ADVANCED MENTORSHIP COMPETENCES Modules I-III of advanced mentorship competences Qual QualMen Me t nt Quality Mentorship for Developing Compete nt Nursing Stude nts. 2 The project Quality mentorship for developing competent nursing students Editors (QualMent) has been founded with the support from the European Dr. Kristina Mikkonen¹ Dr. Olga Riklikiene² Commission. The support from the European Commission for the Dr. Bojana Filej³ Dr. Boris Miha Kaučič³ preparation of this material does not imply any confirmation of the content, 1University of Oulu, Faculty of Medicine, Research Unit of Nursing Science and Health Management, Finland 2 which only reflects the views of the authors, so the Commission cannot Lithuanian University of Health Sciences, Lithuania 3College of Nursing in Celje, Research institut, Slovenia be held responsible for any use which may be made of the information Peer Reviewers contained therein. Assoc. Prof. Dr. Nadja Plazar Assist. Prof. Dr. Tamara Štemberger Kolnik Proofreading Ashlee Oikarainen Alenka Brezovšek Published by Visoka zdravstvena šola v Celju / College of Nursing in Celje Publication design Tina Červan, Neža Penca Available at http://www.qualment.eu/publications Year of issue 2021 CIP - Kataložni zapis o publikaciji Univerzitetna knjižnica Maribor 616-083:378+005.963.2 ADVANCED mentorship competences [Elektronski vir] : modules I-III of advanced mentorship competences / editors Kristina Mikkonen ... [et al.]. - E-publikacija. - Celje : Visoka zdravstvena šola, 2021 Način dostopa (URL): http://www.qualment.eu/publications ISBN 978-961-92865-9-3 1. Mikkonen, Kristina COBISS.SI-ID 68278531 3 About the QualMent project The College of Nursing in Celje was the coordinator of the European development and research project Quality mentorship for developing competent nursing students (QualMent), which was selected under the Erasmus+ Programme, Strategic Partnerships in Higher Education. The project includes as partners: The College of Nursing in Celje (Slovenia), University of Oulu (Finland), Lithuanian University of Health Sciences (Lithuania), University of Alicante (Spain), and European Federation of Nurses Associations (EFN). The project has been conducted during the timeframe of September 1, 2018, and August 31, 2021. The project has been intended for the development of a training programme for clinical mentors with the objective to increase the quality of clinical practice for undergraduate nursing students, which complies with the EU directive. The project has had three main outcomes. More information about the QualMent project at: https://www.qualment.eu 4 Introduction Figure 1. The evidence-based clinical mentors’ competency model in European countries. MENTORSÍNDIVIDUAL MENTORSĆULTURAL MENTORSĆOMPETENCE IN SUPPORTING THE This Advanced Mentorship Competencies publication includes a COMPETENCES, INTERACTION IN COMPETENCE LEARNING PROCESS description of Modules I1, II2 and III3 of advanced mentorship THE WORKPLACE & RESOURCES competencies training. The aim of this publication is to strengthen clinical nurse mentors’ mentoring competence development by sharing open-access education contents with all European Union countries and providing concrete guidance for mentors to enhance MENTORS’ their mentoring competence when working with nursing students CULTURAL CHARACTERISTICS COMPETENCE in clinical practice. The publication is based on an evidence-based clinical mentor’s competency model (see Figure 1), which has been developed and pilot-tested in education intervention with 216 mentors in four European Union countries (Finland, Lithuania, AWARENESS GOAL Slovenia and Spain) in the Erasmus+ project - Quality Mentorship MENTORS´ SENSITIVITY ORIENTATION COMPETENCE for Developing Competent Nursing Students (QualMent). IN STUDENT- KNOWLEDGE MENTORS’ CENTERED The course framework of Modules I-III includes each module’s MOTIVATION COMMUNICATION EVALUATION training contents, objectives, learning outcomes, forms of training, SKILLS didactic materials and a number of training hours and study REFLECTION forms, and can be reviewed in QualMent official website4. This CONSTRUCTIVE DURING publication will focus on the contents of the course and will not FEEDBACK MENTORING include pedagogical teaching methods and phases of the learning process related to the content. MENTORING PRACTICES & RESOURCES (MENTOR, TEACHER) 1 Dr. M Flores Vizcaya-Moreno, Dr. Paul De Raeve, Dr. Rosa M Pérez-Cañaveras. Module I. Introduction to mentorship in nursing. Pages 5-20. 2 Ashlee Oikarainen, Dr. Kristina Mikkonen. Module II. Competence in mentoring culturally and linguistically diverse nursing students. Pages 21-32. European Union Directive 55 (Article 31) 8 competences 3 Dr. Olga Riklikiene, Erika Juskauskiene. Module III. Competence in mentoring assessment and reflective discussion. Pages 33-44. 4 https://www.qualment.eu/wp-content/uploads/2020/02/Advanced-Mentorship-PERSON-CENTERED CARE Competences_upgraded_december_final.pdf 5 Module I. INTRODUCTION TO MENTORSHIP IN NURSING Authors: Dr. M. Flores Vizcaya-Moreno, Dr. Paul de Raeve, Dr. Rosa M Pérez-Cañaveras 6 Mentors play a key role in nursing students’ clinical practice. Mentors’ competence encompasses versatile and multi-dimensional areas, including mentors’ individual competencies and interaction in the workplace. Mentors’ individual competencies include mentors’ characteristics, their motivation for mentoring, and having knowledge about their organizations’ mentoring practices, collaboration and recourses (see Figure 15). In order to ensure mentors’ individual competencies and their interaction in the workplace when mentoring nursing students, Module I. on Introduction to mentorship in nursing has been developed. The main objective of Module I is to improve clinical mentors’ individual mentoring competence and for mentors to reach the learning outcomes reported in the course framework. The module has been divided into five themes: the European clinical mentors’ competency model, EU Directive 2013/55/EU, EFN Competency framework and mentoring competence, didactics and teaching methods for good reflective practice in mentoring, learning and knowledge technologies (LKT) in mentoring and coaching, and impact of mentors’ competencies on quality mentorship. 5 Mikkonen K., Tomietto M., Kääriäinen M., Oikarainen A., Tuomikoski A.M., Riklikiene O., Juskauskiene E., Vizcaya-Moreno M.F., Pérez-Cañaveras R.M., De Raeve R., Filej B., Plazar N., Čuk V., Kaučič B.M. (2019). Development of an evidence-based nurse mentor’s competency model. QualMent EU-project. Celje. Univerzitetna knjižnica Maribor, Slovenia. Available at: https://www.qualment.eu/wp-content/ uploads/2019/12/Development-of-an-Evidence-Based-Nurse-Mentors-Competence-Model_QualMent.pdf 7 Theme I. learning can be improved by modifying the learning environment’s positive conditions. In the same way, negative clinical environments make it difficult for students to learn. In the scientific literature, the following factors have been identified as positive: responsibility and independence of the students, performance of activities under mentor’s supervision, perception of control of the THE EUROPEAN CLINICAL MENTORS’ COMPETENCY situation, and global understanding of the context of practices. The negative factors are problems in MODEL: THE CLINICAL LEARNING ENVIRONMENT, THE the student-tutor relationship, organizational defects in clinical practices and problems related to the ROLE OF DIFFERENT ACTORS AND THE CLINICAL MENTORS’ students’ own negative experience9,10. COMPETENCY MODEL Saarikoski and Leino-Kilpi11 (2002) affirmed that the main elements of an excellent CLE are the following five: Nursing is a practice-based profession in which clinical practice in healthcare centers is an essential component of the European undergraduate curriculum. European countries signatory to the Bologna • Supervisory relationship: the one-to-one relationship is the most important element in clinical Declaration6 are committed to restructuring their educational systems so that these become more instruction and mentoring/supervision. transparent and similar, and to promoting the mobility of students, teachers and administration in • Premises of nursing on the ward: high-quality nursing care is the best context for successful Europe. According to evidence found in our QualMent Project, we recommend that mentors of learning experiences. nursing students in Europe receive proper training in mentoring. • Premises of learning on the ward: many practical components that offer an opportunity for professional development. Numerous authors have defined the clinical learning environment (CLE) and studied it in recent • Ward atmosphere: non-hierarchical structure and displaying teamwork and good communication. years in the nursing field7,8. CLE has been defined as an interactive network or set of characteristics inherent to the practices that influence learning outcomes and professional development. The • The ward manager’s leadership style: he/she is aware of the physical and emotional needs of internship position offers students optimal scenarios to observe models and reflect on what is seen, the students and nursing staff. heard, perceived, or made. CLE is the “clinical classroom” with a diverse social climate where students, mentors, nurses, teachers and patients interact. Scientific evidence shows that clinical The quality of the clinical learning process depends mostly on the quality of mentoring. Mentoring practices allow students to develop critical thinking, training in psychomotor skills, communication (also called supervision) of nursing students during clinical practice should serve as the professional skills, time management and distribution skills, and also increase students’ self-confidence to act as development vehicle for nurses, being crucial for the students’ professional modelling. Mentoring is nurses. also essential for future nursing professionals’ socialization and cultural competence, and the mentor is the key actor in this process. In this line, the authors of the present report consider as a crucial The CLE influences the students’ learning process; for example, the students’ results during clinical 9 Gurková, E., Žiaková, K., Cibríková, S., Magurová, D., Hudáková, A., & Mrosková, S. (2016). Factors influencing the effectiveness of clinical learning environment in nursing education. Central European Journal of Nursing and Midwifery, 7(3), 470-475. doi: 10.15452/ 6 The European Higher Education Area (1999). The Bologna Declaration of 19 June 1999. https://www.ehea.info/media.ehea.info/file/ CEJNM.2016.07.0017 Ministerial_conferences/02/8/1999_Bologna_Declaration_English_553028.pdf [04/05/2021]. 10 Dobrowolska, B., McGonagle, I., Kane, R., Jackson, C. S., Kegl, B., Bergin, M., Cabrera, E., Cooney-Miner, D., Di Cara, V., Dimoski, Z., 7 Saarikoski M., & Strandell-Laine (Eds.) (2018). The CLES scale: An evaluation tool for healthcare education. Springer International Kekus, D., Pajnkihar, M., Prlić, N., Sigurdardottir, A. K., Wells, J., & Palese, A. (2016). Patterns of clinical mentorship in undergraduate nurse Publishing. doi: 10.1007/978-3-319-63649-8. Available at: http://www.springer.com/us/book/9783319636481. education: A comparative case analysis of eleven EU and non-EU countries. Nurse Education Today, 36, 44–52. https://doi.org/10.1016/j. 8 Vizcaya-Moreno, M. Flores, & Pérez-Cañaveras, Rosa M. (2020). Social Media Used and Teaching Methods Preferred by Generation Z nedt.2015.07.010 Students in the Nursing Clinical Learning Environment: A Cross-Sectional Research Study. International. Journal of Environmental Research 11 Saarikoski, M., & Leino-Kilpi, H. (2002). The clinical learning environment and supervision by staff nurses: developing the instrument. and Public Health 17(21), 8267. doi: https://doi.org/10.3390/ijerph17218267 International Journal of Nursing Studies, 39(3), 259–267. doi: https://doi.org/10.1016/s0020-7489(01)00031-1. 