Facilitating a 2nd Year student who is assisting in leg ulcer redressing including compression bandaging.

Abstract

Part of the role of the mentor is to “facilitate the selection of appropriate learning strategies to integrate learning from practice and academic experiences” (NMC SLAiP Standards 2008). Assessing and carrying out leg ulcer dressings is a vital part of working as a community nurse and this report describes how I as a mentor facilitated a student to assist with this activity and identifies some of the range of facilitative strategies to support learning in practice. It describes carrying out an activity, from preparation, implementation and evaluation of the activity, assisting my student to to evaluate her own learning, identify further learning needs and planning and management of how these learning needs can be met.
Overall this report demonstrates how supervising a student in a learning situation, setting learning objectives and giving feedback are all part of the role of the mentorship.

Background and introduction to the activity

Student S is a year two semester two student nurse currently on her second week of a nine week community placement. At this stage she should be using evidence based practice and focusing on the service user. Student S has identified that wound care, rationale behind different dressings and types of bandaging is an area where she needs to gain more knowledge. Further practice in the practical aspects of using aseptic non touch technique and physically applying bandages was also identified as a learning need.
Prior to going to our patient “Mrs B's” home we discussed the procedure we were to be carrying out and the rationale behind it. We set aside a time slot of 45 minutes to complete this activity.
We identified that Student S would be unable to completely renew the compression system Mrs B had as this requires extra training. This would be completed by myself.

Rationale and theories/concepts related to mentorship
We had arranged for student S to attend the leg ulcer clinic and spend time with the tissue viability nurse as part of her outreach activities during her placement. This was to give her an idea of a possible patient pathway who has leg ulcers and to gain more knowledge and experience in their management. It's suggested by Pollard (2004) that ideally students would follow one patient through the sequence of events, but it is recognised that the reality, as in the case of Mrs B. makes this almost impossible.
As a mentor my role as defined by RCN guidelines (2007) is to support Student S through “application of theory, assessing,evaluating and giving constructive feedback and facilitating reflection on practice, performance and experiences”.
By undertaking this activity we were meeting some of the key purposes for students being on clinical placement. Casey (2011) describes how Lloyd Jones et al (2001) suggests this to be the acquisition of skills and knowledge as well as applying theory to practice and professional identity formation and “enculturation”.
Whilst undertaking Mrs B's dressings I was aware that as a mentor I was accountable for any decision to delegate work to my student and for that work being undertaken and I knew that Student S should at her level of training be able to undertake this activity with supervision,in keeping with RCN guidelines. The aspects of care that Student S was unable to complete i.e. applying the compression layers of bandaging would also support her learning in practice by using my clinical skills and professional behaviour to demonstrate this and as a role model whilst interacting with Mrs B.
I was however aware that as a mentor I should not make assumptions about student S and her abilities at her level. According to Canham (2002,p.35) 'Although some taught skills and knowledge are universal, teaching and learning skills acquired previously cannot be assumed to be automatically transferable to specialist practice, especially in community settings'. She also states the importance of meeting the needs of the public and the organisation so it was important to be aware of meeting Mrs B's needs as well as Student S.

Analysis of what occurred during the activity

We agreed that student S would “lead” the visit. Our patient was well known to me. S. introduced herself and gained verbal consent to carry out the redressing. Mrs B is quite deaf and appeared to be missing some of what student nurse S was saying so I suggested she moved slightly closer and spoke a little louder and as clearly as possible. After preparing all the equipment we would need, she removed the old dressings asking Mrs B how she had been with them over the past week. She washed Mrs B's legs and we talked about the merits of using tap water or saline and the different emollients that can be used. I noted Student nurse S was positioned slightly awkwardly and suggested she think about how to make things easier for herself in terms of her environment. She asked that I move two chairs that were behind her, giving herself more space.
We observed the leg ulcers together and I asked if she felt the current dressings were suitable and why. Mrs B had been experiencing quite a lot of pain from her ulcers and we decided we would try a different primary dressing that is useful for wound pain. I asked student S how we could measure the pain in order to evaluate the effect at our next visit. We agreed using a visual analogue scale would be most appropriate with Mrs B.
My opinion was that Student Nurse S was being competent and confident. She was talking to Mrs B during the procedure, reassuring and answering any questions. She completed the wound care chart, measuring the ulcers and noted the ulcer on the leg in which currently was not having compression on had become larger. We talked about why this might be and agreed a plan of action to check last doppler results which were not in Mrs B's home as it was unclear why Mrs B only had one leg in compression.
After completing the dressing and bandaging, Student nurse S completed the written notes and I asked her if she had any questions or concerns regarding the procedure. We thanked Mrs B and left.

Change and recommendations for best practice

Whilst this activity was mainly using humanistic learning by facilitating student S to reach her potential, I felt on reflection that I could have stood back more as Student nurse S was clearly competent in her practice, including acknowledging her limitations.
Although we had prepared and discussed the procedure beforehand I had not realised that the physical environment was not ideal for the practical procedure and I did not check beforehand that all the records were available. However Wilkes (2006) does propose that a less than ideal environment of care does not negate a good learning experience.
As a mentor, I met the goal of facilitating learning by creating an environment for a specific learning activity, evaluating the learning activity and promoting evidence based practice in line with the NMC domains for standards to support learning.

Reference List

Great Britain. Nursing and midwifery council (2008) Standards to support learning and assessment in practice [online]. Available at: http://www.nmc-uk.org/Documents/Standards/nmcStandardsToSupportLearningAndAssessmentInPractice.pdf (Accessed:1 May 2013).

Pollard C,Hibbert C. (2004) 'Expanding student learning using patient pathways' Nursing Standard,19 (2) pp. 40-43

Royal college of nursing (2007) Guidance for mentors of nursing students and midwives [online]. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0008/78677/002797.pdf (Accessed: 28 April 2013)

Lloyd Jones M,Walters S, Akehurst R(2001)'The implications of contact with the mentor for preregistration nursing and midwifery students'. J Adv Nurs 35(2):151-60

Canham,J,Bennett J (2002) Mentorship in community nursing: Challenges and opportunities. Dawsonera [Online]Available at:http:/dawsonera.com (Accessed 2 May 2013)

Wilkes, Z. (2006) 'The student-mentor relationship: a review of the literature'.
Nursing Standard, 20(37), pp. 42–7.