, in essence, an alternative way of structuring a learning experience: It replaces a content plan with a process plan." Malcolm S Knowles (1991, p.39). While the learner faces a challenge to remain updated with the latest skills the mentor faces the challenge to provide an environment that provides active learning. In today’s situation unless the learner is actively involved he tends to withdraw. This has far reaching psychological impact on the overall learning process. Joseph R. Codde, Ph.D., Associate Professor, Michigan State University quotes Knowles in his abstract saying that “Contract learning is an alternative way of structuring a learning experience: It replaces a content plan with a process plan (Knowles, 1986). According to Knowles (1980), contract learning solves, or at least reduces, the problem of dealing with wide differences within any group of adult learners. Characteristically, in our field we get people with widely varying backgrounds, previous experience, interests, learning styles, life patterns, outside commitments, and learning speeds. Didactic teachers usually cope with this situation by "aiming at the middle," with the hope that those at the lower end will not get too far behind and that those at the upper end will not get too bored (Knowles, 1980). The solution is to help students structure their own learning. We can meet the needs of these widely varied students by the use of learning contracts”. Learning contracts when set up carefully offer benefits both for the clinical mentor as well as the newly qualified staff nurse. Didactic teaching has also been stressed upon by Jarvis as cited in the editorial by Joe Bouch on “Continuous Professional Development for Psychiatrists: CPD and learning”. “Reflective learning based on one’s personal experience is a key feature of adult learning” (Jarvis 1995 cited in Joe Bouch’s article 2003). Contract learning involves strategy, negotiation, learning objectives, resources and evaluation. For a continuous progress, for participative learning, constant reflective analysis has to be done on what has been learnt. The ability to relate is of utmost importance, be it in the clinical or the non-clinical area. The mentor – learner relationship has to be given time to develop even outside the class room. Workshops, where the learner is given the task to prepare and present a report or views or gather information helps in building the confidence in the learner. The learner has to be made to understand the need to learn – its benefits and the disadvantages in case of failure. At this point it is necessary for us to understand the meaning of the word ‘mentor’. A mentor is one who is a wonderful source of advice and information and not merely a teacher. The mentor understands the needs of the learner at all times and helps instill self confidence in the learner. It is the responsibility of the mentor to make the learner get involved in the learning process and recognize their responsibilities. The mentor has to guide the learner through problems and difficulties and help find solutions. Eye to eye contact is another wonderful way to build a relationship. The concept of mentoring has a long history, one that comes to us from Greek mythology. In Homers Odyssey, Mentor was the teacher of Telemachus, the son of Odysseus. But Mentor was more than a teacher. Mentor was half-God and half-man, half-male and half-female, believable and yet unreachable. Mentor was the union of both goal and path, wisdom personified (Daloz, 1983- cited in Mentor teacher Chapter 1). The mentor too derives great satisfaction when the learner benefits and the results are evident. The mentor may also be fulfilling a desire to contribute to the growth of a new staff nurse. A mentor is expected to have excellent communication skills, a positive approach, sympathetic to the younger nurse and her concerns, a role model, and a friend. Mentoring also helps the senior nurse to understand the healthcare system and its needs. The concern that the mentor would have for the younger nurse or the learner also impresses and instills upon the learner to inculcate these qualities in her self. This would naturally have a very positive effect on the young nurse’s professional career. As the mentor is in close touch with the learner, the mentor is the only one who can decide upon the learner’s achievements and the outcome of the training. Nursing students come from diverse backgrounds and at this point the role of the mentor is crucial. Learning environment is as vital as the mentor herself. Overseas registered nurses come in as senior carers and need mentoring. They have to be first made to feel comfortable in an alien environment before they can start honing the nursing skills. It can be such a trying time initially that the learner may quit out of frustration. “Mentoring to me is having someone help guide you through the ups and downs of what happens in nursing, especially in that first year,” said Kathleen Reeves, MSN, RNC, clinical assistant professor at the University of Texas Health Science Center in San Antonio and a clinical nurse specialist at Methodist Healthcare System. The nursing courses are supposed to prepare confident, competent nurses able to keep pace with the changing environment at the NHS. The mentor serves as the bridge between the theory and practice as more than half the course is practical in nature. Motivation and enthusiasm of the mentor has a great role to play in the development of the learner. The mentor cannot push for immediate changes. The environment and the mentor’s attitude should lead the learner towards the recognition of her own capabilities and responsibilities. Initially, the students do find it difficult to adapt to the learning environment and the clinical procedures. The clinical practice provides students with the opportunity and privilege of direct access to patients or clients, opportunities to take responsibility, work independently and receive feedback on the practice. A congenial environment helps them to understand the integrated nature of practice and to identify their learning needs. It also helps to stimulate the learner and to acquire the skills critical to the delivery of quality patient and client care. A mentor needs to have the skills to provide students with clinical support to help them in reflecting upon their practice and enable them to become safe, caring competent nurses. A quality clinical learning environment is influenced by dynamic democratic structures. The staff has to be valued, highly motivated and deliver quality care to the patients. Good staff morale, team spirit, excellent interpersonal relations between