8 issue, how mentors perceive their mentoring competence in the CLE. The role of the mentor, which require different types of teaching methods. Millennials appear less mature than previous generations, is essential in the nursing mentoring process, is the role of the leader. The mentor has in professional and express doubts about their academic competence. They experience difficulties communicating literature also been called facilitator, peer instructor, preceptor, nurse tutor, supervisor or clinical through traditional channels and do not like to write or read. Their multitasking propensity makes instructor12. A mentor is a “Registered nurse who supports undergraduate students in their learning it difficult to focus on one activity. Generation Z are true digital natives, racially and ethnically and is responsible for teaching and assessing students in clinical practice” 13. Frequently she/he diverse and open-minded. They have “a unique combination of attitudes, beliefs, social norms, is not employed by an educational institution, and most of the time, they have to combine their and behaviors that will impact education and practice for many years” 18. They are defined as high mentoring job with a high workload. It has been studied how the mentors’ characteristics positively consumers of technology, cravers of the digital world, and pragmatics. They have underdeveloped or negatively influence the students’ learning. Positive characteristics in mentors include the elements social and relationship skills, being cautious and concerned with emotional, physical, and financial of flexibility, negotiation, confidence and positively reinforce the student. Negative characteristics safety. They are individualistic, with an increased risk of isolation, anxiety, insecurity, and depression. in mentors include elements of being insensitive, not tactful or not showing compassion towards the Also, they lack the attention span, looking for their convenience and immediacy. There are only student and excessive expectations of perfection12. few scientific studies about Generation Z nursing students at the moment. However, given their generational characteristics (strong work ethic, conservative nature, self-fulfillment over salary, and The evidence-based clinical mentors’ competency model is shown in Figure 1. The development of job stability), there is a reason to believe that Gen Z students may pursue nursing19. For this reason, this model has been part of the work done in the QualMent project. The first element of the model mentors and educators have to understand how these new generations of learners think or how they is the mentor’s individual competences and interaction in the workplace. Mentor’s characteristics prefer to interact. Mentors and educators have to recognize and consider the differences in these are essential, e.g., supporting and coaching, motivating, advising, keeping professional integrity, generations to successfully engage and guide students and novice nurses. honesty, accessibility, approachability, respect, enthusiasm and empathy14. Mentoring practices in the workplace can be defined as combining the CLE elements15,16. The role of the nursing student is wished by mentors to be an active role. Students need continuous and individualized feedback and support from their mentors, who help them feel more secure and involved in patient safety. In addition to providing nursing students with standardized nursing education, social generations of Millennials and Generation Z17 should be taken into consideration, as these generations of students 12 Vizcaya-Moreno M. F. (2005). Valoración del entorno de aprendizaje clínico hospitalario desde la perspectiva de los estudiantes de enfermería. Doctoral Dissertation. Alicante: University of Alicante. URI: http://hdl.handle.net/10045/13280 13 Tuomikoski A.M., Ruotsalainen H., Mikkonen K., Miettunen J., & Kääriäinen M. (2018). The Competence of nurse mentors in mentoring students in clinical practice –A cross-sectional study. Nurse Education Today, 71, 78-83. doi: 10.1016/j.nedt.2018.09.008. 14 Hale, R. L., & Phillips, C. A. (2019). Mentoring up: A grounded theory of nurse-to-nurse mentoring. Journal of clinical nursing, 28(1-2), 159-172. doi: https://doi.org/10.1111/jocn.14636 15 Saarikoski M., & Strandell-Laine (Eds.) (2018). The CLES scale: An evaluation tool for healthcare education. Springer International Publishing. doi: 10.1007/978-3-319-63649-8. Available at: http://www.springer.com/us/book/9783319636481 16 Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: a concept analysis. Journal of advanced nursing, 72(3), 501–513. doi: https://doi.org/10.1111/jan.12861 18 Chicca, J., & Shellenbarger, T. (2018). Connecting with generation Z: Approaches in nursing education. Teaching and Learning in Nursing, 17 Vizcaya-Moreno, M. F., & Pérez-Cañaveras, R. M. (2020). Social Media Used and Teaching Methods Preferred by Generation Z Students 13(3), 180-184. doi: https://doi.org/10.1016/j.teln.2018.03.008 in the Nursing Clinical Learning Environment: A Cross-Sectional Research Study. International Journal of Environmental Research and Public 19 Williams, C. A. (2019). Nurse Educators Meet Your New Students: Generation Z. Nurse Educator, 44(2), 59-60. doi: 10.1097/ Health 17(21), 8267. doi: https://doi.org/10.3390/ijerph17218267 NNE.0000000000000637 9 Theme II. healthcare information. • To take responsibility for lifelong learning and continuous professional development. • To accept accountability for one’s own professional activities and to recognize the limits of EU DIRECTIVE 2013/55/EU, EFN COMPETENCY FRAMEWORK AND one’s own scope of practice and competences. MENTORING COMPETENCE B. Health promotion and prevention, guidance and teaching Appropriate clinical mentorship for nursing students is the vehicle for compliance with the eight • To promote healthy lifestyles, preventive measures and self-care by strengthening empowerment, nursing competencies outlined in Annex V of the EU Directive 2013/55/EU20, which defines that promoting health and health-enhancing behaviors and therapeutic compliance; the half of all contact hours of each nursing study programme are done in the clinical environment • To independently protect the health and well-being of individuals, families or groups being and mentored. Mentorship during nursing students’ clinical placement is an important factor in their cared for, ensuring their safety and promoting their autonomy. education, as this is the first time that they will step into the reality of the working practice. High- • To integrate, promote and apply theoretical, methodological and practical knowledge. This quality clinical education is paramount to the development of a competent workforce of nurses enables the promotion and development of nursing care in long term care, comorbidity, and in able to deliver safe people-centered care. Giving some much-needed structure and guidance to situations of dependency in order to maintain an individual’s personal autonomy and his/her nurse educators would ensure greater consistency in approaches and foster appropriate learning relationships with the environment in every moment of the health/illness process. environments for the future nursing workforce. Hence, nurses’ mentorship must be based on and argued in research and evidence. C. Decision-making In order to mentor according to the 8 EU Competencies in Article 31 of Directive 2013/55/EU, it • To apply critical thinking skills and systematic approach to problem solving and nursing is necessary to break down the competences according to core areas and to further describe them decision-making in the professional and care delivery context. considering the existing competency frameworks21. The competence areas defined below by EFN, • To carry out actions, by previously identifying and analyzing problems that facilitate seeking provide a clearer understanding of the competencies and the list of related topics, and allow the the most beneficial solution for the patient, the family and the community, reaching objectives, formulations of learning outcomes. improving outcomes and keeping the quality of their work. A. Culture, ethics and values D. Communication and teamwork • To promote and respect human rights and diversity in the light of the physical, psychological, • To be able to comprehensively communicate, interact and work effectively with colleagues and spiritual and social needs of autonomous individuals, considering their opinions, beliefs, values inter-professional staff, and therapeutically with individuals, families and groups. and culture, and the international and national codes of ethics, as well as the ethical implications • To delegate activities to others, according to the ability, level of preparation, competence and of healthcare provision; ensuring their right to privacy and honoring the confidentiality of legal scope of practice. • To independently use electronic health records to document nursing assessment, diagnoses, 20 European Council (2013). European Council Directive 2013/55/EU on the recognition of professional qualifications. Official Journal of interventions and outcomes based on comparable nursing classification systems and nursing the European Union (L 354/132). Available at: https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32013L0055. taxonomy. 21 EFN Competency Framework for Mutual Recognition of Professional Qualifications Directive 2005/36/EC, amended by Directive 2013/55/EU. EFN Guideline to implement Article 31 into national nurses’ education programmes. http://www.efnweb.be/?page_id=6897 10 • To independently retrieve and apply information and share information among patients and • To respond appropriately and in time to unexpected and rapidly changing situations. health care professionals and across health care facilities and community. • To perform independently efficient measures in crisis- and disaster situations that allow • To independently coordinate care for patient groups and to work interdisciplinary towards the preservation of life and the quality of life. common goal of ensuring quality of care and patient safety. It is important to emphasize the vital mentor’s role in making sure that the competencies²¹ and E. Research & development and leadership learning outcomes are achieved. Learning outcomes are related to students’ competence development • To implement scientific findings for evidence-based practice. (knowledge, skills, attributes), which are expected to develop after completing an education and training process. In this document we provide competence areas defined according to EU Directive 55 • To consider the equity and sustainability principles in healthcare and strive for the rational use and EFN Competency Framework by integrating learning contents and potential learning outcomes of resources. suggestions. • To adapt leadership styles and approaches to different situations concerning nursing, clinical practice and healthcare. • To promote and maintain a positive image of nursing. F. Nursing Care • To show sufficient knowledge and skills to provide professional and safe care adequate to the health and nursing care needs of the individual, families and groups the nurse is responsible for providing care to, taking into consideration the developments in scientific knowledge, as well as the quality and safety requirements established in accordance with the legal and professional conduct regulations. • To independently assess, diagnose, plan and provide person-centered integrated nursing care focused on health outcomes by evaluating the impact of the situation, background, and the care given, through clinical care guidelines describing the processes for the diagnosis, treatment or care, and making recommendations for future care. • To know and implement the nursing theoretical and methodological fundamentals and principles, basing nursing interventions on scientific evidence and the resources available. • To independently establish assessment mechanisms and processes for continuous quality improvement in nursing care, considering the scientific, technical and ethical developments. • To understand and act according to the social and cultural contexts of individuals’ behaviors, and the impact on their health within their social and cultural context. • To understand the importance of having care systems aimed at individuals, families or groups, while assessing their impact. 11 COMPETENCE DIRECTIVE 55: Competence H – “Competence to analyse the quality of care COMPETENCE DIRECTIVE 36/55: Competence C – “Competence to empower individuals, in order to improve their own professional practice as general care nurses” relates to EFN families and groups for a healthy lifestyle and self-care” relates to EFN COMPETENCE: Health COMPETENCE: Culture, ethics and values promotion and prevention, guidance & teaching CONTENT POTENTIAL LEARNING OUTCOMES CONTENT POTENTIAL LEARNING OUTCOMES • Ethics and philosophy of • To show an ethical, legal and human conduct in the • Principles of health and • To recognise the main risk and protection factors that nursing, human rights development of all actions to deliver nursing care to illness influence the process of health and illness. • Patient autonomy, rights patients, families and the community. • Public health and • To involve groups and communities in health education and safety • To promote and respect human rights and diversity in health promotion and and training activities aimed at strengthening behaviours • Legal aspects of light of the physical, psychological, spiritual and social prevention, community/ and the adoption of a healthy lifestyle. healthcare and the needs of autonomous individuals. primary care • To provide patients with tools that favour treatment profession, social and • To accept accountability for own professional activities • Patient guidance and compliance and to identify and monitor individuals healthcare legislation and to recognise the limits of one’s own scope of health education with a higher risk of non-compliance that can pose a • Confidentiality practice and competences. • Societal and intersectoral risk to themselves and to the community. • To delegate activities to others, according to ability, perspective and influence • To apply preventive measures to healthy individuals level of preparation, proficiency and legal scope of • Citizens’ empowerment and patients throughout all life stages and in all phases practice. and involvement of the natural history of illness. • To show consideration for the opinions, beliefs and • To guide individuals, patients and groups on how to values of patients and relatives. handle illness prevention measures and use the services • To respect ethical and legal requirements, including provided by the healthcare system. national and international codes of ethics and understand • To empower individuals by implementing healthcare the ethical implications for healthcare delivery. educational activities that allow them to be independent • To take responsibility for lifelong learning and as long as possible, as well as to take decisions on their continuous professional development. health and illness. • To ensure the right to privacy respecting the confidentiality of the information related to healthcare provision. 