Constructive Teaching Methods: Nursing
I am a registered nurse working in one of the largest NHS hospitals in the UK. There are three different specialities on my ward. Infection disease, Tropical disease, Immunology, but we are well known as the Infection Disease ward. My ward is a Fourteen bedded ward; consisting of mostly single and double lobby side rooms, we also have five bedded bay. Due to the NMC (2008a) confidentiality code I must refrain from using any information regarding the identity of people in order to protect the identities, trust and clinical settings. The purpose of this assignment is to explore the experience of mentoring student nurses and also to establish a working relationship.
This professional study will enable me to nurture the student nurses and improve the outcome of the student learning process and how the experience will affect my future practise. The definition of a mentor is a registrant professional e.g. nurse, midwives or any other professionals who has successfully completed an accredited mentor preparation programme from an approved HE programme. The NMC definition of a mentor is, a registrant who following successful completion of an NMC approved mentor preparation programme – or comparable preparation that has been accredited by an AEI as meeting the NMC mentor requirements – has achieved the knowledge, skills and competence required to meet the defined outcomes” (NMC, 2008b).
Mentors need to be qualified for at least a year in their current profession and most mentors would have worked with students as co-mentors. A mentor is therefore an individual who has achieved the knowledge, skills and competence required to meet the defined outcomes of stage 2 of the developmental framework to support learning and assessment in practice (NMC, 2008b). The role of the mentor is teach and guide future nurses in a clinical area, whilst keeping to the NMC standards of mentoring in health and social care (NMC, 2008b). Mentors play a vital role in supporting, teaching and assessing students in the practice area. Helping study to learn or have better understanding of the ward speciality, according to their level of learning stage.
Relate learning and teaching strategies to ensure effective learning experiences and the opportunity to achieve learning outcomes for students by giving the student nurses the confidence to ask questions about their learning experience. Communicating and evaluating principles of assessment, including direct observation to the demonstration of competence, utilising appropriate criteria for the student nurse. Facilitating learning opportunities, by allowing students to work with the Multi-Disciplinary Team (MDT) and going to surgical or non-surgical procedures to improve their learning development.
The NMC also known as The Nursing and Midwifery Council is a supervisory body for nurses and midwives. The main purpose of the NMC is to protect the health and welfare of the general public by retaining a register of all nurses, midwifes and specialist community public health nurses that are able to work inside the UK. They ensure this by setting up a framework for their education, conduct, training, presentation and principles.
When issuing new standards or giving advice, the NMC turn to nurses and midwives as well as potential nurses and midwives, the general public, employers and all those involved in the teaching and educating of nurses and midwives. When those standards have been set, they are revised once every five years (NMC, 2004a). As part of the NMC standards for mentors; practice teachers, teacher nurses and midwives must correspond to the 8 domains. •Establishing effective working relationships
•Facilitation of learning
•Assessment and Accountability
•Evaluation of learning
•Creating an environment for learning
•Context of practice
Establishing an effective working relationship and creating an environment for learning are two important standards that a mentor must create at the start of their mentorship. When establishing an effective working relationship with their student they must exhibit a decent understanding of all factors that affect how the undergraduates integrate into the practice as well as helping the student overcome obstacles that would affect meeting that standard.
They must also provide the continuous support and guidance to simplify change from one learning environment to another by providing the student with time to adjust to the changeover. Above all a mentor must have an authentic professional and semi-professional working relationship to support the student with their entry into the register (NMC, 2004). When creating an environment for learning, a mentor must remember to give guidance and support to a student by identifying the level their working at and by giving the right provision that they need.
Also they must use a variety of learning experiences including patients, clients, carers and the professional team; to meet definite learning needs; also they must classify aspects of the learning environment which could be improved by discussing with others to make suitable alterations. But above all they must perform as a resource to simplify the personal and professional growth of others. The daily challenges that mentors face is time and having a place to address their students. As a mentor you have your own job to carry out as well as teaching and assessing students, which makes time-keeping difficult.
A mentor is expected to perform different roles, the main focus lies on a mentor’s ability to serve as a role model to nursing students. A mentor cannot neglect their other duties as a nurse, they need to be able to carry out the duty of being a nurse which is a time consuming job, and this also affects how they assess their students as they have barely enough time to do so. Another problematic issue that is hard to solve is having a place to address students in the work environment, it is understandable that a hospital isn’t exactly an office building but a busy environment where all the employees need to be attentive, however this is our place of work nonetheless and students deserve a place where their mentors can thoroughly converse with them on any issues they may have.
