Learning environment/ Appendix one

Level six only

NMC domain five and six

The clinical environment has a stated philosophy of care which can be found at the entrance of the ward. All care in these acute clinical settings is given on the researched base evidence, care that is relevant to individual needs.  Interpersonal and practice development skills are fostered through arrangement of teaching and learning methods. The medical Staff is encouraged to participate in continuing professional development based on identified learning needs and appraisal. Students are allowed to participate in multidisciplinary meetings and multi professional working together as a team. Students are supported by link tutors on the ward and are given effective and accurate feedback and they are also encouraged. Students are allowed to put theory to practice when they come to the ward by given care to acute ill patients with various types of disease and illnesses. When the students come to the ward environment they are orientated, they are given briefing on health and safety on the work place, evacuation policies in case of emergency, they are shown the assemble point in case of fire, how to use the crash call when necessary, how to put call out using by dialling 222 which they are they are shown the backup telephone in case of electricity outage. They are taught safe disposal. They are given initial interview agreed and sign to the learning outcome. Their learning needs and achievements are regularly reviewed. They are allowed to work with other senior staff build relationships and hold discussions with them relating to issues within the learning in the learning environment. The supervisor observes me working with the student and give  me individual feedback in a confidential manner. Clinical staff are not given time during the working ours to update their knowledge this is done on a personal basis in their own time or during the allocated study days. Link tutors has set date and times when they come to the ward and meet with the students on a one to one as well as in groups. I believe that six weeks was a long enough time for the student to develop effective clinical skills and competencies within her league. Assessment and evaluation are carried out accordingly and where necessary time is given for continuous learning to take place.

Evaluation teaching session from a mentor’s point of view

In my opinion the teaching lesson went well, I was able to express myself clearly even though in the beginning I was a bit nervous.  The teaching lesson was my first as a mentor and it was a supervised session by my supervisor. I planned the whole session and I tried to deliver a well organised and structured lesson on how antihypertensive medication and insulin is administered safely. I did not use any visual aids but it helped me the fact that we were on the ward and we had access to use patients’ notes, drug charts and leaflets from different medications. I tried to keep the information at the basics level in the same time with giving important information about safe administration thinking that the student is in the first year and the teaching lesson should be tailored to her needs and level of understanding. We used the interview room for our session away of any disruption. Even though we established a good relationship and she was comfortable with me, the student was as nervous as I was, but in a couple minutes the atmosphere relaxed and we were able to continue calmly with our lesson.  The student shown interest and even though I left a few minutes reserved at the end for questions, she politely asked me a couple questions during the session.  Overall, the teaching session ran well and we achieved our learning outcomes. From my point of view, I believe that having established a good relationship with the student and a well-structured teaching lesson is a bonus for a successful teaching session.

Inter-professional learning and practice

NMC domain two and seven

Report on the learner’s engagement with the multi-disciplinary team

In the clinical placement it is vital to promote and maintain a close communication and collaboration between the members of the professional team in order to deliver the best patient care. Our inter-professional team is formed of a multi-professional staff such as doctors (SPR, SHO, HO, consultant), sisters, discharge sister, dialysis nurses, staff nurses, healthcare assistant, physiotherapists, occupational therapists, dietitian, porters, and outside from the clinical practice such as social services, district nurses. Each member of the teamwork has their role in order to run efficiently the medical process that needs to be delivered to the patients according to their needs. There are always running meetings between the multi-professional team on our ward in order to achieve the best care plan for our patients such as nursing handover, ward rounds, MDT meetings to discharge a patient in a safe environment with the appropriate care tailored to each patient according to their needs. The student was taught and encouraged to attend at these meetings for further professional development. The student was also taught the sequences of the process such as how and to whom to pass a message when a scenario needs urgent input for the patient, how to refer a patient to the physiotherapist, OT, dietitian for specialist input, how to get in contact with porters for equipment or blood, how to access the external medical team through the phone etc. In order to understand the importance of being part of teamwork, the student was asked to give continuous feedback and encouraged to reflect upon and ask questions whenever necessary. By the end of the placement the student understood how important is to work as a teamwork for patients’ good, the role and importance of each member of the teamwork and acknowledged that failing to pass on medical information to the right member or skipping a member of the teamwork can have a major negative impact on the patient.

