So far you have had the opportunity to consider the overall concept of mentorship – in particular, how this relates to supporting students on pre-registration nursing programmes. You have also been provided with an oversight to the Nursing and Midwifery Council (NMC) (2008) document that defines the standards for mentors – Standards to Support Learning and Assessment in Practice. As potential mentors in development, you are asked to pay particular attention to Stage 2, as this is the defined set of competencies required of this role.
This week will consider how learning can be optimised and what strategies you might adopt as a future mentor to maximise learning opportunities for others. Some of the work you will look at is dated – particularly that of Bloom’s Taxonomy of Educational Objectives, the origins of which date back to 1956. However, in all instances the models discussed continue to be refined and therefore remain contemporary to inform and evaluate learning.
Here’s Fiona Dobson, introducing the week’s work:
In certain activities you will have the opportunity to reflect on your practice to examine strategies that you might adopt to enhance the learning of others.
It is likely that you have come to this week’s study with experience of learning ‘in’ and ‘from’ practice. Therefore, these themes may not be new. However, as you prepare to take on mentoring roles, the focus of this week on models or tools to enhance learning will provide resources that you might adopt to increase your effectiveness in supporting others.
If you are completing this course as part of an NMC mentor preparation programme, the materials and activities in this week’s study relate primarily to the following NMC domains:
You should have already registered on KG006 Facilitating learning in practice: mentorship portfolio assessment, or be preparing to do so. KG006 requires you to build evidence within a portfolio to demonstrate achievement of NMC mentor competencies. You are advised to consider using the learning activities included in this week’s study in your portfolio as sources of evidence to demonstrate achievement against required competencies.
After this week, you should be able to:
You are constantly exposed to opportunities for learning, although you may not always recognise them as such. Think back to a time when you were a student; perhaps a student of nursing. It is probably easier to detail the learning that came from formal and explicit learning activities – such as a teaching session that a more experienced practitioner offered to explain some clinical skill – than to pinpoint the informal learning that can occur if you reflect on interactions that you are involved in.
Before you look at some theory that underpins learning, spend a few minutes on Activity 1, which asks you to consider learning from recent occurrences. You do not have to focus on learning from healthcare practices – although please feel free to use such examples if relevant.
Start by selecting one or two examples of activities that you have recently been involved in that were new experiences for you. You might want to keep a record of your comments to this activity in a notepad so that you can revisit your responses later, if you find that helpful.
For each activity respond to the following statements or questions:
As author to this week’s material, recently I witnessed a newly registered nurse being supervised giving intravenous medication – on this occasion to a patient who was in severe pain and had not responded to previous oral drug medication (I assume) to alleviate or control his symptoms. By the time he had his medication reviewed and a stronger drug (this time intravenous) prescribed, he was agitated and distressed. He was also pleading for the staff to leave him alone and allow him to sleep, as he stated he was exhausted. Although I witnessed this from the periphery as an observer, there was every indication that he was not prepared to play the role of the compliant patient. Indeed, I would argue that his distress and agitation offered richness to the learning that would not have been possible with a more compliant patient.
Into this mix the nurse was seeking to develop and demonstrate new skills of competence in administering intravenous therapy. From my observation point, I did not see the process and potential learning associated with the preparation of the intravenous drug, nor any discussions that followed the actual administration of the drug; but what I saw was an impressive demonstration of multiple skills at the bedside, many of which could be transferred to other caring interventions. For example, I witnessed skilled interpersonal skills that sought to calm the patient, carefully explaining how this medication was designed to be more effective than that previously used. I also saw a willingness to allow sufficient time for questioning and sharing of concerns. The reason for supervision was explained fully, and there was evidence of care and attention being given to the intravenous drug administration procedure and record-keeping. I was confident that the knowledge of intravenous drug administration was demonstrated, along with recognition of person-centred needs and understanding of the drug itself.
During your assessment of a learning activity, did you map out the process of learning as a series of steps akin to that of a learning curve, or classify the learning under common themes – such as knowledge, understanding and skills?
