Gibbs_Model_of_Critical_Reflection_in_the_Practice_Learning_Enviornment

A Structured critical reflection on assessment within my role as a mentor in the practice learning environment This essay will discuss a clinical skill in which I as a mentor assessed a student during the skill, looking at different areas and reflecting on my mentoring experience Reflection encourages a deeper approach to learning. Reflective learning is the process of internally examining and exploring an issue of concern, triggered by an experience which creates and clarifies meaning in term of self, and which results changed conceptual perspective (Boyd and fayles, 1983). The model of reflection should be tool to guide stimulate and not constrain the range and potential complexity of reflection (Boyd and fayles, 1983)A Structured critical reflection on assessment within my role as a mentor in the practice learning environment The reflective model I have chosen to use is Gibbs model (Gibbs-19980. Gibbs model of reflection incorporates the following: • Description • Evaluation • Analysis • Conclusion • Action plan The model will be applied to the essay to help demonstrate critical reflection within my role of assessing a student in the practice learning environment. Through my discussion I will also be applying the literature which underpins my experiences in practice. It will also help me to demonstrate my competence as a mentor and my professional development as mentor. Reflection is an active process that enables health care professionals gain a deeper understanding of their experiences (Conway 1996) and serves to extend our professionalism and develop our confidence in a bid to make sense of clinical experiences (Ghaye, Gillespie and Lilyman 2000) . Mason 1991 suggested that empowerment includes enabling people to recognise their strengths, abilities and personal power Reflective practice as a concept for learning was introduced in to many profession in 1980’s. Reflective practice can be summarised as having three components • Things (experiences) that happen to a person • The reflective process that enable the person to learn from those experiences • The action that result from the new perspectives that are taken (Dwey1988) Schon (1999) identifies two kinds of reflection reflection-in- action and reflection on action. Fade (2005) states reflection involves describing, analysing and evaluating our thoughts, assumptions, beliefs, theory base and actions. He also argues reflection is important as it help us capture and understand practical learning experiences which is essential for effective practice and can facilitate the improvement of patient care Applying Gibbs model of reflection will allow me to analyse and evaluate my experience of assessing a student. Description The first stage of Gibbs (1988) model of reflection requires a description of events. This is a comprehensive evaluation of our learning programme that took place in my ward (Gastroenterology ward) for four weeks. My mentee was newly qualified Band 5 nurse. My main role as a mentor was to assess my mentee throughout her time with me. I assessed a mentee to administer intramuscular injection. I identified the staff nurse had observed this clinical skill on variety of occasions and had previously administer an intramuscular injection under supervision. Then I explained about the procedure and we then prepared sterile tray using aseptic non touch technique. Then we checked the prescription chart whether it clearly prescribed, date time and allergic status of the patient. I asked her to check the B N F to find more about this injection, why this drug is using for and what are the contraindications. I ensured my mentee clearly understood me giving her opportunity to ask any doubts. She asked me why we are not using alcohol wipes to clean the area prior to the injection. I said if the area is clean, not necessary to clean with alcohol wipes and I recommended to read some literature about cleaning the injecting site. We had taken out the injection and double check with other member of staff nurse. We then the drug drawn up and was ready to administer and the patient consented to have the newly qualified staff administer the injection. I was talking to her through the procedure step by step. She did come across some difficulties to find the injection site. At this stage I assisted her to complete the procedure successfully. After the procedure I asked her thoughts and feeling. She said she was very nervous and under pressure, she did not want the patient to feel that she did not know what she was doing. I gave some constructive feedback to my mentee. I gave some feedback on areas for improvement but also highlighted the positive points about the procedure. I also said that she may need continuous learning to reach the competent level. Boud, Keogh and Walker (1985) states that reflection is an important human activity that re-capture their experiences, analyse and evaluate them I am now going to enter in to the second stage of Gibbs (1988) model of reflection which is discussion about my thought and feelings After the procedure I was look at myself, whether the student clear about my expectations. I was thinking whether my expectations are realistic. Duffy (2003) identified that mentors often have their own ‘hidden’ criteria for assessment. During the procedure I felt the things were going well but I was aware the student was nervous when I asked her to use the alcohol wipes to clean the area before giving the injection. Patient was really unwell and unsettled due to his abdominal pain; I think that’s why she was struggling to find the injection site I felt it that was a good learning experience for my mentee and it helps me to improve my assessment skills as a role of a mentor After the event I spent more time with my mentee and I made her comfort and I given full feed back about the procedure I explained all the positive factors at first and areas need development, answering her questions and I giving her advice on further reading about human skeletal and muscular system specially gluteus maximus muscle and sciatic nerve. Evaluation Evaluation is the third stage of Gibbs (1988) model of reflection and requires to with state what was good and bad about the event I feel as a mentor the method of assessment I adopted were beneficial to the mentee I and my mentee discussed about the event from beginning, she asked me why we are not using alcohol wipes to clean the area before the administration. I was aware that research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean and an aseptic technique is adopted, along with stringent hand washing by the nurse. It has also been noted that the use of cleansing with an alcohol wipe can cause skin hardening (Mallet & Dougherty 2000). Bernard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses. The second thing I noticed mentee was struggling to find the areas, I advised to revise the anatomy of muscular