It is sometimes said that the body is invisible in nursing. The dominant western perspective that knowledge and theory are supreme has tended to push the body into the shadows. Ideas take preference to embodiment as a way of understanding human agency and culture (Rudge 1997). Even though the scientific body is very much the focus for nurses, the lived body, which is how patients experience their bodies, often takes back stage.
In mentoring, another meaning of bodies shows through. The patient's body becomes a site of teaching and learning. It is a teaching and learning space - for showing a student how to do eye drops, insert a catheter, take blood pressures, apply dresssings and bandages and so on. There is, therefore, commonly a patient as third party present to mentors and students in workplace teaching situations. Mentors also use their bodies as teaching tools, physically showing practice or guiding a student's hands.
Tuesday 7 December 2010
Friday 24 September 2010
Florence Nightingale rocks!
Who would have thought that Florence Nightingale could still be so current?
"I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient."
"The everyday management of a large ward, let alone of a hospital—the knowing what are the laws of life and death for men, and what the laws of health for wards—(and wards are healthy or unhealthy, mainly according to the knowledge or ignorance of the nurse)—are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art? They do not come by inspiration to the lady disappointed in love, nor to the poor workhouse drudge hard up for a livelihood." (Florence Nightingale 1898, 2004 )
"I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient."
"The everyday management of a large ward, let alone of a hospital—the knowing what are the laws of life and death for men, and what the laws of health for wards—(and wards are healthy or unhealthy, mainly according to the knowledge or ignorance of the nurse)—are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art? They do not come by inspiration to the lady disappointed in love, nor to the poor workhouse drudge hard up for a livelihood." (Florence Nightingale 1898, 2004 )
Wednesday 2 June 2010
What did the Nursing Times survey tell us?
The Nursing Times survey (reported on 27th April) seemed to reveal some quite shocking statistics about mentors passing students who they wanted to fail. Then, on the 11th May it was reported that the Nursing and Midwifery Council (NMC) will take "immediate action" to address the concerns the survey raised.
The front line of this action entails writing to the directors of nursing in all NHS trusts and all deans in the universities and the commisioners of the education programmes to take immediate action and remind everyone involved of their responsibilities. While this is a useful first step, one wonders whether this will have the desired effect, which is presumably to ensure that students receive adequate support in their practice placements and have a fair and accurate assessment of their achievements.
The job that mentors have to do to support and assess students is incredibly complex and in my opinion is severely underestimated when you consider the lack of time they have in which to do the work and the lack of formal or informal recognition they seem to have from their employers of the difficult job they do.
Those who do it very well can contribute a lot to our overall understanding of just what it takes to be a skilful facilitator of learning and a fair and just assessor who can really tell who you can trust to progress towards entry to the professional register and who you can't.
The front line of this action entails writing to the directors of nursing in all NHS trusts and all deans in the universities and the commisioners of the education programmes to take immediate action and remind everyone involved of their responsibilities. While this is a useful first step, one wonders whether this will have the desired effect, which is presumably to ensure that students receive adequate support in their practice placements and have a fair and accurate assessment of their achievements.
The job that mentors have to do to support and assess students is incredibly complex and in my opinion is severely underestimated when you consider the lack of time they have in which to do the work and the lack of formal or informal recognition they seem to have from their employers of the difficult job they do.
Those who do it very well can contribute a lot to our overall understanding of just what it takes to be a skilful facilitator of learning and a fair and just assessor who can really tell who you can trust to progress towards entry to the professional register and who you can't.
Friday 7 May 2010
Sunday 25 April 2010
Compassion in nursing
I'm not so sure that being compassionate excludes calm, somewhat emotionally detached decison-making. I think that nurses need to find a balance between being able to empathise with patients and be responsive to their emotional needs alongside the more fact-based clinical reasoning. Surely, in the end, it's about knowing how to treat people as people and not "conditions in a bed". Some of the best nurses I know do this juggling act incredibly skilfully and seemingly without effort, but no doubt they are paddling furiously under the surface. Then, there are some nurses who are incredibly compassionate with patients but pay less attention to the emotional needs of their colleagues.
