Practice arena as a learning environment Essay

Learning is an ongoing process of acquiring knowledge and skills. Mentoring is one main criteria being practiced in clinical setting to facilitate learning process among new learners in hospital. Effective guidance and coaching is important for new nurses to perform efficiently .Within this assignment ,i as a mentor will discuss and emphasize on learning strategies and learning styles that can be used to facilitate my mentees learning in clinical practice.

I am State Registered Nurse (SRN),a diploma holder, working for 5 years. I am working in medical surgical ward with 32 normal beds and 2 vvip beds.Mentor- mentee programme had been practiced in our hospital for newcomers with three months of probationary period. Assimilation programme will be arranged. Nurse manager will assigned a mentor for each new staff and evaluation will be done after 3 months of probationary period. Mentee will evaluated using Benner’s stages,(see Appendix 1). Mentor-mentee meeting also available every three months.All mentees will be attached with assigned mentors until they able to perform competently. My learner is my mentee (nurse A) not a real name.She is a new graduated staff nurse.She attached with me for three months.

An ample orientation about the unit and guideline on basic clinical procedure taught to her. Andrew,M and Wallis,M (1999) cited that effective mentorship is important in developing practice .In this paper i will assess nurse A basic knowledge on nursing practice and i will guide her with good direction to perform well. I choose her as my learner because she need some initial guidance and supervision to perform her tasks. Before start teaching her i ask nurse A consent to be my learner. The consent letter attached (see Appendix 2).After concern and discuss with her ,nurse A says that she want to learn on intranavenous fluid administration.

Identifying learning needs, planning and managing student experience Teaching is a process of sharing information, knowledge with another person. Freeman, D. (1989) ,define teaching as decision making process towards knowledge,skill, attitude,and awareness.Teaching will induce learning, Proper teaching include goal oriented activities which will help the learner to absorb new information to achieve their learning goals.

Effective teaching will enhance learning process.Before i start my teaching,i try to identify nurse A learning needs.I interview and discuss with her about the procedure.Based on the discussion i notice that she have lack of knowledge and in intravenous ( iv) fluid administration for patients. Before i go further i test her basic knowledge about this procedure.I prepare questions(see Appendix 3) about iv fluid therapy. Nurse A took longer time to complete the test.After marking the test,i found nurse A need to know basic knowledge on iv fluid administration and calculation. NMC (2008) emphasize nurses and midwives to keep their skill and knowledge up to date and uphold the standard of their professioanal code.

Learning will be easy if the learner shows intrest to learn. Nurse A asked me a lot of questions about the procedure. She also observe other colleagues administer iv fluid for patients. she is quite ready to learn as she is showing some intrest in learning about iv fluid administration.Showing intrest is the positive emotion that facilitate learning process.

Nurse A is an educated person with diploma holder in nursing and just graduated. During interview and discuss with her ,i assess nurse A listening skills.So it will be easy to facilitate her.While communicating with her,she pay attention and listen very carefully.Nurse A loves reading.So i can use reading material to teach her.

Nurse A prefer to learn in her own way of learning.She prefers written notes, question and answering,and also practice the procedure for several time for better understanding.Nurse A prefers cognitive approach in learning.Bloom,B(1956) explain that cognitive domain involves knowledge and development of intellectual skills. I will use cognitive approach to teach nurse A, which she feel comfortable to learn .

Self motivation is important in teaching and learning.Learners should be motivated well to absorb teaching well.I also assess her whether she is motivated or not to learn.I provide some positive reinforcement by praising
her for knowledge that

she have in iv fluid..B.F. Skinner (1953) cited that positive reinforcement will induce occurance of the behaviour.I motivate her by giving full support and guidance for her to learn. As a teacher for her,i also maintain a conducive learning environment which facilitate teaching and learning in practice .Lack of motivation can make the learner reluctant to learn.

At last, i decided to teach her in her own style,which is reflective style .Where learn by observation,notes,lectures.She also take longer time to make a decision in learning. Honey, P and Mumford, A (1982) ,define reflective style as learning from observation,listening skills.Based on Honey,P and Mumford ,A theory i will provide my learner best guidelines to achieve her learning outcome.

