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I currently work as a nurse in the Obstetrics and Gynaecology department where I am allocated with the duty to care for pregnant female patients and female patients with varied gynaecological problems. In the clinical setting, I am responsible to support the induction of new nurses and student nurses to work by our side to appropriately care for the patient. The common learners often got in the setting are student nurses from the second and third year of nursing. They are mostly pursuing BSc degree in nursing with a keen interest in learning practical ways to care for patients by applying their theoretical knowledge learned while studying at college.
On the first day of their induction, the student nurses are welcomed at the placement by offering a verbal appreciation speech and a rule sheet to be followed as a nurse in the care under different conditions. They are inducted on the first day of work by providing detailed information about the patients in the ward they are to work for and care. Further, the student nurses are introduced to all the ward staff and multi-disciplinary teams with details regarding the way they are work collaboratively with them to get trained in delivering care. The student nurses are later provided with the duty sheets which inform their time of duty for each patient to be care in the hospital.
In the placement, many key learning opportunities are present for the student nurses in their induction one of which is identifying way patients react during childbirth and way to calm along with care for them during child labour and delivery to ensure smooth childbirth. The other opportunity for student nurses in the induction process is understanding practical ways to assist and perform routine examinations on real-life patients for pap smears and sample collection. Another example of learning opportunity for student nurse in the placement is they become accustomed with the way to assist obstetrics consultants in obstetrical examination of the patients like prenatal screenings, pelvic exams and others. The other two key learning opportunity is to become educated to practically monitor, weigh and vaccinate newborns along with learning way to counsel women who face childbirth failure in the delivery process.
The learner which is the student nurses in the induction work with the gynaecologist consultants in helping them screen patients for their health condition. In the induction, the student nurses also work with colonoscopy consultants and general practitioners to understand the needs and demands of care of the patients based on their health diagnosis made by the consultants. A monitoring of the student nurses at work is done by me as the supervisor after their initial induction on the first day at work. I observe and evaluate their working nature and interact with them at intervals to understand that the learning is taking place and they feel settled to learn as well as work to care for patients at the same time without making any errors.
In the placement, I planned and facilitated learning for one of the student nurses about the venepuncture method for collecting blood to test for glucose tolerance of three of the pregnant women. This is because the student nurse expressed anxiety and lack of practical knowledge of the way to draw blood for blood test from vein of patients for laboratory testing. In supporting the learning of the venepuncture process to the student nurse, I asked her to follow the instructions I am providing verbally and watch me practically execute the act to later perform the process on own for the next two patients. As analysed through the Honey Mumford Learning assessment, I follow the learning style of reflector and activities in achieving any goal or experience. The activists are individuals who are enthusiastic about new experiences and intend to learn any action by doing the action required (Costa et al., 2020). However, the reflectors as learner ensures best learning is achieved when the learners are provided the opportunity to watch people and reflect on it to understand the way it is happening to perform the task (Dantas and Cunha, 2020). This idea of being both activist and reflector as a learner made me think that the student nurse could only learn efficiently regarding the way to perform venepuncture to collect blood for testing from patient if the individual actively performs the task after I have shown her the process of venepuncture. Thus, I made the student nurse perform the act on own two patients after I had shown her the process and informed the instructions to be followed to execute the act on one patient.
In supporting the learning of the student nurse regarding venepuncture, as a reflector, I followed Gibb’s reflective cycle as a learning theory. This is because Gibb’s reflective cycle helps nurses to analyse and evaluate their experience to share the strengths and weaknesses of skills in the situation along with skills and information learned in the practical experience (Li et al., 2020). Thus, I asked the student nurse to provide me with a reflection of her experience by following Gibb’s model after watching me perform venepuncture to draw blood. Moreover, being a half-activist learner, I followed the constructivism learning theory. This is because constructivist learning theory mentions learners construct their knowledge from experiences rather than passively gather information to execute the work (Epp et al., 2021). Thus, according to the learning theory, I asked the student nurse to actively perform the task of venepuncture in drawing blood for testing from the other two patients after she had already watched me perform the task. This is because the theory indicates learners develop knowledge from experience and reflecting on it and not merely gathering information on the way to execute any act.
