Mentors In Practice Critical Analysis
A Critical Analysis of Supporting and Assessing Learners in Practice.
This portfolio will critically analyse my development to mentor students and colleagues in a mental health care setting. Portfolios improve competences by recording professional and personal development goals, growth and achievements (Sherrod 2005; Pietroni and Irvine 2001). As I have drawn upon different experiences of learning, self- awareness, reflection, analysis and critique, this will be written in the first person (Hamill 1999; Web 1992). Guided by the Nursing Midwifery Council NMC Code of Professional Standards and Ethics (2008a) confidentiality will be met by referring to my student using the pseudonym of Ann and references to patients, colleagues and the setting …show more content…
shall remain anonymous. I addition consent was granted to use information for this assignment.
Donovan (1990) states that mentorship originated from Greek mythology, where Odysseus entrusted Mentor, an older wiser friend to look after his son in his absence. Price (2005) defines mentors as experienced trusted people who guide inexperienced individuals to their full potential, however others theorists describe mentors with interchanging terms such as coach, preceptor, teacher, advisor and networker (Burnard 1990; Milton 2004; Morten-Cooper and Palmer 2000). Guided by the NMC Standards to Support Learning and Assessment in Practice (2008), it is mandatory that students are allocated a mentor, however mentoring is complex, requiring the development of bounded and purposeful relationships underpinned by knowledge, experience and opportunities for reflection (West, Clark and Jasper 2007). Mentors are therefore required to complete an NMC approved mentorship programme and to achieve competence when establishing effective working relationships; facilitating learning; assessment and accountability; evaluation of learning; creating an environment for learning; contextualising practice, evidence based practice and leadership (NMC 2008; Pickering and Thompson 2003; Jones 2005) (appendix 1). Upon successful completion of this module, I need to be supervised on three occasions for signing off proficiency at the end of final placements by a sign-off mentor before being annotated as such on the local register and I will have to mentor at least two students every three years (NMC 2008). Furthermore, to maintain registration mentors must participate in annual updating, including the opportunity to meet mentors, explore assessment and supervision issues and collaboratively discuss the validity and reliability of judgments made when assessing practice in challenging circumstances (NMC 2009).
Considering the Knowledge and Skills Framework (Department of Health DoH 2004), I was nominated for this module during my annual review (NMC; Post-Registration Education and Practice 2004) which represents continual learning related to professional practice (NMC; Supporting Nurses and Midwifes through Lifelong Learning 2002). As required, it was acknowledged by senior nurses that I had developed my competence beyond registration and had acquired the requisite knowledge and skills to be a positive role model for students which is an important learning strategy in practice (NMC 2008; NMC 2008a; Davidson 2005). I have also acted as associate mentor to students and felt rewarded when feedback suggested the demonstration of mutual respect, empathy, commitment of time and energy which authors depict as crucial elements necessary for mentoring (Allen 2002; Morten-Cooper Palmer 2000) (appendix 2). This experience made me reflect upon Eric Erickson’s developmental model, in which the tasks ascribed in the years from 25-64 are to produce and nurture next generations (Erikson 1959). This model is applicable to nurses’ who seek to support students through socialization and offering encouragement (Kozier, Erb, Berman and Snyder 2004). Additionally, it was suggested that I would advocate evidence based practice which supports standards delivered by clinical governance (National Institute for Health and Clinical Excellence; National Service Framework for Mental Health DoH 1999; National Institute for Mental Health in England 2004). My nominator suggested that I had the personal qualities to demonstrate effective leadership skills, however I would welcome the opportunity to attend the Leading Empowered Organisations programme as the Human Resources Strategy makes clear that leadership and robust strategies to support and develop the workforce are foremost to improving patient care (DoH 2002).
For the purpose of this module, I identified an approachable sign-off mentor. I acknowledged that I was responsible for my learning, however support from my mentor ensured that knowledge, skills and attributes were learnt through finding methods that suited my needs and the module outcomes (Canham and Bennett 2002). My mentor provided me with clinical supervision, was responsible for my practice assessment and ultimately the signing-off of both mine and Ann’s competence profile (NMC 2008) (appendix 3 and 4). My mentor would have to consider practice evidence to make a judgement that all our competencies had been met and that we were both considered proficient and capable of practicing safely and effectively (NMC 2008). I am aware that this might be a challenging time for mentors, particularly if failure is a possibility, so mentors are required to develop upon their assertive skills (West, Cark and Jasper 2007). At this initial stage I assessed my strengths, weaknesses, opportunities and threats as a method to develop my self-awareness (Jasper 2003) (appendix 5). I then formulated a learning contract with my mentor, enabling me to work towards my objectives on an incremental basis (Nicklin and Kenworthy 2000) (appendix 6). I was encouraged to develop my professional competence not merely by emulating experienced and accomplished practitioners, but by learning through experience with the aim of developing into a reflective practitioner (Schon 1983; Burnard 1990).
Prior to Ann’s placement, I became familiar with the link tutor’s roles and responsibilities. Managing students’ is a co-ordinated approach involving mentors, student services, learning support staff, personal tutors, placement co-ordinators and clinical educators. Collectively, teams can support each other to prepare nurses for the future (NMC 2008). Many students and professionals note that learning from placement experience is often more meaningful than that acquired in the lecture room (Stuart 2007; Quinn 2000). Reflecting upon my placements as a student nurse, I felt those which incorporated a humanistic approach to learning, a good working team spirit, regular feedback with teaching and learning being recognised was conducive to my knowledge and skills development. This is supported in Higgins and McCarthy’s (2005) evaluative research which concluded that the quality of mentorship students’ received had a major impact on the efficiency of their learning. Bennett (2003) however argues that pressure of time and other commitments can often prevent these attributes; furthermore inadequate access to mentors can result in a lack of consistency for setting goals and assessing performances. Upon reflection I can recall a placement where a mentor had a rigid and ego mind which represent disabling behaviours (Rose and Best 2005). Morten-Cooper and Palmer (2000) reiterate that these traits are undesirable in a mentor-student relationship as they work against the mentor’s role and are further described by Darling (1986) under the heading of “A Galaxy of Toxic Mentors”. A key to the effectiveness of my future role will be to gain a deeper understanding of the characteristics of poor mentoring so that these will be minimised. Furthermore, to promote my development, I am enrolled on an on-line development programme commissioned by the National Health Service Education for Scotland (Flying Start 2010) offering learning activities for mentors.
