Nursing Mentorship

For this mentorship course I have been allocated a second year student on her first placement lasting for twelve weeks. I will be observed and assessed by a qualified professional who is a sign-off mentor within my learning environment. In accordance with the Nursing Midwifery Council (NMC) (2008) I have changed the name of the student in order to maintain confidentiality therefore I will refer to her as Violet. Violet is a youthful and very enthusiastic student who intends to learn all aspects of community nursing. She also aims to identify the diversity of nursing from a hospital setting to a home environment. As a first student year she completed two placements which were orthopaedics and liver/gastro wards. She enjoyed both placements
and through reflection identified her strengths and weaknesses. She aims to combat these throughout the remainder of the nursing course. I qualified as a staff nurse in May 2011, this led me to achieve a post as a community nurse. Prior to this I worked several years in Plastic and Burns reconstruction as an Assistant practitioner where they gave me a seconded to university for my Advanced Diploma in nursing studies. Throughout this course my knowledge and skills increased considerably and it gave me the confidence I needed. I feel community is the place for me and I endeavour to continue and advance in this learning environment therefore my next step is to complete the mentorship course. Throughout my nurse training I experienced some highs and lows so I endeavour to support my student to turn any negatives into positives and make her learning experience positive whilst build an effective working relationship. This will effectively facilitate support of learning for entry to the register NMC (2008). I believe as a community nurse it is essential to obtain a mentorship qualification due to lone working and small teams of staff. On her first day I greeted Violet and introduced myself along with the team, next giving her a tour of the learning environment whilst pointing out fire exists. It is policy to explain emergency procedure and introduce them to the team within the first 24 hours Royal College of Nursing (RCN) (2007). I explained that I was also a student and was under assessment for guiding and teaching her throughout her placement in order to exist as a qualified mentor. To evaluate me as a mentor my assessor was over seeing my teaching and approach through observation, interviews, feedback and my practice assessment document. It is important to be registered as a mentor in order to deem the student competent Burton Ormrod (2011). The initial objective we learn when entering a workplace is how we mix with preceding staff and establish our individual position within the team whilst knowing how we work together Braille et al (1989). Although students are only with us for a short period of time they should still be made to feel part of the team. Being approachable and friendly and gaining an effective working relationship plays an important part of the learning environment. Being a good mentor, makes a good role model Grossman (2013). The NMC (2008) identifies that nurses have a duty to facilitate students learning in order for them to develop and complete competencies. Within the first week of placement it is important to establish a learning contract between myself and the student (see appendix 1). This identifies goals in order to devise an action plan for achievable development. This will bring together evidence from both theory and practical in cross reference to the universitys placement assessment document (PAD) to achieve the NMC outcomes. These goals need to be completed before the second stage interview. Gaberson and Oermann (2010) states a learning contract is an explicit agreement between teacher and student which includes written agreements through discussion of learning activities to be reached. Subsequently this should be implemented and evaluated if any concerns transpire. Hopefully this will encourage the student to take initiative in their learning and use reflection to identify areas of development. Several goals were identified on the initial interview but on further discussion it was distinguished that wound care and bandage management was of high interest to Violet. Within our nursing team a high percentage of our caseload is wound and bandage management so there would be no restrictions in accomplishing her target. This would be reviewed on the intermediate interview which we agreed to carry out in five weeks time. In clinical practice knowledge is applied to practice, this includes problem solving, critical thinking, decision making and clinical reasoning Gaberson Oermann(2010). A plan of action was derived she would research and look into evidence based practice in order to understand the rationale behind our plan of care. Walsh (2010) states as a mentor you should support the student in applying evidence based practice in their training. Honey and Mumford look at four different learning styles these are described as activist, pragmatist, theorists and reflectors Gray et al (2004). To gain a more holistic view of Violets learning style she completed the questionnaire with an outcome of pragmatist. (See appendix 2). McNair et al (2007) says it is important to recognise the learners style so that it can be incorporated to facilitate effective learning. This means that these learners need a demonstration from an acknowledged expert before carrying out any skill Gray et al (2004). These results gave me supplementary scope to power the best teaching technique for Violet to achieve her goals. John and Freshwater (2005) says reflection is a process where we critically analyse our actions and look at ways of changing and improving practice in which we can use in personal and professional development. Ness et al (2010) backs this by saying reflection is an active thinking process of care delivery which results in nurses learning from the processes. The aim is to also apply evidence based practice to my work and the students in addition to contribute with the further development of knowledge Kinnell Hughes (2010).
