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The purpose of this essay is to critically analyse the role of the mentor when establishing learning opportunities with the student that are appropriate for their level. Mentors in a Gynaecological ward are trained and qualified nurses, and often engage in mentorship programmes to help student nurses gain first hand insight and experience of working within a busy and demanding environment. The students vary from first year to third year nursing students and therefore their learning opportunities and abilities differ, and the mentor's ability to facilitate any learning opportunities varies accordingly. The essay will consider key terms and concepts and clearly determine what learning opportunities mean both for the mentor and the mentee. The learning opportunities to be discussed in this essay are based on the student's needs and requirements as stipulated by their university. These needs are usually the requirements of the pre-registration nursing programmes and are mandatory skill clusters to help the student meet the Nursing and Midwifery Council's registration requirements. The essay will also critically analyse how a mentor supports and facilitates learning and manages to engage and teach students in a busy environment, ensuring that students are gaining the relevant skills and knowledge appropriate to their level and course expectations.
A key facet of being a good mentor is having the ability to set realistic objectives and learning needs having assessed the capacity of the student (Gray and Smith, 2000). Nicklin and Kenworthy (2000) suggest that learning objectives are goals that encourage development of skills that students did not previously have. It is important to have a good supportive learning environment which will essentially provide the basis for many learning opportunities for the student (NMC, 2008a). The first thing to do when mentoring a student is to ensure that they are properly introduced to the ward, the staff and the environment. This helps to eliminate any stress or anxiety the student may have had prior to coming on the placement (Manthorpe and Stanley, 2000). This is especially so when it is the student's first time on a placement and clinical environment. Following on from the introduction, the mentor will give the student an explanation of the different surgical procedures that are carried out, followed by a student information pack for further reading. The mentor is also required to explain to the student the requirement of maximum attendance during placement. This is not only stipulated in the university requirement, but also in the ward, and all students are required to have at least 40% attendance at placement as required by the NMC code (2008a).
One of the first learning opportunities afforded by the mentor to his/her mentee in a gynaecology ward, is the chance to work in a multidisciplinary team to deliver the best care possible to the patient and his/her carers. By working in a multidisciplinary team, the student can engage with professionals of different levels from physiotherapists, occupational therapists and gynaecologists. In allowing the student to be involved in this environment, the mentor offers the student the opportunity to learn different skills and medical techniques that would perhaps have been less visible, if the student was to only work with the mentor and focus on specific learning needs (Gray and Smith, 2000). In a gynaecology ward, the mentor is able to facilitate such learning opportunities in a multidisciplinary team, by allowing a first year student to prepare a theatre patient and take the patient to theatre before retuning back to perform other tasks. However, there are occasions where a first year student may be more qualified than anticipated as they have been working as Health Care Assistants previously and therefore have acquired the necessary skills to be able to not only prepare and take a patient to theatre, but also return with the patient after the surgery. In this instance, the mentor needs to be aware of the different learning needs and provide the correct learning opportunities tailored to the student's level. Contrastingly, the mentor may be given a final year student to teach in which case, the mentor needs to create and identify new learning opportunities for the student. Price (2004) specifies that it is the responsibility of practice staff to develop an environment conducive to learning, and mentors should continually monitor students' progress to ensure that they provide appropriate support and experience for learners (Hand, 2006). In a gynaecology ward, the mentor can provide the final year student with the opportunity to not only prepare the patient for theatre, but then collect the patient after the surgery and take hand over notes from the recovery nurse in order to then continue with the post operation care plan. Nevertheless, all the nursing students are offered the opportunity to work in other gynaecology areas including theatre to learn new processes, work with different professionals, and understand the different instruments and sutures used such as the gowns, gloves, operating table, drapes, skin preparation, swabs used, and the method of checking swabs and instrument numbers (Maxwell, 2004).
The mentor can also provide more learning opportunities for their final year student aimed at developing their communication skills, by encouraging them to attend and participate in a hysterectomy meeting with the view of conducting their own meeting. At this meeting, the student will observe and listen to the material, then conduct her own research using the facilities available on the ward and the hospital such as the clinic, the library and other colleagues, to prepare her own presentation. This learning opportunity will give the student confidence in her ability to present to a diverse group of people ensuring that her communication skills are adaptable to all situations.