Mentor/learner relationships

NMC domain one

Report (270 words)

I orientated the student to the ward and I establish a relationship with the student. Then I met with her and agreed a learning contract setting clear goals and time for achieving these goals. I worked with her as much as possible and gave her the opportunity to work with other staff nurses for her to build a relationship with the team and feel comfortable working within. I allowed her to attend and participate in multidisciplinary meetings, doctors ward round, teaching sessions organized by other colleagues and as well as I allowed her to company me to collect postoperative patients and those attending or returning for other procedures. I often speak in the clinical room or in the staff room in break time and I found out she was comfortable. I also encouraged her to feel free to discuss with me out side offset meeting times any problems she’s having or anything that she’s not comfortable with. This is to allow her to relate any fears or worries that she might have. We set appointments to meet for midway interview and end of placement evaluation. At the midway interview I was pleased that this student had met all her set goals and learning outcomes. During the evaluation she confided in me that she felt that she was a part of the team and she acknowledge and thank me for my time and patience which helped her to achieve good learning outcomes. She also commented that she admired my professional and caring attitude in the clinical environment and she stated that she will strive to also be an excellent professional nurse.

Leadership

Level six only

NMC domain eight

My supervisor believed that I had established a good relationship with my student and there was good communication between us. My learning contract based on the student’s experience and goals was acknowledged and she stated that the objectives set were appropriate for a first year preregistration learner. I had a clear plan of action which included the frequency of our protected time and place of meeting and this was agreed with the student.  The supervisor indicated in her report that I demonstrated my competence in assessing the student’s learning needs and I managed to plan a good learning contract.

The teaching session in my supervisor s opinion, went well, I had a well-structured lesson with the subject being introduced very well. As said in previous reports, my mentor observed that I was nervous but the lesson went well because of my skills communication and knowledge. I did not use any visual aids but I used patients’ notes, drug charts and leaflets. The student asked question during the lesson and my supervisor realised we had a good relationship because the student was comfortable in asking questions. I set up a good learning environment away from disruption, everyone was seated and I maintained the eye contact with the student.  My supervisor confirmed that I achieved the learning objective and I delivered a good lesson.

In regards to the student’s achievements I was capable to provide the evidence that the student achieved her learning objectives. During of the student’s placement I reflected on the student’s SWOT analysis and I gave continuous feedback where appropriated. I took in consideration the fact that the student is a first year pre-registration student and I tried to deliver basic information from the  medical field but of quality against her goals already set by her and university and against of the learning contract. The evidence of achieving the learning outcomes was documented as per learning contract. I demonstrated the competence required in assessing learning needs and the learning programme was effectively planned as my supervisor stated in her report.

Reflecting on this report I believe there is sufficient left to improve on my teaching skills. I understood how important it is to have a good initial interview established on the student’s background. I acknowledge that is very important to have a good and effective relationship with the student, especially a relationship based on trust in order to work together to achieve the learning objective. I understood how important is to develop a good and structured learning contract in agreement with the student and most important based on student’s needs not on my needs. I realised the importance of introducing all the objectives slowly during the student placement without overloading the student and the importance of the continuous feedback and most important to give positive feedback, constructive criticism in order to motivate and encourage the student. 

References

Anderson, L., (2011) A learning resource for developing effective mentorship in practice.

Nursing Standard. 25, 51, 48-56

Aston, L., Hallam, P., (2011) Successful mentoring in nursing. London, Learning Matters.

Bastables, S., (2008) Nurse as educator. Principles of teaching and learning for nursing practice. London, Jones and Barnet Publishers

Beskine, D., (2009) Mentoring students: establishing effective working relationships. Nursing Standard. 23, 30, 35-40

Cassidy, S., (2009) Interpretation of competence in student assessment. Nursing Standard. 23, 18, 39-46.