The advantage of the activist learning style is that it makes the learner become flexible as well as open-minded to perform any task with the motivation and enjoying to learn something new (Childs-Kean et al., 2020). This is true as I was open-minded in allowing the student nurse to perform the task of venepuncture without my supervision just after watching me execute the task. In contrast, the advantage of the reflector learning style is that it makes them individual be cautious of their action and memorise facts along with avoid jumping to conclusions (Dantas and Cunha, 2020). It is evident as after getting a positive reflection regarding the venepuncture training experience from the student nurse, I allowed her to perform the task on own for the other two patients. This is because she showed confidence to execute the task and confirmed to having all knowledge and skills to execute the act.
The strength of the activist learning style is that the individual supports to get involved in new experiences and has optimistic attitude (Pološki Vokić and Aleksić, 2020). I have always seen the nurses acting as supervisors perform the work for which the student nurses to be trained at first for two or three times to help them observe and learn to later supervise by being present while performing the task. However, I believed in new experience which led me to ask the student nurse to perform venepuncture by following my verbal instructions and practical support on own. This is because it would be a new way of learning for the student to actively learn in performing task and gaining skills for care. Moreover, allowing freedom to execute any task after being supported to learn it makes the nurses have feel favourable to execute the task. This is because they do not fear that the supervisor is watching which may make them execute mistakes out of fear (Rajkumar and Ganapathy, 2020).
The limitation of following the activist learning style is that it influences the learner to take needless risk and sometimes makes the learner feel to be rushed into action which makes them nervous to perform error in care (Yadav et al., 2020). In the case of the student nurse, who was being supported by me to learn venepuncture in drawing blood, one of the needless risky impacts faced is that two of the patients reported of pain in the hand from which the blood was drawn. I checked the area and found the muscle is being damaged due to improper needle angle during insertion to draw out blood from the patients. The risk could have been avoided if I would have been present while the task is being performed to supervise the student nurse rather than believing on her experience after watching me execute venepuncture on one patient to be able to execute the task. In contrast, the limitation of reflector learning style is that it avoids the learners to show direct participation which does not concern them (Ratnaningsih and Hidayat, 2020). Since the drawing of blood for glucose test through venepuncture was not my concern as it was the duty of the student nurse to be performed, I avoided to remain while she performed the action that led to the issue of muscle damage. This is because my presence could be able to instruct the student nurses about the angle of needle to be maintained while puncturing through muscle to reach vein to avoid damage and pain to the patient.
The role of the nurse educator is to teach prospective clinical nursing skills to new nurses or student nurses in making them develop enhanced practical experience to deliver quality care (Billings and Halstead, 2019). However, failure to teach clinical skills to student nurses makes them show non-competence in performing complex care and make errors in care (Bastable, 2021). Thus, the role was followed by me in the placement as an educator, I took the initiative of teaching the student nurse regarding the way to perform venepuncture to draw blood for laboratory testing when she informed to lack of information regarding the action. The role of the nurse educator is also to maintain effective communication in sharing important tips and protocols of medical procedures to be followed in performing any medical care or assessment for the patient (Billings and Halstead, 2019). The role was effectively followed as I verbally communicated the importance of angle of the needle to be maintained while inserting and drawing blood through the venepuncture process. Moreover, I shared the hand hygiene tips and needle disposal techniques to be followed by the student nurses to avoid any risk of infection to the patients while drawing blood for testing through venepuncture.
The role of the nurse educator is to show effective leadership to guide students regarding the way execute care and health assessment of patients (Billings and Halstead, 2019). Miles and Scott (2019) argue that failure of effective leadership towards nursing students causes poor quality care and raises unnecessary error in care. This is because lack of leadership from supervisor makes student nurses remain confused regarding the way to perform a care out of lack of constructive guidance to perform the task. A similar condition is faced in case of supporting the student nurse in learning venepuncture to draw blood as I have avoided to guide her during the process after showing way to execute the process. The role of the nurse educator is to inform about the best collaboration practices to the student nurses. This is because it would help the student nurses to learn about the strategic ideas to be followed to work with different professionals as a team to deliver quality care to the patient (Jeffries, 2022). The role was effectively followed as I educated the student nurse regarding the way to collaboratively work with the gynaecologist and obstetric consultants to reach quality care to the female patients in the ward.
The role of the nurse educator is to inform the student nurses regarding the way to work within competence to deliver care without causing error or mistakes (Bastable, 2021). However, I fail to follow the role as I did not educate the student nurse that she needed to consult me in case of any further confusion regarding venepuncture as it would help her to work with competence and professionalism. It is evident as the NMC Code mentions the nurses to ask for assistance from colleagues and other professionals to deliver care without confusion and beyond their competence (NMC, 2018). The nurse educator also has the role to assess the performance of the student nurse to determine their level of skill and knowledge to become a future nurse (Bastable, 2021). I being a half reflector in learning, I assessed the learning of the student nurse based on reflection. This is evident as I asked her to provide me a self-reflection of her learning from me about venepuncture process in drawing blood to test for glucose level in pregnant women.