12 COMPETENCE DIRECTIVE 55: Competences A “Competence to independently diagnose the COMPETENCE DIRECTIVE 55: Competences B “Competence to work together effectively nursing care required using current theoretical and clinical knowledge as well as to plan, organise with other players in the health sector including participation in the practical training of and implement nursing care when treating patients and F “Competence to independently ensure health personnel” and G “Competence to communicate comprehensively and professionally the quality of nursing care and assess it” relate to EFN COMPETENCE: Decision-making and to cooperate with members of other professions in the health sector” relate to EFN COMPETENCE: Communication and teamwork CONTENT POTENTIAL LEARNING OUTCOMES CONTENT POTENTIAL LEARNING OUTCOMES • Decision-making is a • To use common sense and experience to identify crosscutting competence, problems and situations as well as to solve them. • eHealth and ICT, health • To use the IT systems available in their healthcare which should be • To recognise opportunities to look for the best and nursing information system. developed throughout the alternatives and decide about the best actions to solve systems • To apply healthcare technologies and information and curriculum. problems. • Interdisciplinary and communication systems. • To this end, it is • To efficiently solve problems arising in the care multidisciplinary work • To communicate clearly, showing respect and democratic important to establish provided to the patients, the family and the community • Interpersonal authority, with the healthcare team, patients, families learning outcomes that by capitalizing on material and temporary resources. communication and communities taking the multicultural context into can be assessed following • Multicultural account. a crosscutting approach. nursing, working with • To use scientific language orally and in writing, adapting multicultural clients and it to the person they are addressing. in multicultural work • To establish clear objectives together with colleagues communities as well as with the multi- and interdisciplinary team to • Language skills reach common goals, accepting the necessary changes • Knowledge transfer to achieve such objectives. • To take on the responsibilities of the role as a member of the interdisciplinary team. • To show an attitude oriented towards continuous improvement. • To be committed to teamwork 13 COMPETENCE DIRECTIVE 55: Competences A “Competence to independently diagnose the COMPETENCE DIRECTIVE 36/55: Competences A “Competence to independently diagnose nursing care required using current theoretical and clinical knowledge as well as to plan, organise the nursing care required using current theoretical and clinical knowledge as well as to plan, and implement nursing care when treating patients” and G “Competence to communicate organise and implement nursing care practice” and E “Competence to independently advise, comprehensively and professionally and to cooperate with members of other professions in the instruct and support individuals needing care” relate to EFN COMPETENCE: Nursing Care health sector” relate to EFN COMPETENCE: Research, development and leadership (practical-clinical education and training) CONTENT POTENTIAL LEARNING OUTCOMES CONTENT POTENTIAL LEARNING OUTCOMES • Evidence-based • To provide nursing care based on scientific evidence in • Acute care The following learning outcomes must be contextualised nursing crosscutting all order to offer safe and high-quality results. • Newborn, paediatric and on the basis of the type of patient and the moment of the competences • To apply the fundamentals as well as the theoretical adolescent care lifecycle in question, considering as well if the illness is • Basics of research, and methodological nursing principles, basing nursing acute or long term and the level of care. It could be further • Maternal care methodology and interventions on the available scientific evidence and specified on the basis of each content. terminology resources. • Long-term care Assessment and diagnosis • Innovations and quality • To participate actively in professional forum and • General internal medicine improvement in nursing continuing education programmes. and surgery • To recognise biological, social, psychological and environmental risk factors that could have an impact • Nursing leadership, • To be responsible for one’s own professional • Mental health and on people’s health. management and development according to the latest scientific and psychiatric illness • To ask people, patients and families about their psycho- continuum of care and technological developments. • Disability and care for social and religious needs in order to cover them in services • To recognise the keys to leadership, which are necessary disabled people their treatment. • Organisation of to coordinate health teams. • Geriatrics and care for • To assess the individual’s physical, psychological and healthcare services and • To identify the characteristics of the management the elderly socio-cultural aspects. intersectoral service function played by nursing services and care • Primary health care, • To identify the individual’s and patient’s care environment management. community care requirements throughout their life cycle by means of • Work ergonomics and • To understand the different stages of the administration • Palliative care, end physical tests, observation and adequate propaedeutic safety at work process: planning, organization, management and of life care and pain tools. assessment and its contextualization in nursing services. management • To perform a nursing assessment and diagnosis establishing a relationship with the indication and use • To adapt leadership styles and approaches to different of healthcare products. situations. 14 Care planning the effectiveness of the actions carried out. • To prioritize and delegate the interventions based on • To devise and implement improvement plans. the patient’s, families’ and communities’ requirements. • To provide safe and quality nursing assistance (care) to • To establish a nursing intervention plan. individuals and patients throughout the life cycle. • To adapt the care plan to the characteristics of patients • To establish assessment mechanisms and processes and to their context and environment. for the continuing improvement of quality nursing • To plan care integrating the use of medicines and care considering scientific, technical and ethical healthcare products. developments. Nursing intervention • To implement patient-based care, showing an understanding of human growth and development, physiopathology and pharmacology within the healthcare system framework, considering the health- disease continuum. • To apply nursing care ensuring the healthcare system’s sustainability. • To complete registers on the activities carried out. • To apply critical thinking skills and a systems approach to problem solving and nursing decision-making across a range of professional and care delivery context. • To respond appropriately and in time to unexpected and rapidly changing situations. Assessment and quality • To identify and gather evidence on care activities. • To consider the protocols set by the different quality models established. • To assess the implementation of care plans. • To process the data and examine the evidence, evaluating 15 Theme III. have characteristics, depending on their nature and the interest they arouse in the student, and they are developed from a group of objectives, content, teaching methods or strategies, etc. We would also have some outputs, the results of learning, the competencies that have to be achieved. In addition, the evaluation of what has been learned can be associated with concepts such as success, failure, DIDACTICS AND TEACHING METHODS FOR GOOD REFLECTIVE academic performance, abandonment of studies, etc. PRACTICE IN MENTORING Among the actors that we have considered central in this process are mentors and students. That This theme focuses on quality mentoring for the development of competent nursing students. So we have only considered these two does not mean that there are no more actors in this process, it far, we have analysed the learning environment, the role of the various participants in the teaching/ is only that, in this case, we do not think that other elements, which may also be present, are of learning process, and the competency model of clinical mentors as a whole. This section will address nuclear interest in the process. Finally, the environment would be part of our model, including the aspects related to the remaining elements of the first block of the model: mentoring practices environmental or surrounding factors, as well as time, in the sense of temporal limitations and and resources for mentors and nurse educators. Our objective is to obtain knowledge about the best resources and technology. teaching methods for good reflective practices in mentoring. The concept of teaching is defined as “interactions between the student and the teacher under the responsibility of the latter in order to facilitate the expected changes in student behaviour.”22 The purpose of teaching, according to this same author, is to help students to: • Acquire knowledge • Understand, analyse, synthesize and evaluate • Possess the required practical skills • Establish habits • Adopt attitudes For teaching to happen, a change must occur in the way of thinking, feeling and acting of the person who learns23. For this reason, we prefer to speak of the teaching-learning process. We consider that in the teaching-learning process, we have some inputs (see Figure 2), which in the case of higher education are materialized in subjects and, more specifically, in the present case, clinical practice subjects. These constitute the object of learning; that is, what one wants or has to learn. The subjects 22 Guilbert, Jean-Jacques & World Health Organization (1998). Educational handbook for health personnel. J. J. Guilbert, 6th ed. rev. and updated 1998. World Health Organization. URI: https://apps.who.int/iris/handle/10665/42118 23 Pérez-Cañaveras, R. M. (2005). Perfil de los alumnos universitarios según sus intereses práxicos, estilo cognitivo y diferencias de género: bases para una acción tutorial. Doctoral Dissertation. University of Alicante. Spain. URI: http://hdl.handle.net/10045/13254 16 Figure 2. Elements of the teaching-learning process and their relationships23. A clinical mentor, who is a nurse, is responsible for half of the training of nursing students, and to perform this function, they need tools that facilitate their teaching work, and also that their teaching Elements of the teaching/learning process role is appropriately recognised. Mentoring is a specific form of teaching, which has been considered throughout the three modules of this project. Teaching in mentoring happens by setting learning INPUTS MENTOR STUDENT OUTPUTS goals with a student, assessing their learning process by having reflective discussion, providing feedback, and guiding students’ progress by offering them learning tasks. Biological factors Biological factors Psychological Psychological factors factors Sociological Sociological factors factors Learning Learning object outcome MILIEU - Objectives - Success - Contents - Failure - Teaching - Environment - Dropping out of strategies. - Time studies. - Technology Characteristics of the learning object 17 Theme IV. are that it requires more than one player, so it would not be recommended if the mentor has only one student assigned. • Padlet: Is an ideal tool to promote students’ participation. Traditionally, students regard LEARNING AND KNOWLEDGE TECHNOLOGIES (LKT) IN themselves as passive agents in the learning-teaching process. They feel powerless. For this MENTORING AND COACHING reason, Padlet tries to strengthen participants’ engagement through collaborative walls, where students can work together to solve problems, discuss topics and post their ideas. Also, it can be used to practice how to solve clinical cases (problem-solved learning). It is ideal for organising Information and Communication Technologies (ICT) have changed the way we access information ideas, allowing the creation of walls and portfolios. and handle it24; they constitute a new form of communication in society, and they have changed the way we build relationships25. When these technologies are used to obtain information and improve Social networks are defined as virtual communities where users can communicate with each other the learning-teaching process, they are called Learning and Knowledge Technologies (LKT). There and share information. Young students better use these platforms in a social context rather than is a vast diversity of technologies that respond to different teaching