Posted at 11.16.2018
Nursing, like all the health care occupations, is a practice self-control which requires ongoing development of knowledge and skills to be able to provide quality health care to our clients. To carry out this, we have to develop certain skills to modify to a regularly evolving knowledge founded practice. A great part of learning within health care professionals is performed through medical practice, which requires the need for a supervisor used, who is alert to the mentorship process and who'll perform its facilitation. A highly effective mentor will provide future professionals with sufficient and effective knowledge and skills, making them ideal for safe practice.
The goal of this article is to provide a critical examination of my diagnosis of my learner's knowledge and competence and critically echo can certainly make money supervised and performed as a mentor for this learner. I have included in this essay through appendices a weekly diary that we kept showing how exactly we both identified and how exactly we could attain the objectives that people have set.
Neary (2000) areas a good learning environment for a student makes way for better learning opportunities. At the start of the module, I spoke to my supervisor about mentoring a worker and was given this learner. My supervisor is my brand manager where myself and the learner is an associate. The labor force in the machine is split into a flexible set up team and each team has a line manager (Band 6 or Strap 7) and one or two junior line managers (group 6) then there are experienced staff nurses (Band 5), and staff nurses (music group 5) which my learner belongs.
These flexible clubs facilitate mentoring and allow learners to be mentored by the mentor and available senior staff. In order to these learners are being recognized effectively by their mentors and improvement are followed-up not only by the mentors but also other senior personnel nurses who entirely provide responses to the learner and the line director. Gopee (2008) recognized that some of the factors that promote learning are the correct time to instruct and sufficient staffing levels. We make sure mentors work next to the learners and this has been done during patient allocation at the end of the overall handover. However, this will not always happen and in this case the nurse-in-charge makes sure that the learner is working next to a older staff in the same team. This will not only promote the team-work but also that responses can be made to the mentor and the collection manager.
I conducted a short interview with my learner to examine how she seems working in the device and to identify her learning needs, and what she identifies as her advantages in terms of her knowledge and skills (Appendix A). Diagnosis of professional knowledge and competence is vital to identify following learning needs and would imply being supportive to the learner (Gopee, 2008). Nicklin and Kenworthy (2000) define analysis as a measurement that directly relates to the quality and quantity of learning and it is therefore, worried about students' progress and attainment. The analysis of my learner's current knowledge and awareness of her areas of further learning was conducted to suggest improvement and identify those areas that needed to be improved. I've allowed the learner to execute a self-assessment that may enable her to own the learning and control the way she fits her needs (Gopee, 2008).
A learning agreement (Appendix B) and course of action (Appendix C) has been arranged between me and my learner. That is area of the knowledge and skills framework competency publication that she actually is necessary to do. The use of the learning contracts was advocated by Knowles et al (1998) in the framework of adult learners needing to exercise some self-direction in their learning. These learning aims gives the learner some control over their learning, stimulates their desire to learn and engage with the training experience (Gopee, 2008) and therefore, gives them the self confidence and sense of empowerment. The benefits of the learning deals have been reported by Ghazi and Henshaw (1998), who found that learning contracts help the learner's performance in assessments. A couple of, however, merged views among authors about whether learning agreements are lawfully binding. Neary (2000a) argues that they are not but Mazhindu (1990) suggests that they are legally binding. It is useful to note that NMC (2005a) has pressured their position on good record keeping, and written details can be used as proof actions considered or omitted. It really is for this function that I've stored a written diary (Appendix D) was manufactured in agreement with the learner.
During the first week working jointly I have pointed out that my learner can specify a few of the terms that are contained in our goals and also have not confirmed in-depth knowledge of the subject area. (Appendix D). When she was presented with feedback about this, she does not take it very well and became frustrated. She expressed that her self-confidence had dropped, which she will not feel motivated to review and learn. Students can be too home critical (Gopee, 2000) which might aggravate their poor self image and could have a negative result in their self-confidence. In our unit nurses are being empowered to make a sound common sense and good decision-making in delivering care to the patient. To get this done you need to obtain knowledge and skills by demonstrating and articulating an aspect of health care that is in question. However, the learner hasn't shown this and hasn't demonstrated the amount of competence that is expected of her.