Whether you are learning for yourself or supporting others to learn, learning does not occur as a straight progression – it is often viewed as a process that contains growth, peaks, troughs and plateaus (Atherton, 2013a). You might have reflected a little on this in Activity 1, especially as you considered inhibitors to learning. Atherton (2013a) depicts a typical learning curve in Figure 1.
Such a curve is probably easier to plot out for the large skills learnt during life, although a similar pattern would probably emerge if we were to examine in microscopic detail the learning from the many small skills that we constantly engage in.
This illustration of the learning curve immediately took me back many years when I was learning to drive. I remember starting with so much confidence and enthusiasm – grasping and running with every suggestion that my instructor offered and making tremendous progress in the early weeks. I also remember struggling with hill starts and becoming very frustrated because I could not master this skill. To this day I still avoid driving in areas that require hill starts if possible. I believed I had reached the peak of my confidence and was performing competently when I entered my driving test only to have hopes dashed when I failed the test at the first attempt. Having to pick myself up and rekindle the earlier enthusiasm and confidence was essential in order to prepare for a subsequent test (this time successful!). During the development of that skill I could identify with all stages of the depiction above – the fast and slow learning, and the peaks, plateaus and troughs.
The following activity allows you to plot out your learning against such a curve.
In your notebook, and using one of the selected learning activities that you explored in Activity 1, draw a graph with time on the x-axis and competence on the y-axis, as shown in Figure 1. Next plot out your learning as you developed increasing competence in the intervention. Focus on all aspects of this learning curve, i.e. any upward trajectories, plateaus, troughs and declines in the learning that occurred.
What pattern emerged?
Your diagram is likely to be different to Figure 1; indeed, if you were to select another activity; it would be different again. What you are most likely to have drawn, however, is a learning curve that is not perpendicular but one that has many twists and turns. Were you able to identify any circumstances that clearly affected your ability to progress – for example, any unhelpful feedback or comments from others? Students that you support will themselves be on a learning pathway towards competence. If you found aspects of behaviour unhelpful, it is likely that those you mentor in the future will also be similarly challenged.
It is perhaps also worth remembering that although you will be supporting others to seek consistent and competent practice at a level indicative of their development, students will also experience periods where their confidence plateaus or dips. You might wish to consider how you might react to this so that you can provide the most effective support to enable, encourage and nurture their development and competence.
In the acquisition of any skill, a major focus must be on the reliability of the performance. For nursing this has to be at levels defined by the Essential Skills Clusters detailed as Annex 3 in the NMC (2010) Standards for pre-registration nursing education.
If you are completing this session as part of an NMC mentor preparation programme, you will need to be familiar with the skill levels expected of students at various points in their development, as detailed by Annex 3: Essential Skill Clusters. Remind yourself of these requirements, paying particular attention as to how the skills become more complex as the student moves through Progression Points of their pre-registration nursing programme.
The need to ensure that skills are practised reliably is particularly true as you support and assess students. Atherton (2013a) argues that any student can get it right occasionally – this is seen as beginner’s luck – but what counts must be the consistency of their practices, with progress of learning assessed against this consistency.
Developing the theme of skill acquisition, Atherton (2013a) adapts Reynolds’ (1965) model. It was originally designed to examine skill development in social work, but is transferrable to other professional groups. Reynolds suggested that learning skills was largely a matter of the learner ‘soaking in’, so that performance becomes less self-conscious as learning progresses, and that the transition from one phase to another enables the learner freedom to concentrate on other things.
Reynolds’ model of skill acquisition is shown in Figure 2, where the horizontal line represents a notional threshold of ‘competence’.
Applied to the practice of nursing, it is probably true to assume that in the early phases of this model, students are unlikely to possess the confidence to analyse their own practice thoroughly and share their insights with others. Atherton (2013a) suggests that there is often ‘mystique and fragility’ associated with the skill development in these early phases and it is not until the later phases (relative mastery and seeing the skill as second nature) where the learner might confidently share learning with others.
Now pause for a moment and consider Reynolds’ model.
