Student Essay 2003

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Student Essay 2003 - The Learning

Experience of a student nurse, a critical

analysis.

Author: Emma-Louise Greenwood, Student Essay Award 2nd Prize, 2003, University of

Stirling.

Introduction

My learning throughout the first year has been helped by an unerring optimism in the value of nursing, and an appreciation that each and every daily interaction augments my experience

(Spouse 2003:200, Marris 1986 cited by Johns 2000:65). This enthusiasm, however, hascaused an inhibitory effect on my self-directed researching, and created conflict in some

placement areas. Whilst developing my role as a nurse, my activities as a person at home and

beyond have diminished, as I attempt to adjust to the demands of both domains (Spouse

2003:109). I resent distracting influences, and frequently domestic pressures restrain my

desired pace to accumulate factual knowledge. As described by Palmer et al. (1994:40), my

learning can oscillate between two extremes, ³all or nothing´. Spouse (2003:42) depicts the

student nurses¶ need to develop multi-tasking skills emotionally, mentally and physically as

they are caught between the cultures of clinical areas, peer driven University life and home.

The conflicts arising from these settings creates a disharmony, which I believe for some, may

undermine nursing as a career choice. The developmental educative process in nursing is a

sophisticated and complex combination of scientific, logical, humanitarian, communicative

experiences and psychomotor skills, designed to consolidate abilities and produce

³knowledgeable doers´ (Sajiwandani 2000:51, Slevin 1992:36, Cheung 1992:159). Level one

students are progressively introduced to models of self-assessment, for example Johns¶

Model of Structured Reflection (1993:11), patient assessment models, for example Roper etal. Activities of Living (1999). They are also exposed to many intellectual academic and practical concepts simultaneously within the multi-various placements. The learning

experience is an attempt to focus the mind, and is defined by Kolb (1986, cited by Earnshawand Dale 1994:16), as part of the perpetual cycle of reflection, generalisation and application

of any event. This process is a vital and fundamental principle in the creation of a sound, andintellectually processed evidence-base of knowledge required by Nursing and Midwifery

Council (NMC) (2002 6:8) to underpin professional nursing practice. Eligibility to practice

requires completion of the nursing curriculum and qualification, and registration with the

NMC. Throughout training, student nurses are obliged to meet educational standards,

demonstrating they are: µcompetent, health-orientated, thinking, reflective, change-receptive

and accountable practitioners¶ (Slevin 1992:31). Proof of competence comes from a

documented evidence-base, tutors, mentors, assignment and examination results, and is basedon continuum of regular assessments. It is ultimately mentors in clinical practice and tutors in

academic practice who determine level of attainment and discriminate between satisfactoryand unsatisfactory student performance (Walton and Reeves 1999:44).

The good and the not always so good: the experience in clinical placement ±

working alongside the mentor



MacLeod (1994:46-48) develops the argument that there is real value in the everyday wardexperience. There is a complex interface between the lecture-based, group learning,

intertwining with the noticing, understanding, responding in practice-based experiences.Here, the students take the initiative to interpret, participate and immerse themselves with

practical care issues under the guidance of an assessing mentor. The NMC (2002: 6.4:8)

states that as a registered practitioner, a nurse has a duty to facilitate students of nursing, to

develop their competence, that is, they have a responsibility to assist in their training. Thishowever, makes an assumption based on point 6.1, that the mentor has, to the best of their

abilities, kept-up in learning skills and competencies required to develop their own

performance. In all forms of mentored ³supervision´, the personalities and experiences of

each staff member and student will provide for different qualities of transfer of learning

(Hilgard et al. 1971, cited by Sajiwandani 2000:69). That is, for a student to recognise the

relevance of a situation, requires they have a prior knowledge or familiarity with that

experience (Spouse 2003:200). Initially, the mentor will be obliged to direct the student¶s

attention to relevant experiences and initiate the reflective process. Therefore, one of the

major influences of a student¶s learning experience is the quality and nature of mentorship

(Spouse 2003:214). Where mentors befriend students and provide good support, theylegitimise student¶s work, who in turn readily seek opportunities to participate to achieve

learning outcomes. Where this relationship is lacking, students are unable to gain access to professional practical knowledge (Spouse 2003:210). In this respect, where worst case

situations manifest and structured assistance is missing, the most helpful card in a studentnurse¶s hand, is their supernumerary status. It is the student¶s responsibility to foster better

relations or to be reassigned to a different member of staff, explore relationships with patients, colleagues as well as literature, thereby stimulating their understanding.

Communication with fellow students at this time, may also improve their commitment to

study and reduces a potential sense of isolation created by the lack of attention from qualified

staff (Spouse 2003:211). Through this reflective discussion it is commonly noticeable that

some mentors either misunderstood their role or were too preoccupied by their own

responsibilities to engage with the students on their anticipated agenda. The reflective process

on the other hand also enables the student to gain a sense of proportion. Whilst researched

academic study underpins practice, there are frequently qualifications made by nursing staff

about ward performed procedures, stating that µreal-life¶ situations employ differing methods

to those taught in the class-room. These instances challenge student¶s assumptions and

provide the impetus for further clinical reflective investigation (Spouse 2003:205). They also

serve to demonstrate the existence of multiple methods of care delivery, attuning them to

motives and perspectives of other practitioners in the health care team, indicating that other¶s,

have legitimate reasoning (Palmer et al. 1994:69). The traditional apprenticeship model doesnot fit well in today¶s nurse training. Instead, mentoring uses a form of µscaffolding¶ practice,

whereby students work alongside, are provoked to think aloud, and, where they not likely to become overwhelmed, stretched in their abilities to undertake tasks in a safe environment.

