Research Topics: Mentoring In Health Care

Examine the significance of the practice enhancement role of the mentor on the facilitation of learning in your current place of employment.

Examine the significance of the practice enhancement role of the mentor on the facilitation of learning in your current place of employment.   Mentoring has been described as a process that helps an individual adapt to new and expanded professional roles. Mentoring involves a nurturing relationship between a mentor and a mentee. Mentoring occurs when a senior person (the mentor) provides information, advice, and emotional support for a junior person (the mentee) in a relationship lasting over an extended period of time and marked by substantial emotional commitment by both parties. The mentor takes an active role in the professional development of the mentee. “Inherent in the concept of mentoring is a personal, one-to-one, nurturing relationship between the mentor and the mentee” (2001). Mentoring has been an effective strategy in many disciplines, including all the health professions, to develop expertise and leadership within the profession. The traditional concept of mentoring involves a voluntary alliance between an experienced senior professional and a less advanced one, for the dual purposes of career development and the enhancement of the profession. It is impossible to separate mentoring from learning. Mentoring or teaching is an interactive process that promotes learning in an individual. It consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills (2004). Mentoring usually highlights interpersonal skills such as being ‘approachable’ and ‘supportive’. This is not to say that mentors do not see skills more directly associated with learning as necessary, just less important ( 2000). The nursing literature shows the consensus seen in other disciplines regarding the concept and value of mentoring. The focus for mentoring in nursing has shifted over the past 3 decades, paralleling the emerging concerns of the profession; current emphasis is on mentoring in research. This growing national and international need generates concern about the necessary resources to effectively mentor researchers (2002). Mentoring is a special way to transfer knowledge, and it can occur in all the settings in which scientific inquiry is being deliberately pursued. Development of nursing science is the foundation for the growth of the nursing discipline and profession. Knowledge development takes place in the various settings in which nursing is learned and practiced. The processes and products of knowledge-work belong in academic environments for many disciplines but the practice professions both use and create their knowledge beyond traditional scholastic settings. Practice professionals continually merge their knowing with their doing (2002). Nurses have an ethical responsibility to teach not only their clients but also other health care workers. The nurse has the responsibility to teach the information that other health care workers need. The nurse also often clarifies information provided by physicians and other health care providers and may become the primary source of information needed for adjusting to health problems ( 2004). Assessing and adapting educational information and approaches to the needs and preferences of the health care support workers enhances the success of educational efforts. Not all individuals are comfortable in class settings or in support groups. Educational programs that use these methods should have other educational opportunities available to the health care support workers that needed to be educated. Nurses must at all time also remain creative and responsive to other health care workers when providing education. In this paper, I will discuss the significance of the practice enhancement role of the mentor on the facilitation of learning in my current place of employment – the out-patient department of a local hospital. I was tasked to educate health care support workers in the new skill of suture removal. How do you teach the skill of removing sutures to health care support workers? The developmental capacity has to be first considered in selecting the teaching method to be used. Since all the health care support workers are already adults and would each exhibit responsibility and discipline, many methods would actually be applicable for them. As a nurse, I am a primary member of the health care team responsible for ensuring that all the educational needs of clients as well as other health care workers are met. However, there are some cases where the needs are highly complex. Thus, the choice of instructional methods depends on the learning needs, the time available for teaching, the setting, the resources available, and the nurse’s own comfort level with teaching ( 2004). As I already know the skill of suture removal, I am comfortable that I can teach them this. Nurses may choose to teach health care support workers and clients in groups because of the advantages associated with group teaching. Groups are an economical way to teach a number of individuals at one time, and they would also be able to interact with each other and learn from the experiences of others. Groups can also foster the development of positive attitudes that help health care support workers and clients meet learning objectives. This is what I have reflected by using the group teaching technique in educating the health care support workers. They can learn from what I teach them but they can also learn more from each other. Group instruction often involves both lecture and discussion. Lectures are highly structured and are efficient in helping groups of health care support workers and clients learn standard content about a subject. A lecture does not ensure that learners are actively thinking about the material presented; thus discussion and practice sessions are essential. After a lecture, learners need the opportunity to share ideas and seek clarification. Group discussions allow health care support workers to learn from each other as they review common experiences. A productive group discussion helps the participants solve problems and arrive at solutions toward improving each health care support worker’s improvement. To be an effective group leader, a nurse must be able to guide participation. Acknowledging a look of interest, asking questions, and summarizing key issues foster group involvement (2004). Demonstrations are most effective when learners first observe the mentor and then during a return demonstration have the chance to practice the skill. Nurses usually use demonstrations for teaching motor skills; however motor skills are not learned separately from attitudes and factual knowledge. A demonstration should be combined with discussion to clarify concepts and feelings. This is what I had in mind when I employed demonstration and discussion within the group of health care support workers. An effective demonstration requires advanced planning: <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Make sure that the learner can easily see the demonstration. Position the learner to provide a clear view of the skill being performed.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Review the rationale and steps of the procedure.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Assemble and organize equipment. Be sure that all equipment works.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Perform each step in sequence while analyzing the knowledge and skills involved.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Determine when explanations are to be given, considering the learning needs.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Judge proper speed and timing of the demonstration, based on the learner’s cognitive abilities.</li> Teaching during routine care is actually efficient and cost-effective. Teaching is done more effectively whole delivering the skill. This becomes easier as confidence increases in one’s own clinical skills. For example, while actually performing suture removal on a patient, I can provide explanation on what is being done. But the catch of this is that the patient may not appreciate being made an example to a group of health care support workers for their education and learning.     Credit:ivythesis.typepad.com

Examine the significance of the practice enhancement role of the mentor on the facilitation of learning in your current place of employment.

Examine the significance of the practice enhancement role of the mentor on the facilitation of learning in your current place of employme...