If mentors were able to instruct their students on certain responsibilities that they need instructions on and assess their students without the challenges that occur around the work place, mentors would have less of a hard time trying to see to all of their responsibilities at once (NMC, 2008b). The Nursing and Midwifery Council standards are to support the learning and assessment in the practise setting. The practise do provide a framework for mentors, however the nature of documents it is not comprehensive enough to consider all angles of competence in the interpretation of the student assessment (Cassidy, 2009)
It could be reflected that on some level of assessment that it can remain biased despite the framework being provided, due to the innate nature of the involved profession and the variation of skills to be assessed. Duffy (2003) identified that one reason mentors may “fail to fail” students in practise is lack of knowledge of the assessment process. Price (2005) says that practise-based assessment needs to be conducted transparently, rigorously and fairly, and discussed two purposes of assessment: Formative and summative assessment.
Holistic assessment of competence is challenging to structure on a framework, predominantly when considering a student reflexive action to develop their knowledge skills and attitude with emotional intelligence (Freshwater and Stickley 2004). This is somewhat corrected by the responsive development of a ‘sign off mentors’ who make a final judgement on the fitness for practice of the student at the end of their training at the end of their third year placement (NMC 2008b).
Part 3: My practice based assessment session
Practice based assessment is a core method of assessing the knowledge, skills and attitude of a student (Bloom 1956, Wallace 2003), but is complex to ensure objective management (Carr, 2004). To accommodate a diversity of patients and needs (Dogra and Wass, 2006), different types of assessment are necessary, all of which are part of the mentor student relationship (Wilkinson et al 2008, Figure 3, NMC 2008b).
Type of assessment
Clinical evaluation exercise; is a demonstrations of the student performing an important clinical skill, this can be integrated into ward environment or routine patient encounter (e.g. seeing a student wash their hands with alcohol gel after seeing a patient) Direct observation of procedural skill; observing a student carrying out a procedure and providing feedback afterwards (e.g. performing the seven stages of the hand washing technique). Case based discussion; this is a structured interview to explore behaviour and judgement (e.g. discussing aspects of a study and what a student did or observed). Mini peer assessment; is when a qualified professional providing feedback on an individual’s performance, including self-assessment (e.g. feedback from observers that supervise a student in their clinical placement).
Validity and reliability are the cornerstones of a fair and objective method assessment, and mentors need to ensure that their assessment sessions is appropriate to the level of the learner (Walsh, 2010) Assessment is formal knowledge that allows mentors to review of abstract of knowledge, including the possibility of probable risks or other influencing factors. Assessing an individual in practice, is related to collecting information as evidence of the student’s ability to perform particular in a clinical settings, these includes observing, measuring, interviewing and making decision (Gopee, 2011).
These skills are also used to evaluate a students’ knowledge and skills. For the evaluation of health professional learners’ for the clinical competencies and related knowledge, assessments can be described as a purposeful observation and questioning commenced to ascertain the learners’ ability to perform particular clinical interventions in a precise accordance with established or approved guidelines, and the knowledge of rationales for each action (Gopee, 2011).
Consistent assessments have limitations regarding validity and reliability for many reasons. There is an obligation for co-ordination between educators and service providers to approve on suitable assessment pathways for formative and summative assessments, allowing a fitting level of an assessment and practice theory link (Price, 2007). Mentoring in a complex clinical setting, makes it difficult to assess the competence of our student learners, also student skills might be ignored due to congruence necessary between possession of personal qualities and their applications in a moment of care, given the complexity of many nursing situation.
Therefore, mentors need to be conscious of providing safe, high quality patient care while supporting the participants and learning in complex care situations (Cassidy, 2009). This is critical, as being an expert practitioner may not automatically equate with being a proficient assessor (Cassidy, 2009). Competence has become especially significant to the achievement of clinical learning outcomes as 50% of fitness for practise (Department of Health, 1999).
My assessment was to assess the competence of a first year student using the seven stages hand washing technique in a clinical setting. I consider hand washing to be an important skill in nursing because it prevents the spread of diseases and infections from carer’s to patients. Poor hygiene enables infections and bacteria to spread around the hospital, especially when health professionals do not wash their hands thoroughly before and after seeing a patient.
Therefore, if everyone washed their hands thoroughly we would reduce the risk of cross contamination. By teaching my student the importance of the hand washing technique this would then make a huge impact on their learning outcome. I would consider this assessment a direct observation of a procedural skill (Wilkinson et al, 2008). During my assessment, an observing qualified mentor was present and observing at all angles of the assessment and feedback. The observing assessor has completed the written feedback about the assessment provided (Appendix 2). My assessment was planned using the criteria and a number of selected questions developed, to test the students understanding (Appendix 1).