Duffy, K., (2007) Supporting failing students in practice 1: Assessment. Nursing Times. 103, 47, 28-29.

Duffy, K., Supporting failing students in practice 2: Management. Nursing Times. 103, 48, 28-29.

Gopee, N., (2011) Mentoring and supervision in healthcare. 2^nd Edition. London, Sage.

Hand, H., (2006) Assessment of learning in clinical practice. Nursing Standard. 21, 4, 48-56.

Hodges, B., (2009) Factors that can influence mentorship relationship. Nursing Standard. 21, 6, 33-35.

Knowles, M.S., Holton, E.F., Swanson, R.A., (2011) The Definitive Classic In Adult Education and Human Resource Development 7^th Edition Butterworth-Heinemann Publications. Oxford, United Kingdom.

Laird, D. (1985) Approaches to Training and Development. Addison-Wesley, Reading Massachusetts

McGill, I., Beaty, L. (1985) Action Learning: A guide for professional, management and educational development. 2^nd Edition. Kogan Page, London

McGregor, A., (2007) Academic success, clinical failure: struggling practices of failing student. Journal of nursing education. 46, 11, 504-511.

Morris, D. and Turnbull, P., (2006) Clinical experiences of students with dyslexia. Journal of Advanced Nursing. 54, 2, 238-247.

Moscaritolo, L., (2009) Interventional strategies to decrease nursing student anxiety in the clinical learning environment. Journal of nursing education. 48, 1, 17-23.

Nursing and Midwifery Council (2008) Standards to support learning and assessment in  practice. NMC, London.

Oermann, M., Saewert, K., Charasika, M., Yarbrough, S., (2009) Assessment and grading practices in schools of nursing : National Survey Findings Part I. Nursing Education Perspectives. 30, 5, 274-278.

Price, B. (2006) Addressing problematic behaviour in learners. Nursing Standard. 20, 40, 47-48.

Rassool, G., Rawaf, S., (2007) Learning style preferences of undergraduate nursing students. Nursing Standard. 21, 32, 35-44

Stuart, C., C., (2007) Assessment, supervision and support in clinical practice. Second Edition. Edinburg, Churchill Livingstone.

Schober, J.E. and Ash, C., (2006) Student nurses’ guide to professional practice and development. London, Hodder Arnold.

Tanicala, M., Scheffer, B., Roberts, M., (2011) Pass/fail nursing student clinical behaviours phase I: Moving toward a culture of safety. Nursing Education Research. 32, 3, 155-161.

White, J., (2007) Supporting students with dyslexia in clinical practice. Nursing Standard. 21, 19, 35-42

Wilkes, Z.,(2006) The student-mentor relationship: a review of the literature. Nursing Standard. 20, 37, 42-47.

Critically explore the management of a student/ learner whose standard of practice are of cause for concern

Gopee (2011) quote the definition of a mentor that was given by The Nursery and Midwifery Council (2008) in its standards: the mentor is a “registrant who…facilitates learning, and supervises and assesses students in practice settings”. To do this NMC has set clear guidelines for continuous training, education and professional development in the clinical environment and requires this must be upheld at all times. Aston and Hallam (2011) state that there is a lack of agreement over what the role of a mentor is because there are many terms used to describe a mentor such as, supervisor, mentor, preceptor, coordinator, facilitator and assessor.

This essay will critically explore the management of a student/ learner whose standards of practice are of cause for concern. The author will look at the importance of establishing effective working relationships, facilitating learning including an analysis of the learners’ needs and the development of a delivered structure to meet these needs, evaluation of learning, assessment and accountability and critically analysing the underperforming student. Firstly, the author will look at the mentoring and then will analyse the challenges met in the clinical environment while evaluating the teaching and learning process between the mentor and learner, followed by conclusion.

