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Assessment and accountability in mentorship

Introduction

The Nursing & Midwifery Council (NMC) (2008a, p.23) declares in its Standards to Support Learning and Assessment in Practice that a “mentor is a mandatory requirement for pre-registration nursing students”. This simply means that student nurses must be guided by nurse mentors. The Royal College of Nursing (2009, p.3) declares that the “significance of the role of a mentor and the quality of the mentorship offered in practice cannot be over-emphasised”. The NMC (2008a, p.23) defines a mentor as “a registrant who, following successful completion of an NMC approved mentor preparation programme or comparable preparation that has been accredited by an AEI (approved educational institution) as meeting the NMC mentor requirements has achieved the knowledge, skills and competence required to meet the defined outcomes”. The NMC (2008a, p.13) also provides for eight domains in the framework to support learning and assessment of students in practice. In essence, this means that in order to become an effective mentor, a nurse must be able to accomplish these eight domains. These domains are establishing effective working relationships, facilitation of learning, assessment and accountability, evaluation of learning, creating an environment for learning, context of practice, evidence-based practice and leadership (NMC 2008a, p.13).

This essay will explore one of the eight domains, specifically the domain of accountability and assessment in mentorship. This will be done in relation to mentoring two first-year adult branch nursing students placed in the Dermatology Department. Before proceeding any further, it is imperative to relate that the NMC (2008b, p.3) declares the need to respect people’s right to confidentiality. In compliance with this, the real identities of the student-mentees will be kept anonymous.

Main Body

Accountability is essential in the professional practice of nursing (NMC 2010, n.p.). A literature review in defining professional nursing accountability conducted by Krautscheid (2012, p.45) revealed that accountability is usually linked with responsibility particularly the responsibility for one’s own actions and behaviours related to the practice of one’s profession. The professional accountability of a nurse is expressed by no less than the Nursing & Midwifery Council in its Code for Standards of Conduct, Performance and Ethics. To be specific, the NMC (2008b, p.2) states that “as a professional, a nurse is personally accountable for actions and omissions done in practice and must always be able to justify one’s decisions”. The accountability of a nurse as a mentor is also grounded on the same NMC Code. The NMC (2008b, p.5) states that a nurse must facilitate students and others to develop their competence. This specific provision directly requires a nurse playing the role of a mentor to be accountable for the learning of students during practice placements. In the case of the two first year adult branch nursing students, it is safe to declare that a mentor is accountable for the total learning experience of the students while in the placement.

To effectively mentor the two students, it is necessary to first establish a positive mentoring relationship with them. This is because a positive mentor-mentee relationship can help make the mentor and the mentee feel more comfortable with each other and this facilitates the smooth interaction and communication between them. Gopee (2011, p.28) supports this when he declared that a mentor and his or her mentee are initially strangers to each other and so they must develop rapport and cultivate a positive working relationship in order for the mentorship to really work.

A practice placement is where students begin to apply their knowledge and practice skills in order to achieve the required competence for registration (RCN 2006, p.1). The need for a strong and positive mentoring relationship is crucial especially because clinical placements can be a daunting environment for the students. This is particularly true during the first few days of the placement. A clinical placement can pose a great challenge for students such as during a busy day and the ward or department is understaffed (Levett-Jones and Bourgeois 2011, p.227). It is therefore vital for the mentor to initiate a friendly but professional approach when interacting with the students in order to help them feel at ease in the clinical environment of the placement. One way by which this can be done is for the mentor to conduct an orientation wherein the students are made familiar with the different areas of the Dermatology Department and are introduced to the entire healthcare staff working there. Beskine (2009, cited in Walsh 2010, p.23) state that an “orientation is the gateway to a successful placement”. Walsh (2010, p.23) suggests that an initial orientation is a vital part of helping a student get off on the right foot and make the most of their placement. Walsh (2010, p.23) further relates that one strategy for the mentor to accomplish this is by sharing with the students information about one’s personal experiences as a student and one’s expectations as a mentor. This strategy can be made formal by providing an information or welcome pack. Typical contents for a welcome pack include a welcome letter encouraging the student to visit the placement prior to that start of the actual placement, the location of the placement, a list of learning opportunities and learning outcomes, the expected roles and responsibilities of the students, a dress code or guidelines on what to wear and the shift hours (Stuart 2013, p.157). It should contain a description of the various areas within the ward or department and a list of the names of personnel working within the placement (Bailey-McHale and Hart 2013, p.129).