methodologies. However, their academic context, which emphasises students’ need to be educated in using these platforms in a main advantage is the active role in learning given to the participant. LKTs force us to reflect on professional way. On the other hand, mentors (as other health educators) are often described as how nurse educators incorporate these technologies in nursing student clinical supervision. Nursing scarcely prepared to use new technologies. They should, however, expect a continuous change students prefer teaching methods such as linking mentorship learning to clinical practice, online in learning and methodologies with each new generation of students. For example, Generation Z tutorials or videos, interactive gaming, and virtual learning environments as learning tools and students are known for their flexibility in using new technologies and expect educators and mentors strategies during clinical placements17. Mobile technologies can be taken anywhere, and they share to move fast, like technologically. For this reason, mentors must stay updated as much as possible, similar characteristics to a computer’s (smart mobile phones or tablets). These are described as the and use social networks used by the students in order to provide adequate new technologies to latest technologies that provide students with a more active role in their learning and, consequently, teaching-learning methods in the clinical environment. develop critical thinking. We can ask ourselves which ICTs we can use for mentoring nursing students. The answer is that there is an infinite number of technologies so that we have to find the ones who Some of the social networks popular with students and mentors that we could use as a tool during fit in our teaching methodology, in the goals to achieve, or base them on our personal preferences. the mentoring practice are: • Twitter: Users can respond to a post, or open a discussion and invite other community members Some of these examples are: to participate. It offers collaboration among mentors, students, other health professionals or • YouTube: Is a potential tool in the health science education field - from learning human anatomy those interested in the topic. Besides, students could use Twitter as a great way to promote to teaching nursing procedures. For example, it could improve the mentee’s critical thinking by health in their community. In this way, they would be actively taking part in the education of analysing diverse nurses’ performances over the same technique. the population. We found the 280 character-limit a disadvantage - it could be a potent distractor, • Kahoot: It improves the participant’s motivation through rewards and rankings. We can check and students could use the platform to humiliate a classmate. students’ understanding of a lesson and check if the goals are achieved. The main disadvantages • WhatsApp: Its groups allow communication with students, enhance students’ sense of belonging to a group, or to share information through links, pictures and videos. It is a disadvantage that 24 Moya, M. (2013). De las TICs a las TACs: la importancia de crear contenidos educativos digitales. Revista DIM, (27), 1-15. Available at: teachers feel overwhelmed by the number of messages. https://www.raco.cat/index.php/DIM/article/view/275963 25 Malo, S., & Figuer, C. (2010). Infancia, adolescencia y Tecnologías de la Información y la Comunicación (TICs) en perspectiva psicosocial. • Facebook: Its global use provides mentors and students with the chance to communicate with Intervención Psicosocial, 19(1), 5-8. doi: http://dx.doi.org/10.5093/in2010v19n1a2 18 professionals and mates from different countries. It promotes cultural and linguistic diversity among colleagues. Students regard Facebook as a tool to grow professionally. Disadvantages of Facebook are that it can act as a potent distractor, and students might prefer not to share their profiles with mentors. • Instagram: It is one of the most popular social networks for Millennials and Generation Z students. Users can share and re-share information, pictures and videos quickly. Instagram is widely used in the health-education sector. The main disadvantage is that it draws people’s attention to images. Descriptions below pictures are less frequently consulted. In conclusion, during nursing students’ placement clinical learning activities and mentorship should be taking into account educational tools and teaching strategies preferred by students to enhance learning quality, and, above all, to enhance students’ and mentors’ motivation and satisfaction8. 19 Theme V. • Promote intellectual discipline • Use examples of your professional experiences to support their understanding Mentors’ awareness regarding mentoring competence can be emphasized by educating them and IMPACT OF MENTORS’ COMPETENCIES ON QUALITY providing them with all the needed recourses they need in order to mentor nursing students in MENTORSHIP clinical practice. We recommend that mentors build their competence according to our evidence-based mentors’ competency model in the areas of: This theme of module I is aimed to explain and raise awareness about mentoring competence • Mentors’ individual competences, interaction in the workplace and resources: of nurses in the present and future in Europe. The evidence-based clinical mentors’ competency • Mentors’ characteristics model was used as a strong basis for teaching material. In this theme, mentors were acquainted with previous evidence on mentoring practice by selecting publications developed in QualMent project. • Mentors’ motivation The mentors were encouraged to discuss and make suggestions about good practices in competent • Mentoring practices and resources (between mentor, teacher and student) nursing mentoring in the present and future of the nursing profession in Europe. The means used to • Mentors’ cultural competence perform the activity was the teaching method of the online debate. In order to start the debate, we • Mentors’ competence in supporting the learning process suggested thinking about good mentors’ competencies and the improvement of those. • Goal-oriented mentoring Mentors need to be encouraged to use the following mentoring methods to support the learning • Reflection during mentoring process of students22: • Constructive feedback • Be available to a student • Student-centred evaluation • Provide constructive criticism of the student’s learning objectives and work methods • Analyse and evaluate health problems • Support student to define learning objectives • Evaluate student work • Prepare learning resources • Select professional activities for students • Confront students with new problems • Develop problem-solving skills • Help understand basic scientific principles • Monitor student progress • Identify the factors underlying health problems 20 Summary points • Mentors’ individual competencies include mentors’ characteristics, their motivation to mentor and having knowledge about their organizations’ mentoring practices, collaboration and recourses. • Clinical learning environment has been defined as an interactive network or set of characteristics inherent to the practices that influence learning outcomes and professional development of nursing students. • Mentors’ role in clinical learning environment is essential in building safe learning atmosphere and offering support to nursing students. • Appropriate clinical mentorship for nursing students is the vehicle for compliance with the eight nursing competencies outlined in Annex V of the EU Directive 2013/55/EU. • High-quality clinical education is paramount to the development of a competent workforce of nurses able to deliver safe, people-cantered care. • Mentors’ awareness regarding mentoring competence can be emphasized by educating them and providing all needed recourses they need in order to mentor nursing students in clinical practice. 21 Module II. COMPETENCE IN MENTORING CULTURALLY AND LINGUISTICALLY DIVERSE NURSING STUDENTS Authors: Ashlee Oikarainen, Dr. Kristina Mikkonen 22 Mentors’ cultural competence encompasses the attributes of cultural knowledge, sensitivity, awareness, intercultural communication and interaction, and cultural skills and safety along with an ability to create a culturally safe learning environment26,27. Culturally competent mentors are required to provide culturally congruent people-centered care and culturally conscious mentoring to culturally and linguistically diverse (CALD) students (see Figure 1). In order to ensure mentors’ cultural competence in clinical practice, Module II. on Mentoring competence of cultural and linguistical diverse nursing students has been developed. The main objective of Module II is to improve clinical mentors’ cultural competence in mentoring and for mentors to reach the learning outcomes reported in course framework. The module has been divided into six themes: cultural competence, cultural sensitivity and desire, cultural awareness, intercultural communication and interaction, cultural skills and safety, and cultural people-centered care. 26 Campinha-Bacote J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. Online J Issues Nurs 16:5. 27 Oikarainen, A., Mikkonen, K., Kenny, A., Tomietto, M., Tuomikoski, A., Merilainen, M., . . . Kaariainen, M. (2020). Educational interventions designed to develop nurses’ cultural competence: A systematic review. International Journal of Nursing Studies, 98, 75-86. doi:10.1016/j. ijnurstu.2019.06.005 23 Theme I. According to Leininger29, culture means the values, beliefs, norms and lifestyles of a particular group, and it is learned and shared from one gender to another. Culture guides human thinking, decision-making and action in a systematic way. Today, culture is thought to be a constantly changing, diverse process, and the definition emphasizes the diversity and uniqueness of people, families and communities. Since culture is constantly changing, it is difficult to identify the typical characteristics CULTURAL COMPETENCE of a particular culture. In the module we define culture as the system of human knowledge, values and beliefs through which people observe and construct their interpretations, and act and make International mobility has increased with globalization. People are moving from place to place choices between different options. now more than ever. The number of international immigrants worldwide has grown rapidly in recent years, with 2017 statistics showing 258 million immigrants across the globe. Globally, it is estimated that there are approximately 26 million refugees and asylum seekers, equivalent to AREAS OF CULTURAL COMPETENCE REFLECTIONS FOR MENTORS 10% of all international immigrants. 78 million of the international immigrants live in Europe, of which the majority of international immigrants live in Germany, Britain, France, Spain and Cultural knowledge is a process through which How and why should a student’s / patient’s Italy. The globalization of educational staff and students has become increasingly important as a the mentor seeks adequate information about cultural background be considered in student result of internationalization. Internationalization contributes to increasing student mobility, global the cultural beliefs and practices of the student mentoring /patient care? competitiveness and knowledge in health education28. / patient to establish a good relationship with one another. VERSATILE CONCEPTS ARE USED IN THE TOPIC OF INTERNATIONAL MOBILITY: Immigrant = migrant, regardless of income. An immigrant can be, for example, a returnee, a refugee Cultural sensitivity refers to awareness of How motivated are you to develop your own or an asylum seeker. one’s own culture and the values and beliefs of cultural competence? What motivates you another culture. Cultural sensitivity involves to mentor students or care for patients from Refugee = an alien who has reason to fear of being persecuted for his or her religion, origin, nationality, not judging one another based on a person’s different cultures? membership of a particular social group, or political opinion. cultural background and beliefs, but being Ethnic group = a group that combines religion, heritage, origin, language or appearance. receptive and open to other cultures. Ethnic minority = groups of people representing a minority in the state’s cultural heritage. Cultural awareness means an in-depth How can your own prejudices and assumptions examination of one’s own cultural and influence student mentoring / patient care? professional background and the recognition 28 United Nations, Department of Economic and Social Affairs, Population Division (2017). International Migration Report 2017: Highlights(ST/ESA/SER.A/404) 29 Leininger, M.M. (1991). Culture Care Diversity and Universality: A Theory of Nursing. NLN Press, New York. 24 of one’s own prejudices and assumptions about students’ / patients’ backgrounds Cultural communication and interaction means How can you facilitate interaction and constant interaction and communication with communication with a person from a different people from different cultures. culture? Cultural skills denote the ability to collect How did you consider the student’s / patient’s culturally relevant information related to a need for mentoring or care? How do you student’s / patient’s current needs in mentoring collect culturally relevant information needed / care, and to be culturally sensitive towards in mentoring / care? other people. Cultural competence is a process, which requires meeting people from different cultures and engaging in intercultural interactions. Cultural competence can be learned and taught to a certain point, but personal experience is essential. Competence gradually evolves and requires, above all, the ability of a professional to reflect. With the development of cultural expertise, the healthcare professional is able to provide high quality, effective and culturally safe care in collaboration with clients from different cultures and their closer circle members. 