Developing And Delivering Teaching Nursing Essay.

 

The role of the mentor in nursing is a crucial one and should not be undertaken lightly, it is a privilege with much responsibility, as the mentor is accountable for their own and their mentoree’s performance. It is a privilege as a professional nurse mentor to be able to help a student realize their potential and rewarding to see them putting the theory they have learned into practice and helping them get the most out of their placement. The role of the mentor ‘cannot be over-emphasized; learning experience in the clinical setting ensures that the nurses and midwives of the future are fit to practice’ (RCN, 2007) and in this way the role is central to patient safety. Most registered nurses in the NHS will be expected to assume the role of mentor and with 50% of pre-registration nursing programs embedded in practice (RCN, 2007), with resources becoming less and less and the NHS becoming busier and busier, practice learning and mentoring play an increasingly important role. Mentoree’s need to be able to rely on the consistency, competency and superior knowledge and professionalism of the mentor to guide their learning, assess their competence and thus effectively act as ‘gate keepers’ to the profession (Duffy, 2004) and as such is an extremely important role. The following essay will draw upon types of leadership to enhance the skills of the mentor and improve the relationship between the mentor and mentoree.Developing And Delivering Teaching Nursing Essay.

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The first question that needs addressing, is what is a mentor?. There exists many definitions, and the term mentoring has been used interchangeably with, preceptor, coach, supervisor and teacher (Morton-Cooper & Palmer, 2000). Price (2004) defined it as ‘an experienced professional friend, charged with the teaching, guidance and assessment of a learner in practice’. The NMC considered it as, ‘a mandatory requirement for pre-registration nursing and midwifery students’ (NMC, 2006a). Some have defined mentoring as essentially an evidence-based intervention that inspires confidence and innovation, and encourages continuous professional development, (Jakubic, 2004). In addition mentoring can be both informal and formal; informal mentoring is often used as an adjunct to the more formal process of supervision and is based on a agreed plan of action to help the mentor achieve realistic goals or address specific problem areas. Whereas formal mentoring involves a structured and time managed process with clearly set objectives to be realised in a timely manner (Tourigny & Pilich, 2005). The role of the mentor primarily is to enable the student to understand the theory and it’s application in in the clinical context; the mentoree must learn to put theory and knowledge and be able to apply what they have learned to clinical practice. This process involves among others, assessing, evaluating and providing constructive feedback. It also involves assisting the mentoree in developing the ability to constructively reflect upon their practice and experiences and importantly be able to learn from this reflection (Schon, 1983). It is important to note that in order to facilitate reflection the mentor themselves must be able to self-reflect. The mentor must also have adequate knowledge and skills in order to integrate theory and practice effectively, (Eraut, 2004). The RCN (2007) in their toolkit for mentors draw attention to the obvious but crucial need for the mentors to be fit for effective practice themselves and to have the ‘depth and breadth of learning to be awarded a diploma or degree’ (RCN, 2007). The RCN also states that, a mentor is a role model and as such should be aware of their own practice and how it impacts the mentorees; the imitation of bad habits is not desirable. The mentor should be able to encourage, motivate and help the mentoree to improve skills and practice thereby increasing their confidence. It is also important that the mentor has the confidence in their own practice and knowledge in order for them to instill confidence in the mentorees. Mentors also need to have the experience and knowledge to identify learning points in practice, for example where something could have been done in a more productive manner or where an important mistake has been made; which is partly the reason for mentors being required to have at least one year experience post-registration. This can only really be achieved if the mentor has the interpersonal and communication skills required to build a professional relationship in which honest, objective and constructive feedback is received and given.Developing And Delivering Teaching Nursing Essay.

