Assignment Report on Eight Domains of The Nmc Framework

The purpose of this assignment is to demonstrate my clinical and educational practice, especially in mentoring pre-registration nursing students, newly qualified nurses and internationally-educated nurses. All registered nurses have a professional duty to become mentors and play an important role in facilitating students to build their competency. I will aim to reflect on practice relative to the Eight Domains of the NMC framework and give an accurate analysis on how this can impact a student’s experiences and learning opportunities. Papp (2002) stated that, “student nurses highly value clinical practice and the possibilities it offers in the process of growing to become a nurse and a professional”. It is essential to create a positive learning environment that allows students to build confidence and therefore, bridge the gap between theory and practice. This promotes students’ interests in learning and encourages them to participate more.

NMC Domains

Establishing effective working relationships

I was expecting a second-year student starting on the ward, therefore a students’ welcome pack was prepared and a discussion took place over the phone a few days prior the start day. The student had a few questions about shift times and was excited but worried to start, due to having no neurosurgical experience. I assured them that most of the other students were in that situation and that the team was looking forward to meeting and working with her.

On the morning she arrived, I, as the nurse in charge, had allocated some of my morning duties to other members of staff so I could have an initial conversation with the student. In addition, I introduced her to the rest of the team, orientated her within the unit, and explained my role in the ward and the type of patients and how we distributed them. We discussed the student’s goals for this placement, the action plans to achieve them and further beneficial learning opportunities, for example: theatre time, bed meetings, shadowing specialist nurses, etc.

I believe this initial meeting is an essential factor in building a mutual trust and working relation. Dunn and Hansford (1997) highlighted the importance of staff and student relationship informing initial perceptions of their learning environment as well as feeling part of an established nursing team.

Facilitating Learning

Within the initial conversation with the student I was working with, we discussed the learners’ objectives for this placement. I asked her what she felt she wanted from me as a mentor, what style of learning she preferred and what she felt assisted her to gain confidence with clinical skills. I discovered this made the student feel at ease in the learning environment.

Furthermore, the student was reluctant and anxious to a verbal handover on the phone and we identified that as a goal to achieve in this placement. On the following days, I took the student and sat her next to me in three different occasions when I had to handover a patient to a local hospital. After she observed how I conduct myself, I asked her to go away and list the important clinical aspects she would need to inform the other hospital when doing a handover.

A few days later, she had the occasion to handover a patient independently with me sitting next to her for support and with the list she made as a guide. She started very nervously but gained confidence towards the end of the call. She was very proud of what she had achieved and the approach allowed the student and myself to develop a learning plan based on the student’s needs.

Research shows that clinical learning environments are considered as an anxiety and stress-provoking factor for pre-registration nursing students which can be barriers to learning. Effective and supportive mentorship help reduce anxiety and stress and could enhance students’ learning and performance.

Assessment and Accountability

Pellatt (2006) explains the importance of the nurses’ accountability when working with the students. As the nurse is accountable for the tasks they may delegate to the student, but insuring the student is competent in these tasks it will allow for safe practice. It is important to find out whether students have the traits to practice safely and effectively without any direct supervision on their own to be competent.

A third-year student was allocated by myself the task of checking the vital signs of four patients. Even though the student was the one performing the task I, as the registered nurse, had the responsibility to check the observations were recorder and documented. When checking the patients’ observations charts, I realized that although they were filled out, one patient who should have been scoring on the Early Warning Score (EWS) system had not been identified and had been scored at 0. The EWS is a guide used to quickly determine the degree of illness of a patient. It has a policy to escalate and act quickly to prevent further deterioration (. As this student has been placed in the hospital for other clinical placements, I had expectations that he would have fully understood the EWS. We must work within our limits and if we do not know something, we must ‘ask’ in order to provide safe care.

Moreover, I asked the student to evaluate his performance by asking him how well he thought he did. I listened to his side of the story and provide constructive feedback to identify his strengths as well as areas he has to work on. Giving constructive feedback is an important role of a mentor in student assessment.

From this discussion, we put into place an action plan that allowed him to practice more on patients observations and study the anatomy and physiology of the cardiovascular and respiratory systems. I gave him a list of articles about EWS and asked him to read and interpret them. I also directed him to a microteaching session of EWS system. Once he felt confident and comfortable with his skills, the sign-off mentor and myself allocated him with four patients and evaluated him at the end of the shift. By the end of the day, the student was competent and self-assured in carrying out vital sign observations and mapping them on EWS.

Mentoring gives an opportunity to reflect on our own actions and beliefs and helps us change our practices. Upon reflection, I have acknowledged my own strengths and weaknesses as a mentor, and become more aware of my role as an assessor. Thus, sometimes, nurses fail to fail students because they are not adequately prepared for the role. However, when a student does fail to meet the necessary foundation competence required by the NMC, then the only option would be to fail the student based on these ground rules. I believe that it takes a skilled mentor to quickly identify when a student requires more support and guide them through their learning with all available resources.