In my recent work on trust as revealed by the mentors in my PhD study, I had a glimpse into just how complex all of this is. Trust is essential for cooperative teamwork. Nurses want and need to be trusted both by their patients and their colleagues - and although trust judgements are partly made in terms of cold facts ( can I rely on this person to do the job properly?), trust is also about emotional connections with people (if I reveal my personal or professional vulnerability, will this person respect that and respond appropriately?). Psychological safety is crucial if nurses are to maintain a no-blame culture and learn from clinical mistakes. The less trust there is in the workplace, the more errors and near-misses will be swept under the carpet and the system will struggle to improve.
Monday 15 March 2010
The meanings of place and time
Spring is late this year. The snowdrops are still in full bloom and the daffodils are yet to grace us with their show of bright yellow, even the early ones, so St David's day came and went in a more subdued way, botanically speaking, than in recent years. The waxing and waning of the seasons provides an anchor, a way of grounding human experience. Today is the "ides of March", the thought of which fills me with a tiny sense of forboding, but not being superstitious, I don't attach any real significance to this.The idea of place and time as being meaningful is often uppermost in my thoughts as I work with my research data. The different environments in which nurses work have an enormous impact on how they experience their work and their mentoring. A busy surgical ward presents a range of opportunities, challenges and constraints to a mentor that are quite different from a rehabilitation unit or a community nursing team. Whatever the setting, they all experience certain things that frustrate their efforts to be a good mentor and can strain their relationships with students and colleagues, along with the things that make their work worthwhile and that they feel passionate about sharing with students.
The work context dictates the pace of the work. The experience of time is very different in the different contexts and time dictates the rhythms of the work, the priorities that are constantly juggled and the affordances available to mentors to be with and support their students. Physical space is also significant - whether they can physically see the student at any time; whether there is a space for a private conversation; or how close is too close when working together. How these mentors feel about being a nurse, and nursing, in the context of their own lives is often an overarching driver for how they approach mentoring.
Tuesday 26 January 2010
Reflections on discussion with HSC Practice learning research group
I thought a useful way to start talking about my more recent considerations of mentoring and learning styles was to introduce the different mentoring styles (and the metaphors) that I had identified. I could then steer it to what people think of the concept of learning styles, and/or to the idea of “do mentors teach” depending on responses.
There was initial interest in the hierarchy I had created (low-high intervention) and some discussion about what values should be placed on this. Low intervention isn’t necessarily a negative. This is interesting for me in the sense that I hadn’t said that low intervention was necessarily of lower value than high intervention, but there seemed to be an immediate sense around the table that I was saying that, and perhaps the way I described the mentors reinforced this impression. This may well reflect my own feelings that the mentors I placed at the high intervention end seemed to have more energy for the role and seemed to have thought in great depth about how they can support students. This could, of course, be more a case of being more able or willing to talk about what they do and find the words to describe it. People often do think that doing more is better. Perhaps it shows greater motivation and greater application to the task or role.
What is the “right” disposition to be a mentor? Can mentors intervene too much and become “toxic”? One type of toxic mentor described by Lou Ann Darling (1985) is the “hoverer” who blocks development by too close supervision. The idea of “too close supervision?” was discussed in the Trust Chapter, and very specific explanations were given by the mentors concerned as to why they were supervising closely at those times. In fact, the reasons were very different and the mentors felt very differently about them. I didn't get any sense that these participants were toxic in any way, and the circumstances for close supervision were quite appropriate. We did agree, though, that working as co-workers needs to be valued as a valid way of supporting workplace learning.
We tried to come up with a metaphor for the mentor who I’d labelled as the person who was team oriented and offered a menu of experiences rather than see herself as a direct source of learning for the student. “Quality Street” was one offering. I like this, as I do think she offered quality to students.
Another way of articulating what mentors do is to say that they are negotiating and brokering a learning contract with students. The idea of mentors as brokers of learning is an interesting one, and may offer another way of thinking about what the role is and how mentors experience it.
