The aim of this assignment is to critically analyse the learning environment and to discuss the mentor’s role in supporting learners during their clinical placement, acknowledging mentors’ accountability throughout the whole process. Mentorship is a very complex, integral role which has been described by Kinnell and Hughes (2010) as a process of transferring knowledge, skills and attitudes from mentors to students, facilitating learning in order to ensure their fitness for practice.
Clutterbuck (2006) considered mentor’s role as a learning provider and role model, as well as a challenging, critical friend, from network building and resourcefulness to listening and helping students to find out what they want to achieve. In 2008, The Nursing and Midwifery Council published Standards to support learning and assessment in practice.
The document highlights the importance of sharing knowledge and expertise with others, identifying the key responsibilities of a mentor: establishing effective working relationships, assessment and accountability, leadership, creating an appropriate learning environment in the context of evidence based practice, facilitate learning and evaluating it. Successful learning is associated with creating a positive and supportive learning environment and is regarded as essential in transferring learning for students (Henderson et al, 2006).
Mentors should ensure that learning environments are learner centred. Ali and Panther (2008) noted that, the clinical learning experience is an integral and invaluable resource in developing nursing students and the quality of the clinical placements has a fundamental influence upon the learning process. The level of support and guidance that students receive from suitably qualified practitioners, able to assess their competence, is the key to successful practice learning.
Price (2004) suggests that the learning environment needs to be continually monitored by clinical staff and audited in order to maintain quality and to provide appropriate support for learners. An effective placement for students is perceived according to their own personal goals and aspirations. The context of practice for this review is a Respiratory Centre, which is very well resourced clinical area with highly experienced members of staff who deliver care for patients with acute or chronic respiratory conditions. The Centre encompasses the Outpatients Department, Procedures suite, Physiology Department and a Day Ward.
The staff have specialised knowledge and skills, being able to perform a variety of investigative procedures and a multitude of therapies guided by the National Services Framework for Respiratory Health and Wellbeing (2009). The Matrons and Senior Sisters display very good leadership skills (Gopee 2008), creating and preserving a learning environment, motivating and encouraging the members of staff to reach their full potential by ensuring various continuing professional learning programmes are available for staff.
The Respiratory Centre is committed to supporting students achieve the desired level to promote maximum confidence and experience in safely delivering effective and efficient evidence based patient care services despite the high demands to the Centre and the staff as acknowledged by Clark et al (2003). In order to promote learning, the teacher needs to develop genuine, non-threatening relationship, based on mutual trust and respect with the student (Hand 2006).
The mentor-student relationship needs to remain at a professional level, rather than personal, as it can interfere in mentor’s assessment and should not be allowed. Wallace (2003) considered a good mentor encourages the students to ask questions and clarify queries. One of the most useful communication skills in mentoring is active listening (Bayley et al 2004). Being approachable, patient and having a good sense of humour are essential attributes for a mentor, as identified by Ali and Panther (2008).
Student’s orientation in a new clinical area is the gateway to a successful placement and establishing effective working relationship with the student (Beskin 2009). The orientation includes introducing the student to the team and culture, giving them a tour of the area, essential information as fire and emergency procedures, security issues, policies and procedures. Making a student to feel welcomed and accepted as part of the team should be a mentor’s first priority (Hilton and Pollard 2005).
Students, especially if they are on their first clinical placement, can find a specialised learning environment intimidating and overwhelming at times. For some students, the realisation that they have to acquire basic knowledge on specialised wards makes them feel frustrated, lowers their self-esteem and interferes with their learning. By developing an effective learning contract, considering students` previous experience, their needs and expectations, the mentor can avoid this problem and keep the student motivated and focused on aspects of practice that are appropriate to their stage of learning.
Introduction of learning contracts has showed a significant improvement in students` performance (Lemieux 2001). Learning contracts are used for the learner’s evidence of achievement, as required by the University (Hyatt et al 2008). They are considered to be an effective tool for developing mentor-student relationship while encouraging students` autonomy (Quinn & Hughes 2007). It is very important to encourage the student to become self-directed in the development of their needs whilst using their mentor as learning resource (Morton-Cooper and Palmer 2000).
During their placement in the Respiratory Centre students have the opportunity to work within the Multidisciplinary Team, enabling them to observe and practice a holistic approach to patient care which enhances their knowledge and skills. It has been suggested that short placements and visits to other ward areas maximizes the learning experience and enables students to gain a variety and skills and opportunities (Hand 2006). The nursing team in the Respiratory Centre have created a Student Guideline Handbook which enables them to adhere to policies and procedures followed by the team.
The Handbook introduces them to the basic knowledge needs, a variety of learning opportunities, the importance of the inter-professional learning team and students` responsibilities; all these should encourage them to follow a gradual progression of learning from simple to complex task building. Siviter (2004) discussed the high expectancy for student to absorb considerable amount of information during their course as a foundation for later practice, before the student actually understands why it is important.
It saves the nursing student time spent searching for sources and information and points the students towards sources of academic support. One of the negative influential factors upon students learning is the busy nature of the clinical environment. Mentors should acknowledge it and deal with the problems associated in order to prevent student alienation and loss of motivation. Clinical experience shows that students can also learn by observing evidence based practice and through direct interaction with patients. Having the appropriate support and supervision encourages them to play a part alongside their mentors.
