Mentorship of 1st Year Nursing Student: A Reflection

I work in an acute mental hospital. In my workplace, we get students all from different background and different levels in knowledge as it’s a mixture of 1st years to 3rd years. In terms how a first-year student may differ from a third-year student in terms level of learning, the third-year student has previous clinical experience therefore can build on the existing knowledge whereas my first year student does not have experience working health care. By helping my student to engage in experiential learning through reflection,

I was allocated a first-year student who has never worked in psychiatrist hospital before. Making sure that students feel welcomed, creating a safe environment is crucial to enhance students learning. In the Maslow theory, he mentions that learning cannot take place until the persons other needs, one of them being feeling safe in their environment is met (Walsh 2014).

Many student starting placements may feel a sense of anxiety and nervousness. As a mentor, it is my duty to ensure that the students starting placement, are introduced to the team, shown round the ward and where they can put their belongings. Walsh (2014) mentions that including students in discussion, staff activity outside of work will make the students feel wanted and valued so when I have time, I try and engage my students in conversation and including them in discussion.

As a mentor, one of my responsibility is facilitating students learning. It is best practice for students or the placement provider to arrange a placement pre visit. As a mentor I find this to be very effective, because it allows me to sit down with my student and I’m able to assess what level of knowledge my student is at so that we are able to devise a plan together of the learning opportunities such as: shadowing support workers, working with other teams in the multi -disciplinary, patient visits, observing medication etc. Giving the students a placement booklet and suggesting essential reading list will help students know what to expect and be prepared when they start.

Also, during in the placement pre- visit will give my student the opportunity to address any concerns the students may have prior commencing their placement. This will include: childcare, shift patterns, dress code, negotiating what shift pattern the student is able to do. Walsh (2014) mentions that a good pre-placement visit can begin the process of socialisation and integration into the team and instill the need for belongingness into the student.  

 In section B, I will be reflecting on how I have planned and facilitated learning for my first year to enhance their learning. I will be taking a humanistic approach to my teaching  I will be critically analysing how the andragogy and humanistic theory fits into my students learning and will be looking different methods in which how I effectively facilitate learning.

A learner facilitator is defined as a helper and not a conveyor of information (Francis et al 2013) and (Cross et al 2016). Andragogy theory views the facilitator as creating learning opportunities for the student which differs from the pedagogy theory which focuses on how children learn (Smith 2002). Andragogy theory believes that adults are problem solvers and learn well in experimental learning. Experimental learning helps to enrich existing knowledge to gain new insight which done through reflection.

Through the lenses of my first year student, experimental learning can be viewed as chaotic, disordered and inefficient, however this form of learning is crucial because it is the way in which we develop our ‘know how’, knowledge and skills (Francis et al 2013). The role of a learning facilitator is to make experimental learning more ordered and more efficient. Understanding the nature of my environment, I can understand for my first student that  this could be a very daunting sight and frightening due to rapid changeover of the ward environment, so I find that planning the activities, whom the student will be working in each shift can help the student to navigate and understand the ward routine and slowly integrate into the community. 

 When planning teaching, a few different factors need to be taken into consideration, the student’s level of knowledge, time, the resources available, and the Nursing and Midwifery conduct (NMC) competency guidelines (Walsh 2014). When planning or facilitating learning for my student, I like to ensure that I am integrating the FAIR principle which stands for feedback, activities, individualised and relevant. By applying this principle into my practice , this ensures when I work alongside my student that I am giving constructive feedback about their performance throughout , setting relevant goals that is timely achievable, in terms of relevancy, ensuring that practice is evidence based and up to date and the last principle  individualised, ensuring that my method of teaching is tailored to preferred learning style of my learner.

The learning theory that I will be applying to planning and facilitating for my student is the andragogy theory. This learning theory believes that adults and children learn differently each other. This theory focuses that adults are self-directed learners which is inspired by motivation, a willingness to take responsibility over their learning and the ability to draw from previous experience to create a new one.

However, the critical aspect of this theory is that its primary focus is creating learning opportunities so one can become proficient practitioners however these disregards social changes. In my work environment, it can be a very busy and is constantly changing due to the quick turnover of patients as it is an acute ward and is unpredictable which I think can cause many barriers to effectively facilitate learning for my student. Teasle (1992) argues that much clinical teaching is unstructured and often over reliance on role modelling. Teasle (1992) suggests that mentors need to structure and plan what they are going to teach by using a teaching plan (Walsh 2014). Although it is apparent that students are self-director learners, my job as a learning facilitator is not only to create learning opportunities but to assist my student to make sense of this learning in an environment which naturally can hinder effective learning taking place. As my ward is constantly changing, new learning opportunities could arise from this. As I mentor, if I think there could be a learning opportunity for my student experience, I would allow my student to partake in this and reflect so that my student can gain new insight.

