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An analysis of a learning environment within a clinical placement

This assignment will reflect on the nature of teaching and learning processes within a surgical unit at a local Hospital. Some of the factors influencing a learning experience will be discussed and linked to known teaching and learning theories. Physical and psychosocial factors that affect the learning process will also be explored. To assist in the development of learning for future students, an action plan will be formulated from the issues recognised throughout this paper.

The learning experience discussed in this report has been chosen because it is felt that the mentor on this particular placement has been the most effective at contributing towards the development and progression of my learning as a student. Reflection enables people to recapture their experiences (Bond & Walker, 1985). I have therefore reflected on the placement as a whole. Any names mentioned are fictitious in accordance with the Nursing and Midwifery Counsel (NMC) Code of Professional Conduct (NMC, 2004).

An introductory letter was sent by the student facilitator two weeks before the placement began. It covered all necessary details such as examples of surgical procedures the unit regularly encounters, and required work hours. Using this information I was able to investigate the type of care that would be needed. I was also able to establish

An analysis of a learning environment within a clinical placement

some key areas that I could enquire about to fully understand necessary procedures. This type of self-directed learning is driven by motivation and andragogy, which are key components known to influence the direction of the adult learner (Rogers, 1996). Charters (2000) also states voluntary learning that is active and personal to the individual are effective methods of learning.

An introductory questionnaire was also received. Although this was a welcome difference compared to most placements, my answers were not discussed with my mentor upon my arrival. This limited my opportunities to communicate any additional needs or concerns but I did have the chance to discuss the learning contract that I had developed prior to my arrival. This is again principally a self-directing, andragogical process, as stated by Knowles (1990). Additionally, it is well recognised that learning contracts can provide the means to meet the needs of the learner (Rogers, 1983).

During the initial discussion with Anna I felt I was able to influence the upcoming learning events, because I was able to identify my advanced beginner status (Benner, 2001) which allowed Anna to act accordingly to develop my learning needs. I voiced my expectations and the curriculum requirements, both of which factors are associated with the self-direction of the adult learner (Knowles, 1990).

We agreed to be in close contact for the initial 3 weeks and it was arranged that I shadow her work hours to ensure I had as much one-to-one mentoring as possible. This was extremely beneficial as she could track my progress and provide me with guidance during the first few weeks (Chow & Seun, 2001). At this point my learning was being promoted because Anna was skilled in student-led strategies. For example, she consistently explored my understanding of a task whilst providing support (Heron, 2001). I also felt positive about having the opportunity to develop a good relationship with her which is recognised as being beneficial to the learning process (Dix & Hughes, 2004).


According to Maslow (1971) the humanist theory of learning is concerned with feelings and experiences. My learning was definitely influenced by her positive attitude and manner, which, as suggested by Maslow leads to personal growth and individual fulfilment. In addition, Anna had adopted a neobehaviourist approach to learning, which is identified by constant communication, planning of feedback and regular evaluation (Nicklin & Kenworthy, 2000).

During my time on placement it was clear that Anna was creating learning opportunities and resources at all times. I also found she was able to explain tasks clearly and to answer any questions that I had. This is something typically favoured by nurse educators (Li, 1997). A question would never go unanswered and if she could not provide a full answer, she always directed me to a colleague whose knowledge was adequate enough to satisfy my learning needs. This is in line with the English National Board mentor guidelines (ENB/DoH 2001b).

Anna was extremely approachable and would often demonstrate tasks with which I was unfamiliar. I learnt mainly through observation until I felt confident to practice a task independently. This is an effective social learning method as learners are able to learn new behaviors as well as to modify undesirable behavior through imitation (Bandura & Walters, 1963). This is associated with role modeling and I was also influenced by Anna’s enthusiasm and interest towards a subject (Bidwell & Brasler, 1989).

Anna’s teaching methods involved a lot of immediate positive reinforcement. This was an effective stimulus likely to produce a repeat action (Thorndike, 1986). Gagne (1985) proposes that information is more likely to be retained when encouragement and guidance is utilised by the teacher. Anna was able to acknowledge my efforts when I had researched a subject or task. This made me eager to learn and sustained my level of interest. This theory of learning is well established by the works of Skinner (1968).

