Mentoring in Practice

• Thembelani Dube

Mentoring is described by Kinnell and Hughes(2010) as the transferring of knowledge ,skills and attitudes from health professionals to the students that they are working with. The royal college of nursing states that the role of the mentor is to enable the student to make sense of their practice through the application of theory, assessing, evaluating and giving constructive feedback and facilitating reflection on practice, performance and experiences. the NMC(2008) adds that a mentor is a nurse ,midwife or specialist public health nurse who facilitates learning, supervises and assesses students in a practice setting.

The Nursing and Midwifery council (NMC,2006) have set standards for Nursing and Midwifery practice education, the standards to support learning and assessment in practice(SLAIP). The eight standards are a mandatory requirement for both students and mentors. The standards clearly outline the mentor’s responsibility for developing and ensuring the practice competence of students and provide a more defined statement regarding accountability for decisions that lead to entry to the professional register. These domains are going to be discussed individually in depth.

Establishing effective working relationships

Mentorship is the process that allows transference of knowledge, skills and attitudes from health professionals to the students that they are working with (kinnell and Hughes 2010). Wilson (2014) in his study concluded that mentoring involves modelling nursing practice, selecting learning opportunities for students, articulating one’s own practical and theoretical knowledge and assessing student’s competence in practice. By being role models, mentors provide an observable image of imitation, demonstrating skills and qualities for the student to emulate, Ness (2010). Wilkes(2006) points out that it is important to establish an effective working relationship where a mentor offers support but can also be objective and analytical. The student mentor relationship is crucial to the student’s learning experience particularly because the mentor’s role includes assessment of practice. Gopee (2011) listed some of the qualities of a mentor as nurturing, role modelling, focusing on the professional development of the student, sustaining a caring relationship over time and functioning as teacher, sponsor, encourager and friend,

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Beskine (2009) suggests that orientation is the gateway to a successful placement. Starting off well promotes the quality of the placement. To establish an effective working relationship with the student a mentor should start by orientating a student to the placement, this provides an opportunity for the student to express any concerns. However the RCN (2007) recommends that in preparation of the placement a checklist should be discussed on the first day of working and this should include an up to date orientation pack. Walsh (2010) adds that there are two major facets to establishing effective working relationships, managing the student’s first day and week in a productive and welcoming way and mentor’s good use of communication skills and active listening. Gopee (2011) states that skills and techniques of communication are some of the most important tools the person undertaking the mentor’s role has to utilise.

Facilitation of learning

The major role of the mentor is to assist and encourage students to link theory and practice in a practical setting (Botma et-al,2013) the author adds that the student should be passionate, eager to learn, participate and be committed to make the relationship work. A study done by Jokelainen et-al(2010) identifies that facilitation of learning includes advance planning of training and placement learning , which includes ensuring planning and organising learning opportunities and being aware of details of the student and their training documents. Naming mentors and organising the student’s first day at work and ensuring that the student has the same shifts as the mentor.

The NMC(2008) code of practice specifies that the registered nurse must be willing to share skills and experience for the benefit of others and has a duty to facilitate students and others to develop their competence. Wilson (2013) recommends that in order to facilitate learning, nurses should include students in their daily work, teaching clinical skills, giving written and verbal feedback. Aston and Hallam (2011) agrees that facilitation of learning includes planning relevant experiences for students, providing support and assessing clinical performance. However Kinnell and Hughes(2010) argues that finding out how a person learns is the key, this area should not be underestimated as it requires thought, insight and clinical background. The authors confirms that it is worth spending some time to think the student, the level they are at and what the best strategy would be to ensure their learning and development is facilitated appropriately depending on where they are at on their course.

Walsh(2010) identifies that there are many different theories and models of learning , but the three major ones are behaviourist, humanistic and cognitive. Gopee(2011) states that the humanistic learning theories have been developed with regards to how learning occurs. Carl Rogers’ student centred approach to learning reveals that a learning environment where a learner feels able to speak their mind and give their views is a healthy one. Thus mentors provides a safe, encouraging environment, guides the student to resources and opportunities and facilitates the student’s exploration of them. Marslow’ s humanistic hierarchy of needs model(1943) identifies that student mentor relationship and the learning environment are important elements of learning as this would ease anxieties and give the student a sense of belonging therefore enabling the student to achieve their learning needs.

