Mentorship: Nursing and Samantha

This assignment aims to critically evaluate the four key professional requirements for mentorship practice. The assignment endeavours to reflect on clinical practice with Samantha a third year student nurse on her final placement in the Emergency Department. The assignment aspires to critically discuss different theories of adult learning relating to Samantha’s practical and academic experiences. The positive and negative aspects of effective learning environments are identified and discussed making recommendations to improve the current learning environment. The assignment critically analyses the accountability of the mentor in relation to the assessment of the student and the student’s professional growth and development. Recommendations to improve self performance and knowledge, as a mentor identified through reflection and reference to literature will be referred to throughout the assignment. To maintain confidentiality names and places have been changed in accordance with the Nursing and Midwifery Council Code of Professional Conduct (NMC 2008).

The purpose of Samantha’s A&E placement was for her to learn the function of an A&E department and to gain skills in relation to patient assessment. On Samantha’s first shift in the department the author conducted an initial interview. The purpose of this was to discover Samantha’s background, stage in her training, aims and objectives for her A&E placement. Philips et al (2000) highlights the importance of discovering what the student already knows. This is important because if the mentor fails to check the students stage of learning then the teaching could be give on the wrong level resulting in no new learning taking place.

It also provides an opportunity for the mentor and student to build a rapport by discussing their past experiences together. Wallace (2003) highlights this helps the mentor devise appropriate strategies for the student to aid the student’s learning. This then creates the basis of a working relationship thus encouraging the student disclose any fears they may have about their placement. Bennett (2003) states to establish a good student mentor relationship the mentor could adopt strategies such as orientating the student to the environment and introducing the student to other members of the team. The author discovered Samantha was in her third year of nurse training and A&E was her first placement of that year.

Samantha stated in her initial interview that she wished to gain confidence in performing ECGs, assessment of all patients including children and gain knowledge of the A&E process including simple triage methods. Stuart (2003) recommends devising a learning contract between the student and mentor. Walkin (2000) states the use of a learning contract gives the student a guide to achieving their intrinsic goals. This provides clear guidance what the student will learn and how the learning will be assessed. Day (2001) recommends the use of a learning agreement because the student may feel they already have the skills necessary to achieve their clinical competencies. The author and Samantha devised a learning agreement (see appendix a). To improve the initial assessment stage the author and Samantha could have met at the end of the first shift to recap on the initial goals devised.

Evidence from Hand (2006) suggests there are four main learning theories. Hand (2006) states student learners will either be an activist, pragmatist, reflector or a theorist. Hand (2006) recommends adapting the teaching session to suit the learning style of the student. Quinn (2000) suggests adult learners differ widely in their styles of learning. Therefore it is imperative to remember not all students will learn skills in the same way. Bastable (2003) suggests creating the opportunity for the student to learn using their preferred style. Therefore if the student utilises their preferred style of learning, it is likely the student will enjoy learning and learn skills quicker and easier. Hand (2006) states learning can be influenced by other factors including embarrassment and student anxiety. Therefore this implies to teach the student effectively the mentor needs to ensure the student is relaxed and at ease with the current situation. Psychologists studying behaviour believe the environment is fundamental to learning (Hand 2006).

Hinchliff (1999) demonstrates a variety of factors including the environment can affect learning. Price (2004) states it is the responsibility of the clinical practice staff to create and develop an environment which is conducive to learning. Dunn et al (2000) define a learning environment as a network of forces within the clinical setting influencing the student’s clinical learning outcomes. This suggests the clinical environment should be constantly monitored to ensure it provides appropriate support and experience for learners. Ali and Panther (2008) argue a good learning environment encourages students to ask questions and clarify information to avoid misconceptions. In relation to Samantha the author asked if she had any questions or queries following each assessment or intervention. In relation to the learning environment Price (2004) advocates conducting a strengths, weaknesses, opportunities and threats analysis to evaluate the learning environment (see appendix b). The author considers the environment of A&E to be an excellent area for students to spend time in due to the variety of patients and clinical conditions.

