GUIDELINE ON CLINICAL NURSE MENTORS’ MENTORING COMPETENCE DEVELOPMENT Qual QualMen Me t nt Quality Mentorship for Developing Compete nt Nursing Stude nts. 1 Authors Published by Ashlee Oikarainen, Visoka zdravstvena šola v Celju / College of Nursing in Celje Dr. Kristina Mikkonen Erika Juskauskiene Publication design Dr. Maria Kääriäinen Tina Červan Veera Kaarlela Neža Penca Dr. M. Flores Vizcaya-Moreno Dr. Rosa M Pérez-Cañaveras Available at Dr. Paul de Raeve http://www.qualment.eu/publications Dr. Boris Miha Kaučič Dr. Bojana Filej Year of issue Dr. Olga Riklikiene 2021 Proofreading Ashlee Oikarainen CIP - Kataložni zapis o publikaciji Univerzitetna knjižnica Maribor 616-083:378+005.963.2 GUIDELINE on clinical nurse mentorʹs mentoring competence development [Elektronski vir] / [authorʹs Ashlee Oikarainen ... [et al.]. - E-publikacija. - Celje : Visoka zdravstvena šola, 2021 Način dostopa (URL): http://www.qualment.eu/publications ISBN 978-961-6889-36-0 COBISS.SI-ID 68282627 2 This European Union (EU) guideline aims to strengthen clinical SUMMARY OF THE GUIDELINE Target groups: Clinical nurse mentors, nurse nurse mentors’ mentoring competence development, which can improve health system resilience in EU countries. The guideline Background: A significant proportion of nursing educators and educational organisations, nurse is based on critically evaluated research evidence and has been developed during the years 2018-2021 through the Erasmus+ education is carried out in clinical learning managers at all levels, other health professionals, project - Quality Mentorship for Developing Competent Nursing environments. Clinical nurse mentors have an undergraduate and postgraduate nursing students, Students (QualMent) under the leadership of an international team national nursing associations, nursing regulatory of experts with extensive knowledge and expertise in mentoring. important role in supporting nursing students’ professional competence development. Mentors bodies, politicians and policymakers. The following authors have written and compiled this document: who attain core competencies in mentoring are Ashlee Oikarainen Recommendations: Countries across the globe 1, Dr. Kristina Mikkonen1, Erika Juskauskiene2, Dr. Maria Kääriäinen1, Veera Kaarlela1, Dr. M. Flores Vizcaya-able to better support nursing students in obtaining continue to search for solutions to address Moreno3, Dr. Rosa M Pérez-Cañaveras3, Dr Paul de Raeve4, Dr. the eight competency areas defined in European Boris Miha Kaučič5, Dr. Bojana Filej5, Dr. Olga Riklikiene2 Union Directive 55 Article 31. challenges related to maintaining a sustainable nursing workforce. Securing high-quality clinical This document has been reviewed by expert panels in Belgium, Aim: To provide recommendations on the Finland, Lithuania, Slovenia and Spain. learning environments and supporting mentors´ development of clinical nurse mentors’ competence competence development in mentoring nursing 1University of Oulu, Research Unit of Nursing Science and Health Management, Finland; 2Lithuanian University of Health Sciences, in mentoring nursing students in clinical practice. students continue to be important strategies Lithuania; 3University of Alicante, Faculty of Health Sciences, in improving the recruitment, retention and Spain; Objectives: 1) To promote and support effective 4European Federation of Nurses Associations, Belgium; graduation of competent nursing students. 5College of Nursing in Celje, Slovenia mentoring practices; 2) to enhance mentors’ Strengthening of quality mentorship should be Development of this guideline was supported through funding competence development; and 3) to improve priority of the political agenda of Member States, from the European Commission. The authors have provided nursing education on an international level the information in this document and the information does not along with the requirement that clinical mentors necessarily represent the decisions or the stated policy of the through high-quality mentoring and clinical in all healthcare settings participate in structured European Commission. learning environments for nursing students. mentoring education. This document is available on the QualMent project website: https://www.qualment.eu/publications 3 1 Mentoring competence The evidence-based clinical nurse mentors’ competence model Pages 5-6 Pages 7-8 Pages 9-10 Designed to support you in your role as a clinical nurse mentor, MENTORSÍNDIVIDUAL this guideline outlines your responsibilities and opportunities COMPETENCES, INTERACTION IN MENTORSĆULTURAL MENTORSĆOMPETENCE IN SUPPORTING THE in supporting nursing students’ learning. The importance of the THE WORKPLACE & RESOURCES COMPETENCE LEARNING PROCESS role of clinical nurse mentors and of the realisation of quality mentorship cannot be overemphasized. High-quality clinical learning environments are crucial in the preparing the sustainable nursing workforce of the future. It is in these environments that MENTORS’ CULTURAL students apply their knowledge, learn key skills and achieve the CHARACTERISTICS COMPETENCE required competence needed to practice