In order to facilitate learning that is unique to my learner and to make a holistic assessment of my student, I found a learning need analysis to be an effective tool in obtaining information about the students learning needs. Using open ended questions can reveal a lot of crucial and important answers unlike closed question which can only give yes or no questions. Open questions can reveal anxiety, uncertainty, the learner’s level of knowledge and their preferred way of learning. Which is why is crucial as mentor to form therapeutic relationship with my student.  I believe this step is very important in the initial assessment as it can assist me to formula a plan which can give my learner the support that they require.

 A learning contract is a written agreement between the student and mentor which outlines what learner need to achieve to reach competency (Walsh 2014). This helps the student to learn on their own and can result in a deeper meaning and understanding. Learning contract can be useful in time management and self- directed learning.  By allowing the student to take ownership of their learning, the andragogy theory highlights that that the student will be able to learn more efficiently, better, will be able to learn more purposefully and are able to retain the information that they have learned (smith 2002).

A theory that shares similar beliefs to the andragogy theory is the Humanistic theory. The main concept of the humanistic theory is that adults are naturally self- directed learners and autonomous when given the opportunity (Francis et al 2013). Carl rogers (1902-1987) was a psychotherapist who developed a theory to education. He believed that individuals learn well when they are committed to their subject and have autonomy over the pace and content of their learning (Walsh 2014). However, carl roger’s work was written for education in schools so implying this to adult learning has no validity (Francis et al 2013). Also, the humanistic approach is fully focused on self and intelligence and knowledge is disregarded (Francis et al 2013). Nonetheless, the benefits derived from self- directed learning is that it promotes motivation for learner to achieve competencies on placement, promotes self- assessment. however, the disadvantage of a learning contract is that unrealistic goals can be set, students may find it difficult to identify learning needs which can cause anxiety and negative emotions to occur. Malcom Knowles mentions emotional distress occurs when they student did not learn the skill of self-direct which will cause failure to achieve in their education programme (smith 2002). To promote and to instil self-learning in my student, I need to know what motivates my student to want to pass and do well and then helping my student set clear concise goals and document this so that the student has clear guidelines of what and how they can successful achieve competency in their placement. 

In this section C, I will be reflecting on how I have set aim and objectives using the Bloom taxonomy as a guideline to ensure that I am assessing the student’s knowledge, still and attitude. The assessment tool I will implementing to assist me in my assessment is the competent assessment tool (CAT) and I will critically analyse its effectiveness in assessing students cognitive (knowledge domain), skill (psychomotor domain) and lastly the affective domain (attitude). Also, in the session, I will discuss how I would support my student.

The importance of setting an aim and objective is that it will help my student and myself to keep focused on what it is important. The aim will tell me what they should be doing at the end of the teaching session and objective are steps to achieve the aim (Walsh 2014).

I will be reflecting on how I have assessed my student administering medication to a patient. I have found the taxonomy of educational objectives as a guideline to be useful in assessing  my student’s knowledge, skill and attitude. The taxonomy of educational objectives classified objectives into three domains which are: cognitive domain, which is concerned with the student’s intellect and knowledge, the psychomotor domains which focuses on the motor skill and  lastly, affective domain which focuses on attitude, value and interests. The domains are further categorised in the form hierarchy of different levels, where the simple level as to be achieved before the harder level. (Francis et al 2013)

When implementing and applying the taxonomy of education objectives in medication administration, I will be able to assess and focus on: the student’s understanding of the common medications used in our ward (cognitive domain) administering medication in the correct route which includes intramuscular injections  and subcutaneous injections (psychomotor domain) and Lastly, did my student showed the correct attitude when administering the mediation for instance, asking for consent , showing compassion and empathy(affective domain).

The assessment tool that are used regularly to assess student’s competency in my practice is the competency assessment tool (CAT). I will be implementing this tool to assist me in assessing my student’s level of competencies. Duffy (2019) mentions that this tool is effective when assessing the student’s performance in practice. This assessment tool has a series of yes and no question and is formulated as a check list.

This allows a nursing facilitator to reach an overall score of how well the student did. The benefits derived of using a checklist is that subjectivity is reduced ensuring that the assessment is reliable and accurate, however this can only be achieved if the learning facilitator is competent in assessing effectively (Duffy 2019). Checklist requires direct observation (this can make the student feel uneased and anxious which might interfere with performance)

Using the (CAT) tool against the Bloom Taxonomy classifications, when assessing the students’ knowledge base, this assessment tool mentions that a mentor should use direct questioning to obtain information on the student’s level of knowledge. However, by obtaining information in this manner could make the student feel anxious. As I know that my student is  a first year student on their first placement, I understand they are more likely to experience anxiety and stress, so the methods I like to implement to obtain information of students knowledge is asking the student to complete e learning assessment and complete a medication booklet which has  the common medication used on our ward. Duffy (2019) mentions that this will help prepare the students for direct questioning where the student can feedback what they have learnt.

I have discovered that the (CAT) assessment tool provides a criteria of how to assess the students  psychomotor (skills) and the cognitive domain (knowledge) but does not clarify or specify how to assess the affective domain.