Price (2004) feels the range of experiences a learning environment has to offer is a success. Papp et al (2003) argues the quality of mentoring and the quality of patient care impact on the learning environment. However it could be argued that due to the nature of the department and the busy environment the student may feel they are lacking knowledge in some areas. Therefore to improve the learning environment in A&E the author has recommended the introduction of a student area on the notice board. This area will contain research in relation to emergency care such as papers on triage methods. The notice board will also contain information about specific conditions patients present with such as chest pain. Therefore the introduction of the notice board provides the student with resources to access theory. Price (2007) highlights nurses consider their profession to be practice based and work hard to ensure a large part of the students learning takes place in the clinical environment.

Nursing is a competency based profession and registered nurses who become mentors are responsible for assessing student nurses’ skills and abilities in the clinical area (NMC 2008). The NMC (2008) define competency as ‘the skills and abilities to practise safely and effectively without the need for direct supervision.’ Rutkowski (2007) suggests although assessment of clinical competency may appear an easy task; it is often a complex process. Dolan (2003) argues assessment of clinical competency is subjective as it is based on direct observations made by a mentor involving value judgements which can vary from person to person. Therefore this suggests the clinical assessment of student nurses is unreliable because the current assessment format is not consistent and standardised. It could be recommended to ensure the assessment of student nurse’s clinical competencies is accurate and reliable to devise a new method of assessment. Fordham (2005) recommends benchmarking standards of attainment and objectivity should remain paramount providing a fair test.

Rutkowski (2007) states a mentor has many roles including the adviser role to assist the student to adapt the best method of assessment, and the role of facilitator of critical thought and reflection which involves using past experiences to help the student anticipate the possible outcomes of a planned action. In relation to Samantha, who requested spending time with the paediatric nurses, the author liaised with the paediatric nurses for Samantha to spend a day working with them. Wilkinson (1998) suggests giving meaningful feedback to students to reduce anxiety and increase job satisfaction. Wilkinson (1998) highlights the importance of avoiding meaningless statements without explanations as this does not achieve the desired effect.

Hand (2006) states a testimony can increase the reliability of an assessment because the decision is confirmed by other sources. Stuart (2003) agrees stating a testimony can make an assessment strategy more feasible as it provides more evidence from clinical practice. Therefore the author wrote Samantha a testimony to include her nursing portfolio booklet. . A copy of this testimony has been included in appendix c. This testimony provides evidence of the type of nurse Samantha was in her A&E experience. Hand (2006) states students often spend time working with other professionals in practice to gain experience and a testimony from other professionals can also demonstrate evidence to the assessor of the student’s progress. Therefore whilst Samantha was working the paediatric nurses, the author advised her to obtain a testimony from them

However a review of the body of literature surrounding mentorship training suggests mentors are not adequately prepared to assess the competency of student nurses in clinical practice. Rutkowski (2007) argues a three month mentorship course is a short period of preparation for the role of assessor. Therefore it could be implied that mentors who are not adequately prepared to assess the competencies of student nurses should not be mentors. Price (2007) concludes mentorship preparation programmes only have time to
introduce the principles of assessment and supervision.

Rutkowski (2007) highlights registered nurses acting as mentors remain accountable to the nursing profession for teaching and assessing student nurses. The NMC (2008) demonstrate professional accountability is taking responsibility for one’s actions and decision in accordance with the consequences. As a mentor, the registered nurse has a legal responsibility to the patient in relation to the covert administration of medicines and informed consent. In relation to clinical practice, prior to Samantha assessing a patient, the author ensured Samantha had the patient’s consent to perform the assessment or intervention required.

