Nurses as mentors
As described in the NMC standards the 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 Approved Educational Institute (AEI) as meeting the NMC mentor requirements - has achieved the knowledge, skills and competence required to meet the defined outcomes (NMC 2008).
A mentor should be able to agree learning objectives with the mentee, address their educational needs, identify their strengths and weaknesses, explore options, act as a challenger, encourage reflection and provide a challenging relationship (Morton-Cooper and Palmer 2000: Quinn, 2000: Nicklin & Kenworthy 2000) and to remain non-judgmental. Mentors are responsible for understanding the assessment process on competence/incompetence and should be able to defend decisions made about students in practice (RCN, 2007). Assessment is an essential component of the mentoring process. Duffy (2004) stated that mentors must ensure that clinical skills are assessed as a required standard. Mentors are required to support student's learning in an interpersonal environment and assess and judge their proficiency. In accordance with The Code (2008) mentors should be able to support students meeting continuing professional development needs. A mentor is a role model who is willing to help develop clinical competence through support, honesty, appraisal, reflective communication and being a critical friend. (RCN & ACE, 2007).
According to the NMC (2007) the term mentor is used to denote the role of a registered nurse who facilitates learning and supervises and assesses students in the practice place. A mentor must show that they are competent in practice and this can be achieved by the successful completion and implementation of the eight domains and outcomes otherwise seen as the eight mandatory competencies delineating the responsibilities of mentors (NMC 2006), which are detailed in the NMC's Mentors Update Workbook 2009-2010. Competences are a crucial element of mentorship practice and provide evidence that the mentor possess the necessary skills to teach and assess students and that the mentor understands the requirements to be effective within the mentorship role having reached the standard appropriate to being entered onto the register. Mentors have a responsibility to their students for understanding their expected learning outcomes, participating with the student in reflective activities, providing a supportive learning environment, helping the student to identify and accomplish their learning needs and objectives, making sure that the student has completed a satisfactory number of mentored hours and is practising in line with The Code (NMC 2008). Mentors are also required to participate in formative and summative assessment and evaluation of the student's learning in clinical practice to ensure accomplishment of clinical competencies (NMC 2006). Whilst fulfilling such demanding responsibilities, mentors have to face various challenges. These include limitations on time, dual responsibilities of patient care and student teaching, high workload (Bennett 2003), the mentors own personality, the student's level of learning, the number of students allocated to a mentor (Moseley and Davies 2008), and the level of commitment required (Mills et al 2005). Other challenges include the mentor's knowledge about the theoretical aspect of learning, assessment methods and ways to provide constructive feedback, (Nursing Standard 2008). Thus mentorship is an integral part of the experienced nurse's role. Basic nursing education must furnish starting nurse practitioners with the skills, knowledge, and judgment to grant effective, ethical, and safe nursing care. Being a self-regulatory profession, with Medical colleges serving as its regulating body, nursing arranges standards for educational training and credentials of individuals taking on the profession and the role of a mentor is crucial to this process.
Experienced nurses, who serve as mentors, help the less-experienced, as well as experienced nurse learners adapt to novel settings and ad hoc responsibilities (Kucey, 2001, p.8). Mentoring typically involves the establishment of long-term relationships, necessitated to cultivate the passing on of knowledge, insight, and competencies. It is different from preceptoring, which generally engages in short-term relationships, for mere teaching of certain skills and for clinical supervision (Hynes-Gay & Swirsky, 2001, p.12). Successful mentoring necessitates time and considerable personal commitment. In most cases, mentoring is undertaken by existing hospital nursing staffs that have a considerable amount of experience of the ins and outs of working in the hospital setting. Thus, the ultimate goal of mentoring nursing students is to immerse them in actual duties they are expected to carry out in their projected nursing career. The immersion process involves practical and hands-on activities, as supervised by the mentors, in order to familiarize the nursing students with the kind of work that are expected out of them when they graduate and take on the profession.The mentor and learner will have a close working relationship and Quinn (2000) regards trust as the hallmark of any meaningful relationship whilst Power (1997), insists that the working relationship between mentor and learner is the most significant aspect of the entire process. If the relationship is based on mutual respect and a sense of partnership, students' learning is enhanced.(Nursing Standard, 2008).
Due to changes in nursing school entrance requirements and disability legislation (widening participation agenda), students with a variety of physical and learning disabilities are more likely to be accepted in nursing and healthcare programmes (HMSO, 2001; Coriett,2004). Therefore mentors are required to work with the student to help develop strategies that enable them to achieve the required standard of performance in practice,(DDA, 1995) utilising "reasonable adjustments" within the practice setting.
This essay is based on scenario 2 which is about Paul in his foundation year and currently in his second term. Within the two weeks that Paul has been in the author's area of practice, he appears to have some co-ordination difficulties and shows behavioural problems. The author is going to focus on stress and learning difficulties as possible reasons why Paul is underachieving as these two areas are most likely to be affecting Paul's actions.
