In nursing, learning in clinical placements is facilitated by a unique individual called a mentor. The Nursing Midwifery Council declares that one vital function of a mentor is to create an environment conducive for learning. In line with this thought, I shall critically discuss how learning will be facilitated in my area of practice which is in the Cardio-Thoracic Theatre. I shall focus my discussion on the organisation and management of learning in my area taking into consideration the initial, intermediate and final interview of students. I will discuss how learners will be oriented into the placement and the importance of adequate student induction. I will also explore effective teaching strategies that may be used to maximise the learning of students during placement. Finally, I will analyse the methods of evaluating students’ performance.
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The NMC (2008) states that a mentor is responsible and accountable in assessing the total performance of students including their skills, attitudes and behaviours. This is important to remember when organising and managing the learning of students because to organise and manage learning means that a mentor must be able to identify the students’ learning needs and preferences as well as the overall manner as to how student learning in the placement can be maximised. During the initial, intermediate and even in the final interview of students, a mentor must be able to professionally assess the students’ capacity to learn and potential to improve on their performance as well as their deficiencies or weaknesses. Assessment is the first step in determining the students’ competencies and learning needs. Organisation and management of learning begins with assessment of what students need to learn and how they will be able to learn it the quickest possible way. A mentor is required by law to assess students (Kinnell and Hughes 2010). Assessment may come in the form of directly questioning students and observing them. According to Rose and Best (2005) the act of observing students during clinical practice entails monitoring their skills, behaviours, communication and even body language. In the case of the Cardio-Thoracic practice placement, it is best to conduct a simple assessment of the students at the start of the placement to determine what they currently know about the placement and the activities particularly the nursing functions that are routinely done in the placement. Another important aspect of student assessment is the need to assess their preferred learning styles. It must be kept in mind that an individual student’s learning style may vary depending on the type of activity that must be learned. A student may even employ more than one learning style all at the same time. A study conducted by James et al., (2011 cited in Gopee 2011) revealed that many students are multi-modal which means that they use all the four modes of learning identified in the VARK model. Aside from this, an individual student’s preferred learning style may change once he or she joins a group of learners. Determining students’ learning styles as individuals and as a group will help facilitate learning. The VARK model is a simple representation of the 4 major styles of learning namely the visual, auditory, read/write and kinaesthetic. A second learning theory that can be used in assessing preferred learning styles is David Kolb’s experiential learning theory. This theory involves four unique learning styles namely diverging, assimilating converging and accommodating which can help a mentor categorise the type of learning a particular student or group is inclined to adhere to (Quinn 2008).
Gopee (2011) relates that the reason for identifying students preferred learning styles is to be able to adapt to it. If a student prefers to immediately learn how a nursing function is applied in practice then the mentor should focus on the practical application of the learning first before proceeding to the theories that underpin the nursing function (Gopee 2011). On the other hand, if the student will benefit more in learning the theory that underpins the nursing function then the mentor must first teach the concept behind the skill before allowing the student to demonstrate it (Gopee 2011).
Assessing students’ preferred learning styles may consume a significant amount of time during placement and it can also be challenging because it may not be immediately obvious as to what learning style a student prefers. Students may also hesitate to assert their preferences in learning. Fortunately, one of my strengths as a mentor is effective time keeping which will allow me to conduct an assessment of my students’ preferred learning styles without consuming too much time that is dedicated for actual performance of nursing functions.
Another important aspect of organisation and management of learning is the need to establish rapport with the students. Gopee (2011) states that a mentor and mentee are initially strangers to each other; therefore, in order for them to learn to interact with each other effectively they must develop rapport and cultivate a working relationship in order for their mentor-mentee relationship to be a success. Walsh (2010) suggests that building rapport is a must. It means developing a non-judgmental relationship with students that is based on trust and confidence. Only with such open and trusting atmosphere will a student truly feel supported by the mentor and therefore will feel at ease in asking questions that will facilitate his or her learning in the placement (Walsh 2010). Building rapport with students will not be difficult. As a mentor, I am confident that I will be able to establish a professional relationship of trust and confidence with my students.
Taylor (2003) suggests that the first few days of placement in an acute setting such as an operating theatre can be stressful and discouraging. In order to minimise if not completely dispel these negative impressions, a mentor must conduct an orientation. No less than the Department of Health (2001) mandates the need for learners to receive a comprehensive orientation from each of their placements. This will facilitate the gradual desensitisation of the students from whatever worries, fears and hesitations they might be harbouring with the placement, with the patients, with the mentor and other personnel. A good orientation will also encourage them to actively participate in the activities within the placement. The Cardio-Thoracic theatre already has an appropriate induction and orientation for future students and this is also coupled with local guidance and policy package prepared for the students. This is one clear strength of the placement which can greatly affect the way students perceive the learning environment within the Cardio-Thoracic Theatre.
A natural part of the orientation is the tour of the placement. It will be advantageous for the students to be toured within the theatre particularly those important areas such as the actual operation room and nurses’ station. An important point to consider is that this orientation should be made a day or two before the start of the placement. The purpose of which is to minimise the loss of time consumed if it were to be done at a time allocated for the performance of different nursing functions in the placement.
Another part of the orientation is to introduce the students to the members of the healthcare team in the theatre. I believe that it is important on my part to exert extra effort in personally introducing my colleagues to my mentees. This will help my mentees be acquainted with the right personnel in cases where dependent nursing functions are to be performed which rely on the input of other healthcare professionals. This will also give the personnel a chance to contribute to the learning of the students. The personnel in the Cardio-Thoracic placement are all highly qualified and skilled; hence, their capacity to contribute to the learning of students cannot be doubted. On the other hand, one identified weakness of the placement is that some personnel may be perceived as unfriendly primarily due to the heavy workload and emergency situations which they have to attend to. The shortage of staff in the area may also hinder students from seeking help from the personnel who are always busy doing some important functions.