Where the mentor observes that the student has gained a good level of understanding of the basic processes of a gynaecological ward, the mentor can find new learning opportunities for the student to develop his/her skills and competence (NMC, 2008a). Another opportunity which a mentor can afford to their student is providing the chance to perform the removal of a catheter using the aseptic technique. To help the student meet this learning need, the mentor identified several patients over a period of 3 shifts that required removal of a catheter and vaginal pack. The mentor explained to the student what this task was and the reason why it had to be carried out. Once the mentor had explained the purpose of the exercise, with the patient's consent, the student observed the mentor removing the pack and catheter, carefully explaining each step of the process and the equipment used. After the student had observed this process 3-4 times, with the patient's consent, the student was allowed to carry out the same clinical process explaining to the mentor and the patient each step of her action as the mentor had done to demonstrate her understanding. This was a way for the mentor to assess the student's competency and ability to take in large amounts of information (Watson et al, 2000). After the task was completed, documentation in the patient's nursing notes was done. The mentor's intervention ensured initial exposure to this clinical task was given, however the mentor needs to always be aware of areas for further improvement and building of confidence in the student's performance (RCN, 2007a). Morton-Cooper and Palmer (2000) explain that a good mentor/student relationship will allow the sharing of knowledge between two individuals, and Collis-Pellattt (2006) add that mentors are expected to facilitate learning opportunities and tailor teaching to the students individual learning needs. The intervention accomplished both of these points.
In a gynaecology ward, it is crucial that students have a sufficient knowledge of the fluid balance sheet. This is knowledge acquired from their university teaching and it is the mentor's role to ensure that the student can put their theoretical knowledge in to practice whilst on their placement, by providing relevant learning opportunities designed to explore these practices (Morton-Cooper and Palmer, 2000). In a gynaecology ward, the majority of patients return from theatre with intra venous fluids as well as catheters. This is a prime learning opportunity for the student where the mentor can allow them to monitor the input and output of fluids and document the information accurately and clearly in the fluid balance chart. It is an opportunity for the student to learn how to calculate and measure the fluid output correctly in order to get an accurate figure of the patient's medical needs. In doing this effectively, the student learns to detect any risk of retention or dehydration. In providing this earning opportunity, the mentor ensures that the student understands the need to manage risk effectively, reporting risks in order to maintain the safety and well being of the patient and all those concerned in the care of the patient.
Due to the pace of a gynaecology ward, it is sometimes necessary for a mentor to allow the student to work independently provided that they have demonstrated the ability and willingness to progress and lead with limited supervision. NMC (2008a) suggest that the student is also responsible for their own learning and must "follow the policy for completion of clinical assessments as set out by the clinical placement provider and reflect on and respond constructively to feedback they are given" (NMC, 2008a). Often when a mentor is given a third year student to teach, the student will demonstrate a keenness to take on added responsibility on the ward. In this instance, the mentor can entrust the third year student with the management of a small number of patients, ensuring they carry out the necessary care for the patients, all in aid of helping the student develop the skills to prioritise patients care needs. In order to do this effectively, the student would have observed the mentor in the first instance in his/her management of patient care. The mentor will explain that it is necessary to firstly prepare the theatre patient first before anything else, ensuring that the patient is changed into the correct garments, the theatre bed is made and the patient theatre checklist is completed and accurately documented. Once this is done, other tasks can then be followed in order of urgency. The mentor must also highlight to the student what is construed as urgent in a gynaecology ward, as perceptions differ on what is urgent in terms of prioritising work. Once the student has observed this process several times and the mentor feels that he/she is ready to take on this responsibility, the mentor can assign the student with a small number of patients to look after and with guidance, observe the student in action. The mentor will always ensure that the student is not left alone, and has guidance and supervision at all times (RCN, 2007a). All documentations will be checked and countersigned by the mentor before hand over to the next shift. Where appropriate, the student will also progress to learning bed allocation and the admission and discharge process. Although, some progressive second year students may also be afforded the opportunity to manage the care of patients in this learning environment, the mentor will often only assign one patient to the student and maintain continuous supervision due to the limited theoretical knowledge acquired at university to that point. By doing this, the mentor ensures that the student and the patient are not put at risk.
In summary, it has been established that mentoring pre-registered nurses is a vital part of nurse education and has become common practice in the UK. It has been accepted that good mentoring is the result of well-planned learning opportunities and the provision of support and coaching for students, which should also incorporate an appropriate level of supervision (RCN, 2007a). The mentors are also learners in the process and they too require support and guidance from different professionals such as link tutors. Although this assistance is not always available to mentors, they are able to deviate from this problem by having more contact and communication with the students in order to bridge that gap. Duffy (2004) suggests that mentors often feel ill-prepared for their roles and lack the necessary support to carry out their duties as required not only from professional staff, but also from the students' education institutions. Experience has shown that there are instances where mentors needed to contact link lecturers to discuss students competence levels but was unable to reach the lecturer and get the matter resolved urgently. What has also been noted as a hindrance to the mentoring process is the lack of quality time spent with the students whilst working on a clinical setting. There were many times when the ward was busy and it was impossible to maintain contact or teach the students during these times. I am of the opinion that clinical settings need to be made more adaptable to students and there needs to be an improvement made on making clinical settings also cater to a learning environment to assist training nurses wanting to progress into the nursing field.