Mastering Mentorship: A Practical Guide for Mentors of Nursing, Health and Social Care Students

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Julie Bailey-McHale & Donna Hart

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    Acknowledgements

    For Mike McHale (1936–2011), who gave his daughters the most precious of gifts – the courage to dare to dream. This is for you, Dad!

    For David ‘Tim’ Hart (1941–1991), who is so proud of every little thing my sister and I achieve.

    About the Authors

    Julie Bailey-McHale is a Senior Lecturer in the Health and Social Care Teaching Team, Department of Health, Isle of Man. She is programme leader for the pre-registration mental health nursing programme and leads a number of modules at levels 6 and 7 on both mental health and mentorship. She qualified as a mental health nurse in 1990 and has worked in acute inpatient and forensic settings. She moved into nurse education in 2002 and worked at the University of Chester where she developed an interest in mentorship and has pursued this interest with enthusiasm on her move to the Isle of Man. She has developed strong collaborative links across mental health services. She is currently studying for a PhD.

    Donna Hart is a Principal Lecturer in the Health and Social Care Teaching Team, Department of Health, Isle of Man. She has responsibilities for pre-and post-registration programmes and leads on a number of modules at levels 6 and 7 including public health and mentorship. She has enjoyed a career in nursing, qualifying in 1986, initially working in a surgical area before moving into the community in 1988, and qualifying as a District Nurse in 1990. She moved into nurse education in 1995 and worked at the University of Brighton as a Senior Lecturer in Community Nursing. On moving to the Isle of Man in 2000 she built on an existing interest in mentorship and has contributed to the strategic development of mentorship on the Isle of Man.

    Foreword

    I was delighted to be invited to write the Foreword for this book, which is a long overdue text linking the theoretical underpinnings of mentorship to the art and practice of it.

    It recognises the pivotal role of mentorship within the experience of health and social care students, whatever their level of study, and is particularly timely with the move of nursing to an all graduate profession at the point of registration.

    As a University Dean with exposure to students from the health, social care and other practice-based disciplines there is evidence, and anecdote, that confirms the importance of mentors in moulding and modelling the development of safe, competent practitioners and to support the development of appropriate attitudes and behaviours which underpin professional practice.

    Reports such as those produced by the recent Commission on Nurse Education, chaired by Lord Willis of Knaresborough (Royal College of Nursing, November 2012), the Prime Minister's Commission on the Future of Nursing and Midwifery (Prime Minister's Office, March 2010) and numerous reports from professional and statutory bodies all provide evidence of the importance of high quality, well-informed mentorship for students in practice. Students, in giving evidence to these commissions, said that good mentorship was the one thing that ‘made a real difference’.

    This book deals with the traditional thorny issues surrounding the compatibility, or not, of the mentor assessing student practice. The multifaceted role of the mentor is explored with the use of case studies and bravely recognises the inherent contradictions within some of those roles.

    It takes the reader through the support and key leadership needed in mentorship from organisational level through to the individual mentor and mentee. Identifying the fundamental importance of positive and productive relationships that are needed between health care providers and universities, the mentor is found at the forefront and operational end of that relationship; the cement that binds it together.

    The case studies within the book carefully illuminate important issues in a pragmatic way, offering, in many cases, helpful strategies and insights to enhance mentorship for both the mentor and mentee. The learning objectives at the end of each chapter serve to ask the reader to reflect on the content and undertake activities which develop understanding and learning.

    This book deals with the ‘how’ and ‘what’ of mentorship, as well as the context in which it is delivered. With the careful use of real world examples and exemplars it recognises the reality of balancing mentorship with the delivery of care and services to patients and clients. It offers teaching opportunities for mentor preparation and the opportunity to explore it's theoretical basis.

    Although the chapters could stand alone, they provide a rich exploration of the role of the mentor and offer insights into its complexity. The book explores the situations and challenges inherent in this important role and the many personal, professional and organisational factors which can influence it.

    For practitioners undertaking the mentorship role it offers the opportunity to develop areas of potential improvement and revisit some fundamental principles.

    This book underpins the Master's level education of those professionals, in practice, who are central in the development of the next generation of health and social care practitioners.

    In conclusion this book needs to be in libraries that support health and social care professional education, on the bookshelves and desks of professionals who take this role on, or support it, providing everything from helpful insights to new theoretical perspectives.

    Susan BernhauserEmerita Dean of Human and Health Sciences, University of HuddersfieldPrevious Chair of the Council of Deans of Health UK

    Acknowledgements

    We would like to thank the following people for their help and support throughout the process of writing this book.

    Our gratitude must go to Pauline Golding for her patience and humour through hours of proofreading and formatting. Also to our colleagues at Keyll Darree for putting up with our occasional states of distraction and helping in ways too numerous to list.