Select a skill that you feel confident with – perhaps one that you would see as ‘second nature’. If relevant, you are encouraged to consider one that relates to your healthcare practice. Try to select a skill that you have developed over time and that was not the result of a one-off learning opportunity.
As a suggestion, Activity 1 used the observation of a newly registered nurse being supervised in intravenous drug administration. To get to the point of intravenous administration, much learning would need to have been undertaken – for example, around infection control, cannulation, safe drug calculations and key pharmaceutical understandings. You do not have to use this example, but try to consider a skill that has a similar rich history of development.
Table 1 can be downloaded as a Word document. Once accessed, complete the table, breaking down your selected skill against Reynolds’ phases of skill acquisition.
|Phase of skill acquisition||The detail of what was involved||Describe how you felt|
|Have a go|
|Hit and miss|
As your examples and experience are unique, it is impossible to provide a standard. ‘one size fits all’ response to this activity. But were you able to relate to Atherton’s observation that the early phases are clouded by mystique and that confidence is developed through ongoing rehearsal and reflection?
The phases in Reynolds’ model are not dissimilar to those described in the ‘conscious competence’ model: each model reflects a series of steps or routes through to possible competence. In this model, a significant feature is the focus on conscious as well as unconscious learning. Although the origins of the ‘conscious competence’ model are somewhat uncertain, the model remains essentially a very simple and helpful explanation of how we learn in stages. Very simply, learners are thought to begin their skill development at Stage 1 ('unconscious incompetence'), passing through Stage 2 ('conscious incompetence') and Stage 3 ('conscious competence'), ideally to reach Stage 4 (‘unconscious competence'). The simplicity of this model reinforces the need to ensure that as you work with students, you need to assess their stage of development rather than make ill-founded assumptions.
An article by Chapman (2015) suggests that learners will not be able to achieve ‘conscious competence’ until they have become consciously and fully aware of their own incompetence. It goes further to suggest that failing to recognise and respond to appropriate staged learning is the ‘fundamental reason for the failure of a lot of training and teaching’. The authors argue that it is essential to establish awareness of a weakness before attempting to begin training and move learners through the stages towards conscious competence. The authors argue, perhaps correctly, that people best respond to training when they are aware of their need for it and can see the personal benefit they will derive from achieving it. If you’d like to read the full article, it’s available online.
Table 2 came from the article described above. You might be aware of other models presented in similar ways, such as the Johari Window – a tool that supports insight on levels of self-awareness. It is not appropriate to go into more detail about the Johari Window here, but a short article has been suggested as part of recommended reading for this week if you wish to follow this up further.
Stage 3: Conscious competence
Stage 2: Conscious incompetence
Stage 4: Unconscious competence
Stage 1: Unconscious incompetence
Pause again now to reflect on the value and insight that this information might offer as you prepare yourself to support and develop others in a mentor role.
Imagine you are working with a student who is on a pre-registration nursing programme. They have recently moved to your practice speciality and they have told you that they have little experience with many of the specialist skills that they expect to see. You seek to teach and evaluate their learning in a relevant clinical skill.
The skill you decide upon does not have to be highly complex; it could be, for example, blood pressure monitoring or undertaking nutritional assessments.
Once you have selected your teaching episode, complete Table 3 (which you can also download as a Word document) based on the conscious competence model to describe how you think the student might present at each stage of the model. Use the information presented in Table 2 above to guide your thinking if you consider this to be relevant. At each stage, identify strategies that you would use to move the student forward to the next stage where and when relevant.
|Stage of model||Anticipated behaviour of the learner||Your strategies for helping progress the development of the learner|
Let’s just look briefly at an example of two possible responses to this activity, with the assumption that you work with older people and that you have specialist interest in ensuring that individuals have access to, and receive, adequate nutrition. On this occasion you decide to teach the student about the importance of nutritional assessment and dietary management.
