Introduction
Mentoring is a professional relationship where an experienced individual assists a junior employee in development of skills necessary for practice in an occupation (Honey 2007 p. 3654). This allows for professional growth for the less experienced person and helps the mentor to advance in personal growth. There are growing interests in mentoring and these face influences from social and economic factors (Kelan 2012 p. 179). For example, there is an influx of women into the job market beyond past days and that leads to the need for incorporation of the minority groups into the workforce without compromising of the professionalism and work standards of an organization (Duncan and René 2011 p. 20). In the healthcare sector, the development of friendliness with new aspects such as evidence based healthcare and patient focus make it necessary for organizations to consider the best means of having employees as equipped as possible for the mitigation of any challenges in the workplace (Bridges and Colman 2012 p. 95). Mentoring becomes a clear way of ensuring professionalism in health workers practices because it is expensive taking employees through all trainings formally.
Organizations include mentoring for the implementation of strategic implementation of their objectives through recruitment, professional development, retention and multicultural development of the workforce (Wankel and Bob 2009 p. 56). I have 4 years working experience with 3 years in Malaysia and 1 year in Saudi. I have a diploma in nursing and advance diploma in preoperative nursing. I have been exposed to the multidisciplinary field like plastic, urology, ophthalmology and many more. Currently, I am working in a semi-government hospital in Riyadh, Saudi. It has 14 operating rooms, which are well equipped with high technical equipments like laser machines and robot. Being in Saudi has given me a great opportunity to explore in depth my passion towards scrubbing, as this hospital is a trauma hospital and with well-equipped facilities. I have to choose a learner for mentoring so I decided to choose a newly graduate nurse who is a Saudi citizen. It is her first time working in Saudi. Therefore, we will choose surgical scrubbing, gowning and gloving as a procedure to teach her. Therefore, it should mention how we teach her and we need to have an evidence which will be included in the appendix later on (Carmichael 2011 p. 379). I will use andragogy, which is the employment of teaching strategies with a focus on incorporating learning accommodating to adults. This is necessary for the engagement of a learner to adopt experiences and understand theory for practice.
Identifying learning needs, planning and managing student’s experience
Through the orientation process, I engaged Miss. M in conversation and that socialization process helped me in knowing her learning styles. The process required an understanding of learning models acceptable to the student (Wilson 2010 P. 65-66). I was looking to know her level of experiences and from what she said, she had had very few experiences in scrubbing, gloving and gowning. However, she indicated some idea on scrubbing and that opened up a path of what was necessary to show her. She had inadequate competency of scrubbing in diagnostic situations since she was just a newly graduate nurse on her first time working in Operating Theatre. That was a gap that as a mentor, I knew must be dealt with to give her new skills. That assessment process opened the point for tackling her needs in a collaborative manner. The models used in this process were observations, demonstrations, lectures, presentations and competency tests among others (Mountford, Sue and Beatrice 2006 p. 128-136).
There was collaboration in the setting up of goals and objectives for the process as we agreed on confidentiality through a trustworthy environment (Swennen and Marcel 2009 p. 143). It is important for the process to be of mutual agreement and free in presentation of the process so that the mentee can feel free to speak and express her feelings, opinions and even ask any questions. Through the process, she admitted to being a risk taker, doing things to satisfy her feelings without deeper thoughts about them, enjoying challenges and trying new things, facing situations as they come instead of planning, pitching in ideas during discussions, being talkative, not being so good at following rules, being in control and being accommodative of mishaps. That made Miss. M an activist learner. I found that the learning that the learning style of Miss. M was that of an activist, because I noted that she was ready to take up new experiences and she enjoyed every moment. She was flexible, open minded and enthusiastic she was a quick actor and loved engaging in activity characteristic for an activist learner (Honey and Mumford 1992). After observing the learning methods of Miss. M, I have a clue in the best learning method to use. However, I employ the learning questionnaire of Honey and Mumford because I would want to give her a favorable learning environment. I employ Kolbs learning style because of the incorporation of present challenges in the creation of learning experiences. This combines psychological, cognitive and affective behaviors of a learner through the emphasis of the adopted learning strategies, environment and modes. Through the questionnaires of Honey and Mumford, I learn that she is a risk taker, loves experimenting and is always willing to take action.
