This is my reflective account of my performance as a mentor in a clinical setting, assessing the learning environment and the strategies used for teaching and assessing a newly qualified theatre nurse. The purpose of this essay is to reflect upon aspects of my professional practice and development that I have encountered during my time as a student mentor. This reflective essay shall be written in the first person, In accordance with the NMC (2002) Code Of Professional Conduct, Confidentiality shall be maintained and all names have been changed to protect identity.
I have been teaching students and newly qualified theatre practitioners as a registered ODP for more than 10 years and as a SODP for one year. Working with different mentors in the past, has helped me to understand the different characteristics of being a mentor and develop my own style of facilitating learning within a clinical setting. I have experience of conveying knowledge to others in a way that is comprehensible and significant through my work as a multi-skilled theatre practitioner.
Whilst ODPs have a separate code of professional standards, this essentially provides a similar outline to supervision and mentorship (HPC 2008). The concept of mentoring is also part of the NHS Knowledge and Skills Framework whereby practitioners have to assist in the development of others through a variety of learning approaches and must demonstrate these through portfolio development (DH 2004). In order to be an effective role model the mentor must have high standards, must be able to demonstrate these high standards consistently, and must have good attitudes and beliefs regarding the role of their relevant profession in the wider context of healthcare (Murray & Main 2005)
As this assignment is a reflection of my performance in mentoring and assessing a mentee in nursing/theatre settings ,I have chose to use Gibbs Reflective Cycle as it is clear and precise, allowing for description, analysis and evaluation of the experience helping the reflective practitioner to make sense of experiences and examine their practice. To reflect is not enough, you then have to put into practice the learning and new understanding you have gained therefore allowing the reflective process to inform your practice. Taking action is the key; Gibbs prompts the practitioner to formulate an action plan. This enables the reflective practitioner to look at their practice and see what they would change in the future, how they would develop /improve their practice. Gibbs reflective cycle (1998).
On the first day of meeting my mentee (Helen) immediately after her orientation of the department, we had a meeting to draw up her learning opportunities so that there was an awareness of what Helen hoped to gain from her new profession as a theatre nurse. As part of her learning opportunities a teaching session and assessment was arranged. The teaching session included both formal and informal assessments . Both sessions were carried out in the theatre operating room , the formal assessment involved performing a surgical hand scrub which is always done prior to any surgical procedure. Even though I am a competent practitioner, I still had a moderate level of stress and anxiety regarding fulfilling my role as a mentor.
However, upon reflection I could draw on my previous experiences as a basic life support key trainer , previous teaching sessions I have delivered, and the support I have had from my sign off mentor (Teresa). My Mentor has helped me a great deal throughout my career, we have a great understanding of each other , and have built up a trusting and honest relationship over the years. For Helen this was her first experience of theatre post qualification, Helen had no theatre placements during her nurse training, so theatre is a totally new setting for her. Before any learning lesson took place, it was crucial to build an effective working relationship with Helen ,by being supportive to her and offering assistance for any needs she might have,it was also important that Helen felt that she is part of the team and that she doesn’t feel alone.
Gopee (2008) categorically states that mentors should be ‘aware of their impact as role models on students’ learning of skills and professional attitudes’. Armstrong (2008) states, however, that role modelling is not just about observing practice, but also includes considered linkage between practical skills acquisition and the underpinning knowledge that relates to the skills, i.e. closing the theory-practice gap. I planned my teaching session to ensure Helen was aware of the current information and guidelines about effective surgical hand-washing.
Prior to the assessment I discussed with Helen the varying techniques that colleagues use and how they may differ,however, I informed Helen I will show her how to scrub correctly in the format used by the scrub nurse team in our department. My aim was to give her more confidence and enable her to gain the necessary knowledge and skills to carry out the procedure. I planned to use the Peyton 4 stage approach throughout the process. Peyton (1998), a general surgeon, describes an excellent and widely advocated model for teaching skills in simulated and other settings, known as the ‘four-stage approach’.
