Description
Workshop and Visit Report
‘Competency Assessment in Clinical Teaching and Development of a local Mentor Training Programme’
Facilitated by
The University of Nottingham,
School of Health Sciences
Dr. Helen McIntyre
Ms. Paula Dawson
December 1st to December 7th 2013
Executive Summary
Background
This report describes activities undertaken by University of Nottingham, School of Health Sciences (SHS) (formerly the School of Nursing, Midwifery and Physiotherapy (SNMP))faculty (Dr Helen McIntyre and Paula Dawson) during a visit to Odisha between December 1st and December 7th.
The activities included:
(i) two planning meetings on December 1st , the first with members of the Technical Management and Support Team (TMST), and the second with senior faculty at the Berhampur College of Nursing (CoN);
(ii) a workshop on clinical assessment and supporting practice learning for students, intended for Berhampur College of Nursing (CoN) faculty, from December 2nd to December 6th;
(iii) concluding meetings in Bhubaneswar on December 7th to review the achievement of workshop outcomes, to identify progress and development since the overall initiative’s inception, and to consider any strategic planning for further work which might be proposed.
The visit and workshop formed the latest and final part of a continuing collaboration, established in 2011 with the Government of Odisha’s Department of Health and Family Welfare and the CoN, Berhampur, facilitated by the Technical Management and Support Team (TMST).
Workshop Aim, Process and Outcomes
The workshop focused on principles of partnership working to promote excellence in clinical learning. It involved faculty from the CoN, and teaching staff from the School of Nursing, Berhampur. Unfortunately, neither ward staff from the two clinical demonstration sites nor any other clinical representatives were in attendance, although it had been proposed that they should be. The attending group was augmented by the presence and active participation of some postgraduate nursing students from the College’s Master’s programme. The workshop included lectures, group work, debate, action planning, literature reviewing and the demonstration and practice of a variety of assessment/evaluation techniques which may be applied and transferred to a wide range of clinical skills.
Recommendations
The recommendations include implementation of previous outcomes as the four visits have developed themes and principles of teaching, learning and quality improvement strategies.
(i) Creation of welcome packs for ward areas
(ii) Formal, written evaluations of student experience in clinical areas, modules, teaching sessions
(iii) Systematic audit of clinical learning areas
(iv) Creation of support mechanisms for students in clinical areas
(v) Implementing an appropriate mentorship programme for pilot in a clinical area
(vi) Greater use of the whole day for clinical teaching
(vii)Greater engagement of students with direct patient care
(viii)Active identification of faculty/students with potential to develop and
implement change
(ix)Implementation of transferable principles of interactive teaching, clinical
skills development and assessment.
A key practice recommendation would be the instigation of nursing/midwifery documentation to recognize the contribution these professionals make toward the implementation of care pathways. Secondly a dependency audit of patient care for each ward area to consider appropriate and sufficient numbers of staff for safe patient care.
Table of Contents
Page
Executive summary i
1. Introduction
1.1 Background to the visit
1.2 Aim of the visit
1.3 Objectives of the visit
1.4 Extent to which objectives were achieved
1.5 Structure of the report
2. Initial planning meetings
3. Developments and achievements since January 2013 visit
4. Workshop report
4.1 Workshop aim
4.2 Workshop learning outcomes and activities
4.3 Activities, Results and Recommendations – Days 1 and 2
4.4 Activities, Results and Recommendations – Days 3 and 4
4.5 Workshop conclusion
4.6 Workshop evaluation
5. Final meetings
5.1 Meeting with TMST personnel
5.2 Meeting with Government of Odisha Secretary for Health and Family Welfare
6. Reflections and looking forward
Appendix 1
Appendix 2
Appendix 3
1. Introduction
This report describes the activities undertaken by University of Nottingham, School of Health Sciences (formerly the School of Nursing, Midwifery and Physiotherapy (SNMP)) faculty (Helen McIntyre and Paula Dawson), during a visit to Odisha in the week of December 1st to December 7th.
The activities included: (i) planning meetings on December 1st , (ii) a workshop on clinical education for Berhampur College of Nursing (CoN) faculty from December 2nd to December 6th , and, (iii) attending meetings in Bhubaneswar on December 7th to consider project follow-up planning.