the registered nurses and the students help the new learner to settle down comfortably. It should be an atmosphere that everyone can trust, where policies, procedures and guidelines are laid down and adhered to. It should be able to transform the learner into competent decision makers, willing to take personal and professional accountability for evidence based nursing care. A supportive learning environment provides the intellectual, social and physical conditions in which effective learning can occur. Policies and practices should be designed to foster in students the knowledge that they can be successful autonomous learners and support the development of a confident approach to learning and a desire to achieve well. This means, for example, that students should feel challenged and able to take sensible risks in their learning in the knowledge that the errors, which may result, will be regarded a necessary, acceptable and often helpful part of learning. Furthermore, learning environment should range of resources, including space and equipment, print and other materials and useful technology. “For (Continuous Professional development) or CPD, it is reflective learning that is of key importance, with its emphasis on applying knowledge to practice. Some Colleges have formalized reflective learning by crediting ‘reflective notes’ (i.e. a written account of personal reflections following a significant educational experience) with ‘continuing medical education points’. By establishing peer-group review as the central CPD mechanism, our own College has raised the standing of reflective learning considerably higher”, says Joe Bouch. When educating the healthcare professionals there is a statutory duty to ensure that the professionals are trustworthy. The public or the patients have a right to know that the new entrant is competent and safe to a certain acceptable level. Jarvis & Gibson (1997, pg. 115) state: Whilst it is common practice for institutions of higher education to assume responsibility for admitting new learners to the profession based upon the outcomes of all aspects of the qualifying examinations, the professional associations or the statutory bodies still retain the responsibility for accrediting these institutions. Having been accredited much of the responsibility of both preparing the students in the professional practice situation and assessing them in it rests with the mentors/assessors. It is they who, as a result of their own experience and education, may recommend that specific learners should be accepted into the profession. The mentor has to keep a regular record of the progress made by the learner/nurse and should be familiar with the techniques of assessment. Jarvis & Gibson (1997) describe 5 basic requisites that should be undertaken when assessing students (cited in the website of the University of Birmingham, School of Health Sciences): 1. Look Mentors/assessors should observe their students whilst practicing. This need not be formal or overt but the mentor/assessor needs to be aware of the students actions. 2. Listen Students will often provide information to mentors/assessors about their learning needs and attitudes. 3. Listen Patients, carers, colleagues and other members of the multidisciplinary team may all have comments about the students. The patients/carers opinions are often the most valid, they may not understand the intricacies of professional practice but they are the recipients of care. 4. Discuss This is part of the diagnostic process and a way of checking the students understanding. Not all aspects of practice can be observed but by discussing elements of practice, knowledgeable competence can be proven. 5. Decide A conclusion has to be reached and this should be a result of the above 4 processes, especially discussion. If you are in doubt a second opinion should be sought. Throughout the assessment process it is important to make the student feel supported and at ease with the situation. The assessor should ensure the student is ready to be assessed; discussing the students self-assessment can facilitate this. The student should be thus prepared to be able to identify her own strengths and weaknesses and seek support accordingly. Apart from this responsive assessment is a new concept continuous assessment of clinical competence, as developed by Dr. Mary Neary, Professional Tutor, School of Social Sciences, Cardiff University. It is based on the perceptions of the skilled practitioners and students of their own experiences. It consists of semi-structured focused interviews. It emerged from the study conducted by Dr. Neary that while the students appreciated the need for continuous assessment, they desired a change in the way the continuous assessment booklets were used and written. It was also found that students and assessors hardly knew the detail of the assessment criteria or how to interpret them. Some assessors even fostered student competition rather than student collaboration. Continuous assessment was created to evaluate performance over time, to reach acceptable standards but it was revealed during the study that the students and the mentors devised their own objectives, deviating from the objectives set by the institution. Studies have revealed that mentors tend to overpower the students and brush aside all that they may want to convey. This leaves the learner disheartened and makes her want to run away or withdraw into the shell. It paralyses their capacity to think and work. It also reflects in her care towards the patients. What emerges from this is that mentors are supposed to be guides and advisors and not use veto power. Exercise of power would only de-motivate and take the students away from the basic objective. The Kleinian view suggests that the mentor-student relationship should be just as an infant-mother relation. The infant needs to feel safe and protected to be able to grow up into a healthy adult. Similarly, a student also needs the same feeling of security, support and confidence to move ahead in studies, profession and discharge of her duties. This relation or supervision cannot be compared to management supervision. In the abstract on Clinical Supervision: A Psychodynamic Approach by Fulton & Oliver (2001) it is mentioned ‘that the situations in which the nurses find themselves give rise to anxiety, dynamics of dealing with patients give rise to strong feelings and anxieties in nurses’. Here clinical supervision has been seen parallel to psychotherapy. This according to me is a very modern approach and should be allowed and practiced by all mentors. Fulton & Oliver state that just as a child is allowed to play, the