The criteria for the assessment, was planned at an appropriate level for the student to comprehend on both a theoretical and practical level (Stuart, 2007).I will establish a rapport by introducing myself to the student and explaining the teaching that I will do without making the student learner feel anxious or nervous. I am planning to do a checklist where my student will be able to evaluate my teaching by completing a questionnaire. In this questionnaire my student will be able to evaluate me by choosing a mark between 1-5, 1 being very bad and 5 being very good (Appendix 3). With this plan I will be able to reflect on my teaching and identify my weaknesses so that future students will be able to learn even more from me.
My observer informed me that I had established a good rapport with my student which helped reduce any anxiety with the student, also I was informed that I connected with my student which helped the student feel comfortable. The environment was calm which means that the location was suitable for the teaching session. My observer also indicated that I had a good use of verbal language which also means that the student and I had no difficulties communicating pre and post teaching sessions.
My positive attitude helped the teaching outcome as it eased the student’s anxiety and provided a good learning atmosphere. Considering the feedback and upon my own reflection on the assessment, there is need for my future development. However, I can say that my teaching was affective in a positive light, and I feel that my student has demonstrated a good hand washing technique that they have learnt from my teaching demonstrations.
For future references, I will arrange for my student to take on more responsibilities for example; doing a hand washing audit. In conclusion, my observing assessor thought that my assessment of the student was suitable for their level of knowledge, skill and attitude (Bloom 1956, Hinchliffe 2009, NMC 2008b) and effective in defining the level of competency in this clinical area.
Part 4: My practice based teaching session
I have arranged a teaching plan (Appendix 4), a power-point presentation and a hand out of the presentation prior to the teaching session. My presentation mentions the importance of the hand washing technique and gives step by step instructions that my student will find valuable. This teaching took an andragogy approach as an opposed to pedagogy approach, however, during my demonstrations it was clear that the learning allows for a more pedagogy approach. The pedagogy approach uses a descriptive of the old-style approach to teaching which regards the teacher as the font of all knowledge and upon whom the student is dependent. The learning theory description
The humanistic approach takes into account base feelings, attitudes and values when examining knowledge and skills and recommends that rationale for learning in personal growth. This approach is very useful in nursing, as the attitudes and ethics are closely linked to nursing. One of the key factors of this approach is the importance of creating an independent, student centred, pleasant and safe teaching environment. The humanistic theories identify two different types of teaching approach, andragogy and pedagogy. The andragogy uses the concept of adult learning, where the pedagogy is generally regarded as relating to teaching children. There are four basic differences between the adult learner and child learner. Self-concept:
Adult are more responsible for their own learning experience, they are less dependent and self-directed in their own learning. Adults are more involved in the planning and evaluation of their work, whereas children rely predominantly on the teacher to plan and also evaluate their learning. Experience:
Adults use their past experiences and previous knowledge as a guide to their future learning. Readiness to learn:
Adult learners are likely to be in education of their own accord therefore
they take their initiative for learning and tend to focus more on that which has direct relevance on their lives. Orientation to learning:
Adults are more enthusiastic to try and apply their learning to life and will usually become more problem focused rather than content oriented.
The difference between the cognitive and behaviourist learning theories is that behaviourist believe that learning is based upon the key concept of stimulus response and condition whereas the cognitive believe that learning involves the mental process such as perception, reasoning, memory and information processing (Walsh, 2010).
I have arranged for a qualified mentor to assess and observe my teaching and my feedback that I provided to the student (appendix 5). My assessor provided written feedback on my session. My assessor also noted how beneficial the use of further reading and hand outs. Provision of printed hand-outs, particularly with space for notes beside them, may help accommodate students who have dyslexia, and may otherwise struggle to absorb the information provided (White, 2007).
I arranged the presentation to a standard where my student would be able to comprehend, with visual and audio guidance where each slide has just enough information to be thoroughly understood; as I was going through the presentation I was keeping good eye contact and body language to ensure that my students felt comfortable. At the end of the slide, I asked my student if they understood what I said and demonstrated. My assessor commented upon the open questions I asked, keeping the student interested, engaged and relating to practice, encouraging andragogy learning.