Facilitating Learning and Assessment In Practice

Facilitating Learning and Assessment In Practice       Introduction   . I am a student nurse mentor and needs to tell the examiner how I mentor her during my placement. The examiner Catherine (not the real name of the examiner) and as a student nurse mentor I have to assess and evaluate the examiner’s performance based on my style of mentoring thus, in providing basic posits of teaching for learning facilitation is imperative to the session we have in a daily set of activities with Catherine. There was other examiner in the area but I believe Catherine needs extra attention in order for her to become effective examiner   Learning Needs, Planning and Managing   As a student nurse mentor I have full responsibility to whatever plan of actions there maybe upon mentoring the examiner, Catherine as a fact that she agreed to be the examiner I allowed Catherine to experience orientation within the area in which I am a part of and thus, explaining to her several resource materials that is integrated within the process. As for Catherine, she has enhance and focus more on the programs of learning and education specs for the betterment of her career path working in the field of examination division into the nursing education unit and I said to her if there are problems or unclear situations, she should not hesitate to tell me right away. Being a student nurse mentor, it is my duty to ensure proper facilitation for learning to be realized and that certain assessments have to be in parallel with such activities as well as the availability of the learning materials such as aids is a must for me to check and confirm.  Then, after explaining to Catherine, we had agreed to write down our views and come up with a discussion plan for a particular period of time, one week to be specific. Indeed, Catherine identified certain objectives as well as the learning needs and the style of learning approach she wanted thus, as student mentor I have to allow such examination centered evaluation and be it return to the organization after having the details and Catherine will have to assess me as a student mentor. Working as a student nurse mentor is a challenging and rewarding activity that is pivotal to the effective development of such practitioners and as a nurse mentor I will be working collaboratively with other members of the care team and the academic staff as Catherine experience and receives feedback on her role progress. I have some essential responsibilities as follows:  (cited in, Spouse J, (1996; Spouse and Redfern, 2000) -          Provides social and professional induction to practice and health care team -          Has reasonable expectations of the student and be aware of their program of study -          Assesses Catherine’s capabilities in order to help them progress through direct and indirect observation of practice -          Provides regular feedback on the progress -          Develops an action plan with the student should there be areas of improvement required -          Maintains own professional knowledge and updating   I believe there can be a number of strategies in place to support my assigned work as a student nurse mentor as I can be a Practice Experience Facilitator being responsible for supporting the mentor in practice and for placing student in practice settings that are designed to meet their educational needs. Aside, as a Lecturer in Practice Education being responsible for liaising with specific, identified practice areas and where possible they will visit the student nurse/midwife at least once during their practice experience to provide academic support. I do provide support and guidance using different kinds of supervision:  (cited in, Spouse, 1996; Spouse and Redfern, 2000) Collaborative supervision – that takes place when Catherine is new to the area of practice and requires opportunities to learn from direct contact with a qualified practitioner so she can observe and learn through active participation in care. Coaching – here Catherine needed additional support through guidance and supervision to fulfill the activity which may involve a skill that is new to the student. Occasional supervision – Catherine has demonstrated that they can work independently to deliver care and needs opportunities to consolidate and further develop her performance like the opportunity to take charge of the department under supervision.   Thus, certain learning strategies can be used respectively by the examiner in specific steps that could be taken upon building assessment consensus and provide enough basis for developing comprehensive learning strategy and the execution pertaining to a resource table for increased resources to be spent on education and learning as well as the establishment of ‘learning partnership’, bringing together relevant education and learning with view to considering the priority areas for action as enable students to engage in effective partnerships, using effective education experience and expert assistance from mentoring. The recent increase in published work relating to the supervision of nurses and in particular mentorship suggests that nurses value the opportunities that such schemes present for developing practice. Much of the literature surrounding mentorship concerns the supervision of students in practice settings but more recently, especially following the changes to post-registration education, attention has shifted to the supervision of qualified nurses. No one model is seen as more appropriate than another and choice usually depends upon the mentor’s familiarity with a particular framework (cited in, Spouse 2003; 2004).   It is also evident that there is inconsistency in the length and level of preparatory courses for mentors. The teacher was the expert on nursing education, the aims set for each practice, as well as student nurses and their skills, but then again the nurse mentor knew the ward on which students were practicing. This was why collaboration between nurse mentors and nurse teachers was considered very necessary.   As a student nurse mentor, I have to incur ample guidance and support as the student examiner does experience competence and I agree that several students need much attention guidance as compared to others. The duration of activity with Catherine are to be based on the learning needs and assessment as directed to her from knowing her capability to due the work assigned.   Catherine is diligent and can understand instructions well but, she lacks a charismatic touch in dealing to pressure oriented situations like, taking down proper minutes of the time needed for a successful examination. Then, I have the opportunity to ask her if she can handle pressure on both sides and she told me  that most of the time she’s hit by being too overly occupied in her actions, being too safe and careful to commit mistakes and failures at work. Furthermore, constructive feedback helps her to maybe twist her mind a bit on a brighter disposition so, I utilize constructive feedback strategy towards Catherine hoping and wishing her the best in terms of her role as an examiner and that motivation is the core domain in strengthening such learning medium thus, through scaling approach in such questions is the one I used in discovering Catherine more as an effective examiner. The role Catherine and I must work in synchrony for good learning outcomes. The setting is important and places limitations on time, space and access as the student is expected to be an active adult learner; the faculty is expected to assess the student’s needs and arrange for learning environment consistent with program goals and to evaluate the student’s work in providing better teaching while meeting education practice expectations. Meeting the expectations is not always easy for any of the parties. Successful teaching is a complex process that requires not only expertise in clinical content but also positive personal attributes. However, I adopted reflective practice to Catherine as it can be focal notion dealing to professional development in nursing that has facilitated self-assessment of competence through reflective practice integration (cited in, Spouse 2003; 2004).  