students should also be given due consideration by the mentor. They should be ready to accept changes and challenges in the development of the students and always bear in mind that each student or individual is different. Creative ideas should be allowed to emerge and this in no way minimizes the serious nature of the student-mentor relationship. On the contrary it allows creative ideas to develop and explore newer ways of dealing with problems that arise daily. We can now conclude that a learning culture needs to be created without considering the dynamics of change. It is essential that everyone in the team is allowed to suggest changes; this requires a lot of energy. Involvement of all ensures each one owns the project and is responsible for the outcome. Communication and feedback are essential. Hart and Rotem (1995) identified six factors that contribute to a positive learning environment: autonomy and recognition, job satisfaction, role clarity, quality of supervision, peer support and opportunities for learning. Brock field (1986) reminds us, however, that adult students must be helped to become self directed and self motivating. Consideration needs to be given to selecting resources, identifying relevant knowledge, establishing appropriate contexts, providing relevant learning and teaching strategies and meaningful assessment practices. Students can only learn to do what they have the opportunity to encounter, do or see being done. They should have the opportunity to engage fully with the concepts they are to develop; observe people engaged in the processes which they are to learn; and encounter examples of high-quality products of those processes, so they can see what it is they are aiming for. This is nutshell amounts to active participation in the learning process. Students should have the opportunity to engage as fully as possible in the processes they are expected to learn about or through, rather than only components or analogues for them: for example, if they are to learn to be creative or to communicate in a second language, they need the opportunity to be creative and communicate in realistic (and possibly unfamiliar) settings. If they are expected to learn to plan, investigate and make choices, then they must practise these skills, rather than simply carrying out the plans, investigations and choices of others. Where skills need to be developed to a high level of proficiency or automatic response, appropriate practice of the actual skill is needed in settings that approximate those in which the skill is to be used. In clinical practice the nurse should be challenged to go beyond what they already know, understand or can do in order to build new knowledge, understandings and skills. Sometimes existing conceptual frameworks and capabilities can be readily extended to incorporate new learning; at other times they need to be exposed (and possibly discarded) in order for new learning to occur. Either way, learners need to be able to connect new experiences to what they already know and can do, while at the same time reconstructing what they know and can do to take account of the challenge provided by their new experience. Learning is likely to be enhanced when the learner engages actively with the task at hand. Students should be encouraged to think of learning as an active process on their part, involving a conscious intention to make sense of new ideas or experiences and improve their own knowledge and capabilities, rather than simply to reproduce or remember. This means that learning experiences should be potentially meaningful and involve students in both doing and reflecting. Students should learn to carry out relevant actions (do, imitate, plan, experiment, test, create, rehearse, make, choose, try alternatives) and reflect upon and make sense of the results of those actions (What does this mean? Why did that happen? Am I surprised by this answer? Does it make sense? How is this problem like others I have seen before? What worked? Why? How does this connect with other learning? Are these ideas related?). Language plays a major connecting role between doing and reflecting and students need to learn to use language as a tool for their own learning. As part of the reflective process, mentors should assist to make connections between apparently unrelated ideas and experiences and different areas of knowledge. They should emphasize the interconnectedness of knowledge, skills and values, both within and across different fields of nursing. Constructivism should also be considered which, is a philosophy of learning founded on the premise that, by reflecting on our experiences, we construct our own understanding of the world we live in. Students are given the opportunity to achieve intended outcomes. Constructivism calls for the elimination of a standardized curriculum. Instead, it promotes using curricula customized to the students prior knowledge. Also, it emphasizes hands-on problem solving. Under the theory of constructivism, educators focus on making connections between facts and fostering new understanding in students. Mentors tailor their teaching strategies to student responses and encourage students to analyze, interpret, and predict information. Mentors also rely heavily on open-ended questions and promote extensive dialogue among students. Constructivism also calls for the elimination of grades and standardized testing. Instead, assessment becomes part of the learning process so that students play a larger role in judging their own progress. In conclusion we can say that enough flexibility is required in the mentor-mentee relationship. The mentor has to constantly devise new methods, be able to recognize the anxieties and concerns of the learner. The learner too has to be willing to allow the mentor to teach her through interactive methods. The learner’s co-operation is equally vital and it is a combination of the two which can bring about the result of more quality nurses with enhanced nursing skills which is the need of the day. *************************** Works Cited: Alison Morton Cooper and Anne Palmer, Mentoring and Preceptor ship. Jarvis and Gibson, The Teacher, Practitioner and Mentor in Nursing, Midwifery. John R Cutcliffe, Tony Butter Worth, Clinical Supervision. Knowles M 1990, The Adult Learner, Fourth Edition. Mary Neary, Dr., Teaching, Assessing and Evaluation for Clinical Competence. http://www.gse.uci.edu/MentorTeacher/Chapter1.html http://www.nursezone.com/stories/SpotlightOnNurses.asp?articleID=11617 http://www.healthsci.bham.ac.uk/student/clinical/nursmentor.htm http://www.nursing-standard.co.uk/archives/ns/vol15-09/pdfs/p3436v15w9.pdf. Read More