This model may be expanded or reduced depending on the background skills of the learner. As with all teaching, the learner must be given constructive feedback and allowed time for practice of the skills. A surgical skill has both a cognitive and a psycho-motor component. In fact, in those with reasonable manual dexterity, the instructions require to teach a skill that centres on the cognitive process of combining the steps of the operation in the mind, and ensuring this combination has occurred before attempting the skill. Basic techniques from effective surgical hand washing to scrubbing for a minor procedure, may be most efficiently and effectively taught in the four stage procedure based on the work of Peyton. The learner can go from a unconscious incompetence (where they do not know the procedure), through conscious incompetence (where they realise what they do not know), to conscious competence (when they begin to understand and carry out the task to the required standard).
The final phase to unconscious competence is achieved through experience until the task becomes a habit or routine (Immenroth, M, 2007). These stages allow the learner to quickly progress through the first three of the four levels of learning. It is essential during the first 3 stages of skills training that the procedure is carried out on each occasion in as close as possible to a uniform manner, without any bad practice in the demonstration of the skill, the explanation by the trainer or the description by the trainee. Similarly, in the fourth stage when the trainee both explains and carries out the procedure, any significant deviation from the pattern should be immediately corrected so that bad habits are not allowed to develop. In the event that the trainee is unable to carry out stage four, then the process should be repeated from stage two through stage three to stage four. A common mistake in teaching is to continue to oscillate between stage two to stage four, missing out on stage three which is one of the most important parts of the process, particularly when it comes to more complex procedures which will be discussed later (Grantcharov,TP, 2008).
I planned to try and build up Helen’s confidence by expressing to her that at any point of the teaching session, if she did not understand a protocol, or why things were done, or why that thing is important, I will be there to explain and guide her. The learner must be made feel that they are welcome and important; this way will assist the learner to incorporate themselves into the clinical environment (Welsh and Swan 2006). The setting of our formal and practical learning session was essential as Helen was not familiar with working in a hospital theatre based environment. Present during the procedure were myself, Helen, and my sign off mentor (Teresa).The chosen location was a unused theatre suite, it was chosen as it is a quiet area,and would minimise interruption. This setting also ensured that Helen had my full attention during the teaching session.
Using Peyton;s 4 Stage approach allowed me to have a structured session in place with observation, discussion and direct questioning, so Helen is fully aware that she is being assessed at the time of questioning. I had taken into account in which manner Helen learns ,as it is important to recognize her learning style ,so that it can be incorporated into the learning material to facilitate effective learning (McNair et al 2007). Recognizing her individual learning style helps me to arrange her learning preferences. According to Kolb (1984) there are four distinct styles of learning or preferences which are based on four stages, diverging, assimilating, converging and accommodating learning styles. Being approachable and friendly, I was able to maintain a trusting and comfortable relationship beneficial to learning. Helen felt that my character was strong with a professional relationship throughout the learning experience.
According to Helen and Teresa feedback, I had delivered the teaching session well,it was well structured and with a relationship hich reduced her tension and anxiety and helped her ability to learn. Personally I thought it went very well, having planned my session and using the 4 stage approach, it gave me and Helen a greater understanding of the process and also has given me more confidence for further experiences. Personal attributes of the mentor is sometimes the number one barrier when creating an effective learning experience. You need to be a good role model to be a good mentor.To be a successful mentor, it is important that you will find ways to improve the learning environment.
It can be a difficult task when creating a suitable environment and can affect the learning experience. Students can come from varying nursing backgrounds and have also had varying experience working in their chosen healthcare setting. Therefore, it is necessary to make an appropriate environment for each individual to take full advantage of the learning process (Lowenstein and Bradshaw 2004). The operating theatre can be a fantastic clinical learning environment. However, students sometimes feel that they are left to their own devices for too long and can feel like ‘a spare part’, due to not working with their mentors enough and perhaps more worryingly working in ways which were not relevant to their practice as a theatre nurse. Observations, perhaps highlight that it is not only students that need to reflect on their practice, but also mentors as learning is a lifelong process (Gopee 2008).