It is also crucial for effective practice learning, that mentorees need time and attention from their mentors (the RCN, 2007, state that 40% of the time should be spent with the mentoree).Turner (2001) describes the pressures on clinical staff and the impact of high patient turnover resulting in little time to devote to the supervision of students; an issue that is exacerbated by the increasing demands on the available practice placements (Bennett 2003). This however is not set in stone as different people have different rates and styles of learning; what works for one does not necessarily work for all. The competent mentor should be able to discern the appropriate approach for each mentoree’s learning style and should not impose theire preferred way of learning and mentoring on the mentoree. Learning styles include; activists, those that are very active in their learning, reflectors, those that stand back and think over what they do and what others do, the theorists, they approach learning from an almost empirical standpoint, they reject everything that does not have evidence and do not like subjectivity (Bayley, Chambers & Donovan, 2004). The fourth style of learning (according to Honey & Mumford, 2000) is that of the pragmatist; the pragmatist likes solving problems , likes to learn through trying new approaches and getting feedback, (Bayley, Chambers & Donovan, 2004). Therefore if the mentoree has been identified as largely an activist then emphasis could be placed on learning through action, giving them new challenges often enough ensuring they do not get bored whilst making sure they learn and retain that learning, from each challenge and experience. It is down to the skills and competence of the mentor to detect the mentorees learning style and then tailor their learning plans, structures/ strategies to meet the needs of the mentoree.Developing And Delivering Teaching Nursing Essay.

As well as interpersonal and professional leadership styles the mentor (and the mentoree) must both keep thorough records of the mentoree’s progress. Research has shown that innovation was taking place in practice based learning but it was not recognized because there was a lack of formal documentation (Aston et al, 2005). Effective and comprehensive records have to be completed so that the mentor can see how the mentoree is progressing and what they still need to work on. Similarly it is also important that the mentoree keeps thorough notes of what they should be doing, what they have found difficult and what they are still to do. A corollary to the need for thorough, comprehensive records is that of assessment which the mentor has to carry out; they must ensure that essential clinical skills are completed. To carry out a thorough assessment the mentor has to be sure what they want to measure and how measurement can be done, for example the mentor cannot asses most clinical skills by verbal communication alone, the mentoree must be observed in practice (perhaps asking patients if they thought their care was good). To be an effective mentor one must be able to evaluate which involves a number of skills, including observation, communication, confidence in ones own professional ability and knowledge. In the evaluation process the mentor must be able to identify problem areas partly by observing the mentoree’s practice and also by the mentoree’s self reports and assessment. It is also incumbent on the mentoree to identify failing students; this is crucial as patient safety could potentially be at risk if the mentor fails to spot a failing mentoree (RCN, 2007). There are a number of actions that a mentor can take to identify a struggling student; for example if a mentoree does not respond to constructive feedback and fails to incorporate improvements suggested by the mentor, if they are inconsistent in the clinical practice, high absence rate, or is unable to organize or plan their time adequately (Maloney et al., 1997). Duffy (2004), in her study of nurses in Scotland, found that all mentors highlighted the need for the topic of failing nurses to be addressed in mentorship programs. Duffy goes on and state that; ‘the literature supports the view that mentors feel ill prepared for their role’ and ‘given that mentors are ill prepared for their role in failing students it is recommended that mentorship programs address the issue of accountability’ (Duffy, 2004). The next section draws upon leadership styles to help the mentor.