On representation, I feel that motivation is the key in which my learner would learn especially with her being frustrated with her progress and her plummeting self-confidence (Appendix A). Having acknowledged this, Personally i think that I had a need to build rapport and build a good working marriage with her. Regarding to Brown (2002) he defines rapport as 'a point out of deep spiritual, psychological or mental interconnection between people', including understanding and empathy. The necessity for effective working human relationships are recognized by the NMC (2006a).
Rogers and Freiberg (1994) state that, a working marriage can be built by ensuring that the individual are being accepted as who they are, that is, for his or her individual strengths and weaknesses, and shared respect. You need to show genuineness as a person, credibility and also should show empathic understanding- being able and willing to view situations from the other person's point of view which is precisely what I am aiming to do. I have encouraged her to read the resource record in the coaching area and have photocopied an article from a journal highly relevant to this topic. I have assumed the role as a supporter (Darling, 1984). I have suggested her that she should not be too hard on herself rather than get frustrated easily because I possibly could support her and instruct her if she does not know. I have explained that every person has experienced what she actually is experiencing at the start, and this she should not feel bad about it and should not stop her from learning. This is actually the role of mentor as energizer (Darling, 1984) as I've encouraged interest and inspiration.
I asked her what she believes could help her to avoid her from forgetting what she's read and discovered and pointed out that taking notes makes her retain information that may help her bear in mind things. I have encouraged her to do this, if we discuss things in the medical area. In doing so, I have assumed the role of a problem-solver where I was helping her to find means of resolving and stopping issues (Darling, 1984). That is also backed by one of the guidelines of learning (Knowles et al. 1998) which declares that when given responsibility for his or her own learning, the students are highly determined and likely to learn and preserve more. Evenly, Carl Rogers (1983) advocated that the utilization of empathic understanding, genuineness, and being non-judgemental promotes or facilitates student-centered learning. Personally i think I've achieved this by creating a good learning environment, empowering my learner to become responsible, to build up self-awareness and let her think of alternate means of learning.
Overall what I was looking to do is to find my learner's learning style and developing a good learning environment for her. Everyone discovers throughout their lives, and they learn new knowledge and skills for a number of reasons, a few of that are for self applied improvement and to acquire complete relevant knowledge because they take satisfaction in their build (Gopee, 2008). My learner is keen to learn as a result of dependence on more responsibility as she needs to be a skilled staff nurse, and also she wished to do the intensive good care course. However, she must be deemed proficient first before she'd have the ability to do that.
Competence is a term that has several definitions, as determined by Bradshaw (1997). Being qualified as Benner (2001) views it, has been at the midway point in the periods of skill acquisition. This is actually the point where in fact the learner is seen as able to perform the skill unsupervised, but further learning is required to become proficient or expert.
Benner (2001) further suggests that competence can be an interpretively defined part of skilled performance identified and referred to by its objective, function and meanings. The NMC (2005b) recognizes competence as relating to the pupil demonstrating their ability in certain skill areas to a required standard at a specific point in time, and this competencies are component skills that contribute to be competent and also to achieve the standards of skills for subscription. The NMC (2004c) recognizes a competent nurse as you who consistently shows the fitness for practice. Insurance plan and research documents, therefore, show that the conditions competence and proficient apply to the person, that is, the professional's overall knowledge, skills and attitudes, and their fitness to apply (Gopee, 2008).
My learner's lack of competence was visible on the third week of us working along. In the next week, she was able to identify the standard blood gas values (Appendix E) but on the third week she had not been able to show understanding of the significance of the blood gases with regards to the health of the individual and subsequently had not been able to interpret blood vessels gas results accurately (Appendix F). That is regarding as treatment and interventions are dependent on the practitioner's know-how in interpreting these results and not knowing these poses a great danger for the individual as they could receive the incorrect treatment.
One thing that I came across while I was working with my learner is the fact that she needs desire to learn. How individual learn has been explored and identified over a number of years.
Curzon (2001) defines learning as the 'evident modification of a person's behaviour through his activities and activities, so that his knowledge, skills and behaviour, including settings of adjustment, towards his environment are evolved, more or less entirely'. In medical care occupations, learning is a lifelong procedure for skill and knowledge acquisition and updating them through organized participation in centered reading and set up programmes of analysis.
