Supporting Learning and Assessment in Practice Essay
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The aim of this assignment is to reflect upon my experiences as a mentor in relation to a student’s introduction to the clinical placement, focusing on the establishment of a learning environment. In addition, the author intends to examine the learning theories behind the teaching of the practical skill of carrying out a manual blood pressure. The author’s performance as a mentor is assessed by whether the standards of practice out lined by the NMC, (2006) have been met.
Literature suggests the concept of mentorship originated from Homer’s Odyssey, in which, a wise and trusted friend of Odysseus took on the role of rearing and nurturing of his son in his absence (Bracken & Davis, 1989).
From the nursing point of view the role of the mentor within a practice placement is to support the students learning and the assessment process (Wilkes, 2006). The NMC (2006) believes that it is role of the mentor to establish an effective working relationship based on mutual trust and respect.
The relationship is complicated, it is essential that an effective connection is established where the mentor offers support but can also be objective and analytical (Wilkes, 2006). An essential factor in the creation of a bond between the mentor and student is the introduction of the student to the clinical placement and mentor at the earliest possible stage (Stuart, 2003). Therefore, when the ward sister informed me that I was to take on the role of a mentor to a third year student I discussed the allocation of specific time to complete the student’s orientation during their first day.
On reflection I found that meeting at an early stage helped us to build a successful relationship which was then built upon. In addition I was also aware that as a mentor I would be acting as a role model providing the student with the opportunity to observe, practice, and develop their skills and problems-solving ability (Twentyman, 2006). Furthermore, I was conscious of what I had expected from my mentor as a role model and on reflection I endeavoured to meet those expectations.
Papp, (2003) believes that a ‘good’ mentor from a students’ perspective is friendly and patient with a good since of humour and has a positive attitude providing individual support. Therefore indicating that the qualities required by the student are based in emotion and there is a need for the student-mentor relationship to be nurturing. A bad role model is defined by students as a nurse who sees patients as a burden, is quick to criticise and has an abrupt or ‘superior’ manner (Morton-Cooper and Palmer, 2000).
However, I was conscious that if I was to over protect my student, it could lead to the development of a dysfunctional relationship in which I suppressed the student learning, creating dependency on the mentor, resulting in an attenuated version of themselves. This is known as ‘toxic mentoring’ (Morton-Cooper and Palmer, 2000). Nevertheless, the author believes that the formation of a good student-mentor relationship in which student sees the mentor as a good role model is the key to a successful learning experience and environment.
It is the responsibility of the practice staff to create and develop an environment conducive to learning (Price, 2004). The educational environment within the clinical setting is a constantly changing situation and it the responsibility of the mentor to ensure ongoing constructive support which facilitates transition from one learning environment to another (NMC, 2006). Price, (2004) encourages mentors to conduct a strengths, weaknesses, opportunities and threats (SWOT) analysis to evaluate the learning environment. This process should not be a one off, but an evolving process.
Quinn and Hughes (2007) believe that is easier and more accurate if the analysis is carried out in partnership. Therefore I used it as a planning tool; in the initial interview enabling input from both parties. This process made my student aware of the wide range of available resources such as intra/internet, local guidelines/policies and access to excellent library facilities. Furthermore, due to the nature of the placement area a wide range of clinical skills demonstrated by the staff were both varied and of a consistently high standard.
However, due to the high turn over of patients and staffing issues time constraints can be placed upon the learning environment. Therefore I recognised that time management was going to be an important factor within the student-mentor relationship and if it was not administered collect it would damage the learning environment (Neary, 2000). By evolving my student it allowed them to become more independent, more motivated and take responsibility for their own learning.
The busy nature of the ward led to my decision to hold are first meeting in the relaxed atmosphere of the teaching room away from any potential distractions. This ensured that the student felt they had my full attention. On reflection I believe that in these circumstances, this was the most appropriate environment for our introduction. Duffy (2007) believes that all meeting should be held in a private area away from interruptions. However, it is important to remember that during a clinical placement a student is gaining practical skills which are underpinned by knowledge.
Therefore, the teaching room is not necessarily the ideal learning environment because students need hands on practice experience. Otherwise the student will have the knowledge without the skill, which can lead to incompetence (Hand, 2006). Psychologists from both the behavioural school and the humanistic approach believe that the environment is fundamental to learning (Quinn and Hughes 2007). However in contrast Wilkes (2006) has found that the most important influence identified by students in optimising learning was the individual mentor, not the learning environment.
