It is accepted that there are many aspects, which affect a student’s ability to learn (Hinchliff 1999), and a vast array of theory relating to learning, which can be utilised. No two students will be the same, as age and life experiences will vary, although they will have some characteristics in common (Rogers 2002). This will create a need for the mentor to be flexible and creative to facilitate learning outcomes. An understanding of a student’s preferred learning style is an area that could be explored at the start of the placement. Honey and Mumford’s learning styles cited by Downie and Basford (1998) could be utilised to create a tailored learning experience for the student. This would depend on the student knowing their preferred learning style and the mentor having the knowledge to create the right learning opportunities to suit this style. Community nursing is an ideal environment to use this theory as the student mentor relationship is usually exclusive and only one learning style would need to be catered for. This is a theory that would be useful to inform my future practice as I become more experienced as a mentor.
Valuing the individuality of students is important (Rogers 1993), but one factor they do have in common is that they are all adults. The theories of adult learners can be taken into consideration when planning to facilitate learning. This is as opposed to a pedagogical approach, which is more didactic and child centred. Knowles (1984) theory of andragogy proposes that adults are generally motivated to be self directed, drawing on their life experiences to inform the learning process. Adults are driven to learn what they feel will be important to them; this learning is most effective in real life situations, such as in clinical placements. The humanistic approach to learning as advocated by Carl Rogers (1993) has similar elements to andragogy, as well as the concept of self-directed learning and the importance of life experience, greater significance is placed on the emotional relationship between the mentor and student and the impact it has on facilitating learning. The onus to learn is placed on the student, which is facilitated by the mentor.
Whilst I recognise the importance of the principles of adult learning theory there are flaws in their use when mentoring student nurses. Rogers (1993) supports the idea of an emotional involvement and the sharing of feelings to aid learning. I feel that a relationship which allowed this would be difficult to build over two weeks, and that an emotional involvement might hinder objective assessment. To have rapport with the student is desirable but it is not necessarily inevitable, or even possible and may take longer than two weeks to build. I would argue that pre-registration students can never be totally self-directed, this is supported by the document Preparation of Mentors and Teachers (ENB/DoH 2001b), which says that they need support to identify their learning needs. Students are not fully accountable for any errors or omissions they may make (Nursing and Midwifery Council 2002b), this also has implications for self-directed learning. As a registered nurse my first responsibility is the safe and ethical care of the patient, I would be cautious about the use of any theory that jeopardised this. The nature of community nursing is mainly autonomous, to maintain safe practice second year students would be supervised at all times in patient’s homes and would therefore not have the chance to be autonomous.
Only one student is allocated to our nursing team at any one time, which could be seen as a benefit due to the amount of input the student will receive. However it could also lead to a feeling of isolation for the student who will have limited peer group support, which is usually beneficial to the student (Morton-Cooper & Palmer 2000). Quinn (2000) acknowledges that the effects of strained relationships are more evident when there are just two people involved. It is important to help the student feel part of the team by socialising them into community nursing as this may be their first clinical experience away from the ward environment (Oliver & Endersby 1994). Quinn (2000) states that prior preparation is vital to ensure the student gains the most from the placement. The reality is that contact before the placement is usually just a phone call made by the student. This is an area of communication that could be improved by compiling a welcome letter with orientation details to be sent out prior to the placement.
The first day of a placement is a significant time for the student, anxiety and stress levels may be high. Stengelhofen (1992) states that first impressions have an influence on the student’s motivation and views about the placement. The first day will set the scene for the two weeks and can be influenced by the attitude of the mentor. Being friendly and showing an interest are seen as helpful behaviours when mentoring students (Jackson & Mannix 2001), commitment by the mentor is seen as one of the most important personal attributes when mentoring students (Morton-Cooper & Palmer 2000). The commitment shown by the mentor will make the student feel welcome and enhance feelings of safety and security, which leads to a reduction in feelings of anxiety (Maslow 1970). Commitment can be demonstrated by completing the orientation to placement and setting dates for interviews in a prompt manner.
It is important that students play an active part in the learning process (Knowles 1984). The student’s own self assessment will give some indication of what they consider to be their strengths and weaknesses and provide a baseline for what they already know, which can then be built upon. The negotiation of a learning contract is one way to give students control over their learning (Quinn 2000). The learning contract should be organised early in the placement as the setting of goals gives structure and focus to the placement and allows for re-negotiation at a later date. The learning contract gives direction to students and mentors so each party knows what is expected of them (ENB/DoH 2001a). During the negotiation of the contract ideas and strategies to meet the learning outcomes can be discussed. If the student does not know what opportunities are available, valuable experiences will be missed. In community nursing, clinical practice can be gained in patient’s homes, and clinics run by nurses, but there are many other learning opportunities for the student to access to make the placement enjoyable and stimulating. Placement profiles are available from the university, but at present we do not have a comprehensive placement profile at the base. This is an area that could be developed within the team to improve orientation and identify experiences that would meet the student’s learning objectives.