Malcolm knowles’s andragogy learning theory(1990) highlights that it is important to acknowledge students as adult learners.it describes adult learners as being more self directive, motivated and having a wealth of experience. Therefore it is important how mentors relate to and teach their students most of whom are readily regarded as adult learners.

Assessment and accountability

Kinnell and Hughes(2010) believes that it is a statutory requirement to assess healthcare students, it is necessary to assess student nurses during their training in order to licence them as competent practitioners and subsequently protect the public. Assessments highlight weaknesses and strengths and provides a baseline for future learning needs Nicklin and Kenworthy(1995).There are many methods of assessment including testimonies, reflective writing or discussions, direct observation and feedback from colleagues. Gopee(2011) points out that there are a number of other essential facets of assessment, this part is going to discuss formative and summative. The primary aim of the formative assessment is to promote learning so that the learner can do the skill safely and effectively and knows the rationale for each step of the intervention. Summative are conducted to determine whether the learner is now competent to work without direct supervision. it is summative that constitute a periodic record of the student’s achievement of the aims and outcomes of a course or module.

The NMC(2008) requires that most assessment of competence are to be undertaken through direct observation in practice and therefore registered nurses have a duty to facilitate students to develop their competence, they are accountable for ensuring that the individual who undertakes the work is able to do so and they are given appropriate support and supervision.

Andrews et-al (2010)comments that assessment has become a major element of the mentor’s role. Many take on the role willingly but when faced with the notions of continuing assessment process become overwhelmed by the responsibility. Many nurses have difficulty taking responsibility for the student learning, especially making decisions about competency required while Lauder et-al (2008) argues that while mentors are crucial to developing students ’achievement of fitness to practice, they are hampered by lack of time to undertake the role.

Walsh(2010) identifies that because the assessment process is for a whole host of good reasons it must be very robust. lt should accurately enable mentors to make realistic judgements about the students’ level of competence and thus whether to pass them or not. For the student a good assessment process also gives them valuable feedback, it helps them to identify what they need to do and enables them to set realistic future goals. NMC (2008) validity for assessment ensures that assessments measures what it’s designed to measure, there are two important key issues, how to measure and what to measure.

The code of conduct points out that as professionals, nurses are personally accountable for their actions and omissions in practice areas and must always be able to justify decisions therefore it is important that weak students are identified early and given the right encouragement and support, and concerns are dealt with in a timely manner. Sharples et-al(2007)points out that it is wrong to assume that all students entering clinical placement will have the knowledge, skills and attitude to be successful. They will always be students who struggle to achieve competence and mentors who fail to evaluate a learner’s unsatisfactory performance accurately are said to be guilty of misleading the learner, and potentially putting the patient care at risk and thus failing in their accountability to the NMC (2006).

The Duffy report of (2004) ‘failing to fail’ concluded that there are several reasons why some mentors are failing to fail students like not identifying problems early to the student therefore not giving the student sufficient time to improve, leaving it too late and that mentors may give students the benefit of the doubt when it comes to a final judgement regarding their clinical competence. Failing to fail creates poor standards, it leads to having practitioners entering the profession that are not fit for practice (Wells and McLoughin,2014)

Evaluation of learning

Mentors have the responsibility of developing the practice learning experience they are providing for students, evaluating how effective or ineffective the practice environment helps to fulfil this role (Aston and Hallam,2011).NMC(2008b)requires that registered nurses participate in self- and peer evaluation to facilitate personal development and contribute towards the development of others. In a mentor’s role the term evaluation is used in the context of the student’s practice learning experience. Evaluation assist in identifying areas that need to be improved as well as what is working well, it enables mentors to improve their mentorship skills and the learning experience for future students. NMC (2010) points out that feedback from students and mentors is used to inform the programme and enhance the practice learning experience. Elcock and Sharpes (2011) adds that just as evaluation is the key for improvement, without it there is a risk of making the same mistake over and over again.

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Aston and Hallam(2011) comments that evaluation is not to be confused with assessing as this is to measure the overall value of the learning experience or how worthwhile the practice learning opportunity has been. The process of evaluation involves obtaining feedback from relevant people, reviewing and discussing the feedback and planning action to implement change, and this can either be formal or informal Price (2006). Kinnell and Hughes states that mentors and students are exposed to a variety of evaluation approaches, from patient care to facilitation of learning. Students are required by the universities to evaluate their experiences in practice at the end of each placement and this contributes to the university quality assurance process Elcock and Sharples(2011). Students are asked to reflect on their practice placement and comment on the experience that they have gained based on four dimensions, the mentorship process, the available learning resources, their mentor and the quality of the practice placement.it will be at this stage that action of plan is developed if there are issues to be addressed.