The advantage of assessment through reflection is that it helps in identifying the strengths and weaknesses of the learner from their view to determine the support expected by them to improve their learning experience (Bjerkvik and Hilli, 2019). However, the limitation of assessment through reflection is that it leads the tutor to believe the learning success from the perspective of learner which may be manipulative (Klenke-Borgmann et al., 2020). For example, the initial assessment of the student nurse regarding her capability to perform venepuncture for extracting blood after I showed her to execute the action indicated she has developed enhanced efficiency to execute the activity without error. However, the later feedback from the patients indicated her failure in successful learning indicating the student nurse may have manipulated to express her weakness in reflected based on which her efficiency to care is assessed.
In the current condition, I acted mostly as an educator and least as an assessor. In future context, where I will be acting as an assessor, I plan to use the informal formative assessment theory. The informal formative assessment theory informs that assessments are to be made in real-time to gather immediate information regarding their impeding progress. It helps in gathering insight regarding the way to guide the students or learners while in the process of learning a lesson to accomplish it effectively (Lajane et al., 2020). The different ways in which informal formative assessment is made include questioning, peer assessment, feedback and self-assessment or self-reflection (Lajane et al., 2020). During the initial assessment of the student nurse in the care, the feedback, peer assessment and questioning protocol are not used which led to poor assessment and support to develop enhanced learning (cambridge-community.org.uk, 2023).
The feedback assessment is important because it helps the learners have detailed qualitative information about their level of efficiency and area of weakness to be further worked on to be improved to become successful learners (cambridge-community.org.uk, 2023). Immonen et al. (2019) argue that lack of feedback assessment lowers the performance of a learner. This is because they fail to understand their weakness and areas to be improved. Further, questioning in the formative assessment process helps in identifying the issues and gaps in learning and performance faced by the learners that are unknown to them. This is because it helps in deeper analysis to understand the information or learning lacking in the individual beyond their realisation (Hodges et al., 2018). Further, peer feedback in formative assessment is to be used for assessing learner’s performance because the peers have the efficiency to look past the learners regarding their weaknesses at work (cambridge-community.org.uk, 2023).
In supporting a student nurse who is struggling to learn any skill or developing knowledge in the workplace is to be initially supported by identifying the learning style followed by them. This is because it would help to understand the techniques through which information for learning is to be provided to help the learner successfully grasp and remember the information to develop knowledge that they are struggling to achieve (Elmir et al., 2019). A Personal Development Plan (PDP) is to be created for the student nurse as a learner who is struggling to learn things in the workplace by evaluating their level of development and skill. This is because PDP helps in suggesting specific ways the poor skills in a struggling student to be improved to help them achieve effective learning. The PDP being specific to the learner’s context is useful in suggesting person-centred support for their enhanced learning opportunity (Amsrud et al., 2019).
In the workplace, a student nurse as a learner who is struggling to learn any skill is to be supported by providing one-to-one group intervention and training for the aspects with which they are struggling to achieve. This is because one-to-one support helps in specifically deliver assistance to the single student to share their difficulties to be personally resolved in improving their learning (Humphries et al., 2020). The learner struggling at the workplace is to be monitored and assessed throughout the lesson instead of assessing them at the end of the lesson. This is because continuous monitoring and assessment throughout the lesson would immediately help the educator to determine in which aspects the learners are struggling and the reason for the struggle that could be resolved at the same time. It helps in responsibly and coherently resolving issues as they rise instead of leaving them to be managed in the end of lesson which create increased chances of error (Amsrud et al., 2019). For instance, if the student nurse performing venepuncture to extract blood was continuously monitored and assessed by me, the moment she hindered to maintain the angle of the needle to draw blood could be identified. The issue could be resolved immediately and muscle pain as experienced by the two patients could be averted.
Thus, it can be concluded that formative assessment theory is effective to be followed in assessing the learner’s performance. The role of the assessor is mostly followed but effective leadership and guidance to be shown as educator was not effectively achieved. The struggling learners are intended to be supported by framing specific PDP for them, offering them one-to-one group support and others.
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