nursing. GOAL The evidence-based clinical mentors’ competence model MENTORS´ AWARENESS ORIENTATION (Mikkonen et al., 2019) outlines the key components of mentoring COMPETENCE SENSITIVITY competence. Clinical nurse mentors act as role models to students IN STUDENT-and have the opportunity to instil professional values and integrity CENTERED KNOWLEDGE MENTORS’ EVALUATION in clinical settings. They support students in practicing safe, MOTIVATION COMMUNICATION person-centred care that is in line with EU Directive 2013/55/EU SKILLS Article 31 (page 4). CONSTRUCTIVE REFLECTION FEEDBACK DURING MENTORING Mentoring competence consists of 1) mentors’ individual competences, 2) cultural competence in mentoring and 3) competence in supporting students’ learning process (pages 5-10). MENTORING PRACTICES Recommendations for mentoring in clinical learning environments & RESOURCES (MENTOR, TEACHER) can be found on pages 10-11 of this document. European Union Directive 55 (Article 31) 8 competences PERSON-CENTERED CARE Page 4 4 2 Foundation of mentoring placement experiences and the majority of students felt their mentor was an important professional role model (Antohe et al., 2015). It was recommended that continuing professional development programs on mentorship being offered to nursing staff at the basic and advanced levels. Mentors have expertise in both the clinical area they operate in and in their pedagogical approach 2.2 Person-centred care in supporting the learning of nursing students. Mentors are not only clinical experts, but act as role models for students and help them develop into professionals competent in providing high-quality, Mentors support students´ professional growth in becoming responsible professionals who integrate safe and person-centred care. the approach of person-centred care into nursing practice. This approach is the main focus of students’ clinical learning process. It is essential that mentors are competent in guiding students in consciously 2.1 High-quality and evidence-based mentoring adopting the perspectives of individuals, families and communities into clinical reasoning and decision-making processes. Mentors are responsible for mentoring students in an evidence-based manner. The elements of evidence-based mentoring are defined below. 2.3 European Federation of Nurses Associations competency framework Clinical mentors are required to support students in such a way that they obtain the eight competency areas defined in Directive 2013/55/EU Article 31 which include: (click here for more details) What is needed to RECOGNITION OF STUDENT’S • To independently diagnose the nursing care required using current theoretical and clinical RESEARCH ensure that mentoring INDIVIDUAL EVIDENCE AND knowledge and to plan, organise and implement nursing care when treating patients; LEARNING NEEDS GUIDELINES ON is of high-quality and • To work together effectively with other actors in the health sector, including participation in MENTORING evidence-based? the practical training of health personnel; CLINICAL Evidence-based • To empower individuals, families, and groups towards healthy lifestyles and self-care on the KNOWLEDGE AND mentoring basis of the knowledge and skills acquired; EXPERTISE OF THE MENTOR AVAILABLE • To independently initiative life-preserving measures and to carry out measures in crises and ORGANISATION disaster situations; RESOURCES FOR MENTORING • To independently give advice to, instruct and support persons needing care and their attachment figures; OR • To independently assure quality of and to evaluate nursing care; SE MENT NUR • To comprehensively communicate professionally and to cooperate with members of the other CLINICAL professions in the health sector; The realisation of quality mentorship requires the development of practices that better meet nursing • To analyse the care quality to improve their own professional practice as a general care nurse. students’ needs and advance their professional identity as nurses. A study conducted in four Central/ Eastern EU Member States revealed that nursing students were very satisfied with their clinical 5 3 Mentor’s individual Important characteristics of clinical mentors include: • Confidence in personal competence in performing nursing tasks and meeting the responsibilities of being a mentor competences • Ability to create a supportive climate for learning • Taking initiative in strengthening relationships and collaboration with the student and the nurse educator and interaction in the • Competent in integrating students into healthcare teams and introducing students to colleagues • Willingness to discuss students’ learning experiences on a regular basis workplace • Ability and willingness to express an empathetic attitude towards mentoring and person-centred care • Understanding of the mentor’s own role and responsibility in the students’ learning process. 