Any individual mentor will also have their own particular approach, Bayley et al (2004) list them as; authoritarian, as the name suggests, democratic, developmental, and task-orientated. The task-orientated approach, again as the name suggests, may be the most appropriate for a mentoree who has been identified largely as a pragmatist. The mentor should be able to understand and identify different learning styles and must adapt their own approach to mentoring to suit the needs of the mentoree. Moreover, the more contemporary styles from the leadership literature of transformative and transactional leadership styles can be applied to mentoring. The transformational leader (mentor) does not always lead from the front but tends to delegate responsibility amongst their team, they spend much of their time communicating and are highly visible and accessible (Bayley, Chambers & Donovan, 2004). This leader tends to focus more on the needs of the members and their wants; they try to involve all members to work together. The transformational leader is quite similar to the democratic style as both leaders value fellow team members and focus on empowering nurses (Bayley, Chamber & Donovan, 2004). Transformational leaders are inspirational and easily motivate those under their leadership (Aarons, 2006); they go above and beyond exchanges and rewards which are inherent in transactional leadership styles (see below). The transformational leadership style is said by some to be best suited to ‘close supervisory relationships, compared with more distant relationships’ (Aarons, 2006) and ‘this close relationship may be typical of a supervisor-supervisee relationship and is also captured in the notion of “first-level leaders” (Priestland, 2005). Mentors can be thought of as first level leaders as they are ‘functionally’ close to the mentoree, in the organizational setting and because of that are vitally important, (Aarons, 2006). Mentors work closely with their mentoree, the RCN (2007) in their guidance for mentoring stipulates spending 40% of the time working and observing the mentoring. This leadership style would be good for the mentor – mentoree relationship as the mentor is inspirational, positive and innovative; inspiring new, creative ideas and fosters an open honest learning relationship. This is a type of leadership that allows a person to step away from their comfort zone, promotes a high level of openness and innovation, is externally open in the hope of developing a high level of discovery and competence; they embrace deep change in order to obtain meaning, purpose and vision. The transformational leader (mentor) according to Aarons (2006) is a leader that works towards a goal in order for both members to benefit (Aarons, 2006). This style although appropriate for the needs of the mentor-mentored context perhaps could benefit from the some of the principles from the transactional leadership style outlined below.Developing And Delivering Teaching Nursing Essay.

The transactional leadership is orientated towards satisfying subordinates self interest through suitable transactions’ in the work environment, (Aarons, 2006 ). There is a clear structure with this leadership style and Aarons (2006) comments on it as being a ‘give and take’ technique. Rewards are given for work that is done, the work is set for the members and recognition is given when the task is completed; in this way it would be applicable to the mentor-mentored as mentoring should have a clear structure and achievement should be rewarded, however failure should not be punished but recognized and learned from . The transformational leader is similar to the autocratic style as there are clear set tasks within set time frames, the task is order to be done by the leader and the members will follow orders in assurance they will be rewarded. Aspects of the transactional leadership coupled with the innovative and open transformational style may be the most appropriate style; providing both motivation, inspiration and structure and security. The new nurse has just stepped from a secure environment of university and now has to be able to control what is happening within their new clinical setting. Whilst structure and security are important for the mentoree it is also important that they feel they are able to speak freely, honestly and openly to their mentor; for example the mentor should encourage the student to ask questions and speak openly and honestly about their views on the progress, and the mentor should give praise where it is due, as suggested in the RCN Toolkit (2007).The new or student, nurse need to feel secure within the ward; they are new to the role within the team and have a need to be perceived as confident in what they are doing. The mentor is also responsible for the professional socialization of a new nurse in the clinical setting (Bulman & Schultz, 2008). The need to fit in must be balanced with the need to perform. Professional socialization is seen to be a process in which a person acquires a professional identity, and thereby is accepted by others in the profession (Bulman & Schultz, 2008). Having support from their mentor is vitally important when making the transition from student to qualified nurse; their experiences can help to set aside any worries and issues that are felt by the new nurse.Developing And Delivering Teaching Nursing Essay.

The mentoree is on a journey with a steep learning curve and it is the role of the mentor to help the them navigate the problems and challenges and help transform them into learning experiences, therefore the mentor should be able to identify learning opportunities which step from student to staff nurse is a journey that involves many problems and uncomfortable situations, though these problems are what help the student to learn and develop. The mentor is an integral part of the learning and orientating process of the new nurse, not only do they explicitly teach and inform but they also play a large part in the implicit learning process; for example positive role modeling and practice under supervision of the mentor helps the mentoree to develop the processes of integrating the knowledge with the conditions under which that knowledge applies and the culture in which that knowledge is used. A key skill required of students is that they learn to integrate into the culture and ‘communities of practice’ (Eraut 2003). Mentoring, in an increasingly stretched national health service, is becoming more and more important; if done effectively it can instill confidence and competence it can also ensure that the mentored are ‘comfortable with their identities and competencies leading to the retention of good nurses who contribute in the effort and emphasis of maintaining nursing excellence in practice’ (Godfrey, Nelson, & Purdy, 2004).Developing And Delivering Teaching Nursing Essay.