Mentorship has been forever present in healthcare for many years. Gopee (2008) suggests that this concept has been evolving and developing since the early 1970s, but it was formally adopted by the nursing profession in the 1980s and subsequently by Operating Department Practitioners (ODPs) (CODP 2009). The philosophy of supporting junior colleagues and students has had many different titles and names since its inception: preceptor, assessor, supervisor and clinical facilitator to name but a few (Gopee 2008, Myall et al 2008, Ousey 2009). There have been many different definitions of mentors, and according to Jackson (2008) these definitions have added to the ambiguity of the role of the mentor in today’s nursing press, perhaps the most clear definition is by the Nursing & Midwifery Council (NMC 2008) who state that “A mentor is a practitioner who has met the outcomes to become a qualified mentor and who facilitates learning and supervises and assesses students in the practice setting”. Nevertheless, mentorship is now an integral part of nursing and other healthcare practitioners’ roles (Jackson 2008, Ali & Panther 2008).
Indeed, Ali & Panther (2008) suggest that mentoring is an important role that every nurse and ODP has to accept at some point in their working life. Mentoring is also a part of the respective codes of professional conduct which state that “Nurses must facilitate students and others to develop their competence’s and that nurses must ‘be willing to share skills and experiences for the benefit of colleagues” (NMC 2008). Duffy (2003) suggested that there needed to be a change of emphasis for assessing and mentoring students, She argued that there was evidence of mentors ‘failing to fail’ students whose competencies were under question. This certainly defies the CODP (2009) standards for mentorship preparation and also contradicts the two separate codes of professional conduct (HPC 2008). Duffy (2003) states that “Although sometimes the reasons for failing students proves to be difficult, the consequences of not doing so are potentially disastrous”.
It is imperative that nurses and ODPs understand their accountability for their assessment decisions of a student’s competence. Practitioners are accountable to their professional bodies and are also accountable for the safety of future patients. The RCN (2007) states that mentors are accountable both for their professional judgements of student performance, and also for their personal standards of practice, the standards of care delivered by their students, and the standards of teaching and assessing of the student under their supervision. A mentoring relationship is therefore a very complex and demanding role and one for which nurses and ODPs should be adequately prepared (Duffy 2003). The recommendations from the Francis report (2013) and the NHS England Constitution (2013) both emphasise the importance of strong leadership at all levels and by all disciplines of staff. Good leaders should be role models for their peers and students, they should exhibit the values expressed in both the Francis report (2013) and NHS England Constitution (2013).
These are compassion, caring, respect and dignity, competence, commitment, putting patients first, ensuring we improve people’s lives and that everyone counts regardless of who they are. This is particularly important for mentors as you are guiding and shaping the practitioners of the future and we need to ensure your student takes on and displays these values. As professionals we must equip and support our students in all care environments and at all levels of organisations to really embed “ Compassion in Practice”. There should be a clear relationship between strong leadership, a caring and compassionate culture and high quality care. We all have parts to play in providing strong compassionate leadership within and across teams, and across organisational boundaries.
The Francis Report 6Cs (Care,Compassion, Competence, Communication, Courage,Commitment) are values for leadership, this action area is concerned with the support and empowerment of professionals, to enable them to lead change locally and motivate their teams to improve the experience and outcomes of the people using their services. The 6Cs belong to all health and care staff from nurses, midwives and doctors to executive boards and commissioning boards. For the vision of Compassion in Practice to become a reality, every person involved in the delivery and management of the healthcare system should commit to ensuring that staff work in supportive organisational cultures. (Compassion in Practice – One year on Author NHS England/Nursing Directorate Publication Date 26 November 2013).
In conclusion, it is clear that the role of the mentor is not an easy one. The task revolves around two key characteristics, namely being a good role-model and being an active facilitator of learning. It is highly complex and carries a great deal of responsibility and accountability. Indeed, mentorship formulates the new generation of healthcare professionals and therefore poor mentorship can lead only to a lack of dedicated, knowledgeable and competent practitioners of the future. Successfully teaching and nurturing a student for myself has been be a very satisfying experience. Mentoring has also helped me to keep my practice up to date and has allowed me to network with other students and their mentors.
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