    We send heartfelt thanks to our families, Michael, Emily, Josh, Lisa, Ron and Len, and to our mums. Special thanks goes to Bex for all the love, support and patience throughout.

    Finally, to all the case study authors – thank you for your continued support of learners and for bringing to life and sharing your experiences of mentorship within your case study contributions.

    Introduction

    The old adage of George Bernard Shaw suggesting those who can, do, and those who can't, teach, is undoubtedly challenged by the role of the mentor in professional practice. Mentors in health and social care practice must not only ‘do the do’ but must also be able to teach that ‘do’. Mentors along with colleagues in practice and the wider learning organisation require passion and enthusiasm for mentorship. They also need to value and have a belief in the merits of mentorship and an understanding of the evidence to underpin this fundamental role. We hope to demonstrate these qualities throughout this book. In it we will explore the complexity of the role of mentor, preceptor and supervisor, as well as celebrate the mastery required to perform this role well. At its heart is the desire to demonstrate that mentors utilise Master's level thinking skills in the advanced practice activity of mentoring in professional education. As health and social care professions negotiate their way through the second decade of this century they will continue to look for innovative and effective ways to teach the art of their professional practice.

    The move to a degree-only preparation for nursing, the inclusion of social work within the Health and Care Profession's Council and increasing political and economic uncertainty have all contributed to a growing scrutiny of pre-qualifying professional programmes. The continuing professional development of qualified health and social care practitioners is also under examination. The ‘appalling suffering of many patients’ detailed in the Francis Report (2013: 3) highlights in stark terms the multitude of failings within the healthcare system. The role of mentors in supporting health and social care students to develop the professional curiosity and courage to always put their patients first is now more crucial than ever.

    This book will define, contextualise and present theoretical explanations of mentorship and we hope its chapters will demonstrate both the art and craft of mentorship, supervision and preceptorship. We believe their content will resonate across health and social care professions and will also have value for health and social care practice education colleagues internationally. A unique feature of the book is the inclusion throughout of contributions by Master's level health and social care student mentors, who showcase the complexity of the integration of the theory and practice of effective mentoring. The chapters are divided using the Nursing and Midwifery Council (2008) domains described in the Standards to Support Learning and Assessment in Practice (NMC, 2008). These domains are establishing effective working relationships, the facilitation of learning, assessment and accountability, evaluation, creating an environment for learning, the context of practice, evidence-based practice and leadership. Although nursing led, these reflect the various skills, knowledge and values that are required to mentor regardless of the health and social care professional role and are widely acknowledged within professional practice education literature. These domains are implicit within the Health and Care Professions Council Standards for Education and Training (HCPC, 2012). In addition, The College of Social Work are in the process of phasing in new practice educator standards for social work (TCSW, 2012). Those standards detail four domains: to organise opportunities for the demonstration of assessed competence in practice; to enable learning and professional development in practice; to manage the assessment of learners in practice; and effective continuing performance as a practice educator. Throughout the book both the HCPC (2012) standards and TCSW (2012) standards will be directly referred to.

    Each chapter is supported by a number of case studies which reflect the practical application of the key theoretical features discussed within that chapter. The case studies have been written by health and social care professionals who are currently actively involved in mentorship in its broadest terms. All of the case study contributors have successfully completed a Master's mentorship module delivered by the authors. Indeed it was the quality of this academic work that led the authors to consider writing this book. The case studies showcase key mentorship issues within contemporary health and social care practice and how our mentors, often through innovative approaches, demonstrated their mastery in mentorship.

    Chapter 1 explores the current landscape of mentorship and links this to the qualities and knowledge mentors require to do this role well. The authors will demonstrate that the qualities associated with Master's level study and practice are essential to achieving excellence in mentoring. The complexities of mentorship in practice demand higher level thinking skills and particularly require mentors to deal with uncertainty and difficult decisions. The case study within this chapter provides a personal reflection regarding the experience and expertise that are necessary to mentor and links these to the academic level of study.

    Chapter 2 discusses the nature of relationships within mentoring and the importance of an effective relationship between the mentor and mentee. The skill of facilitating effective learning in practice and assessing such learning appropriately ultimately relies on the strength of that relationship. In the chapter three case studies are used to show the complexities of the mentoring relationship. The first of these reviews the use of a coaching model within a social work mentorship relationship and describes the ways in which the case study author has successfully implemented this approach with postgraduate social work students. The second case study takes the reader to the operating theatre and explores the effect of assessment on the mentorship relationship. The case study author here explores the skills required to unpick the delicate balance between mentor and assessor within the context of an effective relationship. The third case study author is a nurse in an accident and emergency department and demonstrates the important characteristics required within the mentor/mentee relationship.