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Integral Part of Developing Skills to Improve Essay.

 

Reflective writing is as a medium for an individual’s reflective capacity to be communicated and examined both internally and externally. Self directed learning is emphasised through reflective writing as students engage in a more holistic approach which uncovers the reasons behind their actions.Integral Part of Developing Skills to Improve Essay.

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Experience and learning

Moon (2004) emphasised that an individual can both reflect in order to learn or learn as a result of reflecting. Through experiencing new situations medical students are able to learn and develop new skills but the level of learning depends on the depth of reflecting of the experience. This is often why reflection is described as learning through experience. Reflection of an experience is associated with deep learning where the student is able to gain more insight into the decisions behind the actions involved. (Marton,Hounsell, Entwistle 1984) By learning through experience students are able to build on previous knowledge which covers a solid knowledge base that can be applied to changing situations and which experiences can be drawn from. Learning does not stop at reflection but involves the changing in decision making processes and actions that reflection should bring about in future situations. What is learnt from reflection must be put into practice for it to be effective.Integral Part of Developing Skills to Improve Essay.

Kolb (1984) proposed that Learning does not result from having an experience but occurs when an experience is examined, reviewed and reflected upon. This process allows a connection to form between theory and actions where an experience involves preparation, action, reflection and connection back to previous knowledge. Refection involves lifelong learning as the changing nature of medicine and ethical concerns continues to challenge practitioners.Integral Part of Developing Skills to Improve Essay.

Emotions and Reflection

William (2002) said “Actions are so much more powerful if they arise from both feelings and thoughts”. Reflection involves the process of understanding and examining emotions and how they affected a situation. Emotions are an integral part of any experience and it is through reflective practice that the impact emotions has on a situation comes to light. Practitioners have to deal with many different situations that can cause psychological and emotional strain. Reflective writing allows emotions to be dealt with and not compressed. Through expressing personal feelings practitioners are able to be more focused and self-aware which can increase their capacity to feel empathy for patient’s situations. Empathy makes patients feel more understood and heard and through reflective writing the promotion of understanding of patient’s situations and vulnerabilities can be achieved. (Squier 1998)

Negative feelings can hinder performance through self doubt and lack of confidence but through reflecting on negative experiences these emotions can be used to improve performance and encourage self directed learning. (Olckers, Gibbs, Duncan 2007) Reflective writing allows students to use emotion in their writing which assist in overcoming psychological and emotional barriers which they may face and provides an opportunity to examine potential moral consequences of an action. Reflective writing allows students to deal with their emotions instead of suppressing them and allows the development of strategies to deal and express emotions in different settings. This promotes a sense of practitioner wellbeing where the mental, emotional and spiritual health of practitioners is looked after. Through reflecting on emotions a connection between the medical profession will the rest of society is built where there is less risk of practitioners becoming detached and intolerant.

Reflection and learning in the Professions

Reflection in the medical practice can be viewed from three directions; reflection-on action, reflection-in action and reflection-for action. (Killion, Todnem ,1991)

Donald Schon (1983) developed theory of reflective professional practice by developing reflective- in and reflective-on action. Reflection- in action involves connecting past experience, feelings and knowledge to a current situation. This process allows new insight and understanding to be established in relation to the situation which will influence the decisions made by the medical practitioner as the situation develops. This type of reflection is particularly important to medical practitioners who face complex and new situations regularly and who need to make fast accurate decisions and actions. (Schon 1983)

Reflection-on action involves reflecting on a situation that has occurred and analysing decisions made to determine weaknesses or possible improvements that could be implemented in future practice. This form of reflection is often only undertaken when something goes badly or not to plan but it is essential for reflection to take place after experiences that went well to fully reflect on an individuals strengths and weaknesses.Integral Part of Developing Skills to Improve Essay.

