Establishing Effective Working Relationships * a mentor

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Mentoring and Assessing in Healthcare Settings (Module 308CPD) – E-Learning
Programme
Establishing Effective Working
Relationships – a mentor domain
Presenter: Neil Gopee
EEWR
Establishing Effective Working Relationships
1. What is it about?
2. Why should the mentor Establish Effective
Working Relationships with mentees?
3. How does the mentor do this?
4. What are the likely issues / problems in
working relationships?
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Q1 What? NMC mentor domain: Establish effective working
relationships
Demonstrate effective relationship building skills sufficient to support
learning, as part of a wider inter-professional team, for a range of
students in both practice and academic learning environments.
Outcomes
• Have effective professional and inter-professional working
relationships to support learning for entry to the register, and
education at a level beyond initial registration.
• be able to support students moving into specific areas of practice or a
level of practice beyond initial registration, identifying their individual
needs in moving to a different level of practice
• support mentors and other professionals in their roles to support
learning across practice and academic learning environments
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Activity 1 - Establishing Effective Working Relationships
Consider the following questions, and make some notes
1. Who are the various people who you relate to during your normal
day to day activities, and what is the relationship with each?
2. Next to each name write W or H to indicate whether you relate to the
person because you want to or because you have to.
3. For those who you want to relate to, how did you establish the
relationship and how do you maintain this relationship?
4. For those who you relate to only because you have to:
i.
Describe why you relate to the person
ii. What are the things that you do to ensure an effective relationship
is maintained?
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What? Definition of effective relationship
An effective relationship in the work or clinical setting
can be defined as one that comprises acceptance of
each other by the two parties involved, establishing a
mutual understanding and rapport, which might
constitute small negotiations and giving time, and
requires intrapersonal awareness and interpersonal
skills such as empathic listening (Gopee, 2010 p29).
An effective professional relationship in healthcare
requires fulfilling all components of this definition, as
well as full awareness of components that each is
responsible and accountable for. There must also be
adherence to work related protocols and policies, and
to professional codes of practice (Gopee, 2010 p29).
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Activity 2: Initial contact & points to consider
The first NMC outcome for mentor under
establishing effective working relationships states
that the mentor should be able to ‘Have effective
professional and inter-professional working
relationships to support learning for entry to the
register …...’
View the video entitled ‘Mentoring 1’ under this
section, and note down all the actions that you
consider both the student and the mentor take to
start building an effective working relationship.
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COMMMUNICATION - What is communication?
‘Communication is a complex, ongoing, dynamic process
in which the participants simultaneously create shared
meaning in an interaction. The goal of communication is …
a common understanding of the message sent, and the
one received’ (Sullivan and Decker, 2009 p122).
The process of communication involves information processing +
response
Sender
compiles a
message
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The message is
sent to the
recipient
Recipient
receives
message &
responds
Activity 3: Building EWR
Building effective working relationships is founded on use of
basic communication skills, as well as certain skills that we
develop for specific situations. Identify the basic
communication skills that we all have to learn to be able to
interact meaningfully with others.
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MODES OF COMMUNICATION
Communication may be:
• Written: handwritten, typed, emailed, faxed, printed, etc
• Oral (spoken): face-to-face, one-to–one, in groups, by telephone, etc
• Non-verbal (NVC) - vocal and non-vocal
Non-verbal messages communication always accompany oral (spoken)
communication. NVC include:
• Body posture
• Body orientation, position
• Eye contact / Gaze, or lack of
• Facial expression: agreement / disagreement
• Touch
• Tone of voice, volume & emphasis
• Gestures of shoulders, arms, hands, fingers
• Proximity
• Dress & appearance
• Etc
Non-verbal behaviours are trusted more than verbal messages (Sullivan and
Decker, 2001).
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Effective communication is affected by:
• Past conditioning of the person, including LTM, STM, culture, etc …
• The present situation the individuals are in
• Each person’s purpose in the current communication
• Each person’s attitudes towards self, the topic, and each other
Past conditioning
experiences
Sender
Message
The present
situation
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Response
Non-verbal Signals of a ‘friendly attitude’ (Argyle, 1994 in Ellis et al,
2003 p10) [vs ‘unfriendly attitude’]
Proximity
Closer, lean forward if seated
Orientation
More direct, but side to side for some
situations
Gaze
Facial expression
More gaze and mutual gaze
Gestures
Head nods, lively movements
Posture
Open arms stretched towards each other
rather than arms on hips or folded
Touch
More touch in an appropriate manner
Tone of voice
Verbal contents
Higher pitch, pure tone
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More smiling
More self-disclosure
SO WHY DO PROFESSIONALS COMMUNICATE? At individual levels
or in teams
In nursing, to (Sully & Dallas, 2005):
• work in teams and groups
• empathise and comfort
• interview and assess
• be assertive, advocate, negotiate
• communicate where there are physical barriers (e.g.