Orienting the students of what to expect in an operating theatre will help them prepare for the placement. An orientation must provide students with clear descriptions of what behaviours are expected from them in a specific clinical placement (Rose and Best 2005). It is a must for the orientation to be structured. It must follow a schedule of activities which must be clearly laid out to the students. One good example of structuring an orientation is through the use of a welcoming pack. A mentor must ensure that students receive a welcome pack and if there is none, then the mentor must develop one (Hole 2009). A welcome pack will serve as a written orientation for the students to be familiar with the pertinent information about the clinical placement including the rules and regulations, protocols and policies. The policy package of the Cardio-Thoracic Theatre can serve as a welcome pack for the students; however, it must be emphasised that a welcome pack should not only contain the policies. It must also include other tips for the students on how they can enjoy their experience while learning in the placement. As a mentor, one of my strengths is my extensive experience in my area of practice; hence, I would be able to provide personal tips in the welcoming pack on how students can make their learning in the placement fun and exciting. Finally, Spouse, Cook and Cox (2008) suggest that a welcoming pack should be sent to students at least a week before placement. This will provide the students ample time to study the contents of the pack especially the policies involved.
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The primary benefit of a welcoming pack is to make the students feel at ease. It is important that students feel comfortable in the environment for them to absorb learning and for the experience to be long lasting and memorable. Making students feel welcome is a prerequisite in creating an atmosphere conducive to learning (Stuart 2006). I am aware of the possibility that some of the students may not appreciate the learning experiences in the Cardio-Thoracic Theatre. This is in connection with one of the identified weaknesses of the placement and that is its being a highly specified area which involves emergency situations which can overwhelm students. As a solution to this, I must exert extra effort as mentor to make the learning experience as interesting as possible by using different teaching strategies.
After the orientation comes the actual mentoring experience. This involves utilising different teaching strategies in order to inform the students about the different nursing functions that are performed in the practice placement. The first teaching strategy is role modelling. A good role model is someone who enjoys his or her profession and who leads by example, enjoys teaching and demonstrating clinical skills and willing to listen and respond to students (Kilgallon and Thompson 2012). Role modelling is teaching by example and learning by imitation (Dake and Taylor 1994 cited in Murray and Main 2005.) I am an experienced nurse; therefore, I am confident that I will be able to play a good role model for my students. One important thing to remember in role modelling is the need for the students to believe and trust in their mentor in order for them to model their behaviours from that of their mentor. Without that trust, students may not follow what the mentor is trying to exemplify.
Another teaching strategy is simulation. Simulation provides an opportunity for students to practice their skills first before applying it in real scenarios involving actual patients (Campbell, Daley and Daley 2008). I believe that simulation is particularly helpful in the Cardio-Thoracic Theatre because of the urgent nature of the nursing functions that are performed here which usually entail a level of competence that leaves no room for error. This is especially true during actual surgical procedures where the life of a patient is in the balance. The use of simulation may also prove beneficial when it comes to the use of the different instruments and equipment in the theatre and other functions such as those that involve anaesthetic inductions, airway management and arterial canulation.
Coaching is another teaching strategy that can be used in the Cardio-Thoracic Theatre. Proper coaching helps students to overcome weaknesses in the performance of certain nursing functions (Grossman 2007). Another is providing constructive feedback. Feedbacks should include not only praises for an excellent performance but also alternative ways of performing nursing actions. Constructive feedback means communicating to the students about the quality of their performance (Bayley, Chambers and Donovan 2004). It must contain clear advice and recommendations for students to reflect and improve their practice. It has a big impact not only on student learning but also on the students’ self-esteem (Bayley, Chambers and Donovan 2004); hence, it must be given cautiously so as not to offend or hurt students’ feelings.
Feedback can also serve as a form of evaluation of students’ performance particularly when it comes to formative assessment. For summative assessment which is the final assessment of the students’ performance, the use of structured assessment tools can help serve as the criteria for judging performance. Neary (2000) relates that evaluation should be made against agreed criteria and standards. Common examples of assessment criteria that can be used include the NMC code and the written learning objectives for the placement. The Royal College of Nursing (2009) identifies the testimony of others, student self-assessment, interactive reflective discussion, learning contracts, patient comments, peer evaluation and observation as some of the other methods for evaluating students’ performance. Regardless of which among these are used, the important thing to remember is the need for the evaluation to be fair and objective. As a mentor, I must keep in mind that the ultimate goal of judging students’ performance is to ensure that only those truly fit to practice the profession must be given the opportunity to do so.
In summary, mentoring is an exciting new phase of my role as a professional nurse. To mentor students in the Cardio-Thoracic Theatre means an opportunity for me to mould the future nurses. To mentor students requires the creation of an environment conducive for learning. In order to accomplish this, I must learn to organise and manage the learning environment. I must begin by conducting an orientation to acquaint my students with the placement, the patients and the personnel. I must also develop rapport with my students for me to be able to build a trusting professional relationship with them that will facilitate effective learning. Assessing my students’ learning needs and preferred learning styles is also crucial. I must pattern my teaching strategies base on these identified learning needs and styles. The use of role modelling, coaching, simulation and feedback are some of the effective teaching strategies which I can use to mentor my students. Evaluating student performance may be done using different techniques but such must be fair and objective.
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