I was encouraged that Ann made contact prior to her placement. Guided by Rose and Best (2005) we agreed a start date and organised an introductory meeting to orientate Ann to the environment, patients and colleagues. Upon reflection, it felt important that I conveyed a sincere welcome by my tone of voice and use of words. It is easy to understand the anxiety of a junior student but equally important to recognise the anxiety of senior students because of the expectations mentors may hold about their competences (West, Clark and Jasper (2007). Furthermore I recognise that students come from different educational backgrounds, have had different practice experiences, learn at different paces and have individual learning preferences (Frankel 2009). Rose and Best (2005) find that students report their best experiences start with the receipt of an orientation package. To facilitate this I posted Ann a copy of the Placement Learning Experience Document (PLED) and a route map. I felt that this would relieve any anxieties, which in turn would promote Ann’s learning (Wallace 2003). I gained Ann’s consent to work alongside myself for at least 40% of her placement hours, together with her understanding that we would both be adequately supervised throughout (NMC 2008). I realised my accountability of delegation as up to 60% of Ann’s placement time, she would work under the direct supervision of others (NMC 2008). Subsequently, I established that those staff could carry out instructions and that the outcome of any delegated task met the required standards (NMC 2008a). To promote a supporting and informative environment Ann was maintained under the status of supernumerary and supervised. This ensures that students should not be employed under a contract providing nursing care (RCN 2007; NMC 2008). Upon reflection Ann was not seen as a replacement or a substitution for the existing manpower requirements, but considered a valuable team member additional to the workforce, therefore ensuring a primary educational experience (RCN 2007; NMC 2008).
It is suggested that the mentor-student relationship develops over time and passes through various phases; initiation, working and termination (Cahill 1996; Morton-Cooper and Palmer 2000) (appendix 7). Within the initiation phase I introduced Ann to the wards philosophies, goals, policies, procedures and professional developmental challenges. As suggested by West, Clark and Jasper (2007), I initiated effective questioning skills to develop a rapport and to assess Ann’s learning needs which I continued throughout the placement to continuously review Ann’s progress. During Ann’s initial interview we set dates for her interim and final interview and formulated a learning contract. Learning contracts are essential tools to encourage success of individual learners and provide clear documentation of what is to be achieved within a timescale and how students can bring together theoretical learning with practice (Morton-Cooper and Palmer 2000). As reiterated by Howard and Eaton (2003), I ensured that Ann’s learning contract included her learning objectives, strategies and resources, evidence of achievement and means for evaluation. For this to be successful, we studied the PLED as a guide to the available learning experiences, involving patients, carers and the professional team together with Ann’s Action Plan and mentor’s comments derived from previous placements (NMC 2008). Additionally we reviewed Ann’s Personal Skills Development Profile and discussed the skills that could be practiced during the placement, together with the NMC Standards of Proficiency as set out in the Competency Profile and ways that Ann may work towards achieving or consolidating these. Howard and Eaton (2004) acknowledge that for mentors, learning contracts are useful for recognising the different levels and abilities of students; however I agree with Kember, Jones and Loke (2001) who argue that the major benefit of a learning contract appears not to emerge directly from the contract itself but from the communication, negotiation, discussion and feedback between mentor and student.
I noticed that Ann had several unsigned competencies from her last placement. Respecting Ann’s autonomy, she reassured me that she had an appointment with her previous mentor to facilitate the achievement of these. Ann’s preceding placement was a formative assessment, where progress is assessed against specific criteria, without the ultimate outcome of pass or fail, but as a learning pathway through to summative assessment (Nicklin and Kenworthy 2000). As this was a summative placement it would have an end stage of the learning and assessment process; pass, fail or refer (Howard and Eaton 2003). Within this stage, Ann disclosed that she was encountering family problems. To promote Ann’s empowerment we made adjustments by negotiating shifts around Ann’s personal commitments and professional development. Spouce (2003) nevertheless depicts that students’ need to develop multi-tasking skills emotionally, mentally and physically as they are caught between the cultures of clinical placements, university and home life. The NMC (2008), however, have set standards to meet the requirements of equality and diversity schemes, promoting equal opportunities on the grounds of race, gender, disability and treating individuals with fairness, respect and understanding. These standards enhance the recognition of diversity, such as emphasising the need to tailor learning and assessment in an appropriate way and recognising that students have many different learning needs and preferences. To promote my future mentoring, I have followed the advice of the NMC (2008) by completing the disability and equality training which will guide my personal and professional commitment to the Special Educational Needs and Disability Act (2001); Disability Discrimination Act (DDA 2005). These establish that education and practice settings have a legality to provide students with the best available support (NMC 2008; Royal College of Nursing RCN Guidance for Mentors of Nursing Students and Midwives 2007; Shobe 2003; Kinnell and Hughes 2010).
Ann was at the commencement of her final year and acknowledged that her quest for competency would need to be focused on a greater refinement of skills (Norman and Ryrie 2004). It felt paramount that I was aware of Ann’s competency level as a lack of familiarity could have led me to implement a lower level of assessment criteria which would not have reflected her third year status (Stoker 2004). Some authors refer to competency in a binary manner, where a nurse is either competent or not (Clinton, Murrells, & Robinson, 2005), however Benner’s (1984) Stages of Clinical Competence, describes the development of nursing expertise based on Stuart and Hubert Dreyfus’s Model of Skill Acquisition. The Dreyfus Model posits that in the development of knowledge and skills, a person passes through five levels of aptitude; novice, advanced beginner, competent, proficient, and expert, which considers advancement in skill performance, based on experience, education and the development of clinical knowledge ((Benner 2001). Furthermore competence comes from a documented evidence-base by tutors, mentors, examinations and is based on continuum of regular assessments (NMC 2008). The code states that it is ultimately mentors and tutors in academic practices that determines level of attainment and discriminate between satisfactory and unsatisfactory student performance (NMC 2008) (appendix 8). One measure of Ann’s success was exhibited when I assessed that she could demonstrate self-efficacy in performing the role and functions of a competent third year student under occasional supervision, which empowered Ann to develop problem-solving skills independently (West, Clark and Jasper 2007). Gray and Smith (2000) report that qualitative analysis collected from student’s dairies indicated that there was a gradual distancing from their mentors as they progressed through their programme and grew in confidence, however mentors still remained a vital aspect of practice learning.
|It was during the working phase that both Ann and I felt that we had developed a therapeutic relationship as we worked and | | | |
|observed each other closely and had access to providing support for each other. In addition I observed how Ann interacted and | | | |
|processed information as everyone has some particular preferred method (Kember 2001). A widely known learning theory is the | | | |
|visual; auditory; kinaesthetic (VAK) style (Dunn 1984). The theorist finds that people with visual styles tend to learn mostly | | | |
|through sight; those with auditory learning styles benefit most from listening to oral sessions. Throughout Ann’s placement we | | | |
|both felt we shared a kinaesthetic learning style as we both preferred to carry out a physical activity opposed to watching a | | | |
|demonstration (Dunn 1984).