25 Theme II. Studies have shown that students from different cultures, unfortunately, continue to face prejudice, discrimination, racism and stereotypes30,31. In an interview, two African students reported their experiences as follows: “In the ward, where the students were doing their clinical practice, discrimination and racism were observed. The students hoped that this would be addressed by the CULTURAL SENSITIVITY & DESIRE educational organization. Students were worried about their student friends who were being bullied, ridiculed and misunderstood. They found to be surprising that there were health professionals who acted so disrespectfully towards students from different cultures. They say that it is not easy to Cultural competence is a holistic, goal-oriented and multi-structured growth process. Competence adapt to a new country or to learn a language. The way students were treated discouraged and is based on a variety of qualities such as flexibility, patience, positivity, openness, interest, curiosity, affected them in a very negative way. Even a small amount of understanding from nurses would empathy and fairness. The development of competence is not automatic, but requires conscious have helped.” 30 exercise. The motivation of the mentor towards mentoring significantly influences the development of a successful mentor relationship. By acting culturally sensitive, the mentor demonstrates a genuine Experiences of outwardness, isolation and discrimination are perceived as frustrating and threatening. desire and sensitivity to understand the student. The mentor also respects and welcomes the student’s Students are particularly vulnerable and at risk of being rejected or socially excluded if they belong backgrounds and values. In addition, the mentor creates an atmosphere where the student feels that to a minority group. Mentors play an important role in recognizing and addressing unequal treatment he or she is heard, seen and encountered as an individual and valued. or discrimination. Adapting to a new culture takes time and students may feel negative emotions when they have to give up their own cultural values and practices. Respect for diversity, dignity CONCEPTS THREATENING THE CULTURAL SENSITIVITY IN MENTORING: and individuality is essential both in delivering good care and in mentoring students. Openness to different cultural beliefs or practices and respect for the uniqueness of human beings are important features of modern society. Accepting different cultures requires a friendly attitude, as well as the • Prejudice means pre-made, unfounded preconceived idea of an individual or group of people. ability to accept diversity and the values or worldview of others. Under mentoring, the student • Ethnocentricity refers to the tendency to view foreign culture from the point of view of one’s own must be seen as an individual, rather than as a stereotype. It is important that the mentor is ready to culture, whereby cultures are valued on right-wrong and good-evil axes. Person believes his/ recognize his / her ethnocentricity as well as his / her possible prejudices or stereotypes towards the her way of thinking, his/her actions and his/her beliefs are the only ones right. Ethnocentricity student’s / patient’s background. Cultural competence can be developed by being actively involved is narrow and prejudiced, it can begin to dominate a person, and thus may interfere with in multicultural encounters, offering the mentor the opportunity to learn about different cultures. interaction with a person or community from a different culture. Ethnocentricity can turn into, Encounters can help the mentor to shape their previous perceptions of different cultural groups and for example, racism or then over-sensitivity. to challenge stereotypes. • Stereotypes are shared, well-established, concise and often unconscious negative or positive perceptions, expectations and assumptions about the characteristics, or behavior connected to different kinds of people. It is good to remember that every person has a unique background in addition to their cultural background. 30 Korhonen, H., Tuomikoski, A., Oikarainen, A., Kaariainen, M., Elo, S., Kyngas, H., . . . Mikkonen, K. (2019). Culturally and linguistically diverse healthcare students’ experiences of the clinical learning environment and mentoring: A qualitative study. Nurse Education in Practice, 41, 102637. doi:10.1016/j.nepr.2019.102637 31 Mikkonen, K., Elo, S., Kuivila, H., Tuomikoski, A., & Kaariainen, M. (2016). Culturally and linguistically diverse healthcare students’ experiences of learning in a clinical environment: A systematic review of qualitative studies. International Journal of Nursing Studies, 54, 173-187. doi:10.1016/j.ijnurstu.2015.06.004 26 Theme III. • Improving access to services, in particular different interaction styles for minority groups • Employee exposure to prejudice and • The ability of a multicultural work discrimination by supervisors, colleagues, community to better consider and respond or clients CULTURAL AWARENESS to the needs of clients from different • Endangering customer safety due cultures, thus improving customer to cultural differences or linguistic Mentors will be more successful in understanding students’ values, beliefs, and practices when they satisfaction with their care challenges themselves are aware of their own values, beliefs, and practices. Identifying and understanding one’s own culture are the starting points for appreciating the values and views of other cultures. It would be good for the mentor to try to understand how his / her own culture influences other multicultural encounters. In these encounters, it is important that the values of both parties are respected. One should avoid the idea that one’s own culture is better than another’s. The mentor does not have to build a client-professional relationship and thus reduce the quality of care and patient safety. give up their own values in order to resolve situations where the values conflict. As has emerged in The work community needs to look at traditional ways of working and interacting. Increasing the past, the concept of multiculturalism is broad and interdimensional. At its best, multiculturalism cultural diversity in health care environments increases the need for health care professionals to is the coexistence of different cultures that respect others. Diversity is reflected in the daily lives of develop customer-oriented, safe and effective care in these environments, while also considering health care professionals. There are differences between people in the work community and in their their cultural and linguistic needs. clients, for example because of gender, age, religion, education, status or life situation. Diversity can be viewed more narrowly as cultural diversity, meaning that people differ in their cultural backgrounds, for example because of their ethnic origin. Increasing cultural diversity is due, for example, to internationalization and the growth of immigration. Diversity needs to be considered CULTURAL in the daily life of health care, as cultural differences and language barriers can make it difficult to DIVERSITY IN THE WORK COMMUNITY CULTURAL DIVERSITY IN THE WORK COMMUNITY POSSIBILITIES CHALLENGES Support structures are Managing a culturally Creating a tolerant needed to effectively diverse work environment and supportive work integrate out-of-home health care professionals requires both managers and • Developing the cultural competence of • Ensuring adequate competence of environment is emphasized employees to face the other in diverse work communities. and students in these work all staff professionals coming from outside communities. person, respecting diversity. • Linguistic competence of non-professional • Professionals from other countries lack professionals to serve a diverse client base local /national language skills and have 27 Nursing students from different cultures often face the greatest challenges of their education as they complete their clinical practice. Facing cultural differences, especially at the beginning of practice, can cause feelings of anxiety and hopelessness. Linguistic challenges or lack of language skills can cause difficulties in understanding, recording, or reporting professional vocabulary. Students may find that cultural or linguistic challenges limit their ability to practice, for example, their clinical skills. For example, they may only be offered the opportunity to observe procedures, provide basic care, or perform tasks that do not meet their learning needs. Students may experience distrust from their mentors, staff and/or patients and have to continually to prove their skills. TIPS FOR FINDING KNOWLEDGE ABOUT DIFFERENT CULTURES: • Finding and obtaining reliable information from a patient/client’s or student’s cultural background can facilitate care and mentoring. However, it is good to keep in mind that learning about culture is not just about getting information and being alert, but about being active, interested and involved. • It is possible to work with people from a foreign culture without knowing or understanding all the rules of conduct or their purpose. • The necessary information can be obtained, for example, by asking and discussing with a representative of a foreign culture. At the same time, this shows that you are genuinely interested in another’s culture and want to learn more. • Under guidance, the ability of the mentor to learn about the student’s cultural backgrounds, values, and worldviews and developing a common understanding of cultural differences can foster a sense of community between the mentor and the student. • In addition, in order to support student learning, it is important that the mentor strives to understand the individual needs of the student, such as his / her learning style or language needs. 28 Theme IV. is a big-hearted and important part of communication (e.g., Southern Europe and Latin America), while in other cultures gestures and expressions are used more moderately (e.g., the Nordic countries). In many Asian cultures, however, it is not appropriate to express negative feelings. INTERCULTURAL COMMUNICATION AND INTERACTION In intercultural communication, different people strive to understand others and to be understood. LISTENING / USE OF SILENCE During intercultural communication, both parties adapt to each other. Culture has a significant impact The tolerance of silence and its interpretation are different in different cultures. In some cultures, it on verbal communication. Culture is formed and maintained by a common language. Language is is common to talk to one another while talking to one another, while in other cultures it is expected used to express things accurately. Without a common language, it would be impossible to share that the other will finish. values, social norms or beliefs from one generation to the next. Non-verbal communication is strongly culture-related and different communication models play a key role in intercultural encounters. In different cultures, gestures, expressions, postures, eye contact, touch, dress, silence and the use of space have different meanings. What is appropriate and polite in one culture can be disrespectful or POSITIONS / TOUCH even offensive in another culture. In intercultural encounters, you should be aware of how you behave Volume and tone of voice communicate different things in different cultures. The volume of the yourself and how it can potentially interact. In addition, our culture affects how we experience and sound, for example in Spain, plays a big role in how meaningful it is. Based on the volume of make observations about the world around us, and how we make decisions and solve problems. In the sound, interpretations of the speaker’s influence can be made. Silence, in turn, is also part of different cultures, situations also have different cultural rules that are used to interact. For example, nonverbal communication and members of one culture are more tolerant of silence than the other. some cultures may have topics that are inappropriate to discuss, while others may talk openly about the same topic. What is considered an appropriate physical distance will vary across cultures, and the rules of space use may also vary within a given culture, depending on the gender, age, or familiarity of individuals. HOW DOES CULTURE AFFECT COMMUNICATION AND INTERACTION? While in the North the interlocutor who is too close is perceived as embarrassing, while in southern Europe the long physical distance can be interpreted as coldness and arrogance. EYE CONTACT The amount of appropriate eye contact varies between cultures. In Western culture, maintaining eye The same interactions or messages can be understood in different ways between people from contact for longer is seen as a sign of respect for the interlocutor. In many cultures, this is the exact different backgrounds. Failures in intercultural interaction can lead to uncertainty, overload, opposite, and avoiding eye contact is a sign of courtesy and respect for the partner. misunderstandings, and contradictions. Mistakes cannot always be avoided even by a skillful culture-conscious communicator. Getting the message across is the most important thing in all communication, and you don’t have to have perfect language skills. Clearing misunderstandings FACIAL EXPRESSIONS / GESTURES offers an opportunity to build a common understanding. Intercultural communication skills play an important role in avoiding misunderstandings. At the organizational level, the development of There are many differences between cultures in expressions and gestures. In other cultures, gesturing personnel skills can be supported by providing sufficient support, resources and training. 