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Reflective practice

Throughout this essay I will reflect on the knowledge and experience I have had whilst undertaking the module facilitating and Assessing work place / placement learning. This essay begins with some introductory discussion about reflection and the importance of reflective practice in nursing profession. Gibbs reflective cycle (Gibbs 1988) will be utilised to discuss and analyse my learning on this course. According to Ried (1993), reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practise. The essay concludes with the positive impacts of reflective practice on my own profession.

There are number of arguments about the benefits of reflective practice and how it is performed. Bailey (1995) believes that reflecting on tasks does show improvement in problem solving skills, but there was no evidence that the quality of nursing care improved. However, Jarvis(1992 ) felt that reflection was needed as nurses are dealing with people who because of their individual nature requires us to be responsive and reflective, instead of simply carrying out routine, ritual tasks. Although mentorship has assumed respectability in professional education, Jarvis and Gibson (1997) maintain that it remains a term that is not easily defined as numerous articles have debated its meaning. However evidence suggests, mentoring is primarily associated with clinical setting and lesser extent education establishments (sword et al, 2002).

Rolfe (1996) suggests that reflective practice enables theories to change to practice and practice to theory as a cyclical process. On this ground, reflective practice is a part and parcel of any professional activity where learning through one's self assessment and improving one's practice goes on as a continues process. This also provides opportunity for practitioners to put theory in to practice and testify it on the basis of what worked on reality and what not. This practice gives way to examine and modify theories on the light of their practical implementations. As an overseas trained nurse I was not aware of this process I used to think about my action and decision in critical situation at work and used to learned through experience. I have now understood the process of reflective practice as being very relevant to nursing career which helps to establish a systematic approach of learning.

As part of reflective practice, I present my learning experience of working as a learner a facilitator. During that time I have had a more concrete realization of how I can improve my mentorship skills through reflection and how I can help students become competent practitioner; benefit will pass onto patients eventually. As a registered nurse I have a duty to protect client from risk (NMC 2008) as well as a duty to facilitate students to develop competencies. Even though I had supervised students' occasionally, this course has helped me to understand role and responsibility of mentor from a different perspective. As a result I have now realised the need to ratify my students not out of sympathy but through constant evaluation of students performance. Allowing incompetent students to succeed poses serious risk to a patient which is also a breach of NMC code of professional conduct(2008). Being a registered nurse, my professional accountability therefore is patients, public at large , the employer and the NMC. Hence by liberal in assessing even the incompetent student, I could face legal actions owing to the gross negligence to my professional accountability(Diamond 2002).

When I was offered to undertake mentorship course it gave me a feeling of ambivalence, whether I have the capacity to do it or not as it entails huge responsibility and I also thought that I might not be able to cope with the workload of studying and working in the busy department. Quinn and

Hughes (2007) explain that adult's readiness relates to the things he or she needs to know and do in real life adult need to know why they must learn something and take responsibility for their own learning. However it is a great opportunity to undertake this course. The Nursing and Midwifery council (2008) states that on completion of this course, its outcome could lead to career development and skill enhancement in the clinical setting. In addition, I was delighted to know that NMC standards require that nurses and midwives who intend to take the role of mentor must be registered practitioners within the particular field in which the students are to be assessed.

As a learner, I enjoy new development and method in my practice area. I learned about sensory modalities in learning in learning information by Fleming(2008) prior to my session. When I completed the VARK questionnaire, I learned, I have a strong preference of learning by multimodal. I am a person who likes to observe, I clarify my doubts by questioning and listen to the explanation, I learned by reading as well.

On the first day of the course, I was very anxious about what I was going to learn and how I would have impact on my professional life. Obviously, as a adult learner, my learning needs and expectation were different.

My main motivating factor to undertake this course was the challenge, I have to face as well as rewards I could get when I teach students which would be eventually helpful for my professional development. I appreciated the warm welcome extended to us by our facilitator on the day of the class and her willingness and eagerness to guide us throughout the session. It ease my apprehension and anxiety. My facilitator made sure, all learners in the class room are comfortable, met their basic needs which includes psychological needs, safety needs, love and belongingness needs, self-esteem needs and self-actualization need(Maslow 1987).

In addition, Price (2004) mentions that students emulate mentors practice and applaud mentors support. In a group, we discussed about the positive and negative influences in adult learning and concluded that as an adult learner, we have special needs as we are tied down with many responsibilities and have to make multiple arrangements to make learning happen. Furthermore, adult learners usually have greater volume of life experiences. Knowles (1990) differentiates pedalogy and androgogy as a science of teaching children and as a science of teaching adults respectively. He describes that children have experience of little worth as learning resources and children are to motivate to learn by external motivators whereas adults have greater volume of life experiences and most potent motivators are internal pressures like self esteem, job satisfaction and quality of life. Although it is true in most situations, it is inappropriate to label students as adult learner according to their age. Therefore, while facilitating learning, learner's individuality should be respected and acknowledged rather then the age.