Kolbs learning cycle (1984) says Learning is the process whereby data is produced through the transformation of experience. This is my preferred style of reflective learning. Reflection is also associated with swot analysis (Strength, weaknesses, opportunities and threats). According to Humphreys it is a process of assessment and robust construction for comparing different learning styles Gray et al (2004). It is a useful tool for decision making and can help to plan your career, although you know your chosen pathway is nursing it is still undecided which profession you want to work within Whitehead et al (2010). A learning environment can be separated into two different categories, University (academic) and placement (clinical), this needs to be combined and achieved in order to complete the course. Stuart (2007) says learning within a clinical setting is as important as attending university for educational work it gives completion from information taught. Working within the community can be a challenge due to nursing patients in their own home for example varying personalities/environment, limited materials/equipment and staff exposure to
vulnerability. It can be very daunting at first for the student coming from a hospital setting to such a varied clinical environment but with ongoing and constructive support we can facilitate learning from one environment to another Murray et al (2010). Building a good working relationship and being an effective advocate will support their learning and reduce the usual anxieties. Increased anxiety can reduce learning Walsh (2010). Community nurses work autonomously this involves making independent decisions and judgements in assessing, evaluating and planning patient care. At times this may be very stressful and prove a negative aspect in the students teaching Donovan et al (2013). On a positive the student is always under direct supervision, as they work on a one to one with their mentor and are never left in any clinical setting on their own. A patient on our visiting list who violet had never met before could sometimes prove to be difficult. Prior to visiting this lady I spoke to violet interpretating my thoughts and findings and if she was not happy to perform the intervention then I would be happy to take over. Whilst observing violet carry out 2 layer bandaging I noticed her uneasiness as this lady was proving difficult today and very vocal. I thought it best to discuss and reflect on this after the visit. We discussed the visit and how she felt and how she could adapt when in that situation again. Frequent discussions and reviews of the students progress gives constructive feedback of their strengthens, weaknesses and areas for improvement Kinnell Hughes (2010). Overall the teaching and feedback was a success and Violet Claimed that she had learnt it is vital to take into account the patients values, opinions and wishes when providing holistic care. Time management is identified within the SWOT analysis as on some occasions it is impossible to bring practical and knowledge together, for example limited time, staff shortages/sick/ and patient call outs (see appendix 3). If this is not addressed it could delay the students learning. I spoke to my manager and agreed some protected time which was incorporated into my working week and highlighted on my work load. Identifying aspects of the learning environment which can be enhanced and negotiated will help make the appropriate changes Walsh (2010). Kilgallon Thompson (2012) says mentors are expected to provide a supportive learning environment in order for students to progress and achieve their outcomes. Our learning environment can be a bit boisterous due to the large amount of staff within the open office surroundings. Dolland Winefield (2003) says it is important to keep noise to a minimum to balance stimulation and relaxation and not cause stress while heightening motivation. Therefore I ensured I prepared a less noisy area when completing my office duties and imputing patient information. This in effect did not hold back teaching my student and the constraints of the environment for teaching was utilized at its upmost. Burton Ormrod (2011) says students will come into the clinical setting with a detailed set of competencies. These may not essentially be what they expected but the main aim is to meet their goals and skill clusters. The NMC (2008) says evaluation of the students practice must be frequently carried out ensuring they have the correct knowledge and skill to complete these goals and become a qualified nurse. Hopkins (2009) also says continuous assessment of the student throughout placement is very important in order to measure and monitor their level of performance and knowledge. The process of continuous assessment is a more effective and rewarding part of the mentorship course that enables the mentor to work smarter Kinnell Hughes (2010). In order to gain an effective assessment the use of effective communication is important, verbal and non-verbal. This needs to be phased clearly and in a way that can be understood by each personality Braille et al (1989). The intermediate interview was carried out as planned and at present Violet had completed her identified goals which was set in her initial interview. The next step was to look into the aetiology of wound care and the dressing selection. Assessment is not all about observation and questioning it also involves looking at their testimonies, reflection, feedback and their professionalism (see appendix 4). RCN (2007) says whilst reviewing their skills and knowledge, professional behaviour, attitude, team work and caring skills, motivation and appearance should be monitored. If the students attitude gives cause for concern you should sought additional opinions from colleagues and act on it Quinn (2000). Accountability lies within the mentors hands ensuring protection of the public, until the final stage is assessed and completed. Informal feedback will help if any issues materialize, they can be discussed and evaluated with the student before any severe actions are