This essay is a critical reflection on the NMC mentor outcomes of assessment and accountability and Leadership. The changes brought about by development of nursing education was explored as well as NMC providing guidance through standards. Assessment and accountability and leadership was examined extensively. A practical observation of assessment in my clinical area was critically discussed and the exercise was appraised for what went well and challenges encountered. The writer also identified action plans for her future development as an NMC mentor.

The Nursing and Midwifery Council (NMC) has an important role of safeguarding member of the public by supporting the health care professionals on its register deliver better and safer care. Hence NMC set standards of education, training, conduct, and performance so that nurses and midwives are regulated and expected to deliver high- quality healthcare consistently throughout their careers. Nurse training has undergone some changes over the years in response to changing needs for care.

Nurse training is made up of academic and practical training to enable nurses to gain the skills required for their duties as nursing care professionals. Previously nursing training was not formalized and nurses were not respected(Thomas,2016) until in 1860 when Florence Nightingale opened a nursing training school in London. In the 1900s, nurses were taught in more hospitals but they had to give the hospitals 2-3 years of free nursing care in exchange for their training. In 1961, the Royal College of Nursing was founded and Nurses Act 1919 established the first professional register of nurses. NHS was launched in 1948 to provide free treatment for all at the point of care. Now registrants to the register are university degree holders, evolving from Project 2000 started in 1986 which moved the training of nurses out of hospitals and into universities. The change raised concerns that increasing academic content of nurses training may curtail the practical care training and nurses may become

too posh to wash

Driscoll, Allan and Smith,2009. Nurses and Midwifery Council(NMC) issued Standards to Support Learning and Assessment in Practice, (SLAiP) to ensure the concerns on the nurses’ competencies are assessed during their training by competent registrants. On clinical placements, students are provided with opportunities to gain knowledge as well as pick up and master practical skills while working alongside their mentors (Emmanuel and Pryce-Miller, 2013). Henderson,2011, agreed that learning in placements are important as practice learning is weighted fifty percent of the nursing curriculum.

The NMC described competence as the skills and ability to practice safely without the need for direct supervision(NMC,2002). Competency is important to assess the knowledge, skills, and attitude required for carrying out the task as a nurse and is the base for nursing education. Nursing practice requires the application of combined knowledge, performance, skills, values and attitudes (Cowan, Norman and Coopamah,2005). NMC has made mentors accountable for confirming that students have met or not met the NMC standards for proficiency in practise for registration.

In general terms, assessment denotes tests and examination, judgement or evaluation of written or oral coursework. Stuart,2013. Specifically, in the reference to healthcare

, Gopee 2010 likened assessment to collecting and interpreting evidence of learning and competence given by a student and making decisions on the appropriateness and quality of the evidence against pre-determined criteria.

Rowntree agreed with this and his definition was:

Assessment occurs whenever one person in some kind of interaction, direct or indirect, with another, is conscious of obtaining and interpreting information about the knowledge and understanding or abilities and attitudes of this other person. These definitions indicate assessment as being an elemental part of learning ascertaining quality, quantity, and appropriateness of learning, Gopee 2010. The

NMC places the responsibility of guidance and support for students to prepare them for registration on mentors to enable students on clinical placements to maintain a high-quality standard of practice at all times Stuart, 2013. Mentors are responsible and accountable for evaluating students’ competencies. Assessments can be used to motivate students which will impact on their attitudes and possibly reduce anxiety faced by students who are mindful that they are being watched all the time by others. Most importantly assessment can be used to support teaching and learning in the clinical placement. Students are assessed to identify their strength and weaknesses Howard 2006, to determine the extent student have achieved specified learning goals and objectives or to promote students’ future learning and progress, Allin and Turnock,2007.

My practice setting affords the opportunity for students to learn about the care of neonates. Clinical areas provide students with an ideal environment for learning, Houghton, 2016 I have a third-year nursing student, C who had just started her placement on my ward. I welcomed her to my ward and performed a local induction for her and she was introduced to the other team members. I encouraged her interacting with the patients and their families. Ali and Panther 2008 said this experience will help students develop technical, interpersonal and communication skills. Kilgallon and Thompson, 2012. As she had just begun her placement and did not have the knowledge of nursing care of neonates with hypoglycaemic episodes