The technique known as narrative reflection, I have narrated to Catherine such approaches that she needs on a further weight knowing that narratives does provide important opportunities for uncovering nursing practices that often go unnoticed and innovative appreciation of the knowledge and skills of clinical practice as being embedded in practice and provide ways for knowledge and practice to be linked together into a meaningful dialogue that promote interpretation and reflection stance. As a mentor it is a must for me to be aware and understand the learning process that is ideal for Catherine. Research into the affective mode of continuing education fuelled research investigation into how learning explains changes in practice and the one assumption is through self directed learning and it is imperative that the student can surpass such stages as discussed (cited in, Bennett and Fox, 1993; Confessore, 1997) Stage 1, the learning here is directed toward understanding and estimating personal levels of need to learn upon adopting change in practice Stage 2 – certain energies are applied to learning fresh competencies needed to practice diverse process Stage 3 – acquiring learning as organized around the problems of using specific skills, altering the practice environment to increase the goodness of fit     Catherine, as a learner will amicably need to understand how she learns and how her learning strategies may improve in order to become more efficient and effective in the process. Then, I do need to understand the natural patterns of assessment learning so that I can design learning programs and experiences that complement self-directed curriculums into nursing profession where change and learning are necessary to take place (cited in, Dimmock and Lear D, 2002; Watkins and Marsick, 1993).   In addition, “professional education in general should develop in students their own conceptions and theories of the profession which allow them to generate best practice. To achieve this aim, professional education involves not only developing students’ competencies in content knowledge and professional attitudes, but also provides opportunities for students to reflect on their experience and practice in order that they might see how their practice could be improved. In fact, developing reflective practitioners has become the core element in many professional education programs such as medical, nursing and teacher education. Dewey (cited in, 1933) defined reflection as “the active, persistent and careful consideration of any belief or supposed form of knowledge in the light of grounds that support it and the further conclusion to which it tends” (cited in, p. 7).  Thus, Schon (cited in, 1987) argued that reflection should be more tied to action, so he went beyond Dewey, and characterized reflective practitioners as being able to think while acting, reflection-in-action, and also subsequently after an action, to consider what has been done, reflection-on-action. The literature indicates that reflective journal writing enhances reflection, critical thinking, integration of theory with practice, and promotes professional growth (cited in, Brown and Sorrell, 1993; Callister, 1993; Kea & Backon, 1999; O’Rourke, 1998; Patton, Sinclair & Woodward, 1997). As an assessment process, reflective journals do not only provide evidence of understanding of content knowledge, reflection, professional judgment and application, but also enhance critical self- reflection and self-awareness (cited in, Biggs, 1999; O’Rourke, 1998), and improve student assessment performance (Conner-Greene, 2000)’’, (cited from, Tang, 2002 pp. 1-5)           Facilitating Learning Assessment   Learning assessments do play an important role in health care as for Catherine she needs to learn more values pertaining to learning and its underlying as duly required to for the development of Catherine’s confidence and competence into the area thus, determining that opportunities is a must to take place and that I facilitated Catherine through discussion plans we will be having into a form of learning documentation and the incorporation of such evaluation in such formative structure upon understanding Catherine behavior and personality thus, I do give suggestions to Catherine on how she can be effective driven examiner and by a targeted time, it does allow Catherine and me to acquire the needed learning and tell her to have specific goals and that Catherine should follow the following points and do take down notes   -          Introduce and discuss more about herself -          Ask about learning experience of the health care area she belongs -          Allow Catherine to write 3-4 sentences on what is the learning condition on the process before examination take place    For making the learning objective and practical experience clear to Catherine and the learning style had matched my teaching strategies was utilized accordingly and to gather evidence of learning is essential for facilitation success during feedback sessions. The process of documentation is important and that, I evaluate Catherine’s performance by summation approach of assessment as it is found at the end of such placement, where there focuses on the whole information about how much learning there is for Catherine to adopt. Then, I assess Catherine’s competency through tasking performance in providing some examinees that she will handle and observe her as an examiner if she has improved within the area successfully. Then, I told her that, she have undertaken activity on several occasions and given the understanding of why it is important to document clearly and accurately any assessment that she do. Her skills at conducting exams have improved over the last weeks and you she is now confident and demonstrate understanding at the level of good examiner (see, appendix one for standard relationship indication pointing to such development in learning)   Providing of Support and Guidance     The mentoring program allowed Catherine to move into her job far more smoothly and comfortably than if she had just been tossed in alone.  It would have been far more difficult to provide good service without the support of me as her mentor thus, certain mentoring components have been adopted in the process wherein there are:       Source, adopted from:  Kim Thiessen and Brian Buma in Mentoring the Mentors Creating a Mentoring Program Available at: http://www.wwu.edu/depts/drs/contact.htm       Schedule by asking questions as: Does the potential mentor have the time? Can the mentor and the pre-professional be paired together for a real class? Without a shared class, the mentoring process is extremely difficult  Mentor Personality/Skill asking will the mentor be a good match in terms of personality?, Does the mentor have the requisite skills for mentoring?   The experienced partner will be specially trained to be the independent lead in the mentoring process as each experienced team member will be provided with lists of introspective questions to elicit professional skill development with regular updates on Catherine’s progress. As Catherine said, mentoring allowed her to work at a pace which I could handle while still having sessions as my mentor saw things in my work which I would never have noticed, and by correcting those things I became a better examiner faster then I could have on my own. Catherine can adapt and follow the rules and regulation and be more committed and she is lucky to experience humanistic approach in her workplace where teamwork plays an important role upon observing new procedures that contribute to learning and support for Catherine’s achievement. In certain placements, media resources tend to be a few and that I do encourage Catherine to make use of the suggestions I gave because there is weight on such learning approach upon my effective and successful facilitation, I have provided needed guidance to Catherine upon the support for learning and that the earning process continue within greater heights as present with complete education and the practice of learning experience within competence applicability and that systematic paradigm approach do provide the ideal stature for Catherine and anyone who is a part of the workplace (cited in, English National Board, 2000; English National Board and Department of Health, 2001)   Furthermore, I instructed Catherine to create a reflection diary that will contain her thoughts and wishes for me as her mentor of the week long activity that we are together (in, Sumsion and Fleet, 1996), please refer to appendix two for the specific reflected diary). Thus, believing that, if Catherine set reflective writing as a task, she should know what she mean by having to make one as some students do not find it easy to write reflectively – perhaps either because they have the notion of academic writing so ingrained as a habit, teach students to write reflectively relating to assessment. However feedback is important for Catherine and myself and agreeing that mentoring assist Catherine in terms of adapting innovative circumstances and helps them to reach informed goals in life. During the process, there is guidance ideal for Catherine in support to her learning as acquired by proper education and level of competence as a core concern.   