M E D S U RG N U R S I N G

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1 M E D S U RG N U R S I N G CNE Objectives and Evaluation Form appear on page 234. Mentoring as a Te a c h i n g - L e a r n i n g Strategy in Nursing M a rguerite Riley Arleen D. Fearing C u rrent nursing and facul - ty shortages necessitate development of strategies that pre p a re all students to function in their roles imme - diately after graduation. This study used a practicum expe - rience through which nurse educator students mentore d nursing students to enhance the teaching and learning of both groups. Study methods, evaluation, and results are d i s c u s s e d. M a rguerite Riley, PhD, RN, is an Associate Pro f e s s o r, Southern Illinois U n i v e r s i t y, Edwardsville School of Nursing, Edwardsville, IL. Arleen D. Fearing, EdD, RN, is an Associate Professor Emerita, Southern Illinois University, Edwardsville School of Nursing, Edwardsville, IL. Note: The authors and all M E D S U R G N u r s i n g Editorial Board members re p o rted no actual or potential conflict of interest in relation to this continuing nursing education art i c l e. As the nursing and faculty s h o rtages persist, a need exists to develop unique teaching and learning strategies to facilitate students transition into their professional roles immediately following graduation. The development and use of student-centere d practicum experiences while students are still under the guidance of faculty is an effective strategy to p rovide real situations they are likely to encounter as graduates. The nursing faculty ro l e includes application of numero u s t e a c h i n g - l e a rning strategies to a d d ress students complex learning needs. This typically involves teaching large and small groups in both classroom and clinical settings. Nurse educator students are i n s t ructed on teaching-learn i n g strategies, and during their teaching practicum course they are encouraged to utilize a variety of e ffective strategies in their classroom and clinical practice teaching. An area that often lacks emphasis is how to assist students having difficulty with the nursing content on a one-to-one basis. Strategies for individual, at-risk students or nontraditional students should be varied, including academic support to meet their specific learning needs and help them experience academic suc- cess in the nursing pro g r a m ( J e ff reys, 2001; Price & Balogh, ). The purpose of this descriptive study using student-centere d l e a rning theory was to examine the e ffectiveness of using a nurse educator graduate student in an u n d e rgraduate nursing student mentoring program. Overall expectations were to provide a true life practicum experience for the nurse educator students, and enhance the teaching and learn i n g that could be transferred to their p rofessional roles after graduation for both gro u p s. L i t e r a t u re Review A review of the nursing literat u re using the key words m e n t o r i n g u n d e rgraduate/graduate nursing and practicum in the Cumulative Index to Nursing and Allied Health L i t e r a t u re (CINAHL) database ( ) revealed a number of studies generally related to mentoring undergraduate students using faculty members, alumni, and various levels of student peers. These studies (Fredricks & We g n e r, 2003; Neary, 2000; S p rengel & Job, 2004) primarily examined formal mentoring programs to promote clinical development and increase student re t e n- tion. Research literature was limited in the area of using graduate 228 MEDSURG Nursing July/August 2009 Vol. 18/No. 4

2 students as mentors for undergraduate students. Only one study e x p l o red the use of graduate (MSN) students as mentors for BSN students (Lloyd & Bristol, 2006). No studies were located involving graduate nurse educator students as mentors for undergraduate students. Barker (2006) discussed mentoring of advanced practice nurse (APRN) students. In addition, most of the studies e x p l o red mentoring as a learn i n g p rocess for undergraduate students (Kostovich & Thurn, 2006; M o rr i s o n - B e e d y, Aronowitz, Dyne, & Mkandawire, 2001; Scott, 2005; S w o rd, Byrne, Dru m m o n d - Yo u n g, H a rm e r, & Rush, 2002). None of the studies examined mentoring as a student-centered teachingl e a rning strategy to benefit both the mentors and the mentees. This literature review re p o rts on the studies found related to form a l mentoring programs in nursing which includes faculty and alumni as mentors, student peer- t o - p e e r mentoring, and graduate student m e n t o r s. Faculty and Alumni Mentors Kostovich and Thurn (2006) conducted a qualitative study at a liberal arts university school of nursing to investigate the faculty s p e rceptions of doing group mentoring with students in nursing courses. Faculty mentors were asked to volunteer; eight part i c i- pated. Students enrolled in a 1- hour mentoring course led by one of the eight faculty mentors for four consecutive semesters. The re s e a rchers