Providing Feedback to a Year 1 Student Following Drug Calculations and Medication Round

Abstract: The provision of feedback to students is one of the various roles of mentors in the context of nursing education. This essay provides a critical analysis of the process of giving feedback to a nursing student in the context of achieving one of the competencies identified as part of the Mentorship Preparation Course.

Providing feedback to students has long been considered as a fundamental aspect of the learning process. The requirement for mentors to give feedback to students is a key component of student assessment and mentors are responsible for providing regular feedback to their students to ensure that they are able to meet their learning objectives. This has been emphasised in the Nursing and Midwifery Council’s (NMC) (2008) Standards to Support Learning and Assessment in Practice, which specifically states that: ‘Mentors are accountable for assessing total performance including skills, attitudes and behaviours’. It is essential for mentors to possess the necessary skills and to be competent in ‘providing feedback to students and assist them in identifying future learning needs and actions’ (NMC,2008). Feedback enriches the student’s learning experiences and is also considered as a measure of teaching quality (QAA, 2008). Therefore, mentors should be able to provide constructive verbal and written feedback to students, including programme providers (Duffy, 2013). On the other hand, some mentors still feel that providing feedback remains as a challenging endeavour (Cornell, 2014). In fact, educators have raised concerns about the feeling of not being confident with their feedback skills; sometimes avoiding giving feedback as they are concerned that it could lead to a defensive response on the part of the student or ruin the mentor-student relationship (Johnson, 2016). This activity was selected in order to gain more knowledge and skills in giving feedback to students as one of the Learning Needs identified at the beginning of the course.

The student who took part in this activity is on Year 1 of the BSc (Hons) Nursing (Adult) [Pre-registration Nursing] programme from BPP University and is on her second placement. The student’s previous placement was in a General Medicine-Diabetes Ward. Based on the curriculum, the course that the student is currently taking is classified as a Level 4 programme. In reference to the SEEC Descriptors (2016), students on Level 4 programmes are expected to carry out certain tasks that are complex and non-repetitive in nature. The learner must also be able to fully engage in self-reflection. The placement was undertaken in the Regional Neurology Unit which is a 31 bedded ward specialising in the care of patients with various neurological conditions including those who have had a traumatic brain injury (TBI). In reference to the most recent Practice Learning Environment Audit carried out by one of the Link Lecturers in April 2017, the practice area has been assessed as meeting all the Placement Learning Standards. In addition, the assessor has specified that “The Ward has very good learning opportunities for students. Students can gain an excellent foundation in the basic nursing care as well as specialised neurological conditions. There is a good team to support students”.

The student was tasked to carry out simple drug calculations followed by completing a supervised medication round. These activities are embedded in the student’s Practice Assessment Document as part of the NMC Standards for pre-registration nursing education, specifically under the Essential skills cluster for Medicines Management (NMC, 2010). Following the completion of the two activities, the student was invited to proceed to the dayroom and was asked if she wants to receive the feedback. After the student has confirmed that she wanted to receive feedback about her performance, the mentor has confirmed with the student if she was ready for the feedback session. The student was happy to proceed with the discussion about her performance. Schartel (2012) has suggested that feedback should be given with consideration to privacy and should be focused on the events being discussed. In addition, Rudland et al (2010) has stressed the significance of giving the feedback in a timely manner, ideally soon after the event. Moreover, it is important that the learner should be ready to receive feedback in order to maximise its benefits. The Pendleton model was utilised in giving the feedback to the student. It is a recognised method which creates a positive environment by allowing the mentor to put emphasis on what was done well (Hardavella et. al, 2017). This model focuses on the learner and the learner-mentor conversation. Furthermore, it allows the learner to identify an action plan or goals which leads to “reflection for action”. During the initial point of conversation, the student was asked about what she has done well during the medication calculation activity and the subsequent supervised drug round. The student was prompt to discuss about the near miss incident that she was able to identify and subsequently reported. She also feels that she was able to promote patient safety by correctly checking the patient’s identity prior to looking at the online drug chart. The student has also mentioned about taking an active role in liaising with the Ward Pharmacist to rectify the issues identified during the drug round. It is important to note that the mentor has used a positive approach at the beginning of the conversation with the student. This strategy allows the mentor to open up a protected atmosphere first by emphasising the good and therefore avoiding the learner to become defensive. Since most of healthcare professionals learning is practical, this has been an opportunity for the mentor to promote a reflective and experiential learning, including the prospect of reflecting on the whole experience of completing the drug calculation and the drug round, reflecting and reporting on the incident, and overall feelings about the learning activities. The mentor has agreed with the student about the good points mentioned. In the subsequent step, the student was asked about what was done poorly or what could have been done better. She was able to mention about not checking the patient’s drug allergies and the blood glucose level prior to administering subcutaneous Insulin. The last part of the feedback process allowed the mentor to tackle about the areas that could have been improved such as: gathering all the medications and materials needed before commencing the drug round, following the 5 Rights of Medication Administration and ensuring that patient allergy is checked, involving the patient with their care by asking if they would like to self-administer the Insulin, and proper documentation. Altmiller (2016) suggested that constructive feedback should require a balanced analysis of the performance, describing events as they happened, with the purpose of rectifying mistakes and promote understanding.

