“the way you structured the questioning…it gave me ideas in my head in how I wanted the interview to go” (from interview transcript)

Incident:

The key point during the interview, I thought, was when J. spoke about how he wanted the interview to go and what questions and information he wanted to find out. For me, J. had reached the point I wanted him to get to, where he realised it is possible to control and change an interview using a structured approach. I suggested to him as further learning to develop in the future, using examples of questions about self harm and suggesting using formal interview tools in informal ways.

I did not ask J. what he meant by “ideas in my head”. I hesitated to ask him what he meant and to encourage him to reflect on this.

Reflective observation:

Looking over the transcript and analysing it, I think I missed the boat with J. here. I perhaps let an opportunity pass to explore his learning with him in greater depth. We could have discussed how to develop skills in interviewing and what he wanted to learn next. This would have moved the focus away alcohol and withdrawal symptoms towards his skill development. It could also have been a good opportunity to practice critical incident analysis.

I think there were two reasons why I was “wary” of delving deeper at this point with J. and trying to help him reflect on his learning:

First, I had not worked with him for two weeks which was unfortunately due to training and holiday schedules. This meant I had no chance to work with him and observe and assess him directly. I had set him guidelines in how to interview and knew he could get support from other staff nurses. However, I had only what he was giving me during the interview to assess and give him feedback.

Secondly, I had started the interview with a clear idea that we were going to cover his CAP booklet in some areas. I really felt some pressure inside myself to cover the whole assessment aspect and not risk going off at a tangent. I regarded the purpose of the assessment as giving J. feedback on how he had met his competencies. I knew that most students saw completing their CAP booklets as a priority.

Perhaps if I had helped J. explore his learning it may have been more useful for his future. I felt he was interested in the subject and seemed motivated to learn. He reported making several attempts to talk to different patients on the ward about their drinking. He did link what he had learned to his next placement and how he could use it. It is a little ironic that I was not flexible and adaptable in my approach to interviewing. But we were both learning: J. as a student nurse and myself as a student mentor!

Related theory:

Rowantree (2003) describes six different purposes for assessment: including selection, standards, motivation for students, feedback to students, feedback to teachers, and preparation for life. Selection here can be conceived as both access to a course or profession and passing or completing a course of education.

There are number of purposes here which are not necessarily compatible or perhaps easily reconcilable. Selection and maintaining standards can be seen as competitive and even as almost elitist. Feedback is described as “the life-blood of learning” (Rowantree, 2003: p416), where assessment is meant to teach the student something. Preparation for life can be seen as inspirational which maybe at odds with maintaining standards, in the sense of maintaining a status quo.

Jarvis and Gibson (2001) talk about the two common types of assessment current in nursing education: formative and summative assessment. They describe formative assessment as diagnostic to try and find out what the student has learned and still has to learn. Summative assessment is about making a judgement of whether a nurse has learned enough to become competent (Bradshaw, 1989).

Duffy and Hardicre (2007) in their first article on failing nursing students describe a three stage process of an initial meeting which is formative; a mid placement meeting which is formative with constructive feedback and a final summative meeting where both the student and mentor should know what to expect. In part 2 on managing failing students they state that feedback should be regular and ongoing (Duffy and Hardicre, 2007). This prescriptive approach to assessment is about meeting standards and ensuring public and patient safety. Even though they are discussing the failing student their approach if used must apply to all students in order to be consistent, fair and balanced.

The mentor has to balance the idea of educating and learning with a duty of ensuring that the student is safe to practice. On the one hand the mentor should provide feedback that facilitates the student identifying what they have learned and what they still have to learn. On the other the mentor is accountable for the safety of patients in their care. Beattie (1991) argues that this can make assessment more effective by ensuring consistency to meet the accountability need. This is not easy and involves gathering a lot of information about learning to make a judgement based on this evidence.

However, if our aim is to create a profession of reflective practitioners then assessment must perhaps include an open ended formative element as well. Driscoll (Baird and Winter, 2005) makes the point that “there is no end-point in learning about practice.” Perhaps mentors have to allow their students the freedom to explore their learning. During assessment students should have opportunities to reflect and to broaden their understanding. Students perhaps should be given choice and participation in the learning process. This is in line with teaching nursing students as adults who are internally motivated, self directing and who bring past experience to their learning. (Knowles, 1990)

The challenge is to foster this desire and motivation to learn when it occurs. Biggs (1987) discussed the differences between deep and superficial learning. Assessment that encourages anxiety and recall of knowledge can lead to superficial learning. Where deep learning is promoted by motivation to learn and should be more effective in creating professional nurses.

One way to foster “deep” learning could be to use questioning skills. It is possible to ask questions that will broaden learning and develop critical thinking. There are different types of questions: closed; open; questions looking for simple answers; questions that promote discussion. The mentor should form a question at an appropriate cognitive level for the nursing student. The mentor can ask a series of questions aimed at getting a response from the student and encouraging an increasing complexity if appropriate. (Nicholl and Tracey, 2007)

In exploring some of the literature on assessment, it seems apparent there are two intertwined elements present: the formative strand is about what has been learned and what still needs to be learned; the summative strand is about making a judgement about meeting a proficiency standard to become professional and safe in practice. The challenge for the mentor is to meet both strands adequately in their assessment of student nurses.

Future Action:

There are some things I would try and do differently. I would try and structure assessment over the whole placement as suggested in Duffy’s model (Duffy and Hardicre, 2007). However, I would try and find a place both the formative and summative elements within the assessment process, while trying to clearly have separate interviews for each.

I would like to observe my student directly in learning situations, as well as gather information from colleagues and of course from the student. I would now see feedback as having to be based on a sound judgement based on facts in order to be helpful for the nursing student. Even where the student is more senior and capable I would still like to have some element of direct observation to justify my assessment. Another part I would consider is planning my feedback and possibly giving it in writing beforehand. This could remove anxiety on the student’s part about “passing” and perhaps allow time to explore formative aspects of the assessment.

I think growing as a mentor would involve becoming skilled at encouraging learning during assessment while giving feedback and passing a student or not. If I had another instance like with J. here, I would like to try and ask a few questions to delve a little deeper into what he was saying.