hearing problems)
• deal with difficult situations
• teach
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WHY EFFECTIVE AND EFFICIENT COMMUNICATIONS BY MANAGERS / IN
ORGANISATION S
Communication is needed (Scammell, 1990 p11):
• To establish and disseminate the goals of the organisation
• To develop plans for the achievement of these goals
• Organise human and other resources in the most effective
and efficient way
• Select, develop and appraise members of the organization
• Lead, direct and motivate members of the organization
• Control performance
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Analysis - Directions of communication (Sullivan and Decker, 2009)
Formal & informal communication can be:
Downward - Manager telling subordinate what needs to be
done, or giving information on how the job could be done
Upward - To provide management with information for decision
making
Lateral - Between peers on same hierarchical level – for
information sharing, negotiation
Diagonal - Between individuals or departments at different
hierarchical levels – for information sharing, negotiation
i.e. not just top-down / bottom-up
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Directions of communication (Sullivan and Decker, 2009 p123)
Band 6
Sister
Band 7
Sister
Band 5
Staff nurse
Band 5
Staff nurse
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What ….. Nurse – patient relationship
• May (1990) researched the theoretical and educational literature on
interpersonal relations between nurses and patients, and concluded
that there are two contending perspectives.
One is characterised by technocratic factors, which are task-oriented,
routinised and superficial interactions by the nurse; and the second is
contextual factors whereupon nurses engage in meaningful
conversation with patients about their health, and therefore forming a
more health benefiting relationship for the patient.
• Waters (2008) explored the qualities that patients rate in nurses, and
found these qualities to be: attentiveness, caring, organised,
professionalism, kindness, sympathy, cheerfulness, thoughtfulness,
selflessness, advocacy, efficiency and politeness. These qualities
would therefore comprise a precondition for forming nurse-patient
relationships.
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Activity 4 …
a) For question 3 and question 4, you might have indicated that you ‘accept’
the person for who they are. Rogers and Freiberg (1994) refers to this
concerted view as ‘acceptance’. For one of those who you relate to
because you have to, what are his or her attributes / habits / ways that
you ‘accept’, willingly or unwillingly?
b) Rogers and Freiberg (1994) also indicate that the other considerations for
an effective working relationship are genuineness and empathy. With
patients and service users, we have to ensure we develop and have an
effective working relationship. Think of a particular patient or service
user who you are caring for, and determine in which ways you exercise:
i)
Acceptance
ii) Genuineness
iii) Empathy
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HOW do we form working relationships? They are based on mutual
trust between the two parties, that in turn relies on three key
conditions namely (Rogers and Frieberg, 1994):
• Acceptance – of the person for who they are, despite their
differentiating features, their strengths and weaknesses, etc
• Genuineness – being honest about one’s level of knowledge and
skill, preferences, experiences
• Empathy – endeavouring to see situations and developments
from the mentee’s point of view
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Why effective mentor-mentee relationship ….
A sound mentor-mentee relationship is crucial to
the efficiency of mentoring (research by
Crawford et al, 2000).
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How is effective mentor-mentee working relationship established?
Webb & Shakespeare (2008 p563) cite previous research findings
that good learning support depends to a good extent on
students themselves initiating and building a relationship with
their mentors. They emphasise that in their view ‘much of the
burden of creating effective mentoring relationships falls on
students’.
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How is effective mentor-mentee working relationship
established?
Burnard and Morrison
(1989)
study revealed that some of the personal qualities of an
interpersonally skilled or competent person include: being
approachable, empathic, helpful, genuine, good listener,
verbally skilled, acceptor of self, open and credible.
Levett-Jones et al (2009)
explored whether pre-registration students feeling of
belongingness to the clinical team during practice placements
had any effect on students’ learning experiences, and found
that it is an essential ingredient for both learning and a
positive clinical experience. They suggest that receptiveness,
inclusion, legitimization of the student role, recognition,
challenge and support had the most important influence on
students' sense of belonging and learning. Levett-Jones et al
suggest that nursing students' motivation and capacity to
learn, self-concept, confidence, the extent to which they are
willing to question or conform to poor practice, and their
future career decisions are influenced by the extent to which
they experience belongingness.
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How is effective mentor-mentee working relationship
established?
Wilkes (2006) reviewed the literature on the studentmentor relationship, and concluded that as this
learning support role is performed as one of multiple
roles, for the relationship to be effective and not
compromised, mentors should exercise caution and
set clear boundaries at the very outset.
She suggests that both parties will then have realistic
expectations of each other and reduce the likelihood
of misunderstanding and mistrust. Furthermore,
ground rules for the placement should be
established at the initial interview and documented
in the learning contract.
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How ….. teacher-student relationship - 4 stages of building ‘learning
relationships
Price (2005) refers to the teacher-student relationship in clinical
settings as a ‘learning relationship’, and suggests that there are
4 stages of building ‘learning relationships’, viz:
1. initially the teacher and mentee recognise that they are
‘strangers’ and start to communicate;
2. as ‘explorers’ they get to know the other as a person and
ascertain ways of facilitating learning;
3. as ‘companions’ they get on with their respective roles as
teacher and learner; and
4. as ‘network associate’, i.e. they still keep in touch after the
placement ends.
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How is effective mentor-mentee working relationship established?
