Mentorship in British Nursing - Essay Example

Running Head: Mentorship in British Nursing MENTORSHIP IN BRTIISH NURSING This Paper examines the role of mentors in British Nursing. The benefits of mentors in training nursing students are examined. The professional, personal and educational role of the mentor is assessed, in the context of their function as role models. Theories and strategies of learning are also discussed in this Paper, with strategies for assessment and evaluation of nursing students. Mentorship in British Nursing Introduction: “ In high school, I had a really good mentor/science teacher, and he stayed with me even when I was in college, and that was extremely helpful.”…………Temple Grandin. [Interview, 2000]. Temple Grandin is one of the most famous autistic people around, demonstrating skill and flair in her understanding and treatment for animals. She credits her progress to the support and encouragement she received from her mentor/teacher who helped her to gain confidence in herself in spite of her handicap. This is merely one example of the talent that has been unleashed into the world through the efforts of mentors on behalf of their protégés. In a specialized field such as nursing where the extent of knowledge that may be acquired from text books is limited, a trainee nurse can benefit enormously from the support and services offered by a mentor who can share the gift of his knowledge and experience with her as he guides her through real life medical emergencies and health crises. The field of nursing involves a major portion of its learning within the parameters of clinical cases and it is only the eye of experience that can detect and diagnose diseases correctly. Such learning experience must of necessity, be acquired on the field, in real life clinical situations. If a young nurse steps into this uncharted terrain on her own, she is likely to experience fear, uncertainty and apprehension; she is likely to exhibit nervousness and make mistakes. However the same nurse working with a mentor can benefit from increased self confidence and observation in real life situations which ensure adequate preparation for the tough world of real world nursing. The relevant literature in this regard points to the fact that quality nursing practices need to be based on current knowledge [Francis et al, 2001] and traditional theoretical, text based learning is inadequate to prepare a nursing graduate for the real world [Goode and Krigman, 2001]. According to MacAllister (1999), “teachers aim to teach students how to think while students are more motivated to acquire workplace skills.” Nursing graduates can be better prepared to face the world of real life nursing through training acquired under a mentor and even a six month training period in this manner is effective in imparting necessary skills [Reid, 1994; Johnson and Preston, 2001]. A well informed, practicing mentor who is experienced in clinical procedures while simultaneously being aware of the requirements in the teaching field functions as an effective teacher for a nursing graduate, to orient her into clinical practice [Reid, 1994]. A good mentor helps a student to develop her critical thinking skills and helps her to avoid picking up poor hospital practices [Melia, 1987] and even a bad mentor could still be helpful to a nursing student in developing her perceptions and learning in a clinical environment [Langridge and Hauck, 1998]. Studies conducted in the area of mentor contribution to development of clinical skills in nursing graduates are not conclusive in nature [Fitzgerald et al, 2000] and some mentors are ill prepared for their role as teachers, orienting students in the area of clinical performance through monitoring and training [May et al, 1997]. Nevertheless some pilot studies on the incorporation of the clinical approach into nursing curricula show that graduates demonstrate a promising degree of enthusiasm when inducted into a clinical learning situation with a mentor and they develop clinical experience through a practical, hands on learning situation [Edgecomb et al, 1999; Hoyles et al, 2000] The Role of Learning: A mentor is cast in the mold of a teacher. In order to assess the impact of the mentor’s role in enhancing learning, it would be useful to explore how learning actually takes place. Book learning or assimilating theoretical principles are not in question here, since theories and knowledge from textbooks can at best, serve as a general guideline to a nurse faced with real life clinical situations. The ability to perform well in a clinical environment can be grasped only dimly from text book theory and cannot substitute for the valuable experience gained in a working situation under the guidance of a mentor, who functions as a teacher and a role model. The issue to consider here is the manner in which learning takes place and several theories have been presented in this regard. (a) The Classical learning Theory: According to this Classical learning Theory, propounded by Skinner, we learn by the trial and error method that results in long lasting acquired behavior [Hilgard et al, 1940]. This theory proposes that we, as thinking people, are exposed to a variety of stimuli in day to day life that condition our responses and thereby our behavior, aiding the learning process through trial and error. But when applied in the context of nursing, trial and error would be a very dangerous method of learning in the context of the daily medical emergencies a nurse is faced with. Moreover, human beings do not merely respond to stimuli, they also interpret them, hence learning must