Facilitating Learning And Assessment In Practice

Introduction I am a registered nurse based in a ward that manages spinal and orthopaedic conditions among patients. Currently, I am finalising my training as a qualified mentor. This paper presents a reflective account of my experiences in facilitating, teaching, and assessing student learning during their learning practice. It also highlights the learning outcomes drawn from the experience. Due to ethical considerations of any academic publication, which demands confidentiality, and anonymity of the persons that were actively involved in my encounter, this paper omitted names or used pseudonyms in the development of the account (Polit & Beck, 2008). Practice-based learning provides the students with needed experience, which is an essential aspect of skill development that enhances their ability to effectively interact with clients as well as their families by developing the student’s communication, interpersonal, psychomotor, and technical skills (Myall et al., 2008). Practice-based learning is also an effective opportunity that allows the learners to link theory and practice, which are vital in the learner’s professional development (Zachary, 2011). Furthermore, practice-based learning is essential in a nursing career due to its vocational nature as well as its role in determining the learner’s clinical competency and hence protecting the public from instances of incompetency in nursing practice (NMC, 2008). Through demanding and instilling high standards of professionalism during assessments, practice-based learning makes sure that nursing students are able to effectively practice before they are registere d as nurses (Myall et al., 2008). This demonstration of my eligibility to assess and supervise nursing students in practice coupled with successful completion of this training will allow me to be an effective mentor in nursing (Price, 2007). Therefore, I will be able to actively participate in the development of future nurses that will meet the needs of patients, which are increasing in diversity and complexity (Polit & Beck, 2008). Nursing Standards In order to promote adherence to specific attributes that support assessment and learning in practice, the nursing standards offers specific guidelines that must be met by teachers, practice teachers and mentors (NMC, 2008). Specifically, the fixed requirements cover standards, frameworks, and information on the approaches for assessment in nursing practice. There standards are defined by eight domains including: leadership, evidence-based practice, context of practice, creating a learning environment, learning evaluation, assessment and accountability, learning facilitation, and establishment of valuable working relationships (NMC, 2009). Linking these domains to my own practice, I hold high regard for leadership and formation of useful working relationships. Establishment of good working relationships is essential in nursing as a nurse works together with the patients family in ensuring the best nursing care is provided for the patient (Polit & Beck, 2008; Appendix 1) enhancing the standards of care. Good working relationship is also important in minimizing the negative student experiences building on the student’s competency in practice (NMC, 2008). Consideration of the imperativeness of family-centred approach to nursing care and the promotion of good working relationships demands effective leadership. To be specific, leadership in my case involves influencing others, improving nursing care, and role modelling (NMC, 2009). This demands application of a situational approach to leadership when handling different leadership situations at work. In my work setting, leadership is broad ranging from handling the pa tient’s family issues, which requires participative leadership, or directing a practicing student, which demands assertiveness. However, it is imperative for a nurse to act in the best interest of the patient (Price, 2007) which can best be achieved through autocratic approach to leadership. Consequently, establishment of effective leadership and relationships require knowledge, skill, and experience and are vital in the provision of high-quality nursing care (Myall et al., 2008). There are several professional challenges that I encountered during the assessment which emanated from the complexities related to staffing levels and hastiness in the ward that negatively influence the quality of practice assessment (Polit & Beck, 2008). The sustained pressure from clinical commitments and the limited time availability affects the process of student supervision and assessment during practice-based learning (NMC, 2009). More so, there may be inconsistency in achievement, which affects the process of student assessment with regard to their fitness to practice (NMC, 2008). In other cases, some students in practice-based learning do not conform to the existing support systems for instances of failure limiting their learning and effectiveness of the assessment. In addition, the supervisor may be reluctant to fail an incompetent learner due to perception that he process is too complex or general poor assessment, this also posed a challenge in my practice. The existing nursing standards that guide learning and assessment of students in practice offer frameworks for nursing mentors. However, the document is limited, as it does not consider all competence