According to Schober and Ash (2006) successful mentoring, should be goal orientated and focus on the learner’s skills, knowledge and attitude for development. In preparation, the learner needs to have a development plan before meeting with the mentor. Schober and Ash continue that learners do best by observing and being assessed. The role of the mentor involves familiarising the learner to the clinical environment, overseeing teaching and learning opportunities, observing the learners performance liaising with the link and personal tutors when necessary and review the progress of the learner, keep accountability and act as a professional role model. The NMC (2008) requires all trained nurses to facilitate teaching of students as part of their professional role and failure to uphold this standard may compromise not only the clinician but also colleagues and the nursing profession as a whole (Stuart, 2007). Mentoring is used as learning experience for all nurses (Aston and Hallam, 2011) and requires them to be capable to teach and train students to achieve lifelong learning skills, acknowledging that the healthcare system has a continuously changing nature and is a career that needs continuing professional development. In the same time, a mentor should be able to provide to the patient a safe and high quality care while supporting student’s learning (Cassidy, 2009).

According to Wilkes (2006) the role of the mentor in practice placements is important and it is essential to establish an effective relationship.  However, a friendship enhances student’s achievement but it might not be the right relationship because the mentor’s assessment can be subjective, not showing the student’s true competency. Alternatively, a negative experience can have unfavourable effects on both of them, affecting mentor’s performances and his/her further mentoring and student’s learning experience who can suffer from a non-effective mentoring. However, the mentor – student relationship needs to be constant, for example, seeking and giving help, the mentor being described as a trusted adviser. This concept is based on the theory of facilitative learning developed by Rogers cited in Laird (1985), where he believed that learning will happen by the teacher acting as a facilitator, establishing a comfortable atmosphere enabling students to learn stress free.

In regards to establishing a successful mentor-student relationship, in her article, Beskine (2009) stated that “it is the mentor’s responsibility to establish an effective relationship with the student”. The first step would be the student’s orientation to the placement and setting’s ground rules. Orientation should be a planned event because it has an important role in creating a positive start to a placement, influencing the quality of the placement, the student’s experience and the student’s process of learning. However, within the clinical practice students can have traumatic placement experiences and poor relationships with the mentor, therefore, when a student is assigned to a mentor, the priorities are to make the student to feel welcomed and to establish a good and proper working relationship (Price, 2006). Hodges (2009) suggests that “an effective mentoring relationship should help motivate the student and improve confidence and self-esteem”. Hence, the student’s career development will be enhanced helping them to reach their potential and the mentor will gain satisfaction, recognition and further development. In the clinical environment, the relationship between student and mentor is not always harmonious, but sometimes disagreement might be useful helping in strengthening the relationship through reflection.

However, in some cases, the student is the cause of concern for not having a successful relationship with the mentor. The students might have an unprofessional behaviour and they struggle between learning environments (Price, 2006). Sometimes the mentor discovers that they do not have the essential commitment to work effectively in a team, which is a fundamental element in nursing. In this case, the mentor needs to maintain a professional approach to investigate the problem without an emotional involvement. The involvement of the link tutor may be necessary in order to prevent the reappearance of such behaviours. However, if there is no chance for a fruitful relationship and conflict remains unresolved, the student is allowed to change to another mentor (Hodges, 2009). Hence, it might be suggested that the reason for the failed mentorship was that they did not establish a good relationship.

Due regard is essential to facilitate the learner in order to acquire clinical skills and knowledge. Gopee (2011) stated that the mentor needs additional skills through structured learning activities and teaching sessions, in an appropriate environment settings designed for this purpose. The mentor has to ensure that the learning outcomes are met based upon the student’s own learning needs, simulating situations, scenarios, questions and create an environment that facilitates learning for student. Both, the mentor and the student should engage in the research process and after a few sessions of learning, the student should be capable to demonstrate their skills or competency in verbal explanation, guided practice with or without supervision.