During Stage 1 (unconscious incompetence), you probably identified that you need to use time observing and questioning the student on what they do or don’t know. Fundamentally you find that at this stage, the student appears to know little about the special needs of the older person related to nutrition. You see no evidence of any assessment being undertaken on the suitability of food offered, nor of their health history, the condition of the mouth or any feeding challenges associated with impaired physical ability or weight. Your responsibilities at this stage are about ensuring public safety by effectively monitoring the student, offering instruction to aid teaching and (where necessary) intervening to promote timely evidence-based practises. At this stage you probably would have identified the need for timely feedback so that learning opportunities (which may not have been recognised by the student) are provided.
Moving to Stage 3 (conscious competence), you should have suggested that you would expect to see the student demonstrate effective skills in all areas related to nutritional assessment. At this stage, you might consider the student to be rather ‘rule-based’ than demonstrating the ability to practice spontaneously; but you are confident that they are safe. In terms of your role, rather than a teacher you probably saw yourself more as a facilitator who encourages the student to arrive at a place where these practices become so ingrained that they become normal activities requiring very little thinking.
You are likely to have ongoing opportunities throughout work and life that will inform your teaching and facilitation, and determine the ways that you choose to support the practices of others. The tools you have explored so far may provide you with a framework to support and develop others. This is a core activity of mentors, regardless of where you are practising your mentoring skills.
If you are studying this resource as part of an NMC mentor preparation programme, use the reflections from this activity as evidence towards demonstration of achievement of competencies in your practice portfolio on KG006 Facilitating learning in practice: mentorship portfolio assessment.
So far you have examined what your learning development looks like and thought about tools that help you break down and define how skills are developed. In Section 4 you will look at another model – that of Bloom – that again helps you to break down learning. Bloom’s model is an important one to examine, as many programmes of study use adapted versions of this model to construct learning outcomes. These form the basis of assessment and evaluation.
The other core role of many mentors – especially those working with pre-registration nursing students – is assessment. You will be looking at assessment later in this course; however, because this week’s study is looking to the many tools or models that inform learning, it is also pertinent to examine a tool that enables you to break down the characteristics of the learning into identifiable themes (often used to categorise learning outcomes) that enable evaluation or assessment of learning to happen.
The model you will review was created by Benjamin Bloom. In 1956, while working at the University of Chicago, he developed his taxonomy (classification) of educational objectives that have become a key tool in structuring and evaluating learning.
The origins of Bloom’s work are derived from higher education and were designed to promote higher-order thinking in learning such as analysing and evaluating. Over many years this model has had an impact beyond the higher education sector and is frequently now used in schools, for example, to question and promote learning. Likewise with the students you work with, the model can help to structure your design of questions to promote and assess learning.
Before you seek to explore how Bloom’s thinking might impact on your role as a mentor, you first need to examine the theory that underpins this model.
Bloom’s model consists of three domains. When Bloom used the term ‘domain’ he was referring to set values that share similar properties. Bloom’s three domains are identified as:
The cognitive domain is the most used part of the model and the domain that is most prominent when you engage in any search on Bloom’s Taxonomy. It is also this domain that has seen the more significant modification, with Lorin Anderson (a former student of Bloom’s) changing the categories from noun to verb formats, engaging in minor sequencing readjustment of the two higher-order categories (see Figure 4) and creating a process and levels of knowledge matrix. (You could optionally explore this at the end of this week’s content if you are using this study as part of an NMC mentor preparation programme.)
The original domain reflected learning development through the thinking skills shown in Figure 3.
Anderson and Krathwohl’s (2001) adaptations are shown in Figure 4.
Note the changes in categories in Figure 4 compared with Bloom’s original proposition (Figure 3) from noun to verb formats and the minor sequencing readjustment of the two higher-order categories, as mentioned above.
The affective domain is concerned with values, or more precisely perhaps with perception of value issues, and ranges from awareness (receiving), through to being able to distinguish implicit values through analysis. This domain is represented in Figure 5.
Bloom never completed work on the psychomotor domain (Figure 6), although others have attempted to complete the model. As with other domains, what is proposed is a model of skills acquisition (like the models you looked at earlier in this study).
In many respects, the one-dimensional depiction of each domain suggests a simplicity that is probably misleading. In each domain, there is an expectation of increasing complexity and competence, whether that is in knowledge and understanding (the cognitive domain), attitudes and values (the affective domain), or in skills (the psychomotor domain).