explored group mentoring along with the process of faculty becoming mentors for nursing students. The results of their study showed some faculty role ambiguity but overall definite personal and pro f e s s i o n a l satisfaction for both faculty and students (p. 12). M o rrison-beedy and colleagues (2001) described the use of experienced faculty members to mentor students and junior faculty in the re s e a rch process. The purpose of the study was to extend the concept and practice of mentoring beyond its traditional focus on clinical training to the realm of nursing re s e a rch. Students and junior faculty part i c i- pated in a re s e a rch project that allowed the principal investigator to delegate many diff e rent tasks as team members learned aspects of the re s e a rch process. No original re s e a rch was involved; only re p o rting studies by others, authors concluded that good mentoring could extend to all part n e r s involved in the re s e a rch pro c e s s. Ryan and Brewer (1997) described a formal mentoring program for undergraduate BSN students utilizing faculty as mentors. The authors described how a mentorship program and a pro f e s s i o n- al role development course were integrated into a BSN pro g r a m. This seminar-type program (graded s a t i s f a c t o ry / u n s a t i s f a c t o ry) involved mentors who had fulltime faculty positions and a minimum of 2 years teaching experience in the BSN program, and w e re willing to serve as mentors for up to 10 students for 2 years. Even though students gave positive comments re g a rding the weekly program, they expre s s e d some concern about the commitment of time re q u i red for an ungraded course. Another mentor pro g r a m design found in the literature involved assigning alumni members as mentors for underg r a d u- ate BSN students (Sword et al., 2002). A Canadian nursing school conducted a mentoring pro g r a m in which baccalaureate nursing students were mentored by alumni from the same nursing pro g r a m. Unlike preceptorship, which generally involves clinical superv i s i o n and perf o rmance evaluation, this mentorship was focused more on sharing and nurturing to pro m o t e personal and professional gro w t h. Student involvement was volunt a ry. The use of alumni as mentors was considered an innovative a p p roach which allowed the students to benefit from their mentors experiences within nursing and the shared experience of graduating from the same underg r a d u- ate program. Because the alumni mentors had no formal evaluation role for the students course grade, greater re c i p rocal re l a t i o n- ships were possible. Benefits for students included incre a s e d understanding of the roles and responsibilities of nursing. Mentors also provided students with c a reer development inform a t i o n and employment re f e rences as well as other learning opport u n i- ties. The mentors re p o rted a sense of satisfaction from working with students and gained an i n c reased awareness of trends and issues in nursing education ( S w o rd et al., 2002, p. 430). Price and Balogh (2001) discussed nurse alumni mentoring of at-risk students in an eff o rt to reduce attrition. Nursing graduates who met GPA and other stand a rds volunteered, were selected as mentors, and matched to at-risk students who signed a contract a g reeing to meet objectives for the one semester program. Even though abiding by the terms of the contract was problematical for both mentors and students, 21 of 24 students completed the term. A high majority of the mentors and students indicated this mentoring p rogram met their needs. Conflicting work and school schedules interf e red with the mentoring contract and led to meetings being missed or postp o n e d. Student Peer- t o - P e e r M e n t o r i n g J e ff reys (2001) described and evaluated aspects of an enrichment program for students, with study groups led by peer mentor/ tutor students. The author noted many students entering nursing p rograms are nontraditional students (older, employed, pare n t s ) MEDSURG Nursing July/August 2009 Vol. 18/No

3 who often are at-risk; a program of enrichment was designed encompassing the various stages of the educational process (p. 143). U p p e r-level nursing course students or those in the RN-BS nursing program who perf o rmed at high academic standards in prerequisite nursing courses and clinical skills, and who had excellent communication skills, were selected and trained to be peer/mentor tutors. Participants in the enrichment program achieved positive academic outcomes, and the author concluded such support strategies should be encouraged and developed. However, Jeff re y s also found retention is influenced m o re often by environmental variables than academic variables. A peer-to-peer mentoring program to teach collegiality was developed in response to the s h o rtage of student advisors and the increased faculty workloads caused by budget limitations (Scott, 2005). Students were encouraged to use , face-toface exchange, or the telephone as mentoring vehicles. Senior students could experience nurt u r i n g, leading, and advising of young student nurses, while the junior students entering the pro g r a m received benefits of a support system. Scott concluded this type of mentoring teaches the value of collegiality; that lesson may carry into the practice environment and reduce the possibility of new graduate burn o u t. A similar program by Spre n g e l and Job (2004) involved secondyear nursing students who serv e d as mentors for first-year students within their initial clinical setting. Each first year student was assigned a second-year student mentor who was enrolled in the m e d i c a l - s u rgical course. Specific role preparation was given to both levels of students. The mentors worked with their mentees pertaining to clinical pre p a r a t i o n s, client care, and expectation for f u t u re clinical courses. This mentoring took place for 4 hours once during the semester because that was the only clinical they re c e i v e d in their 2-hour Fundamentals of Nursing course. Even though only one 4-hour session was involved, those acting as mentors generally believed the experience was positive and a boost to selfconfidence; the mentees were i m p ressed by the knowledge and clinical skills of the mentors. F redricks and Wegner (2003) described a program in which senior nursing students mentore d f reshman students enrolled in a human anatomy and physiology course. Each freshman student shadowed a senior nursing student on a critical care nursing clinical rotation for exposure to critical thinking skills that are necess a ry to apply theory to practice. As a result of their experience, the f reshmen tended to emphasize the i m p o rtance of anatomy and physiology in nursing coursework, and the seniors validated nursing knowledge gained during their 4- year nursing pro g r a m. Graduate Student Mentors Lloyd and Bristol (2006) o ff e red the only study of graduate students (MSN) mentoring undergraduate (BSN) students. This pilot matched the MSN students as mentors with BSN student mentees in a community clinical practicum. Faculty and clinic staff developed the mentoring network as a team to implement health education programs for the clients. Ten students part i c i p a t e d along with one faculty member f rom the MSN and BSN pro g r a m s. Two BSN students were matched with each MSN student to plan e ffective client teaching for clients with asthma, hypertension, and diabetes mellitus. All students completed a Likert survey re g a rding the mentorship and collaboration processes. The survey included six items relating to the perceived effectiveness of the mentoring program in the community practicum, with responses ranging from 1 (s t rongly disagre e) to 5 (s t rongly agre e). The collaboration f o u r-item survey used the same L i k e rt scale. BSN students gave s c o res of points on the L i k e rt scale for the mentoring portion, and for the collaboration surv e y. MSN student evaluations were for the mentoring portion and for the collaboration process. These positive results demonstrated the eff e c- tiveness of the process for this p roject for both levels of students in the community clinical p r a c t i c u m. Mentoring of the APRN was discussed by Barker (2006) as a means to support growth and develop success in the advanced practice role. Her review of studies in advanced practice nursing and other disciplines, including vocational behavior, management, p s y c h o l o g y, guidance counseling, and ethics, concluded a successful mentoring relationship includes understanding the nature of mentoring, monitoring the pro g ress of the relationship, realistic expectations, and positive compatibility of the mentor and mentee. Pitfalls identified in the review included poor communication, impro p e r l y identified limits, and inappro p r i- ate objectives. The author concluded properly stru c t u red mentoring relationships tend to i m p rove professional growth, prod u c t i v i t y, and competence. In summary, this literature review demonstrated the use of mentoring as a means to develop student practice at various levels in the clinical setting. This finding is consistent with the nursing tradition of mentoring used in clinical to promote professional practice (Lloyd & Bristol, 2006; Morr i s o n - Beedy et al., 2001; Ryan & Bre w e r, 1997). In most of these studies, mentoring was a teaching strategy with the main goal to support students in their clinical courses ( F redricks & We g n e r, 2003; Neary, 2000; Scott, 2005; Sprengel & Job, 230 MEDSURG Nursing July/August 2009 Vol. 18/No. 4