skeletal system and I explained what the risk to giving I M injection. The site used in the IM injection was the gluteus maximus, this the most commonly used site for the administration of IM injections (Greenway 2004, Workman 1999). The gluteus maximus area is both thick and fleshy with a good blood supply (Watson 2000). It is located in the hip area and forms the buttock (Watson 2000). It has been noted by Watson (2000) that the gluteus maximus is near the sciatic nerve and Greenway (2004) suggests that this presents a risk of threat of injury in the administration of IM injections. After evaluation I felt this was a good experience. This experience of mentoring has given me personal satisfaction, professional growth and importantly confidence in my leader ship skills. Mentors need to be conscious of providing safe, high quality patient care while supporting student participation and learning in complex care situation (Cassidy, 2009) Analysis Now I am discussing the forth stage of Gibbs model of assessment. In this stage we discuss about the event very detail. Bengtsson (1998) suggests that reflection can be understood and used as thinking and self-reflection. Self-reflection helps nurses to learn about the actual practice of the profession and help them to evaluate their own practice and performance. Bengtsson (1998) further suggests that nurses need to learn from these experiences and by doing so; they may acquire the competence that is needed to teach others. According to Maggs and Biley (2000) evaluating practice in this stage Gibbs encourages the reflector to make sense of the situation. I will do this by exploring the skill and looking at the evidence underpinning it. An IM injection is the administration of medication into the muscle; there are many reasons why drugs are given via the IM route (Workman 1999). Hemsworth (2000) comments that IM injections are rarely used in certain specialities and suggests that, in this case, nurses current practice in IM injections may not be up to date with recent research findings. According to royal college of nursing 2007 report state that assessment is a critical element of mentoring process and continue assessment of the student through out the placement The NMC 2006 advice that the total assessment strategy should include assessment through direct care, simulation, objective structured clinical examination Defining assessment is measurement that directly relates to the quality and quantity of learning and such is concerned with student progress and attainment (Neckline and Kenworthy, 2000) Assessment is a critical element of the mentoring process as Duffy (2004) explain “mentors must ensure that assessment of clinical skills does occur as required passing students who should have failed or in the hope that they will improve later puts patients at risk” The purpose of assessment is to protect an innocent public, to predict the future behaviour of nurses, judge the level of student achievement, monitor progress, motivate students measure effectiveness of teaching, assess competence (Nckli&Kenworthy 2000) Most educators would accept that prolonged periods of observation of students working with patients on a regular basis would have more validity than most assessment tests of clinical competence. There are different assessment strategies, formative and summative evaluation Formative assessment is diagnostic in nature and is concerned with the development of the student, with identifying strength and weakness, and with providing the student with feed back on their progress during the learning process (Allin & Turnok, 2007). Summative assessment usually on completion of a course or module which says whether or not you have passed (Allin&Turnock, 2007) Formative assessment is developmental and summative assessment is judgemental. Registrants from any profession may be involved in formative assessment (NMC2005). Only NMC registrants from the part or subpart of the register that the student will apply to enter should make summative judgements on achievement of competence for safe and effective practice We used formative assessment. Formative assessment is continuous assessment. The main aim of the assessment is to encourage the student to undertake self-assessment and reflection on their learning (Quinn 1995) Giving feed back is the important factor in assessment process. There are two different type of feed back, verbal and written. I choose both. In verbal feedback I highlighted positive factors and I made suggestion to improve the area. Through explicitly refocusing the learning potential within formative assessment and feedback, it can bring a dramatic culture shift to teaching and learning in nursing education Through evaluation of the event in question I under stand my mentee become more aware of different practices concerning the use of alcohol wipes in skin cleansing and she is more aware of injection sites and the risk factors. My mentee needed some further development on anatomy and physiology and attitude towards the patient. I suggested some literature for further reading. I believe my assessment is reliable and validity. I am very confident about my mentee; she can perform the same procedure with other mentor Formative assessment in curriculum practices and makes it a more engaging and rewarding learning experience for both students and teachers (Koh, 2008) NNMC Code of professional conduct (NMC, 2004) identifies the mentor supports learning and assessment in practice, and judgements relating to students fitness for practice and registration Conclusion I feel overall experience of assessing a student went well. The model of reflection and assessment has helped me to structure my thoughts and feeling appropriately. After the event I felt my mentee’s competence, with in this clinical skill, has been further developed. After the evaluation and assessment I have identified areas of development with in my role as a mentor Action plan I feel every thing went well, I would do things the same way in the future with other student. Next time I will try to spend more time with my student and also I will encourage them to work with others. Feedback I gave at the end of the procedure was effective and I will improve my feedback skills Reflection on Assessment - References Bord Altranais, (2003) Guidelines on the Key Points that May be Considered When developing a Quality Clinical Learning Environment, An Bord Altranais, Dublin. Black, P. & Wiliam, D. (1998) Assessment and classroom learning, Assessment in Education, Vol. 5, No. 1, pp. 7–73. Boud, D., Keogh, R. &Walker, D. (1985) Reflection: Turning experience into learning, London, Kogan Page. Boyd, E. & Fales, A. (1983) Reflective learning: Key to learning from experience, Journal of humanistic Psychology, Vol. 23, No. 2, pp. 99-117. Cassidy S. (2009) Interpretation of competence in student assessment, Nursing Standard, Vol. 23, No. 18, pp. 39-46. 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