29 TIPS TO AVOID MISUNDERSTANDINGS IN MULTICULTURAL ENCOUNTERS: and to find employment. Poor language skills can be interpreted as a student’s ignorance or inability to carry out nursing procedures. According to the previous evidence it is also known, that lack of language skills can develop a student’s non-verbal communication skills and empathy for people • Try to understand the social and cultural background of one another and remember that not with speech impairment of who lack language skills31. everyone shares the same thinking and behavior with us • Identify and avoid stereotypes HOW TO CONFIRM THE OTHER PERSONS’ UNDERSTANDING? • Discuss, listen and agree with others how to deal with situations • Ask the other’s wishes and needs with open questions • Constructive feedback - positive experiences reinforce the student’s sense of community, open • Pay attention to non-verbal communication up opportunities for new, diverse learning experiences, strengthen confidence in professional • Understand different communication styles and note that they can lead to misunderstandings skills (self-centered or contextual communication style) • Illustrating and explaining the meanings, habits and attitudes of the language • Seek to identify and regulate your own and others’ feelings in intercultural interaction • Observing linguistic practices and language norms / expectations • Consciously develop your interaction skills, for example through real-life interaction situations • The mentor’s empathy for the student can help create an atmosphere in which the student dares to ask questions, interact with others, and share their concerns Mentors have an important role in supporting students’ language learning. When mentoring culturally and linguistically diverse nursing students, the mentor needs to identify student’s individual language learning needs. If the skills are not sufficient, measures are planned together with the students’ higher educational institutions and the student him/herself. Mentors needs to provide space for the student to use the language in real situations and provide the necessary support needed in these situations. For example, the mentor can involve students in discussions ask questions so that students can actively participate, and provide timely support. Mentors can also practice possible situations (e.g., taking care of patient) together beforehand by creating open atmosphere. The mentor and student need to agree when and where the mentor can correct the student’s language and give feedback. Establishing common rules in practice can provide more confidence to the student. The key to learning a language is to accept a person from another culture as a person, be open-minded, and to give them time. Low language skills have strong impact on interaction. It can cause misunderstanding and confusion, can risk patient safety and cause the mentor to feel burdened. For a student it can cause frustration, discrimination, loneliness, shame; dropping out of education; make it difficult to learn, to graduate 30 Theme V. TIPS TO SUPPORT CULTURALLY SAFE ENVIRONMENT: • Students are treated with respect and equality, and no discrimination, racism or violence are CULTURAL SKILLS AND SAFETY not allowed • Mentoring takes into account the student’s individual learning needs Nursing professionals’ cultural skills include the ability to collect culturally relevant information • Encouraging students to be spontaneous, motivated, self-directed, responsible, empathetic and about a patient’s health problems from different cultures and the ability to examine a patient in a active culturally sensitive manner. In student mentoring, cultural skill refers to the ability to collect culturally relevant information related to a student’s current need for guidance and to be culturally sensitive in • Sufficiently comprehensive orientation into clinical practice can help mentors and students to mentoring. It is important that the mentor is provided with information about the student’s cultural set rules of behavior and set learning outcomes background, educational background, previous health care experience and clinical practice before • Acting according to agreed schedules and policies or at the beginning of the clinical placement. Some educational organizations ask students to create • The mentor and the student reflect on the learning experience together, also challenges need to portfolios or CV-type documents that the mentor can review prior students-mentor first meeting. be identified and resolved These are considered useful because they allow the mentor to quickly gain insight into the student’s • The mentor gives constructive and positive feedback background. If the student has not prepared a portfolio or CV, the mentor may ask the student to do so. • The mentor has the capacity to support the student learning process • The student is integrated into the nursing team and provide the student with the opportunity to Students need to enter a culturally safe learning environment in order to be able to succeed in their learn from peers and other professionals clinical practice. Through clinical practice, students develop their interpersonal skills and better • Systematically integrate the principles of a safe learning environment into the organizational connect with patients, colleagues, and students. A culturally safe learning environment means an culture of the organization environment that is physically, socially and mentally safe for the student. Creating and maintaining • The entire work community commits itself to supporting the adaptation of a student from a such an environment requires constant reflection and development of the skills of the mentor. The foreign culture mentor should build a confidential and open mentoring relationship with the student because the mentoring relationship has a significant impact on the student’s learning experience. Confidence • Additionally, students feel the importance of peer support and sharing of mutual experiences must also be built in meetings with customers and relatives to ensure that the environment is safe for with their peers. Mentors could integrate the collaboration between students during their everyone. It has been found that creating a supportive and safe learning environment supports both mentoring. the mentor and the student32. Clinical practice challenges put additional stress on students and can sometimes even lead to a change of career or interruption of studies. Challenges can also be very difficult for mentors and affect their willingness to mentor students from different cultures. 32 Mikkonen, K., Merilainen, M., & Tomietto, M. (2020). Empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students. Journal of Clinical Nursing, 29(3-4), 653-661. doi:10.1111/jocn.15112 31 Theme VI. CULTURAL PEOPLE-CENTERED CARE The right to health is a human right. Everyone has the right to the highest attainable physical and mental health. In addition, every person has the right to receive personalized and good treatment in a non-discriminatory manner that respects his or her cultural values and beliefs33. Health care professionals are ethically, morally and legally obliged to provide the best possible and culturally safe care. Professionals need the ability and courage to defend human rights. Work communities play an important role in ensuring that each client receives care that respects their background and takes into account their individual needs. It is therefore important that such nursing values are integrated into the values of the health care organization. For example, the right to health is regulated at international level by human rights treaties and by national laws. In addition, there are various recommendations that promote the provision of culturally competent care by health care professionals. Traditionally, it has been thought that in multicultural encounters, it is essential to know different cultures on the basis of their general and external criteria. Today, health care is confronted with many different cultural groups and, increasingly, people who represent more than one cultural group at a time. There can also be great differences within the same culture. Professionals have less time and resources to learn about the practices and beliefs of different cultural groups. In addition, cultures are constantly changing, making it very difficult or impossible to identify all the typical characteristics of a particular culture. When taking care of culturally diverse patients / clients, organizations should allow interpreters to interact in situations where there is a lack of common language. Nurses’ competency framework by EFN34 defines culture, ethics and values as nurses competence to promote and respect human rights and diversity in light of the physical psychological, spiritual and social needs of autonomous individuals, taking into account their opinions, beliefs, values and culture, and the international and national codes of ethics as well as the ethical implications of healthcare provision; ensuring their right to privacy and honouring the confidentiality of healthcare information. 33 The Universal Declaration of Human Rights (1948). https://www.un.org/en/universal-declaration-human-rights/ 34 European Federation of Nurses, EFN. (2015). EFN competency framework for mutual recognition of professional qualifications Directive 2005/36/EC, amended by Directive 2013/55/EU. EFN Guideline to Implement Article 31 Into National Nurses’ Education Programmes. Available at: http://www.efnweb.be/?page_id=6897 32 Summary points • Insufficient support and information from the educational institution causes frustration for mentors. Collaboration with nurse educators has been seen as important. Nurse educators can provide support to students • Mentors of culturally and linguistically diverse students are required to by providing feedback, visiting the clinical practice and providing personal have good theoretical and clinical judgment skills, good interpersonal support to students and mentors. skills, mentoring and assessment skills, and the ability to understand the impact of cultural diversity and defend this. • It is if vital importance that mentors have the ability to create a culturally safe learning environment. • Guiding students from different cultures requires knowledge, time and patience. Providing guidance in a foreign language in particular has been perceived as exhausting, stressful and challenging. Mentoring can take more time and resources and it is important to get support from the work community and the nursing higher educational institution when needed. • Adequate support from leadership and higher educational institutions should be provided to mentors to maintain the motivation associated with mentoring. • Mentors should receive support from both educational institutions and the work community, especially at the beginning of the student’s clinical practice. • In addition, we highly recommended that mentors be provided the opportunity to attend mentoring education and also the opportunity to share their experiences with other mentors. 33 Module III. MENTORING COMPETENCE IN ASSESSMENT AND REFLECTIVE DISCUSSION Authors: Dr. Olga Riklikiene, Erika Juskauskiene 34 “Assessment involves gathering information about student learning and performance, which can be used to determine further learning needs of the student and to plan activities that will assist students to meet such needs35,36. It is a part of the learning process which is combined of the elements of goal orientation, reflection during mentoring, constructive feedback and student- centred evaluation (see Figure 1). Challenges were found in students’ competence assessment during their clinical practice³. In order to ensure mentors’ competence in assessment and reflective discussion, Module III. on Mentoring competence in evaluation and reflective discussion has been developed. The main objective of Module III is to improve clinical mentors’ assessment and reflection discussion competence in mentoring, and for mentors to reach the learning outcomes reported in course framework. The module has been divided into five themes: assessment and evaluation, assessment tools, learning through reflection and continuous feedback in student learning, and assessment linkage to the EFN competency framework for mutual recognition of professional qualifications. 