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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

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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 The message is sent to the recipient Recipient receives message & responds

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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). EEWR

• • • •

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

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Past conditioning experiences

Sender Message Response

The present situation

Non-verbal Signals of a ‘ friendly attitude’

(Argyle, 1994 in Ellis et al, 2003 p10) [vs ‘

unfriendly attitude’ ] Proximity Orientation Gaze Facial expression Gestures Posture Touch Tone of voice Verbal contents

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Closer, lean forward if seated More direct, but side to side for some situations More gaze and mutual gaze More smiling Head nods, lively movements Open arms stretched towards each other rather than arms on hips or folded More touch in an appropriate manner Higher pitch, pure tone 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 5 Staff nurs e Band 7 Sister 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 contextual factors technocratic factors , which are task-oriented, routinised and superficial interactions by the nurse; and the second is 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 student mentor 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 student mentor 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 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 How student mentor can demonstrate competence in these outcomes

…..

…….

……….

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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).

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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 (2 nd 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 (3 rd edn). New Jersey: Pearson Education. Sullivan E J, Decker P J (2009) Effective Leadership and Management in Nursing (7 th 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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