1.1 Background to the Visit
The visit and workshop were a continuation of a collaboration that was established in 2011 with the Government of Odisha, Department of Health and Family Welfare and the CoN, Berhampur, facilitated by the Technical Management and Support Team (TMST). This visit represents the 5th input from the SNMP (now SHS), as follows:
• SNMP undertook a short scoping visit to Berhampur/Bhubaneswar (January 2011)
• Berhampur/Cuttack nursing faculty came to the Nottingham SNMP (UK) for a one week insight visit, July 2011
• SNMP faculty delivered a one week workshop (in Berhampur) on clinical education to faculty from various Nursing Schools in Odisha and the CoN, February 2012
• SNMP faculty delivered a one week workshop (in Berhampur) on the promotion of excellence in clinical learning to faculty from the CoN and from the School of Nursing, Berhampur, January 2013
1.2 Aim of the Visit
• To continue the provision of mentoring and support to Berhampur CoN for the implementation of a clinical education innovation process started in 2012, with a particular focus on competency assessment in clinical teaching and the development of a local mentor training programme.
• To consider a project follow-up plan in consultation with the Directorate of Nursing and JHPIEGO Odisha team.
1.3 Objectives of the Visit
i. To meet with members of TMST and relevant senior faculty to confirm action plan for workshop delivery and subsequent review meeting.
ii. To review, with workshop participants, progress made in action plans following the last input from the University of Nottingham, SNMP (a workshop on the promotion of excellence in clinical learning in January 2013).
iii. To facilitate a further workshop and intensive small group work with faculty and clinical nurses to support the continued implementation of clinical education innovations.
iv. To review achievement of wider project aims, and action plan for any follow-up and/or additional work.
The visit took place in the context of a major initiative that has recently been announced by the Government of India, Ministry of Health and Family Welfare, (with technical support from JHPIEGO) to improve quality in pre-service nursing education.
1.4 Extent to which visit objectives were achieved
All the visit objectives except for (iii) were achieved.
Unfortunately, neither ward staff from the two clinical demonstration sites nor any other clinical representatives were in attendance, although it had been proposed that they should be. The attending group was augmented by the presence and active participation of some postgraduate nursing students from the College’s Master’s programme.
1.5 Structure of the Report
The report begins with a summary of points made in the initial planning meetings, followed by some information on positive developments at the CoN since the previous visit, and a description and analysis of the 5 day workshop at the CoN. A summary of points from the final consultation meetings completes the report.
2. Initial planning meetings
During the first planning meeting in Bhubaneswar, the following information was shared:
• TMST plans to create a ‘feed forward’ plan, with a representative in place ‘on site’ locally to facilitate further activity and relevant on-going development.
Present at the meeting were Dr Swain (Medical Director for Odisha) and Dr Sen (JPIEGO lead for Odisha).
There are plans for a new national nursing directorate from 2015.
Previous findings on students’ lack of clinical engagement to gain competence, inequity of numbers of students through the 24hour period and within anyone clinical area allocated from various schools, lack of nursing/midwifery documentation were highlighted as inhibiting quality care. The desire for doubling student numbers was cautioned against loosing quality. Possible deficits in pre-registration education were leadership/management competence, autonomy and valuing nursing/midwifery decision making.
Details for the coming workshop were provided by Paula and me.
Evaluations of outcomes were reiterated for this workshop and summatively for previous visits.
Drivers for change were perceived as being through the education system rather than direct practice implementation.
Suggestions for future support included and external examiner role, research/action research projects, faculty/student exchange visits to access pertinent University of Nottingham Learning Beyond Registration (LBR) nursing/midwifery modules.
3. Developments and Achievements at the CoN since January 2013 visit
Since the SNMP’s last visit in January 2013 a number of developments were identified, some by workshop participants within discussion sessions and some by CoN faculty upon request, which have been progressed:
• The introduction of new faculty clinical instructor roles across clinical areas. These staff provide a link between education and practice areas, accompanying students into practice, providing teaching and assessment (known as evaluation) of students’ clinical competence.
• Evaluation of students’ clinical competence is undertaken against a growing range of checklists, with identified indicators to be achieved to demonstrate a ‘Pass’ or ‘Fail’ grade. Examples include the establishment of breast feeding, abdominal palpation, perineal care and insertion of an IUCD. There appears to be some lack of consistency in these documents; some require the number of attempts to be recorded while others do not. There have been some discussions about introducing different levels of competence but these have not yet been determined.