The student welcomed the feedback given after the learning activities. She feels that she has achieved the agreed learning objectives. The mentor has emphasised on the student’s ability to pick up a near miss incident by recognising an Insulin pen which belongs to another patient and is also out of date. Although there was a limited time to discuss the whole picture of Medicines Management with the student, overall, I found that the entire activity was successful. The student was also happy about the outcome of the feedback session.

Good and extensive feedback in a range of educational contexts has been found to have a direct impact on student engagement and high-quality learning (Black and Williams, 1998). This assumption was further strengthened by Parboteeah and Anwar (2009) when they emphasised the effect of feedback on the student’s motivation to enhance their learning. The importance of high-quality positive feedback was further explored by Plakht et al., (2012) in a cross-sectional study which was participated by 124 third year nursing students. The respondents were asked to evaluate the feedback provided by their teachers using a set of survey questions. The researcher has recognised one of the limitations of the study which is the evaluation of the feedback as being subjective rather than utilising an objective approach. The proponents of the study have emphasised that the subjective evaluation of the student’s feedback should be more significant rather than using objective criteria to highlight the individual characteristics of the students instead of an using an identical tool for all. Results of the study puts emphasis on the direct impact of high-quality positive feedback in achieving higher goals and a significant impact on the student’s clinical practice. On the contrary, it is interesting to note that the researcher found out that giving high quality negative feedback has a direct impact on the student’s accurate review of their performance while high quality positive feedback may lead to the student’s overestimation of their performance. Using a qualitative research design, Matua et al., (2014) studied the various approaches that preceptors use in providing effective feedback in a University Hospital in Oman. The researcher has used a modified focus group discussion method to guide the conduct of the study. The findings indicated there were six strategies in the provision of effective feedback: feedback should be given regularly and in a timely manner, must be clear and focused, emphasises current performance and progress, feedback given should start with the positive and ending with negative evaluation, feelings and privacy of the learner must be considered.

Some researchers on the other hand argue that NEGATIVE

Forms of Feedback

Feedback comes in a variety of forms. Vida Tayebi et al., (2017) conducted a randomised controlled trial to explore the effectiveness of oral versus written feedback. Using purposive sampling, 44 nursing students participated in the study. Each participant was designated to either oral or written feedback response groups. Prior to the commencement of the study, three instructors underwent training regarding the arrangement of feedback sessions. They were then tasked to give the necessary feedback to the nursing students. The results of this study indicate that the provision of oral versus written feedback has the same effects on the learner. On the other hand, a previous study by Al-Deen (2008) concluded that written feedback is a more effective technique in teaching methods as compared to audio-verbal feedback. All these findings were disproved by Giles et al., (2014) when in a descriptive study participated by 362 nursing students, they have concluded that students are concerned more about the manner of giving feedback rather than its form. They emphasised that student satisfaction is a more variable measure of the quality or effectiveness of feedback. It is also worthy to note that the provision of feedback does not always relate to the improvement of student performance and may even cause more harm than good (Hattie et. al.,

Several studies have identified the barrier in the provision of effective feedback. According to mentors must give priority to patient care which frequently results in minimal supervision of students. This is particularly true during periods of intense ward activity, precisely the time when students require maximum support and feedback.

Rationale and Critical Analysis

There is a strong evidence base about the need for mentors to provide students with regular feedback on their progress as part of the student assessment. Feedback has always involved an interaction between the mentor and the student. It helps in bridging the gap between the students current and expected level of performance (Clynes and Raftery, 2008). Johnson et. al., (2016) proposed four key themes that may best describe the concepts of high-quality feedback.

The impact of constructive feedback extends beyond the teaching and learning process. Feedback is essential for the student’s growth, provides direction and helps to boost confidence, increase motivation and self-esteem

In the context of medicines management, mentors are encouraged to prepare students for the clinical environment by establishing existing knowledge and learning, outlining negotiated expectations with timescales for achievement, and providing timely and constructive feedback. Mentors are in the best position in influencing the student’s success in medication administration by identifying key issues through assessment and feedback.

Recommendations for best practice

The Nursing and Midwifery Council is primarily responsible for safeguarding the health and wellbeing of the public (NMC, 2010). To realise this, the NMC, through its Code (2015) has explicitly stated the Registered Nurses’ responsibility to practise effectively by being able to “support students’ and colleagues’ learning to help them develop their professional competence and confidence”. Following the

The feedback should also mention specific strategies the individual can use to improve their learning and performance and should provide not only information on their performance but also a guide for their next steps (Matua et al 2014).

Flott and Linden (2015) has emphasised that it is essential for nursing leaders to promote a culture that values future nurses and to remember the professional responsibility of nurses in the preparation of nursing students towards gaining qualification.