In addition to learning styles, learning theories can often assist mentors form a clearer | | | |
|representation of student learning in practice (Howard and Eaton 2003). Welsh and Swann (2002) find that there is a great deal of| | | |
|literature written about the way people learn and numerous theories on the methods to teach effectively or guide people in their | | | |
|learning. Reece and Walker (2003) suggest that the three main educational theories are Humanist, Behaviourist and Cognitive. | | | |
| | | | |
|It was at this stage that Ann considered her assessment criteria and related potential learning opportunities linked to the | | | |
|patient’s journey. To facilitate this, Ann suggested that she could utilise the ‘hub and spoke’ model which was first used in | | | |
|mental health placements (Lee, Edwin, Renaud, Oscar and Hills 2003). The hub being the primary placement where Ann’s assessment | | | …show more content…
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|documentation was completed as necessary (NMC 2008) whereas the spoke facilitated a secondary learning experience related to the | | | |
|hub (Cummins, McCloskey, O’shea and O’sullivan 2010).
The authors reiterate that the spoke experience creates learning | | | |
|opportunities that are not always available within the hub (appendix 2). Furthermore, the ‘hub and spoke’ model facilitates the | | | |
|expansion of the practice placement circuit, ensuring that the NMC Code of Standards and Ethics (2008) and the Quality Assurance | | | |
|Agency QAA (2002) are met. I interpreted this as adopting a humanist approach as Ann was taking responsibility for her own | | | |
|learning experience. This could also be perceived as an andrological approach as Ann was being self-directed in her choice of | | | |
|learning opposed to me as her mentor initiating her learning needs. Androgogy incorporates a greater importance on the student to | | | |
|want to learn and less emphasis on the mentor to teach but to facilitate the student to learn. | | | |
| | | | |
|At this time, the clinical environment was demanding and I felt unable to provide Ann with the support she needed, so it felt an | | |
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|appropriate time for Ann to spend a week with the Crisis Resolution Home Treatment Team (CRHT). Furthermore this experience would | | | |
|enable Ann to experience a comprehensive view of patient care and exposure to collaborative inter-professional practice. I | | | |
|ascertained that a communication system existed between both settings and that Ann would be supervised by an NMC registrant (NMC | | | |
|2008). Additionally I ensured that all relevant documentation was completed by Ann, the sign- off mentor and registrant associate | | | |
|mentor to identify the accomplishment of her set objectives. During our clinical supervision, Ann was able to evaluate her | | | |
|achievements within her self assessment sheet, positive feedback and reflection upon practice. Johns (1995) describes the process| | | |
|of reflection as a tool to assess, understand and learn through our lived experiences. Furthermore, Jasper (2003) acknowledges | | | |
|that reflective practice is recognised as an essential tool for assessing students when making links between theory and practice. | | | |
|My clinical mentor felt I fully supported Ann when she was critically reflecting upon her learning experiences, which would | | | |
|additionally enhance her future learning. It was also suggested that when I offered constructive feedback, I had considered | | | |
|barriers that could affect the intent of my message and had worked out strategies to facilitate Ann’s learning (Twentyman, Eaton | | | |
|and Henderson 2006). As stated by West, Clark and Jasper (2007) if no clear parameters have been set, negative feedback will come | | | |
|as a shock. Upon reflection, I found that both negative and positive feedback aided me as a student to develop my clinical and | | | |
|interpersonal skills (McAllister, Lincoln, McLeod and Maloney 1997). | | | |
| | | | |
Within Ann’s learning contract was the need to develop competence when administering medication. Wallace (2003) notes the importance of reducing the possibility of exposing the student or patient to any potential risks, until the student has acquired the sufficient skill and knowledge base; however if the ethical principle of accountability comes from knowledge, students are rightfully protected from full accountability until they qualify; therefore professional accountability lies with the supervising mentor (NMC 2008). Gordon, Wilkerson, Shaffer and Armstrong (2001) acknowledge that safe administration of medications is more than a psychomotor or mathematical skill as it requires critical thinking and clinical decision making. To prepare Ann for clinical practicum I facilitated a teaching strategy by implementing a cognitive approach, based on expanding Ann’s existing knowledge. Piaget (1970) as cited in Kaplan (1998) determined that there was no cognitive learning beyond the adolescent years however this view is disputed by Kaplan (1998) who proposes that adults use a process called 'postformal operational reasoning'. This encourages the learner to develop opinions, recognition, reasoning, rationales and synthesis. To facilitate this I implemented a teaching strategy using a human/patient simulator based on computer technology which utilises a barcode system in which specific medications can be scanned to activate physiologic responses in real or compressed time (Jeffries 2005). This enhanced Ann’s ability to assess variations in patient responses and increased her competence to formulate strategies for specific situations. In addition, this method poses no threat to patient safety, is reusable and provides a relatively consistent experience. Pallatt (2006) however asserts that when students perform in the working environment opposed to simulation provides a precise representation of their abilities and validates the assessment criteria; however consideration must be given to the students’ adjustment to the busy clinical environment with inherent distractions that may interfere with safe practice (Howard and Eaton 2003). It was therefore paramount that Ann, my clinical mentor and I were guaranteed time free from interruptions to evaluate her competence, so I negotiated in advance protected time for all parties. As stated by Davidson (2005) if teaching opportunities for students are to be productive, planning is an important part of the mentor’s role. I then ensured that Ann could find all the necessary equipment and resources needed as this can provide some degree of ease (Morton-Cooper and Palmer 2000). Despite our established relationship, it was important for me to be aware of learner anxiety (Price 2005). Upon reflection, I experienced a degree of anxiety because my practice was being held up as exemplary and my knowledge continuously tested, however Quinn (2000) states that this opportunity impacts on benefiting patient care as being frequently questioned promotes reflective practice and facilitates development.