• All faculty staff are expected to visits to clinical areas to engage students in making the most of learning opportunities.
• A welcome/induction pack is being developed for students and sessions are timetabled with the CoN to prepare students for practice experience.
• ‘Buddying’ between senior and junior students has been commenced.
4. Workshop Report
4.1 Workshop Aim
The workshop aimed to build further upon previous work to:
• consider how students’ learning and clinical competence may be assessed, demonstrating and practising with a variety of assessment techniques;
• develop a teaching and assessment package for use to train clinical mentors;
• emphasise the importance of a strong link between theoretical knowledge development and practical clinical competence in promoting high quality health care for clients.
4.2 Workshop Learning Outcomes and Approach
By the end of the workshop, participants should have been able to:
• review the concept of assessment in clinical and learning environments;
• consider how we work towards assessment of a student’s competence through the provision of appropriate evidence-based teaching and support, and the provision of learning resources;
• undertake some practical application of assessment techniques using common clinical scenarios in maternal and child health;
• consider how assessment techniques can be developed to monitor and record progressive clinical competence;
The workshop adopted a participatory approach based on adult and experiential learning principles. Most of the sessions required participants to draw upon their own experiences, to critically reflect on the workshop presentations and to apply key concepts and ideas to their own particular contexts. Throughout the workshop, care was taken to highlight generic principles of quality in nursing education and to encourage participants to reflect upon how these could be applied to clinical teaching in any speciality. A full workshop timetable can be found in Appendix 2.
The workshop was delivered with 2 distinct (though not unrelated) areas of focus. Days 1 and 2 concentrated on exploring the concept of mentorship in nursing as a support mechanism for students in practice, with a view to the construction of a locally appropriate mentorship framework.
Days 3 and 4 encouraged participants to engage with some different approaches to the teaching and assessment of two fundamental clinical skills, namely the establishment of breast feeding and the systematic assessment of a sick infant or child. Participants discussed how the clinical competence of nursing students might be developed through the use of such methods and their transferability to all areas of clinical competence.
4.3 Activities, Results and Recommendations – Days 1 and 2
Participants were divided into groups (we made a conscious decision to maintain separate groups for faculty and students, gauging that status and confidence issues would probably inhibit either group from communicating as freely in preliminary discussions in the presence of the other).
They were asked to consider their definitions of a mentor, and identified the following roles:
• Problem solver
• Counsellor
• Role model
• Can be anybody
• Leader
• Trainer
• Special training / assessed
In their groups, participants reviewed several articles on mentorship:
Awaya, A., McKewan, H., Hayler, D., Linksy, S., Lum, D. and Wakukawa, P. (2003) Mentoring as a Journey Teaching and Teacher Education 19 45-56
Bray, L. and Nettleton, P. (2007) Assessor or mentor: role confusion in professional education Nurse Education Today 27 848-855
Nettleton, P. and Bray, L (2008) Current mentorship schemes might be doing our students a disservice Nurse Education in Practice 8 205-212
Stanulis, R.N. and Russell, D. (2000) Jumping in: trust and communication in mentoring student teachers Teacher and Teacher Education 16 65-80
Participants were asked to identify key points from the literature, and their own experience which would be relevant to their own plans to develop a mentorship programme.
Comments included:
• A mentor fosters professional growth in knowledge, skill, attributes and practice
• A good mentor is crucial for student well-being and learning potential
• Mentorship involves building of an equal relationship by trust, sharing of expertise, moral support and knowing when to help students
• Mentor is a guide to practical knowledge and students learn this skill on the job
• In mentorship both taught and teacher learn from each other
• Mentors should be skilled, knowledgeable and experienced
• Able to reduce conflict and maintain equality among participants
• Collaborator
• Source of moral support
• Creating willingness to assume responsibility for their action
• Guiding student teachers work in field
• Generator of ability among participants to learn from situations
• There are potential difficulties when mentors attempt the dual role of mentor and assessor
• In our setting, most of the time, we are stepping upon others foot, we have no chance to implement our own decision
• Our administration is so rigid that we can’t change anything whenever necessary
• Issues include time constraint, role conflict, over burden, upgradation of knowledge, gap between teaching and practice
Suggestions included:
• The role of mentor and assessor should be separate
• There should be a specialized course for mentor preparation
• Strict criteria are needed for the allocation of mentors
• Collaboration is needed between mentors and teachers
Participants watched and commented on some video footage from Nottingham (created by Alison Clark), which showed the mentor relationship and collaborative working in action.
