All through, am going to reflect on my act as a mentor in older adult clinical setting, to student nurse in in her final six-week placement of her second year whilst assessing the learning environment and the strategies used for teaching and assessing a student nurse .
The Nursing and midwifery Council (NMC) outlines eight domains of competency that a mentor must attain in order to perform the role to a fitting standard. These are: establish effective working relationships, facilitation of learning, assessment and accountability, evaluation of learning, creating an environment for learning, context of practice, evidence based practice and leadership
Establish Effective Working Relationships:
The Nursing and Midwifery Council (NMC 2008a) defines the role of a mentor as someone in clinical area who facilitates learning, assesses and supervises learners in practice setting.” The mentor is a key support to students in practice, this is where students apply their knowledge, learn key skills and achieve the required competence for registration.
Mentor was not informed that Sunita Patel, who is a mature nursing student in her final six-week placement of her second year, would be attending her practice area. However, prior to any placement start date, as a mentor I used this to my advantage by reflecting about learning opportunities within the clinical area.
At the initial meeting with Sunita, mentor orientated and familiarized Sunita to the ward. It is the mentors’ duty to establish an effective working relationship with the student nurse and this begins with orientating and also providing student with induction pack (RCN, 2007b). Whilst going through the national, professional, formal, legal, and local requirements mentor was aware about making the orientation a positive experience. Mentor introduced Sunita to the rest of the ward team. Levett et al (2009) in their research explored the students need to feel like they fit in considering that when students feel comfortable they engage with learning opportunities. I believe that the motivation and attitude of the mentor are important in creating an encouraging lead to the placement experience (Beskine, 2009).
As a mentor I talked about my knowledge and experience with Sunita and she talked some of her previous experience as well. Mentors have a duty to use effective communication and facilitation of skills to enhance a personal and professional relationship (Ali and Panther, 2008). Among the learning needs Sunita identified that she is unclear about what opportunities are in her current clinical area of placement where she never had any experience. Exploring that learning outcome, we have discussed that every learning outcome will be specific, measurable, attainable, realistic and time preset (SMART) and also an action plan, based on Sunita personal and professional development to date, which includes her struggling to demonstrate the level of practice required for some part of her undergraduate programme. It is important to take into consideration the ideal learning styles of Sunita. Basically, this means that along with identifying the learning needs of Sunita, it is also important to identify how she can learn best from the placement.Also as a mentor you are expected to act as a role model and The NMC Code (2008) compels a nurse to be of good integrity, trustworthy and honest grounding this on ones conduct and attitude.
Facilitation of Learning.After orientating Sunita to the ward and team, the next process is to conduct the initial interview so we could discuss learning needs and opportunities in placement area. Sunita had not had a previous placement in older adult setting and she is not sure what is on hand to learn as a result Sunita will have an informal discussion with mentor to identify the learning opportunities. During the initial interview mentor will also verified Sunita level of knowledge and expectations. A mentor is accountable for making initial interviews with students to evaluate their learning needs and to create a plan on how to attend to these needs (RCN, 2006). We looked through Sunita Practice Assessment Document (PAD) from previous placements and comments from her mentors. Mentor initial thought was that she may need more support than she had expected at her stage of learning. It seemed that Sunita needs to develop confidence in her clinical skills and the underpinning knowledge.
Sunita did express that she is unclear about what opportunities mentor area offers and is concerned about achieving her learning outcomes in her Practice.It is also important to consider that studies have shown that placements can be very stressful for students during training. (Stuart, 2007). Mentor and Sunita both then agreed and created a learning contract, the goals set were based on cooperatively identified need. Nicklin and Kenworthy (2000) demonstrate that the aim to create learning contract is to ensure learner can achieves agreed learning that learner required. Also The NMC (2008) summarize that an effective mentor needs to have knowledge of the student’s stage of learning consequently selecting relevant opportunities for those specific students learning needs.