Guided by the NMC (2008a), Ann gained consent from patients to administer their medication under my supervision. In addition, I explained that I was also being observed by her mentor and the patients remained agreeable to this. To implement this assessment I utilised the elements of Bloom’s education taxonomy which considers that a learning topic has to reflect upon three domains of learning; psychomotor domain relating to skill development, cognitive domain referring to the acquisition of knowledge and the affective domain involving the formation of attitudes (Bloom 1972). Turnock and Mulholland (2007) clarify that the assessment of these domains provides a more holistic picture of students’ abilities upon specific competencies. Following the NMC Guidelines for the Administration of Medicines (2004), Ann demonstrated her psychomotor skills by reading the drug chart, ensuring patients’ identity and decanted the prescribed capsule/tablet appropriately after checking the expiry date. Once administered, Ann placed her signature at the correct place which I countersigned (NMC 2004). Demonstrating cognitive skills, it was not sufficient for Ann just to administer the drugs, but she reiterated her understanding of their therapeutic uses, normal dosages, side effects, precautions and contra-indications and applied evidence based practice to assist her in decision making to eliminate inappropriate and ineffective practices that could have been potentially dangerous (Donaldson and Carter 2005; NMC 2008a). Throughout this module I have developed the awareness that implementing evidence based practice does not guarantee that the treatment has been carried out effectively therefore, all care providers under my supervision, have evaluated and monitored their practice to validate the assessment of nursing interventions (Glen 2004; NMC 2008). Representing affective skills, Ann promoted patient confidentiality and sought consent prior to administration. The assessment was followed by time to reflect upon any challenging situations, using a problem based approach and seeking clarity of Ann’s understanding by frequent open-ended questioning (Phillips and Dunn 2001). West, Clark and Jasper (2007) state that during assessments these style of questions are critical to being able to make an accurate judgement with regard to competence.
It is important to recognise that no two students will learn in the same way because we all tend to have different learning styles. Kolb (1984) developed a model that provides a framework for identifying a person’s learning style suggesting that learning is a process as well as an outcome and involves four stages; Activists, who prefer to be actively involved in new experiences and tend to learn best when working with others in team tasks; Pragmatists, who learn best through concrete experiences when there is an obvious link between theory to practice; Theorists, who do best in a structured environment where they have to use their knowledge and skills; Reflectors, who learn through observations and brainstorming activities (Stengelhofen 1996). Honey and Mumford’s study (2000) suggests that 35% of people had one preferred style, 25% had two, 20% had three and 19% had none, however it is important to allow students own style to influence mentors choice of teaching methods, even if this means supporting dual styles (Rassool and Rawaf 2007). During the working stage of our relationship, it was established that Ann was receptive to new ideas and was interested in practical consequences apposed to theory; therefore she favoured a pragmatist approach to learning which I incorporated into our planned teaching sessions.
Before embarking on any programme of teaching it is important to recognise that there are different learning theories and styles to consider. Reece and Walker (2003) state that there is a great deal written about the way people learn and numerous theories on the methods to teach effectively or guide people in learning. They discuss that the main learning theories are Behaviourism, Cognitivism and Humanism. According to the Behaviourism theory (Skinner 1974), the learning environment is fundamental to learning, and if this environment is right, learning occurs as connections are made between stimulus and response, and response and reinforcement (cited by Quinn, 2000a). The Cognitive theory (Bruner 1966) considers learning as an internal process that involves higher order mental activities such as memory, thinking, problem-solving, perception and reasoning (cited by Hand, 2006). The Humanistic learning theory (Maslow 1968) is based on the belief that humans have two basic needs, a need for growth and a need for positive regard by others. It is seen as the most holistic approach as it takes into account the drive and motivation of an individual to learn. Reece and Walker (2003) suggest that this theory also depends on the overall influence of the environment which may hinder or aid the learning process.
Howard and Eaton (2003) inform us that each educational approach would seem to have something to offer mentors as potential strategies to promote effective learning. Experience, however has shown that even when using what would appear to be the most appropriate, some students would appear not to learn as effectively as others (West, Clark and Jasper 2007). Marton and Saljo’s (2001) research demonstrates that it is students’ internal or external motivation that affects their style of learning. Students utilising a deep approach are those who are internally motivated to find personal meaning and understanding through their learning activities, whereas students who use a surface approach to learning are those who are externally motivated to memorise just enough information to pass assessments (Quinn 2000). The author finds that effective learning has a lasting impact and is likely to result from using a deeper approach rather than a superficial one, and fortunately most students, like Ann have immense internal motivation.
. “Andragogy” rejuvenated by Malcolm Knowles as “the art and science of helping adults to learn The humanist theory was developed by Carl Rogers and takes the view that learning results from enabling students. This reflects the term” and is the most persistent practice-based instructional method in adult education (Rachal 2002). Knowles (1980) proposed guidelines for teaching adults to become self-directed and independent in their pursuit of new knowledge. It is suggested that they will learn if we provide a secure, motivational environment. This made me reflect upon Maslow’s hierarchical model (1970) focusing on motivation and need theory. At each level the mentor has a specific role in assessing individuals’ needs and helping them to meet these effectively. Maslow argues that if any of these levels are not met there may be some impairment to the learning process. It might however be difficult to fully meet these needs as current nursing programmes comprise of several short placements each year, to provide a breath of practice based experiences in order to meet professional outcomes (NMC 2008). Making students’ however feel valued and part of a functioning team can go some way to achieving Maslow’s model, therefore compromises may have to be made when the ideal proves to be unattainable (Howard and Eaton 2003).
At the heart of these guidelines is an approach based on collaboration between the facilitator and the learner involving a
which had its foundations on the cognitive approach whereby learners gain knowledge by experience (Howard 2004). The behaviourist theories are described by Kaplan (1998) as classic conditioning namely being trained to have a conditioned response to a neutral stimulus and operational conditioning where being rewarded for a specific response is the resulting consequence.
Piaget’s (1970) argues that there is not any cognitive learning beyond the adolescent years, however, this view is disputed by Kaplan (1998) who suggests that adult learn by a method called post formal operational reasoning, encouraging judgement, analysis, synthesis and evaluation. androgogy, the art and science of helping adults to learn as different style of learning to that of pedagogy. Rogers (1983) expands on this stating it is a climate of trust, whereby the teacher is aware of the students learning n The humanist theory was developed by Carl Rogers and relates to learning being facilitated by the educator which had its foundations on the cognitive approach whereby learners gain knowledge by experience (Howard 2004). eed and the importance of motivation for learning so long as they have exposure to a wide range of experience and the teacher can act as a resource pointing the student in the right direction.
Upon reflection, this course has enabled me to develop upon my self- awareness and during my future practice; I will model behaviour that I would want others to adopt. In order to maintain high professional standards attending various study days, workshops and been clinically supervised has offered me the support necessary to increase confidence, accountability, competence, reflection and safe effective practice (appendix 9). I will continue to review and develop upon my knowledge, along with new policies and procedures, therefore committing to continuing professional development (NMC 2008a).