Planning for learning
Proper planning is essential in teaching.Learner needs proper di. Nurse A has no experience and need more knowledge on iv fluid administration.I decide to teach her with proper teaching plan.I will provide nurse A written notes ,data, discussion, demonstration, question and answer set on iv fluid administration .Before teach her ,i noted to her that i will use some teaching strategies to teach her. Nurse A feel comfortable with the teaching methods.I also explain to her that some learning theories will be used to teach her.She agreed with my decision.The teaching strategies listed below ;

1)Data or written notes
2)Behavioural approach
3)Cognitive approach
4)Answer questions
5)Demonstration
6)Discussion (group / self)
7)Practice participation
8)Computer Asserted Learning Programme

These may change in order to facilitate learning process in nurse A in her clinical practice. (see appendix 4). I encourage nurse A to ask question about if doubt. Provide feedback base for improvement in teaching .This is supported by Pashler ,H & Nepeda ,N.J.et al (2005).Feedback is a mechanism that help to determine effectiveness in communication with learner.

As a result both of us agreed with the teaching strategies that wiil utilized in achieving nurse A learning objective.My planning isto achieve nurse A learning goals,provide effective learning with flexible teaching approach.I will ensure,she is comfortable while learning.I also as a teacher will make sure teaching methods properly being utilized in teaching nurse A until she met her learning goals upon completion of this teaching.

Facilitating learning and assessment
For my understanding learning is gain knowledge from teaching, experience, behaviour and practice .Burns (1995) define learning as behavioural changes from thinking attitude and emotions of individuals. Facilitate learning is important in directing learner to reach their objectives. Learning will occur if the learner is aware of what they want to learn.As a teacher, i will promote learning by provide supervision,motivation,give constructive feedback,and a role model for nurse A, so she can develop skills and confidence in iv fluid administration. I provide my support for nurse A to learn about iv administration.I give her some notes on iv fluid therapy before start teaching.It will be easy for nurse A to learn from my teaching later on as she will have some basic knowledge on iv therapy.I give her enough time to read.

Learner attention is important in teaching .She prefer to learn in a quiet and closed room.Sometimes she loss her attention in noisy environment.I teach her in learning room which is available in my ward.I tried to maintain a conducive and supportive learning environment for nurse A to learn.I ensure regular breaks is to nurse A, so she will feel active in learning.

I also encourage her to observe other nurses administer iv fluid for patients when she is free. Shared learning is a helpful method in promoting learners knowledge. Positive reinforcement will keep the learners motivated.I always praise and her for what had been done by her. In between of my teaching i also regularly asks question based on teaching,i will praise and congratulate her if she manage to answer my question.I also give explaination on iv therapy,i prepare equipment for iv fluid administration in a small tray and i use these materials to teach her more easily. She had observe what i demonstrated to her .In between i also explain about the procedure.I demonstrated to her in a simplest way so she can understand well. Bandura (1997) ,states behaviour is learned from environment and by observational learning.

Demonstration is a best method,in teaching new learners who have no previous experience.I use iv therapy management procedure checklist(see Appendix 5).During demonstration, nurse A pays more attention on information and behaviour shown by me. So nurse A can imitate the behaviour later on .But I want her to practice more.After complete demonstration,I ask nurse A to practice on manikin.I reward her with nurse procedure book.She feel so happy and i found she is enthusiastic to learn. I give her some privacy to practice without any interruptions.

Another method that i use to teach her is assess computer for more information on iv fluid administration.She is familiar with computers.I give her few days to search for the information.Nurse A collects few information and photos regarding iv fluid management which will help to give her clear picture of the full procedure. Ajuwon,G.A.(2003),cited that internet is essential source of health information. I gave nurse A opportunity again to clarify with me if there is doubt.She also ask me few question again regarding iv fluid administration. We also arranged for one to one discussion session after working hours.Based on information that she collect,she clarify with me.Active learning will enhance self confidence and promote critica l thinking skills,which helps in decision making in learners.Immediate feedback also given to nurse so she will feel more safe and satisfied with my teaching.

Assesssment is part of teaching an its a powerful process that optimize learning.Its can be used in adjusting learning strategies.Proper assessment on learner will give clear picture about learners progress and achievement which help to identify next step in learning.Learners progress should be assessed frequently. Assessment should be continued until goal is achieved .