assessment aspects (Myall et al., 2008). Therefore, some forms of assessment are subjective as much as the framework for assessment is provided due to the intrinsic nature of the nursing profession and the variations in nursing skill-set to be assessed. It is challenging to establish a comprehensive assessment of competency especially due to learners’ spontaneous action to utilise their skills, knowledge, and attitude from an emotional intelligence perspective (Bradshaw & Merriman, 2008). These issues are enhanced in situations where a mentor fails to fail instances of incompetency among learners (Myall et al., 2008). These problems are resolved through the use of sign-off mentors that offer final evaluation of the students before being accredited to be effective to service as pr ofessional nurses at the end of nursing training program (NMC, 2009). Consequently, more support to the nursing standards is needed to promote effectiveness of learning assessment for practice-based learning. This support is provided various nursing documents such as nursing guides, which offer strategies and support for practitioners in the nursing profession. Facilitating Learning and Assessment This is an important approach for assessing skills, knowledge and attitudes among nursing students (Price, 2007) and is complex in nature with the focus of promoting objectivity in the assessments (Bradshaw & Merriman, 2008). The ensure the diversity of the nursing settings are accommodated during the assessments, there are several assessment approaches that can be used in student mentorship programs including mini clinical assessment exercise, direct observation, case-based discussion, and mini peer assessments (Myall et al., 2008). Mini clinical assessment exercise offers an overview of student performance of key clinical skills. This assessment approach works both in routine patient encounter as well as ward environment. Direct observation of procedural skills involves observing a nursing student which conducting a clinical procedure where the observer provides necessary feedback at the end of the procedure. A good example of a clinical procedure that can be observed is preparatio n of a dressing trolley by a student. Case-based discussion, on the other hand, involves an interview aimed at exploring judgment and behaviour such as asking the student to list what he/she observed during a specific patient care program. Finally, mini peer assessments encompass a team of qualified professionals that offer feedback on the performance of an individual. The process of selecting the method of assessment should consider its cost effectiveness, educational impact, acceptability, validity, and reliability (Bradshaw & Merriman, 2008). Assessing a student’s craft knowledge helps the student to reflect and develop based on experiential learning (NMC, 2009). Effective assessment should focus on developing insights into a student’s craft and formal knowledge in order to understand the student’s ability to assess risks and utilise learned knowledge in meeting practice requirements (Price, 2007). There are four vital areas that cover student assessment, namely motivation, performance, skill, and knowledge. Even though continuous assessment is known to promote effective positioning of a student’s performance, it has limitations with regard to reliability and validity. Therefore, successful implementation of student assessment require coordination between service providers and educators to ensure the assessment approach is appropriate in terms of its summative and formative perspectives which are imperative in promoting a working linkage between theory and practice (Myall et al, 2008). Mentorship program in clinical setting is complex due to the pressure emanating from the need of sustained student assessment in front of the patients and their family as well as other professionals, which may raise anxiety among the students as well as assessors, which may negatively impact on the assessment process (Bradshaw & Merriman, 2008). Anxiety may be caused by a variety of reasons including curriculum changes, which may undermine the assessor’s competency, the student’s readi ness during assessment, and the assessors feeling of competency with regard to the assessment process. This portfolio outlines an assessment of the competency of a nursing student with regard to the appropriate use of pain assessment tools. I considered this to be vital in the profession of nursing due to the importance of pain assessment skills in nursing care as it is classified as the fifth vital sign in nursing (Murray et al., 2008). Considering the requirement that nursing students should actively participate in vital signs, developing this competency is vital for patient safety (Price, 2007). Further, I considered this assessment to be a direct observation of a procedural skill where I was available during the whole process while offering feedbacks and assessments on the process (NMC, 2009). To ensure the assessment was a success, I developed a plan that included a criterion for implementing the process as well as questions that were used for testing the levels of understanding exhibited by the learner. Furthermore, the assessment plan was developed with the consideration for th e student’s level of practical and theoretical learning (Myall et al., 2008). The questioned used in the assessment were open-ended to allow