This portfolio will critically analyse my development to mentor students and colleagues in a mental health care setting. Portfolios improve competences by recording professional and personal development goals, growth and achievements (Sherrod 2005; Pietroni and Irvine 2001). As I have drawn upon different experiences of learning, self- awareness, reflection, analysis and critique, this will be written in the first person (Hamill 1999; Web 1992). Guided by the Nursing Midwifery Council NMC Code of Professional Standards and Ethics (2008a) confidentiality will be met by referring to my student using the pseudonym of Ann and references to patients, colleagues and the setting …show more content…
shall remain anonymous. I addition consent was granted to use information for this assignment.
Donovan (1990) states that mentorship originated from Greek mythology, where Odysseus entrusted Mentor, an older wiser friend to look after his son in his absence. Price (2005) defines mentors as experienced trusted people who guide inexperienced individuals to their full potential, however others theorists describe mentors with interchanging terms such as coach, preceptor, teacher, advisor and networker (Burnard 1990; Milton 2004; Morten-Cooper and Palmer 2000). Guided by the NMC Standards to Support Learning and Assessment in Practice (2008), it is mandatory that students are allocated a mentor, however mentoring is complex, requiring the development of bounded and purposeful relationships underpinned by knowledge, experience and opportunities for reflection (West, Clark and Jasper 2007). Mentors are therefore required to complete an NMC approved mentorship programme and to achieve competence when establishing effective working relationships; facilitating learning; assessment and accountability; evaluation of learning; creating an environment for learning; contextualising practice, evidence based practice and leadership (NMC 2008; Pickering and Thompson 2003; Jones 2005) (appendix 1). Upon successful completion of this module, I need to be supervised on three occasions for signing off proficiency at the end of final placements by a sign-off mentor before being annotated as such on the local register and I will have to mentor at least two students every three years (NMC 2008). Furthermore, to maintain registration mentors must participate in annual updating, including the opportunity to meet mentors, explore assessment and supervision issues and collaboratively discuss the validity and reliability of judgments made when assessing practice in challenging circumstances (NMC 2009).
Considering the Knowledge and Skills Framework (Department of Health DoH 2004), I was nominated for this module during my annual review (NMC; Post-Registration Education and Practice 2004) which represents continual learning related to professional practice (NMC; Supporting Nurses and Midwifes through Lifelong Learning 2002). As required, it was acknowledged by senior nurses that I had developed my competence beyond registration and had acquired the requisite knowledge and skills to be a positive role model for students which is an important learning strategy in practice (NMC 2008; NMC 2008a; Davidson 2005). I have also acted as associate mentor to students and felt rewarded when feedback suggested the demonstration of mutual respect, empathy, commitment of time and energy which authors depict as crucial elements necessary for mentoring (Allen 2002; Morten-Cooper Palmer 2000) (appendix 2). This experience made me reflect upon Eric Erickson’s developmental model, in which the tasks ascribed in the years from 25-64 are to produce and nurture next generations (Erikson 1959). This model is applicable to nurses’ who seek to support students through socialization and offering encouragement (Kozier, Erb, Berman and Snyder 2004). Additionally, it was suggested that I would advocate evidence based practice which supports standards delivered by clinical governance (National Institute for Health and Clinical Excellence; National Service Framework for Mental Health DoH 1999; National Institute for Mental Health in England 2004). My nominator suggested that I had the personal qualities to demonstrate effective leadership skills, however I would welcome the opportunity to attend the Leading Empowered Organisations programme as the Human Resources Strategy makes clear that leadership and robust strategies to support and develop the workforce are foremost to improving patient care (DoH 2002).
For the purpose of this module, I identified an approachable sign-off mentor. I acknowledged that I was responsible for my learning, however support from my mentor ensured that knowledge, skills and attributes were learnt through finding methods that suited my needs and the module outcomes (Canham and Bennett 2002). My mentor provided me with clinical supervision, was responsible for my practice assessment and ultimately the signing-off of both mine and Ann’s competence profile (NMC 2008) (appendix 3 and 4). My mentor would have to consider practice evidence to make a judgement that all our competencies had been met and that we were both considered proficient and capable of practicing safely and effectively (NMC 2008). I am aware that this might be a challenging time for mentors, particularly if failure is a possibility, so mentors are required to develop upon their assertive skills (West, Cark and Jasper 2007). At this initial stage I assessed my strengths, weaknesses, opportunities and threats as a method to develop my self-awareness (Jasper 2003) (appendix 5). I then formulated a learning contract with my mentor, enabling me to work towards my objectives on an incremental basis (Nicklin and Kenworthy 2000) (appendix 6). I was encouraged to develop my professional competence not merely by emulating experienced and accomplished practitioners, but by learning through experience with the aim of developing into a reflective practitioner (Schon 1983; Burnard 1990).
Prior to Ann’s placement, I became familiar with the link tutor’s roles and responsibilities. Managing students’ is a co-ordinated approach involving mentors, student services, learning support staff, personal tutors, placement co-ordinators and clinical educators. Collectively, teams can support each other to prepare nurses for the future (NMC 2008). Many students and professionals note that learning from placement experience is often more meaningful than that acquired in the lecture room (Stuart 2007; Quinn 2000). Reflecting upon my placements as a student nurse, I felt those which incorporated a humanistic approach to learning, a good working team spirit, regular feedback with teaching and learning being recognised was conducive to my knowledge and skills development. This is supported in Higgins and McCarthy’s (2005) evaluative research which concluded that the quality of mentorship students’ received had a major impact on the efficiency of their learning. Bennett (2003) however argues that pressure of time and other commitments can often prevent these attributes; furthermore inadequate access to mentors can result in a lack of consistency for setting goals and assessing performances. Upon reflection I can recall a placement where a mentor had a rigid and ego mind which represent disabling behaviours (Rose and Best 2005). Morten-Cooper and Palmer (2000) reiterate that these traits are undesirable in a mentor-student relationship as they work against the mentor’s role and are further described by Darling (1986) under the heading of “A Galaxy of Toxic Mentors”. A key to the effectiveness of my future role will be to gain a deeper understanding of the characteristics of poor mentoring so that these will be minimised. Furthermore, to promote my development, I am enrolled on an on-line development programme commissioned by the National Health Service Education for Scotland (Flying Start 2010) offering learning activities for mentors.