Before go further,i mainly focused on nurse A self awareness in learning .Nurse A saids she is able to answer questions related to the procedure.She can perform the procedure under my supervision.she had evaluate herself and she is aware of her capabilities.

I encourage my learner to take responsibility for her learning.I prepare group discussion with other collogues.Nurse A discuss and share knowledge on iv therapy with her colleagues.She also asks some related question with her collagues.Her colleagues help nurse A by giving immediate feedback.Nurse A actively involved in this session.Peer assessment promotes learning in learners.This notion supported byTopping,K.(1998).

Assessment in learning is essential because it will help the learner to improve from weakness.I came main 5 elements for assessing nurse A: 1) Why need to assess?
2) What to assess?
3) How to assess?
4) How to explain?
5) How to reply ?

I as the mentor feel ,i should assess nurse A understanding ,knowledge and skill on iv fluid administration.Ifocus on how nurse A apply her knowledge into practice.She is willing to learn and perform the task.She is aware of what need to done before,during and after the procedure.

I use demonstration method as a tool for assessment. To make my assessment more effective,i instruct nurse A to perform the procedure on manikin under my supervision.I observe she perform the procedure and how she apply her
knowledge during demonstrating the procedure.assessment had been done .Nurse A improve a lot in sense of behaviour,and knowledge.From here i know that learning had occurred.

I also check her understanding on the topic.i asks few questions on iv therapy.Nurse A able to answer all the question and take little time only to answer.This shows that she improve in time management as well.Learner should assessed well because it guide the learner to reach their goals.Based on assessment that done on nurse A,I understand that she is fit to perform the procedure.I give her opportunity to perform

the procedure on real patients.She is competent,confident and actively perform the procedure well within an expedient time periods.She also coordinated well on her task.Nurse A able to reach the learning objective,demonstrate,effectively the procedure independently at competent level.

Providing ongoing support and guidance for learner
Continues guidance and support is important in helping the learner to develop their skill and knowledge in learning.Mutual relationship between mentor and mentee will help the teacher to determine learners need and learning objective.Ongoing support and guidance should be continued until learner reach their learning goals.

In teaching nurse A ,i provide my full support by motivating her to learn.I take full charge of teaching her and help her reach her learning goals.I directed her towards her learning objective.I praise and reward her for her achievement in this learning session,which she feels satisfied.Positive reinforcement very important in optimize positive emotion.

As a teacher , i support and guide nurse A w with written notes,nurse procedure book.I also encourage her to ask me question and immediate feedback given to her. Vollmeyer,R (2005) explain learner improve after feedback.So she will feel more confident and active in learning.During this session,she also maintain good relationship with senior nurses.

I supervised nurse A perfomance everytime she practice.I never let her to perform alone.I continue supervise her until she is competent.Proper supervision can prevent mistakes from reoccur in clinical practice.Supervision will increase learners confident level.

Summary of personal and professional development in mentorship Based on this teaching session,mentoring is powerful tool and effective way to help learner progress.They should guided well. Gopee,N(2008),define mentorship as a main component in facilitate learning process.As a mentor,i support and guide her and provide feedback immediately.I also maintain mutual relationship with my learner which she feels comfortable to learn.

We set goal together,learn together towards achieving learning outcomes.We communicate each other well and maintain contact each other by responding to asked question.This encourage active involvement of the learner in learning.Nurse A mention that able to set up iv fluid administration for patient.She says she was guided well in learning and help her to achieve her learning goals.

In conclusion,i as a mentor learn a lot in teaching other people.In future i will be a good role model for my mentee and give her my full support,guidance until learning objective met.i also optimize learning by maintaining mutual relationship with mentees and keep in touch with them to dewvelop their knowledge and skills in clinical practice.

REFERENCES
Andrew,M.& Wallis,M.(1999),Mentorship in nursing:A literature review.Journal Of Advanced Nursing,29,pp 201-207.

Ajuwon ,G.A.(2003),Computer and internet use by first year clinical and nursing students in a Nigeria teaching hospital,BMC ,Medical information and decision making,3(1), p10.

Bandura ,A.(1977).Social Learning Theory.Englewood cliffs,NJ.Prentice Hall.

Bloom, B.(1956),Taxonomy of educational objectives,cognitive domain,Book 1,New York.Longman .