    A key feature of the mentoring role is the effective and creative facilitation and structuring of the learning experience. Chapter 3 explores the ways in which learning can be facilitated across a range of health and social care settings. It offers practical examples of the integration of learning theories to ensure the effective facilitation of learning. There are four case studies presented within this chapter. Two of the case study authors look at reflection as a means of facilitating learning: the first case study explores the difficulties associated with moving from the role of expert to novice within professional practice (examining the strategies used within a Children's Centre to assist staff in this transition and to build confidence and expertise within a new set of skills); the second looks at the application of key learning theories to the facilitation of learning in practice (using a district nursing setting). The third case study describes an innovative Practice Guide role (created within a pre-registration mental health nursing programme). A key feature of the Practice Guide role is to undertake structured, facilitated clinical supervision sessions with student mental health nurses in order to facilitate the linking of mental health nursing theory and practice. A final case study examines the merits and challenges of using reflection to facilitate learning in a community-based drug and alcohol team.

    Chapter 4 goes on to highlight innovative ways in which practice can be assessed across health and social care and the role and accountability of the mentor within the assessment process. The three case studies within this chapter take a wide-ranging view of assessment. The first case study highlights the merits of reflection within the assessment process: it is set within a health visiting team and explores the ways in which reflection can be used to aid assessment. The second case study author describes some of the issues involved in assessing the ongoing competence of registered professionals. The final case study considers the use of service user feedback to inform the personal and professional development plans of staff: the author looks at the challenges of doing this in a district nursing practice setting.

    Chapter 5 details the importance of the evaluation of the learning experience and the various methods used to evaluate learning in practice. Evaluation is embedded in the quality processes of both practice and academic institutions, and in the case study for this chapter the author will address some of the inconsistencies for nurse mentors in evaluating their own mentorship practice.

    The impact of the learning environment on the mentee's learning is explored in Chapter 6, in particular the need for mentors to organise the environment to ensure it is conducive to learning. The concept of the learning organisation is also reviewed within this chapter. The three case studies presented reflect a range of themes connected to the learning environment. The first of these takes the theme of reflection and considers whether reflective practice can enhance the learning environment within a health visiting team. The next two case studies explore the importance of the practice learning environment in pre-registration nursing: the first is within a school nursing team and the second is situated within a multi-professional community mental health team. Both look at the appropriateness of the learning environment for the student nurses allocated to their respective teams.

    Chapter 7 reviews the various practice contexts in which learning takes place and examines especially the ways in which learning happens in practice and the potential barriers to this learning. The first case study highlights some of the tensions and challenges faced by the mentor when supporting a reluctant learner. The second considers the skills involved in health promotion and relates these skills to those of a mentor, with the similarities between the two roles also being discussed. The third case study explores the impact of inter-professional working and learning within a multi-professional community drug and alcohol team and the ways in which a social work student can engage fully in this learning environment. Finally, the challenge of transforming ‘ordinary’ practice situations into a meaningful learning opportunity is considered. The author in this fourth case study describes how the daily morning meeting in a Children's Centre has incorporated a reflective approach to encourage critical reflection within the team.

    Chapter 8 examines the role of evidence-based health and social care and the implications of this for practice mentors. It also explores the notion of values-based practice and the ways in which both evidence- and values-based practice are essential for the development of health and social care students. The case study in this chapter considers the barriers to learning in relation to continuing professional development and the ability to engage in evidence-based practice.

    Chapter 9 explores the nature of leadership within health and social care practice and professional education. It examines the skills required by mentors to lead both practice and practice education. The first case study within this chapter describes the challenges inherent in being the leader of a team, a manager and a mentor. The second case study considers the most appropriate leadership style for mentorship.

    The final chapter draws together key learning from the previous chapters and discusses the future of mentorship within health and social care professions. The case study is written by the two authors of this book and describes their successful efforts to deliver mentor preparation modules at academic levels six and seven only. The rationale for this is explored and the implications for the future delivery of mentor preparation programmes are examined.

    The reader is encouraged to use the Chapter Link boxes found throughout the chapters to review their current understanding of each topic. These Chapter Links act as signposts by indicating the key chapters which discuss a topic further. Each chapter ends with a series of questions to help the reader in applying the contents of that chapter to their own practice setting. The reader is encouraged to use this checklist to consolidate their learning and also to begin to apply it to their own practice as a mentor.

    References
    Francis, R. (2013) Report of the Mid-Staffordshire NHS Foundation Trust Public Enquiry. Executive Summary. London: HMSO.
    Health and Care Professions Council (2012) Standards of Education and Training. London: HCPC.
    Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice. London: NMC.
    The College of Social Work (2012) Practice Educator Professional Standards for Social Work. London: TCSW.

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