The Effectiveness of The Learning Contract – Education Essay
The aim of this essay is to reflect on the role played by the learning contract in achieving the overall learning outcomes, the effectiveness of the learning contract and to explore the principals that underpin it. In this essay,
the author shall explore constraints and advantages encountered while applying the principles of the learning contract in a mentorship relationship. The author shall also explore strategies applied to overcome the constraints and how the advantages were put to maximum use.
The learner was a qualified nurse, trained abroad, new to the unit and to ITU.Being new to ITU, the learner was required to demonstrate competence in key areas of critical care nursing. In this regard, the learner with the help of the mentor identified arrhythmias and grieving as the two topics that they were going to work on achieving competence in within a five-week time frame. The department of health promotes and recognizes the need for nursing staff to have high levels of clinical competence (DOH 2000) comprehensive critical care review. Stuart (2003) maintains that it is our duty as individual and accountable practitioners to maintain professional standards in the work place, while Hinchliff (2004) adds that a large part of the qualified nurse as mentor should be directed towards creating and contributing to an environment that promotes the post registration education and practice. Canham (2002) is quick to point out that the task is not easy when considering the demands of ill or distressed patients, carers, relatives, and challenging students. The NMC (2000) also insists that qualified nurses have a duty to facilitate students of nursing and others to develop their competence.
After the learner had been assisted in identifying relevant and appropriate learning objectives (Bennett 2003) and an agreement reached on how and when the objectives were to be met, it was agreed that learner and mentor should request to have similar shift so as to maximize the chances of interacting with each other. An integral part of the agreed contract emphasised openness, honesty and reliability to be expected of both parties (Tang et al 2005,Morton-Cooper & Palmer 2000,Proctor 2001).
Confidentiality was assured and agreed as the most important aspect of the contract (Epling & Casseddy 2001,Jarvis &Gibson 1997) to dispel the learner’s possible distrust of disclosing information to the wrong person. Only in a trusting relationship can people share thoughts feelings and ideas without fear in the knowledge that no one has an axe to grind (Quinn (2000), Van Ooijen (2000). Quinn (2000) regards trust as the hallmark of any meaningful relationship while Power (1997), insists that the working relationship between mentor and learner is the most significant aspect of the entire process. Brown & Bourne (1996) cited by Van Ooijen (2000), concludes that the mentor learner relationship is the means by which other relationships, for example, with patients, clients, relatives, colleagues, doctors, and managers, are reflected and analysed. It was incredibly difficult to set aside time to sit and plan the programme of learning and it was equally difficult to stick to agreed subsequent meeting times due to work and occasionally personal pressures. Specific, manageable and achievable objectives were eventually agreed upon as part of the learning contract. Learning contracts are an effective tool for developing mentor- learner relationship while promoting learner autonomy (Quinn 2000).
Working in a very busy cardiothoracic ITU, it became clear that time management was going to be a very significant factor if the programme of learning was ever going to be a success. Power (1997) asserts that treating and caring for patients is the main reason nurses come to work, while Fish & Twinn (1997) add that it is very demanding for nurses to manage the dual responsibility of patient care and mentoring. Time for teaching and learning, therefore, had to be squeezed out of an already tight schedule. While it is accepted that the clinical learning environment is unpredictable (Stuart 2003), the learner and the mentor both felt that there was not enough effort applied by the unit managers in facilitating and enhancing the environment for learning. On some days, either mentor or learner or both would be assigned to side rooms with very ill patients with brief break periods, just about enough for a cup of tea and a quick visit to the toilet. This was despite having made formal requests to work side by side. On attempting to raise the issues with the unit manager, the responses the mentor got was mostly to be blamed for poor planning. Their explanation was that it was up to the mentor to facilitate the learning environment and that includes time off the clinical area. A request for supernumerary status for one day a week was also turned down for the same reason. Fish & Twinn (1997) argue that allocation of supernumerary helps by removing the learner
from contributing to the workforce for the day in question. Morton-Cooper & Palmer (2000), while acknowledging that organizational demands and constraints and the distribution of resources, human and material, have to be taken into consideration, insist that mentors should be supported in their work. As it is accepted that mentorship should be a life long activity (Epling & Cassidy 2001), therefore, the infrastructure and managerial support need to be in place in order for quality mentorship to occur.
Hinchliff (2004) concedes that a large part of the mentor’s role should be directed towards creating and contributing to an environment that promotes the post registration education and practice, while Stuart (2003) adds that the mentor has the responsibility for ensuring that the learning environment is conducive to learning. There are, however, real issues in the real world, which are beyond any mentor or manager’s control, such as the chronic staff shortages where temporary staff are employed for a day and cannot, understandably, be trusted to know their way around. Nicol & Glen (1999) warn of acute care settings becoming increasingly complex, hence nurse managers at times find themselves outsmarted by the competing and at times conflicting immediate and long-term needs of the patients. Patient turnover and patient dependency changes dictate the course of events of every day (Stuart 2003). Dolan (2003), however, argues that more resources do not necessarily translate into better learning. It could be that this particular period had a much higher patient turnover and unusually less staff to meet requirements for which nothing could be done.