Stress is defined as the body's reaction to a change that requires a physical, mental or emotional adjustment or response coming from any situation or thought that makes one feel frustrated, angry, nervous or anxious (Morrow 2009). Paul's actions indicate that he is anxious, sometimes angry, not with other persons more with himself for not being able to complete a task set, thus stress could have impact on Paul's performance, manifesting itself in his actions. Paul could also be suffering from dyspraxia. Dyspraxia is a developmental co-ordination disorder (DCD) which results when parts of the brain fail to mature properly as they develop - resulting in atypical brain development (Kaplan et al, 1998 cited in RCN 2010). It is used to be called 'clumsy child syndrome' or 'minimal brain damage'. It is now sometimes referred to as perceptuo-motor dysfunction or, more commonly, developmental co-ordination disorder (DCD), (Colley, 2005). The Dyspraxia Foundation describes dyspraxia as an "impairment or immaturity in the organisation of movement. Associated with this there may be problems of language, perception and thought." (Dyspraxia Foundation, 2010). Thus stress and dyspraxia could both be reasons for Paul's co-ordination difficulties.
My role as mentor is to support the learner and critically analyse the reasons for non achievement. The author has shown how stress and dyspraxia would affect Paul and this is going to have an effect on his ability to cope with the requirements of patient care within the placement area. It is also important for the individual to acknowledge areas that are being avoided and endeavour to find other ways of conquering the difficulty. This is particularly so in the case of a student nurse who will need to function independently once they qualify. Mentors must therefore ensure that students are being assessed on all required competencies and that they are not avoiding areas they find difficult RCN (2010). Nurses with dyspraxia are usually very aware of their strengths and potential challenges. As a result they are extremely careful about checking things they are less confident about in order to avoid making mistakes, particularly those that involve patient safety (Morris and Turnbull, 2006 cited in RCN (2010), however it is not expected that educational standards should be lowered to accommodate disabled students Corlett, (2004). RCN (2010) It must also be stressed that all student nurses, including those who have declared a disability, will still be expected to demonstrate that they are "fit for practice". This means that they must meet all of the learning competencies and skills that other students are required to do.
The fundamental difference is 'reasonable adjustments' which are contained in the Equality Act 2010 and requires employers to make changes to help disabled people work. Reasonable adjustments can include, making changes to the building or premises where the person works, changing the way in which work is done, providing equipment that will help the person do their job EFD (2010)and can be central to enabling a disabled member to retain their employment. "Reasonable adjustments" should be in place before competence is assessed. RCN (2010) and in order to receive "reasonable adjustments" it is normally expected that an individual will have been formally diagnosed with, in this case, dyspraxia RCN (2010) which is not the case with Paul. At this juncture it would be recommended that Paul meets with his general practitioner enabling a formal assessment of his condition to be carried out. Due to its potential overlap with certain neurological conditions, the diagnosis of dyspraxia needs to be confirmed by a general practitioner (GP), once they have eliminated other possible causes. The GP could refer the individual to an appropriate specialist, such as those included on the following list devised by Colley (2005) who can then assess the individual for dyspraxia and make a formal diagnosis, educational psychologists, occupational, neuro or clinical, psychiatrists, neurologists (although this is mainly in the case of acquired dyspraxia) and paediatricians who specialise in developmental disorders (although their main work is with children, paediatricians will see adults when asked to assess for a developmental disorder such as dyspraxia) (RCN 2010). If Paul is diagnosed with dyspraxia this will be to Paul's benefit enabling "reasonable adjustments" to be put into place, although Paul may experience stress if he fears discrimination and struggles to conceal his problems (RCN 2010) which may well be the case at present confirming Paul's actions, maybe to certain extent, stress related.
RCN (2010) states that ultimately the choice of whether or not to disclose a specific learning difference is a personal one and is something that needs to be considered carefully. Employers need to promote a culture of inclusivity, where individuals feel able to discuss their specific needs without fear of discrimination or negative attitudes. Their decision of whether or not to disclose is based very much on the personal and professional qualities of their mentor. Where mentors were perceived as empathetic and receptive, levels of disclosure were higher, conversely where they were viewed as patronising and lacking in insight, students were less likely to confide in them. Legally employees (or students) have no obligation to disclose a disability to their employer. The Data Protection Act (1998) overrides disability legislation, thereby allowing an employee to choose to keep it private, although it should be noted that
health and safety legislation takes precedence over both. Whilst they therefore have a right not to
disclose, the individual needs to be aware that unless they do, and in certain cases provide evidence, they will not be able to receive the 'reasonable adjustments' that they require and are therefore putting
themselves at a disadvantage. RCN (2010)
RCN 2010 All mentors, but particularly sign off mentors, receive appropriate training and support to help them to make appropriate judgements relating to fitness to practice where students have a disability. This needs to inform mentors about the requirement to ensure that reasonable adjustments are implemented but stress that if the student is still not reaching the required standard that it is then appropriate to fail the student. RCN 2010
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