Students coming to the community will already have some degree of motivation brought about by the extrinsic need to complete skills while they are in placement. Motivation has an impact on learning, students will be motivated by the need to complete their required skills but further learning will take place if they have the motivation to explore issues more deeply. Motivation is said to be either from intrinsic or extrinsic factors with intrinsic motivation having the stronger influence (Rogers 2002). Intrinsic motivation can be driven by the goal of increased self esteem, or the sense of accomplishment that will be achieved from the action (Stengelhofen 1992). Rogers (2002) states that motivation may not be strong and it is the role of the teacher to strengthen it. A sense of achievement is said to strengthen motivation, and a sense of achievement can be brought about by relating theory and practice (Hinchliff 1999), It would therefore be invaluable to look at ways to help the student integrate theory and practice. I feel that this can be achieved by identifying patients on the caseload who require care encompassing the skills that need to be completed.
Rogers (2002) talks about creating structured and purposeful learning episodes for the student, this can be brought about by linking the learning objectives to help the student plan holistic care for individual patients. By selecting a patient who has both diabetes and a chronic wound more learning opportunities become available because of the interaction of the problems. The wound will require dressing and capillary blood samples taking, both clinical skills. Further learning can be achieved by understanding how diet can impact on both wound healing and diabetes. Steinaker and Bell’s experiential learning theory (cited in Oliver and Endersby 1994) proposes five taxonomies of learning: exposure, participation, identification, internalisation and dissemination. I would encourage the student to take this holistic care one stage further and produce a health promotion leaflet or poster which would be suitable to give to the patient or carer. A higher order taxonomy would then be achieved which will lead to deeper understanding and meaningful learning which would create a sense of achievement.
Experiential learning is valued in nurse education (Milligan 1997), it is described as personal knowledge gained through an actual experience (Burnard 1990). Reflection is a main method of experiential learning and one that can be utilised to facilitate further understanding through critical thinking and problem solving. According to Knowles (1984) reflection on experience is part of a learning cycle leading to action and further critical reflection. Others are more cautious about the use of reflection. Rogers (2002) says reflection may not suit the learning style of some students while Rich and Parker (1995) highlight the problems that may be created through the use of reflection on critical incidents. Analysis of experience through reflection is the essence of adult education and mentors should ensure students are given time to reflect on their practice (ENB/DoH 2001a). This will require a degree of motivation on the student’s part and can never be demanded by the mentor (Palmer et al 1994).
The use of reflection to enhance learning became apparent to me after discussion of a reflective account from a second year student. Gibbs (cited in Palmer et al 1994) reflective cycle was used to structure the account. It concerned a visit to a patient who had multiple chronic health problems; he had been receiving twice weekly visits for a number of years. His main carer is his wife, who had previously stopped all outside help preferring to care for her husband herself, with back up from the district nursing team and the G.P. when needed. To me this had become a routine visit and I did not see the need to give the student any insight into the situation before entering the house. During the visit I noticed that the student was anxious, with little communication between the student and carer or patient. After the student reflected on the experience we were able to go through the reflective account together. The student found the visit challenging, this was mainly because of the difference in control between nursing a patient in their own home and the hospital environment. This was exacerbated by the patient’s wife answering all the questions even if asked directly to the patient. The student expressed feelings of frustration, intimidation and nervousness, the situation made her feel very
uncomfortable. She also felt that the patient’s psychological health was being compromised by his wife. I was pleased that the student had been able to share this with me as I felt this demonstrated I had been open to questioning about my practice. I had felt a little uncomfortable about suggesting she do a reflective account as this could be seen as a private experience. We were able to discuss the student’s analysis of the situation and look at the theory of nursing patients in their own homes and why his wife might be behaving in this way. This was a learning opportunity for both of us, I reflected that I had become complacent about my communication with the patient and allowed his wife to answer for him, and was able to take steps to improve this. I felt it was significant to discuss the reflective account with the student to aid learning. I recognise that nursing patients in their own homes could have a significant impact on a student’s confidence and will be able to prepare for this in future.
Conclusion
Throughout this essay I have highlighted the particular problems faced by second year pre-registration nursing students on a short community placement. I have recognised the responsibility that being a mentor brings and the impact this can have on students both negative and positive. The theory of teaching and learning in relation to adults has been examined and its application to mentoring explored. I recognise how the application of a humanistic approach to mentoring can help the student to feel valued and provide the ideal environment for learning.
I understand the importance of planning a learning experience which should start prior to the placement, and how good orientation and timely interviews show enthusiasm and commitment which reduce the student’s anxiety. The use of reflection as an aid to linking theory and practice has been explored and how meaningful learning for both student and mentor can be achieved.
I have identified areas within my own practice, which can be improved, and strategies to achieve this. I feel that being a mentor can be a mutually beneficial relationship, which will allow insights into own practice.
