2000 Word Critical Reflection on Strategies the Learner Has Used to Facilitate Learning

The purpose of this assignment is to critically reflect on strategies used to mentor a second year mental health student in a community mental health team. The essay will refer to interpersonal skills used to develop the mentor-mentee relationship, and the practical steps taken to facilitate learning; to make this more tangible the focus will primarily rest on the author’s approach to teaching the learner how to administer an antipsychotic depot injection.The discussion will encompass major theories that underpin learning, explore the relevance of learning styles, and draw on relevant literature. Any discourse on mentoring ought to begin with the question: what is the definition and role of a mentor? McAllister (1997) offers this: ‘A professional who engages in a teaching and learning process which is student centred and occurs in the context of client care. It involves the translation of theory into the development of knowledge and professional skills, with the incorporation of the affective domain needed for sensitive and ethical care. (McAllister 1997 p3).

Darling (1984) identified the expected roles of mentors , which included that of role model, supporter, teacher and coach, giver of feedback, problem solver, challenger and investor; whilst Gopee (2007) offered a long list of desirable characteristics, such as patience, open mindedness, approachability, a sound knowledge base, self-motivation, good teaching skills, the ability to provide psychological support, tact, diplomacy, confidence, honesty and trustworthiness, versatility and flexibility, and willingness to be a mentor.Taking in the complex array of suggested roles, characteristics, and the ideas around mentoring, the author considered it pertinent to initially approach the mentor-mentee relationship with the simple tenets of a person-centred approach – Carl Rogers (1983) advocated using empathic understanding, genuineness, and being non-judgemental in learning situations. Carl Roger’s proposition was that the teacher (or, in this case, mentor) facilitates student-centred learning – this was supported by Knowles et al (1994) – as opposed to dictating the teaching.With this in mind, the first step in developing a relationship with the learner was to organise time, away from colleagues, during which she could have the opportunity to speak about her past experiences as a student and her expectations of learning on this placement. During the initial conversation the author encouraged the learner, Laura (name changed to protect confidentiality, as defined by NMC ((2010)) to speak about her previous experiences of being mentored. She spoke of having had disparate experiences in her past placements.

She defined her positive experiences during one placement as being welcomed as part of the team, being shown respect, and being given the right level of responsibility and supervision. Conversely, Laura had also had one particularly bad experience of being mentored. She described this experience as being shown little interest, having all her ideas rejected as invalid, receiving limited support to carry out tasks, and being subject to some very out-dated professional views held by her mentor.Heirs and Farrell (1986) and Darling (1984) both identified negative features of some mentors, which included being unavailable, self interested, and not providing enough support for learners to carry out new skills. It is clear that good mentors ought to guard against such prohibitive practice. Laura’s past experience also underscored the pivotal role mentors have in the development of learners.

At the conclusion of this first discussion, the author and the learner discussed setting up a learning contract. There was conversational emphasis on the need for the learner to formulate and lead this process.Knowles (1975) outlined three immediate reasons for self-directed learning: firstly, he argued that evidence indicated that proactive learners (individuals that take initiative in learning) learn better than reactive learners (those that act as passive recipients of teaching); secondly, he suggested being self-directed is congruent with our natural psychological progression – ‘An essential aspect of maturing is developing the ability to take increasing responsibility for our own lives – to become increasingly self-directed’ Knowles 1975: 15); lastly, he said that changes in the education system demanded that learners are more proactive, so ‘students entering these programs without having learned the skills of self-directed inquiry will experience anxiety, frustration , and often failure, and so will their teachers. ‘ (Knowles 1975: 15). Laura agreed with the rationale and, after relevant discussion, set about constructing a contract.

The contract objectives and aims included a few areas for development, but Laura had identified the administration of antipsychotic depot medication as a clinical skill that provoked anxiety in her, but one that she wished to address during this placement. Laura also stated that she was currently studying a module on medication at college, and elements of her practice document included the development of knowledge in this clinical area.NMC (2010) suggest that mentors should support students to identify both learning needs and experiences that are appropriate to their level of learning, and Laura’s suggestion seemed very appropriate for her stage of development, i. e. a mature second year student. Following the decision to focus on the learning of the aforementioned clinical skill, the author and student discussed individual learning styles and thought about which approaches would most benefit the latter.

Laura was familiar with Honey and Mumford’s (2006) Learning Styles Questionnaire, had previously completed one, and her dominant learning styles were reflector and theorist. Honey (2006) suggests that learning is most likely to happen when activities match the learner’s preferences. According to Honey and Mumford (1982), theorists tend towards an analytical approach and learn best when they have an opportunity to ask questions and understand the subject as a whole; reflectors learn best by thinking about things, obtaining and reviewing information and evidence, before forming conclusions.With Laura’s learning preferences in mind, the author and she discussed and agreed upon the following course of action:

• 1) Laura would research about administration of antipsychotic depots.
• 2) The author would provide a basic teaching session about the subject and facilitate a post-session discussion.
• 3) The author would demonstrate the skill in a depot clinic.
• 4) Laura would carry out the skill.
• 5) The two would reflect upon the process.
• 6) Laura would have further practice throughout the placement.