Summary   Learning to be composed student mentor is what I learn the most from the experience wherein I have made certain adjustments on how I communicate and interact to such intermittent situation wherein I should act as an ideal mentor and have understood the learning facilitation assessment and its related processes from within norms of standards and conformity and that being a mentor is not an easy role since, you have to be in rational aspect in terms of making decisions and imparting learning to others especially those within the other level of competence. Most of the reflective diaries were written from within suggested format and students will address the completion of a reflection while others adopted open format without adhering to what has been included as the concept helped me to evaluate more on my mentoring abilities for me to consider such things as possible for valuing in me as a mentor, that I should be effective no matter what, as there can be concrete evidence demonstrating achievement on the objectives into reflection on current application of theory and formulation of action plans for improvement as tit is helpful upon illustrating ample learning facilitation from within applicable aspects. Thus, it is a must for a mentor to be a good and effective listener in order to meet halfway with the attitude of a student as a focus of the mentoring agenda and that being a role model gives so much weight and relevance into professional development that astounds learning principles on direct and precise foundation and stance. Truly, proper management should play a vital part in mentoring like, time management wherein it is important to have such consideration of the things that are happening in black and white upon having a wonderful career realization in the field nursing education and study.     REFFRENCES                                                                                                                 Bennett N L, Fox R D. (1993), Challenges for continuing professional education. In: Curry L, Wergin J F, eds. Educating professionals: responding to new expectations for competence and accountability. San Francisco: Jossey Bass   Biggs, J. (1999). Teaching for quality learning at university. Society for Research into Higher Education & Open University Press   Brown, H.N. & Sorrell, J.M. (1993). Use of clinical journals to enhance critical thinking. Nurse Educator, 18(5), 16-19   Callister, L.C. (1993). The use of student journals in nursing education: Making meaning out of clinical experience. Journal of Nursing Education, 32(4), 185-186   Conner-Greene, P.A. (2000). Making connections: Evaluating the effectiveness of journal writing in enhancing student learning. Teaching of Psychology, 27(1), 44-46   Confessore S. (1997), Building a learning organization: communities of practice, self directed learning and CME. J Continuing Educ Health Professions, 17:5-11   Dewey, J. (1933). How we think: A relation of reflective thinking to the educative process. Chicago: Henry Regnery.   Dimmock V, Lear D, (2002), Facilitating Learners in Practice – A Mentors Guide. London. City University   English National Board (2000), Practice and Assessment: An Evaluation of the Assessment of Practice at Diploma, Degree and Post Graduate Level in Pre and Post Registration Nursing and Midwifery Education. London. ENB Research Highlight No. 43   English National Board and Department of Health (2001), Preparation of Mentors   Kea, C.D. & Bacon, E.H. (1999). Journal reflection of preservice education students on multicultural experiences. Action-in-Teacher-Education, 21(2), 34-50   O’Rourke, R. (1998). The learning journal: from chaos to coherence. Assessment and Evaluation in Higher Education. 23(4), 403-413   Patton, J.G., Wood, S.J. & Agarenzo, T. (1997). Enhancing the clinical practicum experience through journal writing. Journal of Nursing Education, 36, 238-240   Schon, D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey Bass   Sinclair, C. & Woodward, H. (1997). The impact of reflective journal writing on student teacher professional development. Journal of the International Society for Teacher Education, 1(1), 50-58.   Spouse J, (1996), The Effective Mentor: A Model for Student-Centred Learning in Clinical Practice. Nursing Times Research 1(2) 120-132.   Spouse J, Redfern E, (2000), Successful Supervision in Health Care Practice. Oxford. Blackwell Science   Spouse J, (2003), Professional Learning in Nursing. Oxford. Blackwell Publishing   Spouse J, (2004), Mentor Guidelines. London. City University   Sumsion, J and Fleet, A (1996) ‘Reflection: can we assess it? Should we assess it?’ Assessment and Evaluation in HE 21, (2), pp121 – 130   Tang, C. (2002) Reflective diaries as a means of facilitating and assessing reflection. HERDSA   Watkins K, Marsick V. (1993), Sculpting the learning organization: lessons in the art and science of systematic change. San Francisco: Jossey Bass   Woodward, H. (1998). Reflective journals and portfolios: learning through assessment. Assessment and Evaluation in Higher Education. 23(4), 415-423.       APPENDIX    ONE             Developing professional and constructive relationships Evidence   Standard Have high expectations of people including commitment to ensuring that they can achieve their full educational potential and to establishing supportive and constructive relationships with them.     Hold positive values and attitudes and adopt high standards of behaviour in their professional role.                 Recognise that communication is a process and encourage parents and carers to participate in discussions about the progress, development and well-being of children and young people.     Have a commitment to collaboration and co-operative working where appropriate.     Manage student behavior constructively by establishing and maintaining a clear and positive framework for discipline, in line with the school’s behaviour policy.     Use a range of behavior management techniques and strategies, adapting them as necessary to promote the self-control and independence of the examiner, as a learner.           Work within mentoring program and identify opportunities for working with students, managing their work where appropriate and sharing the development of effective practice with them.     Ensure that students working are appropriately involved in supporting learning and understand the roles they are expected to fulfil.               Professional skills Evidence   Planning and assessment   Standard Plan for progression across the age and ability range they teach, designing effective learning sequences within lessons and across series of lessons informed by secure subject/curriculum knowledge.     Design opportunities for the learner to develop their literacy and thinking and learning skills appropriate within phase and context.           Make effective use of an appropriate range of observation, assessment strategies for setting challenging learning objectives and monitoring progress     Provide learner and carers with timely, accurate and constructive feedback on learners’ attainment, progress and areas for development.     Support and guide learners so that they can reflect on their learning, identify the progress they have made, set positive targets for improvement and become successful independent learners.     