University of Surrey
European Institute of Health and Medical Sciences
Centre for Research in Nursing and Midwifery Education
Development of a good practice tool for mentors
FINAL REPORT TO LEARNING AND TEACHING SUPPORT NETWORK – SEPTEMBER 2004
GINA FINNERTY & ROSEMARY POPE
Acknowledgements to Helena Knowles
Acknowledgements
We would like to thank all the mentors who gave their time to participate in the focus group interviews. Thanks also to the Mentor Preparation Module teaching team for their assistance in setting up the focus group interviews.
Thanks to Claire White and Penny Robinson for providing administrative support throughout and to Carin Magnusson for her assistance with the focus group interviews.
This project is funded by the Learning & Teaching Support Network (LTSN).
The LTSN has been identified as a sponsor of the work, and will be acknowledged in all reports and materials associated with the work and included in all of the Centre’s publicity and dissemination activities.
CONTENTS
Executive Summary 6
1 Introduction 9
2 Background 9
3 Literature 10
3.1 Introduction 10
3.2 Supporting practice learning 10
3.3 Mentor preparation 11
3.4 Action Learning 12
3.5 Support for mentors 12
3.6 The learning environment 13
3.7 Audit 14
3.8 Quality assurance 15
3.9 Project Aim 15
4 Objectives 15
5 Methodology 16
5.1 Main methods of data collection 16
5.1.1 Focus group interviews 16
5.1.2 Documentary Analysis of the Mentor Preparation Module 17
5.2 Sample and setting 17
5.3 Recruitment 17
5.4 Limitations 18
5.5 Data Management and analysis 18
6 Ethical considerations 19
7 Progress to date 19
7.1.1 Focus group interviews 19
7.2 Findings from focus groups 20
7.2.1 Prior & current experience of mentoring 20
8 Expectations of trainee mentors for the mentoring role 21
8.1 Learning support 22
8.1.1 Annual Mentor Updates 23
8.1.2 Social support 24
8.1.3 Pastoral support 25
8.2 Educational Audit of Clinical Settings 25
8.3 Documentary analysis 27
8.3.1 Mentor Preparation flyer. 28
8.3.2 Review of audit tools 30
8.4 Current available ‘checklists’ and ‘toolkits’ 31
8.4.1 Preparation of Mentors and Teachers: 31
8.4.2 Placements in Focus 32
8.4.3 Helping students get the best from their practice placements 33
8.4.4 Commissioning midwifery education and training: a toolkit 34
9 Educational audits: A review of some tools 35
10 Discussion 37
10.1 Introduction 37
10.2 Mapping support needs of mentors from local NHS Trusts 37
10.3 Learning support 38
10.4 Conclusion, Recommendations and Implications for Practice 40
10.5 Revising the tool 40
11 Dissemination strategy 41
12 Summary 42
13 References 43
Appendix 1a - SUPPORT FOR PRACTITIONERS WHO MENTOR 47
Appendix 1b - SUPPORT FOR PRACTITIONERS WHO MENTOR (Revised Version) 48
Appendix 2 – Interview Schedule 49
Appendix 3 – Consent form 51
Appendix 4 - Progress Reports December 2003-September 2004 53
Appendix 5 – Abstract for 3rd Annual Hawaii International Conference on Education 55
Executive Summary
Introduction and Background
Previous national research by Pope et al (2003) revealed that mentors needed more structured support to fulfil their role as supervisors and assessors in the range of practice settings.
A good practice tool for mentors has been developed at the University of Surrey. The purpose of this research was to test the tool with trainee mentors employed locally and revise it for possible wider application. It is envisioned that this tool will complement current evaluations of practice settings. Used as part of the audit process, the tool has potential to stimulate dialogue around good practice in teaching and learning in clinical settings.
Aims
The overarching aim of the study was to map the perceived support needs of those undertaking mentor preparation and use these perceptions to inform the development of a good practice tool for use in educational audit and clinical areas.