implemented Casey Clark (2011). We can also encourage the student to ask questions on things they do not understand, all this will give a good overview of the students feelings and development. It is important to let the student know that their views are valid and that they are being listened to Burton Ormrod (2011). Duffy (2009) states passing a student who fails to meet the required assessment standards in the hope they will improve, puts patients lives at risk. If a student proves incompetent we recognize this through continuous assessment prior to her final interview. Skingley et al (2007) says it is important to identify students at an early stage in order to pre-empt failure. If working on her weaknesses as not proven proficiency by their final interview then by no means must you pass that student. It is not rewarding for the mentor when the student fails to achieve what they are capable of achieving Smith Fitzpatrick (2006). Carr et al (2010) Says failing a student for not meeting clinical competencys can be distressing for both student and mentor. While Scholes (2006) states having self-confidence to fail a student is crucial. Failing to fail students who do not meet the required standards are measured without considering the outputs for example problems/barriers of assessment and documentation, insufficient time to work with the student, staff shortages and numerous students in a clinical setting Rutkowski (2007). Measuring competency may differ from one mentor to another while one may pass a student another may fail the student for the same competency. The mentor must be definite of their decision and the course of action to be taken whilst providing sufficient evidence to support this Dolan (2003). As a mentor I have a responsibility to ensure my student can carry out all aspects of care safely, I have very strong opinions off this and would not hesitate in failing a student. It is also essential that the correct action is applied and the relevant people are informed. This involves feedback to the university by email, telephone and documentation via the students PAD booklet Thomas (2013). The student may feel angry, upset and frustrated but the mentor my also feel this due to thinking they have failed as a teacher. We must maintain our professional status and not let our personal opinions, obstruct judgements and decisions. Carr (2010) says personal feelings must be maintained to provide a positive experience for the failing student plus objective feedback can help them move on and succeed in the future. On discussion through reflection it was apparent to see that Violet had gained more confidence in her recognized interventions and through self-directed learning, deeming her competent. Direct questions regarding her self-learning was discussed and constructive feedback was received from other health professionals of violets practice. Constructive feedback is used to review progress to highlight skills which need to be developed Aston et al (2010As a facilitator of learning it is imperative for me to generate an apt learning environment for myself and the student Young Paterson (2007). Looking into the theories of the diverse learning styles as brought to my attention that all students will not learn and act the same way as Violet. This is when I need to adapt and apply skills learnt from my mentorship course in order to develop my future nursing students. In conclusion this assignment has made me recognize the virtues of being a good mentor at the same time enhancing my knowledge, learning and teaching techniques. Through the process of reflection, I have recognized that my knowledge and performance has notably improved and I strongly agree that being a mentor is a fundamental part of nursing for both the student and mentor in increasing education. I was able to adapt to and apply the appropriate learning style to my students needs. In return she achieved her skills clusters and completed her placement document. Violet gave me feedback about my role as a mentor which highlighted my skills and approach to teaching (see appendix 5). References ASTON, Liz et al (2010). The student nurse guide to decision making in practice. England, Open University press. BRAILLE, Virginia K et al (1989). Effective nursing leadership A practical guide. USA, Aspen Publications Inc. BURTON, Rob and ORMROD, Graham (2011). 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Clinical teaching strategies in nursing. 3rd ed. New York, Springer Publishing. GRAY, D et al (2004). Learning through the workplace A guide to work based learning. United Kingdom, Nelson Thornes LTD. GROSSMAN, Sheila (2013). Mentoring in nursing A dynamic and collaborative process. 2nd ed. New York, Springer Publishing. HOPKINS, Susan (2009). Guidance for mentors of nursing students/midwives. 2nd ed. London, Published at HYPERLINK http//www.rcn.org.uk www.rcn.org.uk JOHNS, C and FRESHWATER, D (2005). Transforming nursing through reflective practice. 2nd ed. Oxford, Blackwell. KILGALLON, Kate and THOMPSON, Janet (2012). Mentoring in nursing and healthcare A practical approach. Oxford, Wiley-Blackwell. KINNELL, David and HUGHES, Phillip (2010). Mentoring Nursing and Healthcare. London, Sage Publications LTD. KOLB D (1984). Experimental learning Experience of the source of learning and development. New Jersey, Prentice Hall. MUMFORD, A and GOLD, J (2004). Management development strategies for action London, CIPD Enterprises. MURRAY,, Cyril et al (2010). The nurse mentor and reviewer update book. Berkshire. Open University Press. NESS V et al (2010). Supporting and mentoring students in practice. Nursing Standard. online. 25 (1), p 41-46. NURSING and MIDWIFERY COUNCIL (NMC) (2008). The code standards of conduct, performance and ethics for nurses and midwives. online. London, at HYPERLINK http//www.nmc.uk.org www.nmc.uk.org NURSING and MIDWIFERY COUNCIL (NMC) (2006). Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers. online. London at HYPERLINK http//www.nmc.uk.org www.nmc.uk.org ROYAL COLLEGE of NURSING (RCN) (2007) Guidance for mentors of nursing students/midwives.