My learner has her own learning style and discovers even constructive criticisms hard to simply accept which her previous mentor diagnosed, and I really do agree, that it creates her stop learning and be disappointed and frustrated with herself which. Therefore, bruises her ego and self-confidence (Appendix I). How I develop the right strategy on my mentoring has posed a great obstacle for me, especially about how I would communicate my assertions when giving reviews and requesting questions. I must create a plan and systematic procedure so my learner could learn more effectively.
What I suggested to her as with week two (Appendix E), is that of representation. In order to keep information, she can pull from her past encounters and knowledge, so she'd have the ability to put it into practice. It was apparent that she already has the knowledge and skills as she has done them on her workbook in the past and has looked after patients such as this before. The explanation for reflective practice in medical is that it is a means of building or producing knowledge from particular happenings (Kolb, 1984). This is being backed by Ausubel et al. 's (1978) assimilation theory one of the cognitive theories of learning, which is based on the view that most important cognitive learning takes place because of this of interaction between the knowledge the average person already procedures, and new information that the average person encounters. The factor that a lot of influence learning is what the learner already is aware, which forms the foundation of copy of learning. This also improves retention of knowledge and information (Gopee, 2008).
My learner sensed determined to learn when I praised her and gave her good reviews with the items she has done well. This was evident when she said that she thought valued and part of the team. Behaviorist learning theorists assume that learning occurs through respond to particular stimuli leading to classical fitness. Classical conditioning identifies change in behavior through stimulus- response, whereby attractive responses to particular stimuli that is, newly discovered behaviours are rewarded (Gopee, 2008). Behaviorist learning theory could be applied to my learner as she learns more when she was positively reinforced both by the feeling of a feeling of accomplishment and by me as a coach acknowledging or knowing her recently developed competence.
The third (Appendix F) and fourth week (Appendix G) were the most difficult times for my learner as she battled to acquire competence and skill to interpret bloodstream gas results and associate this to the health of the patient and possessed trouble understanding the concept behind the ventilator modes. Relating to Curzon (2001), an art signifies having knowledge within an activity which has been developed as the consequence of training and/or experience, enabling the given individual to perform this task with effectiveness and overall flexibility.
Although my learner has received the required skills and knowledge and experienced completed her competencies on these aspects, it required her a longer period than expected.
How I help her learning has proven to be a challenge for me. I've assumed the role of your learning facilitator. I've utilised the ideas of teaching an art or competency centered from Curzon (2001), that skill acquisition lessons require supervised, reinforced, and carefully spaced practice by learners. Thus, it is only by my learner's experiencing and repeating the essential process and skill that she's found out the cues of being competent on this field. I've evaluated her regularly making sure that she has moved her newly obtained skill to related situations with other patients. I've utilised teaching assists such as practice blood gases analysis, which is located in a source folder. Having done this, my learner has bought not only competence but self confidence as in time; she was able to interpret blood gas results with ease. By allowing her to manipulate options in the ventilator, she was able to understand the explanation or the guidelines behind ventilator modes.
The unit offers a good environment for learning as it gives the chance to new staff and also to the pre-registration students orientation period before they start work in the ward. These orientation programme and induction packages are carefully organized by the teaching sister. My learner has already established this orientation already, which is, in fact, included in her competency book. One characteristic of the good learning environment is that which allows both learner and the mentor to discuss their hopes and objectives with each other whilst in the positioning (Gopee, 2008). I have at the beginning of the formative meeting with my learner asked her what she desires to attain whilst I am mentoring her, and that she said that she desires that I will be able to hint her off her competencies, she wished to get marketed, and she desires to anticipate to do the rigorous good care course (Appendix A). In my own part however, I've told her that because she has been in the machine for a considerable period I expect her to travel comprehensive with the issues that people need to discuss, and this she also has the responsibility on her behalf own learning. That is evident in the training contract that we have both decided to do (Appendix B).
Fretwell (1980) identified the key components of the ideal learning environment as anti-hierarchy, teamwork, negotiation, communication and availability of trained nurses for giving an answer to students' questions. If you ask me, our unit has all of these features as the unit culture is becoming flexible in dealing with learners through time. I have said this because learners, although they have a called mentor or belong to a team, can ask any mature staff about any problem that they can face whilst in the position. It has fostered a sense of teamwork and even our device has survived with a great teamwork no subject how active a transfer becomes. Although there are others, as would happen to every unit, who not bother to help, although there are but a few in the unit, most senior staff nurses in the entire workforce would happily prolong their help.