3.1 Mentors’ individual competences Motivation towards the mentoring of students can be seen in: • the mentor’s willingness to mentor students and interest in getting to know students The personal characteristics and motivation of clinical mentors has great impact on development of a successful mentor-student • recognition and understanding on the importance that motivation has on the learning of students relationship. Mentors play a key role in integrating students into • the mentor’s continuous strive to develop as a mentor work environments and into interprofessional healthcare teams. • the mentor’s ability to identify his or her own level of motivation as a mentor as well as the students’ level of motivation to learn Mentors must be familiar with mentoring practices and on the available resources that exist for mentoring. Mentors involve all Mentors must be familiar with mentoring practices and on the available resources that exist for mentoring. These are an essential part relevant stakeholders such as nurse educators, students and other of mentoring success. This includes: staff members into the mentoring process. • knowledge of mentoring practices within one’s own organisation and beyond • knowledge of students’ current level of competence, their educational context and background • the ability to effectively collaborate with the nurse educator and to recognize when there is a need for additional contact • understanding of resources available to mentors to support them in their mentoring role 6 3.2 Mentors’ role in high-quality clinical learning environments 3.3 Tips on maximising positive learning experiences and outcomes for Mentors play a key role in maintaining clinical learning environments that are physically, socially students as an organisation and emotionally safe. The picture below defines important aspects of clinical learning environments. Tip #1 Integrate positive mentoring practices into the organisational culture of healthcare Students come from various cultural and linguistic backgrounds, and it is vital to maintain respect environments. towards differences. Additional key aspects of clinical learning environments include premises of Tip #2 Make a conscious effort to integrate students into work environments and into the work unit, the role of the student, mentoring, atmosphere, orientation and management style. It interprofessional healthcare teams. is essential that organisations and all professionals within healthcare teams commit to maintaining the safety of students ensure greater consistency in approaches and foster appropriate learning Tip #3 Strengthen mentor-student-nurse educator collaboration as it can help students succeed environments for the future nursing workforce. Hence, nurses’ mentorship must be based on and in clinical practice. argued in research and evidence. Tip #4 Recognise the core characteristics of new generation (Millennial and Generation Z) students in order to consider how to successfully engage with and coach these students. Tip #5 Use learning and knowledge technologies and case studies during mentoring to enhance students’ learning process. ROLE OF THE STUDENT MENTORING 3.4 Tips on activities that can be integrated into mentoring education Tip #1 Highlight the importance for providing nursing students time to orientate to the new PREMISES OF THE clinical learning environment. Clinical mentors can reflect on how they can help students feel WORK UNIT ASPECTS OF welcome and safe. ATMOSPHERE CLINICAL Tip #2 While practicing relevant nursing skills, students need to be supported and clinical mentors LEARNING ENVIRONMENTS must ensure that professional standards are maintained. Clinical mentors can share experiences LINGUISTIC on strategies used while coaching students in the planning and assessment of patient care. DIVERSITY ORIENTATION Tip #3 Integrate strategies into mentoring education that assist clinical mentors in developing CULTURAL the student-mentor relationship and other competence areas essential for effective mentoring in DIVERSITY MANAGEMENT STYLE clinical placements. High-quality mentoring can influence what kind of professionals enter the nursing field and help increase the retention of professionals. 7 4 Mentors’ cultural competence students • knowledge of one’s own cultural background • reflection on how one’s own culture and belief system impacts one’s actions as a professional 4.1 Development of mentors’ cultural competence in mentoring and interactions with others During clinical placement, nursing students from diverse cultural and linguistic backgrounds often • willingness to give up possible prejudices and attitudes towards patients/clients or students and face challenges related to cultural differences and language barriers. The role of the clinical nurse to develop cultural sensitivity mentor can be a challenging one and require special attention on the development of mentors’ • recognition of the importance of cultural acceptance of culturally diverse patients/clients and cultural competence in mentoring. The need to educationally prepare mentors in providing culturally students appropriate mentoring and to meet the professional learning needs of students is key. • fostering a welcoming attitude towards different cultures and views of care 4.2 Definition of cultural competence in mentoring • respect for diversity in person-centered care and in the