Nurse Reflection during Clinical Placement - Essay Example

Introduction Reflection on practice experiences and events is essential for nurses to develop professionally and personally (Nursing and Midwifery Council, 2008a). Reflection is described by Bulman and Schutz (2004) as the way a nurse, irrespective of their career position, links theoretical knowledge and practice and is a very personal thing; no two people will have the same experience and feel the same way about it. Summerville and Keeling, (2004) stated that reflection is important as is allows nurses to consider the ways in which they interact and communicate with their colleagues and helps to develop their aim to become self-aware, self-directing and in touch with their environment. That the profession is dependent on a culture of mutual support. I realised the value of reflection after an experience on a practice placement and decided to use Gibbs’ (1988) reflective cycle to explore and analyse the experience. This six stage model is a popular and common model for nurses; it is clear and simple to follow and it prompts and encourages the learner to formulate an action plan to try and make sense of their experience. Description It was the first day of my placement on a late shift on an acute medical unit ward and I was allocated a mentor. The supervisor called me to his office and notified me of the mentor that I was to work along. The notification was at first done verbally than later on a written document presented by the supervisor while I was off duty. From the very time that the mentor was presented to me, I could see that he was not in terms with the fact that she was to be my mentor. She was totally unfriendly and unsupportive since he even ignored my introduction to him. I received no induction to the unit by my mentor and no interactions happened between me and the mentor, which meant I was left to find out about the ward with the help of other nurses in the ward. My efforts to connect with the mentor were ignored several times and I had to ask other members of the nursing team if I could work with them for the rest of the shift. I always tried to come up with simple stories and made jokes that he never bothered to involve himself in. Sometimes he could even just pass me without a greeting but I could force a handshake and a smile just to win his attention that I never did. The next day I approached the mentor and asked if there was a problem and I was told that she would speak to a matron. The ward sister left me alone in her office and when she came back, she brought a matron with her and I was told that I would be getting a new mentor. A new mentor was sent to me the next day in the morning. No explanation was offered. Everything went well with the new mentor from then on. Feelings I had felt nervous about the placement but was looking forward to getting started so I was shocked to be ignored even while I was asking my mentor if there was anything I could do. I was not given any support and felt as though I was getting in the way because the mentor refused to discuss my learning needs which made me feel awkward. I wondered if she thought I should know how to just get on with it even though I was new to the environment. I don’t think this needed to happen; I was happy and willing to join in with the rest of the team but was disappointed that I had to actively seek out someone who would take an interest in me and that made me feel isolated. At the end of the shift, I was so anxious and shaken that I burst into tears and had to take some time to compose myself before I could drive home. Evaluation At the time, I thought maybe I had done something to upset the mentor to start us off on the wrong foot, but the way the other members of nursing staff helped me as I worked with them made me think I must be doing the right things and was not getting in the way as far as they were concerned. Eby et al (2009) suggest that the success of learning is influenced by the mentor’s attitude towards, and the level of interest they show in the student and I think my mentor’s actions definitely contributed to my negative experience. The fact that things went well with the new mentor afterwards supports this. I had approached the first mentor to ask what was wrong because I had wanted my learning experience to be worthwhile and to get the most out of this opportunity. When my mentor came back with the matron, I thought I must have done something wrong and even though I was told I would be given a different mentor there was no discussion to explain why, which reinforced this belief. However, there were some positives that I gained from this experience. The first was that I was able to engage with other members of the ward nursing team, which helped to improve my on-the-job experience (Kaihlanen et al 2013). Secondly, the change of mentor proved to be beneficial in that the new mentor immediately sought to develop a positive relationship with me and provided the level of support I required to achieve positive learning from the placement (Beskine 2009). Analysis An important part of the reflective process is to analyse what happened during the event that has been described as this provides the foundation for improving future practice (Gibbs 1988), which is equally critical for students as it is for registered nurses (NMC 2008b). On analysing the situation that occurred with the first mentor, I realise that there were several factors that could have contributed to the failure of the first mentoring situation. As a student nurse, I had automatically assumed the mentor would be experienced in the support and guidance elements of the mentoring role as stated in the NMC mentor guidance and outlined by the Royal College of Nursing (RCN, 2007) and, therefore, share her knowledge with me and provide me with constructive information and feedback regarding my placement duties on the ward. Consequently, I felt that the first mentor would be used to working with learners, and to students feeling awkward on their first day of placement and that she would be little more understanding and patient and explain and communicate her mentoring role more effectively to me (Kaihlanen et al 2013). “A mentor is accountable for “what is taught, learned and assessed” (RCN, 6). Yet during my first day the mentor’s body language and actions seemed to suggest that she had no interest in what I was being taught or learned, as she provided me with no instruction at all. During my first meeting with the mentor, her body language including the shaking of her head every time I asked a question she replied in an abrupt manner with a yes or no answer and did not attempt to explain the point further. Moreover, she also interrupted every time I requested to discuss my learning needs. This suggested to me that she was not interested in me or her mentoring role. The NMC (2008b) state that mentors should a) be prepared to undertake the role and b) is willing to share their knowledge of patient care and act as a positive role model for the student. The literature also suggest that, on the first meeting with me, the mentor should take an empathetic approach and build a positive and effective working relationship between us, as this would enable me to fully understand my concerns as a student nurse. (Beskine 2009; Eby et al 2009). The RCN (2007) confirms that it is an interactive reflective discussion with the student that helps to improve their learning about patient care and other facets of nursing. This interaction was not apparent with the first mentor at our initial and subsequent interaction during my first shift. Indeed, I