The importance of making the two students feel welcome in the placement is actually a simple but effective means of showing one’s accountability as the mentor for the students. This is because it is clear that a mentor is accountable for the total learning experience of his or her students and the first step to ensure the learning of students begins with making the students familiar and comfortable within the learning environment. This should then be followed by conducting an initial assessment of the learning needs of the students related to the area of the placement. A mentor is responsible for making initial interviews with students to assess their learning needs and to develop a plan on how to address these needs (RCN 2006, p.6). Naturally, the interview will be smooth sailing if the mentor is successful in building a positive mentoring relationship with the students. In interviewing the two students in the Dermatology Department, it is important to take into consideration the preferred learning styles of the students. In essence, this means that along with identifying the learning needs of the students, it is also vital to identify how they can learn best from the placement. The Royal College of Nursing (2006, p.6) states that a mentor’s responsibility includes being approachable, supportive and being aware of how students learn best. There are many theories and models that can be adopted to label the preferred learning styles of students. An example of this that may be use in the two students is the Honey and Mumford learning styles model. The Honey and Mumford model identifies four types of learners namely activists, reflectors, theorists and pragmatists. An activist learner is a hands-on learner and prefers to learn by trial and error (Temple 2012, p.75). A reflector is someone who prefers to be thoroughly informed before acting on a situation (Temple 2012, p.75). A theorist is someone who utilises theories to make sure that a particular undertaking makes sense (Temple 2012, p.75). A pragmatist is someone who learns best by observing a demonstration from an expert (Temple 2012, p.75). In the case of the two students placed in the Dermatology Department, both have been identified to be pragmatists and so actual teaching of the skill of bandaging was done through demonstrations which the students carefully observed. A simulation strategy was also used wherein the two students were given the opportunity to practice their bandaging skills onto a mannequin before they were allowed to perform the skill onto real patients while under supervision.

In using the demonstration and simulation strategies, it is crucial for a mentor to also take into consideration the internal and external factors that affect student learning. This can be further identified by using the SWOT (strength, weaknesses, opportunities, threats) Analysis. The SWOT Analysis is a useful tool to help mentors identify factors that can either improve or hinder their mentoring skills (Murray and Rosen 2010, p.103). The strengths and weaknesses are the internal factors that affect the efficiency of mentoring while the opportunities and threats are the external factors (Murray and Rosen 2010, p.103). In the case of the two students, one prevailing strength that has been identified is their genuine eagerness to really learn while in the placement. For the mentor, one strength is the mastery of the nursing skills that need to be taught to the students. One weakness of the students was their initial hesitation to interact with the mentor. One weakness of the mentor is the initial uncertainty on how to begin interaction with the students. One opportunity is the presence of diverse learning opportunities in the placement while one prevailing threat is the very hectic schedule of the department which causes frequent interruptions during actual teaching sessions.

In teaching the two students about correct bandaging, it is also important to adopt the concept of andragogy. To simply put it, andragogy refers to adult learning which is in contrast to pedagogy which is all about child learning (Walsh 2010, p.82). The concept of andragogy implies that adults prefer to take an active role while children are passive learners and therefore leave everything to the discretion of the teacher or mentor (Kinnell and Hughes 2010, p.60). Base on these premises, teaching the two students who are adult learners will require the mentor to actively seek the students’ input. This means that the mentor should not on his/her own decide on what and how to teach the things which the students need to learn in the placement. The mentor should brainstorm with the students on how the students’ learning needs can be best met. This will allow the students to have a more active role in planning their own learning during placement.