Furthermore, the quality of the learning depends on the quality of the role model (Quinn and Hughes 2007). On reflection I believed that if my student felt supported I would be able to ensure learning. The NMC, (2006) maintains that is the responsibility of the mentor to apply knowledge of the student’s learning stage to select relevant educational opportunities. Therefore, during the first interview we discussed the student’s curriculum, identified their educational needs and acknowledged the learning opportunities within the clinical area.
Using this information we devised a learning contact which was designed to specify what the student would be achieving, how it would be achieved, the time available and the criteria for measuring its success (Nearly, 2002). Rolfe, (1996) believes that by using learning contracts it can bridge the theory-practice gap and demonstrate the transfer of knowledge to clinical practice. In addition we elected to use a teaching process which has the same structure as the nursing process and consists of four stages: assess, plan, implement and evaluate (Kiger, 2004).
In conjunction with these elements we used SMART targets. This allowed us to develop a teaching plan which was Specific, Measurable, Achievable, Realistic and Timed. Through this process we indentified a specific learning need which was a lack of knowledge of how to complete a manual Blood Pressure; this was a consequence of always using the electronic machines on the ward. Honey and Mumford (2006) have identified four types of learning styles, namely reflector, theorist, pragmatist and activist.
During our first interview I asked my student to complete a questionnaire to discover what type of learner they were. Through this process we discovered that they were an activist, this meant that the student was open to new experiences and had a social nature, albeit rather than egocentric and impulsive (Honey and Mumford, 1989). Recognising what type of learner the student was enabled us to discuss the theory of their work, adapt it, and put it into practice. Haidar, (2007) believes that by establishing the students learning style you improve their educational experience.
The NMC (2006) considers it to be the role of the mentor to understand the learning needs and styles of the student and adapt their teaching styles accordingly. Behaviourists learning theories are based on stimulus and response and the emphasis is on ‘conditioning’ the student to respond in a given way to a given situations (Hinchliff, 2006). As a consequence it is teacher-centred rather than student-centred. Ramsden (1992) suggests that this approach is too limiting as stating an outcome in terms of specific behaviour makes it impossible to ascertain whether real learning has taken place.
The cognitive learning theory believes that information is not just added to in a cumulative way; rather it acts on existing information and both are transformed into a new and more detailed cognitive structure (Hands, 2006). The Humanistic approach argues that humans have two basic needs – a need for growth and development and a need for positive regard by others. It focuses on the individual and believes that education should be student-centred. Adult learning theory known as andragogy is strongly influenced by the humanistic approach.
Both theories believe that the student should shared responsibility for learning and the use of a learner-centred approach. The principle behind this approach is that adults learn differently to children (Knowles, 1984). Reece and Walker, (2002) argues that andragogy is the most appropriate method of teaching within the nursing environment. However as a mentor you need to be aware that students will not always find it easy to adapt to a situation in which they must take responsibility for their learning (Ewan and White, 1996).
In addition the success of individualised learning is often dependent on the student being active rather than passive within the learning process (Quinn and Hughes, 2007). On reflection I mainly used the theory of andragogy when devising the teaching plan with my student. However, the author found that elements from all the learning theories were used to meet the negotiated objective. As a mentor my first action was to ask the student to take responsibility for their own learning; this was applied to practice by asking the student to familiarise themselves with the available equipment.
I directed the student towards various learning resources located on the ward, such as The Royal Marsden Hospital Manual of Clinical Nursing Procedures and the local guidelines/polices. Rogers, (1983) considers it the responsibility of the mentor to act as a ‘signpost’ directing students to the information they require. I informed my student that they would be being assessed on the evidence based practice found within these resources. This ensured that the student had the knowledge to underpin the skill, as having the ability without the rationale makes the practice unsafe (Hand, 2006).
Walton and Reeves (2001) believe that students should be given the information upon which they are going to be assessed. Following a meeting was arranged in the teaching room. This allowed the student to practice taking my blood pressure in a safe environment, so that when the real event occurs there is a degree of familiarity. Gibbs (1988) argues that although it does not exactly represent reality it is invaluable. However, the amount of learning which could be transferred into a real life situation is debatable (Quinn and Hughes, 2007).
Nevertheless, this approach does help to manage the students anxiety which if not handled correctly can be a barrier to learning (Hinchliff, 2006). Knowles’s (1984) theory assumes that adults learn best when they are not under threat. However, the humanistic approach states that if a student is supported in an anxiety-provoking situation it provides them with the opportunity for growth. On reflection I believe that you cannot protect a student from situations which could cause them anxiety nor should you. It is the mentor’s role to help them through those circumstances and to give them the opportunity to learn.