move beyond these limitations of reward and punishment. (b) Bandura’s Social learning Theory: The proponent of the Social Learning Theory – Albert Bandura disagreed with the trial and error approach of the Classical Learning Theory. “Coping with the demands of everyday life would be exceedingly trying if one could arrive at solutions to problems only by actually performing possible options and suffering the consequences [Bandura 1977]. Bandura’s theory relating learning not merely to a conditioned response to a stimulus, but rather emphasizes the impact of the social aspects in learning. The main principles of his theory are that (a) we learn by observing others (b) Role models and the power of examples are important (c) vicarious behavior is a means to modify behavior or the learning experience. Bandura laid special emphasis on the influence of TV on the behavior of children. There is an active learning process that is going on while a child watches TV, that involves (a) grabbing the attention of the viewer (b) retention of the learning by vicariously experiencing it (c) Motivation to try it our for himself or herself to see what happens.[Bandura, 1963]. Therefore, Bandura’s theory defines learning within the parameters of the individual’s social experience and he postulates that most learning activity takes place by observing others and copying them. This theory is particularly relevant in the practice of medicine [Bahn, 2001, p 110-117]. In the field of nursing education, one of the best ways in which a nurse can become proficient in dealing with clinical cases is to observe the manner in which an experienced professional handles patients in real life situations. Bandura’s theory places emphasis on the importance of role models as an aid to learning. A mentor is perfectly cast as a role model and a trainee nurse learns by observation of her mentor and by imitating him or her in her own handling of cases. Through years of experience, a mentor has acquired the benefit of depth of experience, which the nursing student is able to imbibe through observation and imitation. The importance of feedback in the learning process: The mentor functions in the role of a demonstrator for a nursing student, facilitating learning through real life application of medical principles. But in addition, a mentor also functions as a guide for the nursing student, providing valuable feedback on the actual implementation of nursing principles as practiced by the student. On the job performance appraisals are an important learning tool for a nursing student [Black, 2000, pp 37,38]. Feedback provided by a mentor serves as a valuable tool for the student to understand what he or she is doing wrong or right, so that corrections may be made appropriately. It provides an opportunity for the student to reflect every day upon what he or she has learnt and apply the principles in actual practice [Glover, 2000]. The importance of the need for reflection in a nursing graduate has been stressed by many professionals [Stockhausen 1994; Glaze 1998; Greenwood 1998; 2001] However, this needs to be contrasted with the concept of reward and punishment in learning. While feedback on the job may serve to enhance and reinforce learning, the concept of reward and/or punishment handed out by a mentor is likely to be counterproductive, because it becomes a way to manipulate behavior rather than functioning as a learning tool [Kohn, 1995] Rewards are also counter productive and are an ineffective tool to motivate people - encouragement and positive feedback are a much more effective tools as compared to rewards [Kohn, 1995]. Any kind of reinforcement could impact negatively upon motivation. Reward is almost universally applied today, in almost every situation, from schools to businesses. These modern beliefs have been conditioned by the Skinner theories of reward and punishment and have progressed through time to their present universally applicable form today – the widespread “pop behaviourist doctrine”: The core of pop behaviourism is “Do this and you’ll get that.” The wisdom of this technique is very rarely held up for inspection; all that is open to question is what exactly people will receive and under what circumstances it will be promised and delivered.[Kohn, 1995]. Learning is not aided through reward and punishment, rather it is inhibited. A mentor who is over lavish in his praise for a student is likely to quench the intrinsic motivation of the student while the concept of punishment through public reprimands, etc creates escapist or avoidance reactions to punishment, caused by the anxiety associated with the punishment which are counterproductive to learning.[Axelrod, 1983]. The Constructivist approach to learning: The Constructivist view of learning states that a learner is actively involved in the learning process and builds his own ideas or concepts which are based upon his own knowledge acquisition. Constructivist "learning involves constructing ones own knowledge from ones own experiences" [Ormrod, 2003]. According to this theory, learning is not conditioned to such a great extent by external stimuli, neither is it a result of uncontrollable internal stimuli. On the contrary, learning is an active process that fully involves individual initiative and participation and in this instance the teacher functions merely as a facilitator for the learner to build his own concepts and ideas based upon the knowledge that he is acquiring. This theory is the most relevant in the field of nursing. A commitment to life long learning and the development of a self directed approach in nursing graduates