online at HYPERLINK http//www.rcn.org.uk/online www.rcn.org.uk/online RUTKOWSKI, K (2007). Failure to fail assessing nursing students competence during practical placements. Nursing Standards, 22 (13), p35-40. SCHOLES, Julie (2006). Developing experts in critical care nursing. Oxford, Blackwell publishing. SKINGLEY et al (2007). Supporting practice teachers to identify failing students. British Journal of Community Nursing. 12 (1), p28-32. STUART, C.C (2007). Supervision and support in clinical practice. 2nd ed. Edinburgh, Churchill Elsevier. SMITH, Mary J and FITZPATRICK, Joyce J (2006). Best practices in nursing education. New York, Springer Publishing Company. THOMAS, Jenny (2013). A nurses survival guide to leadership and management on the ward. 2nd ed. Philadelphia, Churchill Livingstone Elsevier. QUINN, Francis M (2000). Principles and Practice of Nursing Education. 4th ed. London, Stanley Thorne Publishers LTD. WALSH, Danny (2010). The Nurse Mentors Handbook supporting students in clinical practice. England, Open University Press. WHITEHEAD, D (2010). Essentials of nursing leadership and management. 5th ed. USA, Davis Company LTD. YOUNG, Lynn.E and PATERSON, Barabra. L (2007). Teaching
nursing, developing a student-centred learning environment. USA, Lippincott Williams Wilkins. Appendix 1 RECORD OF INITIAL INTERVIEW - Mentors and students should review previous experience and the Skills Passport document to identify student needs. Action plans should be developed that enable students to meet their goals. Students goals - To understand the aetiology of wound care and implement my understanding into practice. - To have completed catheterisation. - To liase with varying professionals working within a community environment. - To understand system one. - To understand the knowledge behind certain medications in the community and to complete this in practice sub-cut and intra-muscular injections. - To enhance and develop my communication skills in varying environments. Student Signature .. Date 20/11/13 Mentor Signature .. Date Date of last mentor update..Date . The mentor and student should agree an action plan to achieve the students goals, NMC Essential Skills for entry to the branch and additional skills available on the placement. Action Plan Carry out wound assessment and plan of care under supervision and also research the theory behind the practical. i.e. venous/arterial leg ulcers. Arrangements to be made to spend time with the matron, cics, physio, practice nurse and health visitors. Orientation to system one, how to access patients, communication notes, referrals and information. Ordering of materials and tasks to and from other healthcare professionals. Appendix 2 Learning Styles Questionnaire By Honey Mumford I like to be absolutely correct about things. I quite like to take risks. I prefer to solve problems using a step by step approach rather than guessing. I prefer simple, straightforward things rather than somthing complicated. I often do things just because I feel like it rather than thinking about it first. I dont often take things for granted. I like to check things out for myself. What matters most about what you learn is whether it works in practice. I actively seek out new things to do. When I hear about a new idea I instantly start working out how I can try it out. I am quite keen on sticking to fixed routines, keeping timetables. I take great care in working things out. I dont jump to conclusions. I like to make decisions very carefully and preferably after weighing up all the other possibilities first. I dont like loose ends, I prefer to see things fit first into some sort of pattern. In discussions I like to get straight to the point. I like the challenge of trying something new and different. I prefer to think things through before coming to a conclusion. I find it difficult to come up with wild ideas off the top of my head. I prefer to have as many bits of information about a subject as possible, the more I have to sift through the better. I prefer to jump in and do things as they come along rather than plan things out in advance. I tend to judge other peoples ideas on how they work in practice. I dont think that you can make a decision just because something feels right. You have to think about all the facts. I am rather fussy about how I do things. In discussions I usually pitch in with lots of ideas. In discussions I put forward ideas that I know will work. I prefer to look at problems from as many different angles as I can before starting on them. Usually I talk more than I listen. Quite often I can work out more practical ways of doing things. I believe that careful logical thinking is the key to getting things done. If I have to write a formal letter I prefer to try out several rough workings before writing out the final version. I like to consider all the alternatives before making my mind up. I dont like wild ideas. They are not very practical. It is best to look before you leap. I usually do more listening than talking. It doesnt matter how you do something, as long as it works. I carnt be bothered with rules and plans, they take all the fun out of things. Im usually the life and soul of the part. I do whatever I need to do, to get the job done. I like to find out how things work. I like meetings or discussions to follow a proper pattern and to keep to a timetable. I dont mind in the least if things get a bit out of hand. Scoring THEORIST 1 3 6 10 13 17 22 28 38 39 PRAGMIATIST 4 7 9 14 20 24 27 31 34 37 ACTIVIST 2 5 8 