This week you will explore the factors that can contribute to forming a successful relationship with your students. Setting goals and challenges for them is an important part of the relationship, so your learning from last week about skill acquisition and attainment of competence is essential to determine goals that are realistic, achievable and appropriate to their stage of learning.
You will also look at aspects of the relationship that can cause conflict. Nurse mentors have to assess the students that they are supporting, so being confident to give negative feedback that is constructive and developmental is fundamental to your professional mentoring relationship.
In the following video, Fiona Dobson introduces Week 4 and reminds you about the badge quiz at the end of this week.
Welcome to Week 4 of your studies and well done for reaching the midpoint of the course.
Whatever you do in life is dependent on the relationships you have with others. Sometimes their contributions will be invisible. For example, the music that you listen to on the way to work or the vegetables that you buy on the way home. But sometimes their contributions are far more evident. Your friend’s arm around your shoulders when you’re feeling sad or the colleague at work who’s willing to put time aside to discuss a knotty problem with you.
Being an effective mentor requires you to be visible and to interact effectively with others. So establishing relationships with colleagues inside and beyond the organisation is just as important as the relationships that you establish with your students.
You’ll have the opportunity to explore this through activities during this week’s learning.
But before you move on to those activities I want to remind you that this is the week where you take the first of the two badged quizzes. This will give you the opportunity to undertake and review your learning across the last four weeks of the course. And don’t forget if you’re using this course as formal preparation to become a mentor then you must undertake the badged quiz.
If you are completing this course as part of a Nursing and Midwifery Council (NMC) mentor preparation programme, the materials and activities in this week’s study relate primarily to the following NMC domains:
After this week you should be able to:
Recent research involving students, mentees and mentors has explored and identified various elements that contribute to or undermine successful mentoring relationships (Teatheredge, 2010; Straus et al., 2013; Eller et al., 2014). The findings highlight factors that you may consider to be common sense, but this should be viewed positively. First, this confirms that there is nothing mysterious about being an effective mentor. Second, it suggests that you should be able to identify many of the components of successful mentoring relationships by drawing on your own life experiences, which may include being a student, mentee or mentor.
Watch the video produced by the NHS local learning platform, which shows two related interactions between a student and his mentor. As you watch, make a note of the factors that might make a positive impact on their mentoring relationship. Play the clip again and add any factors that you missed during your initial viewing. Keep your list of factors to hand, as you will need it again for Activity 2.
Eller et al. (2014) conducted an extensive research study with students and their mentors from various academic disciplines, including natural sciences, nursing/health sciences, engineering, and technology. Using a defined technique for achieving consensus through twelve focused group discussions, the behaviours considered helpful for effective mentoring relationships were organised into eight themes, termed key components (see Figure 1).
Refer to the eight key components identified by Eller et al. (2014) in Figure 1 and decide whether the factors that you identified from the video clip can be associated with these components. Copy out Table 1 (or download a copy) and add your observations.
|Key components of an effective mentoring relationship||Observed factors from the video clip|
|Open communication and accessibility|
|Goals and challenges|
|Passion and inspiration|
|Caring personal relationship|
|Mutual respect and trust|
|Exchange of knowledge|
|Independence and collaboration|
Were you able to add an observation against each of the components? If not, play the video again with the components in mind and decide whether there are other factors that you either missed or did not necessarily associate with effective mentoring. Add these to the table too.
Table 2 shows some possible observations, but you may have others.
