A second year student will be coming to a mentor’s work area for a 5 week placement. The mentor has been informed that the student had been underachieving in their previous placement. Discuss how the mentor would develop learning, teaching and assessment strategies to support the student to achieve a successful outcome. Utilise /refer to the module content, the learning opportunities and resources in the practice area and further reading, to develop your discussion. Conclude your discussion with how the learning gained would apply to your future practice as a mentor.
Mentorship is usually used and theorized differently in diverse fields (Chen et al, 2016). It is a workplace learning approach that is valuable to the mentor, mentee, and employing institution as a source of communicating the tacit understanding of the workplace. As a result of mentorship, beginners are integrated into present communities of practice in the workplace. Mentorship in nursing is a discrete commitment that thrived in an organizational culture and fortified mentoring interactions (Ferguson, 2015).
Mentorship is considered important for appealing, preparing and holding nursing faculty members and to sustaining the great quality of the education programs (Nowell et al. 2015).
A second year student has come for a 5 week placement to a hospital and it was informed that the student had been underachieving in his previous placement. This article discusses the context of mentorship in nursing, the ways by which the mentor can improve learning, instructing and evaluation policies to help the student in achieving a successful outcome. It uncovers the learning prospects and resources in the practice area to close the article with how the learning gained can be applied by the mentor to the future practice as a mentor.
The underachieving student
Underachievement of student may be defined as constant failure to perform up to realistic anticipations that are built on the inherent capabilities of the student (Parker, n.d.). They generally consider themselves as being substandard to their peers, do not have self-confidence to confront and complete chores, lack the capacity to design, organize, and toil in the direction of an anticipated aim, and lack persistence.
Mostly underachieving students sense excessive apprehensiveness and are apparently incapable of controlling their anxiety. They express their anxiousness to the mentor also by going to them frequently and expressing it. Some other underachievers may try to mark their presence by becoming the prankster in the team thereby complying for the absence of self-confidence. Still other underachievers may be overlooked in the team as they are "invisible" due to their shyness to ask questions. As they do not cause any distraction, the mentor "loses" them as they are silently left behind their peers. In the end they may become so discouraged that they give up completely (Bradshaw et al, 2013).
The underachievers generally score high in aptitude and achievement tests, but ignore classroom assignments. They may be lacking concentration due to numerous external interests apart from studies. They may be having the ability to understand the concepts orally, but may not be able to implement them over to perfection or accomplishment (Siegle, 2012).
The mentor needs to relate professional judgment to the decision-making process by talking personally with the student, observing the behavior of student carefully, and talking to the student in relation to his problems and interests (Butterworth & Faugier, 2013).
There is need to facilitate self-awareness and emotional intelligence in nursing students as these are important speculative and applied concepts that empower students to survive and feel less strain thereby facilitating learning. Emotional intelligence is responsible for positive impact on the welfare, apparent nursing competency, and problem-focused coping and has negative impact on the perceived stress. Augmented feelings of restraint and emotional competency are helpful for nursing students to embrace dynamic and operational coping techniques for managing stress, which in turn increases their comfort. (Por et al, 2011)
Irrespective of their ethos, mentors focused on their learners, their existing prerequisites, psychological states, ways of being, and their impending potentials. “I –Thou” or “You and Me,” is an essential refrain of the mentoring capability (Oreshkina & Greenberg, 2011).
Role of the mentor in clinical practice
The mentor activities include teaching and explaining, support, supervision and encouragement. The difference between encouragement and support evident to the students (Foster et al, 2015). The mentor needs to believe in student’s potential in order to help them in achieving (Oreshkina & Greenberg, 2010). Thus, mentorship is an active, learner-oriented, and fervently indicted activity.
The mentors and the mentees share a mutual relationship for the satisfaction and career success of both. For the mentoring relationship to be successful, the mentor and the mentees should share a relationship of mutual respect, reciprocity, individual connection, precise anticipations from each other, and shared values. On the contrary, the mentor and mentee relationship fails if there is lack of communication, commitment, mentor’s experience or real (or apparent) competition, values and interests differences(Straus et al, 2013)
Another important role of the mentor is to assess the clinical practice of the mentee for registering. However, many mentors are hesitant and inconsistent in doing this, especially while assessing unacceptable performance (Jervis & Tilki, 2011). At times the mentors find this evaluation to be emotionally challenging, stressful, and possibly intimidating for themselves in some cases. Another reason may be that they lack proper training and adequate assessment tools for the same. The assessment tools are sometimes deficient in arduous criteria to determine talents or are impractical. Though specific tools may be created for help but assessment of the degree of sensitivity, empathy, respect, and dignity shown in the clinical setting is difficult to grade using these tools (O’Driscoll et al, 2010).