Evaluation of learning

In mentoring a student nurse it is essential to continuously evaluate and reflect on practice. Vuorinen et al (2001) found that evaluation is an important aspect of professional development. Therefore, ensuring adequate evaluation techniques are being used is imperative to a student nurses progression. As a mentor I encourage and welcome feedback from students with regards to my mentoring techniques and the environment in which they are learning. There is a difference in being a teacher or evaluator compared to being an assessor, an important role aspect of being mentors (Webb & Shakespeare 2008). Being a mentor is challenging, especially when there is a shortage of staff as it reduces the amount of time that mentors could allocate to student assessment. Not only is this important for the progression but also my reflection on a personal practice. Clynes and Raffery (2014) highlight that effective feedback should not only explore areas or current practice, but should empower the student to proceed with excellent practical skills.

Create an environment for learning

When we share feedback on the learning environment, it allows my colleagues and I to ensure the ward is deemed appropriate by students’. Saarikoski & Leino-kilpi (2002) emphasizes the need for a positive ward environment and a good leadership structure within the ward in order to maximize learning potential. Midgley (2006) identifies the importance of learning in clinical practice and the balance of theoretical and practical work by student nurses.

Working with a first-year student on her first placement, we identified her objective e of learning about basic nursing care and how to ensure patients met their Activities of Daily Living (ADLS) (Roper, Logan and Tierney 2000). In order to facilitate her objective, every morning we highlighted the patients with dependency scores that indicated they would need more nursing care that someone who was completely independent with their ADLs. We carried out the basic nursing care together until the student felt comfortable doing this by herself when appropriate. Every morning, she would highlight the patients’ needs and use this to plan the care she would provide. The student excelled in the care given to these patients and updated care plans as and when was necessary.

Context of practice

When I became ward manager that I currently work on, I realized that the handover was not as efficient as required. It was an area in which I felt we, as nurses, could develop our ward handover procedure. In addition, I felt important information was left out which will potentially improve our clinical care for the patients. Sexton et al (2003) discussed the use of good communication tools for nursing handovers in order to provide continuity of care. I decided to use Safety Briefing forms to emphasize the patients who needed more attention (e.g. risk of falls, step down from ICU, etc.) so that the whole team was aware of particular patients’ needs. The students and members of the team seemed to appreciate the simple tool which allowed them to discuss patients’ care, due to the structure they were provided with.

I feel that introducing this tool to the team I work with has changed communication and in turn patients care for the better. Not only has it benefitted the current staff but it gives students the opportunity to practice and gain confidence in what can sometimes be challenging communication situations.

Evidence based practice

Brown et al (2008) recognized the importance of evidence based practice to ensure patients’ safety at all times. However, there are barriers which are identified including time and resources. The importance of applying theory to practice was highlighted by Upton. D (1999) therefore it is essential that a good mentor facilitates this. While working with a second-year student, we allocated him with a patient who had contracted Clostridium Difficile. The patient was nursed in a side room with isolation protocols in place following Infection control policy. The student working with me at the time discarded the apron and gloves inside the side room as per indicated. Nevertheless, he forgot to wash his hands to decontaminate them. Gerding et al (2014) provide evidence to show that C.Difficile spores will survive in the hands, therefore the evidence states that we must only use soap and water in these instances and ensure that patients and visitors use the same approach. I sat with the student and showed him the evidence articles, asking him to read through them. In response, he acknowledged that he needs to improve his nursing care and took it upon himself to remind visitors before and after entering a room that washing hands with soap and water is a must.

Leadership

Bally J. (2007) recognizes the importance of leadership in ensuring effective nursing standards. Not only is it important for nurses to have good leadership support from their seniors, but it is also essential that all nurses are themselves good leaders. Latham et al (2008) states the importance of nurses supporting team members is imperative to good patient care and career progression. Consequently, it is evident that a mentor should have good leadership skills in order to be an advocate for their student nurse and support them though their training. Wilkes Z (2006) describes the mentors role a one of support but also objective and analytical. When working with a student it is always essential that the student’s objectives and aims are met though planning and regular discussions of feedback and encouragement.

I met a student at her first neurosurgical placement. She developed a strong interest in our area and discussed her eagerness of seeing more aspects of neurosurgery, particularly brain tumors. I promoted her spending time with theatre cases of oncology, followed by shadowing oncology nurses and their discussions at the Multidisciplinary Team Meeting every week. She was also present at family meetings where the results were discussed with the patient and the treatment to follow explained to the family. The student enjoyed her time and felt that she engaged well with members of the medical team. We set up objectives for her to achieve and had different meetings afterwards to see if the objectives where achieved. She found ‘difficult and painful’ to break up sad news to patients and found that this area of neurosurgery was very challenging and complex but one she would love to dedicate to in the future. We went thought some literature together and shared experiences with her so she could understand that feeling pain and sadness thrt4ough our nursing career when facing extreme upset situations were common to most of us and nothing to feel ashamed of.