I was encouraged that Ann made contact prior to her placement. Guided by Rose and Best (2005) we agreed a start date and organised an introductory meeting to orientate Ann to the environment, patients and colleagues. Upon reflection, it felt important that I conveyed a sincere welcome by my tone of voice and use of words. It is easy to understand the anxiety of a junior student but equally important to recognise the anxiety of senior students because of the expectations mentors may hold about their competences (West, Clark and Jasper (2007). Furthermore I recognise that students come from different educational backgrounds, have had different practice experiences, learn at different paces and have individual learning preferences (Frankel 2009). Rose and Best (2005) find that students report their best experiences start with the receipt of an orientation package. To facilitate this I posted Ann a copy of the Placement Learning Experience Document (PLED) and a route map. I felt that this would relieve any anxieties, which in turn would promote Ann’s learning (Wallace 2003). I gained Ann’s consent to work alongside myself for at least 40% of her placement hours, together with her understanding that we would both be adequately supervised throughout (NMC 2008). I realised my accountability of delegation as up to 60% of Ann’s placement time, she would work under the direct supervision of others (NMC 2008). Subsequently, I established that those staff could carry out instructions and that the outcome of any delegated task met the required standards (NMC 2008a). To promote a supporting and informative environment Ann was maintained under the status of supernumerary and supervised. This ensures that students should not be employed under a contract providing nursing care (RCN 2007; NMC 2008). Upon reflection Ann was not seen as a replacement or a substitution for the existing manpower requirements, but considered a valuable team member additional to the workforce, therefore ensuring a primary educational experience (RCN 2007; NMC 2008).
It is suggested that the mentor-student relationship develops over time and passes through various phases; initiation, working and termination (Cahill 1996; Morton-Cooper and Palmer 2000) (appendix 7). Within the initiation phase I introduced Ann to the wards philosophies, goals, policies, procedures and professional developmental challenges. As suggested by West, Clark and Jasper (2007), I initiated effective questioning skills to develop a rapport and to assess Ann’s learning needs which I continued throughout the placement to continuously review Ann’s progress. During Ann’s initial interview we set dates for her interim and final interview and formulated a learning contract. Learning contracts are essential tools to encourage success of individual learners and provide clear documentation of what is to be achieved within a timescale and how students can bring together theoretical learning with practice (Morton-Cooper and Palmer 2000). As reiterated by Howard and Eaton (2003), I ensured that Ann’s learning contract included her learning objectives, strategies and resources, evidence of achievement and means for evaluation. For this to be successful, we studied the PLED as a guide to the available learning experiences, involving patients, carers and the professional team together with Ann’s Action Plan and mentor’s comments derived from previous placements (NMC 2008). Additionally we reviewed Ann’s Personal Skills Development Profile and discussed the skills that could be practiced during the placement, together with the NMC Standards of Proficiency as set out in the Competency Profile and ways that Ann may work towards achieving or consolidating these. Howard and Eaton (2004) acknowledge that for mentors, learning contracts are useful for recognising the different levels and abilities of students; however I agree with Kember, Jones and Loke (2001) who argue that the major benefit of a learning contract appears not to emerge directly from the contract itself but from the communication, negotiation, discussion and feedback between mentor and student.
I noticed that Ann had several unsigned competencies from her last placement. Respecting Ann’s autonomy, she reassured me that she had an appointment with her previous mentor to facilitate the achievement of these. Ann’s preceding placement was a formative assessment, where progress is assessed against specific criteria, without the ultimate outcome of pass or fail, but as a learning pathway through to summative assessment (Nicklin and Kenworthy 2000). As this was a summative placement it would have an end stage of the learning and assessment process; pass, fail or refer (Howard and Eaton 2003). Within this stage, Ann disclosed that she was encountering family problems. To promote Ann’s empowerment we made adjustments by negotiating shifts around Ann’s personal commitments and professional development. Spouce (2003) nevertheless depicts that students’ need to develop multi-tasking skills emotionally, mentally and physically as they are caught between the cultures of clinical placements, university and home life. The NMC (2008), however, have set standards to meet the requirements of equality and diversity schemes, promoting equal opportunities on the grounds of race, gender, disability and treating individuals with fairness, respect and understanding. These standards enhance the recognition of diversity, such as emphasising the need to tailor learning and assessment in an appropriate way and recognising that students have many different learning needs and preferences. To promote my future mentoring, I have followed the advice of the NMC (2008) by completing the disability and equality training which will guide my personal and professional commitment to the Special Educational Needs and Disability Act (2001); Disability Discrimination Act (DDA 2005). These establish that education and practice settings have a legality to provide students with the best available support (NMC 2008; Royal College of Nursing RCN Guidance for Mentors of Nursing Students and Midwives 2007; Shobe 2003; Kinnell and Hughes 2010).
Ann was at the commencement of her final year and acknowledged that her quest for competency would need to be focused on a greater refinement of skills (Norman and Ryrie 2004). It felt paramount that I was aware of Ann’s competency level as a lack of familiarity could have led me to implement a lower level of assessment criteria which would not have reflected her third year status (Stoker 2004). Some authors refer to competency in a binary manner, where a nurse is either competent or not (Clinton, Murrells, & Robinson, 2005), however Benner’s (1984) Stages of Clinical Competence, describes the development of nursing expertise based on Stuart and Hubert Dreyfus’s Model of Skill Acquisition. The Dreyfus Model posits that in the development of knowledge and skills, a person passes through five levels of aptitude; novice, advanced beginner, competent, proficient, and expert, which considers advancement in skill performance, based on experience, education and the development of clinical knowledge ((Benner 2001). Furthermore competence comes from a documented evidence-base by tutors, mentors, examinations and is based on continuum of regular assessments (NMC 2008). The code states that it is ultimately mentors and tutors in academic practices that determines level of attainment and discriminate between satisfactory and unsatisfactory student performance (NMC 2008) (appendix 8). One measure of Ann’s success was exhibited when I assessed that she could demonstrate self-efficacy in performing the role and functions of a competent third year student under occasional supervision, which empowered Ann to develop problem-solving skills independently (West, Clark and Jasper 2007). Gray and Smith (2000) report that qualitative analysis collected from student’s dairies indicated that there was a gradual distancing from their mentors as they progressed through their programme and grew in confidence, however mentors still remained a vital aspect of practice learning.
|It was during the working phase that both Ann and I felt that we had developed a therapeutic relationship as we worked and | | | |
|observed each other closely and had access to providing support for each other. In addition I observed how Ann interacted and | | | |
|processed information as everyone has some particular preferred method (Kember 2001). A widely known learning theory is the | | | |
|visual; auditory; kinaesthetic (VAK) style (Dunn 1984). The theorist finds that people with visual styles tend to learn mostly | | | |
|through sight; those with auditory learning styles benefit most from listening to oral sessions. Throughout Ann’s placement we | | | |
|both felt we shared a kinaesthetic learning style as we both preferred to carry out a physical activity opposed to watching a | | | |
|demonstration (Dunn 1984).