Davies and Gilling (1998) make some very straightforward
recommendations on how the learning facilitator can build relationships
with students. They indicate that this involves preparing for the student’s
arrival, beginning the mentor-student relationship and supporting the
student during the placement, and include:
• Preparing for and arranging the first meeting with the student at the
very beginning of the placement, ensuring that they are given full
attention
• Welcoming the student with enthusiasm and interest
• Orientating the student to the clinical environment
• Finding out about the student’s past experiences
• Clarifying mutual expectations
• Setting ground rules.
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The student-teacher relationship ……..
However, Agnew (2005) acknowledges that a good studentmentor relationship is not always easy to achieve, especially if
the individual healthcare professional is reluctant to accept
the mentoring role. Agnew notes that these mentors are
those that ‘tick boxes’, rather than teach and assess students,
and consequently contribute to ‘a vicious circle of
incompetence’ (p26).
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Activity 6 - Why & how working relationship can break down
between mentor & mentee
For this activity, view the video ‘MattandDeb2’,
and:
1. Make notes on the various reasons why
communication broke down between the mentor
Matt and the student Libby.
2. List all the actions that can be taken by Matt, by
his learning supervisor and by the student, to
resolve the problems identified.
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Why & how working relationship can cool or break down between
mentor & mentee
• One or both parties do not comply with / follow agreed ground
rules
• General non-verbal & vocal apathy / disinterest
• Absence of either party
• Lack of rapport / personality clash
• etc
• …..
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What are the likely issues / problems in working relationships?
WHY / HOW DO COMMUNICATION BREAK DOWN?
•
•
•
•
•
•
•
Ineffective sending
Ineffective message composition
Receiver problems
Disjunction between sender and receiver
Noise
Communication media
Lack of formal mechanisms
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How ascertain competence in NMC domain Establish effective working
relationships & outcomes
NMC outcomes for mentor under EEWR
How student mentor can demonstrate
competence in these outcomes
Have effective professional and interprofessional working relationships to
support learning for entry to the register,
and education at a level beyond initial
registration.
…..
Be able to support students moving into
specific areas of practice or a level of
practice beyond initial registration,
identifying their individual needs in moving
to a different level of practice
…….
Support mentors and other professionals in
their roles to support learning across
practice and academic learning
environments
……….
EEWR
How is effective mentor-mentee working relationship established?
Year-long mentorship programmes yield more
beneficial outcomes for students in terms of the
variety of skills that they acquire through the
longer-term relationship than in shorter
episodes of mentoring (a small-scale study of
mentorship (van Eps et al, 2006).
EEWR
REFERENCES
Agnew T (2005) Words of wisdom. Nursing Standard, 20 (6): 24-26
Argyle M (1994) The Psychology of Interpersonal Behaviour. London, Penguin Books.
Berne E (2010) Games People Play: The Psychology of Human Relationships. London, Penguin.
Burnard P, Morrison P (1989) What is an interpersonally skilled person?: A repertory grid account of professional nurse's views. Nurse
Education Today, 9 (6): 384-391.
Crawford M J, Dresen S E, Tschikota S E (2000) From ‘getting to know you’ to ‘soloing’: the preceptor-student relationship. NTResearch, 5
(1): 5-19.
Davies K, Gilling B (1998) Building relationships. Nursing Times Learning Curve, 2 (5): 6
Gopee N (2011) Mentoring and Supervision in Healthcare (2nd edn). London, SAGE publications
Gopee N (2010) Practice Teaching in Healthcare. London, SAGE publications
Gray B (2009) The emotional labour of nursing – Defining and managing emotions in nursing work. Nurse Education Today, 29 (2) 168-175
Gray B, Smith P (2001) Reassessing the concept of emotional labour in student nurse education: role of link lecturers and mentors in a time
of change. Nurse Education Today, 21 (3): 230-237
Levett-Jones T, Lathlean J, Higgins I, McMillan M (2009) Staff – student relationships and their impact on nursing students' belongingness
and learning. Journal of Advanced Nursing, 65 (2): 316 – 324.
May C (1990) Research on nurse-patient relationships: problems of theory, problems of practice. Journal of Advanced Nursing, 15 (3): 307–
315.
Price B (2005) Building a rapport with the learner. Nursing Standard, 19 (22): (no page no. - pull-out preceding p58).
Rogers, C., Freiberg, H.J. (1994) Freedom to Learn (3rd edn). New Jersey: Pearson Education.
Sullivan E J, Decker P J (2009) Effective Leadership and Management in Nursing (7th edn). New Jersey, USA, Pearson Prentice Hall.
Sully P, Dallas J (2005) Essential Communication Skills for Nursing. London, Elsevier Mosby
van Eps, M., Cooke, M., Creedy, D. and Walker, R. (2006) Student evaluations of a year-long mentorship program: A quality improvement
initiative. Nurse Education Today, 26 (6): 519–24.
Waters A (2008) More than a nurse. Nursing Standard, 22 (46): 19-21.
Webb C, Shakespeare P (2008) Judgements about mentoring relationships in nurse education. Nurse Education Today, 28 (5): 563-571.
Wilkes Z (2006) The student-mentor relationship: a review of literature. Nursing Standard, 20 (37): 42-47.
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