|Key components of an effective mentoring relationship||Observed factors from the video clip|
|Open communication and accessibility||Jane, the mentor, is available throughout the time the student, Paul, is carrying out the observations. Jane encourages open communication by asking how Paul felt the intervention had gone. There is good eye contact between Jane and Paul during the post-observation discussion, and she uses positive prompts such as nodding and smiling.|
|Goals and challenges||Jane sets Paul a new set of goals when she explores with him whether he has sufficient information to make a decision about appropriate pain relief for the patient. She indicates the need to establish the patient’s reported level of pain and to check his wound.|
|Passion and inspiration||Jane highlights her considerable experience as a registered nurse and her real desire, even though it might sound ‘corny’, to inspire her students so that they enjoy nursing as much as she does.|
|Caring personal relationship||Paul is unsure about the best way of managing the second patient’s pain. He has no hesitation in seeking his mentor’s advice, suggesting that he values the relationship and feels supported by it.|
|Mutual respect and trust||Paul appears to be comfortable when discussing aspects of care that he has initially missed. This indicates that he believes Jane will not respond in a punitive way. Instead, she will enable and encourage him to find solutions to his patient’s pain problem. Jane gives Paul pointers as to his next actions, but she trusts him to know how to assess the patient’s pain level and to check his wound. She trusts and respects that he will carry out the interventions correctly.|
|Exchange of knowledge||Jane discusses the process of recording observations with Paul, which enables him to highlight what he knows – for example, the importance of a strong, regular pulse, and that removing the patient’s arm from his sleeve rather than rolling up the sleeve might have been a better alternative.|
|Independence and collaboration||Jane allows Paul to carry out taking the blood pressure without interruption, encouraging independence. They work closely together to determine the best approach for managing the second patient’s pain.|
|Role modelling||Jane explains to the first patient that she is there to observe the student, thus role modelling the importance of offering explanations to patients. Paul mirrors this approach by explaining to the patient the outcome of taking his pulse manually. Jane consistently presents herself in a professional manner, both in appearance and behaviour. She demonstrates a calm, assured approach that reassures the students she supports.|
The components identified by Eller et al. (2014) provide a comprehensive insight into the essentials of an effective mentoring relationship and it is likely that you have been able to attribute all of your observed factors to one or more of the components. However, perhaps you have one or two observations that don’t seem to fit very well, or at all. Reading other papers about the nature of mentoring relationships will offer alternative insights and broaden your thinking. Teatheredge (2010), for example, emphasises the importance of reducing student anxiety as a key function of the mentor relationship, whilst Wilson (2014) identifies protecting the student from danger as an integral component.
In Activity 2, you may have identified another key component (Eller et al., 2014) that appears to be missing from the effective mentoring relationship: assessing competence. In many professional spheres this is not typically seen as a function of the mentor role. However, the NMC (2008) specifies ‘assessment and accountability’ as one of the eight domains that nurse and midwife mentors must be competent in, and this specific issue is addressed in Weeks 6 and 7.
If you are studying towards an NMC mentor qualification, you should be allocated a nursing student to support in practice. Now you have finished learning about mentoring relationships, you might work through the following suggestions in the practice setting, in order to provide evidence for your portfolio against the NMC domain:
At the end of the first five days of your time together, write a reflective summary that explores how you feel you have addressed the eight key components of an effective mentoring relationship, giving examples.
If there are components that you haven’t addressed yet or that you feel haven’t gone particularly well, you can focus on these as the relationship continues.
As your time together nears its end, seek feedback from your student about the achievement of the eight components. What worked well, what could have been approached differently and what would your student have liked more or less of?
Using this feedback, return to your original reflective summary and reconsider the effectiveness of your mentoring relationship. Add any additional examples, thoughts or feelings to your summary to show how your approach to the mentoring relationship has developed or changed.
Identify the one key component that you feel was the least well developed in this relationship and that you will focus on the next time you are supporting a student.
The way in which you communicate with your students or mentees is fundamental to your mentoring relationship. You may already have well-honed communication skills developed through life experiences including your work role or roles – but if you haven’t thought recently about the factors that make for good communication, now is the time to review these.
As you know, effective communication involves both verbal and non-verbal skills. Although the words that we use and the speed, rhythm and pitch at which we speak all serve to support the meaning and clarity of our communication, it is often our non-verbal skills that will enhance or detract from this clarity.
Watch this short video from YouTube, created by About.com, to remind yourself about the various aspects of non-verbal communication.