According to Fitts and Posner (1967) the learning process is sequential and we move through specific phases as we learn. There are three stages to learning a new skill: Cognitive Phase – Identification and development of the component parts of the skill and formation of a mental picture of the skill.

Associative phase – Linking the component parts into a smooth action – involves practising the skill and using feedback to perfect the skill.Autonomous phase – Developing the learned skill so that it becomes automatic. It could be considered that parts one to three of the action plan are connected to the cognitive phase; parts four and five involve the associative stage; and part six is mostly related to the associative stage.The session was designed with a view to providing basic information on the skill of administration of injections, but also aimed to draw on the wider ethical implications of prescribing antipsychotic medication, client choice and mental capacity, rationale for depot injections, as well as the importance of interpersonal skills. The author had the intention to foster the critical faculty held by the student as a reflector and theorist, with the longer view of her being able to transfer this to her future practice.The session was also designed with a view to building on Laura’s previous knowledge.

She had expressed that she felt she that, owing to a previous negative experience of a past placement, she had little knowledge to bring to the current placement. This was explored in a humanistic fashion, incorporating the core conditions of empathy, unconditional positive regard and congruence. After exploration, Laura was able to recognise that, as well as having transferable practice skills (for example, she had a good knowledge of aseptic techniques), she had valid views on the ethical questions around wide prescribing of antipsychotic medication.Ausebel et al’s (1978) assimilation theory, which falls under the umbrella of cognitive learning theory, centres around the process of activating the knowledge held by an individual, in order that it can be built upon with new knowledge; as such, this theory considers the learner’s existing knowledge as the most important factor in learning, and, as suggested by Goppe (2007) is the main factor in transferring learning from one area to another. A discussion took place between the author and student, during which there was an acknowledgment of the validity of the underpinning cognitive theory.It was agreed by mentor and student that this insight and understanding may support and enhance future practice for both.

The next stage was to demonstrate the process with a client. According to Bandura (1983) learning occurs as the learner observes the behaviour of others, and Quinn (2001) suggests that Bandura’s social learning theory is a powerful tool that can support the development of professional behaviour and attitudes. The author was aware of a heightened sense of self-awareness throughout the time spent with the student, and process led to a more thoughtful and considered approach to practice. ) Laura watched the process a number of occasions. The author was concerned not only with demonstrating the clinical skill, but also the appropriate interpersonal skills -informed primarily by Roger’s core conditions of empathy, genuineness, and unconditional positive regard – to engage client.

Laura was encouraged to ask questions between seeing each client. The student expressed feeling nervous and this was discussed. Humanistic theorist Abraham Maslow (1987) theorised that individuals need to meet basic needs before moving towards higher needs of self-esteem and self-actualisation. From a humanistic standpoint it felt pertinent to explore Laura’s anxiety, with a view to reducing it. The discussion established that she was concerned about being able to speak with the client, whilst simultaneously thinking about the preparation and administration of the injection.

It was agreed that the first time that Laura administered the injection, the author would engage the client interpersonally (whilst also monitoring safe preparation of the depot injection). It was agreed that her priority was to safely administer the injection, and, at this stage in her learning, it was enough to have an awareness of the interpersonal skills and insight needed to work with this client group in this situation, e. g. having an awareness of client’s anxiety, picking up on perceptual abnormalities, and listening to any concerns that they might have about the medication. The author reflected that he had not truly considered the above aspect that had caused anxiety in Laura in developing this new skill. It would be pertinent to raise and discuss this subject when mentoring future students.

The student was able to focus on the skill of administering the medication and did so competently. In the discussion and reflection, which followed immediately, it was appropriate to positively reinforce Laura’s development of a new clinical skill.Behaviourists – Edward Lee Thorndike and Frederic Skinner were two leading figures of this theory – hold that a behaviour is likely to be repeated when it is positively reinforced, and West (2005) recommends giving reinforcement to students as they adopt new skills and making sure they are rewarded for doing something well. The author concurs with the humanistic view that a purely behaviourist approach ignores important human aspects, such as feelings, values and attitudes, but the concept of positive reinforcement is well supported by research.The author praised Laura’s competence in giving the depot, and also her willingness to take on the wider ethical and professional points.

The student expressed her gratitude for the feedback.  Here the author has to acknowledge that, owing to work commitments, his own practice supervisor was unable to attend the session. The feedback and constructive criticism would have provided opportunities for learning and development. This is an area for improvement for future practice.The development of self-awareness is crucial in facilitating learning, and, as such, opportunities for feedback should always be taken.

  Feedback was provided by the student, both in the discussion, and in written form (see appendix 1), but the relationship and dynamic between mentor and mentee may make it difficult for the latter to provide feedback that might be construed as negative.The essay has reflected on strategies used to facilitate learning in a community mental health team. The discussion has encompassed learning styles and aspects of humanistic, behaviourist and cognitive learning theories. It is clear that each theory has its merits and omissions, none stands alone as the whole approach to learning, but a knowledge and awareness of these theories may enhance the performance of mentors. Learning styles may be used to develop insight into a student’s learning tendencies, and this may enable mentors to work more effectively with students – and it must be remembered that individuals learn in different ways.The reflective process has highlighted insights in teaching and learning, as well as areas for improved practice in the future.