Mentor decided that initially that she would become as Gopee (2011) described nurturing parent to Sunita to establish boundaries to ensure Sunita felt safe. Until her confidence developed, then the rapport would be on an adult to adult basis on equal level for discussions and mutual expectations and discussions. By acting as an advocate for Sunita would promote her self-esteem and confidence. (Neary, 2000) To articulate an effective learning contract it has to have necessary components as explained by Stuart (2007) learning objectives, the activities to facilitate these plans and resources for learning.
In the learning process, it is important to identify Sunita needs. This is to find out what type of learner is Sunita. From here mentor can find identify which learning style and learning theories that suitable for Sunita. From the discussion between mentor and Sunita, it was noted that she has some difficulty linking evidence base and theory to practice, as well as prioritizing and coordinating. She feels not confident.
We agreed to make learning plan for improve her learning process. In this learning plan we concentrate with the important of delegating and prioritizing, what is the goal and what Sunita needed in this learning procedure. The objective is to achieve the goal of the target. My target for Sunita is I require her to be expert and understand the important of delegating. In this situation, the main thing is to find what type of learner is Sunita and which learning style can be applied on her for the learning process. After identify which procedure that been chose, both of us have discussion to make daily plan to achieve our target within the set date. In this daily plan both of use will try to learn different method of learning style.
Assessment and Accountability
Assessment is an important aspect of the mentoring progression. Gopee (2011) specified that mentors must ensure that assessment of clinical skills does occur as required. It is crucial that mentors arrange for opportunities in support of learning and assessment. The purpose of the assessment was to evaluate Sunita’s clinical practice and competence in delegation and prioritizing. Mentor will need backing from colleagues sequentially to carry out assessment and teaching due to the pressure at work environment. Duffy (2003) indicates that a mentor may be unable to supervise and teach students for the reason that patient care needs and overall job.
Accountability is another part of the mentor’s role. Having delegated to Sunita, who is not yet registered with the NMC, am accountable to ensure that Sunita perform the task and she is able to do so in a competent manner and I also make sure that she is given the appropriate support and supervision. Walsh (2014) explores that the areas a mentor is accountable for are
Standards of teaching and assessing
What is taught, learned and assessed
Personal standards of practice
Professional judgements about student performance
Standards of care delivered by learners
It was essential to make sure that continuous assessment of Sunita all through the placement period was agreed at the initial interviewing, as a mentor supporting learning and assessment in clinical practice area and making judgements concerning student nurse’s fitness for practice and registration. Furthermore, Mentors are accountable to the NMC for such judgements and liable for notifying the university staff of any concern regarding student nurse progress or performance.During the placement we identified Sunita learning needs that were relevant to the practice required of her undergraduate programme. She was having concerns about achieving her learning outcomes in her practice. I prearranged some teaching sessions initially and for that I organized some learning material agreeing to the NMC codes and Trust policy regarding shift coordinating. We agreed that Sunita shadow me when am coordinating a shift and within that period I gave her opportunities to ask questions and after that we agreed for her to co – co-ordinate a shift, whereby she will be assess at different levels. I recognized that learning is more useful in the course of practical shift instead of just verbally teaching.
After the shift, I reassessed Sunita to confirm whether her knowledge had been enhanced and she fulfilled her learning objectives. I created a performance and questionnaire check list. Willis (2015) defines evaluation of learning as an important and disapproving part of any teaching programme to assess the usefulness of the outcome. This also gives then learners the chances to ask questions and inspires them to shed light on their enquiries and misunderstandings of their educational needs. It was essential for me as a mentor to define the success of my accuracy and teaching of my assessment. This is because Sunita should be able to transfer her learning within a range of different care giving settings with an unfailing level of performance. And this can be done by discussing with other colleague mentors to establish if Sunita had achieved a reliability of performance and my analyses of Sunita’s performance transpired at the same levels as other evaluators.
Evaluation of Learning.
Mentor carried out skill assessment, which is mainly nonstop formative base whilst using the supports of learning contracts to facilitate attainment of the outcomes by delegating tasks and allocating patients to Sunita, at the same time as liaising with other professionals on the ward. On the entire tasks mentor felt that Sunita lack confidence with prioritizing and coordinating care, but through the process of practice feedback and reflection and the support, she was given from her mentor and the nursing team regarding the outcome of the task was assessed satisfactory, however she has some difficulty linking evidence base and theory to practice. It is mentor’s responsibility to detect and relate evidence based practice and research to his/her clinical area of practice (NMC 2008). Hence as a mentor, I believe it is essential to assess my personal strengths realization and weaknesses as to improve confidence in my competences as a mentor to my nursing student in clinical practice which is very important.
