Senior lecturer in midwifery at Anglia Ruskin University Helen Richmond raises a number of detailed issues that need to be considered by those receiving and providing mentoring.
Midwives magazine: November 2006
This study examines midwives’ perception of their role as mentors and explores their experience of mentoring in today’s professional climate. There is a great deal of research on nursing mentors (Pulsford et al, 2002; Anforth, 1992; Chow and Suen, 2001; Gray and Smith, 2001), but less on midwifery.
Exceptions include Davis et al (1997), Dirks et al (1998), Lloyd-Jones (2001), Jones (2004) and Finnerty (2005). Jones (2004) identified a gap in the research concerning the ‘perceptions of midwives about their role and responsibilities in relation to mentoring’.
There is a need to know the amount of contact that a midwife feels is acceptable with her student, and to examine mentor characteristics. This study partly fulfils this need by examining midwives’ experience in their role as mentors in six contemporary units in the south east of England.
Literature searches show that mentoring is high on the political agenda. Nurses have reiterated that there needs to be a proper, recognised role for midwife and nursing mentors (O’Dowd, 2004; Devis and Butler, 2004; Jones, 2004; Department of Health, 1999; UKCC, 2001). The responsibility placed on the clinical ward mentors has increased due to two initiatives: the review of the healthcare programmes: Making a difference (Department of Health, 1999) and Fitness for practice and purpose (UKCC, 2001).
Both initiatives recommended a greater need for skills acquisition on registration for midwives and nurses. These reports suggest that practice-based learning is the key to the future career progression of health professionals. This makes the mentor a key person in the process of student learning. Student midwives are expected to attain a level of competence as a practitioner (Benner, 1984) at the point of registration (NMC, 2002a).
There has been tremendous reliance on the midwife to train student midwives in the practice area as well as maintaining high standards of client care (Chow and Suen, 2001; White, 2004; Jones, 2004). This fact highlights the need to understand the pressures felt by midwifery mentors today.
The Quality Assurance Agency (QAA) and the NMC are conducting a major review of NHSfunded healthcare programmes in England from February 2003 to December 2006. It places a significant emphasis on the quality of clinical practice and student learning opportunities.
The research took place between October 2004 and January 2005 and investigated two key issues:
Perceptions of midwives in their role as mentors
Experience of midwives as mentors in two contemporary Trusts in England.
The research method was a questionnaire. A total of 270 midwives across six sites received a questionnaire and 109 midwives chose to take part. The questionnaire, collected both qualitative and quantitative data.
To increase the reliability of the questionnaire the main questions were based on other research that had been tried and tested (Darling, 1984; Davis et al, 1997; Davies, 1998; Cuesta et al, 1998).
The researcher added some questions and to ensure validity, the questionnaire was piloted and re-piloted to make sure the questions were understood and clear and any problems were resolved (Polgar and Thomas, 2000).
Gaining access to the midwives was a lengthy process, ethical committees were very protective of their midwives, as they were seen as a vulnerable group who were busy caring for mothers and babies and for this reason, limitations were placed on the researcher.
The first was that no follow-up interviews were allowed, making it difficult to clarify any issues raised in the survey. The second was that only one mail shot was allowed to contact the midwives and no access was allowed to the midwives’ home addresses or personal details by the researcher.
This made distribution of the questionnaire difficult. The statistics were analysed using SPSS statistical analytical software and then transferred to Excel for presentation.
The following results can only be claimed as indicators of trends rather than being statistically robust, as the sample is of limited number. Because the sample was purposeful rather than random, significance could not be calculated using p-values.
Results and discussion
In the sample of 109 midwives, there was a predominance of experienced midwives (midwiveswho had been practising for more than ten years). The experience of the midwives in the whole sample can be seen in Table 1.
These midwives had seen midwifery practice change and develop over more than a decade.
They had been mentoring students for as long as 26 years in some cases, but predominantly they had been mentoring for around ten years. They were practising midwifery in various ways, from ward-based midwifery to caseload and team midwifery and many had attended mentoring courses, although some had had no preparation at all.
Who supports the mentors?
Midwives reported that they did not feel particularly supported by their managers in the mentoring role and they felt less supported by universities. Although it is recognised that it is important to support mentors in their role (Nearly, 2000; Smith and Gray, 2001; Finnerty et al, 2005), what constitutes ‘support’ for mentors by universities and managers needs further research.
However, mentors in Pulsford’s study (2002) stated that they wanted more contact with lecturers and universities.
Perceived qualities necessary for a mentor
Midwives rated the most important qualities for a mentor as:
Role modeling best practice (46%)
Supporting their students (31%)
Feedback givers (31%). Cuesta et al (1998) found that model, supporter, ‘envisioner’ and investor were the frequently identified qualities of mentoring.
Mentors in this study did not express any difficulty in answering this question and were clear about it. This goes some way to defining the role, which has been the subject of much debate (Ravey, 1994; Butterworth and Faugier, 1992; Darling, 1985).
