The Operating theatre is an alien environment for students and may be deemed hostile and uninviting. The role of mentors in such a specialised environment is to encourage interaction rather than passivity and utilise every learning opportunity that exists. Students should be encouraged to reflect on those experiences in a structured manner, to assist in their development of meaningful reflection, which is a valuable tool for throughout their career (Quinn 2000).
The aim of this assignment is to critically analyse and reflect upon an innovation, that relates to learning and assessing in the practice environment of theatres.
The learning outcomes 1, 2 and 4 will be the focus for this assignment because I feel they are the most relevant for reflecting on my innovation as they cover the Importance of the student and mentor relationship in relation to their learning experience, the opportunities and limitations to learning in practice and the evaluation of learning theories and teaching strategies to facilitate the integration of theory and practice.
The innovation was a learning package titled ‘Airway equipment & techniques in the theatre setting”. The pack was designed to be a basic insite into the different pieces of equipment and the techniques used and was presented to a second year student nurse, as part of a teaching session. Bruner (1961) explains that when presenting new information to students, the way the material is structured is important to overall learning. He believed that if students understand the basic structure of a subject they will find out much of the finer detail themselves.
Spouse(2001) recognised that observation can aid in increased understanding, whilst practice can increase competence, provided the necessary knowledge is in place, in order to facilitate comprehension. I believe that understanding the basics of airway management is a valuable and transferable skill that the student can utilise in any clinical setting. Quinn (2000) who formulated a student-centrered approach to learning, visualising the mentor as a helper and facilitator for and providing of, resources for learning, being someone who shares feelings as well as knowledge with their students.
Before introducing some of the techniques and equipment used in airway management, i knew it was important to discuss with the student their level of knowledge and experience. Airway management may be an area that they believe is unique to the theatre environment. In discussion with the student prior to the teaching session, i explained that in every clinical area there is an emergency resusitation trolley, consisting of a defibrillator, emergency drugs and one of the essential components on each one is an airway tray, each containing the equipment that is described in my innovation.
During our conversation it was established that during their previous placements, no aspects of airway management had been covered. On previous placements they had been shown where the emergency trolley was kept, but there had not been any formal teaching to familiarise them with the components. Airway management and equipment was therefore not something they felt they understood very well, despite this they showed a keen interest in learning more about the them, acknowledging that although specialised, airway management skills are highly transferable to any setting.
Welsh and Swann (2002) believe it is essential to assess a students prior knowledge as this establishes a baseline for development and is a prerequisite for planning future learning. By making the time to discuss the students previous learning experiences at the beginning of their placement, it gives an opportunity for the mentor and student to develop the learning outcomes that need to be achieved and discuss how they wish to achieve them. Learning, according to Rogers (1983) is based on three key factors that exist in the relationship between mentors and students.
The first factor being genuineness, were the mentor should come across as a ‘real person’, therefore able to develop a normal relationship with their student. I feel that by welcoming my student to theatres I achieved this. Trust and acceptance, being that the mentor should see and accept their student as an individual, that is worthy of their care and respect. Finally, the empathatic understanding by the mentor, by being able to see things from the students perspective and act appropriately in response to this.
Smith (1992) supports that student nurses feel better able to care for patients when they feel cared for by their mentor and clinical staff. After the teaching session the student kept the learning pack to use as a source of reference, for throughout their placement, when observing the equipment being used in everyday practice. To assess the effectiveness of the innovation the student was asked to complete a questionnaire, to evaluate what they had learned from being provided with the pack, as well as an evaluation form to help me understand how the student felt about the teaching session.
I felt comfortable throughout the teaching session and the student asked questions openly, which I encouraged them to do. Allen (2005) stated that a good mentor should be open and honest as well as be able to take advice and criticism. According to Neary (1997) and Gray and Smith (2000), most students believe that a successful assessment outcome depends on having a good working relationship with the mentor.
A mentor should support the current version of the Nursing and Midwifery Council (NMC) standards (2008b) and note that there are several reasons for supporting learning in practice: ‘to provide support and guidance to the student when learning new skills, applying new knowledge and transferring existing knowledge and competence to a new context of practice’ (pg 36); to act as a resource; to manage the learning; and to observe the practice to ensure outcomes and competencies are met (as defined by the NMC).
Whilst these standards are mainly aimed at student nurses the term ‘student’ could be applied to those learning, even when they are registered nurses as they are participating in lifelong learning. Students feeling welcome and valued when they arrive will assist with their learning throughout the placement. According to Quinn (2000) identifying the learning needs of the student is best approached at the beginning of the placement. How students interact with the learning environment is important, particularly in the context of life long learning and continuing professional development.