mentoring of students Cultural competence has been defined as a “complex know-act grounded in critical reflection and Intercultural communication and interaction: action, which the health professional draws upon to provide culturally safe, congruent, and effective • having the skills to engage in effective communication and to interact with culturally diverse care in partnership with individuals, families, and communities living health experiences, and which patients/clients and students takes into account the social and political dimensions of care” (Blanchet Garneau and Pepin, 2015, • having an understanding of the effects of culture on patterns of verbal and nonverbal p. 12). Cultural competence in mentoring is defined as “the process in which the faculty mentor communication continually strives to achieve the ability and availability to effectively mentor within the cultural context of the student mentee” (Campinha-Bacote, 2010, p. 131). Cultural skills in nursing and mentoring: Mentors’ cultural competence encompasses the following attributes. • having the skills to deal with culturally challenging situations in person-centred care and in mentoring • cultural awareness, sensitivity and knowledge • skills to comfortably and effectively work with culturally diverse students while understanding • intercultural communication and interaction their individual learning needs and communication styles • cultural skills and the ability to create a culturally safe learning environment. • ensuring the culturally diverse student is able to function in the healthcare context and provide 4.3 Mentoring of diverse nursing students safe, culturally congruent care to the patient/client Specific competences required to provide culturally congruent person-centred care and culturally 4.4 Tips on activities that can be integrated into cultural competence conscious mentoring to culturally and linguistically diverse students are defined below. education for mentors Cultural awareness, sensitivity and knowledge: Tip #1 Clinical mentors reflect on their role in assisting the culturally and linguistically diverse • desire and commitment to integrate, mentor, and support culturally and linguistically diverse student to overcome challenges faced in clinical placement and on their role in supporting the 8 integration and adaptation process of the student. Tip #2 Clinical mentors identify and define the attributes of cultural competence in mentoring and use these to plan their personal development in cultural competence. Tip #3 Clinical mentors reflect on their own personal cultural background and how their own value and belief system may have an impact in multicultural encounters. Tip #4 Culture often has an effect on patterns of verbal and nonverbal communication. Communication difficulties have been reported as being stressful for both students and mentors. Integrate content on how students’ professional language development and proficiency in the local language can be supported. Consider utilizing the expertise of linguistic experts in developing content regarding the topic. Tip #5 Clinical mentors’ play a vital role in ensuring safe, culturally sensitive clinical learning environments that support culturally and linguistically diverse students’ learning. Mentors must take immediate action to address possible prejudice, stereotypes and racism in clinical learning environments. Create simulation exercises where clinical mentors can practice their cultural skills in various real-life mentoring scenarios. Tip #6 Mentoring culturally and linguistically diverse students can be stressful and time-consuming. Clinical mentors can think of ways they can get the support they need to succeed in their role. Tip #7 Allow the voice and experiences of culturally and linguistically diverse students be heard. Integrate strategies into mentoring education such as videos, digital stories, interviews or panel discussions with students. 9 5 Mentor’s competence in supporting Mentors can support students in setting their learning goals by: • explaining clinical activities and interventions that can be completed during the clinical practice students’ learning process • referring to the learning goals and assessment criteria set by the educational organisation for the clinical practice in question • identifying the student’s level of competence prior to the start of the clinical practice and 5.1 Assessment of nursing students’ clinical competence making a plan to assist competence development through the assignment of appropriate tasks • ensuring that the student sets short and long term goals that are specific, measurable, attainable, Assessment of nursing students’ clinical competence is complex and challenging for both mentors relevant and time-bound. and nurse educators. It is extremely important to maintain objectivity during the process of finding out whether or not the student has achieved required competencies. The use of effective assessment 5.4 Reflection during mentoring methods and reliable and valid assessment tools is encouraged. Reflection during mentoring means that the mentor encourages the student to