Learning goals & objectives
The learning process requires that by the end of the process, the student is capable of identifying the processes recommended by the hospital for carrying out scrubbing, gowning and gloving through the right techniques. It was also necessary that by the end of the process, the student had hands on the skills of scrubbing, gowning and gloving as outlined by the hospital procedures, shown a demonstrative competency in gowning scrubbing and gloving according to the prescribed hospital procedures and discussed and demonstrated the causes of contamination and how to avoid contamination through PowerPoint presentation.
Learning strategy
The teaching method for use in this situation is andragogy because of its relevance in teaching adults (Spry 2009 p. 326). This will help in the learning of gowning, scrubbing and gloving in a self-dependent way. I used the technique of andragogy to teach Miss. M since it will help her as an adult with the will to learn. This relies on the precepts of experience, willingness to learn, self-concept and the motivation for learning. Since Miss. M has no experience and she wants to learn new skills, andragogy will help in meeting her expectations during learning. Being without experience, Miss. M has the chance for initiating a process of not just knowing about these processes in theory, but practically. This method will focus much on how the student acquires knowledge and uses it to resolve the challenges faced during the process in a self-driven approach. The reason for choosing scrubbing, gowning and gloving is that it is the initial process for ensuring that there is no contamination in a surgical procedure. I had to prepare and brief the student regarding what to expect during the scrubbing process. I opened the students focus towards the opportunities for learning. This follows debriefing after the process and later I had to make explanations. The importance of learning the best means for scrubbing is to promote the integrity of the operating room. It is a lesson that will help Miss. M to be capable of maintaining the basic procedures of scrubbing and in that way helping in the minimization of instances of contamination. Since we use the method of microbiology, Miss. M had the chance to ensure disinfection and sterilization. This in turn opens a means for developing working standards, which are legal and ethical such that the occurrences of the classroom lessons as assimilated in the hospital operating room for effective practice in the future.
Working in a simulated environment gives the student a chance to have an experience similar to being in a real operating room with a real case (Fulton, Bohler, Hansen, Kauffeldt, Welander, Santos, Thorarinsdottir and Ziarko 2007 p. 399-406). It allows the learning of the skill of scrubbing necessary for a surgical scenario. The learning process included practical sessions for a feel of real situation during the process. It was necessary to understand the needs of my mentee and any preferences he had so the process could meet his expectations (Smart and Michael 2011 p. 352). Students have interest in being part of the learning process and they develop personal learning strategies. It is in this respect, that the mentoring process took the form of working with the needs of the mentee in developing the process of introducing scrubbing and gloving (Reid, Harry, Mary and Margaret 2004 p. 316). The mentee also factors in the importance of prioritizing when issues such as resource allocation are necessary. Finally, ethical reasoning is important in the choice of morally defensive approaches whenever there are concerns of competing issues. The mentee has the responsibility of evaluating benefits and risks in ensuring equity within the contexts of time limits and resources for the creation of balances in service provision (Honey 2010 p. 7). This becomes a specific way through, which I managed to ensure that my mentee had the opportunity for dealing with real life issues through professionally defined thoughts and decision-making. For the process, there were reflective activities for practice to help the student. These were such as reflective diaries and reflective worksheets. The student also had many opportunities in practical’s and I guided him through the identification for the best theories to use in each situation we faced during the process. The student faced case studies for the facilitation of critical thinking and I incorporated adequate examples into the process (Gibbs 1988 p. 55).