It would appear that midwife mentors perceive that a good mentor is someone that sets an example, supports their students (supporter) and provides them with feedback on how they are doing during their practice placement with their mentors (feedback givers) (see Figure 1).
This perception is supported by the work of Earnshaw (1994) and Smith and Gray (2001), where students found mentorship a valid means of support. Also, the work by Darling (1984) and Cuesta et al (1998) found that model, supporter and feedback provider were essential ‘mentor attributes’.
The perception of what mentorship is appears to be similar in all the research done about mentoring, despite the passage of time (Darling, 1984; Cuesta, 1998; Bewley, 1995; Smith and Gray, 2001; Finnerty and Pope, 2004). This would suggest that the concept of mentorship may be very similar in different settings. Table 2 lists the things that the mentors found most important about the role. Very little research has been undertaken to find out what the mentors themselves are thinking and experiencing (Davies et al, 1997; Jones, 2004). Midwives do indirectly use the students as a resource – it is interesting that the mentors felt that the student ‘kept them up to date’.
They also felt that they were given ‘more self-awareness’. This suggests that there is a ‘mothering’ aspect (Darling, 1984) to the relationship of mentor/mentee. ‘Role model’ was highlighted again, which suggested some triangulation in the survey. Other authors report high levels of job satisfaction (Caine, 1985; Cuesta, 1998; Finnerty et al, 2005).
In Table 3, the rank order of the answers suggests that midwife mentors were not too prescriptive in their mentoring roles and preferred to allow the student to find themselves as midwives within a supportive atmosphere.
This demonstrated a facilitative approach to teaching that is considered the most effective approach (Benner, 1984; Rogers, 1994; Quinn, 1995).
What do midwives want from their students?
As can be seen in Table 4, the top three requests that midwives wanted were for their students to be enthusiastic, have good manners and good personal hygiene. These qualities also rank highly among mentors’ needs (see Figure 2). Good GCSE results were ranked very low, despite midwifery students being on BSc (hons) midwifery courses in university.
This may reflect that most of the midwife mentors come from an era when academic qualifications were not a prerequisite. It may also indicate a perception that midwifery is a highly practical profession.
Difficulties with mentorship
A total 43.6% of midwives in the sample reported that they had no problems with mentoring (see Figure 3). Davies et al (1997) reported that the midwives in their sample tended to absorb the role of mentor into their working role and it is assumed that those who reported ‘no problems with mentoring’ either had just that or that they did not want to admit to having any problems. Difficulties stated fell into four main categories:
Lack of time to teach the students during their working day
Too much paperwork to complete
Mentor confidence problems.
Lack of time
Time is an important issue. Jones et al (2001) report that where students spend significantly less time with a trained midwife, the student’s development is affected. Earnshaw (1994) reported that students tend to gravitate towards the lower-graded midwives rather than the G grades as they feel that the D and E grade midwives will have more time to teach and support them.
Time was also an issue in the study on mentorship by Pulsford et al (2002), Kent et al (1994), Robinson (1991) and Lloyd-Jones (2001). Wrightson (2001) argues that time spent with students will be rewarded with higher standards of practice.
Over the past two decades the role of the midwife has expanded (UKCC, 2000) and previously, with the move of midwifery education into universities, midwives have been expected to take on more clinical teaching. However, none of these issues have been negotiated with the midwives and no further payment has been received.
Already a situation exists where mentors are carrying out aspects of the mentoring role in their own time (Pulsford, 2002). Certainly this issue needs to be examined by midwife managers in conjunction with the RCM as a matter of urgency, in order to prevent the situation worsening.
Innovative strategies to help midwives include the role of the ‘practice educators’ and the introduction of ‘skills laboratories’. The practice educators teach the students their practical skills before placements, thus allowing mentors to concentrate on reinforcing students’ learning of these skills.
The paperwork problem
Paperwork was a problem for a significant number of midwives (21%). The respondents in the study by Pulsford et al (2002) also complained about needing more user-friendly paperwork – this is not a new problem.
Mentors are offered regular update courses, but like the mentors in the research by Pulsford et al (2002), they do not always attend due to work commitments and poor communication. Much of the responsibility for completing the student paperwork today is on the students themselves and they should be able to explain the paperwork to their mentors.
This problem may become less of an issue as the older midwives retire and the more recently trained midwives become mentors.
Student problems were varied in this study and suggested that the mentor felt unable to deal with them. The problems fell into three categories – students:
With poor social skills
Who dressed inappropriately
Who appeared unmotivated.
Poor social skills
One midwife commented: ‘The student didn’t seem to appreciate that she was a guest in people’s houses.’ Mentorship is based on good will and enthusiasm (Davies et al, 1997) and poor behaviour can demotivate the mentors, so it is important that the mentors are supported with this problem by the link lecturers.
Channels of communication between the link lecturer and the mentor need to be developed so that the mentor can be supported more directly when faced with this problem.