4 2004). There f o re, the purpose of the current study was to explore the effectiveness of a formal mentoring program in which nurse educator graduate students ment o red undergraduate students. E ffectiveness was determined by students academic outcomes and completion of an evaluation survey at the end of the semester. For this study, formal mentoring was a planned teaching-learning situation that included expectations of mentor and mentee as well as time to participate in the assigned re l a- tionship. In addition, the pro c e s s was monitored and evaluated. Study Methods Design. This descriptive study examined the effectiveness of using a nurse educator graduate student to mentor an undergraduate nursing student. The mentoring program was developed and implemented in the nurse educator teaching practicum course. Wi t h the cooperation and assistance of the practicum preceptor, each nurse educator graduate student a rranged to mentor an underg r a d u- ate nursing student who was having academic diff i c u l t y. Mentoring was done in face-to-face sessions which could be supplemented by online communication via . Sample and setting. A convenience sample of 18 nurse educator graduate students was obtained f rom a university school of nursing. All of the nurse educator students from the Southern Illinois a rea were enrolled in the teaching practicum course, which is the final course for the nurse educator m a s t e r s specialization. The 18 nurse educator graduate students chose an underg r a d u- ate nursing student with academic p roblems to mentor for one s e m e s t e r. The graduate student s practicum site preceptor helped identify at-risk undergraduate students who might benefit from this mentoring. Fourteen of the practicum sites were at ADN programs, two were BSN pro g r a m s, and two were LPN programs. The level of undergraduate students varied based on the pre c e p t o r s teaching assignment. Ethical Considerations Institutional review board a p p roval for the study was obtained from the university s committee. An explanatory cover letter was developed to describe the program and sent to each of the graduate and the undergraduate students. Written consent to part i c i- pate was obtained from all graduate and undergraduate students who chose to participate. All re s p o n s e s, re p o rts, and evaluations gathere d during the program were handled in a confidential manner by the re s e a rchers. Permission to use the VARK questionnaire in this study was obtained from Neil D. Fleming, designer of the inventory. Implementation and A s s e s s m e n t s In the first meeting between the graduate student and assigned u n d e rgraduate student, the nurse educator student assessed the u n d e rgraduate student s stre n g t h s and opportunities based on a discussion of study skills habits and academic history. The graduate student admini s t e red the Learning Style Assessment using the VA R K S u rvey (Visual, Aural, Read/write and Kinesthetic) (Fleming, 2001). The VARK surv e y, designed for adults age 18 and older, consists of 13 items that identify a person s p re f e rences for gathering, org a n i z- ing, and thinking about inform a- tion. VARK is the learning style modality of instructional pre f e r- ence. Other modalities are personality characteristics, inform a t i o n p rocessing, and social interaction. In the v i s u a l mode, the learn e r p refers information in chart s, graphs, hierarchies, circles, pict u res, media, videos, and We b sites. In the a u r a l mode, learn i n g occurs best when information is h e a rd or spoken, such as with lect u res, group discussions, seminars, tutorials, and talking with other students. In the re a d / w r i t e mode, the learner prefers inform a- tion displayed in text and printed w o rds. Learners using the k i n e s - thetic mode prefer experience and practice that is connected to re a l i- ty (Fleming, 2001). In considering re l i a b i l i t y, consistency of scores over time is not an expectation of the VARK. An i n d i v i d u a l s pre f e rences for learning are predicted to change over time based on experience and t rends toward multimodalities with aging. Content validity of the VA R K is reflected using multiple studies indicating a matching of pre f e r- ences with a person s perc e p t i o n s and learning strategies. The VA R K does not have predictive validity as its design is not diagnostic or predictive. However, some studies have shown that the pre f e re n c e s identified do predict successful study methods. Learning is facilitated when students and teachers have similar pre f e rences (Fleming, ). As determined at the initial mentoring meeting, identified academic and study skills stre n g t h s and weaknesses and the student VARK survey results related to l e a rning pre f e rence provided the basis for the graduate student to develop an academic plan with individualized outcomes for the assigned undergraduate student. With the approval of the practicum course faculty and the graduate student s pre c e p t o r, the plan was presented to the undergraduate student and implemented with his or her acceptance. Meetings usually were face-toface, but also occurre d often. The graduate student submitted pro g ress re p o rts and a s u m m a ry evaluation of student p e rf o rmance to the course faculty at designated intervals during the s e m e s t e r. At the end of the semester, the u n d e rgraduate students completed a 12-item Likert scale evalua- MEDSURG Nursing July/August 2009 Vol. 18/No