When I was required to learn a skill with which my mentor was unfamiliar, I was encouraged to research these areas. She gave me direct access to multiple sources of information including books and online databases (Neary, 1997). Anna would regularly assign me to a different team member as a temporary mentor. I was grateful, but on some occasions it was clear that I was assigned to a member of staff who did not have the same level of experience as Anna because they sometimes found it difficult to answer my questions. As the action plan states, ensuring that all mentors have the same level of knowledge would be beneficial, albeit unlikely.

Anna would consistently enquire about my existing knowledge on a subject or task which helped me to perform a thorough self-assessment, and to re-examine what I had already learnt. Neary (2000) states that revisiting areas that have already been studied can enhance cognitive learning. This is associated with a major theme in the theoretical framework of Bruner (1996), who explains that learners are able to construct new concepts and ideas based upon their current or past knowledge.

Feedback sessions were typically planned but were sometimes spontaneous. This was due to time restrictions and nurse workload. These unprompted sessions could perhaps be improved if they were more structured (Hinchliff, 1999). This is also supported by Quinn (2000) who believes that lesson planning is vital for learning because it ensures that all areas of learning are addressed, which results in higher productivity in terms of learning (ENB/DoH 2001b).

Essentially, teaching and learning sessions should be conducted in an environment conducive to learning (Neary, 1997). Typically the physical learning environment was acceptable. There was adequate space, privacy, appropriate lighting and satisfactory noise levels. However, one teaching session was conducted in the surgical Recovery Room. I found this learning experience particularly memorable as it was far too cold and there were a large number of distractions. The action plan at the end of this report states that this problem could be alleviated for future students by organising a consistent and suitable area prior to such meetings (ENB/DoH, 2001a).

Psychosocial factors that encouraged my learning included my first impressions of the staff. Most were accustomed to having students and were friendly and helpful. This made me feel safe and accepted within the team. The majority of staff on the ward demonstrated adequate levels of knowledge whilst also being approachable and supportive. Staff members would often seek out learning opportunities for me which was particularly valuable.

Morgan (2002) states that it is vital that qualified nurses ensure students become part of the ward team, because this can be beneficial to their learning. In addition, the NMC requires that nurses support the development of student nurses. This was evident because each member of staff readily contributed to my learning experience through their willingness to share their professional knowledge with me (NMC, 2004).

In conclusion, this placement was a positive and memorable learning experience. Primarily I learnt by observation and role modeling whilst utilising cognitive processes. Teaching behaviours that are humanistic also motivated me to repeat an action when praised and supported. Andragogical processes involving self-directed learning were also important to my learning.

Regular discussion is vital to ensure the learner is provided with some form of direction, as well as provide the opportunity to express any needs. Planned and structured teaching sessions are particularly beneficial to the learner because they enable the mentor to teach a session logically, and to maximise learning efficiency by utilising time effectively. Multidisciplinary team members with the same level of knowledge as the main mentor are also preferable. Additionally, factors influencing learning with regards to the physical learning environment are significant in the enhancement of learning for students, as stated in the action plan overleaf.

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Developmental points

Action

Rationale

Questionnaire answers were never discussed upon my arrival at the placement

Mentors or educators could allow time for students to express all particular needs and concerns with regards to their learning

Provides students with the opportunity to direct studies more effectively and perhaps reduce any anxiety or stress

Teaching sessions were sometimes spontaneous and unstructured due to time constraints and / or nurse workload

To protect time needed for teaching sessions / student evaluation by agreeing on and adhering to a set date and time

Increases learning outcome by encouraging a more thorough and consistent teaching session / evaluation

One particular physical environment chosen to evaluate my progress was not conducive to my learning as it was uncomfortable and was surrounded by distractions

To ensure that future meetings take place in private, comfortable, well lit, quiet rooms where there are minimal distractions.

Increased concentration and focus, which will allow for greater progress in context of learning and teaching aspect

On some occasions temporary mentors had inadequate knowledge levels due to inexperience

For permanent mentors to seek out appropriate team members to enhance the learning for the student

Results in higher productivity in terms of learning as student can inquire about skills or information the permanent mentor may be inexpert in

Table 1: Action Plan to highlight problems associated with teaching and learning.