There is also the need to consider the current level of aptitude of the students in relation to the skills that will be taught to them. In this case, the Benner’s Skills Acquisition Model will be helpful. Stuart (2013, p.126) states that a student or even a newly qualified nurse will have to pass the five stages of nursing competence as identified in Benner’s Model. The model classifies learners into five stages namely novice, advanced beginner, competent, proficient and expert. It is safe to deduce that the two students being mentored are still under the novice stage; hence, it is vital for the mentor to create teaching strategies that would fit their current level of knowledge and skills. For instance, it would be unfair to teach the students advance skills on four layer compression bandaging without first teaching them the basic principles of bandaging.

Blooms Taxonomy should also be adopted by a mentor to enhance teaching sessions. Cannon and Boswell (2012, p.140) state that Bloom’s Taxonomy is an important learning theory as it distinguishes learning into three domains: namely affective, cognitive and psychomotor. Teaching correct bandaging skills naturally involves the cognitive domain since it requires mastery of steps or procedures. It also involves the psychomotor domain because it entails using instruments and tools. It also incorporates the affective domain because it requires positive and encouraging feelings and emotions which help motivate a student to do the procedure correctly.

It is also important for a mentor to make the learning objectives SMART. This means that the objectives are specific, measurable, attainable, realistic and time-bounded. In the case of the two students, this has been achieved since the objective involves making the student understand and perform the steps of bandaging. This makes the objective specific. This will be done under supervision with the policy on bandaging as the criteria. This makes it measurable and realistic. The said objective is to be accomplished at the end of the placement. This makes it time-bounded.

A mentor’s accountability naturally includes assessing the students’ performance. Aston and Hallam (2011, p.60) relate that assessing students’ learning while they are under one’s mentorship is one of the important role of a nurse mentor. This is grounded on the Nursing & Midwifery Council (2008a, p.16) declaring that students must be supported and assessed by mentors. Mentors are responsible for assessing the total performance of students including their knowledge, skills, attitudes and behaviours (NMC 2008a, p.23).

It is vital to relate that there are basically two types of assessment namely formative and summative assessment. Formative assessment happens during the course of the placement wherein it is done on a continuous basis to gauge how much progress a student has reached without necessarily grading such progress (Kilgallon and Thompson 2012, p.153). It typically involves the giving of feedback in order for the student to further improve (Kilgallon and Thompson 2012, p.153). This kind of assessment is done in order to prepare the student for the final assessment which is the summative assessment. Summative assessment marks the end of the mentorship and involves the actual grading of the student’s final performance (Kilgallon and Thompson 2012, p.154).

It is essential to point out that the giving of feedbacks is an important component of effective student assessment. Kinnell and Hughes (2010, p.96) relate that “feedback must be constructive and not destructive”. It must highlight the strengths as well as the weaknesses of the student (Kinnell and Hughes 2010, p.96). Kinnell and Hughes (2010, p.96) further relate that it must emphasise areas for improvements and incorporate praises appropriate for the student’s achievements. Constructive feedbacks given by mentors and the clinical staff can help the student grow and develop as a future professional (Levett-Jones and Bourgeois 2011, p.48). One strategy for the effective giving of feedback is to use a strategy called feedback sandwich. This involves sandwiching a negative feedback between two positive feedbacks to avoid hurting the student’s feelings and self-esteem (Elcock and Sharples 2011, n.p.).

There are several methods and strategies by which a mentor can effectively assess a student’s competence. The Royal College of Nursing (2009, p.8) states that assessment can be done through direct observation, simulation, objective structured clinical examinations or OSCE, testimony of others, student self-assessment, written portfolio evidence, active participation, interactive reflective discussion, learning contracts, guided study, interviews, patient comments, peer evaluation, collection of data, case studies and team mentorships.

In the case of the two students, one was assessed through direct observation and questioning while the other was assessed through direct observation and through written reflection. This was in consideration of the fact that one student has a prior degree in English literature, while the other one was awaiting a dyslexia test; hence, it would be unfair for both of them to be assessed through written reflection.