Although, to enable the student to acquire new skills and knowledge, the mentor has to prepare a learning contract and an action plan based on student’s goals and modules according to the students learning styles (Rassool and Rawaf, 2007). The existence of a learning contract allows the discussion of goals, which helps to clarify the expectations and organises the responsibilities of the learner and the mentor (Hodges, 2009). This individualised plan can form the base of a more structured and directed mentorship experience. Therefore, to provide effective learning and positive educational outcomes, the mentors should also determine their own teaching and learning styles and they should incorporate a combination of different learning styles. It was stated that a dual learning style has an important role in the development of skills (Anderson, 2011). The same author also states that continuous feedback from students and encouragement to acknowledge their weaknesses and achievements makes students more aware of their progress. The findings from above are based on the many different theories of learning.

Knowles et al (2011) is a humanist theorist specialised in adult learning and he identified six dimensions of learning: the learner’s need to know, the learner’s self-concept, the learner previous experience, the learner’s readiness to learn, the learner’s orientation to learning and learner’s motivation. Adult learners are believed to be self-directed and this is the core concept of andragogy, putting the emphasis on the student to take responsibility for their learning. Kolb cited in McGill and Beaty (1985) researched adult learning and devised a four-stage learning process often referred to as the experiential learning cycle. He discovered that people learn in four ways, favouring one mode over the other. The cycle involves: concrete experience, observation and reflection, abstract conceptualisation and active experimentation.

The learning contract is a written document adapted against the student’s performance.   Bastables, (2008) suggests that the specific purpose of a learning contract is to focus on the following elements: what the learner needs to learn, resources needed, methods and tools, how, where and when the student needs to achieve a predetermined goal. Although for the underperforming student, the mentor might have to make “reasonable adjustments” and adopt different strategies which must take in consideration the need for more time,                                                                                                             emotional aspects and different work settings (Morris and Turnbull, 2005). The learning contract might need to be broken down in smaller steps, with manageable strategies and objectives specific for the student’s disabilities.

According to the Disability and Equality Act 2010 a mentor must ensure that a student is not treated less favourably for a reason related to their disability and failed to take appropriated measures to achieve the learning goal. In underperforming students’ category, we can meet students with dyslexia, mental health difficulties and visual impairment.  In her research White (2007) included the following typical difficulties: reading and writing reports, retaining information and instructions, organisational skills, the succession of the activities and emotional factors. However, a mentor might consider a unique approach for each student accordingly to his or her disability without making assumptions, being flexible, adapting to his or her needs, referring to the link lecturer and university for advice or information. For each of the above difficulties a mentor has to anticipate areas and activities where the student might need help. This can involve allowing extra time and explanation, avoid giving too much information and instruction at once, being patient, listening, explaining, being supportive and encouraging the use of other sources of information.

Stuart (2011) stated that the clinical environment is the place where clinical activities are performed and patients looked after to help them realise wellness. The learning in clinical environment is full of challenges (Moscaritolo, 2009) and might cause students to perceive stress and anxiety. These environments usually are erratic and vibrant and they are the places where the students learn and interact with professionals. Due regard is essential to their learning and so the clinical environment becomes an educational environment. The students need to adapt and adjust to this environment even though sometimes it becomes unpredictable. It was suggested that the time spent in a clinical practice is three times larger than the time spent in a classroom and this might affect the students’ levels of stress and anxiety. Therefore, it is agreed that students need more attention and more support to facilitate the learning process (Moscaritolo, 2009). The mentor should ensure that the student is fully integrated into the team and has given the opportunities to work as a member of the multi-professional team. Feeling welcomed and being accepted in the team can increase the student’s confidence and working alongside professionals can help the student to gradually become competent.

To sign off a student fit for practice, the mentor need to first assess the student thus ensuring that they can practice safely and effectively as a professional nurse without supervision whilst working within the law (NMC, 2008).  According to Quinn (2008) the assessment has an important consequence for the student’s development stating that the students believe that the assessment is the most important part of their course. However, an assessment can have positive as well as negative influence on the student’s performance. Therefore, an assessment needs to be carefully planned to influence a positive teaching and learning experience. The assessment of a student should also include a learning contract, with its assessment plan, as well as formative and summative assessment. Stuart (2007) stated that the student needs to be given the opportunity to prove what he or she has learned through assessment.