5 tion from 1 ( s t rongly agre e ), to 5 ( s t rongly disagre e ) about the eff e c- tiveness of the mentoring. The tool assessed communication, level of assistance, accessibility, feedback and response time, supp o rt, and attitude. Three openended questions addressed the most helpful strategies, areas for i m p rovement, and any additional comments. This formal mentoring p rogram was a graded assignment for the graduate students, pro v i d- ing an actual one-on-one teachingl e a rning experience. Communication. The graduate student and undergraduate student met face-to-face for the initial assessment and administration of the VARK. was used for clarification, communication, and questions. Subsequent meetings w e re arranged jointly; many of the graduate students met weekly with their undergraduate student. Graduate students used s to send academic plans and pro g re s s re p o rts to course faculty members. Faculty members were available to answer questions via , or on the We b - b a s e d practicum course site. They also p rovided feedback on the academic plans and pro g ress re p o rts via . Preceptors were available at the practicum site to discuss c o n c e rn s. R e s u l t s Vark survey re s u l t s. The following single modal learning pre f e r- ences were found for the undergraduate students: one aural, one v i s u a l / read write, one visual/aural, and four kinesthetic. Eleven students were m u l t i m o d a l, with no one channel predominant; two or m o re, up to all four, sensory modes are pre f e rred by the learne r, who is able to adjust to a variety of teaching strategies used by an instru c t o r. Also, they may be able to adapt to other students modes when working in peer g roups. This process is known as m a t c h i n g. Even though all modes can be used by a learn e r, one mode may be pre f e rred more s t ro n g l y. A reas identified for mentoring. Eight major areas for mentoring w e re identified by the graduate students in their assessment plans. Many students cited writing skills as a weakness. Undergraduate students also re p o rt e d c o rrect use of American Psychological Association re f e rencing format and care plan or care map development as problematic. For senior students, résumé development was identified as an area for i m p rovement. In the area of study skills, the graduate students identified undergraduate student needs in management of larg e reading assignments; test-taking skills, especially for standard i z e d multiple-choice questions; and time-management skills. Another a rea in which students fre q u e n t l y requested assistance was pre p a r a- tion for clinical assignments. A number of graduate students worked on specific skill acquisition, such as venipuncture or intramuscular injection, with their u n d e rgraduate student. Also, graduate students assisted the u n d e rgraduates to understand specific content from their courses. Each graduate student developed objectives and teaching strategies, as suggested in their nurse educator courses, in the academic plan to address the a reas identified. Teaching strategies used by graduate students. The graduate students developed teaching strategies based on the VA R K results, as well as discussions of l e a rning needs and pre f e re n c e s with the undergraduate student. A variety of strategies was utilized for the multimodal students with an emphasis on what the individual undergraduate needed. For s i n g l e - p re f e rence students, the strategies best suited for the identified mode were included; howeve r, many graduate students also included strategies to help s t rengthen the student s other modes of learning to assist with adaptation to a variety of learn i n g s i t u a t i o n s. End-of-semester evaluation re - sults. Sixteen of the 18 underg r a d u- ate students completed the evaluation tool; 89% of the scored items w e re in the s t rongly agree o r a g re e categories. One item on each of two evaluations was scored as d i s - a g ree or not enough information t o a n s w e r. The rest of the items on these evaluations were scored in the s t rongly agree o r a g ree c a t e- gories. Several undergraduate students who had been in danger of failing the course stated they passed in part because of the extra help from their mentors. Specific areas of assistance mentioned by the undergraduate students were critical thinking case studies and multiple-choice questions developed by the mentor, l e a rning their study strengths and weaknesses, time management and organization skills, individualized support, and encouragement. No negative comments were received. Graduate students evaluation of the mentoring experience. M a n y graduate students commented that online communication via facilitated implementation of the academic plan they developed. Many used teaching strategies based on the VARK re s u l t s and re p o rted these helped meet the undergraduate student s learning needs. The graduate students re p o rted pro g ress on the goals of the academic plan and also indicated a belief that study skills, critical thinking, understanding of content, clinical time management skills, confidence levels, and overall clinical perf o rmance impro v e d as a result of the mentoring pro j- ect. A number of graduate students stated the experience with one-on-one mentoring incre a s e d their self-confidence in the ability to apply the nurse educator content in the practicum setting. Many re p o rted in narrative comments that pre requisite nurse edu- 232 MEDSURG Nursing July/August 2009 Vol. 18/No. 4