Visual; Learns through images, visual tools or imagining events. Completed tasks on time, has a reasonable interest in theoretical values Auditory; Learns well through talks or lectures. Absorbs sequenced organised information well, Uses checklist. Great at multitasking. Can focus well and understands the big picture. Kinaesthetic (Tactile) Learns through doing. Tends to enjoy the experience of learning. Finds it easy to demonstrate. Can completely understand instructions or information when presented orally. Finds attention to detail simple.
Upon reflection I can use this experience to expand my personal knowledge and how to develop my skills as mentor in the future. I will different resource to expand on my teaching as a mentor, different methods to suit the individual needs to learn. A wider range of learning styles would accommodate all types of learning (Rassool and Rawaf 2007, Pashler et al 2009). I would also ask my student, the best way to learn and accommodate their learning needs. I can also put more emphasis on patient safety issues (Beskine 2008).
During my mentorship preparation, I have learnt that being a mentor is essential part of the student learning curve. As a mentor it is my responsibility to support my student in meeting the continues professional developments needs in agreement to the Code of Practice (NMC 2008b, Ali and Panther 2008). I also learnt that being a mentor is fragment and section of leadership behaviour to teach students (Girvin, 1998). Transformational direction focuses on the ability to influence circumstances or people by affecting their methodology of thought and their role modelling (Girvin, 1998). Transformational guidance in nursing inspires independence and allows students or staff to reach their potential and encourages good interprofessional rapport (Pollard, 2009).
By assessing and addressing the daily obstacles mentors face in clinical environment, I would act as role model to overcome the difficulty of time and having a quiet place to assess my student. I would manage my time by planning ahead and adhere to this set time and book a room to interview my student in advance. This will help me to develop my student and help me as a mentor, but would also set a good example for the other mentors on the ward, this will improve their behaviour and practice in a positive way (Girvin 1998, Pollard 2009).
Overcoming obstacles such as bad staffing levels, busy ward situation and the burden of clinical commitments influence me on a harmful effective working relationship between the student and I (Beskine 2009, Hurley and Snowden 2008, McBrien 2006). Finding time to provide written feedback in the student’s documentation can be limited (Price, 2007). By e-mailing other colleagues mentors regarding the student progress on regular basis it may become common practice providing a greater range of student evaluation and a positive learning environment (Cassidy, 2009). This feedback can then be sent to the mentor at a quieter time, and discussed with the student prior to signing and entry into their documentation with time being less of an issue. Despite this being a good use of resources and time management (Beskine 2009).
Preventing influencing factors such as anxiety of the student or I affecting the reliability, subjectivity and the validity of the assessment (Price, 2007). This can be supported by facilitating the learning of my student by having flexibility and understanding of the different learning styles of the student, including students with learning difficulties or disability (White 2007, Stuart 2007). As mentors, we must place strong relations between practice and theory to ensure suitability of assessment and teaching. With these concerns, the student mentor relationship must be encouraged to provide a good quality learning experience (Ali and Panther, 2008).
Pre-assessing my students learning style in the initial interview would help me encourage the student to participate in a higher standard of learning (Knowles, 1990). This would help me to adjust my working strategy to build a better relationship between the student and I. I am currently mentoring a first year student on their first clinical placement, and from observation I could identify they lack a great deal of experience with adult learning and constantly need extra support and provision of resources to facilitate the learning curve, predominantly with practical skills.
Orientation is the gateway to a positive placement (Beskine, 2009). All students deserve to be assessed fairly and objectively (Ali and Panther 2008), however this might cause hostile emotions or teaching environment to both the student and assessor, so it is important that this is done properly, to ensure student progression is not impaired (Duffy 2003, Wilkinson 1999) and competence is insured to maintained patient safety(NMC 2008b, Lomas 2009).
My main concern is to ensure that all the students I work with are properly assessed and are competent and fit for practice (NMC, 2008b). It is vital to frequently work with students and have clear objectives set for them from the initial interview (Duffy and Hardicre, 2007a). I am aware that my responsibility as their mentor is to make sure all concerns with the student performance are raised by midpoint the latest, so we can set action plan for the final interview. There should be no sudden surprises for the student summative assessment and for their progress and level of competence (Duffy and Hardicre, 2007a).
In conclusion, mentoring is a complex and diverse role, and it is a role I will take on with focus and knowledge and the endeavour to continue to develop as a practitioner, assessor and teacher in the clinical setting. This reflective process has been incredibly valuable in preparing me to be a mentor, and my personal and professional development. I have gained a much deeper understanding of the mentor student process through investigation of the various aspects of NMC standards, as well as various assessments and teaching strategies. Areas on which I must develop are clear and in completing this course I feel adequately prepared, and look forward to further developing my skills and knowledge within this role.