Facilitating Learning and Assessment:
The process started with pre reading for creation of understanding of the expectations of the course. I then gave her handouts for the procedural recommendations and techniques for scrubbing, gowning and gloving. I used a PowerPoint presentation to show the process of scrubbing, gowning and gloving and since we were in a simulated environment, I was able to set up practical work with me as the facilitator. All this took a time duration of 40 minutes.
Time
(min) Teaching objective Teaching strategy
5 -provision of session outline
-Briefing Miss. M about competency testing process Facilitated discussion
10 Demonstration of scrubbing, gowning and gloving Demonstration of skill
10 Giving the student a chance to practice Skill practice
10 Competency test and certification Competency assessment by mentor
5 Evaluation Questionnaire
Resources
Because of the importance of evidence, I provided the student with documentation such as journals. Miss. M had to keep a reflections diary of the process we went through. We also made a list of the duties to perform during the session. I provided Miss. M with procedural concepts for scrubbing. We designed a collaborative learning plan, making schedules for class attendance, journal reading, lectures, library research and laboratory practical starting with the basics and building on them gradually. The resources for this stage are Handouts (appendix 1) and PowerPoint. The process also needs a facilitator (mentor) to demonstrate and assess the process, Sink, scrubbing materials, gown and gloves. For the assessment, the process needs Sign-off sheet or certificate for competency and a student evaluation form.
Assessment
As the mentor for Miss. M I was in charge for doing the mentoring and the assessment as an expert using Attachment 2. I will allow the intern to do continuous practice in the process within the required time and observe the process. The initial studies were on pre procedural skills. The post procedural skills followed on to avoid confusing and overwhelming my student. I observed all the processes to know how Miss. M conducted her procedures and I noted all the perfect and imperfect portions for guidance. Since my learner is in the activist category, I did not have to interfere during procedures and I allowed her the chance for to keep trying until she gets things right. I was prepared to make future explanations and to continue the processes continually until my student grasps the skills effectively. There was regular formal assessment of the process and feedback period followed regular reviews of the process. Because of the need for a capacity degree of formal assessment, the process entailed reflecting and giving of feedback through dialogue with the mentee regarding the process (Honey 2008 p. 9). There was also time-to-time review of the achievements of the set goals through the learning process. The giving of informal feedback helped in developing of consistency in times of work while formal assessment was for the recording of performance (Lewthwaite, Julie 200 p. 14-31).
Evaluation
I will use a questionnaire to evaluate the sessions such as in attachment 3. This will take place at the end of every session. I will collate the results and present them to the hospital matron as well as my recommendations (Schell, 2003). I initiated reflection because of its crucial nature to adult learning and lacking in my student. This helped in the development of the skill of combining new experiences and becoming self-aware. There were sessions for thinking about experiences every Wednesday afternoon and elucidating the lessons learnt from their occurrence (Gibbs 1988 p. 55). There were regular prompts during breaks and other times of the day for the encouragement of reflection on the work done and lessons learned from the process (Jasper 2011 p. 79). The framework used focused on her development of reflective skills for evaluating her performance from experiences and being capable of planning (Mohanna 2011 p. 69).
Reflective diaries were other important tools for use in the process because they allow for personal recording of accounts (Jasper 2011 p. 79). Some of the questions I gave for consideration of diary entries were for answering questions about her roles, the kind of mentee she was and her presentation during practice for her analysis of personal consistency in observation of professional codes of conducts. The learning entailed reflective worksheets, which the matron at the hospital helped in developing to give me ease of assisting this mentee. In addition, we had an effective process because the hospital has adequate amounts of books in the library (Honey 2008 p. 9). The library at the hospital has journals from where there were sessions for conducting research on the best means of helping the student, and it gave the student a chance for doing private studies at his free time. I utilized the computers in the library to develop PowerPoint presentations for use in visual demonstration of reviews of the week and even to develop leaning plans for each week.