35 Oermann, M.H. (2018). Chapter 12: assessment methods. In: Oermann, M.H., De Gagne, J.C., Phillips, B.C. (Eds.), Teaching in Nursing and Role of the Educator: The Complete Guide to Best Practice in Teaching, Evaluation and Curriculum Development, 2nd ed.. Springer Publishing Company, New York . 36 Immonen, K., Oikarainen, A., Tomietto, M., Kaariainen, M., Tuomikoski, A., Kaucic, B. M., . . . Mikkonen, K. (2019). Assessment of nursing students’ competence in clinical practice: A systematic review of reviews. International Journal of Nursing Studies, 100, 103414. doi:10.1016/j.ijnurstu.2019.103414 35 Theme I. are required to develop³. Mentors should also be well informed about the students’ learning goals since they have strong involvement in students’ learning outcomes38. Beside the formal requirements for the students’ assessment, the characteristics and skills of the assessor are important. The mentor who participates in students’ evaluation process should be advanced in counselling, managerial and practical ASSESSMENT AND EVALUATION skills, have up to date professional knowledge, be familiar with the nursing curriculum, express interest in the learner and practice, demonstrate appropriate attitudes toward patients and students, and show The focus of assessment is to encourage the continuous learning process of students which requires respect for them, improve self-awareness and assure continuous competence development. Patients constructive feedback and opportunities for reflection between the student, mentor and educator.³ It can also be involved in students’ competence assessment. Students, as our mentoring practice shows, is an action where the information about the student’s activity, progress and competences is collected treat their assessment by patient very seriously, and are rather sensitive to it as an honest feedback – determination of student’s individual and professional progress. Quinn37 described the student’s from care recipient. And patients are usually the most positive assessors, which can improve nursing assessment relevant to health and social care professionals as the assessment that is not only concerned students’ motivation to learn continuously and be well prepared for the future career. with the measurement of student’s achievement, but includes such aspects of an individual as attitudes, aptitudes, personality and intelligence. Assessment of students’ learning and competences can be conducted using formative or summative approaches39. Formative assessment is a helpful strategy where feedback is seen as essential in aiding The rationale for the student assessment during clinical placement includes: learners to understand their own performance including their deficiencies in knowledge or practice. • to give feedback to the learner so that they can then develop further The regular feedback helps learners to be aware of their shortcomings, which is imperative for them in • to enhance the motivation of the learner through this feedback order to be able to practice. On-going formative assessment is based on information about the student and his/her learning needs, determined ways of improvement, and, in this way, it motivates student’s • to encourage the importance of lifelong learning and achievement to the learner learning. The formative assessment type creates opportunities for the discussion between the student • to support the learner and the mentor. The summative assessment is usually used at the end of the placement or course, in • to give the learner satisfaction order to ascertain whether the learner has acquired the appropriate knowledge or skills. The aim is to • to promote learner’s confidence and independence form a conclusion about an individual’s achievement at the end of a period of learning. This type of student assessment is based on formative assessment and supported by the documented evidence. The The student’s competence assessment in clinical practice is directly related to the learning goals of summative assessment evaluates the student’s learning at the end of an instructional unit and allows us teaching and learning. Each clinical placement period has particular learning goals or outcomes defined, to compare student’s achievement against some standard or benchmark. which lead the student towards specific competency achievement. According to Oermann35, learning goals represent the level of nursing competence that the student is required to achieve and may be A nursing student may during clinical placement be assessed by using different approaches40. Episodic written in the three domains of learning: cognitive, affective, and psychomotor. Learning goals need to be clearly defined and measurable, as they guide students in their learning and also guide those 38 Dobrowolska, B., McGonagle, I., Kane, R., Jackson, C.S., Kegl, B., Bergin, M., Cabrera, E., Cooney-Miner, D., Di Cara, V., Dimoski, Z., involved in assessment, i.e. mentors, tutors, nurse managers35,36. Prior to entering clinical practice, Kekus, D., Pajnkihar, M., Prlic, Ń., Sigurdardottir, A.K., Wells, J., Palese, A. (2016). Patterns of clinical mentorship in undergraduate nurse education: a comparative case analysis of eleven EU and non-EU countries. Nurse Education Today 36, 44–52. https://doi.org/10.1016/ students need to be familiar with what they are expected to learn, and of the clinical competences they j.nedt.2015.07.010. 39 Neary, M. (2000). Teaching, assessing and evaluation for clinical competence. A practical guide for practitioners and teachers. Cheltenham: Stanley Thorpes Publishers Ltd. 37 Quinn F.M. (2000). Principles and practice of nurse education. Cheltenham: Stanley Thorpes Publishers Ltd. 40 Kinnell, D., & Hughes, P. (2010). Mentoring nursing and healthcare students. Sage. 36 assessment allows testing the learner at a particular stage in the educational programme. The major drawbacks when student is assessed episodically, are: 1) the learner’s one-time performance on the day of the assessment is evaluated, and the performance may not reflect their general ability; 2) it creates the falseness of the situation and the real abilities of the learner, as he or she can practice the scenario until they are perfect. Continuing assessment appears to be more holistic in practice as all aspects of learner’s abilities are tested throughout the course. The advantages of such approach relate to 1) the continuous awareness of the teacher of the learner’s development and knowledge; 2) the gradual build-up of the evaluation, resulting in a cumulative judgement about performance. In addition, there are two main methods of assessment: norm-referenced assessment and criteria-referenced assessment. Norm-referenced assessment compares students’ performance to each other, i.e. when students’ scores are ranked from low to high, and their rankings are compared to each other’s. There is no attempt to interpret the scores in terms of what students know and can do, except in the limited sense that a student’s performance is typical of other low-, middle- or high- performing students in the group36. Norm-referenced assessment is contrasted with criteria-referenced assessment. In criteria-referenced assessment each student is judged against predetermined absolute standards or criteria, without regard to other students41. In education, criteria-referenced assessments are usually made to determine whether a student has mastered the material taught in a specific grade or course. What aspects of student’s achievement should be assessed during clinical training? There are four main areas of assessment: • Knowledge –What an individual knows, the ability to remember facts, so that these facts can be put into practice. • Skills – Something that an individual learns to do well and practices to continue to do well. • Attitudes – Combination of reasoned and unreasoned responses • Understanding – The ability to get the meaning of concepts and behaviours. Usually, the terms assessment and evaluation are used interchangeably, even though they have different meanings. Evaluation it is the process of assessing what has been achieved and how it has been achieved. In other words, it is the decision about the level of achievement. This is the result of the assessment. 41 Lok, B., McNaught, C., & Young, K. (2015). Criterion-referenced and norm-referenced assessments: compatibility and complementarity. Assessment & Evaluation in Higher Education, 41(3), 450–465. https://doi.org/10.1080/02602938.2015.1022136 37 Theme II. Table 1. Student’s assessment methods and tools for clinical training. ASSESSMENT TOOLS ASSESSMENT METHODS AND TOOLS Mentors find assessment of students’ competence to be particularly challenging and emphasize the importance of clear assessment criteria, support from nurse educators and further education on assessment 35. Traditional quantitative manner of students’ assessment during clinical training Report Individual work Scientific paper review which focused only on the numbers of performed procedures or on fundamental care activities, Case study Individual project Report on clinical learning has been changed to more qualitative approach of assessment where not only numbers but also quality matters. However, it can be said that a certain amount of inconsistency still exists among the Final assessment Self-assessment Problem solving assessment methods and tools between countries and higher education institutions42. For this reason, Portfolio Peer assessment Test with multi-choice answers it has been suggested that mentors and nurse educators should work together to achieve agreement Diary Oral presentation Tasks on assessment contents and processes. Moreover, the mentor–student relationship is an essential premise to achieve openness and mutual understanding in the assessment process35. Exam Poster presentation Test Essay Ideas map Simulation In the project we have conducted a systematic review of reviews¹, which further revealed that assessment tools used to assess nursing students’ competence in clinical practice commonly focus Team work Literature review and presentation on the domains of professional attributes, ethical practices, communication and interpersonal relationships, nursing processes, critical thinking, and reasoning (see Table 1)36. In the review, it was suggested that collaboration between higher education institutions and clinical practice needs to be strengthened in order to ensure assessment strategy, consistency and reliability. All actors in the clinical training of nursing students must have consistent understanding of the assessment criteria. The main properties of the assessment criteria are43: Validity - the extent to which the assessment measures what it is designed to measure. For example: • Student’s demonstration of injection procedure shows his/her clinical knowledge and skills. • Simulation session allows us to assess skills of teamwork and leadership. 42 Cant, R., McKenna, L., Cooper, S. (2013). Assessing preregistration nursing students’ clinical competence: a systematic review of objective measures. International Journal of Nursing Practice 19 (2), 163–176. https://doi.org/10.1111/ijn.12053. 43 Quinn, F.M., Hughes, S.J. (2007). Quinn‘s principles and pracice of nurs education, 5th edn. Cheltenham: Nelson Thornes Limited. 38 • Project assignments are a suitable way to express student’s creativity and knowledge. Assessment bias. Awareness of both ethical and legal frameworks of practice is of paramount • Problem solving shows student’s ability to think critically. importance for the assessor, to ensure that the process of assessment is both humanistic and valid. If mentors allow themselves to be influenced by factors that are not relevant to the area of assessment, Reliability - indicates whether the assessment measures what it is designed to measure consistently. then they are being subjective and at risk of allowing error to influence their judgment. It should demonstrate similar results when used on different occasions if the other variables remain the same. THE MAIN ERRORS IN THE ASSESSMENT ARE: Practicality - the assessment undertaken must be appropriate for this purpose. The assessment criteria for nursing students have been formulated based on advice and guidance from both educationalists • Generosity or leniency – A tendency for rates to mark higher than they should. and practitioners. At each level of training, from the start of the training programme until the end, • Stringency error – Opposite to the generosity error – but acknowledged as less likely to occur. the assessment requirements have been agreed in accordance with the anticipated development of Some people appear to be proud of holding a reputation for being a “hard maker”. the student. • Errors of central tendency – Assessors are hesitant to use either end of the grading scale, with a resulting grouping of students around the mean. This may indicate the lack of confidence in Assessment needs to be documented in order to provide the evidence on assessment, especially in the assessment situation. critical situations where students fail to pass. Not only mentor, but also a student has responsibility in the assessment process. It is important to involve learners in making judgements about their • Logical error – Similar to halo effect, this occurs when the assessor assumes a