Review the impact of the constructive feedback provided to learners and guide learners on how to improve their attainment         Developing practice Evidence   Standard Evaluate performance and be committed to improving their practice through appropriate professional development.     Have a creative and constructively critical approach towards innovation; being prepared to adapt their practice where benefits and improvements are identified.     Act upon advice and feedback and be open to coaching and mentoring.     Review the effectiveness of their teaching and its impact on learners’ progress, attainment and well-being, refining their approaches where necessary.           APPENDIX   TWO: THE REFLECTIVE  DIARY   August 2008   9.00 am          I greeted my mentor hi Sir and good morning with a cheerful smile. Mentor is feeling great and this day is my evaluation as an examiner to such nursing students. 9.30 am          I am happy and excited by then as my mentor gave me a nice smile and has asked me if I am okay and if I need anything. I told him that I am just fine in giving extra details into the examination. That’s cool he said and believes in what I do and trust me on the preceding events. 10.45 am       One student approached me and clarifies something to me, my mentor was an inch away observing me communicating with the student and giving further instruction. After, I review such examination details in order for me to in right pace. The whole process was organized and my mentor commended me for a job well done and agrees to the steps I made 11.20 am       I went for a snack break together with my mentor into the cafeteria and told me that I can be more effective if I learn the essence of learning into a more systematic way but, anyhow he is confident I will succeed in whatever way 11.52 am       He provided some significant points and I take down those points into my personal journal and he has taught me how to be effective yet objective examiner. 12.40 pm       Lunch break has come and me and my mentor went out near the area and have lunch together with his other colleague 2.15 pm         My supervisor came over to observe us and talked few reminders with my mentor. After the talk my supervisor face was calm and happy and went beside me and said congrats for a nice work. I feel good and motivated to go beyond my limitations and discover in me my potentials.                  Credit:ivythesis.typepad.com

Facilitating Learning and Assessment In Practice

Facilitating Learning and Assessment In Practice Introduction . I am a student nurse mentor and needs to tell the...

Training and Development in the Perioperative Area

Part A: Evaluation report from a critical analysis of training and development and performance management in student’s workplace.     Background of London Health Science Centre               London Health Sciences Centre (LHSC) constitutes a large teaching hospital following the merger of hospitals and clinics in London, Ontario. The focus of LHSC is the development and enhancement of knowledge and skills of healthcare workers on patient care, especially acute care through continuous learning and research. Due to research, LHSC has played an important role in discovering breakthroughs in healthcare and medicine. To facilitate learning, LHSC collaborates with universities and healthcare institutions to provide training and development for around 1,800 healthcare professionals every year. At present, LHSC comprises of a number of hospitals including South Street Hospital, Victoria Hospital, University Hospital, Children’s Hospital, and St. Joseph’s Health Care London together with a number of clinics including the Byron Family Medical Centre and Victoria Family Medical Centre. LHSC also comprise of a number of training and research institutions including the London Regional Cancer Program, Lawson Health Research Institute, and Canadian Surgical Technologies & Advanced Robotics (CSTAR). Included in LHSC are two foundations, which are Children’s Health Foundation and London Health Sciences Foundation. Due to the size of LHSC, the administrative staff and medical health workers of the organization has increased to 10,000 catering to the health care needs of one million patients visiting its hospital and clinics. As a learning healthcare centre, LHSC provides both healthcare services to patients as well as supports the training and development of healthcare professionals. (London Health Sciences Centre, 2008a)   Types of Training and Development at London Health Science Centre             LHSC provides two forms of training and development. One is practical knowledge and skills building and the other is technological training. Both forms of training target different outcomes but are complementary.             Practical knowledge and skills building is the continuation of theoretical knowledge from the academe. This time the intention is to build knowledge and skills for healthcare delivery practice. Two general groups are beneficiaries or participants of training and development. Future doctors undergo medical training at the hospitals forming part of LHSC in order to earn their license. Training and development works through experiential learning by allowing residents and fellows alike to work the frontline in delivering perioperative services (Joint Commission Resources, 2007). In addition, the resident doctors support in the training of aspiring doctors. Nurses also undergo training and development in the hospitals and clinics under LHSC as part of their academic requirements. LHSC established learning agreements with many universities and schools for the provision of academic training of future medical and nursing professionals and LHSC to sponsor practical training of students. This type of training occurs in the hospital or clinical setting and in actual service delivery via mentoring and precepting. (London Health Sciences Centre, 2008b)             Technological training involves the enhancement of the capability of healthcare professionals in utilizing innovations on technological tools during healthcare delivery. Lawson Health Research Institute together with Canadian Surgical Technologies & Advanced Robotics takes charge of technological training by engaging healthcare professionals in innovative research as well as training healthcare professionals to utilize tools such as robotics for surgery. Mentoring and precepting are also the means of implementing technological training. (London Health Sciences Centre, 2008b)             In this sense, the approach to trainings is experiential learning, which constitutes the process of enhancing knowledge by experiencing daily health service situations by healthcare professionals. This means that the interactions, relationships, cognitive processes, mentoring and precepting, and outcome assessment constitute continuous training. As a goal-based training, the intention of experiential training is for healthcare professionals to draw insights or lessons from their experience in actual healthcare settings as well as develop competence for self-assessment. (Brenner, 2004)             There are four stages in experiential learning integrated into the training program at LHSC. First stage is the concrete experience, where healthcare professionals become active participants or players in actual healthcare situations. During the stage, the trainees assess the situations to identify problems and apply the solutions. Second stage is reflective observation where the trainee ponders on the healthcare delivery experience at the personal level. Third stage is abstract conceptualization, which involves the drawing of general principles that describe the experience using theories. Fourth stage is active experimentation that involves the determination of ways in improving response or actions when faced with a similar experience in the future. The stages form a cycle so that improved responses and actions find implementation in the following concrete experience. (Brenner, 2004)             Developing the training and development programs of LHSC using the experiential learning approach involved advantages as well as disadvantages. One advantage is motivation (Brenner, 2004) on the part of