They identified the following as the key emphases they would want their own mentors to be responsible for demonstrating and supporting their students to understand:
• Theory and practice links
• Reflective practice
• Valuing students
• Role modelling, demonstrating, teaching, developing skills, solving problems, giving advice, guiding
Some criteria/minimum standards for access to mentorship training were discussed, considering demographics and personal and professional qualities. Consensus was achieved on the following:
• Shows desire to be a mentor
• Good communicator
• Collaborator skills
• Critical thinking skills
There was much variation of opinion on qualifications and length of experience required, without consensus being reached such as:
• Acute setting – GNM or above
• Community setting – LHV or above
• Experience 3-5 years with 1 year in the speciality
• Optional: post registration speciality training
Job descriptions were agreed as needing to include the following:
• Demonstration of clinical procedures
• Collaboration with faculty members
• Supervision and guidance of students
• Action planning with students
Recommendations for inclusion in mentor training programme were agreed as follows:
• Introduction to the concept of mentorship
• Communicating in English
• Communication skills
• Teaching methods, e.g. role play
• Supervision methods
• Patient management
• Student guidance and counselling
• Performance appraisal methods
• Developing skills in a skills laboratory setting
• Updating knowledge and skills
• Evaluation skills
• Psychology, sociology and biological sciences
Important additional issues:
• Should the mentor be remunerated?
• Certification of mentor status
• Assessment and updating of mentor status
We understand that a State (and possibly national) intiative to introduce clinical mentorship to nurse education programmes is likely. The CoN principal hopes to develop a proposal for consideration at the highest levels, and plans to utilize workshop material accordingly.
Despite great enthusiasm for the development of a suitable local programme, it must be highlighted that qualified staffing levels within the local health provider institutions are very low. Many workshop participants expressed concerns about the practical implications of implementation, and contributors recognised that any formal proposal would need to be realistically structured for application.
4.4 Activities, Results and Recommendations – Days 3 and 4
Participants were divided into 2 groups in a random manner and each undertook the following two days in turn.
One day was spent with practical demonstration and individual participation in the ABCDE approach when assessing the clinical condition and care needs of a deteriorating infant or child.
Participants considered how student’s competence in undertaking this assessment and care may be monitored and recorded, analyzing different elements of knowledge/skill. We discussed:
• Knowledge of evidence base
• Practical skill
• Professional issues
• Care management and delivery
• Communication and attitude
We considered how these can be assessed, with examples such as
• Clinical assessment (OSCE)
• Observation
• Question and answer
• Other forms of evidence, such as annotated reading, work products, reflective writing, etc.
• Written examination
• Scenario work/simulation
The other day used interactive teaching methods to revise and update theoretical and practice learning in infant feeding, particularly breastfeeding. Application was gained within the local postnatal ward.
• Balloons and games were used for revision of anatomy of the breast/constituents of breastmilk and physiology of lactation
• Role play was undertaken for breastfeeding facilitation and hand expression of the breast following the use of training videos. The importance of principles in positioning and attachment of the baby to the breast and accurate sequential communication was stressed within a ‘hands-off’ facilitative model.
• Participants were encouraged to create their own breast model for use within these sessions.
• Following simulation, practice was gained within the postnatal ward.
• Role play within complicated infant feeding scenarios was undertaken.
• Assessment tools within an OSCE framework were employed and discussed in light of competency levels.
Participants on both days were encouraged to consider how their learning on each day would help with the development of assessment strategies which show competence, and how strategies can be transferred for application and use in any clinical setting.
4.5 Workshop Conclusion
The workshop concluded with a valedictory session, attended by senior personnel from the TMST team, in which workshop content and outcomes were summarized. Workshop participants and other stakeholders present were unanimous in declaring their motivation and intent to work for further developments to improve clinical learning locally in order to deliver high quality clinical care.