I discussed with the student about my intention to give her some teaching on hypoglycaemia and she consented to being taught the topic. I asked her what her choice of desired topics was and she chose to learn about hypoglycaemia in neonates. We also agreed to a suitable place and time for the teaching. This gave me time to prepare for the session. I was able to determine the learning style of the student and provided teaching tailored to her preferred learning style. I was able to get a trained mentor to observe the teaching session and got her make comments and provide a feedback in my Mentorship Assessment observation record. The domains of learning used to assess this competency are knowledge of policy for treatment of hypoglycaemia in neonates, how to access the policy on the intranet, knowledge of the risk factors for hypoglycaemia and knowledge of the management of hypoglycaemia in neonates. The knowledge of the use of Glucoboost gel, which contains 40% glucose for treatment and control of hypoglycaemia. The nursing skills to be assessed was blood glucose monitoring from pre-feed heel pricks, monitoring total fluids or feeds requirement. Other skills assessed were the acceptable ranges of blood glucose(BM) and when interventions of the medical team are required if low BM persists. This learning provided the student the opportunity for her personal development and will hopefully increase her confidence in providing safe care for neonates with hypoglycaemia. After the teaching, I set aside some time to ask questions that I had developed to test the full extent of competence taught in the session. I asked for verbal feedback from the student and requested written feedback in a couple of days.

On reflection, the planning and execution of the teaching session. Time was needed to make give quality teaching. I had time to prepare and teaching was not spontaneous and was able to consider a topic desirable to the student. I was able to determine the learning style of the student and the teaching was tailored to that style. The student preferred visual and auditory style. The student gave a valuable feedback, she felt supported, motivated and would seek opportunities to pass on the knowledge gained to other students. A challenge that was encountered was in respect of location. The teaching was planned in the seminar room but due to staff shortage we could not leave the ward and stayed by the nurses’ station and we were interrupted by parents making enquiries and had to attend to alarms on monitors during the session. In future, teachings would be rescheduled and done in locations away from the ward or distractions. I could have done a prestudy assessment of knowledge of the student as well as post – study to assess the knowledge gained in the teaching.

According to the Thesaurus dictionary, Leadership is the ability to lead, it is an act of guiding, directing and leading others. A nurse leader like the ward manager, senior nurses and experienced nurses guide novices or student’s in the clinical area. In the clinical environment, good leadership is evident in nurses who are knowledgeable in patient care and patient needs. Thompson and Kenward, 2012.Hence in the clinical environment, nurses are likely to engage in a range of leadership activities in their daily routine. Creating and sustaining a positive learning environment for students is the responsibility of the entire nursing team. Although there are many factors that contribute to effective learning, the quality of learning is affected by the environment. Practice placement has been noted in an earlier study to be difficult to control and constantly changing (Papp et al,2003). This feature of clinical placement was experienced in the cause of this study when I had planned with an assessment activity with a student to carry out a planned admission procedure. However, the admission arrived after our shift and this teaching session was carried out instead. Studies show that students gave feedback about their feelings of vulnerability and anxiety when the environment is unpredictable, unstructured or overwhelming. Ongoing issues of staff shortages, increased workload, increased acuity or lack of mentors have aggravated students’ anxieties. This was reflected by the findings of Masoumi and Sharif in 2005 cited by Emmanuel and Pryce-Miller, 2013. Another study by Chan 2004 revealed that students’ anxieties are reduced by feelings of familiarity, acceptance, trust, support, respect, and recognition of their contribution to patient care, emotional and clinical support, opportunities to practice and teachings based on current evidence was cited by Emmanuel and Pryce-Miller, 2013.

Teaching students and novices is a vital aspect of a mentor’s role. Emmanuel & Pryce-Miller 2013. I was able to identify a learning need and responded by providing a teaching session. The feedback from the student confirms changes in her knowledge status and as a practitioner am a leader having caused change no matter how small. This model of leadership held by Thompson and Kenward, 2012. Leaders have plans and steer their teams to their desired goals Mahoney, 2001. Bray and Nettleton (2007) suggested that to be an effective mentor needs adequate preparation and teaching and assessing skills. Leaders in clinical placement should review regularly the learning opportunities available to maintain optimum learning experiences.

A mentor should be an advocate for students to access learning opportunities that meet their individual needs. The placement is obliged to assess additional adjustments necessary for students. Efforts should be made to identify the learning styles of students. I had to find the time to spend with the student immediately after the teaching to enable the student to reflect on the learning and provide feedback. I encouraged her to write a reflective piece for her portfolio. I gave feedback to her main mentor on the experience about the effectiveness of learning and assessment in practice of care of a neonate with hypoglycaemia.