According to Hand (2006) assessment is to demonstrate that a student has reached the standard of practice on which a decision can be made to declare a student competent. Therefore, through assessments a student should prove that they have increased their knowledge, have acquired and developed new skills and have attained professional attitude. The formative assessment is a small part of the continuous assessment process and its purpose is to facilitate academic and professional development providing the students with feedback in regards to their progress and promotes student’s self-awareness of performance and self-directed learning. The summative assessment marks the student’s performance, values and skills achieved against the objectives which were set up for the whole course or for a substantial part of it Oerman et al (2009). However, in the clinical practice the student needs to achieve the outcomes which were specified by the university to be achieved in a placement area Hand (2006). Hence, to pass these assessments the student needs to be capable to solve problem and cope with the job requirements. In addition they also have to demonstrate that they have acquired the necessary knowledge and the skills to perform accordingly to the standards required by an employment.

Duffy (2007) suggested that the mentor should be able to recognise the early signs of an underperforming student and manage the situation appropriately, avoiding where is possible to fail the student. When problems arise, they must not be ignored and the mentors should analyse their process of teaching and reconsider their expectations if they are not realistic and measurable. Duffy (2007) also highlighted the importance of the three assessments: initial, mid-placement and final placement underling the fact that the underperforming student is usually reluctant in giving and receiving the feedback necessary for mentors to take action in regards to any concerns that they might have. However, the documentation is essential in this situation and the mentor should identify the student’s underdeveloped areas, along with a well-developed and structured learning plan. In some cases, the mentors should raise the concerns to the ward manager and link tutor and they should not avoid failing a student even though the situation is uncomfortable and they have not achieved the proposed learning outcomes.

In clinical evaluation, the contributing factors to the failures in the clinical environment are mainly credited to students’ behaviour and attitude. Tanicala (2011) identified typical difficulties which are met in the clinical practice and mostly due to an unsafe practice as medication errors, failing to check patient identity, unprofessional and unsafe conduct, unable to identify difficulties and make change, unprofessional behaviour and attitude and failure to seek help as needed. Nevertheless, McGregor (2007) affirmed that not all the students will be successful therefore, when a mentor is about to fail a student after he or she have exhausted all the possibilities the student’s dignity and future possibilities must always be taken in the consideration. It is known that some students need more time to be successful and the mentors need to be fully involved with students who are at risk of failing. However, when the risk of failing a student appears, mentors as well are at risk to disconnect from students to protect themselves rather than nurturing personal and student’s professional growth.

In conclusion, this essay has critically explored the management of an under performing student, highlighting the most important keys in the facilitating learning and the assessment of learning to prevent the under performing student’s failing. It is essential that the mentor’s approach to the teaching process is tailored to the student’s type of learning, enabling positive learning outcomes. In some instances, the whole teaching and learning process can be challenging for both teacher and learner. The learning outcomes might not be the one expected in the beginning of the course or the clinical placement. However, in the clinical practice it has been stated that sometimes the mentor might call upon different strategies methods and different methods of assessment according to the student’s capability to adapt in a new environment and also to the student’s capacity to retain and acquire information, the mentor being accountable for signing off a student fit for practice according to The Nursing and Midwifery Council  standards (2008).

Mentorship in professional practice – level 6

I uploaded my work as a reference for the new students. The main essay: Critically explore the management of a student/learner whose standard of practice are of cause of concern was marked with 67, not bad though, especially as English is not my first language. I remember I could not find anything to use it as a reference to start writing my essay, so this is way I decided to put it up on internet, for students like me. I uploaded as well, a few reports written for the work book: Mentorship in practice, hope you will find them useful too. I am sure you will find a way to pay me back! For example, you could take a closer look at my blog! Some of the games are really good! Thank you!

Good luck!