 In terms of assessment, the affective domain is equally as important as the psychomotor domain and cognitive domain when it comes to assessing competencies (Walsh 2014). Black et al (2013) mentions many mentors have expressed that measuring affective domain is the most difficult and challenging domain in assessment which is why many mentor nurses fail to fail incompetent nursing students. In this review that was conducted the findings revealed nurse expressed negative emotions such as fear, anxiety and guilt when failing incompetent nurses which is why many mentors avoid the stress of having to fail incompetent nurses. However, both Black et al (2013) and Duffy (2013) argue that nurses have a duty of care to protect the public from unsafe and incompetent practice and by not failing incompetence student nurses could be a sign of neglect on duty of care from their end.  Black et al further states that failing incompetent nurse should be viewed as a strength and concludes that nurses should challenge cultural norms that influence bad practice.

A review of the disciplinary tribunal report revealed that most of the cases were related to poor patient care which lacked compassion and empathy (Doyle et al 2014). The review points out that more attention needs be focused on assisting student nurse to develop in the affective domain. How can I assess student’s attitude (affective domain) in practice if the (CAT) tool does not specify this? In the disciplinary tribunal review, a nurse researcher has recommended the pre and post to measure a shift in value and attitude to patients with stigmatised behaviour (Doyle et al 2014). some of the examples that were mentioned were: patients with mental health distress, patients going through palliative care, those going through immense etc. This Research further mentions that students that were able to this scored highly in empathy were deemed to be competent. However, I disagree with this statement because to deemed competent a nurse needs to show a combination of skills, knowledge and attitude in practice.

Although, the CAT tool really gives guidance on how to measure attitude and is more focused to knowledge and skills aspect, in my workplace we implement the 6cs into our practice. This ensures that the patients are receiving high quality care. Duffy (2015) mentioned that role modelling is a powerful learning for student and can influence positively influence the student’s skills, knowledge and attitude. By implementing the 6cs which are: compassion, care, competency, commitment, caring communication and courage into my mentorship, I can positively embody these traits and attributes into my student through role modelling.

Providing students with feedback in a timely and consistently manner can help students achieve competency in practice. In an action research that was conducted it revealed that 68% of students voiced that they received insufficient feedback whilst on placement (Adamson et al 2014). From this study it is apparent that students value feedback. Students’ expressed that provided with feedback about their performance throughout their placement acted a vehicle in improving their practice. Not providing student with feedback can result in dangerous practice and put the public in danger (Duffy 2013).

The NMC highlighted that all nurses and midwives are required to provide constructive feedback if students are under achieving in practice (Duffy 2015)

Feedback is part of a formative assessment and when giving feedback it should be given after the assessment in a quiet place. If this is delayed this can reduce its validity and reliability (Duffy 2019). Feedback should be integrated into everyday clinical practice (Adamson et al 2014). When feedback is given effectively, this can assist students in motivation, increased confidence and self-esteem (Duffy 2013). However, many mentors have expressed difficulty to provide negative feedback to their student (Duffy 2019). Mentors mentions that they are not skilled in providing training in feedback and stated that training is required in preparation (Adamson et al 2014).

The practice education defined constructive feedback as “the process of telling on telling another person how they are perceived hinting at the emotional aspect involved in providing feedback (Duffy 2013). Developing giving constructive feedback is important to students who are under achieving (Adamson et al 2014).

As mentor, I like to implement feedback into my practice, the  benefits deprived from this is that it my student opportunity to correct their deficiency in knowledge, feedback can encourage my student reflect on their practice to improve competency. As I am aware that feedback is a powerful tool in helping student achieve competency, it is the manner in which how I communicate these feedback  which can either motivate or do the opposite, providing constructive feedback is the better format because it only focuses on the students’ performance rather focusing and directing feedback on their personal qualities (Duffy 2013).

In conclusions, I have critically analysed how effective the competency assessment tool (CAT) is in  assessing the student’s knowledge , skill and attitude using the bloom taxonomy assessment theory as an guideline to enable to assess effectively. I have discovered that the (CAT) was efficient in assessing the cognitive domain (knowledge) and psychomotor domain (skills) but had no implication of to assess their affective domain (attitude). I have explored the need

Reference

• Walsh, D. (2014) The nurse mentor’s handbook. Maidenhead: McGraw-Hill.
• Hughes, S. & Quinn, F. (2013) Quinn’s principles and practice of nurse education. Andover: Cengage Learning.
• Scott, I. & Spouse J (2013) Practice-based learning in health and social care. Chichester: Wiley-Blackwell.
• Cross, Vinette, et al.(2006) The Practice-Based Educator : A Reflective Tool for CPD and Accreditation, John Wiley & Sons, Incorporated
• Smith, M.K. (2002) Malcolm Knowles, informal adult education, self-direction and andragogy. The Encyclopedia of Informal Education. [Online]. Available at: www.infed.org/thinkers/et-knowl.htm (Accessed: 2nd November 2019).
• Duffy. L(2019) using competency assessment tool to enhance student  learnin