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 underperforming student, highlighting the most important
keys in the facilitating learning and the assessment of learning to prevent the
underperforming 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).