The experience of mentoring has reinforced to the author the importance of empathy and understanding in the mentor-mentee relationship. The process of spending time with the Laura brought sharply into focus the importance of the mentor role in student development.Reference list: (1. )Ausubel, D. , Novak, J.

, & Hanesian, H. (1978). Educational Psychology: A Cognitive View (2nd ed). New York: Holt, Rinehart & Winston. (2.

)Bandura, A. (1962). Social Learning through Imitation. University of Nebraska Press: Lincoln, NE. (3. )Bandura, A (1983) “Social learning Theory” New Jersey: Englewood Cliffs (4.

)K K Chitty, Professional Nursing: Concepts and Challenges, third ed (Philadelphia: W B Saunders Co, 2001). 5. )Darling LA (1984) What do nurses want in a mentor? Journal of Nursing Administration 14 (10), 42-44 (6. )Darling LA (1984) What to do about toxic mentors. Nurse Educator 11 (2): 29-30 (7. )Fitts, P.

M. , & Posner, M. I. (1967). Learning and skilled performance in human performance.

Belmont CA: Brock-Cole. (8. )Gopee, N (2007) Mentoring and Supervision in Health Care. London:Sage publications (9. )Heirs B, Farrell P (1986) The Professional Decision Thinker- Our New Management Priority, 2nd edn.

Garden City Press, Hertfordshire. (10. )Honey, P & Mumford, A (2006).The Learning Styles Questionnaire, 80-item version. Maidenhead, UK, Peter Honey Publications.

(11. )Honey. P, Mumford. A (1982. ) The manual of learning styles. Maidenhead: Peter Honey.

(12. )Knowles, MS (1984) Andragogy in Action: Applying Modern Principles of Adult Learning. Jossey-Bass, San Francisco (13. )Knowles, M. S.

(1975) Self-Directed Learning. A guide for learners and teachers, Englewood Cliffs: Prentice Hall/Cambridge. 135 pages. Programmatic guide that is rather objective oriented. Sections on the learner, the teacher and learning resources. (14.

)Maslow. A.H (1987) Motivation and personality. London: Harper & Row. (15.

)McAllister, L (1997) An adult learning framework for clinical education in:McAllister, L. Lincoln, (16. )NMC (2010) Guidance on Professional Conduct, 2nd ed. (17. )Quinn F.

(2001) The Principles and Practice of Adult Education 4th ed. London: Chapman Hall (18. )West. S (1995) – PFPL&A August 2005. (19.

)www. peterhoney. com Appendix One: Student Feedback Relevance of plan to your learning: The plan was built around my needs. We talked about my needs before the teaching, so I felt it was completely relevant.I felt my needs were listened to.

The teaching/learning methods used: For me it was good to be able to go and research the subject before the lesson. This is the way I like to work, rather than being thrown into a task. I like to know the theory first! The teaching session was good and helped to clarify some of my doubts and uncertainties. There was lots of time for discussion and the whole thing was informal and helpful, with just about the right amount of info. It was good to have the chance to observe a few injections, and then have lots of practice.My mentor was very thorough.

Whether the intended outcomes were met: Yes! I have a new skill and feel quite confident to give injections in the future. How your learning was measured: Partly against my placement objectives, but also by discussion and reflection afterwards. We went through my learning and understanding afterwards and talked about the main point. My mentor assessed me as competent, and I feel competent in that area. Any suggestions that would have made the learning more positive for you: I will sound like a creep now, but, no, the learning was very positive!Appendix Two: Facilitation Plan Aim: Learner to develop the skill of giving a depot injection, but also to have considered the wider ethical considerations around prescription of depots. Objectives: -To have discussion of current knowledge and experience of giving a depot.

-To look through the learner’s objectives, as laid out by the training institution. – Learner to develop confidence in this skill. -To establish desired knowledge around the subject. -To advise learner of useful sources of information, in order that she can carry out self-guided study on the subject. Provide a teaching session.

-Learner to observe mentor giving depot injections. -When she feels confident, to give depot under supervision on mentor. What experiences will help your learner achieve their objectives? -Prior discussion of experience, expectations, etc. -Opportunity to research the subject. -Teaching session, including opportunity to practice on orange.

-Observation of experienced staff administering injection. What Skills will need to be facilitated as part of your plan? – Safe administration of depot. -Aseptic techniques of injection. Safe disposal of sharps. -Critical thinking around legal and ethical issues of giving injections (and other medication).

-Understanding of rationale for prescribing depots. How are you going to know if your objectives have been achieved? -Feedback from learner. -Reflective and retrospective discussion on the experience for the learner. -Checking the objectives in learner’s handbook. How to evaluate the process: -Discussion with learner and practice supervisor. -Formal written feedback sheet completed learner.

– Summary of key learning points.