Feedback from Sunita viewpoint on the clinical area of practice as a learning environment is beneficial as part of the current evaluation of the learning environment. Considering that it reviews the placement and learning opportunities thus developing skills of professionals within the team. The future registered nurses must be skilled in assigning, leading and accountable for own practice (Francis, 2009). Also the reviews will draw attention to the clinical practice areas where nursing students are struggling to achieve and thus providing the University chance to address the matters. Gopee 2011 defines action plan as a must attain method that detects competences that require to be attained by a set date in the course of the practice placement, non-achievement of which would indicate a fail mark being given. As a result of putting an action plan in place, it will help promote Sunita’s essential skills such as organizing, prioritizing, scheduling and goal setting.
Skinners theory created in 1974 reports that the environment is important to whichever learning that transfers in a place and if the environment is right and proper therefore learning will happen as links are made from reactions to stimuli and reinforcement (Quinn 2010).As part of Sunita’s action plan we examined other resources open to her, for instance having practice days with other professionals within the teams and also reading journals and guidance line regarding best practice, in terms of the right knowledge and nursing skill mix needed in the team to meet the nursing needs of the patients on the ward. Nurses remain responsible for the overall care of patients in their ward (NICE, 2014)
It is vital within any assessment that a mentor carries out, that mentor is objective, prepared, honest, fair and timely when giving an effective feedback. This ensures all factors collected and documented within the student nurses’ portfolio is a true evidence objective description of the student nurse’s ability and competences.However, I will need to discuss my assessment of Sunita firstly with my educational supervisor within the ward to check whether I have completed a fair assessment and if I need to improve my feedback skills.
Feedback to the student would be given in the form of the praise sandwich. NMC (2006) uses this form of feedback in its documents where it state that mentors should contribute to the evaluation of student learning and assessment experiences by proposing aspects for change as a result of evaluation.
Creating an Environment for Learning
Mentor’s ward makes available an effective environment for learning as it provides the opportunity to pre-registration students and new staff orientation period ahead of starting work in the ward. These orientation programme and induction packs are carefully organized by the Trust lead placement facilitator. Sunita has had her orientation by now, and it is, in fact, included in her Practice Assessment Document (PAD). One feature of a good learning environment is that, it permits mutual discussion of mentor and student nurse in regards to their expectations and hopes with each other throughout the placement (Gopee, 2011).
Mentor have at the beginning of the formative discussion with Sunita asked her what she look forward to achieve whilst mentor is mentoring her, and that she said that she is concerned about achieving her learning outcomes in her PAD.In mentor part however, She told Sunita that because Sunita has been on the ward for a substantial period mentor expect her to go in depth with the topics that they need to review, and which allowed mentor to act accordingly to develop Sunita’s learning needs. Sunita voiced her curriculum requirements and expectations, both of which aspects are related with the self-direction of the adult student (Knowles, et al. 2014).
Mentor and Sunita agreed to be in close up contact for the first few weeks and it was arranged that Sunita shadow mentor work hours to make sure that she had loads of one-to-one teaching with mentor as possible. This will particularly be helpful as mentor would be able to track her progress and provide her with direction throughout the initial few weeks (Walsh, 2014). At this point Sunita learning was being promoted as mentor is skilled in student-led approaches. For instance, Mentor regularly investigates Sunita understanding of a task at the same time as providing support. According to Pearcey and Elliott 2004, this will empower Sunita to feel confident about having the opportunity to build a good relationship with mentor, which is acknowledged as being useful to the learning process.