(Glen and Leiba 2002:120). The mentor, monitoring a student¶s readiness to learn and

capacity to perform, is guided by this framework. Students are not encouraged to be µtask-orientated¶ automatons (Slevin 1992:116, Hunt 1992:101). The taught nursing process µputsthe patients first¶, centrally and viewed holistically (Roper et al. 1999:13), that is appreciating

that the patient exists as a member of a social culture, who has (amongst others), a role,

status, relationships and spiritual needs (Roper et al. 1999:27). In many instances, however,

students will meet mentors who have µburnt-out¶, as a result of lack of satisfactory working

environments, long hours, diminished professional respect, and inability to cope with levels

of anxiety in a constructive manner. The burnt-out qualified staff may have experienced, over

prolonged periods, reinforced subordination from other members of the health-care team,



effectively disempowering them. Consequently, through a lack of ability to articulate, the professionals attitude alters in negative ways. These negative responses manifest themselves

in the mentor¶s loss of concern and tendancy to resort to task-allocation or respond indetatched and mechanical fashion (Glen and Leiba 2002:133, Johns 2000:197). When

students are faced with such situations in clinical settings, it is very easy to adopt a similar

approach. The student should attempt to engage staff in reflective discussion, as a means to

remind them of their own reflection, whilst acknowledging their situation, because asmentioned by Moll (1990) cited by Spouse (2003:199), there is an inextricable link between

practice and theory. Their influence on each other is mutual, and without good practice,

theory has no meaning. Theoretical understanding therefore is difficult to explore when faced

with poor practice. The benefits to the student of the continuously asessed nature of their

competence, monitored throughout the nursing curriculum, is that it is not superficial. It is not

dependent on the mood of the mentor in a busy clinical environment, or the particular

relationship between a student and a lecturer (Walton and Reeves 1999:80). It is an up-dated

measurement of progress and achievement. It encompasses real world situations, adult-

orientated problem-solving, close, (but unthreatening), supervision and is graded to the

student¶s expected ability (Walton and Reeves 1999:83). Snapshots of, and overall performance gradings, interpreted reflectively, will begin to acclimitise students to the reality

of critical ambience they can expect to find working on a ward. Students of nursing show agreat flexibility of thought, but they are not always able to articulate their anxieties, either

about study or clinical placements (Palmer et al. 1994:77). Reassurance about their work from mentors and tutors, may serve to reinforce, an otherwise dwindling, confidence and self-

awareness. The evidence-base requiring development by all student nurses differs for eachindividual (Ewles and Simnett 1999:121). It is driven by experience and a need to achieve

specified learning outcomes in clinical placement. Without reflection, and the tutor¶s

corroboration, students may remain unfocused and disillusioned by the lack of strict

guidelines to assist in creating this document. Consistent nurturing by tutors helps to convey

the complexity of the concept of underpinning knowledge. Nursing cannot happen in social

isolation and students require comprehensive acknowledgement to prevent both physical and

mental exhaustion (Palmer et al. 1994:90). Support and guided reflection provided by

mentors during placement and by tutors, preceeding, during and following placements, serve

to reaffirm the validity of the student¶s work, and to justify that they are not being used as

another pair of hands. These vital discussionary times allow the past experiences of the

student to be positively, selectively filtered and thus help in generating new strategies. As

Dewey (1933 cited by Palmer et al.1994:89), expressed, the notion of reflective learning is

primarily a willingness to learn, but further to this is a responsibility to search for meaning

within situations.

Conclusion

A qualified nursing practitioner is a professionally trained integrated member of the health-

care team. This professional education should be life-long, beginning with three years pre-registration factual knowledge and skill acquisition. As previously described there is a

symbiotic relationship between nursing¶s craft and nursing wisdom, and they are required in practice simultaneously. Despite the apparent impression given by traditional methods of

education that these categories exist seperately, for nursing they are fluidly cohesive, one

informing the other, through reflective analysis (Watts 1992:171). The elements experienced

by nursing students during their training are bonded internally together to authenticate their



practice, by unleashing possibilities inherent in the situation between patient and thetherapeutic self (Kirby and Slevin 1992:70). The following guidelines are intended to

promote improvements in the student¶s learning experience. Qualified staff who direct paceand direction of study need to encourage students in imaginative and innovative ways to

prepare them for adoption of new concepts and the flood of changes and that they will need

to make in all aspects of their life. Support such as this will guide them through the

vulnerable initial stages of their steep learning curve of level one, as echoed by thedissonance described in the first paragraph of the essay.

Guidelines

I would like to see better preparation of mentors by lecturer-practitioners within clinical

placements, in order to foster environments of positive, constructively planned activities.From this, students can gain insight to challenge their assumptions and lay-view of nursing.

In this respect, I would like those in the clinical settings to be encouraging students rather

than attempting to degrade their efforts by dismissing their academic research based interest

in the subject of nursing. I would like access to professional teaching staff in-college at all

times, especially immediately prior to and post placement. I hope for tutor liaison with

mentors more regularly within the clinical settings, serving to remind mentoring nurses that

their duty to support students is real, and linked with Higher Education Establishments. I

would like to see in-college tutors giving better, basic and consistent guidance whilst initially

developing the concepts of critical reflective consciousness and the production of an

evidence-base of knowledge thus strengthening the intellectual and practical growth of

students.

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