The coach experience has trained me the importance of producing as a learning facilitator and has made me aware of the skills engaged. I have discovered as Morton-Cooper and Palmer (2000) suggest, facilitative and effective learning is dependant on trust, admiration and valuing the capabilities of others.
Establishing rapport and setting up a good working romantic relationship with my learner was a major task, but I've resolved this by conveying emotions of empathy and really listening to her grievances. This made her thought valued and part of the team. Our anticipations about the other person were discussed and have proven to be useful. We have mutually decided to follow the learning agreement, although we have slightly extended obtaining these on the fifth week of my location.
Her drive in learning has generally been driven by improving her ego and her self-confidence, which motivated her to learn, and I have done this by utilising the learning concepts and both the cognitive and behavioral theories of learning. It is amazing to know that if you tapped within the learner's learning style and the utilisation of any good learning environment would lead to a productive mentoring experience. I likewise have made use of the characteristics and jobs of mentors in forging effective learning.
Having all these in mind, I will work on increasing my mentorship skills further, both by example and facilitation through participating in mentorship changes and reading facts based books on mentorship. Becoming a good role model therefore i can support learners in acquiring new skills, adapting to new behaviour and attitudes. I have learned new means of offering descriptive, non judgemental and constructive opinions to the learner (Neary, 2000). Learning to be a mentor is a fresh and challenging experience and has opened up my brain to focus on learner autonomy and encourage the learner to be more lively in learning, promoting more liberty of choice, which will make the learning experience as empowering as is feasible.
I assessed her learning needs by asking what has she done up to now with regards to the required study times that she's to attend as part of the requirements in her role as a staff nurse in accordance with the data and skills construction. As she's already done all the analysis days and nights I asked her about what she locates difficult in her practice that she feels she had a need to work on.
She has determined areas to learn such as ventilator settings, what they do and their software to care for the individual. She also wish to learn about constant renal replacement remedy works as well as how to use different modes of remedy for a specific patient. She also feels that she needs more knowledge on cardiac outcome monitoring such as a pulmonary artery catheter and the LIDCO.
She has indicated that she must do her competency book signed off as she will need to complete them among the requirements for doing the rigorous health care course that she actually is planning to do soon. She actually is worried that she actually is not progressing needlessly to say in conditions of her completing the competencies because she feels that as it is always busy in the unit, it is difficult if not impossible to get senior staff to signal her publication off. I reassured her that people will endeavor to do that, whilst I am still mentoring her.
Due to limited time-frame that I have to do with her whilst still upon this course Personally i think that it's best to give attention to specific areas such as the the respiratory system as our patients are largely ventilated, so then we can place goals and goals on this area that is attainable ideally in four-week time.
Demonstrate a detailed knowledge and understanding of the anatomy and physiology of the respiratory system and interpret arterial blood analysis results with regards to the following:
Outline the gross anatomy of the lungs.
Outline the mechanism of respiration
Describe the surfactant and its own function.
Define conformity, resistance and work of respiration.
The partnership between venting and perfusion.
Describe intrapulmonary shunting
Define the next:
Partial pressure of your gas in blood.
Pulmonary air flow.
Functional residual capacity.
Describe the physiological - nervous and chemical type control of respiration.
Describe the transfer of oxygen in the blood vessels:
Describe skin tightening and transport in the body and why could it be made by the cell.
Articulate normal arterial blood vessels gas beliefs.
Demonstrate skills to obtain and interpret ABG:
Make reference to Standard of Clinical Practice
Describe and describe the significance of abnormal blood gas results:
Define mechanical ventilation modes and terms, condition when they are used:
Tidal amounts (Vt)
Minute volume level (Ve)
Define the next mechanical ventilation modes and terms, point out when they are used:
Inverse proportion ventilation
Plan of action:
We will attempt for taking patient who's ventilated and preferably with breathing problems, so she would be able to web page link theory into practice.
We will attempt to work next to each other for support.
Read the Respiratory Source of information File in the teaching room.