Rutkowski (2007) states the functions of the NMC are to protect the public and to ensure nursing and midwifery training programmes lead to appropriate outcomes for admission to the professional register thus maintaining control of people entering the profession and within the profession. In relation to failing a student on a clinical placement. Sharples et al (2007) believes nurse mentors are faced with many difficulties in fulfilling their role of facilitator, assessor and clinical nurse. Rutkowski (2007) implies some mentors feel if the student fails the placement they have failed as a mentor to create an appropriate learning environment, facilitate teaching and give appropriate feedback.

However Kenny (2004) states there is increasing pressures within the National Health Service to ensure nursing students are fit for practice and purpose. Duffy (2003) conducted a study which revealed that mentors often pass students who are incompetent as they feel guilty for not spending time with their student due to staff shortages and work pressures. Wilkes (2006) identified a lack of time for the mentor and student is a major problem in the clinical area. Therefore this suggests mentors should be allocated a period of time during a shift to directly work with their student. Duffy (2003) concludes preparing mentors for their role and responsibility in failing a student it is vital.

This assignment has discussed the benefits of developing a learning agreement with a student prior to their clinical placement. The assignment has identified the four learning theories, discussing implementation to mentoring and teaching students clinical skills. In relation to the learning environment the results from the swot analysis in appendix b, provided the opportunity to recommend a method to change current nursing practice for students working in A&E. In conclusion the assignment discussed the validity and reliability of the current assessment process making future recommendations to improve the consistency. The assignment also discussed how mentors need to fail students to ensure only competent practitioners join the NMC register.

Appendix a
A copy of the initial interview Action Plan
Samantha wished to achieve the following:
* To have more confidence with the patient assessment process * To gain a knowledge and understanding of performing ECGs * To learn how A&E patients are managed and triage methods * To develop interpersonal communication skills with children * To have a basic understanding of nursing children

* To observe a resuscitation attempt in progress
* To spend time in the minor injuries unit working alongside the nurse practitioners Action plan

Orientated to the department
For Samantha to gain more confidence in working with patients, nurses, doctors, paramedics and porters within the department, gaining insight into the day to day routine and management of specific patients. To gain an insight and understanding of ECGs and other nursing interventions such as wound management. To spend time with other members of the department gaining an awareness of the nurse practitioner role.

Appendix b
SWOT Analysis of the learning environment in A&E
StrengthsVariety of patientsVariety of nursing skills performedVariety of clinical areas to work inExperienced staffCommunication opportunities with MDTCloser working with medical staffVariety of sections to departmentClose working with paediatricsClose working with psychiatric servicesGood team working Support Supervision Quality of mentoring| WeaknessesCould see untoward events such as childhood deathStressful environmentLack of mentors to studentsStaff morale| Opportunities To work with all patient groups including babies and childrenAble to work with paramedicsAble to work with emergency nurse practitioners| ThreatsBusy departmentNot condition specificNumber of students on department at one timeOff duty problemsTravelling problemsSupport at busy times|

Appendix c
During a night shift I have observed Samantha perform an ECG. She prepared the patient by verbally explaining the procedure including rationale. Samantha then ensured the patient was in a gown and that Samantha had washed her hands and obtained informed consent. Samantha then proceeded to put on gloves and attach the electrodes to the patient. All the electrodes were in the correct position. Samantha then attached the leads to the patient. All the leads were correctly attached. Samantha then asked the patient to remain still to prevent interference ensuring a clear ECG was obtained. After dethatching the patient from the machine and washing her hands. Samantha then asked a doctor to interpret the results of the ECG. Following the ECG myself and Samantha reflected on what we thought had gone well, and what could have been improved. Samantha felt the length of time in which performing the ECG had taken could be improved. I reassured Samantha she had achieved her goal of performing an ECG.