trainees. The interest in training and development heightens the interests of the trainees when learning occurs at the hospital setting. The interest of trainees means better focus and perceptiveness throughout the training and development process resulting to better outcomes. Another advantage is the expansion of the knowledge and experiences of healthcare professionals in learning through practice. Most of the trainees are intern doctors or graduating nurses who have yet to experience a number of healthcare situations. Every practical experience becomes part of the experience pool of trainees enriching their professional practice. Last advantage is the shift in the polarization of the role of teachers or trainers (Brenner, 2004). In the traditional learning setting, the focal point in learning is the teacher giving instruction. However, in experiential learning the focus shifts to the middle making the participation of trainers and trainees equally important with trainers providing mentoring and precepting while trainees explore knowledge through guided participation. These advantages support the achievement of the goal of LHSC to enhance continuously the knowledge and skills of healthcare professionals to address emerging healthcare issues and contribute to the resolution of long-time healthcare dilemmas. However, there are also disadvantages, or rather areas of weakness that requires consideration for effective training programs. One disadvantage is the reliance of experiential learning on the sufficiency of the academic or theoretical knowledge of the trainees. Experiential learning or practical experience supports training and development of healthcare professionals by augmenting the need for practice. Although, LHSC collaborates with universities and colleges to ensure that its training constitutes the continuity of academic learning, there remains the risk of insufficient academic learning that would likely lead to the failure of the training program in enhancing the practical knowledge and skills of healthcare professionals. Another disadvantage is the reliance of experiential learning on self-monitoring and evaluation. This is because learning comes from the outcome of the cognitive evaluation of the trainees to derive insights or pointers they can practice when experiencing similar healthcare situations. Not all trainees carry a strong appreciation for self-monitoring and in this case the training process may not lead to learning unless the training itself incorporates self-assessment in the process.             To facilitate the experiential learning approach, the training programs of LHSC involved two related training methods, which are mentoring and precepting. There are similarities and differences between mentoring and precepting but both support experiential learning. Mentoring refers to the one-on-one learning relationship with the mentor making a personal commitment to addressing the learning needs of the trainee (McKinley, 2004; Hayes, 2005). Due to the specific focus, the scope of mentoring covers personal as well as professional issues requiring extended period of learning. The training then involves the determination of the individual needs of the trainee and the determination of the practical situations that would address these learning needs. Precepting constitutes the learning relationship involving one or more trainees that occurs in a limited period but the scope of the learning is specific and based on practical performance or roles (Carroll, 2004). Both mentoring and precepting involves the relationship between a trainer, who is an expert in a certain field or area of expertise, and trainees with general and basic knowledge of a certain field. The difference is in the parties involved and the scope of the learning process. Mentoring involves only two people, the mentor and mentored covering broader scope of professional learning while precepting could involve more than two people covering a specific area of expertise. These give rise to the limitations of mentoring and precepting but by utilizing both in the training and development program of LHSC allowing the coverage of specific and general aspects of professional learning targeting both individual and group needs.             An example of a mentoring program is the assignment of resident doctors as mentors for interns. A number of resident doctors serve the role of mentors for interns. The scope of the mentoring program covers not only perioperative skills but also handling personal issues such as attitude towards work and balancing conflicting interests. The relationship usually lasts for a long time even after the interns achieved their licenses. A similar mentoring program occurs in the case of nurses, with senior nursing staff taking charge of students training at the LHSC hospitals and clinics in their senior year. The scope of the training is general and the relationship would likely continue especially when the students are absorbed into LHSC hospitals.             An example of perceptive program is the technical training handled by the Canadian Surgical Technologies & Advanced Robotics that trains surgeons in using robotics for surgery. A trainer who is an expert in robotics for the healthcare setting handles a group of surgeons for developing their knowledge and skills on robotics surgery. The scope of the training is specific and lasts for a defined time.             Combining mentoring and precepting covers knowledge and skills training in various areas professional practice from professional ethics to best practices in healthcare delivery.   Development and Implementation of Training and Development Policy             The goal of training and development at LHSC is to enhance the knowledge and skills of healthcare professions to take them forward in their careers (London Health Science Centre, 2008c). The development and implementation of training and development at LHSC follows the stages of learning and career development progress.             A general stage of learning considered in the development and implementation of training and development policy at LHSC involves two general stages, which according to Benner (2004) are teche and phronesis. Techne is the first stage and involves the accumulated knowledge on healthcare deliver processes. This stage of learning involves the practice of rational methods in coming up with outcomes or actualising objectives. The intention of this stage is to transcend mere disinterested understanding and draw trainees to make or do something as part of the learning process. As such, this stage involves the presentation, as an art, of healthcare professional practice. Phronesis is the second stage, which focuses on the development of practical wisdom that comes from moral thought. This process focuses on the ability of the trainees not only to decide the manner of realising an outcome but also to reflect on the outcomes. This extends beyond determining ends but also reflection on actions to achieve improvements and change. The second stage requires more time because it involves the development of habits and deliberation processes directed towards continuous improvement. In this light, the training and development policies of LHSC focus not only on techne but also on phronesis. This justifies the adoption of the experiential learning approach since the two-stage learning process necessitates practical training and development. Since the purpose of training and development is to enhance the knowledge and skills of healthcare professionals, the training and development policies cover the two stages starting with the accumulation of explicit knowledge and moves on to the development of practical wisdom.             