In addition to learning styles, learning theories can often assist mentors form a clearer | | | |
|representation of student learning in practice (Howard and Eaton 2003). Welsh and Swann (2002) find that there is a great deal of| | | |
|literature written about the way people learn and numerous theories on the methods to teach effectively or guide people in their | | | |
|learning. Reece and Walker (2003) suggest that the three main educational theories are Humanist, Behaviourist and Cognitive. | | | |
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|It was at this stage that Ann considered her assessment criteria and related potential learning opportunities linked to the | | | |
|patient’s journey. To facilitate this, Ann suggested that she could utilise the ‘hub and spoke’ model which was first used in | | | |
|mental health placements (Lee, Edwin, Renaud, Oscar and Hills 2003). The hub being the primary placement where Ann’s assessment | | | …show more content…
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|documentation was completed as necessary (NMC 2008) whereas the spoke facilitated a secondary learning experience related to the | | | |
|hub (Cummins, McCloskey, O’shea and O’sullivan 2010).
The authors reiterate that the spoke experience creates learning | | | |
|opportunities that are not always available within the hub (appendix 2). Furthermore, the ‘hub and spoke’ model facilitates the | | | |
|expansion of the practice placement circuit, ensuring that the NMC Code of Standards and Ethics (2008) and the Quality Assurance | | | |
|Agency QAA (2002) are met. I interpreted this as adopting a humanist approach as Ann was taking responsibility for her own | | | |
|learning experience. This could also be perceived as an andrological approach as Ann was being self-directed in her choice of | | | |
|learning opposed to me as her mentor initiating her learning needs. Androgogy incorporates a greater importance on the student to | | | |
|want to learn and less emphasis on the mentor to teach but to facilitate the student to learn. | | | |
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|At this time, the clinical environment was demanding and I felt unable to provide Ann with the support she needed, so it felt an | | |
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|appropriate time for Ann to spend a week with the Crisis Resolution Home Treatment Team (CRHT). Furthermore this experience would | | | |
|enable Ann to experience a comprehensive view of patient care and exposure to collaborative inter-professional practice. I | | | |
|ascertained that a communication system existed between both settings and that Ann would be supervised by an NMC registrant (NMC | | | |
|2008). Additionally I ensured that all relevant documentation was completed by Ann, the sign- off mentor and registrant associate | | | |
|mentor to identify the accomplishment of her set objectives. During our clinical supervision, Ann was able to evaluate her | | | |
|achievements within her self assessment sheet, positive feedback and reflection upon practice. Johns (1995) describes the process| | | |
|of reflection as a tool to assess, understand and learn through our lived experiences. Furthermore, Jasper (2003) acknowledges | | | |
|that reflective practice is recognised as an essential tool for assessing students when making links between theory and practice. | | | |
|My clinical mentor felt I fully supported Ann when she was critically reflecting upon her learning experiences, which would | | | |
|additionally enhance her future learning. It was also suggested that when I offered constructive feedback, I had considered | | | |
|barriers that could affect the intent of my message and had worked out strategies to facilitate Ann’s learning (Twentyman, Eaton | | | |
|and Henderson 2006). As stated by West, Clark and Jasper (2007) if no clear parameters have been set, negative feedback will come | | | |
|as a shock. Upon reflection, I found that both negative and positive feedback aided me as a student to develop my clinical and | | | |
|interpersonal skills (McAllister, Lincoln, McLeod and Maloney 1997). | | | |
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Within Ann’s learning contract was the need to develop competence when administering medication. Wallace (2003) notes the importance of reducing the possibility of exposing the student or patient to any potential risks, until the student has acquired the sufficient skill and knowledge base; however if the ethical principle of accountability comes from knowledge, students are rightfully protected from full accountability until they qualify; therefore professional accountability lies with the supervising mentor (NMC 2008). Gordon, Wilkerson, Shaffer and Armstrong (2001) acknowledge that safe administration of medications is more than a psychomotor or mathematical skill as it requires critical thinking and clinical decision making. To prepare Ann for clinical practicum I facilitated a teaching strategy by implementing a cognitive approach, based on expanding Ann’s existing knowledge. Piaget (1970) as cited in Kaplan (1998) determined that there was no cognitive learning beyond the adolescent years however this view is disputed by Kaplan (1998) who proposes that adults use a process called 'postformal operational reasoning'. This encourages the learner to develop opinions, recognition, reasoning, rationales and synthesis. To facilitate this I implemented a teaching strategy using a human/patient simulator based on computer technology which utilises a barcode system in which specific medications can be scanned to activate physiologic responses in real or compressed time (Jeffries 2005). This enhanced Ann’s ability to assess variations in patient responses and increased her competence to formulate strategies for specific situations. In addition, this method poses no threat to patient safety, is reusable and provides a relatively consistent experience. Pallatt (2006) however asserts that when students perform in the working environment opposed to simulation provides a precise representation of their abilities and validates the assessment criteria; however consideration must be given to the students’ adjustment to the busy clinical environment with inherent distractions that may interfere with safe practice (Howard and Eaton 2003). It was therefore paramount that Ann, my clinical mentor and I were guaranteed time free from interruptions to evaluate her competence, so I negotiated in advance protected time for all parties. As stated by Davidson (2005) if teaching opportunities for students are to be productive, planning is an important part of the mentor’s role. I then ensured that Ann could find all the necessary equipment and resources needed as this can provide some degree of ease (Morton-Cooper and Palmer 2000). Despite our established relationship, it was important for me to be aware of learner anxiety (Price 2005). Upon reflection, I experienced a degree of anxiety because my practice was being held up as exemplary and my knowledge continuously tested, however Quinn (2000) states that this opportunity impacts on benefiting patient care as being frequently questioned promotes reflective practice and facilitates development.