4.6 Workshop Evaluation
The workshop was evaluated very positively by all participants. The formal workshop evaluation summary is given in Appendix 3. Many positive comments were received: participants clearly enjoyed the interactive facilitation methods employed, and felt that they benefitted from observing and participating in learning and assessment approaches which related directly to elements of clinical practice.
Workshop participants were also asked to discuss in small groups what had been good and not good about the week for them – while no negative comments were verbalized, these discussions yielded the additional positive comments shown here:
• Various learning & teaching methods (e.g. assessment of sick children – ABCDE)
• Ideas on mentorship
• Technique of breast feeding
• Video clips were very eye opener (bring in the different perspective to the system of delivery)
• Emphasis on the interactive method of teaching is very encouraging. Each and every student were appreciated for their ideas and views
• We discovered our role as mentor within ourselves and realized that transferability of what you are doing is so necessary
• Competency assessment in clinical practice- trying out newer techniques and skill building exercise
• Different new methods of teaching and delivery (e.g. alternate positions)
• More hands on training is required (e.g. breast feeding)
• Development of selection criteria and curriculum outlined for mentorship
• Helped to develop positive attitude amongst the participants to take up various work related challenges
• Pleased with your effective communication style. Much to learn
• Ice breaker exercise was very nice
• Came to know about student assessment skills
• Prompt evaluation and feedback is very robust way to chart out the way forward
5. Final meetings
5.1 Meeting with TMST personnel highlighted the outcomes and recommendations as described above.
Areas for research suggested were:
• A time a motion study on nurse/midwife activity relative to numbers and dependency of patients within a ward.
• Pilot study on the introduction of nursing/midwifery documentation.
• Quantitative and Qualitative study on student support mechanisms within the clinical and college environment.
• Qualitative study on nurse expectation of career development.
• Baseline study of nurses/midwives requirements for CPD.
• Exploratory study of leadership and management themes within nursing/midwifery curriculum and its teaching and learning/application.
• Exploration of the cascading of principles of interactive workshop learning models.
• Use of e learning for cross communication and collaborative learning.
• Exploration of the development of the midwifery led beds and their outcomes.
• Audit of LSCS times, reasons, time form admission, length of stay, cost benefit exercise.
• Management of pain within clinical areas.
• Care of child development and communication between families and clinical staff and children and clinical staff.
• Exploration of privacy, dignity and consent within clinical areas.
• The role of accompanying relatives in care participation and support.
• The impact of poor infection control and cleanliness within clinical areas on patient outcomes.
Further clarity on TMST understanding of CPD was provided highlighting the development of clinical development within a career pathway and development.
5.2 Meeting with Principal Secretary, Health Family and Welfare Department, Government of Odisha, Mr P Kmohapatra.
The positive changes at the college were highlighted.
The workshops of improvement in practice through EBP was stressed with a requirement for nurse/midwifery documentation to support implementation of learning, re-allocation of care duties and recognition of nurse/midwives within the care pathway and subsequent career trajectories.
Our observation of poor cleanliness in clinical areas were expressed on request from the minister of our impressions of the hospital.
6. Reflections and looking forward
Personal reflection comments from PD (may need selective revision for final report) – bullet points only for Catrin’s info at this stage….
• Poor communication and time management re. workshop participation and release of funds led to no practice representation at the workshop – these personnel were sorely missed and their absence limited our progress.
• Limited apparent ability amongst faculty to consider transferability issues as they relate to the development of a mentorship programme – i.e. they want a programme like Nottingham’s and need much guidance to grasp the need to ‘build’ theirs from a realistic (and possibly small scale) foundation.
• Some great MSc students and clinical instructors present – very bright, very clued-up and very quick to analyse challenges, etc. I would strongly advocate some professional development opportunities for these people – they are the future; succession planning will be crucial to take all developments forward to sustainability and further innovation. We identified those who, in our view, demonstrated the most potential through their workshop contributions in a list for TMST personnel.
• Very evident that the CoN principal is doing some sterling work in building her team and that this is impacting positively on all fronts. She is well respected and has clearly identified the most able of her colleagues to take key roles. She appeared, however, to lose confidence in the presence of TMST colleagues – perhaps an issue again for professional development consideration.
| Period | 2013 → … |
|---|---|
| Degree of Recognition | International |