The development of training and development policies also consider the career stages of healthcare professionals. The training and development seeks to help healthcare professionals move from their novice position to the expert position resulting to the policy of progressive learning. Healthcare professionals start out as novices, characterised by the propensity to seek out rules and guidance for action to handle new experiences and address newly experienced issues. Rules and guides serve as the scope and limitations of actions. Student nurses and interns are novices in the healthcare profession. As novice healthcare professionals accumulate practical knowledge and experience, they move to advanced beginner, characterised by seeking of both strategic as well as context-based knowledge. In this stage, there is also already awareness of the situations when rules are broken but learning accumulated from breaking rules in actual practice with awareness of exceptions and choices. As healthcare professionals accumulate the ability to handle issues emerging from professional practice, they advance to the competence stage. At this point, the trainees start to develop skills for self-monitoring of their performance and decision-making during practical situations. During this stage, the trainees consciously ponder about their actions in various practical situations and base decisions on experience-based insight. Further advancement propels healthcare professions into the proficiency stage. With years of experience and accumulated wisdom in healthcare practice, healthcare professionals develop enhanced utilisation of intuition and implicit knowledge to be able to read learning situations with ease and perceive the linkages and explications emerging from healthcare situations. With further learning, healthcare professionals proceed to become experts, characterised by the ability to understand and assess healthcare situations automatically and fluently. This stage involves full adaptability to the healthcare profession resulting in higher degrees of control over situations.             The training and development policies at LHSC combine the factors of learning and career advancement stages. On one hand, developing training and development policies based on the integration of these stages supports positive results for both healthcare service delivery and healthcare professionals. Progress in learning with career advancement indicate quality healthcare service because continuous learning means the better ability to handle various known and unknown healthcare situations that works for the benefit of patients and hospital management. Progress in learning coinciding with career development also benefits healthcare professionals in terms of motivation and job satisfaction that in turn translate into the voluntary and conscious effort towards self-improvement (Joint Commission Resources, 2005). As such, the integration reflects the strategic plan of the training and development at LHSC to enhance the knowledge and skills of healthcare professionals to get them ahead in their careers.             On the other hand, there are also complexities and difficulties in integrating these learning and career development stages in training and development policies. One problem is the possible disparity in the transition periods for learning and career development. The disparity has adverse impacts more on the motivation and job satisfaction of healthcare professionals. (Joint Commission Resources, 2005) This could be because of the strong reliance on the voluntary action of healthcare professionals. The success of training and development policies strongly relies on the initiative and participation of the trainees. This means that if trainees do not have a strong desire for training and development to improve their performance and support career advancements, then the training may not achieve the stated purpose. This implies the link between human resource management and training and development. Human resource management encompasses the motivation of healthcare personnel to develop strong links with the healthcare profession to support self-conscious learning and performance assessment, which are important to the success of experiential training and development.  Another problem is the determination of the appropriate standard performance assessment in working with a multi-level progression system in training and development integrating both the stages of learning and career development.   Personnel Performance Review Strategies             LHSC implements three categories of personnel performance review strategies. These performance reviews are multi-level covering the three levels of healthcare positions.             First, comprise of senior forms covering the assessment of the performance of senior healthcare staff made by attending consultants. There are five types of evaluation forms requiring completion throughout the duration of the junior training including the following: 1) weekly performance feedback form completed by the senior while on rotation and observance of junior performance 2) senior in-training evaluation report covering the completion of clinical rotation and reviewed with the senior 3) research in-training evaluation report completed after a research rotation 4) witnessed communication form completed while on rotation 5) workplace performance form covering the attitude and behaviour of the senior healthcare personnel and sent as a report to the program director   In the case of senior trainees, there is also the preceptor form, completed by the junior residents after a clinical rotation covering their preceptors. All information from juniors is for tabulation and reporting to the seniors via the Program Director. This means that while the seniors are undergoing training, part of the training is also handling preceptor role for junior healthcare personnel. Training is in itself handling training for subordinates. There is also the RCPSC FITER or the evaluation form filled-up by the Residency Training Committee covering the competencies of the trainee after completing residency. This report ties up the evaluation for the performance of senior healthcare personnel. (London Health Science Centre, 2008c)             Second, consist of the evaluation form for junior officers, particularly the junior in-training evaluation report for completion by the attending consultant after observing the clinical rotation. The attending consultant discusses the result of the evaluation report with the junior healthcare personnel. (London Health Science Centre, 2008c)                Third, comprise of the preceptor form, this time covering the evaluation of the attending consultant by senior and junior healthcare personnel. Completion of the evaluation occurs after the end of the clinical rotation. Tabulation of all filled-up evaluation forms follows before sharing the report to the consultant via the Program Director. Sharing of the report to the attending consultant by the Program Director occurs annually. (London Health Science Centre, 2008c)             Overall, the personnel review of LHSC revolves around a top-down and bottom-up feedback system that allows the trainer to provide feedback on the trainee and vice versa. The trainee can discuss feedback from the trainer openly. A panel also considers individual evaluations together to ensure objectivity before reporting the outcomes to the party under review.             The performance review strategies of personnel at LHSC encompass but transcend the components of the traditional performance measures. Traditional performance measures include the following:   Measures Coverage Targeted Objective 1) input Use of resources Service production 2) output Resulting service Service production 3) activity Activities involved in production Service production 4) efficiency & productivity Amount of service delivered Service production 5) service Addressing customer service needs Service Delivery 6) quality Assessment of errors and feedback Service Delivery 7) explanatory Sharing of information and exchange of feedback Service Production-Delivery Link 8) outcome Accomplishment of goals Service Delivery   These measures find expression in the evaluation criteria in the senior, junior and attending consultant preceptor form. Input measures comprise of the initial knowledge and skills of personnel. Output measures comprise the healthcare services such as consultation and treatment contributed by personnel. Activity involves the processes translating the knowledge and skills to consultation and treatment. Efficiency and productivity refer to the types of consultation and treatment capabilities of personnel as well as patients served during the evaluation period. Service focuses on the ability