Role of a Mentor in Barriers to Learning

Critically analyse and discuss the role of the mentor in managing a student who is not achieving competence in some of their practice outcomes and is not demonstrating an appropriate knowledge base.

Within this assignment I will endeavour to explain the role of the mentor and student highlight the different barriers to learning, critically analyse different theoretical practices to enable learning and be able to theoretically underpin the strategies that I hope to put into practice as a mentor should I encounter a problem with a student being unable to underpin their knowledge with practice, Duffy and Hardicre (2007), suggests that mentors find that one of the most challenging aspects of the mentoring role, is when students are not achieving the expected level of performance. This essay is not concentrating of how to fail a student from the nursing course, but to discuss why a student may be having difficulty in showing the mentor that they are competent with some of their practice outcomes and the student being unable to show the mentor that they can relate their theoretical knowledge to the practice. The mentor is pivotal in being one of the first to usually recognise struggling students, and need to assess, plan, and evaluate how these obstacles can be removed, overcome, compensated for, or managed. This should be, documented, the form of an action plan devised by the student and the mentor perhaps with advice from sign-off mentors on the ward, or if required outside sources such as the disability adviser, or the educational link lecturer for the placement. Arguably the three main areas that can impede a student ability to learn are the mentor, the student and the placement environment.

The placement itself has may have some fixed constraints in terms of environment, room size, as well as some dynamic concerns such as learning opportunities, work load, time restraints, noise, temperature.

The term mentor is derived from a character in an ancient Greek play, The Odyssey. Back in 1978 Levinson et al described the core components of the mentor not only as an exemplar and counsellor but also as a teacher, sponsor, developer of skills, developer of intellect and host, (cited in Oliver and Endersby 1999). The NMC (2006) described a mentor as an individual who has achieved the knowledge, skills and competence required to meet the defined outcome in stage 2 of the developmental framework to support learning and assessment in practice, cited RCN toolkit (2007), therefore the mentor has the shared enhanced knowledge base and key skills which is pivotal in supporting the student in achieving competence in the required skills of a nursing, this is reflected in the amount of classroom theory, and ward based learning being a 50% split, of the students time for the three years pre-registration. Policy documents such as Standards to Support Learning and Assessment in Practice (NMC, 2008a) show the capabilities that a professional needs to demonstrate and the criteria that a professional should work to achieve the status of mentor. Lloyd Jones et al (2001) have suggested three core reasons for providing ward based learning for student nurses are:

• The acquisition of skills and knowledge
• Application of theory to practice
• Professional identify formulation and ‘enculturisation’

Mentorship therefore has came to mean, Haggard et al, cited Nick et al (2012), a one to one reciprocal relationship between more experienced and knowledgeable faculty member and a less experienced one. According to Cahill (1996), cited in Morton-cooper and Palmer (2000), the student mentor relationship moves through three different phases during the duration of a placement these are:

• Initiation phase
• Working phase
• Termination phase

One of the numerous things to consider during this essay will be the assessment process and how this needs to be fair and consistent for the student and allow them to develop individually to achieve a level of competence in the skills required to become a professional nurse.

Before a student even starts on a ward the mentor should prepare for the students arrival reviewing the wards welcome pack, ensuring that it is up to date and that the information held within it continues to be valid and relevant. The welcome pack should include the placement ethos, aims, learning outcomes content, and how these are to be assessed. In addition the welcome pack identifies all the processes that take place whilst the student is undertaking the placement and support mechanisms available to the student. This should allow the student to undertake any pre placement reading, and demonstrates to all students that the placement takes educating students seriously from the beginning. The mentor should also prepare their shift pattern to accommodate the student. Mayall et al (2008) undertook a study exploring the experiences of student nurses and practice mentors and discovered that 10% of student nurses felt that during some of their placements they had ‘never’ been allocated a mentor, and of those who had been allocated a named mentor, 24% felt that they would have liked to spend more time with them. Therefore ensuring that the preparation work for the placement is in place, assists the student to form a positive opinion for the learning environment, and relationship with the mentor, from the beginning improving the chances for lack of competency to be addressed early.