In case you need a prompt for future reference, the eight points are:
Being aware of and deliberately using your non-verbal communication skills can make your relationship with your students much more rewarding for them and less stressful for you. In the video in Activity 1, Jane’s facial expressions and gaze are welcoming and indicate enthusiasm; she also uses gestures of positive reinforcement such as nodding and the pitch and rhythm of her voice to create a sense of calmness, suggesting there is ample time for discussion.
One of the mentors who participated in Wilson’s research study into the experiences of mentors commented, ‘I’ll have my approachable face on so people can come and find me’ (Wilson, 2014, p.315). These mentors understand the impact of non-verbal communication on their students’ emotions and deliberately employ strategies that encourage interaction. Consequently, their students feel comfortable to approach them for feedback or advice; this in turn reassures the mentors that their students are practising safely and appropriately, and that the patients/service users are therefore well cared for.
One of the most important aspects of open communication identified by mentors (Huybrecht et al., 2011) and by students (Foster et al., 2014) is the provision of feedback.
Drawing on your own experiences of giving or receiving feedback, and from reading these extracts from a paper by Clynes and Raftery (2008), answer the questions below and then read the suggested answers.
What is the purpose of giving feedback?
The aim is to offer the student insights into their performance. You can reinforce practices that are done safely and accurately, and behaviours that are productive. You can also highlight skills that need further development and conduct that is not yet sufficiently professional.
How might you give informal feedback?
You might do it spontaneously, whilst working alongside the student. This gives you the opportunity to make direct observation and enables you to relate your comments to the specific nursing intervention taking place at that time. Some students may not recognise this impromptu approach as a form of feedback. Informal feedback can also take place away from the practice setting, for example during a conversation on the way to the bus stop or back to the car park. This may be useful, but you need to be careful about confidentiality or potentially leaving the student disheartened at the end of a tiring day if you mention something that hasn’t gone too well just before setting off to your respective homes.
What is formative feedback?
This feedback usually takes place in a planned way. For example, you might arrange to meet the student every couple of weeks during their practice learning experience in order to review their ongoing progress and reflect on the strengths and limitations of what has been achieved. It should help you and the student plan the focus for the next two to three weeks of experience.
What is summative feedback?
This feedback usually takes place at defined points in a student’s practice learning journey. You will be providing a summary of all that has been achieved whilst the student has been gaining practice skills and experiences with you and the wider team, and making judgements as to whether the NMC skills and competencies have been achieved at the required level.
When is the best time to give feedback?
If your feedback is required to correct the student’s performance of a skill, it is best to do this as close to completion of the skill as is feasible. This will allow the student the opportunity to improve their performance the next time the skill is carried out.
Waiting until the end of a practice learning experience to highlight poor practice is not supportive of the student’s development and could potentially put patients at risk. It is preferable not to correct a student in front of a patient, as this can be demoralising and undermine the student’s self-esteem. However, there can be occasions when the student’s intended action will cause harm, so feedback must be immediate.
Nevertheless, there are ways in which you can still make this a positive intervention. There is a difference between saying ‘Stop, not like that!’ in a loud voice compared with a quieter interjection such as ‘Just before you do X, talk me through the possible options here’.
What factors can interfere with giving feedback?
As a nurse, your priority is always to your patients. In busy everyday practice it can be extremely difficult to find appropriate and sufficient time to provide meaningful feedback to the student. Finding time to give feedback can also be affected by periods when either the mentor or the student are on leave and so not available to either give or receive feedback.
When you consider the key components that contribute to effective mentoring relationships, it is clear that the mentor and the student may become close. As the mentor, this can make it difficult for you to give critical feedback, as you may feel that this will affect your ongoing relationship with the student.
How would you prepare to give formal feedback?
Allow sufficient time for delivering the feedback. Typically, more time is needed for summative feedback, as there are more elements to discuss. If you have to provide corrective formal feedback, arranging to do this at the end of the working day may raise anxiety in the student, who is then likely to be distracted throughout the day and therefore perform less well. Do think through how you will balance the negative aspects of the student’s performance with the elements that are done well. The student needs to leave the feedback session feeling that they have skills in place that can be built on, whilst recognising that there are particular actions that have to be taken forward immediately in order to become a safe, effective practitioner.