have to say that I became frustrated by the end of our meetings and my communication with the first mentor also became short lived meaning that I was not positive towards the communication I was having with her. It was this apparent lack of interest that led me to seek the assistance of other members of the ward nursing team. The fact that I was able to positively engage with these nurses showed that I was able to form a positive interpersonal relationship with ward team members through sharing my experiences and always helping where I could (Baillie 2014), yet could not achieve this with the person who was tasked with acting as my supervisor and mentor. Indeed, had it not been for this engagement, I may have considered leaving the nursing course, which is a potential consequence when students feel under supported and not properly supervised (Cassedy 2010). This indicates that either I had not fully appreciated the issues she faced in her supervisory role (Cassedy 2010), or that the first mentor was lacking in the communication skills required for this task. The use of appropriate communication skills is essential to the building positive interpersonal relationship with others in the healthcare environment (Baillie 2014), which includes those persons in a clinical supervisory position such like me (NMC 2008b). On analysing the situation that arose on the second day, I recognise that perhaps I also contributed to some of the problems that occurred between me and the mentor. I consider that my request on the second day that we met in a private room was the correct approach, as the literature confirms that problems between individuals in healthcare teams should be discussed in private (Baillie 2014). However, in starting our conversation by asking the first mentor what her problem with me was, I realise that this could have been perceived by the mentor as confrontational, and therefore was likely to have an adverse impact on developing a positive relationship with her and resolving the issues in an amicable manner (Beskine 2009). On reflection, had I approached the subject in a more conciliatory way perhaps the mentor would have responded better NMC 2008b). However, being provided with a new mentor did prove positive for me. The meeting with the new mentor was organized on a Monday morning in the boardroom by the chief doctor. The second mentor seemed ready to listen and help me whenever i needed help from them. After the board meeting, this mentor commenced by having a fifteen minute conversation with me, during which she outlined how she would be supporting me and what she expected of me in return (NMC 2008b). She also allowed time for me to discuss my learning needs and concerns and pointed me in the right direction to resolve any issues I had. Some of the issues included poor rapport between the first mentor and I, and lack of cooperation whenever I needed help. Her communication skills and actions during this meeting and subsequently during the day not only were more in line with what was expected from a mentor(Beskine 2009), but also made me feel more confident about conducting the work that I was required to do. I expected an accommodative mentor who was ever ready to guide me through the placement and support me in cases where work overwhelmed me. It gave me more confidence knowing that I had a good working relationship with thenew mentor. Conclusion Reflecting on this placement event made me realise how important it is to have a good relationship with your mentor for a successful placement. Because I did not have that relationship at the start of the placement, I had felt anxious, tearful and isolated which initially resulted in a negative experience for me. However, my experience of being mentored became more positive when a new nurse was appointed to the mentoring role. Nevertheless, I would still speak up if this happened again because I need my learning experiences to be positive to make further progress in my nursing career. The experience has also made me realise how important it is to improve my communication skills so that I am able to develop interpersonal working relationship with other members of the healthcare team who I am being asked to work with. As Beskine (2009) and Baillie (2014) rightly indicate, it is these skills that not only improve my performance as a nurse but also will enhance the quality of the service that we provide as nurses for the patients Action plan One of the benefits of this reflection is that it will help me to improve my practice should a similar situation occur in future placements. I will more openly discuss and communicate my concerns with the mentor at the commencement of our relationship, making sure that she/he was aware of my willingness to learn and contribute positively to the team work. If I were to get the same response as I did with the first mentor during the placement I am reflecting on, then I would either ask him/her to explain if there was a problem during our first meeting or ask if it would be better to change mentors. If this did not produce a positive result then I would ask the ward manager or matron to intervene to resolve the issues. I would also make sure that I understood what the mentor’s role was in my learning as specific to the placement. I have learned the importance of participating in an initial meeting with the mentor at which all of these factors need to be clearly discussed and understood. Additionally, if a problem were to occur between me and the mentor, I would make every effort to be less confrontational in how I communicated with the mentor about the issues. I would be more conscious of my body language and tone of voice that could be interpreted differently. I would also explain how nervous and concerned I was about the placement and make sure that I performed a good job of nursing while I was at the placement location. I now recognise that it is far easier to resolve issues in an amicable manner by working together with the mentor than communicating in a manner that they might perceive to be aggressive which, as I found out, has an adverse impact on the mentor student relationship. References Baillie, L (2014), Developing Practical Nursing Skills, (4thed), New York: CRC Press Beskine, D (2009), Mentoring students: establishing effective working relationship, Nursing Standard, 23 (30): 35-40 Bulman, C. and Schutz, S. (2004), Reflective Practice in Nursing. 3rd Ed. Oxford: Blackwell Publishing Cassedy, P. (2010), First Steps in Clinical Supervision: a Guide for Healthcare Professionals, Buckingham: Open University Press Eby, L.T., Allen, T.D., Evans, S.C.. Ng, T. and DuBois, D. (2009), Does mentoring matter? A multidisciplinary meta-analysis comparing mentored and non-mentored individuals, Journal of Vocational Behaviour, 72 (2): 254-267 Gibbs, G. (1988), Learning by doing: a guide to teaching and learning methods, London: Further Education Unit Kaihlanen, A. Lakanmaa, R. and Salminen, L. (20123) The transition from nursing student to registered nurse: The mentor’s possibilities to act as a supported, Nurse Education in Practice 13 (5) pp. 418-422 Nursing and Midwifery Council (2008a) The NMC code of professional conduct: standards for conduct performance and ethics, London: NMC Nursing and Midwifery Council (2008b) Guidance on professional conduct for nursing and midwifery students, London: NMC RCN (2007), Guidance for mentors of nursing students and midwives, London: Royal College of Nursing Summerville, D. and Keeling, J. (2004), A practical approach to promote reflective practice within nursing, Nursing Times, 400 (12): 42-46 Read More