critically reflect on, Mentors can overcome assessment challenges by consciously supporting students learning process for example, how clinical tasks were performed or how the student succeeded in interactions with throughout the entire clinical practice. The mentor and student continuously reflect on clinical clients. The mentor and student embark in regular reflective discussions. learning and on achievements made during clinical practice. In order to promote effective reflection during mentoring, mentors should 5.2 Student-centeredness during evaluation • create a safe atmosphere where discussion on learning experiences can be openly shared between the mentor and the student A student-centred approach to evaluation can be facilitated when the mentor succeeds to integrate the following continuous cycle into daily mentoring practice. • ask the student to answer questions throughout the clinical practice and encourage the student to reflect on their own actions and developmental areas 1. Goal orientation • integrate various methods to improve the student’s self-reflection and reflection on learning with peers 2. Reflection during mentoring • use a structured approach to promoting mutual dialogue with the student. For example, ask 3. Constructive feedback the student on a daily basis to share how the day went, what the student learned and what the 5.3 Goal orientation in mentoring student is looking forward to learning more. Goal orientation in mentoring means that the mentor and student work together as a team so that 5.5 Providing constructive feedback the student can achieve the learning goals that have been set for the clinical practice. It is essential Constructive feedback that is timely, useful and given frequently encourages and motivates students that goals are clearly defined at the start of the student’s clinical practice. Mentors should have to further develop their professional competence. knowledge on the competencies that nursing students are required to achieve and on how to support students in achieving these competencies. Giving constructive feedback is not always easy. Be empathetic towards to student and remember 10 that the student needs time to learn and develop to become a competent nurse. It is important that Quality mentorship offers students well-planned learning opportunities that incorporate the provision mentors also ask for feedback from students on their mentoring competence and use this to develop of preparation, support and coaching for students together with an appropriate level of supervision. their own competence. This all is dependent on students’ expectations, experiences and what is required of them during their placement in order to meet their learning outcomes and achieve set competencies. The main barriers to giving effective feedback • Lack of specificity when feedback is given. Phrases such as “You need to be more proactive” High-quality clinical training is central to the preparation of future general care nurses. It is in these does not give the student sufficient details that the student needs to create a solution to becoming environments that nursing students are able to integrate theory into clinical practice and achieve the more proactive. required competencies as outlined in Annex V of the EU Directive 2013/55/EU. • Giving the wrong type of feedback. When a student has less experience in delivering a certain task, Therefore, it is fundamental that healthcare organisations within the EU that offer clinical placements he/she needs more positive feedback. When the student’s experience level grows, constructive to nursing students address and implement the modernised Directive 2013/55/EU and ensure that feedback can help to improve professional performance. curricula learning outcomes are in line with the Directive. • Giving feedback in the wrong setting, for example, giving feedback to a student during a team meeting with other students or staff members can be stressful and cause embarrassment. RECOMMENDATIONS URGE CLINICAL NURSE MENTORS TO: • An overabundance of constructive criticism or excessive negative feedback may impede effective clinical learning. Clinical mentors should consider what is the ideal ratio of positive to negative feedback for improving interpersonal relationships. • Refer to set criteria and guidelines that support implementation of quality mentorship and use these to guide the mentoring process. 