You would probably find evidence of the use of Bloom’s Taxonomy, or an adaptation of it, in many nursing programmes across the UK. This would predominantly be seen in the construction of learning outcomes that are often expressed under headings such as knowledge and understanding, cognitive and professional skills – which all align to Bloom’s thinking. Given that learning outcomes clarify the intent of the programme and are the building blocks upon which assessment is determined and measured, the importance of Bloom’s work cannot be ignored.
At the beginning of this section, it was suggested that the model can help structure the design of questions that enable you to promote learning in others as well as serve as a platform for the assessment of learning. Let’s briefly look at that as a final activity for this week’s study.
Table 4 is an extract taken from work by Don Clark (1999) and published online. This uses the revised categories of the cognitive domain and provides examples of activities (in this case broadly focused), along with key words that could indicate whether learning has occurred at the desired level.
|Category||Examples and key words (verbs)|
|Remembering: Recall or retrieve previous learned information.||
Examples: Recites the safety rules.
Key words: defines, describes, identifies, knows, labels, lists, matches, names, outlines, recalls, recognises, reproduces, selects, states.
|Understanding: Comprehending the meaning, translation, interpolation and interpretation of instructions and problems. State a problem in one's own words.||
Examples: Explains in one's own words the steps for performing a complex task.
Key words: comprehends, converts, defends, distinguishes, estimates, explains, extends, generalises, gives an example, infers, interprets, paraphrases, predicts, rewrites, summarises, translates.
|Applying: Uses a concept in a new situation or unprompted use of an abstraction. Applies what was learned in the classroom into novel situations in the workplace.||
Examples: Applies laws of statistics to evaluate the reliability of a written test.
Key words: applies, changes, computes, constructs, demonstrates, discovers, manipulates, modifies, operates, predicts, prepares, produces, relates, shows, solves, uses.
|Analysing: Separates material or concepts into component parts so that its organisational structure may be understood. Distinguishes between facts and inferences.||
Examples: Gathers information from a department and selects the required tasks for training.
Key words: analyses, breaks down, compares, contrasts, diagrams, deconstructs, differentiates, discriminates, distinguishes, identifies, illustrates, infers, outlines, relates, selects, separates.
|Evaluating: Makes judgements about the value of ideas or materials.||
Examples: Explains and justifies a new budget.
Key words: appraises, compares, concludes, contrasts, criticises, critiques, defends, describes, discriminates, evaluates, explains, interprets, justifies, relates, summarises, supports.
|Creating: Builds a structure or pattern from diverse elements. Puts parts together to form a whole, with emphasis on creating a new meaning or structure.||
Examples: Designs a machine to perform a specific task.
Key words: categorises, combines, compiles, composes, creates, devises, designs, explains, generates, modifies, organises, plans, rearranges, reconstructs, relates, reorganises, revises, rewrites, summarises, tells, writes.
Use the following example:
You are supporting in a mentoring role a first placement student nurse who has admitted to having very limited experience of healthcare practices prior to starting their pre-registration nursing programme six months ago. The student is now on the final week of their placement and you have arranged a meeting with them to discuss their progress.
In all fields of nursing practice, one of the areas for development that needs to be met by students is that ‘people can trust the nurse to respect them as individuals and strive to help them preserve their dignity at all times’. (Domain 1: Care, Compassion and Communication). The specific skills underpinning this overarching statement (NMC, 2010, pp. 107–8) are for the student to:
Using one or more of the above statements, determine the following:
Let’s just look at the third competence statement: ‘use ways to maximise communication where hearing, vision or speech is compromised’. The adjective here is ‘use’. Looking again at Table 4, ‘use’ is part of the ‘Applying’ categorisation, i.e. that the student is able to apply what is learnt in the workplace. Although an inexact science, this is probably a fair representation of the complexity of the skills that would need to be shown to demonstrate the competence. It would definitely require more than ‘remembering’ and ‘understanding’ what to do; the application here is crucial. So in reality they are probably at Tier 3 of six in the cognitive domain at this time.