Maslow (1970) states that humanist theory of learning have to do with experiences and feelings. Sunita learning will definitely be motivated by mentor manner and positive attitude, as indicated by Maslow guides to individual fulfilment and personal growth. In addition, Mentor exhibits a behaviorist approach to learning, which is identified by regular evaluation, planning of feedback and constant communication (Nicklin and Kenworthy, 2000).Consistent discussion is essential to make sure Sunita is provided with some form of guidance, as well as giving the opportunity to communicate any needs. Planned and structured teaching sessions are particularly helpful to the learner because they aid the mentor to teach a meeting cogently, and to make best use of learning skill by using time efficiently.
Also preferable, are the multidisciplinary team members with very similar level of knowledge as the leading mentor. Furthermore, Neary (2000) states that a good learning atmosphere for an undergraduate makes way for enhanced learning opportunities.
Context of Practice
Sunita has been in mentor’s area of clinical practice for few weeks; she gives the impression to have some difficulties in co-ordination, still lacks confidence, and appears to be poorly organized. The mentor is going to focus on the possible reason why Sunita is having difficulties in planning and linking evidence base and theory to clinical practice whilst underperforming. Sunita might be struggling with learning difficulties or feeling stress as she has other family commitment as a mature student.
My role as mentor is to support my student and critically examines the reasons for underperformance. Mentor will look at how stress and learning difficulties would affect Sunita and how this affecting her ability in meeting the requirements for episode of patient care in the clinical placement area. It is also vital for the person to recognize areas that are being shunned and strive to discover other ways of overcoming the struggle. Once they qualify, student nurse will be expected to function independently in this case. Hence mentor must make sure that Sunita is being evaluated on all required proficiencies as well as not shunning areas they find challenging (RCN, 2010).
Morris and Turnbull, 2006 states that, nurses with learning difficulties are normally very mindful of their potential challenges and strengths. So they are really cautious about verifying issues they are less assertive about sequentially to avoiding mistakes, mostly all individuals that engage in patient care, however educational standards should not be expected to be lower in order to accommodate disabled learners (White, 2007). All student nurses must meet all the requirements for learning competences and skills, as well as those are have acknowledged a disability, as they are expected to give a demonstration they are fit for practice as highlighted by the royal college of nursing (RCN, 2010).
Mentor will give Sunita, an evaluation form based on theory by Honey and Mumford (2000), as there are numerous theories on learning styles. Honey and Mumford (2000) is model broken down into four Reflector, categories Activist, Pragmatist and Theorist. The characteristics of a reflector are cautious observers. Activist is open minded, passionate and enjoys engaging themselves into new skills, while using all the evidence available to them to make decisions. Pragmatist acts right away on notions and are eager to put new procedures into practice. Finally Theorists think stuffs through in a reasonable manner and value logically and objectivity.
Delegation was the skill that mentor and Sunita aimed on in this practice. Therefore it was appropriate to demonstrate this skill by giving Sunita the opportunities to shadow mentor and other colleagues at placement and prior to that Sunita will be encouraged read through some journals and guideline regarding delegation. Mentor and student will then discussed possible reasons why as a nurse you would be responsible for the day to day smooth running of your shift, despites each day has its own differences. According to Gopee (2011), there must also be loyalty to work linked to policies and protocols, and also to the professional codes of practice.
Evidence Based Practice
Working in an older adult ward where the care needs and learning environment is frequently challenging the skills and capacity of the service. Although during the interviews mentor was able to ensure that they had a quiet room within the ward. I will encourage Sunita to have reflective discussions during shadowing with her. According to the Nursing and Midwifery Council (NMC) code nurses are responsible to the general public to deliver a high quality of care, as a result it is essential that nurses reflect, evaluate the care and keep up-to-date of new evidence and knowledge that is on hand (Burns and Grove, 2007).
As Sunita had not had an older adult placement previously mentor felt that she would update her of the challenges that may arise. These included psychiatric and complex physical problems. Mentor will encourage Sunita to attend conferences relating to improving the health, purpose, and quality of life of older adults and to feedback recent research and practice to the ward.Evidence based practice is important in practice as it enable nurses to deliver high quality care, improve results for families and patient and to lead a more well-organized health service. In addition, Burns and Grove 2007, maintained that other organizations within the health service will profit when care and interventions is based on research.