the student to offer the rationale behind their action path. This was important in developing deeper insight into the leaner’s competency, as well as promotes appreciation of diverse approaches to skills application (Murray et al., 2008). The assessment was initiated after ensuring the ward was quiet enough to minimise the effects of a noisy setting on the assessment program. The process commenced with an official introduction between me and the student as an approach to familiarization between me and the student to minimise instances of anxiety (Price, 2007). After that, I proceeded by informing the student my expectations, the timeline, and offered my reassurance that the process was not formal as I was just interested in observing the process and offering my feedback at the end of the process (Murray et al., 2008). As much as I managed to develop effective background information needed to establish an effective assessment void of anxiety, I did not inquire about the learner’s previous experience, which could have assisted in the assessment process. As much as I had previous encounter with the student, lack of enough background information hampered my effective participation in the growth of the student durin g the practice-based learning. Furthermore, I did not clearly identify the outcomes of the assessment at the beginning of the assessment. As much as appropriate information was provided and the environment was conducive, developing a summary of discussion could have enhanced the levels of student conceptualization of the expectations as well as minimize anxiety and confusion (NMC, 2009). When the student completed the first process, I asked the student several questions. These questions were established to evaluate the student’s communication skills, their understanding of the problem at hand, and general nursing skills (Murray et al., 2008). From the assessment, I observed that the student effectively communicated with the patient as well as the patient’s family a clear illustration of practical application of family-centred approach to nursing (Price, 2007). The student also effectively addressed the nursing situation at hand, as he utilised Wong-Baker pain rating to stabling the pain situation by the patient (Wong et al., 2001). After the student had gained an appropriate pain score, I asked the student a question regarding the appropriate frequency for observing pain, in which the response of the student was appropriate (Bradshaw & Merriman, 2008). From the case, it was evident that I had a problem with my communication skills as I had to repeat mys elf severally before the student could understand what I was addressing. Lowering my communication speed is necessary to enhance the student’s ability to comprehend the information given to them during assessment and minimise on instances where students are overwhelmed by information that is faster than their processing rates. I offered the student a feedback session with the aim of promoting proactive learning relation with the student (Murray et al., 2008). This feedback included active involvement of the student in the development of an action plan for dealing with the identified inconsistencies during the assessment. Considering that the student demonstrated competency in the skill that I was assessing, the action plan was centered on increasing the number of alternative approaches that can be used in applying the skill with the focus on increasing the student’s reflexive skill and hence a holistic competency (Zachary, 2011). The process of provision of the feedback considered developing a positive and constructive impact on the student to assist the student in building self-esteem, cultivating a positive working relationship as well as a supportive learning environment which are important aspects that reduces anxiety during nursing practice (Myall et al, 2008). Research has demonstrated that st udent-mentor relationship influences the student’s learning experience (Price, 2007) and therefore, effective communication between the mentor and the learner can illicit competency concerns at early stages to minimise instances of failure (Zachary, 2011). Even though the student and the mentor may feel sad due to a failed assessment, it is vital for the mentor to appreciate failure as avoiding to report of failure may have an adverse effect on the progression of the student (Bradshaw & Merriman, 2008). This feedback was provided immediately after the assessment session as an approach to providing the student with prompt support and offer immediate corrective measure for any unpleasant conduct exhibited by the student during the session (Zachary, 2011). Based on the assessment and my individual reflections on the outcomes, I identified various areas of my practice that require improvement. Specifically, my feedback on the assessment was limited and did not offer the student a wider scope on improvement. Furthermore, my speaking speeds need to be slowed to ensure effective communication. I also need to focus on developing in-depth background information about the student before the assessment as well as offering the student the expected outcomes of the assessment. In addition, asking the patient about the service will also enhance the determination of the performance of the student as well as development of an effective feedback. Reflective Commentary Mentorship is an important leadership