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During the first interview that the mentor has with the student, in the first week of placement, the mentor should review the progress of the student from any previous placements and experience that they have gained. The mentor also has an opportunity to review the feedback given to the student from the previous mentor. The mentor can review the skills book to find competencies not achieved in previous placements, and highlight learning opportunities within the placement that the student may be lacking at this stage of their study that the student can gain during the placement. This could simply be due to the previous placement not being able to provide a learning opportunity due to case load, time, and type of placement, or this could have been because of the previous mentor’s attitude. Darling (1986), cited in Walsh (2010), described four types of toxic mentors that can negatively affect a student’s ability to achieve competence these are

• Avoiders
• Blockers
• Destroyers
• Dumpers

The student has a responsibility set out by the guidance on professional conduct for nursing and midwifery students to take responsibility for their own learning, working safely for the people they care for, under the supervision and support of a qualified nurse NMC (2010). This duty should allow the student to openly communicate with the mentor highlighting any deficit in their practice or their under pinning theory which needs to be concentrated on in order to become competent, these learning needs could be communication difficulties and educational requirements such as should a student has English as a second language, dyslexia, dyscalculia or hearing issues can be a huge barrier as it can lead to misinterpretation of core theories, or feedback from the mentor. This ideally should be discussed at the initial interview; however the student may not feel confident within the relationship to reveal minor issues at this time but the mentor may have an instinctive feeling from the evidence provided by the student from their previous placement which could restrict the student’s capability for achieving competency in their theory or practice.

The mentor should have prepared for the initial interview and take control of the continuous assessment of the student’s practical learning and be able to link this to underpinning theory, by creating a placement plan for the student to review. The student and the mentor should both contribute to a learning contract to which they both sign up to what the student and the mentor expect to realistically achieve by the end of the placement. Indicating how this is to happen and any learning needs of the student, and when the practical and theoretical evidence should be formatively reviewed and assessed. Once the foundations of the placement expectations have been agreed then the formative part of the student’s placement during which the mentor should be formulating an opinion of the student’s competency practically and theoretically, based upon evidence either witnessed learning, discussions, spoke feedback forms etc.

During the ‘initial phase’ of the placement the mentor has a duty to foster a professional relationship with the student. It is important that when the student is in the ward with their mentor that they feel a sense of belongingness as recognised by Levett-Jones & Lathlean (2007) as this can ‘enhance a students’ potential for learning and influenced their future career decisions.’ The relationship can there for move from the ‘initiation phase’ to the ‘working phase’, Cahill, (1996).

During the ‘working phase’ feedback is an important factor for both the student and the mentor. The mentor may get feedback from colleagues, spoke placements, previous placements or the student which will assist them in forming an opinion of the student’s competency to the required level of study. The student, themselves, needs to receive frequent, clear constructive feedback, on their progress, from their mentor. It is one of the NMC requirements that the mentor provides feedback to a student as often as it is needed to guide performance (NMC 2008). Accurate feedback will encourage students to reflect on their learning and provides an opportunity to identify how they can improve their performance (Elcock and Sharples 2011). This should take place away from patients or other colleagues’, and ideally this should be given as soon after a positive or a negative incident. The feedback should be non judgemental and form the basis of a discussion. This should be given when both the student and the mentor is calm and should be specific on the strengths and weaknesses. Duffy (2013) gives five principles for providing constructive feedback

1. Set realistic goals
2. Gage student expectations of feedback
3. Gather information on student practice
4. Act immediately
5. Be specific

The feedback sandwich where the mentor gives praise, criticism followed by praise, that the student has brought to an incident is an effective feedback theory which can assist with giving criticism of a student’s failings, while still motivating them, however this needs to be done effectively. Belludi (2008) illustrates how a mentor can use this technique incorrectly,

• giving too much weight to the praise compared to the criticism
• by the praise being trivial and having no function
• By overusing the sandwich feedback style to a point where the student recognises that the mentor uses this all the time and waits for the criticism whenever the mentor gives praise.

The feedback sessions should allow the student to reflect on the incident and allow the student to ask questions. The feedback should highlight any further learning required and solutions to address these shortfalls in knowledge. This could be backed up in writing up of the feedback as a discussion or planned subsequent leaning requirements to develop themselves, this written feedback will provide evidence for the student’s competence and development during the placements assessment.

The mid-point interview is the formative interview. Up to this point the student’s relationship with the mentor has hopefully developed, as long as the mentor has not been a toxic mentor, Darling (1986), to the point where, previously, undeclared learning needs of the student may be revealed. The formative interview allows the student and the mentor to assess the progress so far and formatively assess the student’s competency and attitude. This is the point at which deficits in learning should be formatively addressed. Duffy (2003) recognised that “Failing to tell students that they have not reached the required standards does not protect the interests of the public or professions and puts the patients who will be under their care at risk”. The mentor may have doubts as to the students practice or theory demonstrated but is unsure how to deal with this, the mentor may need to liaise with another mentor, or a sign-off mentor for their opinion as they may have more, or different experience in mentoring and be able to advise the student’s mentor as to a strategy to introduce to encourage competency. The student should bring with them the evidence of their competence gathered throughout the placement. The mentor needs to highlight to the student where they are lacking competence and an action plan should be written up describing how the issues are to be addressed. If the mentor has not already highlighted concerns that they have with the student’s competency with the academic establishment then there may be an opportunity to invite them to attend this meeting. The student’s academic advisor, or the link lecturer, may assist in the formulation of the action plan and be supportive of both the student and the mentor. This input by the academic establishment is essential at an early stage should the student continue to not demonstrate competency either practically or theoretically and go on to fail the summative part of the placement. The action plan, however, should identify clearly learning outcomes detailing how these can be achieved during the placement, list the evidence required for achievement and indicate by when the evidence is required to be provided. This needs to be agreed by both the mentor and the student.