6 cator courses pre p a red them for this project. Several of the graduate students expressed concern about u n d e rgraduate students who missed appointments for mentoring, were late, or were unpre p a re d for the mentoring session by not completing assignments. Some believed their students busy schedule was the reason. These graduate students expre s s e d some frustration and disappointment because they had invested their time and energy into the p roject. Even with these pro b- lems, common to nursing faculty at all levels, the graduate students re p o rted they had made a positive d i ff e rence in the underg r a d u a t e students academic situation and level of achievement for the s e m e s t e r. Implications for Nursing This study demonstrated that an effective mentoring re l a t i o n- ship can be developed to assist with academic achievement and clinical perf o rmance of nursing students. Online tools such as can facilitate communication in the mentoring re l a t i o n s h i p and lead to positive outcomes for all levels of students. Use of an assessment tool such as the VA R K can help mentors develop eff e c- tive teaching and learning strategies for the student. F u t u re re s e a rch should assess the effectiveness of a totally online mentoring program. Also, a longer study could assess further the impact of the mentoring re l a t i o n- ship on both parties. Matching the mentor and student according to VARK pre f e rences could be done to d e t e rmine if student learning and communication with the mentor a re enhanced. Mentoring of a new graduate in the health care setting including a VARK assessment and an individual academic plan can assist with NCLEX-RN p re p a r a- tion. This type of mentoring program also could be used in orientation and inservice or continuing education programs for new graduates in a variety of health care settings. For staff development planning, a VARK assessment could be completed with nurses on each unit. The unit educator then could plan programs to complement the s t a ff learning styles. As identified in the literature re v i e w, a need exists for continued re s e a rch on mentoring in nursing. R e fe r e n c e s B a rke r, E. ( ). M e n t o ri n g : A complex r e l a t i o n s h i p. J o u rnal of the Ameri c a n A c a d e my of Nurse Pra c t i t i o n e r s, 18, Fleming, N. ( ). Teaching and learn i n g styles VARK stra t e g i e s.c h ri s t c h u r c h, N ew Zealand: Au t h o r. Fr e d ri ck s, K., & We g n e r, W. ( ). C l i n i c a l r e l evance of anatomy and phy s i o l o g y : A senior/freshman mentoring ex p e rie n c e. Nurse Educator, 28, J e f f r ey s, M. ( ). E valuating enri c h m e n t p r o gram study gr o u p s : Academic outc o m e s, psychological outcomes and va ri a bles influencing retention. N u r s e E d u c a t o r, 26, Ko s t ovich, C., & T h u rn, K. ( ). C o n n e c t i n g : Perceptions of becoming a faculty ment o r. I n t e rnational Journal of Nursing Education Scholarship, 3, L l oyd, S., & Bristol, S. ( ). Modeling mentorship and collaboration for BSN and MSN students in a community clinical p ra c t i c u m. J o u rnal of Nursing Education, 45(4), M o r ri s o n - B e e d y, D., Aronowitz, R., Dyne, J., & M k a n d aw i r e, L. ( ). M e n t o ring students and junior faculty in faculty r e s e a r c h : A win-win scenari o. J o u rnal of P r o fessional Nursing, 17(6), N e a ry, M. ( ). S u p p o rting students l e a rning and professional deve l o p m e n t through the process of continu o u s assessment and mentorship. N u r s e Education To d ay, 20, P ri c e, C.R., & Balogh, J. ( ). Using alumni to mentor nursing students at ri s k. Nurse Educator, 26(5), R yan, D., & Brewe r, K. ( ). M e n t o r s h i p and professional role development in u n d e r graduate nursing education. Nurse Educator, 22(6), Scott, E. ( ). Peer-to-peer mentori n g : Teaching collegiality. Nurse Educator, 2 0, Sprengel, A., & Job, L. ( ). Reducing student anxiety by using clinical peer mentors with beginning nursing students. Nurse Educator, 29, S word, W., Byrn e, C., Dru m m o n d - Young, M., H a rm e r, M., & Rush, J. ( ). N u r s i n g alumni as student mentors: N u rt u ri n g p r o fessional gr ow t h. Nurse Education To d ay, 22, MEDSURG Nursing July/August 2009 Vol. 18/No