Literature
All qualified nurses and midwives now have a responsibility to teach and assess students in practice (NMC 2002). However, processes for supporting mentors in their role as clinical supervisors have been found to be unclear (Goom 2003, Jones 2004). Mentor support files are used in some areas to strengthen the learning environment for the range of students on placement (UWE 2003). Associate mentors have been suggested to contribute to teaching and assessment of students in partnership with mentors in practice (NMC 2004) but will, themselves, require support. Action learning sets have been found to be helpful to consolidate and anchor learning (Wienstein 1985) and to also provide peer support for mentors.
Methods
Focus groups with trainee mentors were held, to aid revision of the good practice tool.
Documentary analysis of mentor preparation materials was undertaken, to provide contextual information.
A literature review of educational audit tools helped to display the variety of auditing systems available, as well as the different emphases on mentoring.
Ethical considerations
Multi-Research Ethics approval was obtained as trainee mentors participating in research were employed by NHS Trusts.
Findings
Experiences of mentoring
· Trainee mentors described a broad range of mentoring activities already being undertaken and feeling like 'full-blown' mentors
· Mentors explained how adaptable they needed to be to support a range of students, for example, degree and diploma students, military nurses, NVQ students and adaptation nurses
· It was generally found to be difficult to perform the entirety of the mentor role well due to lack of time, especially for assisting students to reflect meaningfully on their practice
· Some mentors working in learning disabilities and midwifery specialties explained how being the named mentor for the duration of a student's programme created a feeling of mentoring at 'arms length' when students had work experience with other mentors
Learning support
· Mentors expressed the need for more visual material and teaching aids to support students' learning
· It was suggested that annual updates for mentors could be more specific to individual disciplines
Social support
· It was felt by some trainee mentors that the current associate mentor system did not offer direct support to the mentor
· In schemes where students were allocated to mentors for the duration of their programme (for example, a three year degree) peer meetings with other mentors were found to work well, offering a social support network
Pastoral support
· In several NHS Trusts affiliated to the University, Practice Development Nurses (and Midwives) were found to be supportive to mentors, particularly if concerns arose regarding students
· Regular clinical supervision was said to provide excellent pastoral support for those mentors in learning disabilities
Audit of the clinical learning environment
· Trainee mentors generally described feeling detached from the auditing process
· Some respondents described possible benefits of having a separate section in the audit tool with issues specific to mentoring. Some felt this would raise awareness of issues for mentors and bring mentoring onto the agenda.
Conclusion and recommendations
The research has highlighted a number of issues related to mentoring in practice. It is anticipated that once piloted, the good practice tool for mentors could be of significant benefit to mentors from multi-professional backgrounds.
The following recommendations have emerged from the research study:
Support mechanisms for mentors need to be more structured, particularly with imminent increases in student numbers.
Further clarity of roles and responsibilities of those who support mentors would be helpful to those clinically supervising students, especially the role of Practice Development Nurse\Midwife.
Modified action learning sets could be held with qualified mentors in practice settings.
Development of a good practice tool for mentors
1 Introduction
This report summarises a project which focuses on development of a ‘good practice’ tool for mentors. The mini-project builds on national research undertaken previously by two members of the team (RP and GF) concerning teaching and learning in practice (Pope et al 2003).
The central aim of this project was to investigate the potential benefits to mentors of introducing a good practice tool as part of the educational audit of clinical practice. The main outcome of this study will be a revised tool, based on views of mentors and informed by relevant theory.
This report provides an overview of work completed for the duration of the project (December 2003 to September 2004). It begins with the background, which provides a backdrop to the research. This leads into the literature review, which identifies national literature related to provision of support for mentors and theory of audit. Aims and objectives of the study are outlined, followed by a section on methodology. Findings from focus groups are presented, followed by documentary analysis of local materials used to support mentor preparation. The discussion brings national and local elements together and finally, the conclusion and recommendations put forward suggestions for a revised ‘good practice’ tool, based on evidence.
2 Background
All Registered Nurses and Midwives are required to teach, supervise and assess students in clinical practice as part of their role (NMC 2002a). Currently, education audit tools used in the local area do not contain a separate section on mentoring issues. This creates a lack of information for introducing improvements to local mentoring infrastructures. By including mentors from four local NHS Trusts in the development and revision of the good practice tool, their needs may be clarified. This has the potential to improve the student learning experience and to subsequently influence patient care.