5.6 Tips on activities that can be integrated into mentoring education • Effectively support students in achieving their set learning goals and the eight competency Tip #1 Introduce important issues related to the evaluation of students’ learning process. Present areas defined in Article 31 of Directive 2013/55/EU. various real-life assessment scenarios to clinical mentors and ask them to think of strategies to • Create and maintain a physically, socially and emotionally safe atmosphere in clinical learning overcome assessment challenges. environments. Tip #2 Clinical mentors can share experiences on maintaining the triangle of communication • Continuously reflect upon personal mentoring competence and plan strategies to develop between the nurse educator, nursing student and the mentor – which can succeed to avoid feelings professionally and as a mentor. of working in isolation. • Ask for constructive feedback on personal mentoring competence from students and colleagues Tip #3 Support clinical mentors in identifying the individual learning needs of students and in and use this while creating strategies for competence development. identifying aspects essential in creating effective clinical learning environments. Provide different • Facilitate collaboration with nurse educators from educational organisations to strengthen real-life case examples and tips on how to support students’ learning process throughout the entire nursing students’ learning process and achievement of learning outcomes. clinical placement. Tip #4 Help clinical mentors to feel empowered in establishing effective mentoring relationship, assessing nursing students’ learning and creating a safe environment for learning. 11 RECOMMENDATIONS URGE HEALTHCARE ORGANISATIONS TO: • Assess the current level of quality in mentorship on a regular basis within the organisation. • Plan and implement effective strategies on an organisational level that improve the quality of mentorship of nursing students completing clinical practice. • Empower staff members to develop their mentoring competence according to the Evidence-Based Clinical Nurse Mentors’ Competence Model (Mikkonen et al., 2019). • Support staff members’ continuous professional development and ensure that the necessary resources are in place for effective mentoring. Offer mentoring education to all staff members who mentor students. Click here for additional details on a course framework for mentoring education. RECOMMENDATIONS URGE EU LEVEL AND NATIONAL INSTITUTIONS TO: • Include the topic of strengthening quality mentorship of nursing students in political agendas in order to build resilience in the nursing workforce. • Ensure that each Member State is obliged to set criteria that enable quality mentorship of nursing students completing clinical practice under the supervision of qualified mentors. • Promote the use of the EFN Competency Framework as a tool to ease the implementation of Article 31 of Directive 2013/55/EU into nursing curricula throughout the EU. • Develop further standards and mandatory regulation through national laws and curricula through which clinical nurse mentors can be supported and educated in providing quality mentorship. 12 Expert evaluation on the guideline ‘The guidelines are a very good methodological tool for mentors to facilitate the organization and development of mentoring activities. The guideline on clinical nurse mentors’ mentoring contains a detailed description of mentoring practices, counselling for students, the significance of reflection, consideration of cultural differences competence development and tips for appropriate communication.’ ‘The tips given in every chapter are really valuable, and I think the In total, 19 experts took part in the evaluation of the guideline. The overall guidelines should be based mainly on the detailed methodologies focused feedback from experts was very positive as illustrated through the quotes on KNOW HOW already practicing mentors could daily improve their below. competences, and on HOW educational organizations should assess mentor’s individual and cultural competences.’ ‘Theoretically consistent, reasonable and the logical text of guidelines.’ ‘The guidelines are visually nicely designed. There are useful tables and ‘This is a useful and necessary tool for standardized mentoring training.’ figures that reflect the main aspects related to the guideline content.’ ‘The guidelines have been correctly and clearly directed for clinical nurse ‘The content is consistent, not overloaded and easily complementary.’ mentors and healthcare institutions. The guidelines have been written according to the evidence-based clinical mentors’ competence model and the ‘The image is attractive and easy to understand.’ eight competencies’ areas according to the requirements which are defined in EU Directive 2013/55/EU Article 31. These ensure that mentors are competent in guiding students in consciously adopting the perspectives of individuals, families and communities into clinical reasoning and decision- making processes.’ 13 References Pramila-Savukoski S., Juntunen J., Tuomikoski A.M., Kääriäinen M., Tomietto M., Kaučič B.M., Filej B., Riklikiene O., Vizcaya-Moreno M.F., Pérez-Cañaveras R.M., De Raeve P., Mikkonen K., 2019. Mentors’ self-assessed competence in mentoring nursing students in clinical practice: a systematic review of quantitative studies. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.15127 Antohe, I., Riklikiene, O., Tichelaar, E., & Saarikoski, M. 2016. Clinical education and training of student nurses in four moderately new European Union countries: Assessment of students’ satisfaction with the learning environment. Nurse education in practice, 17, 139–144. https://doi.org/10.1016/j. nepr.2015.12.005 Blanchet Garneau, A., & Pepin, J. 2015. 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