have been found to be invaluable factors that aid learning and acquisition of skills[Candy et al, 1994; Duyff, 1999]. A mentor can function as a facilitator, but inner motivation of the student is a vital ingredient if the services of a mentor are to bear fruit. Assessment and evaluation strategies: Traditional theory based examinations are additionally being found to be inadequate to test learning in nursing graduates. MacAllister (1999) advocates a multi assessment approach, including knowledge, creativity and self knowledge. A student who has benefited from a good mentor is likely to demonstrate adequate problem solving skills in real life situations. There is no single perfect tool that may be said to accurately assess the ability and skill of a nursing student[Lankshear and Nicklin, 2000] in order to evaluate how effective the graduate is likely to be as a real nurse. Studies have also highlighted the lack of involvement by mentors of nursing students in assessment of the students and the provision of adequate documentation to record their progress [Neary, 1999]. In general, surveyed mentors felt that documentation in regard to nursing graduates was cumbersome and too lengthy, it needed to be reduced and made concise while more documentation was needed on assessment of these candidates [The Nurse, 2000]. Thus, there appears to be a need to introduce adequate guidelines for mentors to evaluate their students on a continuous basis in order to assess their skills. Theoretical examinations tend to be self limiting since candidates are not motivated to learn what they will not be tested upon, while writing essays is also not relevant to the nursing field, since it only assesses a potential nurse’s writing skills. However, the mentor is in a unique position to evaluate the candidate on a more positive and relevant basis. Since the student is working on a daily basis in a clinical situation for which no guarantees can be provided and knowledge and skill to be displayed cannot be learnt by rote but are displayed through creative handling of day to day clinical situations, it provides an excellent basis for intelligent evaluation of a graduating student’s performance while imparting valuable knowledge and experience at the same time. The extent to which a student has imbibed the knowledge that he or she needs in the daily job of nursing can be assessed through the clinical situation under the guidance of a mentor. This system also makes provision for self assessment and inner reflection which are an integral part of the learning process in nursing. Critical thinking skills and the ability to respond adequately and sometimes creatively, to real life clinical situations could provide the best indicator of a potential nurse’s skills and the mentor is uniquely positioned to provide this analysis. Therefore the paucity in this area of documentation for assessment by mentors as identified by Neary (1999) needs to be addressed. The role of the mentor: The mentor performs a vital role in the education of a nursing student. He is able to impart to the student, knowledge of a critical nature, knowledge that is likely to be the most useful and practical that the potential nurse is likely to find throughout her nursing education. While working in a clinical situation under the experienced guidance of a mentor who is also qualified as a teacher, a nurse is able to receive educational benefits coupled with professional experience as well. Studies have shown the benefit that students acquire in a professional sense from training acquired in a clinical situation under the guidance of a mentor [Reid, 1994]. Nursing candidates demonstrate an enthusiasm for learning under these circumstances which are likely to be beneficial in refining their nursing skills [MacAllister, 1999]. A mentor’s role is that of an educator first and foremost, because he must take the nursing student under his wing and teach her the ropes of the nursing business. In a clinical situation, the nursing student learns on the job and benefits from the enhanced knowledge of the mentor who has already been practicing in his clinical role for several years. Student nurses are more enthusiastic towards this kind of learning approach, where they have the benefit of being educated in a real, clinical situation [Edgecomb et al, 1999]. However, while a mentor performs an educational role, he also helps the student to benefit in a professional sense as well. Knowledge gained in a clinical situation forms the basis of a valuable core of practical knowledge that the student is able to acquire under the guidance of a mentor. Such knowledge goes towards refining the skills of a student nurse and helping to orient her into the professional scenario that she will face once she graduates. This apprenticeship under a mentor is of value to the student in a professional sense, since it provides practical knowledge and an intuitive medical sense through self assessment and the development of critical thinking skills in real life situations. This training acquired under a mentor could also qualify as valuable on-the-job experience, which will also enable the student to be better prepared for the job market, since she is already armed with some training acquired on the job. Working with a mentor in nursing is similar to apprenticeship in a variety of trades involving skill and ability. Since such practical knowledge forms the core of effectiveness while employed in nursing, it serves to enhance the professional abilities of the student. Mentorship is not however, restricted only to novice nurses who are fresh graduates. Mentors have