The above-mentioned study (Pope et al 2003) explored preparation and support for mentors, as well as supervision and assessment of student midwives on a range of programmes.[1] Findings from case studies across England suggest that mentors need more streamlined preparation and more structured support in carrying out this often diverse and demanding role.
The good practice tool being developed in this project brings together some of the recommendations from Pope et al (2003), which stemmed from data describing what appeared to work well at case study sites. The tool is designed to provide guiding principles, rather than directives, for good practice in mentoring at local level (See Appendix 1).
3 Literature
The purpose of the literature review is to identify relevant policy documents and published papers which have relevance to practice learning and the development of a tool which puts the spotlight on mentor support in practice.
3.1 Introduction
The policy documents, Making a Difference (DoH 1999) and Fitness for Practice (UKCC 1999) were influential in recommending significant changes to practice-based learning. Of key importance was the need to address skills acquisition of pre-registration nurses and midwives as well as the need to support learners to link theory and practice more effectively.
There has been a renewed focus on mentor competency since the introduction of the updated Code of Professional Conduct (NMC 2002). All qualified nurses and midwives now have a responsibility to facilitate learning within the clinical settings. Ways to maximise support to mentors have recently been presented in the nursing and midwifery press (Wilkins & Ellis 2004, Jones 2004).
3.2 Supporting practice learning
A project named ‘Supporting Learning in Practice’ (SLIP) has been published and has direct relevance to development of the good practice tool for mentors. The Avon, Gloustershire and Wiltshire WDC is linked to the University of the West of England in Bristol. A key finding in their NHS Trusts was that processes for supporting mentors were unclear (Goom 2003). With the proposed introduction by the Department of Health of increased student numbers in healthcare settings, the SLIP project team wanted to review the whole local learning culture and in particular, to clarify the roles of all those involved in supporting students in practice. Four roles were identified;
· Academic in Practice –to have minimal involvement with students and be responsible for research and development
· Practice Education Facilitator-to provide support to the mentors and be linked with the University and a Learning Community. A key element of this role is to assure implementation of the Four Year Mentor Update Cycle (UWE 2004)
· Clinical Practice Teacher-this role had apparently become blurred, due to introduction of Practice Education Facilitators and therefore may be phased out
· Mentor-whose role has been clarified elsewhere (ENB/DoH 2001)
It would appear that, if the Clinical Practice Teacher is phased out, the responsibility for all student learning and support in this model rests largely with the mentor. The benefits of introducing a new model for training and updating the mentors may compensate for this.
A pack has been produced by the University of West of England in partnership with the Avon, Gloucestershire and Wiltshire Workforce Development Confederation. An identified problem was that the live register of mentors was not accurate or current. A tension was highlighted as students have a right to expect an agreed standard of competence from their mentors (UWE/WDC 2004).
3.3 Mentor preparation
A four year cyclical programme was developed at University of West of England to increase motivation of mentors through the update and review process within a partnership model. Assurance of mentor competence is documented in a 360 degree assessment grid. Reflection on mentoring practice is encouraged through a series of scenarios with written accounts from mentors of action taken.
This pack initially appeared progressive and would certainly seem to improve co-ordination of update activity within employing organisations and the affiliated University. In particular, the pack does provide opportunity for mentors to address their individual updating needs (which may have been overlooked with the traditional update system). However, there is no rationale for the cycle being four years. Additionally, the pack creates substantial paperwork for mentors, with no obvious indication of structured support being available to assist them. This is an essential consideration in light of recent research which reveals the implications of increased student numbers on placement (Smith et al 2004) and the concomitant extra workload for mentors.
A large multi-centre project entitled ‘Making Practice-Based Learning Work’ (Mulholland et al 2004) investigates drivers for change and barriers to change in preparation of Practice Educators across five health care disciplines. This is because there are currently such varied models of mentor preparation within and across disciplines.[2] A key recommendation is that attendance at training courses should be compulsory for all practice educators (including mentors). Additionally, it is recommended that practice educators need more time to fulfil their educational role.