characteristic (Zachary, 2011). Transformational leadership is founded on the ability of an individual to influence others through affecting their thinking. Adoption of this approach of leadership in nursing promotes autonomy as well as enabling the students to realise their full potential. It is also central to encouraging the development of excellent Interprofessional rapport (Myall et al., 2008). By becoming a role model at work through formulating solutions to problems that exist within nursing mentorship, I will be able to benefit myself as well as the student. This influence can also be transferred to other situations in the nursing environment, which will culminate to a better outcome in my nursing practice (Price, 2007). Common obstacles to mentorship such as staffing issues, hectic hospital environment, and clinical commitments influence my ability to perform as a mentor and hence the development of an effective relation with the student is essential (Price, 2007; Appendix 2). Due to the hectic nature of the nursing environment it is challenging to get time for developing a written feedback for the student however to enhance by mentorship capability I need to establish relationship with other mentors that is founded on sharing evaluation feedback as an approach to building my scope with regard to student evaluation. Being able to share with other mentors about feedback can also expand my evaluation to the benefit of the student. As much as this approach is effective in enhancing a student mentorship program in hospital settings, it is challenging especially in cases where other mentors are not interested in sharing their experiences and work limiting its usability. Promoting teamwork in mentorship can be an effective approach to overcoming this obstacle. Dealing with the problem of anxiety requires innate understanding of the student, which implies discussing with the student the most appropriate way for implementing the assessment. This is effective as it encourages the student to be actively engaged in the assessment program and also creating a better relationship between the mentor and the student (Zachary, 2011). Conclusion The process of student assessment is only successful if it is administered objectively and fairly. As much as this approach may result to some emotional distresses by both the assessor and the student, it is imperative for the success of a mentorship program and prevention of negative implications on the student’s advancement. It is also necessary for ensuring approved nurses are competent enough to guarantee patient safety. Therefore, I am determined to ensure that students that I mentor, assess and approve and fit and competent to service as nurses in their respective fields. To achieve this, I will focus on developing a closer working relationship with the students to ensure all competency issues are identified and addressed timely. This is important in ensuring the students that I encounter do not face surprises later during their summative assessment or even when practicing as registered nurses. Furthermore, involvement of the patients and their families in the assessment of my students will be a major trademark of my mentorship and assessment program as I regard inputs by the patient vital to determining the competency of the student nurse. Consequently, as much as the practice of assessment and mentorship is challenging and compound in nature, I believe that effective application of relevant knowledge and skills while focusing on the expected outcomes, it is possible to deliver efficiently in this function. This reflection process has enriched my understanding on the concept of mentorship and its significance in the nursing profession. It has also enhanced my perception of the concept of professional and personal development. I believe that if I eliminate the few areas of weakness that I have identified in the reflection, I will be able to offer effective mentorship and assessment for nursing students in clinical practice. References Bradshaw, A., & Merriman, C. (2008). ‘Nursing competence 10 years on: fit for practice and purpose yet?’ Journal of Clinical Nursing, 17(10): 1263-1269. Murray, C., Grant, MJ., Howarth, ML., & Leigh, J. (2008). ‘The use of simulation as a teaching and learning approach to support practice learning.’ Nurse Education in Practice, 8(1): 5-8. Myall, M., Levett?Jones, T., & Lathlean, J. (2008). ‘Mentorship in contemporary practice: the experiences of nursing students and practice mentors.’ Journal of clinical nursing, 17(14): 1834-1842. Nursing and Midwifery Council, NMC. (2009). Additional information to support implementation of NMC Standards to support learning and assessment in practice. London, UK : Nursing and Midwifery Council (NMC). Nursing and Midwifery Council, NMC. (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Retrieved from http://www.nmc-uk.org/aArticle.Aspx Price B. (2007). ‘Practice-based assessment: strategies for mentors.’ Nursing Standard, 21 (36), pp. 49-56. Polit, DF., & Beck, CT. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins. Zachary, LJ. (2011). The mentor’s guide: Facilitating effective learning relationships. New York, NY: John Wiley & Sons. Appendices Appendix 1: Critical thinking competency standards Source: http://www.drake.edu/media/collegesschools/soe/images/msld/competency_model.png Appendix 2: Essential competencies for an effective mentor