As in all specialised areas there are procedures that need to be understood and learned as the student progresses along the professional curve. ( Radford and Hunt 1999). As a mentor in the theatre setting, I have learned to identify areas that could be improved for student learning, such as Techniques that are ‘every day’ to the staff as professionals and the jargon that they use, can be seen as bizarre and seemingly difficult to learn for the student.
The idea was to produce an eye catching innovation . A visually attractive and an uncomplicated style of teaching was applied, using indicators for further study for future, current or past theatre placement students. This was to encourage self-directed learning (Ghazi & Henshaw 1998) and avoid over-whelming the student with too much information which may create anxiety and fear. An important aspect of reducing anxiety for students is their introduction to the placement area.
This is something that every registered nurse can relate to because we can all remember being student nurses ourselves and can all recall our ‘good’ and ‘bad’ placements easily, the ‘bad’ often being when everything still felt unfamiliar sometimes weeks into a placement area. Swann (2005) identified that an essential component of the mentor/mentored relationship is communication. Hutchinson (2003) supports this by stating that an environment is not just the physical area but also the attitudes of staff.
The student nurse on placement in theatres was introduced to firstly their mentor, who after a friendly introduction took the student to the locker room to show them where they could leave their belongings and get changed. Once changed into theatre scrubs they were taken through the department and in each area they were introduced to the staff and the allocated mentors for that area. The health and safety aspects of the department and the fire procedure was also explained.
In theatres students have frequently commented on their initial anxieties when coming for a placement. Sampson (2006) carried out a study to identify why there was a shortage of student’s choosing theatres for a clinical placement. Findings suggest that there has been a dramatic fall in the number of students coming to work in theatres and students are not choosing this area due to fear and anxiety about this specialised, unknown environment. When anxiety is high, an individual is immobilised, perceptions are narrowed and learning is impeded (Meisenhelder, 1987)
Positive ways to motivate and encourage learning is described by Sampson (2006) as making learning interesting, ensuring relevance to learners’ needs, reinforcing positive not negative aspects and giving students responsibility for learning. By providing the student with the learning pack, it allowed them to take some responsibility for their learning. Silen-Lipponen et al (2004) identified that students have difficulties combining theoretical and clinical knowledge in the learning process, but the perioperative environment can enhance student education by integrating theory, and practice and developing skills in reflection.
These knowledge and skills are required by the NMC (2008) standards of proficiency for pre-registration nurses which state that; safe and effective practice requires a sound underpinning of the theoretical knowledge, which informs practice, and must therefore reflect breadth of practice and learning. Much evidence exists which suggests that the perioperative clinical area is an invaluable learning environment and it is essential that student nurses are aware of the learning opportunities available within this diverse clinical area (.
Silen-Lipponen et al 2004) Factors that may inhibit learning for students can be described as internal or external in nature. The most common barriers have been identified by many authors (AshCroft, Foreman-peck 1994, Reece and Walker(2000) and Quinn(2000), they include pressure of time and workload, lack of support from the organisation and family. The learning pack was innovated and planned to assist myself in teaching and to provide the student with the most appropriate teaching for their level of learning.
Before beginning the teaching session, i encouraged the student to openly ask questions, as the teaching session was based on explaining the contents of the teaching pack, which they would be using throughout their allocation. Scouse (2001) recognised that observation can aid increased understanding, whilst practice can increase competence, provided the necessary knowledge is in place to facilitate comprehension. Reece and Walker (2002) identified that our perception of learning will affect how we teach. Therefore before we explore how to teach, we must understand how people learn.
Learning is a relatively permanent change, usually brought about intentionally. Jarvis (1983) highlighted three domains of learning that are important for any healthcare professional. Cognitive, affective and psychomotor show that learning can occur from teaching, study or the assimilation of information and skills as a result of experience. The clinical environment offers a challenge in relation to the choices of strategy available to facilitate learning. Oliver and Endersby (1994) suggest that most teaching in practice areas deal with skills, including interpersonal and management skills.
The elements of the educational taxonomy considers that any learning topic has robe considered from three perspectives in relation to what a student has to learn. To apply these using a component of the innovation and given to a student nurse, with something such as teaching a student how to apply an oxygen mask to a patient, the psychomotor skill would be for the student to be able to select and open the face mask, correctly assemble and then connect it to the oxygen source, then document appropriately.
It is not enough just to be able to assemble the mask and administer oxygen, for cognitive skills, the student should should also be able to understand why they are giving the patient oxygen, it’s effects and the correct observations. It should not be forgotten that receiving the oxygen is a patient. To be competent with affective skills the student must display the appropriate communication and interpersonal skills. Quinn (2000) stated that mentors can often tend to use strategies they find useful but must be conscious of the preferred learning style of the student.