Creating an environment for learning.

Walsh (2010) states that this domain entails helping a student identify their learning needs. Students develop their attitudes, competence, interpersonal communication skills, critical thinking and clinical problem solving abilities in the clinical learning environment (Dunn and Hansford,1997)feeling part of the team is the key factor in student’s feeling that they fit in and they are then able to learn. Aston and Hallam (2011) have identified that another way in which mentors can provide consistency in an approach to providing good learning opportunities for students is to identify what experiences you can provide that will enable students to achieve their competencies.

A rapidly embraced and welcomed student is one who will be able to take advantage of the learning opportunities early on in their placement, in contrary a student that feels excluded and unwelcomed will likely shy away, withdraw and have raised anxieties regarding their chances of achieving learning outcomes. kinnell and Hughes(2010) points out that mentors need to appreciate the importance of understanding the healthcare students and the potential individual needs that they have as this will influence the student mentor relationship.

Nicklin and Kenworthy(1995) identified some issues that characterise a good learning environment and they included a supportive mentor, that is able to identify learning opportunities for the student and is able to respond to differing learning styles of individual students. Finding out what stage the student is at in their training and what their particular needs and interests are aids in creating an environment for learning for the student. Walsh (2010) states that consistency, a patient and understanding mentor, protecting student supernumerary status and giving a student a time to reflect creates a good learning environment.

Hand(2006) indicated that factors that are important for the creation of a positive learning environment are said to be a humanistic approach, where all staff are kind, genuine, approachable and promote self-esteem and confidence to students, good team spirits with respect and trust, high standards of care being provided using efficient but flexible approaches as well as teaching students as a key feature.

Context of practice and evidence based practice

The slaip document cements that mentors need to contribute to the development of an environment in which effective practice is fostered, implemented, evaluated and disseminated. Being a mentor does not only mean direct involvement in facilitation learning and assessment but it also challenges them to consider their own evidence base and standards of practice Elcock and Sharples (2011). Kinnell and Hughes suggests that mentors must therefore remember that the end result of evidence based practice is the ability to offer research- based findings in order to justify aspects of care delivery and rationale experiences encountered by patients throughout their healthcare journey. Walsh (2010) says that by adhering to the local policies and procedures and mandatory training is another way for mentors to achieve their use of evidence based practice.

In context of practice, mentors are required by the Nursing and midwifery council to demonstrate their ongoing knowledge, skills and competence and that this should be reviewed and assessed at annual updates and triennial reviews. Duffy (2012) suggests that nurses should have a portfolio of evidence to demonstrate updating and maintenance of competence as a mentor. The aim of annual updating is to ensure that all mentors and practice teachers continue to understand issues relating to supporting students, understand the implications of changes to NMC requirements, have current knowledge of NMC approved programmes and make valid and reliable assessments of competence and fitness for safe and effective practice Elcock and Sharples(2011)and NMC(2008).

Leadership

Leadership is an integral role that mentors have to undertake. Kinnell and Hughes(2011) identify that the mentor’s role is forever changing as they are expected to be co-ordinaters of patient care, a care manager, an expert in their own clinical field and they are also expected to teach and assess healthcare students within their commitment to mentorship. Gopee(2011) establishes that mentors leadership role is crucial in practice at facilitating student’s learning.One of the NMC(2008) outcomes of leardership domain requires that mentors provide feedback about the effectiveness of learning and assessment in practice. Anderson (2011)adds that helpfull feedback should be based on a recognised model of assessment feedback such as ‘praise sandwich’ and Duffy(2013) confirms that mentors need to provide students with regular feedback on their performance, this is integral to the assessment process.

Kinnell and Hughes(2011) identified a number of leadership styles such as autocratic, consultative, democratic and laissez-faire, a mentor should have an insight into different leadership ship styles and evaluate the one that appears to be dominant within their practice placement and how that style could influence the student’s experience.

This assignment has highlighted the impotence of the SLAIP domains as a guidance for mentors. It has explored the qualities and the skills that mentors need to fullful their roles in order to capitalize on the student’s learning experience whilst working towards developing a competent practitioner.

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