Thus many times the mentor is compelled to pass inadequate learners or having a recommendation verdict dominated by the university. They fail to fail the students as the mentors are irresolute about their accountability and believe that flunking poor performance is not their obligation. This has thus prevented the guarantee of only harmless and capable practitioners gaining admission to the register for practice placements (Brown et al, 2012).
Learning styles and their application
Learning is not merely an alteration in behavior, it is a change in the thinking process, understanding, or feeling of the student. Students may be categorized as visual learners, auditory learners, and tactile/kinesthetic learners. It has been assessed that the learning style of a typical student is 37% haptic, 34% auditory, 29% visual (Billings & Halstead, 2015).
Visual learners learn greatest from visual displays, wish to take comprehensive notes, recall info by how it was set on a page. For such students one needs to use images, video recordings, placards, presentations, flowcharts, highlighting, marking, signs, charts, displays, diagrams, and pictures.
Auditory learners are interested in verbal instruction, lecture, and enjoy discussions, gestures, picturesque language. They learn by listening, reading and talking aloud. They perceive and recollect sounds and are good with words and language. One needs to understand that those students that are strong in auditory learning characteristically take more time to read a passage. One needs to provide verbal and written instructions, include entire group discussions, use videos that complement the written text, and let them record lectures. They typically take longer to read a passage (Kanji, 2010).
Tactile / Kinesthetic learners learn via movement, action, and demonstrations by touching. They learn greatly through hands-on practice, use movement as memory aid, enjoy acting, move around when talking or listening, chew gum or snack while they study. They like to stand rather than sit, when learning something new. They lose much of what is said in a lecture, do well with role play, and have a hard time sitting & listening.
They have high energy levels, do best when actively involved, and prefer to do rather than listen, need to take frequent study breaks. They are explorers at heart and like to learn through active participation in what they are learning. Vary your instructions during a single class period. Let students use their hands on learning as much as possible (experiments). Teach them by taking them on a field trip. Use movement of their bodies as much as possible. Use hand tools, procedure based. Let them make models of what they are studying (simulation).
Nowadays there is an increased emphasis on the use of simulation in nursing education. Different scenarios are played in different simulation methods. The response of nursing students shows that they are highly content with the execution of the scenarios irrespective of the simulation approaches being used or the education level of the student (Tosterud et al, 2013).
Learning theories and their application
The knowledge of learning theories helps the mentor to recognize individuals and react to learning based on personal characteristics, learning history & current circumstances. They learn differently & have different timing of readiness. This knowledge makes the mentor sensitive to trainee’s needs / feelings an avoiding the use of same teaching approach for everyone. The mentor then uses different approaches for teaching, organizes the teaching plan appropriately and encourages expression of feelings. Various theories have been proposed to teach students. These include the behavior learning theory, social behavior learning theory, cognitive learning theory, pedagogy and andragogy learning theory (Rathvon, 2010).
According to Behavioral learning theory, learning involves reinforcement of a response, through reward or punishment, which was a simple feedback system. In clinical practice, activity aids learning. Repetition and practice enhance learning. Breaking down the whole process into smaller steps also aids learning. Reinforcement aids learning.
According to Social behavior learning theory, behavior is cultured by noticing others and modeling. Learning occurs by closely noticing other people's conduct and its consequences for them. The learner need not have direct experience. The learner needs to be attentive and observe the role model with high competence, to retain and store what was observed, to imitate the conduct that the model has exhibited accurately. Moreover, motivation is needed for the learners to demonstrate what they have learned. A corrective feedback in the type of strengthening or penance is needed to add value & meaning to the learned behavior.
Once a wrong procedure is learned, it is challenging to forget, therefore, one should try to do and learn to do things correctly, the first time itself. One should rectify an error before it changes to a bad work practice. Practice makes perfect/ permanent. Modeling responses and expectations should be done as a collaborative/team work. To maintain high professional standards, opportunity to observe experts in action should be provided to learner.
According to Cognitive learning theory, learning is cumulative. Cognitive developments and undertakings such as information handling, psychological demonstrations, forecasts, and anticipations are crucial for the cognitive understanding of learning.
The Pedagogy learning theory advocates the traditional method of teaching children, accounting the full responsibility on teachers. It adheres to the concepts of rote learning, content focus, teacher centered learning. The mentor determines what will be learned (content), how it will be learned (strategy), when it will be learned (timing), and if it has been learned (assessment).