15 19 23 26 35 36 40 REFLECTOR 11 12 16 18 21 25 29 30 32 33 Results Numbers 3, 7, 8, 9, 12, 16, 20, 21, 24, 29, 31, 34, 37, 38. Pragmatist Planning the next step, discussion, time to think about applying learning in reality, case studies, problem solving and trying out new ideas, theories to see if they work. Appendix 3 Strengths Weaknesses Excellent communication skills whilst liaising with patients, their families and other healthcare professionals. Adapting to varying cultures and environments. Building a good rapport with patients and work colleague, happy atmosphere. Teaching and encouraging learning, as well as sharing gained knowledge. Approachable. Working alone within patients home and not getting the support and stability of ward nursing. i.e. resuscitation. OpportunitiesThreatsLearning and implementing a very wide range of clinical skills with evidence knowledge Working alongside and liaising with specialist nurses/practitioners. University courses Working alone, can feel vulnerable, health and safety, abuse. Staff shortages due to annual leave, sick and study. I.e. making daily cases loads divide over a reduced amount of staff. TESTIMONIES YEAR 2 This space provides an opportunity for any person (including service users and carers) with whom the student has worked to comment on their progress. Permission MUST be sought from mentor/ qualified member of staff before seeking testimony from any service user or carer. Service users and carers should NOT sign their entries (for reasons of confidentiality) Mentors should countersign these entries. Entries may be dictated if appropriate Throughout Violets 12 week placement, as her mentor she has worked alongside me 80 of the time. I am very pleased with her enthusiasm to work and how she has easily adapted to the way community nursing works and our learning environment. Violet communicates efficiently verbally and non-verbally in all environments via telephone, with patients, among the team and also on one to ones, consequently demonstrating initiative and professionalism at all times. Practical interventions have been demonstrated and backed up with knowledge and through this progression as become more confident and competent. Practice skills performed female catheters, peg feed/flush, wound management/dressings, clip and suture removing, sub-cut/intra-muscular injections, pressure area care, leg bandages, drug preparation for palliative patients and diabetic blood sugar monitoring. Care planning of a patients first assessment has been completed correctly and she understands the rationale behind evaluating and implementing patient care along with best practice. If any uncertainties were brought to light she was not afraid to ask questions and was fluent when participating in handovers. She is aware of the barriers to infection control when working within home surroundings and demonstrates a good hand washing technique. I have thoroughly enjoyed working with Violet and feel that she will feel fulfilled from this placement experience. I wish her the very best for her remaining time as a student and career. I have no hesitation that she will develop into a skilled qualified nurse. Appendix 5 Testimony for Nicola Hoey Nicola has been my mentor for the past twelve weeks on my community placement. These twelve weeks have gone so fast and Nicola has made it extremely enjoyable. I have learnt so much from her and she has made my placement very memorable. I have developed a vast range of new skills I will take with me into my future career. When I arrived on my first day Nicola introduced me to the team I would be working with and the way in which it was run. She made me feel really welcome and ensured I understood the placement and the work I would be taking part in over my time there. Over my placement Nicola was very organised with arranging my interviews and ensured we were able to have a discussion about my progress with the guidance of my sign off mentor. She took the time to set personal objectives and goals with me that I wanted to achieve by the end of the placement and was keen to monitor my progress with these. For example a personal goal of mine involved leg bandaging and this is something we worked on together over the 12 weeks. Nicola made sure the learning experience I had on placement was tailored to the way I learn. She would always demonstrate a procedure and ensure I understood both the theory and practical elements to it before then allowing me to put it into practice. She was always very encouraging when I wanted to carry out a task I had never done before and this gave me the confidence I needed on my first community placement. She always focussed on the positive aspects of any task I carried out but also made sure I understood when I needed to develop in any area. Whilst she recognised when I needed prompting and encouragement to carry out a task, she also never pushed me into doing something I wasnt comfortable doing. Nicolas personality makes her fantastic mentor to work with and learn from. Her caring attitude made the learning environment a comfortable place to work in and I was never afraid to ask questions if I was unsure of anything. As a student I think Nicola will make a fantastic mentor and those who get the opportunity to work with her in the future will be able to take a great learning experience away with them. PAGE MERGEFORMAT 1 Appendix 4 5 5 5 5 Y, dXiJ(x(I_TS1EZBmU/xYy5g/GMGeD3Vqq8K)fw9 xrxwrTZaGy8IjbRcXI u3KGnD1NIBs
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