Facilitating Learning and Assessment in Practice
Introduction and Teaching Plan
For the purposes of this assignment I will examine a teaching session delivered by myself to a student nurse during clinical practice, exploring the lesson plan for this session and various factors, which may have impacted on the learning processes involved. I will use the reflective model as described by Gibbs (1988) in order to guide this reflective work and explore the event in detail.
The teaching session was delivered to a student nurse in the penultimate placement of their nurse training and took place on a 16-bedded inpatient ward for the assessment and treatment of organic mental illness on 24th October 2013. The use of a questionnaire devised by Honey and Mumford (1992) was a useful tool in identifying the learning style of the student and allowed me to cater more specifically for their natural learning preference. The early work of Fleming and Mills (1992) also describes different processes of learning, separating these into the categories of visual, aural, written communication and the kinaesthetic.
The student reported having never been supervised in the administration of an intramuscular injection previously and for this reason this was chosen to be the focus for the teaching session. After referring to the ‘ongoing achievement record’ for year 3 of the mental health nursing programme (a document detailing the requirements for a third year student nurse to be deemed fit to practice) some learning outcomes were identified (UWE, 2013). The specific aim for the teaching session was for the student to be able to safely demonstrate competency in preparing and administering an intramuscular injection to a hospital inpatient.
Due to the detailed and intricate nature of administering medication via such invasive routes a number of teaching methods would be required in order to facilitate this safely (Schultz and Videbeck, 2008), without doing harm to the patient (Wilson, 1994). The methods and resources I intended to use included; discussion; the workplace library; relevant literature; the clinical setting; pictorial diagrams of related anatomy; role-play; local hospital policy; the resource of the qualified nursing staff; the previous experience and knowledge of the student; demonstration; and of course, the patient. A further intended component of my training session would be the opportunity for repetition and for the student to practise this skill, as this helps to consolidate learning (McCausland et al, 2004; and Egan, 2013).
The teaching session planned was to be delivered over a thirty-minute period, during which time an informal discussion with the student would be aimed at establishing their existing level of confidence and knowledge (Reilly and Oermann, 1990). As a resource for guidance and further information the student was directed to familiarise themselves with the BNF (2013), providing comprehensive details of licensed medications in the United Kingdom; and additionally, the “essence of care” benchmarks (Department of Health, 2010).
Following this, I planned for a few minutes engaged in a questions and answers session to provide the opportunity to identify and address any anxieties or concerns that the student had, with respect to taking an active role in this clinical procedure before progressing to demonstration. Issues to be discussed and explored included; types of medication; patient confidentiality and dignity; identifying the patient; checking the prescription; gaining consent; effects and side-effects; checking expiry dates; preparing the injection; administration; and disposal of sharps (UWE, 2013). Having completed this, the next step would be for me to demonstrate this process (after a brief role-play) in practice for the student to observe (Hutchinson and Janiszewski Goodin, 2013), before repeating it for themselves under supervision (IIHF, 2008). Following the completion of this, the student was given the opportunity to attend a clinical skills training session provided by the workplace to refresh on theoretical aspects of this; I also planned for the student to repeat this clinical procedure as often as reasonably and realistically possible prior to the end of their placement in order to increase their skill level and competence (McCausland et al, 2004; and Egan, 2013).
Essay and Discussion
It may now be beneficial to discuss some of the factors, which can impact upon the learning process such as the learning environment, learning styles and teaching methods used; first by examining the learning environment in which the teaching session took place. The session took place in the ward clinic room; a well-lit room with no windows, commonly used for the purpose of administering injections in a safe and private environment.
A private environment such as this can help to improve communication as it can be free from distractions; for example, high volumes of background noise (Sommer and Sommer, 2002). However, due to the nature of a busy inpatient hospital ward it was not possible to be free from interruptions at all times; a factor which according to Hart and Rotem (1995), Peternelj-Taylor and Johnson (1995) can have detrimental consequences for the learning process. Additionally, Ironbar and Hooper (1989) report that unsuitable environmental conditions can be distracting; consequently posing barriers to learning (Fretwell, 1982). Factors including noise levels, lighting, smells and temperature can potentially hamper concentration and distort communication, leading to misunderstandings (Dexter and Wash, 1991; and Johnson, 1997). Additionally, Lazarus and Folkman (1984) suggest that an unsuitable learning environment can increase stress levels for both teacher and student and furthermore, Babenko-Mould et al (2012) suggest that the clinical environment can also impact upon the confidence of a student to practice; with this in mind, it is clear that quality learning environments allow for quality learning (Mrayyan and Acorn, 2004). For these reasons, of the areas available for use for this teaching session, the clinic room was, in my opinion, the most fit for purpose (Emerson, 2007).
A crucial component of any teaching session is to identify clear learning outcomes; this helps to clarify goals and expectations for both teacher and student (Gosling and Moon, 2002). The learning outcomes for the teaching session were identified during a pre-formative meeting with the student in question. Having referred to the ‘ongoing achievement record’ it was clear that the chosen learning outcome was an essential criterion for assessment (UWE, 2013); this document also provided more specific details and components to consider with regard to the required competency, which further guided the content of the teaching session (Mohanna et al, 2004). The learning outcomes and objectives informed the development of a ‘learning contract’, placing responsibilities on both myself and the student to work collaboratively towards achieving this competency (RCN, 2007).
Bloom (1956) describes three categories of learning behaviours; this taxonomy is composed of the ‘cognitive’ (knowledge), ‘affective’ (attitude) and ‘psychomotor’ (skills); put simply, following the delivery of the teaching session the student should have developed their knowledge, attitudes and/or skills. Referring to this model, it was possible to establish some of the types of learning behaviours which would be involved; this in turn proved useful in identifying teaching methods which could be effective for achieving the learning outcomes and objectives. Upon doing so, it was clear that multiple teaching methods would be necessary due to the complex process of preparing and administering an intramuscular injection correctly, as well as the combination of learning processes involved.
Two approaches to teaching can be described with the terms ‘andragogy’ and ‘pedagogy’. ‘Andragogy’ refers to learning whereby the student carries the majority of responsibility for the process of learning and takes an active role in this; ‘pedagogy’ is more teacher-driven and the student is the passive recipient of theoretical teachings and instruction; a combination of both is known as ‘synergogy’ (Quinn and Hughes, 2007). For this teaching session I took the approach of ‘synergogy’ as there was an unavoidable requirement for me as the mentor to take an active role in ensuring that the intramuscular injection was administered correctly, as errors with this could be extremely dangerous (Wilson, 1994); and significantly the teaching of tasks that cannot be learned without physically doing for oneself demands a pedagogical approach (IIHF, 2008; and Popkess and McDaniel, 2011). However, the development of the learning contract between the student and myself also placed an onus on ‘adult’ learning and some responsibility with the student for their role in the learning process; therefore an andragogical approach could not be excluded either.
Throughout the learning process it is important for the mentor to provide feedback constructively to the student as to the progress they are making in their learning (Hesketh and Laidlaw, 2002; and Hill, 2007); without doing so, a mentor can deprive their students from the opportunity to modify, change or adapt specific aspects of their practice which require improving through evaluating their own practice (Westberg and Jason, 2001). For this reason, it can be useful to employ the use of a feedback model to guide this process; Pendleton et al (1984) describe a model of feedback, which I used for this purpose. The model can be broken down into simple stages and allows both learner and mentor to focus on positive aspects of practice before examining areas for improvement and developing an action plan towards improving practice. This model seemed appropriate given the nature of this teaching session as it also directs the teacher to provide full guidance in ensuring safety (Wilson, 1994).