The Andragogy learning theory, on the other hand, advocates self-directed learning in adults. It is the learner‘s directed, experience-based, problem-orientated, and collaborative approach. This theory is based on Knowles' assumptions of adult learning that advocates importance of the need for adult learners to acknowledge the necessity to learn something before actually learning it and need to be accountable for their own choices and to be considered adept for self- direction.
This theory is helpful in establishing a learning atmosphere comprising bodily ease, communal reliance and respect, autonomy of expression, and consideration of experience. Learners perceive goals of learning to be their goals. They are active learners and are committed. They take charge for planning and assessing their own learning.
In context to learning, the various theories find their application based on the learning stage of the learner. A novice is more likely to learn by following the rule-oriented behavior (behavior learning theory), an advanced beginner is more likely to observe others & model (social behaviour learning theory), competent, proficient, and expert stage learners learn by recognizing pattern, common sense, understanding using comprehension of condition, and focus on the actual point of the issue without wasting unnecessary time in problem solving (cognitive learning theory). The pedagogy and andragogy learning theory is also applicable similarly by determining the stage of the learner (Kolb, 2014).
Discussion and analysis of the mentees learning style
It was observed that the student underachieved in the above case as he was a kinesthetic learner and could not grasp much from the commonly used visual and auditory learning styles used mostly in classroom teaching. Thus, there is need to use the mentoring skills for kinesthetic learners.
According to Gagne’s theory of Instruction, the mentor should achieve responsiveness, inform the learner about the objective, encourage recollection of prior information, present motivational material, provide assistance to the learner, stimulate performance, offer feedback, evaluate performance, augment retention and allocation, and assess transfer. Reinforce key points, evaluate understanding, summarize learning, link to next lesson. The cognitive developments comprise thoughtfulness, retention, action, and inspiration (Chen et al, 2016).
First the mentor needs to introduce the task. This includes showing the importance of the task, explaining the reasons for the task, explaining how knowledge / skills gained could benefit the mentee.
Make the task interesting, give responsibilities & encourage commitment. Give manageable amount of information, allow sufficient time to process information, arrange learning experiences to promote success by planning carefully, break material into small discrete parts, relate each part to the whole process, set task at the right level of difficulty (simple to complex), allow ample time for discussion & questions (Damber et al, 2012).
For retaining what one has learned, one needs to see and do what they have learned to remember and understand it. Only listening to the topic makes one forget most of it.
Acknowledge small or gradual success, give praise & encouragement for correct performance, be natural and sincere in your praises, develop positive attitude about mentee (Wentzel & Miele, 2016).
The importance of the clinical learning environment
Being a practice-focused profession, the understanding and skills needed in nursing are obtained from formal education in institutions and from practice in the clinical area that constitutes the “clinical learning environment”. It contains all the things that surround the student nurse comprising the clinical backgrounds, instruments, equipment, staff, patients, and the mentor. A positive clinical learning environment augments positive learning results. An effective learning atmosphere is shaped by encouraging instructional surroundings, good association of nursing care, student coordination, stability of clinical placement, and the noticeable effect of affirmative interpersonal relations ( Jakubik et al, 2016).
A positive clinical learning environment may be defined as the place where teaching and learning can take place in the most effective and productive manner. It is a safe and pleasurable learning environment that engages the student and promotes learning. Students are able to learn in a non-threatening manner and link theory to practice. It increases the competencies of the students and enhances learning thereby helping the student to grow and develop.
The mentor’s role in a positive learning environment is to encourage, motivate, be approachable, and act as a good role model. He should be able to create opportunities for learning to take place by selecting appropriate points from a simple to complex task. There should be effective open communication. During student’s orientation, the mentor should make the student feel welcomed, introduce the clinical staff and doctors, clearly lay out the expectations, and plan the objectives. He should build a bond with the student through support, guidance, good relationships and make full use of the readily available resources like manpower, training room, manikins, procedure manual, SOP/HAP. The knowledge, attitude, an skills (KAS) of the student needs to be adequately analyzed by the mentor.
The most common causes of anxiety among nurses are the fear of failure, looking stupid/ silly, having to change, loss of face, loss of job. To eliminate this anxiety training approach in the clinical environment should use structured instruction, start instruction with known topics, break the learning period into short, easily managed steps (Chuang & Tsao, 2013).
Never leave learner alone for long period, give guidance in a warm & accepting manner, let mentee know the area perform correctly as often as possible, adjust pace according to learner progress, never compare learner with another person, give plenty of opportunity to practice, use positive reinforcement by praising and encouraging for every success.