Burns,S.(1995),Rapid changes required enhancement of adult learning,pp 16-17.

Freeman,D(1989,)Teacher Training,Development,and Decision Making: A Model Of Teaching and Related Strategies For Language Teacher Education.TESOL Quarterly,23(1),pp 27-45.

Gopee,N.(2008) ,Mentoring and Supervision in Healthcare,London,Sage Pulications. Honey,P & Mumford,A.(1982),Manual of Learning Styles London.P.Honey.

Nursing & midwifery Council (2008),The code: Standards of conduct,performance and ethics for nurses and midwifery .London: Nursing Midwifery Council.

Pashler,H.,Cepeda,N.J.,Wixted,J.T &Pohrer.(2005).When does feedback facilitate learning of words?.Journal Of Experimental Psychology:Learning memory and cognition,31(1),pp 3

Skinner ,B.F.(1953),Science and Human Behaviour ,THE THREE PRESS ,Newyork, COLLIER ,MACMILLAN LIMITED.

Topping,K.(1998.) Peer assessment between student in college and universities.Review of Educational Research,68(3),pp 249-279 Vollemeyer,R.& Rheinberg,F.(2005).A surprising effect of feedback on Learning and Instruction,15(6),pp 589-602

STAGE LEVEL
OF PERFOMANCE
STANDARD
FOR
PERFOMANCE
ASSITANCE QUALITY
OF
PERFOMANCE

COMPETENT L5
Independent
Safe and accurateWithout
Supportive cuesIs efficient,
Competent
Coordinated

ADVANCED
BEGINNER L4
SupervisedSafe and accurateOccasional supportive cuesPerform within Reasonable
time period,
confident

NOVICE L3
Assisted
Safe and accurateFrequent verbal,physical directive cuesShows insuffiency,and Degree
of incoordination.
NOVICE L2
MarginalSafe but not alone,performing at risk,not always accurateContinuous verbal& frequent physical cuesUnskilled,ineffient, Incoordination,
NOVICE L1
DependentContinuous verbal and physical cuesContinuous verbal& physical cuesUnable to demonstrate procedure,behaviour,lack confidence
APPENDIX 1 BENNERS STAGES OF CLINICAL COMPETENCE APPENDIX 2
Dear ward sister,
For your kind acknowledgement,i am doing an assignment on facilitate learning in ans assessment in practice for my degree course.The requirements is to facilitate a learner. I am taking Nurse A(not a real name) as my
learner.Thank you for your support.

With Regards,
…………………… …………………. SN.PUANES Ward Sister,
APPENDIX 3
Questions (TOPIC :IV FLUID THERAPY)

1) List down 3 types of isotonic solution :
a)
b)
c)
2) List down the equipment that needed to set up iv fluid for patient: a) e) b) f) c) g) d) h) 3) What is the purpose of iv therapy ?

a)
b)
c)
4) Doctor order to infuse 2 pint normal saline in 24 hours.How many mls /hr to Infuse?

5) What is intravenous therapy?

6) List down common complication of iv therapy.
a)
b)
c)
7) When is the iv tubing due to be changed ?

8)What is the only fluid that being usedin blood transfusiobn?

9) What you will inspect at the solution before administer to patient?

APPENDIX 4

Learning objectiveContent outlineTeaching
method Assessment
1)Describe indication iv therapyIndication of iv therapyExplaination on purpose of iv therapyAnswer questions 2)Set infusion rate Calculate infusion rateTeach how to calculate infusion rate.Answer questions, Demonstrate on infusion pump

3)Set up iv fluid for patientSet iv drip for
patientPerform the procedure Checklist
4)Identify common complication of iv therapyComplication of iv therapyExplain the complication of iv therapyNotes Discussion

APPENDIX 5 (Checklist)
STEPS
?Check orders
?Prepare equipments
?Check the solution

1)Identify patient,greet the patient and explain the procedure. 2)Provide privacy.
3)Hand hygiene.
4)Bring prepared solution to patients bedsite.
5)Swab iv stopper
6)Connect the primed infusion set to stopper.
7)Secure the infusion giving set.
8)Regulate the infusion rate.
9)Release clamp and check for flow.
10)Observe delivery rate on the pump
11)Documentation