In assessing student performance, the mentor’s accountability includes making sure that all the possible opportunities for learning has been exhausted and that the students have been given ample time to master the skills that will be assessed from them. This is because it would be unfair for the students to be assessed for skills which were never taught to them or where they were never given a chance to improve on it. This points to the accountability of the mentor to the students he or she is mentoring. There is also the accountability of the mentor towards the general public. This accountability signifies that ultimately the mentor’s role in guiding students is to ensure that future generations of nurses are truly competent to serve the general healthcare consumers. This suggests that if after giving opportunities to improve, the student has failed to show competence, then the mentor must not hesitate to give a failing mark. On the other hand, a study conducted by Duffy (2004, n.p.) revealed that failing students is a difficult thing to do for majority of mentors and this is because it raises emotional issues for the mentor. The emotional dilemma of failing a study is carried by mentors and sometimes this emotional stress overcomes the need to practice a fair and objective mentoring. It is logical to assume that sometimes the decision to either pass or fail students is influenced by the personal sentiments of the mentor towards the students. This is something that should be avoided because it threatens the very essence of why there is a need to assess students under mentorship. A good mentor is someone who knows when to empathise with students and when to detach themselves in order to objectively assess a student’s performance; therefore, it is important for a mentor to learn when to empathise and when to be objective. In essence, this means that in assessing the final performance of the two students in the Dermatology Department, it is important for the mentor to be objective and set aside any personal friendly relations which he or she may have established during the course of the mentorship.

Conclusion

Accountability and assessment in mentorship in this case involves the responsibility of the mentor to ensure the learning of the two students in the Dermatology Department. Being accountable for their learning starts with establishing a positive mentoring relationship with them. This can be accomplished by using a friendly but professional approach. An orientation can help the mentor inform the students on what to expect from the placement. It is important to assess the students’ learning needs and learning styles by using different theories and models. This is important in order to maximise their learning in the placement. Using demonstration and simulation are only two of the many teaching strategies that may be used to effectively mentor students and the choice of strategy depends on the kind of learner a student is. Assessment is another important role of a mentor. This can either be formative or summative assessment. Assessment should be fair and objective. A mentor’s personal friendship built during the course of the mentoring relationship should never hinder objective assessment of students’ performance.

References

Aston, L. and Hallam, P. (2011). Successful mentoring in nursing. Exeter: Learning Matters Ltd.

Bailey-McHale, J. and Hart, D.M. (2013). Mastering mentorship: A practical guide for mentors of nursing, health and social care students. London: SAGE Publications Ltd.

Cannon, S. and Boswell, C. (2012). Evidence-based teaching in nursing. London: Jones & Bartlett Learning International.

Duffy, K. (2003). Failing students: A qualitative study of factors that influence the decisions regarding assessment of students’ competence in practice. [online]. Available from: http://www.nmc-uk.org/documents/Archived%20Publications/1Research%20papers/Kathleen_Duffy_Failing_Students2003.pdf [Accessed on 12 October 2014].

Elcock, K. and Sharples, K. (2011). A nurse’s survival guide to mentoring. [online]. Available from: http://books.google.com.ph/books?id=t6na8wOS5X4C&pg=PT131&dq=feedback+sandwich+mentoring+nursing&hl=en&sa=X&ei=bjY6VPSCHs-ruQSjloH4Bw&ved=0CBwQ6AEwAA#v=onepage&q=feedback%20sandwich%20mentoring%20nursing&f=false [Accessed 12 October 2014].

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Nursing & Midwifery Council (NMC) (2008a). Standards to support learning and assessment in practice. London: NMC.

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Royal College of Nursing (RCN) (2009). Guidance for mentors of nursing students and midwives: An RCN toolkit. London: Royal College of Nursing.

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Walsh, D. (2010). The nurse mentor’s handbook: Supporting students in clinical practice. Maidenhead: Open University Press.


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