Management of learning experience
Knowing the students intentions allowed for the formulation of common goals and objectives for the study process. Some of the components of the working plan were on the learning needs outlining the lessons the student will learn. It also incorporated contextual learning goals, research and gaps in the practice (Hudson 2004 p. 215-225).
Learning plan
Learning Needs
What are the things you want to learn to reinforce your performance-research, education and professional practice Goals
What you want to achieve Objectives
How will you achieve them (SMART) Implementations/ Outcomes
Indicate outcomes
Enhance communication skills To be a good communicator with clients and staffs Improve on listening skills week 1
Modify and adapt to the communication needs week 1-2
Information and instructions conforming to scrubbing needs week 1-2 Feedback from mentor in the weekly meeting
Develop presentation skills Presentation of an scrubbing procedure by end of week 2 Present ideas of scrubbing procedure to the mentor by week 2
Researching through internet and journals week 2
PowerPoint presentation to the mentor in week 3 Topic negotiation week 2
PowerPoint presentation week 2
Presentation feedback by mentor
Improve time management skills Meetings and appointment attendance and timely completion of tasks Daily diary keeping for work tasks week 1
Familiarization with hospital routines week 1
Daily records of events week 1-3 Maintained appointments diary week 1-3
Discussed with mentor and followed hospital protocols
Record of events week 1-3
The sessions took place in simulated process of work where the student acted as an assistant in the preparation processes for handling of operations (Mohanna 2011 p. 69). During the practical sessions, the student had the opportunity of making trial on some of the activities as a means of having on-the-job feel of what the job requires. Friday afternoons were free time to allow the student to write reports of what they learnt throughout the week. The report included challenges and areas he wished to have clarified (Ligadu 2012 p. 350-363). That allowed for an evaluation over the weekend and preparation for the week ahead. Through evaluation of such reports during the weekend, as a mentor, I could identify of the student was progressing or not (Thomas, et al. 2011 p. 372-380).
The process of scrubbing requires holding hair up, wearing of the surgical facemask and protective eyewear and removing of finger nails. After choosing the appropriate antimicrobial cream, I demonstrated the opening of the packaging that holds the scrubbing brush and put the brush on the sink, wetting hands and arms, applying the antimicrobial agent , lathering hands, scrubbing hands and rinsing procedure. I also demonstrated the procedure for drying hands and closing of the tap using the elbow all this was timed for her to understand the importance of sticking to standard timings. For gowning, I taught the aseptic technique for gowning and took her through the steps of putting on the gown. I showed her how to dry her hands mentioning to her that the sterile towels can only be used once. I mentioned that it is always important to keep the sterile parts of the arm without water and so the towel should be used when leaning forward. I showed the best way to lift the gown from the package, let it fall and tie it onto the neckline. I showed how to hold the gown and the means for slipping arms into the armhole to allow the learning nurse to slip in her gown in an effective and appropriate way. For gloving, I taught her by preparing the gloves and showed there are two method of wearing it. It can be open and close method. When do you use open method and when do you close method. I taught the process of gloving through the closed and open methods. Use the closed method at the beginning of the procedure and the open method at the beginning of the surgical process. The open method is necessary for changing gloves.
References
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Carmichael, J. 2011. Leadership and Management Development. Oxford: Oxford UniversityPress. pp.379. Print.
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Fulton, J., Bohler, A., Hansen, G., Kauffeldt, A., Welander, E., Santos, M., Thorarinsdottir, K. and Ziarko, E. (2007). Mentorship: An international perspective. Nurse Education in Practice Vol. 7, pp.399-406.
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Appendixes
Appendix 1- procedure on how to scrub
Make sure you cover all your hair
Wear your surgical facemask correctly
Wear protective eyewear
Make sure that your nails are short have no polish as that helps in maintaining glove integrity
Remove all jewellery
Wear your hospital badge
Make an appropriate choice for a scrubbing solution
Take a non-irritant cream with long lasting residual effect
Use a broad-spectrum fast actor cream
Use a cream with antimicrobial ingredient
We have an initial scrubbing session of five minutes and late three minutes according to the procedure at our hospital
Scrubbing steps
Open the packaging that holds the scrubbing brush and put the brush on the sink.