Students who dress inappropriately
One of the problems with the schools of nursing and midwifery being amalgamated with universities is that there is a conflict between popular university dress and professional dress codes.
While it is acceptable for general students to dress unconventionally, it is inappropriate for professionals in training to do so. A collaborative approach between the universities and NHS Trusts would be helpful to resolve this conflict for the mentors.
Students who appear unmotivated
‘Unenthusiastic students’ was the comment made by some midwives. Pulsford et al (2002) also noted in their data that some students appeared unmotivated.
Some students come to university with severe social and personal problems coupled with financial problems and mentors are not always able to perceive these with their client focus.
Mentor confidence problems
One mentor commented: ‘Being a newly-qualified mentor myself, I was given a third year student to mentor and I felt inadequate.’ Mentor confidence problems were apparent in the more inexperienced mentors, especially when they had had no training at all. Bewley (1995) found that mentors felt unprepared for the role and not all midwives were suited.
Lansdale (1996) suggested that mentors should be selected for the role, however with the shortage of midwives there is an ‘all hands on deck’ mentality about the role as we seek to increase the number of midwives. One solution might be to integrate mentor preparation into the midwifery degree pathway, thus introducing a new attitude towards mentorship.
However, although this has been considered, it is not thought to be a good idea, as newly-qualified midwives need to consolidate their training with experience before embarking on the mentor role.
The rewards of being a mentor
Nearly all the midwives in the sample said that they found it rewarding to see the student qualify and then practise knowing that they had helped to train them. However, such altruism may not be sustainable in the changing and fast moving learning environment (Finnerty et al, 2005).
When mentors’ experiences were cross referenced with their problems, it appeared that midwives with over ten years experience of practice had more problems with lack of time, paper work, and student problems (see Figure 4).
However, mentor confidence was less of a problem in this group. There does not appear to be any similar data in the literature search except complaints of too little time spent with students (Pulsford, 2002; Lloyd Jones, 2001; Jones, 2004).
Experienced midwives will also probably have higher professional grading and therefore more responsibility and heavier work loads.
In their role as mentors, midwives perceived themselves as people who were role modeling best practice. They felt this role kept them upto- date in practice, gave then more self-awareness and responsibility.
They perceived that students needed a mentor who would help them develop safe skills, was confident in her role and would allow the student to develop these skills. This matched requirements highlighted by students in previous studies (Smith and Gray, 2001) demonstrating that their perception was accurate and that there was a high standard of mentoring among midwives.
Recommendations for future practice
There is a need for more research about what constitutes support for mentors in practice
Closer relationships between midwives and link lecturers are necessary if the mentors’ experience and that of the students is to be enhanced
Midwives need to be systematically prepared for mentoring before taking on this role and supportand evaluation should be offered regularly
Midwives need to be allocated specific times within their week to teach their students on a one-to-one basis and to complete paperwork
Midwives need to be made aware of counseling services for students and should not have to take on this role themselves
Students need to be carefully prepared by midwives before going into a client’s home.
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Reflection on Mentorship Essay
2693 Words11 Pages
The aim of this essay is to discuss on how the reflection on mentorship will be undertaken, how and why the model of reflection will be used and the importance of confidentiality. I will reflect the mentorship by ensuring that the mentee during clinical practice is put at ease throughout the learning experience of four weeks (Quinn, and Hughes 2007, p. 29). Also, I will use the principle of Kolb’s learning cycle as my model of reflection because reflecting is an essential element of learning. As I am the mentor, I will follow this cycle in a clockwise direction with Jude, so she would have to reflect on the skills learnt by reviewing the whole situation (Kolb’s learning cycle 1984 in Rose and Best 2005, p.129). This would enable Jude to…show more content…
I explained in details to Jude about parking , public transport ,lunch facilities and other daily requirement to facilitate an environment that is conducive for her learning(Quinn and Hughes,2007 ,p.29). At the end of orientation, I gave Jude an orientation package about the placement. This would enable her to learn about clinical issues which would ensure a good start and her understanding about the department (Rose and Best, 2005, p.55). I have chosen to do a comprehensive orientation, to make her confident and support her learning in practice (NMC, 2008).
I then proceeded to carry out an initial interview with Jude in a quiet private room. I ensured it was free from distraction(Rose and Best ,2005,p.71).To ensure confidentiality, I ensured that the room where we performed the interview was well organized in an informal settings . The chairs were at the same height, with no desk to justify a sense of equality (Quinn and Hughes, 2007, p.241).
Jude was a first year student. I found out her stage of training to enable me to provide an ongoing and constructive support for her (ENB /DOH, 2001).
I then continued with the initial interview by identifying Jude’s previous knowledge and experience. We both discussed this and It has enabled me to ascertain what She knew and teach accordingly( Knowles, Holton , and Swanson.,2005,p.40) . Jude has no disability (NMC, 2006). I also gave Jude the opportunity to