References

Ali, P.A. Panther, W. (2008) Professional development and the role of mentorship. Nursing Standard 22:42:35-40 Bastable, S. (2003) Nurse as educator: principles of teaching and learning for nursing practice. Second edition. Jones and Bartlett, London. Bennett, C. (2002) Making the most of mentorship. Nursing Standard 17:3:29 Day, M. (2001) Developing benchmarks for prior learning assessments. Part 2 Practitioners. Nursing Standard 16:15:35 Dolan, G. (2003) Assessing student nurse clinical competency: will we ever get it right? Journal of Clinical Nursing 12:1:132-141. Duffy, K. (2004) Mentors need more support to fail incompetent students. British Journal of Nursing 13:19:582. Dunn, S.V. Ehrich,U. Mylonas, A. Hansford,
B.C. (2000) Students perceptions of field experience in professional development: a comparative study. Journal of Nurse Education 39:9:393-400. Fordham, A.J. (2005) Using a competency based approach in nurse education. Nursing Standard 19:31:41-48. Hand, H. (2006a) Promoting effective teaching and learning in the clinical setting. Nursing Standard 20:39:55-63 Hinchliff, S. (1999) The practitioner as teacher. Second edition. Scutari Press, London. Kenny, G. (2004) The tensions between education and models of nurse preparation. British Journal of Nursing 13:2:94-101. Nursing and Midwifery Council (2008) The NMC Code of Professional Conduct: Standards of Conduct, Performance and Ethics. NMC, London. Papp,I. Marickanen, M. Von Bonsdorff, M. (2003) Clinical environment as a learning environment; student nurses perceptions concerning clinical learning experiences. Nurse Education Today 23:4:262-268. Philips, T. Schostak, J. Tyler, J. (2000) Practice and assessment in nursing and midwifery: doing it for real. Research Reports Series No 16. English National Board London. Price, B. (2004) Mentoring learners in practice. Number 2. Evaluating your learning environment. Nursing Standard 19:5. Price, B. (2007) Practice-based assessment: strategies for mentors. Nursing Standard 21:36:49-56. Quinn, F.M, (2000) The Principles and Practice of Nurse Education. Fourth Edition. Nelson, Thornes, Cheltenham. Rutkowski, K. (2007) Failure to fail: assessing nursing students’ competence during practice placements. Nursing Standard 22:13:35-40. Sharples. K, Kelly, D. Elcock, K. (2007) Supporting mentors in practice. Nursing Standard 21:9:44-47 Stuart , CC (2003) Assessment supervision and support in clinical practice: A guide for nurses, midwives and other health professionals. Churchill Livingstone, Edinburgh. Wallace, B. (2003) Assessment of Clinical Practice: Why, when and how of assessing nursing practice. Quay Books Wiltshire. Walkin, L. (2000) Teaching and Learning in Further and Adult Education. Cheltenham, Stanley Thorne. Wilkes, Z. (2006) The student mentor relationship: a review of the literature. Nursing Standard 20:37:42-47. Wilkinson, J. (1998) A practical guide to assessing nursing students in clinical practice. British Journal of Nursing 8:4:218-222

Activity one
Negotiate a written learning agreement for the facilitation of learning and assessment. Please include a copy of this learning agreement in the appendix. Reflective self assessment following the activity please refer to the following as guidance: * Appropriate learning outcomes

* Learning opportunities which are relevant to the learning outcomes * Learning opportunities which are appropriate for the learners level of proficiency * The expectations of the learner

* The amount of contact between the learner and the mentor
* How the learning will be assessed
* When a review of progress will be undertaken
When the student attends for their first day in the clinical setting it is important to devise appropriate learning outcomes together. I devised a learning agreement with Samantha a third year student on her final placement in A&E. Samantha wished to gain confidence in the following: * Performing 12 lead ECGs

* Assessment of all patients particularly children presenting to A&E * Knowledge and understanding of the A&E process including simple triage methods The A&E department provides excellent opportunities for performing 12 lead ECGs because the majority of the patients in A&E require an ECG. Chest pain patients and patients presenting generally unwell often require ECGs. Samantha also wanted to become confident when assessing all patients, the A&E department encounters a wide range of patients, such as children and psychiatric patients. Therefore this aim is achievable in the A&E setting. Whilst gaining confidence with the safe assessment of patients, Samantha will gain knowledge of simple triage methods such as MEWS. MEWS is the triage method adapted by A&E. A&E provides a wide range of learning opportunities within the four clinical areas of majors, minors, resus and paediatrics. Samantha was clear in her own personal goals and objectives what she wanted to gain personally and professionally from her time in A&E. As a third year student nurse is was clear Samantha should be capable of providing basic nursing care at a competent level.