My action plans for future development include liaising with the ward management a review of the student welcome pack. I noted the welcome pack was last reviewed over three years ago and some of the information is outdated. I will involve existing students in the task. This will hopefully ease their anxieties and help the mentor-student relationship set off on a good note. This will empower the old students and make them feel valued and new students will be made to feel welcome(Walsh,2014). I will also involve students in healthcare audits carried out on the ward. This will familiarise them with excellent standards of care. I will encourage students to take responsibility for their learning, seek opportunities within and out of the ward for learning. I will advocate for them to access the opportunities identified. A mentor has a responsibility to promote comfort, share ideas assist in their inclusion in ward based activities and their skill development based on honest and open communication, trust and self-respect among team members (Senge ,2006) as cited in Henderson et al,2011.

In conclusion, a student was taught the knowledge of nursing care of a neonate with hypoglycaemia while on a clinical placement. We able to identify a learning need and provided learning opportunity. This alleviated her anxieties and she gained confidence and is keen to pass on knowledge gained to other student. I was able to set professional boundaries and provide her with constructive feedback which will help her identify her future learning needs.

References

• 
  Enabling learning in
  
  
  
  nursing
  
  
  
  and midwifery practice [electronic resource] : a guide for mentors
  
  
  
  / edited by Sue West, Tim Clark, Melanie Jasper
• 
  https://www.dictionary.com/browse/leadership
  
  assessed 06/08/19

Introduction

The Department of Health (DoH) (2003) highlighted the importance for all professions currently regulated by the Health Professions Council to demonstrate competence through continuing professional development (CPD). CPD is a systematic, ongoing, structured process that encourages the development and maintenance of knowledge, skills and competency that assists us in becoming better practitioners (Chartered Society of Physiotherapy (CSP), 2003). As a result of the Health Act (1999) and for registration with the Health Professions Council (HPC), CPD is a legal requirement (HPC Standards of Proficiency, 2007) that must be completed in accordance with the (HPC) Standards of Continuing Professional Development (HPC, 2006). This essay allows for demonstration of life-long learning using evidence from clinical practice and critical evaluation to contribute to my CPD.

Learning outcome 5 will be demonstrated throughout this essay. Throughout this essay the reader is directed to the appendices to support theory with evidence of practice. I considered my motivations for undertaking CPD before writing this essay and reflected upon them again on completion (Appendix 1).

Demonstrate professional behaviour with an understanding of the fundamental, legal and ethical boundaries of professional practice.

Beauchamp and Childress (2001) identify four ethical principles; Autonomy, Beneficence, Non-maleficence and Justice. These ethical principles can be used to morally reason whether an action or decision is right or wrong when used in conjunction with a set of guidelines (Kohlberg et al, 1983). Professional codes of conduct are developed within moral, ethical and legal frameworks to help guide and regulate practice (Hope et al, 2008). Every practitioner has clinical autonomy, therefore they are professionally and legally accountable for their actions. The following will discuss the importance of consent and duty of care for both legal and ethical reasons with regards to case 1 (Appendix 2), encounterd on practice placement 6 (PP6).

Rule 9 of the HPC standards of conduct, performance and ethics (2008) states you must gain valid consent from a patient for any treatment you may perform or else you could face trial for assault, battery or negligence under civil or criminal law (Hendrick, 2002). It is a fundamental ethical priniciple that every person has a right to exercise autonomy (Article 9; Human Rights Act, 1998) and is reflected in the Core Standards of Physiotherapy Practice (CSP, 2005). Performing a procedure without gaining consent, undermines the moral priniciple of respect for patient’s autonomy and human dignity (Sim, 1986). However, inability for Patient X to conform to the Mental Capacity Act (2005) meant he was treated in his best intrest in adherance to section 1.5 of this act and Rule 1 of the HPC (2008) standards of conduct, performance and ethics.

Assuming the medical management of Patient X, a legal and professional duty of care was established (Rule 6; HPC, 2008). As part of this duty and in accordance with standard 2 of the CSP Core Standards of Physiotherapy, all interventions were explained to patient X despite his inability to consent. Had I not treated Patient X on the basis he had swine flu, this would have been failing to do justice to him, acting outside of the Disability Discrimination Act (2005) which states everyone should have equitable access to and utilisation of services regardless of disability and also Article 14 of the Human Rights Act (1998) in that no one should be discriminated against based on their health status. The Bolam Test (1957, cited in Dimond, 1999) states if duty of care to a client is breached and subsequent harm to the patient occurs, professional standards have not been kept and therefore negligence can be assumed. Although not legally binding, the CSP rules of professional conduct effectively have the same status as law and failure to comply with them means they may not only be used in disciplinary hearings but also in legal proceeding as a civil case under the tort law of negligence (Dimond, 1999; Hendrick, 2002).