Guided by the NMC (2008a), Ann gained consent from patients to administer their medication under my supervision. In addition, I explained that I was also being observed by her mentor and the patients remained agreeable to this. To implement this assessment I utilised the elements of Bloom’s education taxonomy which considers that a learning topic has to reflect upon three domains of learning; psychomotor domain relating to skill development, cognitive domain referring to the acquisition of knowledge and the affective domain involving the formation of attitudes (Bloom 1972). Turnock and Mulholland (2007) clarify that the assessment of these domains provides a more holistic picture of students’ abilities upon specific competencies. Following the NMC Guidelines for the Administration of Medicines (2004), Ann demonstrated her psychomotor skills by reading the drug chart, ensuring patients’ identity and decanted the prescribed capsule/tablet appropriately after checking the expiry date. Once administered, Ann placed her signature at the correct place which I countersigned (NMC 2004). Demonstrating cognitive skills, it was not sufficient for Ann just to administer the drugs, but she reiterated her understanding of their therapeutic uses, normal dosages, side effects, precautions and contra-indications and applied evidence based practice to assist her in decision making to eliminate inappropriate and ineffective practices that could have been potentially dangerous (Donaldson and Carter 2005; NMC 2008a). Throughout this module I have developed the awareness that implementing evidence based practice does not guarantee that the treatment has been carried out effectively therefore, all care providers under my supervision, have evaluated and monitored their practice to validate the assessment of nursing interventions (Glen 2004; NMC 2008). Representing affective skills, Ann promoted patient confidentiality and sought consent prior to administration. The assessment was followed by time to reflect upon any challenging situations, using a problem based approach and seeking clarity of Ann’s understanding by frequent open-ended questioning (Phillips and Dunn 2001). West, Clark and Jasper (2007) state that during assessments these style of questions are critical to being able to make an accurate judgement with regard to competence.
It is important to recognise that no two students will learn in the same way because we all tend to have different learning styles. Kolb (1984) developed a model that provides a framework for identifying a person’s learning style suggesting that learning is a process as well as an outcome and involves four stages; Activists, who prefer to be actively involved in new experiences and tend to learn best when working with others in team tasks; Pragmatists, who learn best through concrete experiences when there is an obvious link between theory to practice; Theorists, who do best in a structured environment where they have to use their knowledge and skills; Reflectors, who learn through observations and brainstorming activities (Stengelhofen 1996). Honey and Mumford’s study (2000) suggests that 35% of people had one preferred style, 25% had two, 20% had three and 19% had none, however it is important to allow students own style to influence mentors choice of teaching methods, even if this means supporting dual styles (Rassool and Rawaf 2007). During the working stage of our relationship, it was established that Ann was receptive to new ideas and was interested in practical consequences apposed to theory; therefore she favoured a pragmatist approach to learning which I incorporated into our planned teaching sessions.
Before embarking on any programme of teaching it is important to recognise that there are different learning theories and styles to consider. Reece and Walker (2003) state that there is a great deal written about the way people learn and numerous theories on the methods to teach effectively or guide people in learning. They discuss that the main learning theories are Behaviourism, Cognitivism and Humanism. According to the Behaviourism theory (Skinner 1974), the learning environment is fundamental to learning, and if this environment is right, learning occurs as connections are made between stimulus and response, and response and reinforcement (cited by Quinn, 2000a). The Cognitive theory (Bruner 1966) considers learning as an internal process that involves higher order mental activities such as memory, thinking, problem-solving, perception and reasoning (cited by Hand, 2006). The Humanistic learning theory (Maslow 1968) is based on the belief that humans have two basic needs, a need for growth and a need for positive regard by others. It is seen as the most holistic approach as it takes into account the drive and motivation of an individual to learn. Reece and Walker (2003) suggest that this theory also depends on the overall influence of the environment which may hinder or aid the learning process.
Howard and Eaton (2003) inform us that each educational approach would seem to have something to offer mentors as potential strategies to promote effective learning. Experience, however has shown that even when using what would appear to be the most appropriate, some students would appear not to learn as effectively as others (West, Clark and Jasper 2007). Marton and Saljo’s (2001) research demonstrates that it is students’ internal or external motivation that affects their style of learning. Students utilising a deep approach are those who are internally motivated to find personal meaning and understanding through their learning activities, whereas students who use a surface approach to learning are those who are externally motivated to memorise just enough information to pass assessments (Quinn 2000). The author finds that effective learning has a lasting impact and is likely to result from using a deeper approach rather than a superficial one, and fortunately most students, like Ann have immense internal motivation.
. “Andragogy” rejuvenated by Malcolm Knowles as “the art and science of helping adults to learn The humanist theory was developed by Carl Rogers and takes the view that learning results from enabling students. This reflects the term” and is the most persistent practice-based instructional method in adult education (Rachal 2002). Knowles (1980) proposed guidelines for teaching adults to become self-directed and independent in their pursuit of new knowledge. It is suggested that they will learn if we provide a secure, motivational environment. This made me reflect upon Maslow’s hierarchical model (1970) focusing on motivation and need theory. At each level the mentor has a specific role in assessing individuals’ needs and helping them to meet these effectively. Maslow argues that if any of these levels are not met there may be some impairment to the learning process. It might however be difficult to fully meet these needs as current nursing programmes comprise of several short placements each year, to provide a breath of practice based experiences in order to meet professional outcomes (NMC 2008). Making students’ however feel valued and part of a functioning team can go some way to achieving Maslow’s model, therefore compromises may have to be made when the ideal proves to be unattainable (Howard and Eaton 2003).
At the heart of these guidelines is an approach based on collaboration between the facilitator and the learner involving a
which had its foundations on the cognitive approach whereby learners gain knowledge by experience (Howard 2004). The behaviourist theories are described by Kaplan (1998) as classic conditioning namely being trained to have a conditioned response to a neutral stimulus and operational conditioning where being rewarded for a specific response is the resulting consequence.
Piaget’s (1970) argues that there is not any cognitive learning beyond the adolescent years, however, this view is disputed by Kaplan (1998) who suggests that adult learn by a method called post formal operational reasoning, encouraging judgement, analysis, synthesis and evaluation. androgogy, the art and science of helping adults to learn as different style of learning to that of pedagogy. Rogers (1983) expands on this stating it is a climate of trust, whereby the teacher is aware of the students learning n The humanist theory was developed by Carl Rogers and relates to learning being facilitated by the educator which had its foundations on the cognitive approach whereby learners gain knowledge by experience (Howard 2004). eed and the importance of motivation for learning so long as they have exposure to a wide range of experience and the teacher can act as a resource pointing the student in the right direction.
Upon reflection, this course has enabled me to develop upon my self- awareness and during my future practice; I will model behaviour that I would want others to adopt. In order to maintain high professional standards attending various study days, workshops and been clinically supervised has offered me the support necessary to increase confidence, accountability, competence, reflection and safe effective practice (appendix 9). I will continue to review and develop upon my knowledge, along with new policies and procedures, therefore committing to continuing professional development (NMC 2008a).