As a mentor, I will be taking the role of facilitator in clinical setting. To gain experience, knowledge and skill, a learner needs facilitator. Kiston et al (1998) describes facilitation as ' a technique by which one person makes things easier for others'. In my case, being facilitator who will be dealing with nursing students and operating department practitioner student, my work place will be whole learning environment to them.

I strongly agree workplace learning environment has a great influence to the students. Hence facilitation is achieved by an individual carrying out the specific role of facilitator for the helping others. Even though I was aware of facilitators throughout my nursing career this course has further enhancement my understanding the role of facilitator. I have a duty to facilitate learning for students to develop their competencies. Some important roles of mentor identified by the Mortan-Cooper and Palmer (2000) include advisor, role model, coach, problem solver, teacher, supporter, organiser and planner, counsellor and guide.

I acknowledge that being a mentor and facilitator; I need to be able to carry out above mentioned roles according to situation and need of students because all the students do not have same need. For example; the need of a first year student may be different then that of third year student. Furthermore, according to Quinn and Hughes (2007), from the qualified staff who are the key factor influencing the learning environment in hospital placement, the ward manager, who not only the management of the area, but serves as role model for nursing practice, to the management style and personality of the ward manager are important determinants of an effective learning environment. This is true to my experience. I remember in my previous work place, I had unnecessary pressure from the manager, she was very hard to approach. The situation and the environment was always stressful. Compared to that experience, I am glad to tell that I enjoy every single moment of my present work place as most of the staff are very supportive. The manager is very approachable, always motivates and encourages the staffs. Hence, I am able to carryout my jobs confidently and improve my skills to become a professional nurse.

As a requirement for this course, I have to facilitate a teaching session to a learner. I gave choices of topic to my student; she chose 'Patient control analgesia' as she never had teaching on this topic. Pain management is one of the vital elements when looking after a post operative patient. So finding out the need of learning was a joint work between me and my student. If I had not consulted student, student would not have received any benefit.

My topic was 'Patient Controlled Analgesia'. Teaching is a deliberate and purposeful activity directed towards the promotion of learning and having a teaching plan can help minimise the chance of omitting some vital part of the session (Quinn and Hughes, 2007). A teaching plan was formulated it comprised of the description of PCA, indication, side effects, management etc. of PCA. My students were one new starter and a second year nursing student. My observer was a experienced Operation department practitioner, who has a mentorship qualification. I discussed about the teaching session to my observer prior to actual day of teaching. I provided the students and observer with details of teaching session, date, timing and the venue. I had chosen the quite area of recovery room for the session. On the day of teaching session, I welcomed the students and my observer.

I made sure they are comfortable, provided chairs to sit adequate lighting and the environment was calm and quite (Maslow 1987). Quinn and Hughes (2007) describes ideal learning environment as an environment where learning can be facilitated, encouraged within non-threatening atmosphere, so that learner can value and reflect on their experience.

The session started about 1100 hours. I handed over my lesion plan to my observer. As the part of the introduction the aim of the session and learning outcomes were discussed. A learning outcome as defined by Neary(2000) what a student should know, understand and be able to do following period of learning. Hinchiffe(1990) suggests learning outcome should be SMART, which stands for Specific, Measurable, Achievable, Realistic, and Timed. I tired to follow this approach in my lesion plan as I could make sure how much students have learnt after the session.

Oral questing was carried out to determine the existing knowledge of the students about the topic. This method helped the students to be more active and motivated to learn. Oral questing is an integral part of the two way activity between the teacher and class that characterise many successful lesions ( Curzon,2003). Handouts and PowerPoint presentation were used as a teaching aid. Students were allowed to view the actual 'Graseby 3300 PCA pump. I demonstrated how to set a PCA according to a prescription. Then I let the students to practise the skill. With the use of lecture, an extremely valuable teaching method when you wish to proved the students with particular knowledge(Hinchiffe 2004),and return demonstration, which is designed to show the learner how to perform certain psycho-motor skills(Stuart 2007), I was able to impart the cognitive and psychomotor domains of learning . At the end of the session I summarised on the whole topic, students were given opportunity to ask questioning requiring further clarification. I assessed the students by asking direct questioning which enabled me to find out if learning has taken place.

I felt good about the choice of the topic because my students found it very interesting and they were really enthusiastic to learn which I could evaluate from their keen attitude, questions and eagerness to participate in group discussion. Both student nurse and the new staff had a little knowledge on the topic. I had to repeat certain points and give some additional information to meet their learning needs.

After the teaching session my observer gave me a constructive feedback. My observer highlighted that I created friendly environment, had a good eye contact while teaching plan was excellent, I was encouraging student and they were participating.