also been found useful in situations where nurses have been practicing for some time and are enhancing their skills in other areas of nursing [May et al, 1997]. The nursing profession has become increasingly specialized and basic level nursing is now becoming specialized to deal with midwifery, orthopedics, geriatrics and a variety of disciplines which apply basic nursing standards but are enhanced to add skills in specialized cases of treatment. It is in this professional area that the role of mentors is even more important. Qualified mentors are able to provide valuable, practical training and offer insights into specialized treatments based upon their own skills and knowledge, which is of great benefit to the nurse trainees. The personal element of the mentor’s role is very important. In a generalized, classroom situation, it is not possible for a teacher to evaluate a student with the degree of detail that would be desirable in the case of nursing students. A teacher in a classroom situation has to deal with and evaluate several students and is not able to direct the individual attention that every individual nursing candidate requires. However, a mentor is uniquely qualified to assess individual candidates in a real world clinical situation. A mentor usually works with only one student at a time and is not responsible for the evaluation of several students at the same time. This gives him the means to assess the unique skills and abilities of a nursing candidate in a working environment. While treatment progresses and medical work continues, the student is also being trained and evaluated at the same time. A student is able to establish a close relationship with her mentor and learn much more comprehensively than what would be possible in a classroom situation. A student is more likely to approach her mentor with a problem since she shares a one on one working relationship with him, as opposed to a teacher whose attention is claimed by several students. However, it must also be pointed out that this close relationship could also be detrimental in some cases. A student role models herself on her mentor and is likely to adopt the practices and methods that her mentor uses. While most mentors serve as positive role models, there are also instances where the close relationship acquires unpleasant connotations through conflicts and personal problems. Examples of such problems that may develop could be a too-personal element creeping into the relationship which would impact upon the objectivity of the mentor in assessing his candidate. It could also prove harmful to the student nurse who may be distracted from the development of her skills in nursing. Additionally, there may also be the rare instances when the protégé emerges more talented and creative as compared to the mentor, which could result in conflicts involving ego and other such issues. Organizational framework for training mentors: Mentors also need training in responding to the ever changing demands of the nursing field, in order to better prepare their candidates to face the real world of medical problems. In a survey conducted in early 1999 on mentor preparation at Glasgow [The Nurse, 2000], some of the participants were unsure of all the requirements of their mentor’s role and felt that they needed more preparation. Additionally, some mentors are ill prepared for their role as teachers [May et al, 1997] and there appears to be a need to organize effective lecturers for mentors as well, in order to enable them to emerge as well integrated individuals, who are able to perform their professional role in coordination with their teacher’s role in evaluating and assessing their candidates’ performances and skills. More and more studies are proving the ineffectiveness of traditional methods of teaching nursing theory as outlined above and the need for clinical training is being manifested. Additionally, nursing students also tend to respond with more enthusiasm if they are able to test out the theory they have learnt in a practical, clinical situation. Learning in this manner enhances their skills and knowledge and promotes self assessment, reflection and critical thinking skills. The practical aspect of the training is invaluable and more research is necessary into the role of mentors and their effectiveness as teachers for student nurses. With the rising incidence of deadly diseases like AIDS and the vast numbers of the sick across the globe, the necessity that arises in nursing training is that of imparting skills that can be applied in a real life situation. This is why mentors play a valuable role and their participation must be encouraged by all nursing training institutes, in order to better equip their students to face situations in the real world. Practicing doctors can also be recruited to function as mentors and studies suggest the benefit of training for students in an actual professional workplace [Reid, 1994]. In much the same manner as big organizations which recruit the students of premier institutions as trainees into their organizations, there must be coordination of nursing training institutes and hospitals and clinics. In this way, the graduating nurses can be trained at these professional sites under the guidance of a mentor who has also been trained through the input of qualified lecturers. With the rising incidence of medical emergencies and diseases, it appears vital that the role of mentors be enhanced to effectively train nursing students to equip them to quickly tackle the challenges in the real world. Mentors help to enhance skills in nursing candidates which cannot be