Making time for students can be challenging due to the workload and dual responsibilities of mentors for patient care and student mentoring. This affects the mentor-student relationship and results in compromising learning (Bennet 2003). Walsh (2010) suggested that mentors have to be creative, finding the opportunity for frequent short interactions with the student and dedicate time to teaching them; this helps the student to feel supported. Staff shortages, the number of students and various other ward challenges can result in a stressful environment.
When the situation arises, it can have a negative impact upon staff morale and affects the standard of the care delivered and students` experience (Moseley & Davies 2008). The environment is most conducive to learning when all members of staff are motivated and team spirit is present. Learners that have the opportunity to practice in this type of environment are likely to attain more educational achievements. Hand (2006) discussed the importance of mentors` awareness of different learning theories and styles. By conducting an initial meeting with the learner, the mentor can identify their learning needs and styles.
Learning has been defined as changes in knowledge, skills and attitudes (Curzon 2004). Using different strategies when teaching and learning is related to the facilitator’s preference and their experience. There are more than 50 theories of learning but Atherton (2009) discussed the broad theories of learning: behaviourism, cognitivism, humanism and constructivism. Atherton also talks about learning styles, utilising Kolb’s experiential learning cycle (Kolb 1984) to include: the pragmatist-active experimentation, activist-concrete experience, reflector-reflective observation and theorist-abstract conceptualisation.
The mentor should ensure that the learner proceeds around the cycle in a way that is suitable for their learning style. Skinner’s Behaviourist Theory (1974) talks about learning by association, considering learning environments fundamental to learning. Maslow`s Humanistic theory (1968) provides a holistic approach to learning by empowering the learner and teacher as a facilitator. Bruner’s Cognitive Theory (1966) describes how learners use mental activities for better understanding of their learning materials. Mentors are role models and the quality of learning depends on the quality of the role model.
In 2010, Walsh stated that successful learning depends on the characteristics of the mentor and the learner, the subject to be learnt and the external environment. He has also explored the “toxic” mentor concept, their impact upon students’ experience and how the experiences can become positive. By encouraging the students to use Price’s SWOT analysis- Strength, Weakness, Opportunity and Threats (2004) the mentors can support students to identify their learning needs. That can empower the students, improve their performance and monitor their progress Brockbank & McGill, 2006).
Mentors are also required to involve students in interprofessional learning environment and assess their proficiency as discussed by Chesser-Smith in 2005. One of the NMC requirements is that mentors have to assess student nurses during their clinical placements in order to ensure fitness for practice and protect the public (NMC 2008b). Some of the studies (Stuart 2003, Hand 2006 and Hyatt et al 2008) state that, the most frequently used methods of assessment is: observation, questioning, feedback from staff and scrutiny of patients` documentation completed by the student.
Mentors’ accountability within the assessment process in order to ensure safe practice and their responsibility to fail those students who do not meet the required objectives has been reiterated by NMC(2008). Through early meetings, mentors need to be able to identify the areas where students struggle; these can become focus areas that need developing, especially when the student has a disability problem like dyslexia, so they can avoid potential failings (Duffy 2004 and Woodcock 2009).
Mentors are responsible for the formative and summative assessments of their students (ENB and DoH 2001, pp9). A five-dimensional model of assessment has been found to be a useful assessment tool by Kinnell and Hughes (2010). The tool includes: the rationale for assessment, the components and process of assessment, evaluation and action plan. The evaluation is regarded as a vital part of the mechanism of quality assurance and it is based on feedback, review, discussions and the final implementation of the change.
Providing constructive feedback helps students learn from that experience and helps creating a supportive action plan (Price 2005). Duffy (2004) recognizes that failing a student is more difficult than passing one and it has been considered that an emotional burden is associated with failing a student during their clinical placement. Strengthening mentors’ role and the available support networks to support them in their decision making will enhance the assessment of competence (NMC 2008).
Stuart (2007) talked about the decision of failing a student, which requires the mentor to have courage and strength in order to make the thought provoking comment `would I want this student to be my nurse? `, which is an extremely important point to consider when making that final difficult decision. A number of principles integral to the assessment of professional practice have been identified: practicality, transparency and fairness, motivation, validity and reliability (West et al, 2007).
In conclusion, a mentor’s role comprises the ability to support and guide the students during their transition from the classroom to clinical practice by providing knowledge and understanding in order to cover the gap between theory and practice. This can only be achieved through being a good role-model and encouraging the student to learn new skills, concepts and behaviour by studying, teaching sessions and experience. A mentor-student relationship needs to be based on trust; otherwise, the student might not feel motivated.
In addition, being a mentor can prove to be challenging, as it is not always possible to achieve the right balance between student’s needs and patient care which is a constant priority. The clinical environment represents an essential, extremely important learning experience for all students. By assisting students through these experiences, learning can become a more enjoyable pathway. Finally, the mentorship experience can provide an insight to the mentor which helps them self assess with the view of continuously improving their mentoring skills.