However as A&E is a new clinical experience it is understandable Samantha will require some guidance and support to progress in A&E. Samantha would be working with myself her mentor, and an associate mentor for four weeks. After the second week myself, Samantha and the associate mentor met and discussed her progress within the A&E department. Samantha’s learning will be assessed by a series of questions and answer sessions and direct observations on clinical practice. Prior to the formulation of an action plan, it is important to discuss what prior clinical and life experiences the student nurse already has. Each student nurse will have different skills dependent on their stage in nursing training. At the initial interview as a mentor it is essential to identify the students personal goals and targets to formulate an action plan. When formulating an action plan it is important to refer to the student’s skills passport which is a record of tasks to achieve during the three years in clinical practice.

A copy of the initial interview Action Plan
Samantha wished to achieve the following:
* To have more confidence with the patient assessment process * To gain a knowledge and understanding of performing ECGs * To learn how A&E patients are managed and triage methods * To develop interpersonal communication skills with children * To have a basic understanding of nursing children

* To observe a resuscitation attempt in progress
* To spend time in the minor injuries unit working alongside the nurse practitioners Action plan
Orientated to the department
For Samantha to gain more confidence in working with patients, nurses, doctors, paramedics and porters within the department, gaining insight into the day to day routine and management of specific patients. To gain an insight and understanding of ECGs and other nursing interventions such as wound management. To spend time with other members of the department gaining an awareness of the nurse practitioner role.

Activity 2
Carry out a SWOT analysis of your clinical learning environment and reflect
with peers/colleagues. Following this discuss your SWOT results with your LEM and agree a measure which you can develop for the improvement of the learning environment.

SWOT Analysis of the learning environment in A&E
StrengthsVariety of patientsVariety of nursing skills performedVariety of clinical areas to work inExperienced staffCommunication opportunities with MDTCloser working with medical staffVariety of sections to departmentClose working with paediatricsClose working with psychiatric servicesGood team working Support Supervision Quality of mentoring| WeaknessesCould see untoward events such as childhood deathStressful environmentLack of mentors to studentsStaff morale| Opportunities To work with all patient groups including babies and childrenAble to work with paramedicsAble to work with emergency nurse practitioners| ThreatsBusy departmentNot condition specificNumber of students on department at one timeOff duty problemsTravelling problemsSupport at busy times| |

Activity 3
Participate in the continuous assessment of a learner in your clinical area. Following this write a testimony which specifies the evidence gained from observation and the questions used to assess knowledge and understanding and the learners answers. Indicate the learners overall progress. During a night shift I have observed Samantha perform an ECG. She prepared the patient by verbally explaining the procedure including rationale. Samantha then ensured the patient was in a gown and that Samantha had washed her hands and obtained informed consent. Samantha then proceeded to put on gloves and attach the electrodes to the patient. All the electrodes were in the correct position. Samantha then attached the leads to the patient.

All the leads were correctly attached. Samantha then asked the patient to remain still to prevent interference ensuring a clear ECG was obtained. After dethatching the patient from the machine and washing her hands. Samantha then asked a doctor to interpret the results of the ECG. Following the ECG myself and Samantha reflected on what we thought had gone well, and what could have been improved. Samantha felt the length of time in which performing the ECG had taken could be improved. I reassured Samantha she had achieved her goal of performing an ECG.