My observer suggested the area I need to improve, As a part of my role as a facilitator I also felt that it was important to give feed back to my students as a way letting them know how they were progressing and giving them a chance to improve their skill and knowledge. Hinchiff (1990) suggests that, feedback given during the assessment is essential. I focused on positive aspects of their session then discussed where they could improve and encouraged further learning. Feedback from the student was positive and they felt confident to look after a patient with PCA in the future.

Moreover, assessing the performance of learning is also a vital role a mentor must carryout which needs mixture of knowledge, skills and experience. Assessment is 'a generic term for set of processes that measure the outcome of students learning in terms of knowledge acquired, understanding developed and skill gained (Quality Assurance Agency for Higher Education (QAA) 2000). As a mentor I not only have to evaluate and assess the student's practical tasks but also the professionalism and proficiency students show throughout certain period of time which will include multiple skills, knowledge and understanding. Competencies defined by Nursing and Midwifery council(2008) as having the skills and ability to practice safely without the for constant supervision or to seek supervision if the practitioner does not competent. Continues assessment is needed to evaluate to evaluate learner's competencies. Continues assessment is 'a planned series of progressively updated measurement of student achievement and progress' (English National Board 1997). The process of continues assessment requires periodic discussion, feedback, educational counselling and documentation throughout the placement (Hand 2006). As a mentor, I must give feedback to my students, provide educational counselling and I must record the student's progress throughout.

Under taking the mentorship module was a worth while experience. It improved my skills dealing with the student. I have learned to be conscious in identifying the learner's appreciation of opportunities that are available at work place. In the past, it was very superficial in the way I taught students in the absence of their mentor as I was preoccupied with my duties in the department, but now I realised that as a mentor, I must answer to the students as they are the direct consumer and beneficiary of educational programmes and making sure that they getting the kind of learning that is needed (Stuart 2007).

In conclusion, I have acquired a great deal of learning which will be required while mentoring students as placement. I have come to realise that reflection can be great source of professional development and it is very relevant in nursing profession. I now understand the role of facilitator and mentor in clinical placement. I feel that mentor has a big responsibility and this role needs lots of efforts and commitment. Learning might have many barriers and as a mentor I will have a duty to overcome such a barriers by working together with students. I have also learned about the needs of adult learner; without this knowledge I will not be able to recognise the needs of my students which might result negative effect in learning environment. I understand, mentoring does not only include teaching students in placement but also includes constant support, evaluation, continuous assessment and professional accountability.

Reference:

* Bailey, J (1995) Reflective Practice: Implementing Theory. Nursing Standard 9(46): p 29-31.

* Curzon L.B. (2003) Teaching in further education ( 6th edn.) Cassell, London.

* Diamond B (2002) Getting it Right: The Legal and Professional aspects of Assessment. In welsh I and Swan (eds) Partners in Learning. Oxford: Radcliffe press, pages 100-101.

* English National Board (1997) cited in Hand H (2006) Assessment of learning in clinical practice, Nursing standard, vol21, no4, p49.

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//www.vark-learn.com/English/index.asp ( accessed 24/09 /09).

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* Jarvis P (1992) Reflection Practice and Nursing. Nursing Education Today 12, p 174-184.

* Kiston et al (1998) in Rycroft-Malone J. et al (2002), Getting evidence into practice: ingredients for change, Nursing Standard, vol16, No37, P40.

* Knowles M (1990) The Adult learner. (4th edn.) Huston USA, Gulf publishing company, p 54-65.

* Maslow A (1987) Motivation and Personality. (3rd edn.) New York. harp.

* Mortan-Cooper and Palmer (2000) cited in Ali and Panther W (2008) Professional Development and Role of Mentorship, Nursing Standard, vol22, No.42, P 36.

* Neary (2000) cited in Dix G, Hughes S (2005) Teaching students in the classroom and clinical skill environment, Nursing Standard, vol119, no35, p 42.

* Nursing and Midwifery Council (2008) Code of Professional Conduct, London, NMC.

* Price B (2004) Mentoring Learners in Practice , Nursing Standard, vol18,no52 ( accessed auonline on 22/10/09), http://nursingstandard.rcnpublidhing.co.uk/resources/archive/GetArticleById.asp?ArticlId=6647

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* Quinn, F And Hughes, S (2007) Teaching in the clinical setting : In: Quinn F (ed) The Principles and Practice of Nurse Education. (5th edn) London: Nelson Throne, p 341-347.

* Quinn Francis M ,and Hughes S.(2007), Quinn's Principle and Practice of Nurse Education,5th edn. Cheltenham Nelson Throne, p 202.

* Reid (1993) cited in Reflection on practice, p 305. (accessed online on 10/11/09,www.practicebasedlearning.org),Available from //http:www.practicebasedlearning.org/resources/materials/docs.reflectionpractice.pdf.

* Rolfe (1996) in Wolverson M (2000), on Reflection, Learning Disability Practice, vol3, no2, p24.

* Stuart, C.C. (2007) Assessment, Supervision and Support in Clinical Practice. (2nd edn) Elsevier: Churchill Livingstone, London.