What elements contribute to high-quality feedback?
Asking the student to analyse their own performance of a particular intervention with a specific patient can prove to be fruitful to you and the student. The student may demonstrate to you an awareness of those elements of the skill that were delivered accurately and highlight areas where there was a lack of certainty or dexterity. This will allow you to concur with and reinforce the student’s perceptions, or suggest other factors that you feel may have been overlooked. The important point is to be specific. An overall comment such as ‘Well, that didn’t go very well’ doesn’t offer the student insight into why you felt it didn’t go well and therefore what to focus on to make improvements.
What might you do to make the provision of feedback easier?
Allow yourself sufficient time. Ensure the feedback can be given in privacy with no interruptions. You need to ensure that colleagues know that you cannot be interrupted for the next X minutes. Think through what you would like to say to the student, and also how the student might respond. Being prepared for particular types of response such as anger or crying can help you deal with these more appropriately.
The next time you need to offer formal feedback, you should think through the process first:
If you are studying towards an NMC mentor qualification, here is another activity that you might undertake in the practice setting in order to develop evidence for your portfolio, in the following domain:
Observe your student undertaking a nursing intervention and, if appropriate, review any associated records made by the student in relation to the intervention. At the end of your observation, offer feedback to your student.
Make a list of those elements of the feedback process that you feel went well, and note those aspects of the process that did not go as you intended or were missed (whether intentionally or unintentionally).
Identify what you will do differently next time to address those aspects of the process that you felt were less successful or were unintentionally missed.
Finally, give a rationale for those aspects of giving feedback that you intentionally omitted.
A recent study by Foster et al. (2014) identified that, according to students, the most frequently valued behaviours in the mentoring relationship are teaching and explaining. Clearly, these two interrelated activities contribute to students’ learning in practice, but are most likely to have a positive effect when the student feels motivated to learn. Understanding the factors that help to stimulate and maintain this motivation will influence the way in which you approach your teaching.
A well-established, tried and tested model of learning motivation is the Attention, Relevance, Confidence, Satisfaction (ARCS) model (Keller, 2008).
Keller first proposed his holistic theory of motivation to learn in 1983. His comprehensive review and synthesis of motivational literature led him to identify four conditions that need to be in place for a student to be motivated to learn:
His theory has become represented by the ARCS model of motivation to learn.
The challenge with teaching and learning in practice settings is that specific learning opportunities are difficult to forward-plan and teaching often takes place spontaneously, within the context of that moment in time. However, by thinking through activities that frequently take place within your practice environment, you can develop a range of motivation strategies that you can use when a day-to-day activity also becomes a learning opportunity for your student.
Whilst the ARCS model focuses specifically on the strategies that motivate learners to engage and achieve, there are other useful educational models that combine some of these strategies with other educational principles (Gagné, 1985). Thomas (2012) provides an excellent example of the practical application of Gagné’s ‘nine events of instruction model’, so is well worth reading if you can access a copy.
In any relationship there is always the potential for conflict or relational breakdown, and mentoring is not excluded from these problems. Ensher and Murphy (2011) describe this as ‘the dark side’ of the mentoring relationship, and list a range of behaviours on the part of both the mentor and the mentee that can contribute to such conflict (Table 3).
|Negative behaviours of mentors||Negative behaviours of students|
Ignoring mentor advice
Drawing on your own experiences within the workplace/practice environment, recall any situations that you have observed or comments that you have heard that could represent examples of negative behaviours.
Here are some examples drawn from the academic literature and from our experiences in nursing to illustrate these behaviours.
In addition to relational conflict and negative behaviours, for those of you who are studying this course in preparation to become a nurse mentor there are other types of professional conflict that can arise.