The final part of the placement, the termination phase, concludes with the final interview this is summatively assessed and if a student has not been showing competency previously may also be attended by the link lecturer or another academic member, and should review the whole development of the student during the placement. Evaluating the evidence that the student has provided and all being well the student, with the mentor, should have responded positively to the feedback provided during the placement and address any the action plan put in place at the mid-interview. Meaning that by this point the student should be able to demonstrate competency both practically and theoretically having evidence to underpin this.

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The attitude of the student, during the time of the placement, to absorbing knowledge is affected by many factors. The background experience that the student has experienced such as, prior work experience or learning experience from a mentor, be that positive or negative. Personal life matters i.e. house moving, child care. Financial stress can impact the student’s receptiveness to learning. Academic pressures based on the student can distract the student from gaining an outcome in the ward based placement. As eluded to earlier a student also needs to feel a sense of belonging within the placement team, when students are secure in the knowledge that the nursing staff are supportive of their learning needs and committed to their professional development they can focus on learning rather than being preoccupied with interpersonal relationships, (Levett-Jones and Lathlean 2007).

Student nurses have had their learning styles categorised into different types by various authors, a commonly used classification of learning styles is Flemming’s VAK model which he later expanded on to VARK. These acronyms stand for

Visual -students give better results in pictures, graphs, diagrams

Auditory- students learn better with listening to lectures, or discussing learning opportunities

Reading and writing-learn better with word learning i.e. Reading journals, reports

Kinesthetic/tactile learners learn best through demonstrations, practice experience.

This highlights the need for being able to adapt the teaching style of the mentor to that of the student, and should be taken into account during the placement when learning, participating or reviewing learning opportunities, or by the mentor while developing a lesson plan. Honey and Munford 1986 cited in Brown and Plant 2013 suggested that a student can be classified into more than one of the following four styles

Activists -these students need to experience situations and can become disheartened should they not be allowed the opportunity to undertake skills

Pragmatists-these students like to ‘have a go’ but need to see how the learning opportunity fits into the final outcome.

Reflectors-these students will welcome the opportunity to observe and reflect on a given learning outcome prior to undertaking it but may require encouragement to practically undertaking a learning opportunity.

Theorists-these students want to explore and understand learning opportunities probing questions to uncover reasons and concepts and do very well with structures pathways and systematic approach to nursing but can find it difficult to transcend that knowledge in light of swift changing learning opportunities

Getting the mentoring style wrong when teaching the student, will have a negative effect on the student’s ability to achieve competence in a learning opportunity. If a visual pragmatists learner is given a verbal lecture about a learning objective and not shown how the opportunity fits into the wider care of the patient care, then the student may have a lower understanding of the learning opportunities, and objectives asked of them at that time and would need longer time and further investment by the mentor with a different approach being used to become competent.

The role of a mentor is diverse, in their responsibilities, and requires the professional to be self aware of all the factors that can impede the student manage their expectations, and gain competence in a given area. The mentor needs to follow the assessment process to provide consistent assessments which will indicate areas of learning and allow the student to engage. As well as expanding a relationship with a student, the mentor needs to be able to consider many factors that inhibit learning, recognising that each student, is an individual with their own learning styles and needs. The mentor needs to feedback to the student regularly, motivating them to improve upon their current accomplishments. It should not be forgotten by the mentor that there are various resources available, with improving competency in practice and/or theory, to support both the mentor and the student through what could be a stressful experience in the form of literature, e-learning, other mentors or link lecturers. All the written documentation, skills book, learning contract, student handbook, placement plan, feedback forms, discussion sheets, lesson plans should provide an accurate record of the student’s development and enhancement as a student, throughout the placement. Not addressing a short fall in a students learning, early could make it difficult to evaluate the practical or theological practice of student’s summatively and not following a clear assessment process means that the student could appeal any decisions made at the final meeting. Students often pass placements despite there being serious concerns from mentors. Gainsbury (2010).