However, students need to be given the opportunity to ask questions before carrying out a practical assessment (Walton and Reeves, 2001); I used this occasion for this. Once the student felt comfortable with the skill we moved into the clinical environment where the student was assessed carrying out the skill on a patient. The NMC (2006) maintains that a mentor should assess total performance – including skill, attitudes and behaviour. The assessment of competence should be undertaken through direct observation in practice (NMC, 2006).
Mentors have to be prepared to assess a student’s performance in practice and be accountable for their decision to pass or fail. However, clinical assessment has long been criticised for being subjective (Stuart, 2007). In addition Duff, (2003) believes that all mentors often have there own ‘hidden’ criteria for assessment. Furthermore that the mentors expectations can be unrealistic (Duff, 2007). On reflection I realised that self awareness of their own expectations and attitudes would help prevent difficulties arising (Duff, 2007).
On conclusion of the assessment we returned to the teaching room to evaluate the effectiveness of the teaching/learning system as a whole. I asked the student to reflect upon the learning experience and evaluate their performance. This process develops the student’s self-awareness. However, the confirmation of perceived failings can be disheartening and destructive (Hinchliff, 2006). I then provided feed back on the student’s performance, identifying areas for improvement. Motivation is the key to learning (Sargent, 1990) it can be described as either intrinsic or extrinsic.
Intrinsic relates to personal factors which make a student want to learn. Maslow, (1987) has developed five levels which a person must reach to reach their full potential. The first stage is physiological, for example the learning environment must not be too hot, or noisy. Secondary the student must feel safe, and then there is the social element whereby they need to feel valued. In addition there needs to be mutual respect between the individual and the student, this will foster self-esteem.
Maslow claims that it is only when all these needs are met that the student is able to reach the final stage of self-actualisation. Extrinsic motivation is that which occurs outside of the student’s control, for example the way in which the student is welcomed on to the ward will undoubtedly affect how they feel –no one likes to feel unwelcome. Ewan and White (1996) argue that the two aspects are by no means exclusive of each other. On reflection the author believes that by arranging to have an interview with their student on the first day it helped to motivate the student and improved their learning experience.
During the initial interview the student informed me that she was dyslexic. Wright (2000) defines dyslexia as a difficulty in learning, reading and understanding of language. The NMC (2006) recognises the importance of supporting all students to achieve their full potential and recognise that reasonable adjustments to support the achievement of the programme requirements maybe required in accordance with the Disability Discrimination Act (1995 and 2005). With my students permission I informed the ward sister about the student’s dyslexia.
This was to ensure that I would be able to allocate extra time, if required, to meet the special needs of my student. On reflection I found that the learning contact ensured that my student had a clear understanding of what was expected and how it was going to be achieved, thus ensuring the correct level of support within the clinical and learning environment. Nevertheless, I was aware that if my student did not meet the quality line after being given the additional support, they would fail the placement, as it was my responsibility to ensure their fitness to practice (NMC, 2006).
The teaching of how to take a manual Blood Pressure reading took place in the teaching room. This was to ensure an environment where the student could feel safe and which was free from distractions. However, time was a major constraint, the NMC (2006) states that a student only has to spend 40% of their clinical placement working with their mentor. The author believes that if the other 60% of time is arranged correctly it can ensure that the student obtains a wide range of learning experiences (NMC, 2006).
Nevertheless, the method of teaching applied to learning this skill, required a lot of time away from the clinical environment and therefore shortens the time in which the author could assess the student within the clinical setting. In addition the student feedback showed that they would have liked more learning away from the teaching room. I believe that by trying to create the safe environment, they suppressed the students learning (Morton-Copper and Palmer, 2000). In addition the student had previous knowledge of the principles from using an electronic Blood Pressure machine but not the clinical skill experience of undertaking it manually.
On reflection this was not fully taken into account. Therefore, in my future practice I will endeavour to teach skills within the clinical environment when appropriate. Furthermore I will knowledge the student’s past experience and structure their learning to take account of this. In conclusion mentorship can assist in the development of the student nurse and help to ensure that they meet their full potential. Literature suggests that the students learning experience is dependant on a number of issues. The mentor and student relationship is one the major factors which will effect the learning process.
The building of a good learning environment starts on the first day. It is imperative that the student is introduced to the clinical area and the mentor at the earliest opportunity. Furthermore, the student educational needs should be identified along with their learning style; this will ensure a student-centred approach. The mentor and student relationship can only be effective if the students see it as a two way process. By working together the mentor is able to ensure the development of knowledge and skills, which meet the standards out lined by the NMC (2006) for entry on to the professional register.