Utilize internet sites such as the RCN website, and also access to KA24 or Athens account to access for medical publications and articles.
Borrow books from the town University Catalogue or from the extensive care unit collection.
Meeting every week to evaluate progress and identify areas of improvement.
Revisit and review the workbook and the test that she's done on her respiratory review day and metabolic review day.
Read the Intensive Good care Unit Criteria and Policies Folder
The learner selected an individual with respiratory failure who has developed ventilator obtained pneumonia wit high air requirements.
On questioning she actually is able to format the gross anatomy of the respiratory system and she has exhibited me the illustration that she did for the respiratory research day about the anatomy of the respiratory system. She could identify surfactant, where it is produced and what its role in ventilation and breathing. However she was not able to illustrate in depth knowledge about resistance and compliance and exactly how it affects deep breathing and exactly how it improves venting and perfusion although she was able to define these terms. She finds it difficult to articulate both description and physiology of intrapulmonary shunting. She was able to define the conditions incomplete pressure of gases, vital capacity, and functional residual capacity. She's limited knowledge of alveolar and pulmonary venting, and deceased space.
I have suggested her to learn the respiratory resource file and find out this information. I likewise have photocopied an article from a journal. She's as well during her respite browse through the internet to consider those terms she detects difficult to understand.
We have decided that we will try and revisit these conditions on the very next day.
For the purpose of continuity of care we selected the same patient. Still, she wasn't able to go through comprehensive discourse of alveolar and pulmonary shunting and exactly how it pertains to the patient. She could define deceased space as a general term and had not been able to differentiate between anatomical dead space and alveolar dead space. On questioning she said she's already read about these conditions but she can not remember them as she actually is already tired. I suggested that she needs to jot down and take down notes in a piece of newspaper to help her remind herself what she has learned and read.
The learner finds it hard to keep in mind what she learned both in theory and in the specialized medical setting. She gets easily frustrated and disappointed with herself when these things were emphasized. She feels that her self-confidence has plummeted and will not feel motivated to learn. I've considered this and mirrored to improve my approach when requesting questions and when assisting her.
Although she has achieved these goals at a much later night out, she has needed a lot of encouragement and support.
The learner thought we would select a patient with COPD who's still sedated and ventilated. We are working next to each other and on the first day I've lent her my book for her to learn on another theme that she must discuss. She has said that she could not find it in her book and through the internet. She detects it difficult to even do some research at home because of personal reasons sometimes. I have reiterated that she needs to get balance between work and family life. These details would have been discussed in their breathing study day and that she must revisit the workbook that she's done. I've explained that she needs to think about the actual patient's condition and she needs to relate the knowledge that she's learned into practice. In this way she might be able to remember what she's learned. I likewise have explained that she is to ask my help if she thought that she could not find out any information about this issue. I have enhance her self-assurance by always praising her on what she performed good in the clinical setting up and I was careful on giving feed back again for things that she needs to work on and advanced.
On the second day, on questioning she could discuss about the physiological and chemical control of respiration and summarize the travel of skin tightening and and exactly how it was produced in your body. She was able to relate her knowledge to the genuine patient circumstance that she's to cope with. She also offers a good knowledge of the standard arterial bloodstream gas principles.
With good determination and the right way the learner noticed that she is being respected as a staff nurse so that it brings the best out of her. I also thought that I've provided her with a good learning environment by redirecting her to where she may find this information. I have emphatised with her situation that it is difficult to balance work and personal life especially dividing time taken between family and her job that she couldn't find a chance to borrow literature from the catalogue. I have therefore lent her my e book.
This is a continuation of part of week two about blood gases. She's shown great strategy in how to take test as well as how to do the complete treatment. However she had not been aware that there surely is a policy when planning on taking blood vessels gases in the Criteria and Plan folder. I have instructed her to read on this as guidelines keep changing through time and she needs to regularly upgrade herself with these.
She was not able to interpret the results of the blood gases and she gets perplexed with base extra and deficit in relation to the pH and pCO2. She also had not been able to describe the importance of the results with regards to the patient position. I have suggested her to revisit the workbook that she does in her metabolic and breathing research day. We also have done a whole lot of practice on interpretation of blood vessels gases that could be within the folder in the coaching room. I taught her how to get this done systematically but she locates it hard to grasp.