REFERENCES

Bandura, A. and Walters, R. (1963) Social learning and personality development. Holt, Rinehart & Winston, New York.

Benner, P. (2001) From novice-to-expert: Excellence and power in clinical nursing practice. Prentice Hall, New Jersey.

Bidwell, A.S. and Brasler, M.L. (1989) Role modeling versus mentoring in nursing education. The Journal of Nursing Scholarship, 21(1): 23-25.

Bond, D. and Walker, D (1985) Reflection Turning Experience into Learning. Kogan, London.

Bruner, J. (1996). The Culture of Education. MA: Harvard University Press, Cambridge.

Charters, A. (2000) Encouraging student-centered learning in a clinical environment. Emergency Nurse. 7(10): 25-29.

Chow, F.L.W. and Suen, L.K.P. (2001) Clinical staff as mentors in pre-registration undergraduate nursing education: students’ perceptions of the mentors’ roles and responsibilities. Nurse Education Today. 21:350-358.

Dix, G and Hughes, S. (2004) Strategies to help students learn effectively. Nursing Standard. 18(32): 39-42.

English National Board for Nursing, Midwifery and Health Visiting/Department of Health (2001a) Placement in focus. ENB/DoH, London.

English National Board for Nursing, Midwifery and Health Visiting (2001b) Preparation of mentors and Teachers: A new framework of guidance. ENB/DoH London.

Gagne, R. (1985) The conditions of learning and theory of instruction. 4th Edition. Holt, Rinehart & Winston, New York.

Heron, J. (2001) Helping the Client: A Creative, Practical Guide. Sage Publications, London.

Hinchliff, S. (1999) The Practitioner as a Teacher. 2nd Edition. Bailliere Tindall, London.

Knowles, M. (1990) the Adult Learning: A neglected species. 4th Edition. Gulf publishing company, Houston.

Li, M. K. (1997) Perceptions of Effective Clinical Teaching Behaviours. Journal of Advanced Nursing. 26: 1252.

Maslow, A. (1971) The Farther Reaches of Human Nature. Penguin, Harmondsworth.

Morgan, R. (2002) Giving students the confidence to take part. Nursing Times.
98(35): 36-37.

Neary, M. (1997) Defining the role of assessors, mentors and supervisors: part 1. Nursing Standard. 11(42): 34-39.

Neary, M. (2000) Teaching, Assessing and Evaluation for Clinical Competence: A Practical Guide for Practitioners and Teachers. Nelson Thornes, Cheltenham.

Nicklin, P.J., Kenworthy, N. (2000) Teaching and assessing in nursing practice: an experiential approach. 3rd Edition. Bailliere Tindall, Edinburgh.

Nursing and Midwifery Council (2004) The Nursing and Midwifery Council (NMC) Code of professional conduct: standard for conduct, performance and ethics. [Online] Available at:

http://www.nmcuk.org/nmc/main/publications/Codeofprofconductfinal.pdf

Quinn, F.M. (2000) Principles and Practice and Nurse Education. 4th Edition, Nelson Thornes, London.

Rogers, C. (1996) Teaching Adults, 2nd Edition. Open University Press, Milton Keynes.

Rogers, C. (1983) Freedom to Learn for the 80’s. Merrill, Ohio.

Skinner, B.F. (1968). The Technology of Teaching. Appleton-Century-Crofts, New York.

Thorndike, E.L. (1986) Animal Intelligence; associative processes in animals. Psychological Monographs. 2(4).

BIBLIOGRAPHY

Ausabel D (1968) Educational Psychology: A Cognitive View. Holt, Rinehart and Winston, New York NY.

Dix, G and Hughes, S. (2005) Teaching students in the classroom and clinical skills environment. Nursing Standard. 19(35): 41-47.

Gopee, N. (2004) Effective clinical learning in primary care settings. Nursing Standard. 18(37): 33-37.

Reece, I and Walker, S. (2000) Teaching, Training and Learning: A Practical Guide. 4th Edition. Business Education Publishers Limited, Sunderland.

Williams, M. (2004) Concept mapping – a strategy for assessment. Nursing Standard. 19(9): 33-38.

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