There is also pr-action reflection which describes a form of reflection before an action is taken. This form of reflection aims to prepare professionals to be able to deal with situations where there may be no time to reflect in action so it becomes important to reflect prior to action. (Mann, Gordon and MacLeod, 2009)Reflection prior to action is often done unconsciously where future possible actions are accessed and evaluated and goals are set. In medicine if prior knowledge of patient’s condition is known research through literature, past case studies and communication with other health professions can result so that possible conditions which may be present can be dealt with. Reflection for action can be used to view the situation from a variety of perspective not just from one’s self. It can include perspectives of the patient, other health professional and text based knowledge. This form of reflection can reduce mistakes and prepare practitioners for possible unforeseen circumstances. (Keith Ong 2011)

Reflection and Personal Development

Reflective practice is a key skill for medical students to develop and continue to use throughout their medical careers. Reflective practice assists medical students and practitioners to refine their ability and continually challenge their own decisions making process. The goal of reflection according to Epstein, “should be to develop not only one’s knowledge and skills, but also habits of mind that allow for informed flexibility, ongoing learning and humility”, (full text1 19) Personal and professional development is an integral part of the medical profession. This development is cultivated by reflective practice which allows self-assessment and professional identity to be uncovered. Professional identity is established through reflective writing as a medium for practitioners to express their own voice and perspective, and clarify and refine personal values which may be competing or conflicting to others. (Shapiro 2006)

Through becoming more self-aware reflective practice allows practitioners to become more engaged and aware during clinical encounters and improve clinical reasoning. This is why reflection has close links to safe practice as critical though has been put into decisions allowing care to be solely patient based. (Bansman 95). Critical examination of decisions allows problem solving skills to enhance which contributes to more effective treatment of patients.Integral Part of Developing Skills to Improve Essay.

Reflection assists in guiding present and future decisions and actions in a competent and knowledgeable way through allowing new experiences to draw on pervious situations to increase understanding of patients and to extend empathy towards them. (Wald 2010) Reflective “writing improves clinicians’ stores of empathy, reflection, and courage… Writing that affects the reader is art” (Charon 2004) Reflective practice is shown to have many benefits for practitioners not only through clinical skill improvements but assisting in developing the whole person by developing interpersonal skills. Practitioners improve skills of empathy as they are more aware of their patients and their own emotions and how those emotions may effect the consultation or decision made by the patient.

Reflective practice allows a connection to form between technical and knowledge based facets and emotional aspects. It aims to develop personal skills which will enhance and guide technical learning and performance in a clinical setting. Through assessing the bigger picture though reflective practice students are able to deal with more complex and unforseen issues.

The process of reflection

Reflection may be difficult to teach (Stimson 2009, Roberst 2009) although reflective frameworks can assist in engaging individuals with reflective practices and developing skills for future internal reflection. Reflection in a practical setting needs to be continuous for the knowledge uncovered during reflection to be translated into action. Gibbs’ (1988) created the ‘Five stages of reflection’ model which can be used as a guide for reflective writing. This model represents the cycle that reflective practice is a part of. The five steps of this model include describe, reflect, research and analyse, decide, act and evaluate. Brookfield (1987) approach to reflection involves using the view points of a number of different perspectives know as the ‘four lenses’. It involves researching, analysing and connecting through critical reflection.

Conclusion

Reflective practice is an important attribute for undergraduate medical students as it increases self-awareness, refines problem making skills and prepares students to deal with complex, unpredictable situations. Through reflection students are able to refine their clinical skills by recognising their strengths and weaknesses which develops personal competence and identity. Although reflection takes time and effort the long term benefits create a more competent and compassionate practitioner.Integral Part of Developing Skills to Improve Essay.

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