She can not remember the sources of abnormal blood gases and finds it difficult to relate with the patient position. I have explained these to her and we agreed that she would study and find out about these more.
It took four weeks for the learner to understand fully the importance of the excessive bloodstream gas results and how it pertains to the patient. That is also after I have constantly and regularly go through with her about how to interpret blood gas results and have a great deal of practice every after she have blood gas for her patient. She now feels confident in doing it on her own.
It is currently week four of our working alongside one another and the learner is more confident doing things on her behalf own. That is a week that we will be discussing about ventilator modes and when it is used. In the first week I have already discussed these settings to her within the introductory information and was not discussed in depth.
On questioning she is able to determine the conditions airway pressure, tidal volume and minute quantity, and PEEP but detects it hard to explain the modes of air flow such as SIMV, VC, PS, and CPAP. She has absolutely no knowledge of inverse percentage and what it can for the individual. I have again emphasised that she should browse the respiratory resource document in the teaching room and I've photocopied an article on different ventilator methods and also from the intense care publication.
I also have reiterated that it is expected of her to have learned these by now as she has been in the machine for some time. She acknowledges this and discussed that because before it is difficult to ask older staff nurses as the unit is always active that she had not been able to understand how to associate these settings to the patient. Also she had not been permitted to do anything in the ventilator and mature staff nurses are sometimes hesitant to clarify why they might change ventilator configurations. I have described that from now on I will try to explain why and how a certain mode pertains to a patient and connect it to the condition of the patient. I also have informed her that her learning should begin from within her, that is, she has that desire of learning, and that it is her responsibility to learn for the benefit and safety of the patient.
It took five weeks for the learner to understand the idea of the ventilator modes and how it applies in the professional medical setting. It is however difficult to attain as it needs more time to get experience with a patient on the certain ventilator methods. It had been also difficult for the learner as we are along the way of changing to new ventilators and there are new additional settings that are being presented. I've done this by allowing her to think what needed to be done after interpreting the blood vessels gas results and what involvement she must do with regards to changing modes of ventilation and or changing a specific settings in the ventilator with my supervision.
It is through repeated practice that the learner was able to fully understand and learn the idea of ventilation and exactly how it is applicable for a certain patient. Overall it has been a steep learning curve on her behalf.
It has been five weeks that we have worked alongside one another and I personally think that I've proven a good rapport with the learner. I have considered her concerns in the beginning that she seems under pressure to perform well and become knowledgeable and skilled. Also she thought she actually is not encouraged to learn as there has been frequently when she was remaining on her behalf own rather than being matched with someone mature from the team.
Recognizing the necessity of good desire to improve her morale and gain assurance, I have carefully chosen my approach, providing constructive criticism and praising every good aspects of care that she has done.
She has now shown great eagerness to learn and incredibly willing to ask questions if she seems she needed to know things. Although we still have a lot to do in terms of signing off her competencies, we've met our set in place goals and objectives within the time-frame we've anticipated.
The learner is a fresh staff nurse in the unit who came from a cardiac ward rotation post with absolutely no critical care experience let alone employed in the intensive good care unit. Our unit is a occupied unit running 8 elective operative beds and occasional emergency admissions. Sketching from the learner's experience and interview she has found that working in this product has proved to be very challenging and scary experience. She was given a competency publication which is based on the knowledge and skills framework and should be agreed upon off at least following a time of starting work in the machine. However she's not were able to do that as her past mentor had not been happy to sign her off as they feel she had not been quite ready in conditions of knowledge, competence, and skills.
On interview with the learner she's verbalised that she experienced in so many times approach her mentor to do her book but it was always active and situations wouldn't normally warrant this. She now feels undervalued rather than motivated to follow her competency book as she sensed people were not interested.
Also her self-confidence has plummeted as she considers people are over criticising her work and will not like their way when coaching and encouraging her in the specialized medical area.
I have spoken to her past mentor and she said that the learner finds it difficult to accept criticisms and would ask for feedback at the end of the shift but she cannot take any negative commentary. She has a confrontational strategy when she talks and communicates with her coach, which on interview she herself have acknowledged but said that is not intentional and she has been misconstrued.
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