Furthermore, Melnyk and Fineout-Overholt (2005) recommends evidence based practice is a problem-solving method to the provision of health care. In using a problem solving method the nurse is able to incorporate patient preferences and healthcare professional knowledge in providing individualized care right for the patient.
The summative part of the assessment is the last interview process, so it is the mentor jobs to reflect on the leaner skills overall and also pull on other team colleague’s practices with Sunita. By using the Practice Assessment Document (PAD) as being an objective assessment will guide mentor to see if all learning marks have been achieved. As a mentor, I am aware of the responsibility that I have when making a decision if a student nurse meets the needed standard. Especially on the last placement of the student nurse where there can be no presuming as the pre-registered student nurse will not have time to improve ahead of registration happens. Hence Time will be allocated to Sunita at the end of the last meeting to enquire how she had found her practice with me as her mentor.The role of the mentor is very important in the stage immediately prior to student nurses achieving registration is imperative in producing nurses who are fit for practice and purpose. (NMC, 2006)
As a mentor, in order to execute my role to Sunita in providing support and guidance based on her learning needs in practice placement I acknowledged, I would be acting as a role model. In addition NMC (2008b) has identified in guidelines to reinforce learning in practice. Mentor is aware that she would need to exhibit leadership skills during her profession as a mentor. A leader is someone who makes use of interpersonal skills to motivate others to achieve a purpose (Alleyne and Jumaa, 2007)
Mentor would need to organize a teaching session with Sunita, nevertheless she would be flexible in case of unforeseen incidents such as patient’s condition deteriorating and requires an emergency attention. In the leadership domain of the NMC (2008b) guidance, it is specified that mentors should display leadership skills for training within academic settings and practice.
A succession of learning experiences was prearranged by mentor to meet the identified learning outcomes as arranged during the first meeting and mentor aim was to priorities her work out so as to meet up Sunita’s learning agreements. To act as an advocate for Sunita is part the mentoring role as this will give student learning opportunities access in involving a role model, a manager of change and facilitator.in addition mentors serve as role models for empowering learners to gain knowledge of effective practice and safe (Frankel A, 2008).Mentor reflected on the Learning style chosen by Sunita, as indicated that she learn by observing and pondering about what occurred. Mentor then contemplate that Sunita may need to be an observer of practical procedures firstly prior to making an attempt herself and to support the theoretical component, different instructing methods may be use.
Mentor then established a positive personal relationship with Sunita which imply maintaining a regular interaction, establishing mutual respect and trust, making every session fun and enjoyable as well as supporting her consistently. Furthermore, mentor can help Sunita to acquire life skills such as values clarification, long-range planning and decision making. Through these skills, Sunita can gain personal empowerment and economic independence. According to Gopee (2011) states that mentor is also organizer of care, a researcher and a teacher within their post and that mentor should not only be a role model for clinical skills. Mentors are expected to act professionally at all occasions. As the perceptions of learners on role modelling inside the clinical settings recognized that learners rated highly the significance of skillful role models whose experience they might practice and observe (Hughes, 2004).
However, during mentor instructing sessions mentor was mindful of facilitating the application of evidence based practice, this is practice centered on supporting evidence and research, cost and clinical knowledge. Using evidence based practice is an element in the NMC (2008b) fitness to practice for mentors and its practice supports practice development, clinical effectiveness and effective care in addition its purposes is to improve the quality and standards of healthcare approach. Example of evidence based practice are clinical guidelines, some are created by the National Service Frameworks (NSF) , National Institute for Health and Care Excellence (NICE), and the cancer strategy (National Health Service (NHS), 2014), and both national and local policies.
In conclusion, I have acquired more confidence and knowledge whilst reflecting on the learning assignments in documentation and in future, I will be able to discharge my roles as a skilled mentor. I have also acquired awareness of the learning environment and how a positive learning environment help student to develop. Furthermore, how to get support when concerned about incompetency of a learner am mentoring. Generally, I will continue to develop as a mentor through the update register whilst undertaking a self-directed learning in keeping up with my new skill as mentor.