relationship achievement and the outcomes of their learning. Student’s self-assessment enhances learning, makes between two criteria, and subsequently rates them in a similar way. students feel that they have some control over their own evaluation, develops learner’s autonomy • The “halo” effect – A tendency to rate on an overall general impression, rather than differentiating and cognitive abilities, promotes better understanding of contents and increased quality and between the various criteria. May be influenced by general positive attributes. thoughtfulness on assignments, decreases anxiety and eases students-teacher conflict by demystifying • A “horn” effect is the opposite, where perceived negative attributes are dominant. the grading process. Some issues of students’ self-assessment should be recognised as some students • Obligation error – When a grade is given for a criterion which appears on the assessment form, are reluctant to self-assess, because they may feel they lack the necessary skills, confidence or ability even though the assessor has had inadequate opportunity to assess the student in that area of to judge their own work, or a student expects to be assessed by an expert and sees it as the teacher’s work. responsibility, they are afraid of being wrong, or are too harsh on themselves and are uncomfortable with the responsibility and, finally, students do not like it and do not see benefits in it. Moreover, in • Proximity error – When evaluation of one criterion influences another – more pronounced some students, cultural issues can affect self-assessment because giving themselves a good grade is when the interval between assessments is shorter. considered inappropriate or as boasting. During the assessment process, mentors also carry specific responsibilities. Mentors should establish a safe environment for the assessment process, explore and clarify thinking processes, provide constructive and clear feedback, be aware of the ground rules and protocols, adhere to agreed time and rules, and produce written records of all aspects of the assessment. Mentors need to take a responsibility to ensure that students are fitting for the purpose Awareness of both ethical and legal frameworks of practice is of paramount importance for the and for practice. assessor, to ensure that the process of assessment is both humanistic and valid. 39 Theme III. have happened (experience) and looking at them in a different way (reflective processes or reflection), which enables them to take some kind of action on the new perspectives44. Kolb’s model46 centres on the concept of developing understanding through actual experiences and contains four key stages: concrete experience, reflective observation, abstract conceptualization, active experimentation. LEARNING THROUGH REFLECTION Gibbs’ reflective cycle47 encourages learner to think systematically about the phases of an experience or activity. There are six stages to structure the reflection by asking a series of cue questions about A study by Tuomikoski et al.13 reported that mentors need to develop in the competence area of the event. Borton’s developmental framework, further developed by Driscoll48 in the mid-1990s, is a reflective discussion with students. Reflection is about understanding personal experience differently, relatively simple model and rather suitable for novice practitioner. It is based on the need to identify and act as a result. Reflective practice incorporates a wide range of skills: self-awareness, critical (What?), make sense of (So what?) and responds to real-life situations (Now What?). The most thinking, self-evaluation, analysis of multiple perspectives and integration of insights to inform future recent and advanced is The Bass model of Holistic Reflection49 that would be suitable for reflective learning and practice44. Jasper45 described reflective skills as “a particularly structured reflective mentoring in nursing practice. The model uses six integrated, inter-dependent phases designed to strategies, which enable individuals to make the most of everything that they do.” This includes not promote detailed critical reflection at a deeper personal and holistic level. It is enabling the student only remembering things form the past, but also anticipating and planning for the future. to prepare for holistic integration of the experience developing the capacity for reflexivity. The phases are representative of reflection as a holistic continuum as depicted by the circular design. Benefits of reflective practice during mentoring of nursing students at clinical placement relate to the following: Despite the significance of using reflection in nursing education and mentoring, nurses and students • Support for learning from experience did not regularly use reflection in professional practice due to: • Help in development of critical thinking • Lack of knowledge about reflection and poor skills to apply it • Fostering clinical reasoning • Under-evaluation of reflection (thinking that nursing is a technical work) • Facilitating integration of theory and practice • Difficulties in self-expression and sharing emotions • Stimulating new ideas • Assumption that reflection is ‘a mirror’ of bad practice • Help to be aware of own limitations for competent and safe practice • Honest exploration is important; it is difficult to accept own mistakes • Generation of knowledge in and through practice experience • Indifference to reflection at clinical environment and managerial level • Stimulating continuous learning and developing throughout the career • Lack of time and value placed on reflection • Help to improve professional practice Reflective writing is seen as a valuable way of learning from practice. It is a way to develop critical thinking, and to create evidence to convince others of personal and professional development. There There are many models or frameworks which mentors can use to guide their personal reflection may be various forms and formats of reflective writing: reflective reviews, portfolio entries, essay. process, and the reflection process of their students. Individuals learn by thinking about things that 46 Kolb, D. (1984). Experiential Learning: Experience as the Source of Learning and Development. Upper Saddle River: Prentice Hall. 47 Gibbs, G. (1998). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit, Oxford Polytechic. 44 Mann, K., Gordon, J., MacLeod, A. (2009). Reflection and reflective practice in health professions education: a systematic review, 48 Driscoll, J. (ed.). (2007). Practicing Clinical Supervision: A Reflective Approach for Healthcare Professionals. Edinburgh: Elsevier. Advances in Health Sciences Education, 14(4), 595-621. 49 Bass, J., Fenwick, J., Sidebotham, M. (2016). Development of a Model of Holistic Reflection to facilitate transformative learning in 45 Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning. student midwives. Women and Birth 30 (2017) 227–235. doi: 10.1016/j.wombi.2017.02.010. 40 THE CONSTRUCTIVE FEEDBACK DURING MENTORING IN NURSING PRACTICE MAY BENE-Theme IV. FIT STUDENT, MENTOR AND ORGANIZATION51. CONTINOUS FEEDBACK IN STUDENT LEARNING BENEFIT TO PROFESSION BENEFIT TO STUDENT BENEFIT TO MENTOR The development in feedback practices and providing students with opportunities for reflection are important in supporting the continuous learning process of students35. Mentors should be able to give students constructive feedback on performance in practice and progress throughout their clinical Assurance that qualified Enhancing student motivation Assisting the mentor to placement experience, although for mentors this process creates many challenges associated with nurses are knowledgeable and to learn and to develop work within the professional giving clear and constructive feedback to students regarding developmental needs50. By description, “fit for and to practice” standards feedback is any communication that gives some access to other people’s opinions, feelings, thoughts or judgements about one’s own performance. Continuous feedback is a process where a student Protecting public from Helps to identify learning Stipulation of successful receives ongoing feedback, and is guided in a systematic manner by openly discussing with the qualified nurses who have gaps and formulate action mentorship experiences for mentor their personal strengths and weaknesses. not achieved competence plans for failing students at mentor and helps to avoid possible mid-point periods. catastrophic results in future Helping to produce competent Realistic development of Enhancing personal and and conscientious future student’s confidence and self- professional development of nurses esteem mentor Competent practitioners are Provide formal documented Mentors uphold their introduced into the profession evidence from an early stage legal and professional when failing a student; Fully responsibility to support and inform students on their educate nursing students failings 50 Almalkawi, I., Jester, R., Terry, L. (2018). Exploring mentors’ interpretation of terminology and levels of competence when assessing 51 Wells, L., McLoughlin, M. (2014). Fitness to practice and feedback to students: A literature review. Nurse Education in Practice 14, 137-nursing students: an integrative review. Nurse Education Today 69, 95–103. https://doi.org/10.1016/j.nedt.2018. 07.003. 141. 41 In providing and accepting feedback, both sides are involved - provider and recipient. For provider it is important to provide feedback in a timely manner to increase objectivity, to plan it in advance, to tailor feedback to each individual and the corresponding situation. Good communication skills and assurance of privacy and confidentiality with one-on-one feedback are essential. In order to accept feedback, the recipient has to be open, ask explanatory questions and request feedback on important aspects, to listen actively and hear what was said, to not oppose or comment, to ask other’s opinion, reflect and decide how to use feedback, and finally – to appreciate feedback. The main barriers to providing constructive feedback are: • Struggling with undertaking student feedback, especially when it is of a negative kind, i.e. exceptionally difficult to give negative criticism face to face • Avoiding negative feedback for fear of the opposite demotivating effect for student • Conflicting demands on mentor time • Avoiding harmful effects on mentor-student relationship • Emotional involvement – feeling uncomfortable about possibly ending a student’s career • Feeling of personal failure if your student does not perform • Inducing feelings of guilt and self-doubt in mentors • Physical barriers as noise, lack of private space • Language barrier or lack of knowledge regarding cultural diversity 42 Theme V. ASSESSMENT LINKAGE TO THE EFN COMPETENCY FRAMEWORK FOR MUTUAL RECOGNITION OF PROFESSIONAL QUALIFICATIONS In order to be able to assess nursing students’ competence, nurses need to have an adequate understanding of competency requirements, according to the EU Directive 2013/55. To help mentors with that, the EFN developed the EFN Competency Framework²², which breaks down each of the Article 31 competencies into more detailed competency areas, describing what is expected to be achieved with the competences, the necessary education covered in the curricula, and a series of potential learning outcomes. Measuring these competency areas for each learning outcome is key for transparency and mobility of nurses within the EU. Therefore, the EFN has developed a measurement scale to support you with measuring the nursing students’ compliance in accordance with the EU Directive 2013/55/EU. When mentoring students, it will be the key for the clinical mentor to have a clear view on these questions to reach compliance with the EU legislation. 43 Summary points objectivity and validity of the assessment. • Reflective discussion incorporates self-awareness, critical thinking, self- evaluation and collaboration between students and mentors. • Assessment in clinical practice involves gathering information on students’ • Continuous feedback between mentor and student supports mutual learning and performance in order to assess the level of their nursing professional relationship and competence development. competence. • Nurses need to have adequate understanding on competency requirements • It is a part of the learning process which is combined of the elements of defined by EU Directive 2013/55. goal orientation, reflection during mentoring, constructive feedback and student-cantered evaluation. • Assessment encourages the continuous learning process of students with integration of constructive feedback and reflective discussion. • The student’s competence assessment in clinical practice is directly related to the learning goals of teaching and learning. • Prior to entering clinical practice, students need to know clinical practice expectations and their own needs of competency development. • Mentors also should be well informed about the students’ learning goals as they are involved in assessment of students’ learning outcomes and competencies. • Students’ assessment can be conducted as a continuing assessment to support their learning process, but also as a formative (mid-term) assessment and summative (final) assessment. • Mentors can use different assessment tools and methods to support the