In summary, a sound understanding of the legal implications surrounding consent and duty of care can help avoid unwanted litigation, however they should not undermine the ethical implications. Appendix 3 demonstrates how I have learnt from this experience.

Assess the needs of a range of service users and, with reference to current professional knowledge and relevant research, apply, evaluate and modified physiotherapeutic intervention

A service users is anyone who utilises or is affected by a registrants service (HPC, 2008). The complex needs of a service user encompass a range of issues including social, environmental, emotional and health related, the extent of which varies from person to person. For the purpose of this essay, the physiotherapeutic management of two patients treated whilst on PP6 with differing severities of chronic obstructive pulmonary disease (COPD) exacerbations (Appendix 4) will be discussed.

The National Institue for Health and Clinical Excellence (NICE) guidelines (NICE, 2004) in conjuntion with the guidelines for physiotherapy in respiratory care (British Thoracic Society (BST), 2008) advocates the use of active cycle of breathing technique (ACBT) with expiratory vibrations on the chest wall for the treatment of COPD to help aid airway clearance.

Inability for patient A to comply with ACBT indicated the use of manual hyperinflation (MHI) to passively inflate the lungs and aid mucocillary transport (Ntoumenopoulos, 2005). As identified by Finer et al (1979), atelectasis is a common problem observed in mechanically ventilated patients for which MHI has been found to be beneficial in reducing it in a well controlled clinical trial by Stiller et al (1996), scoring a PEDro rating of 6/10.

Absence of a cough reflex in patient A, resulted in sputum retention and the increased risk of infection indicating the use of suctioning (Pryor and Prasad, 2002) by which, copious amounts of viscous secretions were cleared. Shorten et al (1991) supports the use of saline instilation to loosen secretions prior to suctioining however, conflicting arguments by Blackwood (1999) and Kinloch (1999) question its effectiveness. Patient B’s compliance with ACBT replaced the need for MHI and suctioning.

Patient A developed bilateral shoulder subluxations due to his lengthy intubation for which subluxation cuffs were applied, as suggest by Zorowitz et al (1995) with positive effect. Despite this study being on stroke patients, the results can be generalised to other patient groups as proved.

The importance of mobilising patients with regards to respiratory function is highlighted by Ciesla (1996), however mobilisation of critically ill patients is restricted as they are often non-ambulatory. A high quality, randomised control trial using fifty-six participants by Mackay et al (2005), identified mobilisation as superior to other respiratory techniques, therefore Patient B was encouraged to sit out and treated using a graduated walking program. In the case of Patient B, mobilisation constitutes any change in position therefore the use of postural drainage positions and positioning into the cardiac chair setting on the bed were used (BTS, 2008).

The range of problems service users present with means practitioners need to be adaptable, drawing on current evidence, professional knowledge from different fields of physiotherpy practice and experiences through CPD to deliever indiviualised patient-centred care.

Appraise self management of a caseload and modify practice accordingly, demonstarating effective teamwork and communication skills

Caseload management typically refers to the number of cases handled in a certain timeframe by an individual for which they have a duty of care towards (Scottish Executive, 2006). It is the management of time effectively through appropriate priority-setting, delegation, and allocation of resources to meet the service demand of its users (Curtis, 2002). Self-management of a caseload and adaptability to changing circumstances is expected of a registrant (HPC, 2008).

Well developed time management skills can make a workload more manageable and improve the effectiveness of treatments and quality of time with patients. Prioritising patients to the order in which they will be seen based on their needs is encouraged by SARRAH (2010), however Nord (2002) argues whether it can be justified to prioritise those in most need if their potential benefit may not be as great as those in less need. In my experience prioritisation is dependant on a variety of factors for example, the trust where PP6 was completed, enforced protected meal times which did not run alongside staff meal times. Therefore, to prevent there being a void in the day, patients were still prioritised according to need but considertation had to be given to see patients that would be eating first and treat those that would not be during protected meal times.