Watch the interview with Amy Johnson, an experienced mentor who identifies some of the other types of conflict that she has encountered in her role.
Write a short summary of the types of conflict that are described.
If you are studying towards an NMC mentor qualification, here is a final activity relating to this week’s learning that you might undertake in the practice setting in order to develop evidence for your portfolio, in the following domain:
Arrange a meeting with your own supervisor to discuss the types of conflict described by the experienced mentor.
Share your summary of the types of conflict described (you might do this before the meeting to give your supervisor the opportunity to consider the issues).
Discuss with your supervisor the actions or approaches you feel it would be appropriate to take for each of these conflict types.
Add these actions or approaches to your summary as a reminder of safe, effective and professional mentoring practice.
Nurses may engage in two very different types of mentoring relationship.
The first is often found among more experienced members of the nursing profession, who seek out another experienced colleague to act as a support and sounding board for their career development. These informal relationships may last for a year or longer, but typically reach a natural point of conclusion when one or both members of the relationship feel that there is no further gain to be achieved.
The second is the relationship between mentor and nursing student. This has defined start and finish points, and typically lasts for considerably less than a year. Whether you are in a mentoring relationship with a colleague or with nursing students or both, each will open you to new experiences and learning of your own. Whether you are inexperienced as a mentor or have some experience in the role, you will continue to benefit from the support and guidance of more masterly colleagues, so do seek out your own support networks.
Watch the interview with Charlie Austin, a practice development nurse at Guy’s and St Thomas’ Hospital. She describes the types of support for mentors that her own organisation has already put in place along with ideas for other types of support that might also prove useful.
Now develop an action plan for yourself that shows how you plan to address your own ongoing need for guidance. This could include identification of a personal mentor, who will continue to offer you support and feedback as your mentor role develops.
If you have identified a personal mentor, you could share your action plan with them and seek advice about other useful contacts within your organisation. Add these to your plan if they sound useful to you.
There is an increasing awareness of the support that is needed by mentors to enable them to deliver their mentoring role effectively, so you may be surprised by the opportunities that are available to assist you in forming your own supportive relationships.
You will continue to develop and refine your mentoring skills through practice and experience. At some point it is likely that your manager, a continuing professional development nurse, a clinical educator or another colleague with responsibility for organising and supporting students’ practice learning experiences, will feel that you are ready to become a sign-off mentor.
In preparation for this role you might find it useful to read through the following sections of the NMC (2008) standards in order to understand the purpose of the role and the criteria that must be met before undertaking this role:
Talk to your mentor if you have one and find out how the process of becoming a sign-off mentor is delivered within your organisation. You should add the contact details of the relevant individuals or team responsible for supporting sign-off mentor preparation to your action plan for future reference.
Now it’s time to complete the Week 4 badge quiz. It is similar to previous quizzes but this time, instead of answering five questions, there will be 15.
This week you have reviewed the importance of relationships to effective mentoring, both for yourself and for your students. In addition to exploring the key components of effective mentoring relationships you have also considered how to avoid or manage conflict associated with the relationship, the specific issues of how to give feedback as part of open communication and how to use motivation strategies to stimulate and engage students in practice learning.
Next week you will explore the learning opportunities that are available in your practice environment, so keep the ARCS model in mind because you are likely to find useful relationships between these opportunities and ways to motivate your student.
You can now go to Week 5.
Week 4 of Facilitating learning in practice was written by Fiona Dobson.
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:
Activity 3: extracts from Clynes, M.P. and Raftery, S.E.C. (2008) ‘Feedback: an essential element of student learning in clinical practice’, Nurse Education in Practice, vol. 8, no. 6, pp. 405–11.
Section 5: pages 12, 16, 17, 27 and 28 from: Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice, 2nd edn, London, NMC.
Activity 1: Locally Healthy [YouTube user] (2010) ‘Nurse mentoring on the ward’ (online), YouTube, 1 July. Available at https://www.youtube.com/ watch?v=lzyVbUOlH5s. Courtesy of NHS Local.
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