In a study of 357 second-year nurse students from Cyprus, it was found that the mentor and the regularity of personalized observation meetings were significant determinants in the clinical learning process of learners. Significant correlation was found in the dimensions “premises of nursing care” and “premises of learning”. This indicates the part played by the quality of clinical learning setting in the quality of care provided (Dimitriasdou M et al, 2014).
Importance of orientation/induction to the team and clinical area
Slow learners need time, support & development to provide safe delivery of care for the patients. “Knowing in part may make a fine tale, but wisdom comes from seeing the whole.” The mentor’s role is also to help learners integrate theory to practice, not only focus on assessment of skills in isolation. Thus, team orientation and induction are also important (Lahti et al, 2014).
One needs to maximize the use of learning opportunities and resources in the practice area to maximize student learning. The audio-video aids and simulation techniques should be used to create a real-like learning environment. The team should work in coordination in this simulated clinical environment to develop relationships with both the mentor and the wider team. A supportive team and clinical environment can enhance the learning process greatly (Nowell et al, 2015).
Assessment to promote learning in practice
Assessment is needed for obtaining information on which educational decisions will be based. It includes collection, measurement, and interpretation of information related to student’s responses to the process of instruction. It is a measure of the mentee’s competence and progress.
Accurate records need to be maintained by the mentor to keep a track of the progress of the mentee. Regular meetings with the student are also essential to assess the progress. Self-assessment by the mentee should be encouraged as it is an effective and efficient tool required to identify his strengths and weaknesses. The mentee must develop an awareness of his own strengths, weaknesses, and standard of practice. The mid (formative) and final (summative) assessment both need to be considered (Tosterud et al, 2013). The assessments should be consistent, stable, and valid.
Feedback is an essential part of education and training programs. It needs to be two way, i.e., by the mentor for the mentee and by the mentee for the mentor. Also, feedbacks should be taken from peers, patients or service users, relatives, care givers, inter-professional teams. Feedback process should be both verbal and written. There should be accurate and thorough documentation of assessment.
I have learned that it is important to assess the learning style of the mentee before planning of how to deal with the underachievement. The knowledge of learning theories is greatly helpful in the process, The clinical working environment and team support also play significant roles.
The mentees need to be made conscious and fully aware of their own incompetence. If the awareness of skill and deficiency is low or non-existent, they will not see the need for learning (unconscious incompetence). So, it is important to establish awareness of weakness (awareness of their needs and its benefits) prior to imparting mentorship in order to move to next step, i.e., conscious incompetence (learning).
Butterworth, T. & Faugier, J., (2013). Clinical Supervision and Mentorship in Nursing. Google Books. Available at: https://books.google.co.in/books?hl=en&lr=&id=j1H2BwAAQBAJ&oi=fnd&pg=PP7&dq=nursing+mentorship&ots=wofX_W2DfT&sig=a1WE_o1ubgwys4wb0MDplnMQXbc#v=onepage&q=nursing%20mentorship&f=false [Accessed June 30, 2016a].
Jakubik, L. D.,et al., (2016) .Mentoring Practice and Mentoring Benefit 2: Mapping the Future and Career Optimism - An Overview and Application to Practice Using Mentoring Activities-Pediatric Nursing, pp. 145-146. - ProQuest. Available at: http://search.proquest.com/openview/775995e78c20f8f7724448edac3e98a3/1?pq-origsite=gscholar&cbl=47659 [Accessed June 30, 2016b].
Billings, D.M. & Halstead, J.A. (2015). Teaching in Nursing: A Guide for Faculty, Elsevier Health Sciences.
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Brown, L. et al. (2012). What influences mentors to pass or fail students. Nursing Management (Harrow, London, England: 1994), 19(5), pp.16–21.
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Chuang, Y.-H. & Tsao, C.-W. (2013). Enhancing nursing students’ medication knowledge: The effect of learning materials delivered by short message service. Computers & Education, 61, pp.168–175.
Damber, U., Samuelsson, S. & Taube, K. (2012). Differences between overachieving and underachieving classes in reading: Teacher, classroom and student characteristics. Journal of Early Childhood Literacy, 12(4), pp.339–366.
Dimitriadou M., Papastavrou E., Efstathiou G. & Theodorou M. (2014). Baccalaureate nursing students’ perceptions of learning and supervision in the clinical environment. Nursing & Health Sciences - Wiley Online Library. Available at: http://onlinelibrary.wiley.com/doi/10.1111/nhs.12174/full [Accessed June 30, 2016].
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