Wet your hands and your forearms.
Take the antimicrobial agent and apply on your hands. Take about 30 seconds to lather your hands.
When lathering your hands, start from the wrist lather your arms to the area near the elbow for about 30 seconds.
The amount of time you should use to wash your hands is one minute.
After applying the antimicrobial agent and lathering your hands, take the scrubbing brush and scrub your nails. Always use the scrubbing brush for one scrub in a day and do not exceed 30 seconds in each of your hands. Rinse your hands and arms sufficiently holding your hands above your arms to allow water to drip down your elbows and not into your hands.
Apply antimicrobial agent onto your hands and lather them as well as your forearms in a circular motion. Do this to 2.5 cms under the elbow and finish the hand washing process after ascertaining that everywhere is clean. The overall time for washing hands should be 2 minutes.
Rinse your hands and arms.
Turn off the taps using your elbows.
Aseptic technique for gowning
Dry hands and forearms using a sterile hand towel
Do not drip water on the sterile area
Lean forward from the waist to prevent the towel from touching the scrubbing clothes
Use different towels for different arms and discard when done
lift folded gown from package
step back and allow gown to fall open
grasp the gown at the neckline
hold the gown with the inside facing you
slip in your hands into the armholes
hold hands upwards on shoulder level
have the circulating nurse to tie the back of the gown
Aseptic gloving
Open method
Open the packet of gloves. Your fingers should face your body
Pick the glove at the glove off and thumb
Turn your hands to extend gloves along your forearms
Hold the glove and sleeve cuffs together with your thumb at the hand to be gloved
Use the sleeve covered hand to stretch the cuff over the sleeve and peel above the hand
Cover and grasp the cuff over the gown
Work your fingers into the glove and the cuff onto your wrist
Closed method
Pick the outside cuff with the thumb and index finger
Pull glove onto your hand and leave cuff turned down
Used the gloved hand to slide the fingers into the cuff of the glove with your gloved fingers folded
Pull the glove inwards and rotate your arm and cuff the glove over the gown
Use the gloved hands to pull the glove over the arm and cuff the glove onto the gown
Appendix 2 – skills completion form for scrubbing
Yes No
Made an adequate demonstration for the scrubbing procedure
Was aware of occurrences of contamination
Has completed the session for the skill of scrubbing
Comments:
Students name:
Mentor’s name:
Mentors signature: Date:
Appendix 3 – student feedback form
Your participation in this study is appreciated. Can you please complete this form for planning of future mentorship?
Session Title: Date:
1. What is your rating of this session
Outstanding Very Good Good Fair Poor
2. Please give some feedback regarding the following:
Strongly Agree Agree Slightly Agree Disagree Strongly Disagree
I had a clear understanding of the learning objectives of the session
There was expert demonstration of the scrubbing skill
The time for practicing the scrubbing skill was adequate
The learning environment provided by the mentor was supportive
The session was effective for teaching an adult in possession of some clinical knowledge
3. Are there any recommendations that you can give for the assistance of future mentorship and planning for the scrubbing session?
4. Any other comments:
Thank you for filling the form
Appendix 4 Honey and Mumford questionnaire (Activist learner)
I believe strongly about right and wrong and what is good or bad
I take little caution about issues
Actions on impulse are as good as carefully thought actions
I like it when work is done practically
I am active in seeking new experiences
I like attempting new ideas and approaches and i always look for means of putting them into practice
I am self-disciplined on how i carry out my duties
I have a good relationship with logical and analytic people more than will emotional, expressive and spontaneous people
I maintain a formal relationship with colleagues
I get irritated by people who do not consider their roles seriously
I seek solutions logically