Learners are also increasingly being encouraged to take responsibility for their own learning in developing their skills and becoming life-long learners (Nicol & Glen 1999). In this regard, the learner could have done more to avail themselves on agreed days at agreed times. Quinn (2000) suggests that motivation is a very important factor in the learning process but, Epling & Cassidy (2001), argue that resistance is indeed an unavoidable part of any introduction of something new. The learner’s lack of motivation, therefore, especially in the initial stages of the contract, made it harder for the mentor to get the learning programme off to a good start. As skills need to be constantly redefined and improved throughout professional life (Butterworth et al 1998), the mentor expected the learner to take advantage of the opportunity to be mentored and maximize the benefits. It is a learner’s and indeed any professional nurse’s responsibility to be willing to learn and change irrespective of experience (Bond &Holland 1998). The concept of learner androgogy acknowledges and emphasizes the role of the learner (Humphreys & Quinn 1994); hence the expectation from mentor of more proactiveness from learner was appropriate. Knowles (1984) cited by Humphreys & Quinn (1994) describes pedagogy as the art and science of teaching children and is contrasted with androgogy, which is the art and science of teaching adults. The RCN (2002) cited by Bennett (2003) state that mentors can expect the learners to direct their own learning, act professionally with regard to punctuality, attitude and appearance, maintain confidentiality, effective communication and give and receive constructive feedback. It was sensible, therefore, for the mentor to expect the learner to honour his obligations.
It is possible that contracting could have been given more time and attention with more clarity of expectations. If contracting is carried out effectively and both parties are clear on what to expect from one another, commitment is more likely than if it has been done half-heartedly (Bishop 1998,Van Ooijen 2000). Wilkin (2002) adds that learners who fail to grasp the rationale behind mentorship may renege on their responsibilities. Bennett (2003), however, argues that learning contracts, while requiring the mentor to permit the learner a degree of autonomy, also encourages the learner to be pro-active in learning.
At the beginning of the second and subsequent meetings, an evaluation of the previous meeting would be undertaken at which both learner and mentor would work out what had gone wrong and what had gone right (Cavanagh 2002,Bennett 2003) and adjustments to the contract made were need be. Cavanagh (2002) states that reviewing the learning contract and setting achievable objectives within a shorter time scale can often resolve problems, while Bennett (2003) adds that evaluation and regular feedback makes both learner and mentor aware of areas that require further development. The learner became increasingly more cooperative and proactive after the third meeting at which the mentor had to gently and purposefully confront the learner with the suspicion of a general lack of interest on the learner’s part with the evidence behind the suspicion (Wilkin 2002). Failure to do so
would have represented, according to Wilkin (2002), a relinquishing of the mentor’s responsibilities. Power (1999) argues for a balanced blend of comment, instruction, advice, and facilitated reflection in order to avoid alienating the learner.
The learner had a good theoretical understanding of arrhythmias but it was on applying this knowledge to the clinical setting that help was needed. The mentor made an arrangement with a member of the cardiology department to come to give a bedside talk on arrhythmias and this proved to be a very informative experience for both learner and mentor. Hinchliff (2004) describes the joy of learning in the practice setting as helpful to learners by further categorising and processing existing knowledge by applying the learning directly to care. Price (2004) adds that patient care episodes are key resources and there is much to be gained from observation, discussion and practice. An arranged visit to the bereavement officer failed to take place as it was deemed unessential by the nurse in charge.
The mentor felt that, on the overall, the learning objectives were met, as the learner was able to articulate the issues raised in the objectives and relate them to the practice setting. Bennett (2002) states that while it is important to provide the learner with literature on relevant subjects, assistance with developing strategies and techniques to put the knowledge into practice is very important. While the difficulties encountered had a lot to do with the fact that the mentor was also learning, the experience was very rewarding as both learner and mentor eventually realised that they could enjoy the experience and benefit emotionally and professionally from it. It is certainly true that when in the middle of a situation, as was the case in the initial stages of the mentorship relationship, it is difficult to see things for what they really are (Van Ooijen 2001), things look clearer with hindsight and valuable lessons have been learnt by both parties. Epling & Casseddy (2001) conclude that the experience of receiving good quality mentorship makes nurses more receptive to mentorship in the future.
The benefits of good mentorship are well documented (Morton-Cooper & Palmer 2000,Busen & Engbreson 1999,Bond &Holland 1999), for the mentor there was personal satisfaction and a level of self awareness (Van Ooijen 2000), and the possibility of professional development. Morton-Cooper & Palmer (2000) conclude that the learner benefits from increased job satisfaction and the possibility of advancement while the employer benefits by having a satisfied and motivated workforce with positive outcomes for customers and clients. The ultimate aim of producing competent nurses is to ensure that patients receive the highest level of nursing care possible (Dolan 2003) and the public have a fundamental right to expect competence from qualified health professionals and a fundamental right of protection against unsafe practice (Stuart 2003). The mentor and learner have since developed a mutual ongoing friendship and, while the learner remains grateful for the assistance, the mentor will always look back with pride and joy at a potentially volatile mentorship relationship turned into a very mutually fulfilling one by working diligently by and along the principles of the learning contract.