The discussion has made me think about role modelling. I gave one of my mentors the label “role model” because she stood out as being very aware of how people viewed her and thoughts about how she came across to others seemed uppermost for her. She also had very definite views on the nursing profession and how it is viewed, and that it was important that students were made aware of this. However, it is probably true that all mentors recognise their role model potential and some of my participants talked about influential role models for them in the past. Another of the participants struck me as, if anything, a “reluctant role model” because she felt uncomfortable being observed by students and couldn’t see the point of learning by observation, as it was something that had never worked for her. Whether or not you are a role model for someone else is something you have little control over. Also, you can pick a role model for yourself without making that person aware, but perhaps you are even sometimes unaware yourself that you are doing it. “Role modelling” is a mentoring strategy that has been described recently by Bob Price in the Nursing Standard (Nov 2009). He talks about “role modelling sessions” as defined, planned activities that end with guided reflection. It is clear that I need to be aware that when using the term “role model” there is a range of meanings and activities that are associated with it and I’ll need to be explicit about what I mean by it.
I needed to explain about the data collection, the questions I asked or didn’t ask and why. It goes to show how pivotal the data collection process is - something to remember when writing up.
There was initial interest in the hierarchy I had created (low-high intervention) and some discussion about what values should be placed on this. Low intervention isn’t necessarily a negative. This is interesting for me in the sense that I hadn’t said that low intervention was necessarily of lower value than high intervention, but there seemed to be an immediate sense around the table that I was saying that, and perhaps the way I described the mentors reinforced this impression. This may well reflect my own feelings that the mentors I placed at the high intervention end seemed to have more energy for the role and seemed to have thought in great depth about how they can support students. This could, of course, be more a case of being more able or willing to talk about what they do and find the words to describe it. People often do think that doing more is better. Perhaps it shows greater motivation and greater application to the task or role.
What is the “right” disposition to be a mentor? Can mentors intervene too much and become “toxic”? One type of toxic mentor described by Lou Ann Darling (1985) is the “hoverer” who blocks development by too close supervision. The idea of “too close supervision?” was discussed in the Trust Chapter, and very specific explanations were given by the mentors concerned as to why they were supervising closely at those times. In fact, the reasons were very different and the mentors felt very differently about them. I didn't get any sense that these participants were toxic in any way, and the circumstances for close supervision were quite appropriate. We did agree, though, that working as co-workers needs to be valued as a valid way of supporting workplace learning.
We tried to come up with a metaphor for the mentor who I’d labelled as the person who was team oriented and offered a menu of experiences rather than see herself as a direct source of learning for the student. “Quality Street” was one offering. I like this, as I do think she offered quality to students.
Another way of articulating what mentors do is to say that they are negotiating and brokering a learning contract with students. The idea of mentors as brokers of learning is an interesting one, and may offer another way of thinking about what the role is and how mentors experience it.
The discussion has made me think about role modelling. I gave one of my mentors the label “role model” because she stood out as being very aware of how people viewed her and thoughts about how she came across to others seemed uppermost for her. She also had very definite views on the nursing profession and how it is viewed, and that it was important that students were made aware of this. However, it is probably true that all mentors recognise their role model potential and some of my participants talked about influential role models for them in the past. Another of the participants struck me as, if anything, a “reluctant role model” because she felt uncomfortable being observed by students and couldn’t see the point of learning by observation, as it was something that had never worked for her. Whether or not you are a role model for someone else is something you have little control over. Also, you can pick a role model for yourself without making that person aware, but perhaps you are even sometimes unaware yourself that you are doing it. “Role modelling” is a mentoring strategy that has been described recently by Bob Price in the Nursing Standard (Nov 2009). He talks about “role modelling sessions” as defined, planned activities that end with guided reflection. It is clear that I need to be aware that when using the term “role model” there is a range of meanings and activities that are associated with it and I’ll need to be explicit about what I mean by it.
I needed to explain about the data collection, the questions I asked or didn’t ask and why. It goes to show how pivotal the data collection process is - something to remember when writing up.
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