It is essential to consider that a therapists workload includes not only patient care, but also admistrative and research tasks in which delegation to others can be a valuable stratergy to assist with workload mangement. Curtis, (1999), identifies the need for practioners to show greater awareness of other disciplines competancies so delegation can be more effective. Feedback systems should be enforced to ensure task completion and objectives are being met (Curtis, 2002).

Inter-professional collaboration refers to the process by which different disciplines work together to improve healthcare (Zwarenstein et al, 2009). Poor collaboration amongst healthcare professionals contributes to problems in quality of patient care and consequently poorer outcomes (Zwarenstein and Byrant, 1997). Liaison with members of the multi-disciplinary team (MDT) is encouraged by Shortell and Singer (2008) as practitioners are less likely to work off their own autonomy, ensuring patient safety, as demonstrated during handover in (Appendix 5).

The learning objectives on PP6 to develop MDT collaboration and caseload management have been achieved as demonstrated in the feedback from my educator (Appendix 6) which identifies that improvement in self confidence will allow further development of the skills discussed.

Demonstrate partnership with more junior students and/or appropriate others through the development of mentoring skills

Mentoring is a process aimed at transfering knowledge, skills and psycological support from a more experienced person to a less experienced person, where the desired outcome is for both persons to achieve personal and professional growth (Anderson, 1987). An effective mentor facilitates, guides and empowers the mentee in becoming an independent learner (Coles, 1996) in which the relationships developed are based upon mutal respect, trust, confidentiality and shared beliefs and values (Lyons et al, 1990). The CSP (2005) acknowledges the importance of intergrating mentorship into CPD, in which the mentor develops a range of skills transferable to other CPD activities. This section focuses on peer mentoring as a concept, its practice and clinical application on an informal basis.

Having identified the characteristics of a mentor (CSP, 2005), a SWOT analysis (Appendix 7) was completed to assist recognition of my personal learning needs.

There are four stages to the mentoring life cycle (Appendix 8), in which the mentor needs to adopt and develop new skills to accommodate the mentee and guide them through the process.

A qualitative study using a moderate sample size by Chan and Wai-Tong (2000) encourages the use of learning contracts (Appendix 9) to help establish rapports and facilitate autonomous learning which aids progression to stage two of the cycle. This is further supported in a recent review of the literature by Sambunjak et al (2009).

Gopee (2008) recognises the importance of analysing the mentee’s needs. Foster-Turner (2006) states that different people approach the learning process in different ways therefore, matching the learning styles of the mentor and mentee will produce a more productive and successful relationship (Mumford, 1995; Hale, 2000). Honey and Mumford (1992) suggested people tend to have a predominant learning style and can be classified as activists, reflectors, theorists or pragmatists (Appendix 10). Boud (1999) identifies raising self-awareness as an essential tool used in lifelong leaning and through analysis of learning styles using Honey and Mumford’s (1992) questionnaire, this allowed for reflection on the style of learning that would best suit the mentee to help meet their learning needs (Foster-Turner, 2006) (Appendix 11).

As identified by the learning style inventory, the mentee and myself were both reflective learners, therefore we arranged sessions where we could dreflect on a clinical experience and discuss how new learning could be applied to future events.

A feedback form from the mentee (Appendix 12) an a SWOT analysis (Appendix 13) demonstrates how through increased self-awareness and review of the literature, I have developed a better understanding of the mentoring process, the skills required and its application in into clinical practice. Developing others is central to current and desired practice (DoH, 2000a, 2000b, 2001, 2002) in which mentorship offers all the key attributes to the process. Preparation of an individual for this role, through self assessment, is central to its success, in which the skills developed are lifelong and can enable development into management and leadership roles later on in life.

Demonstrate skills of career-long learning

Lifelong learning is used synonymously with CPD and is concerned with practitioners critically reviewing their skills and knowledgebase with the ultimate goal of providing a better standard of care to all service users (French and Dowds, 2008). A recent inquest into a practitioner who did not maintain his competencies, demonstrates the possible consequences of poor CPD (Appendix 14). Appendix 15 details a range of formal and informal activities that can be undertaken to contribute towards CPD, evidence of which can be documented in a portfolio.

The importance of staff development is recognised by the DoH documents (2000a, 2000b, 2001, 2002) which sets out the Governments vision of an NHS that prepares allied health professionals with the skills to take advantage of wider career opportunities and realise their potential. By using the competency based framework; The NHS Knowledge and Skills Framework (2004), physiotherapists can participate in development reviews which identify development opportunities and contribute to the fulfilment of personal development plans.

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