The second part of this activity asked for behaviours that might suggest competence. In considering this statement, you might, as a mentor, assess the student’s interactions with service users who have compromised aural, visual and oral functions. Did the student adjust their techniques to provide person-centred care? Were their interventions effective? Did you receive feedback from service users themselves to affirm or discredit your assumptions?
In this exercise you have only looked at one competence against one domain – that of the cognitive domain. If you are studying this course as part of an NMC mentor preparation programme, please extend this activity to look at more competencies required of pre-registration nursing students at the three progression points in the Standards for Pre-registration Nursing Education, considering each across cognitive, affective and psychomotor domains as defined on the Big Dog & Little Dog’s Performance Juxtaposition website.
This is a substantial piece of work, but will provide you with an opportunity to consider very carefully the expectations of students of nursing across levels of their programme and what you might look for when asked to support, guide and assess the student in meeting these competencies.
Well done! You have completed the last of the activities in this week’s study before the weekly quiz.
Complete the Week 3 quiz to assess your study of the facilitation of others’ learning.
As you become increasingly familiar with the tools that you have examined this week, the more confident and competent you will become in opening up relevant learning opportunities for others. In addition, the tools provide a means to pitch your questioning and direct your observations so that you are effectively able to evaluate what learning, and at what level, this learning has occurred. Ultimately this will lead to greater insights and consistency in your mentorship support and assessment of learners.
This week’s study has encouraged you to apply models of learning to your everyday practice, so rehearse and reflect on tools that help you support the development of the learning process. This practical application continues next week, where you will move from an oversight on learning to the principles underpinning mentorship itself. Week 4 is all about effective working relationships, motivating others, managing possible conflict and how you are expected to continually develop your enhanced skills as a mentor.
You can now go to Week 4.
Browne, S., Clarke, D., Henson, P., Hristofski, F., Jeffreys, V., Kovacs, P., Lambert, K. and Simpson, D. (2009) ‘How does the acquisition of skill affect performance?’ (online) in PDHPE Application & Inquiry Second Edition HSC Course, 2nd edn, Oxford University Press. Available at http://lib.oup.com.au/ secondary/ health/ PDHPE/ HSC/ Student%20Book/ PDHPE_HSC_e_chapter_Ch8.pdf (Accessed 23 February 2015). Note that this focuses on sports performance using Bloom’s model, but content is transferable.
Heer, R. (2009) ‘A model of learning objectives, based on “A taxonomy for learning, teaching, and assessing”: a revision of Bloom's Taxonomy of educational objectives’ (online) Center for Excellence in Learning and Teaching, Iowa State University. Available at http://www.celt.iastate.edu/ pdfs-docs/ teaching/ RevisedBloomsHandout.pdf (Accessed 23 February 2015).
Self Awareness (2013) ‘Understanding the Johari Window model’ (online), 10 November. Available at http://www.selfawareness.org.uk/ news/ understanding-the-johari-window-model (Accessed 23 February 2015).
Week 3 of Facilitating learning in practice was written by Julie Messenger.
Except for third party materials and otherwise stated (see FAQs), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.
The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this unit:
Figures 1 and 2: adapted from http://www.learningandteaching.info/ learning/ learning curve.htm.
Figures 3–5: adapted from http://www.learningandteaching.info/ learning/ bloomtax.htm#ixzz3NxhuUgGv
Figure 6: adapted from Dave, R.H. (1975) ‘Psychomotor levels’ in Armstrong, R.J. (ed.), Developing and Writing Behavioural Objectives, Tucson, AZ, Educational Innovators Press.
Table 2: adapted from Chapman, A. (2015) ‘Conscious competence learning model’ (http://www.businessballs.com/ consciouscompetencelearningmodel.htm
Table 4: adapted from Clark, D. (1999) ‘Bloom’s Taxonomy of learning domains’, Big Dog & Little Dog’s Performance Juxtaposition (http://www.nwlink.com/ ~donclark/ hrd/ bloom.html).
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