of consultation and treatment services to address the expectations of patients. Quality targets errors and weakness areas of personnel. Explanatory measures focus on sharing of information and sharing of feedback in a one-way communication and/or two-way discussion. Outcome covers the goals accomplished by personnel. (Hatry, 1999; Joint Commission Resources, 2004)             By incorporating all these elements into the personnel review process, the review strategy of LHSC reflects its strategic plan. LHSC has six strategic directions. First is to develop and enhance excellence of personnel in caring for patients. This happens by enhancing the knowledge and skills of healthcare personnel by engaging in continuous training and development and determining fulfilment by using personnel performance measures. Second is to integrate education, research and patient care. Again, experiential learning allows the distinction of LHSC personnel in the area of education, research, and patient care and the extent of distinction through performance measures. Professional networks as well as sharing of evidence-based information through training and development supports the achievement of this strategic direction. Third is development of a progressive workplace in order to fulfil the mission and vision of LHSC for the healthcare facility and service in the community. Performance measures determine the achievement of the mission and vision. Fourth is adjustability or flexibility to the evolving role of the institution and its personnel in strengthening community-based health care delivery. By supporting the training and development of healthcare personnel together with its community partners, such as universities and community organisations, it can strengthen healthcare service to the community as shown in personnel performance evaluations. Fifth is the continuous assessment of its organisational structure in order to renew its directives as needed in addressing emerging problems. The effectiveness of the organisational structure has a relationship with the performance of its personnel and the link is shown by the assessment of the performance of personnel. Sixth is the alignment of resources with existing and changing priorities. This means readying personnel to meet impending healthcare service challenges and the readiness of personnel becomes apparent from personnel performance reviews. As such, the performance review strategy of LHSC reflects and supports the determination of the achievement of its strategic directions. (London Health Science Centre, 2008c)             In addition, the performance review strategy of LHSC also integrates feedback exchanges in practice to have a two-way review process (Joint Commission Resources, 2004) with the personnel under review able to provide feedback to the reviewer on matters subject to consultation. This differs from the traditional evaluation methods of using the performance measures in a one-way assessment. Doing so also supports the achievement of its strategic directions since change in the performance of personnel towards the strategic directions are achieved in an easier manner when there is agreement over the areas of change. The performance assessment strategy of LHSC links the training and development efforts to the achievement of its strategic directions.             Based on the description of the performance review strategy of LHSC, this appears to be a combination of aspects of balanced scorecard, performance dashboard, program logic, and benchmarking. The following table shows a comparison of different performance review methods:   Personnel Performance Review Methods Strengths Weaknesses Balanced scorecard Based on goal achievement Limited to measurable goals Performance improvement measurement model Based on goal achievement Limited to customer feedback Performance dashboard Financial & non-financial considerations Limited to strategy deployment Program logic model Collaboration-based Limited to the strategy planning stage Family of measures model Financial & non-financial considerations Limited to the service delivery stage Benchmarking Based on self-improvement Limited to long-term implementation and not suitable for measuring immediate performance   There are six general performance measurement systems with respective strengths and weaknesses, four of which find expression in the performance evaluation strategy of LHSC. First is the balanced scorecard that focuses on the extent of achievement of goals but this is limited to goals that are measurable (Kaplan & Norton, 1996) such as hours of work, number of patients, cases handled and other measurable performance factors . Second is performance dashboard that looks into financial and non-financial measures such as costs and returns from performance evaluation but limited to the deployment of strategy. Third is program logic model that focuses on the extent of collaboration among healthcare personnel but limited only during the planning stage. Fourth is benchmarking that targets self-improvement by focusing on comparative strengths and weaknesses based on best practices or standards. (Hatry, 1999)             There are two other performance measures not included in evaluation strategy of LHSC. Fifth is the performance improvement measurement that also focuses on the achievement of goals but limited to external source or feedback from patients. Sixth is the family of measures also considers financial and non-financial measures but limited only to the implementation stage. (Hatry, 1999)             The combination of performance methods provides a number of benefits to LHSC. One benefit is the focus on multiple factors including strategy planning, strategy deployment, implementation, and self-improvement to ensure a comprehensive evaluation strategy (Joint Commission Resources, 2005). Another benefit is the consideration of feedback from various parties including the person under review and external parties to ensure objectivity. However, there are still limitations, including the focus on internal feedback, either from the attending consultant or from the personnel under review but without considering feedback from patients. Another limitation is one way performance evaluation for attending consultants when the evaluation of junior and senior personnel undergoing training and development       References Benner, P. (2004). Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science, Technology & Society, 24, 188-199. Carroll, K. (2004). Mentoring: A human becoming perspective. Nursing Science Quarterly, 17(4), 318-322. Hatry, H. (1999). Performance measurement: Getting results. Washington: Urban Institute Press. Hayes, E. F. (2005). Approaches to mentoring: How to mentor and be mentored. Journal of the American Academy of Nurse Practitioners, 17(1), 442-445. Joint Commission Resources. (2004). Overcoming performance measurement challenges in behavioral health care. Oak Brook, IL: Joint Commission Resources. Joint Commission Resources. (2005). Environment of care essentials for health care: Improving health care quality and safety. Oak Brook, IL: Joint Commission Resources. Joint Commission Resources. (2007). Certification central: Health care staffing services requirements for periodic performance review. Joint Commission: The Source, 5(6), 7-8. Kaplan, R.S., & Norton D.P. (1996). The Balanced scorecard – translating strategy into action. Boston: Harvard Business School. London Health Sciences Centre. (2008a). Research and training. Retrieved October 30, 2008, from http://www.lhsc.on.ca/Research_Training/LHSC/index.htm London Health Sciences Centre. (2008b). Evaluation. Retrieved October 30, 2008, from http://www.lhsc.on.ca/programs/critcare/pge/evalu.htm London Health Sciences Centre. (2008c). Strategic directions. Retrieved October 30, 2008, from http://www.lhsc.on.ca/About_Us/LHSC/Publications/2008/3.htm McKinley, M. G. (2004). Mentoring Matters: Creating, Connecting, Empowering. AACN Clinical Issues: Advanced Practice in Acute & Critical Care, 15(2), 205-214.     Credit:ivythesis.typepad.com

Training and Development in the Perioperative Area

Part A: Evaluation report from a critical analysis of training and development and performance management in student’s workplace. B...