acquired in a classroom situation. For example, the ability for reflective thinking and the need for lifelong learning will become very clear to the nursing student while working under a mentor who is himself involved in the life long learning process. Through an observation of the manner in which the mentor does his job, the stage is set for the nursing trainee candidate to imbibe core truths about the medical profession. There is no set theory or practice that may be applied to every clinical case that a nurse encounters. Every patient is a different human being and the factors causing disease are so complex and multi faceted that a limited theoretical knowledge will not serve to aid effective functioning. Real life clinical situations and medical emergencies will only reveal to the nursing candidate that no matter how much she learns, she knows very little. However, the comfort she can find lies in the fact that her mentor is also likely to experience the same problems although he is more knowledgeable and experienced. This will serve to orient the fledging nurse more thoroughly into the nuances of the medical profession than any amount of theoretical instruction in the classroom context. Working with a mentor would serve to illustrate to a nurse candidate the need for critical and reflective thinking skills, the necessity to accept that medical knowledge is limited and all diseases are not curable. It would also serve to bring home to the nurse candidate the realities of the world of clinical medicine in a way no amount of book learning can. WORKS CITED: * An Interview with Temple Grandin. (2000). The Harvard Brain, 2000 (7). Retrieved July 5, 2005 from URL: http://hcs.harvard.edu/~husn/BRAIN/vol7-spring2000/grandin.htm * Axelrod, S., & Absche, J. (eds.). (1983). The effects of punishment on human behavior. New York: Academic Press. * Bahn D (2001) Social learning theory: its application in the context of nursing education, Nurse Education Today 21 (2) 110-117. * Black R (2000) On the job: performance appraisals Giving and getting feedback. Canadian Nurse 96 (7) 37-38 * Bandura, Albert (1977): Social Learning Theory Prentice Hal, Englewood Cliffs * Bandura, A., & Walters, R.H. (1963). Social learning and personality development. New York: Holt, Rinehart & Winston * Candy, P., Crebert, G. & OLeary, J. 1994, Developing lifelong learners through undergraduate education, Australian Government Public Service, Canberra * Duyff, R. 1999, The value of lifelong learning: key element in professional career development, Journal of the American Dietetic Association, Vol. 99, No. 5, pp. 538-543 * Edgecombe, K., Wotton, K., Gonda, J. & Mason, P. 1999, Dedicated education units: 1: a new concept for clinical teaching and learning, Contemporary Nurse, Vol. 8, No. 4, pp. 166-71 * Francis, K., Bowman, S. & Redgrave, M. 2001, Knowledge and skills required by rural nurses to meet the challenges of a changing work environment in the 21st century: a review of the literature, Charles Sturt University, Wagga-Wagga * Glover P (2000) Feedback, I listened, reflected and utilised: third year nursing students perceptions and use of feedback in the clinical setting. International Journal of Nursing practice 6 (5) 247-252. * Glaze, J. 1998, Developing nursing practice through reflection: part 1, British Journal of Theatre Nursing, Vol. 8, No. 7, pp. 9-24 * Goode, C. & Krugman, M. 2001, Evidence-based practice: a tool for clinical and managerial decision making, in: Current Issues in Nursing, McCloskey Dochterman, J. & Kennedy Grace, H. (eds), Mosby Inc, St Louis, pp. 60-68 * Greenwood, J. 1998, The role of reflection in single and double loop learning, Journal of Advanced Nursing, Vol. 27, No. 5, pp. 1048-53. * Hoyles, A., Pollard, C., Lees, S. & Glossop, D. 2000, Nursing students early exposure to clinical practice: an innovation in curriculum development, Nurse Education Today, Vol. 20, No.6, pp. 490-498 * Hilgard, E. R., & Marquis, D. J. (1940). Conditioning and learning. New York: Appleton-Century-Crofts * Johnson, D. & Preston, B. 2001, An overview of Issues in nursing education, Evaluations and Investigations Programme, Higher Education Division, DETYA, Canberra * Lankshear, A. & Nicklin, P.J. 2000, Methods of assessment, in: Teaching and assessing in nursing practice: an experiential approach, Nicklin, P.J. & Kenworthy, N. (eds), Balliere Tindall in association with the Royal College of Nursing, London, pp. 119-138. * McAllister, M. 1999, The competing interests of assessment: an Australian overview, Curriculum and Teaching, Vol. 14, No. 1, pp. 45-62. * May, N et al. (1997). Preparation for practice: Evaluation of Nurse and midwife education in Scotland, 1992 Programmes Final Report. Glasgow Department of Nursing and Community Health, Glasgow Caledonian University. * Neary, M. (1999). Preparing assessors for continuous assessment. Nursing Standard 13, 18, 41-47 * Ormrod, J. E.(2003): Educational Psychology: Developing Learners, Fourth Edition, p. 227, 232. * Reid, J.C. 1994, Nursing education in Australian universities: report of the national review of nurse education in the higher sector 1994 and beyond, executive summary, Commonwealth Department of Human Services and Health; Australian Government Publishing Service, Canberra * Stockhausen, L. 1994, The clinical learning spiral: a model to develop reflective practitioners, Nurse Education Today, Vol. 14, No. 5, pp. 363-71. * The Nurse Lecturer’s role in mentoring the mentors. (2000). Nursing Standard, 2000, 5(6). Retrieved July 9, 2005 from URL: http://www.nursing-standard.co.uk/ archives/ns/vol15-06/pdfs/p3538v15w6.pdf. Read More