There are three main theories of learning, behaviourism, cognitivism and humanism. Each looks at learning from a different perspective. Along with learning theories it is vital to consider the mentor/student relationship and the learning environment, as these can help or hinder learning (Gray and Smith 2000). Behaviourism is the response gained from behaviour. Cognitive theory focuses on psychological processes that are involved in the acquisition, organisation and use of knowledge (knowles 1990). Austell (1987) advocated the concept of an ‘advanced organiser’.
This is a strategy introduced in advance of new material for example, teaching theory before practising a skill. The student was taught the importance of knowing the correct airway management of the unconscious patient in the recovery room, this aided their understanding of which airway equipment or technique was used and why. The learning package and teaching session combined with a perfect learning environment within the theatre and recovery settings, allowed the student the opportunity to apply theory to practice.
Fretwell (1985) stated that an ideal learning environment is seen as one in which the educational needs of the student are met. Along with knowledge of the learning domains, it also useful to consider the learning styles of the students. One of the most often cited model is that of Honey and Mumford cited in Howard, 1999, p 110) of the activist, pragmatist, theorist and reflector. Acknowledging these aspects, along with the use of different teaching strategies, Howard (1999) suggested enabling the learning to be adult-centred rather than following a teacher driven agenda.
Noone (2009), on discussing a nursing curriculum, suggests that it should integrate three aspects: the cognitive/intellectual; the skills-base; and the ethical comportment/behavioural one. Whilst the one-off session about airway management can’t be compared to a full programme of education, it does, never-the-less, incorporate each of these aspects. There is knowledge of the anatomy and physiology, the use of airway adjuncts and the respect for dignity, by utilising good communication skills are all apparent.
By accounting for learning theories, the learning environment, strategies for teaching and learning styles, I have been able to reflect on this experience and discovered areas I can make improvements or change. Theories of learning helped me to acknowledge the relevance of behaviours, knowledge, comprehension and feelings while teaching students, I will use this knowledge to further develop my skills in teaching. The fact that reflection takes place is important as it contributes to the continuing development of a practitioner and facilitates the development of effective practice (johns 2000).
To reflect on my innovation i will follow the framework of Gibbs’ (1998) reflective cycle, which I believe is thorough and logical. I developed a learning package for student nurses to learn, understand and develop knowledge in the skills required for the different ways to manage a patients airway, within the theatre setting. The pack consisted of airway management equipment and techniques ranging from the most basic to advanced. I presented it to a second year student that was on placement in theatres.
My aim was that the student would learn the basics of airway management, some of which they would be able to put into practice in the recovery room under supervision, such as removal of a patients laryngeal mask. Whilst i was developing the teaching plan and the innovation, I refreshed my own knowledge, making me feel more confident to present the session. The evaluation form that was completed by the student was very positive, I will therefore feel less apprehensive the next time I do a teaching session. The learning pack helped the student to become familiar with the airway equipment and techniques easily.
Feedback from the student showed that the pictures and brief descriptions, provided enough information to enable them to recall that information, whilst observing the equipment and techniques being used in practice. This type of learning style could be associated with Dunn (1984) who describes the Visual, auditory, kinaesthetic (VAK) model. When a student nurse has a placement in theatre, the unfamiliar environment and uniforms can be quite daunting. Many things can can be done to promote a good learning environment that meets the needs of the learners.
There is a need to help the students understand the learning opportunities available to them and give them support. The student was introduced to the theatre team, on the first day of their placement and I explained about the different routines compare with their knowledge of the ward placements they had been to. The student was initially very nervous, but by providing reassurances and familiarising them with the layout and routine for theatre, they soon settled into their placement and became part of our team.
I asked the student following the teaching session to complete an evaluation form. I believe my teaching approach worked well and the student achieved all of their learning objectives. I am certain that during the students placement I maintained a professional but approachable attitude and encouraged them to ask questions when they felt they needed to. Overall I feel that I have learned that the foundation for being a good mentor is in building a good working relationship with the student. Achieving this will underpin every other aspect of being their mentor.
Time spent working with the student should be utilised well with plenty of opportunity for discussions. Once a rapport has developed, as a mentor I should display insight into the students needs which will show a degree of empathatic understanding, which will make them more at ease. I now understand the significance of a conducive learning environment so that the student Feels comfortable in the unfamiliar setting and feels supported. The theoretical knowledge of learning theories and teaching strategies that I have gained will enable me to meet the requirements of each individual student needs.