Figure 8.1 illustrates the complexity of the learning environment as experienced by both learners and teachers. The placement or workplace and the university are separated only by a dotted line as they are connected. All settings are located in
= Sociopolitical Context and Professional Body Requirements = The Placement/Work Setting The University Setting Mentor/Line Manager Learning style Philosophy Ideology Professional Skills Attitudes
Tutor Learning Style Philosophy Ideology Professional Skills Attitudes Placement/Workplace Team: Culture/Dynamic/ Size/Gender mix/Ethnicities Range of experience Confidence
Learner Learning styles Expectations Experiences Anxieties Ideology Motivations Learning Group Group: Culture/Dynamic/ Size/Gender mix/Ethnicities Range of experience Confidence
Institutional Arrangements Organizational Culture Accesstoresources Learning Outcomes Assessment Relevance Appropriateness
Learning Outcomes Assessment Relevance Appropriateness = Sociopolitical Context and Professional Body Requirements =
= Opportunity to demonstrate and extend learning = The Patient/Service User Institutional Arrangements: assessment systems; student support; contacts with tutors Organizational Culture Access to resources Overall Curriculum Design and Delivery Figure8.1Thelearningenvironment(adaptedfromAshcroftandForeman-Peck1994)
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the wider sociopolitical context that largely determines organizational policies and directives. In professional and vocational education everyone (students, mentors, consultants, managers and employers) is bound by the requirements and codes of practice of the professional bodies. Such policies, directives and codes of conduct connect the university with the world of practice but most importantly, for our purposes here, organizations and the university are connected through the learner and service user. This makes the learner the primary conduit for communication be- tween the two systems and equally accountable to both organizations. The service user is central in the model as they provide the key site of the student’s immediate learning and are also the focus of theoretical teaching delivered in the university.
This centrality of the patient is made explicit in practice supervision and in the portfolio work and case studies that students are often required to produce for assessment.
Reflection point
To illustrate aspects of the relationship between the university and prac- tice setting, think about a patient who has become a case study for you.
r How and why did you choose this individual? For example, because they were typical/atypical of a health condition, because discussions with your mentor/supervisor highlighted a particular aspect of the in- dividual’s situation?
r How well do the circumstances and experiences of the patient (e.g. di- agnosis, care and treatment, outcomes) fit with the theoretical models discussed in the classroom or textbooks?
r Given these initial reflections, how might you incorporate your think- ing about theory and practice in future assignment, presentation and portfolio tasks?
Figure 8.1 infers that the learner is subject to a variety of communications within both organizations, as indicated by the directional arrows, from tutors, mentors, managers and peers. If the learner does not pay sufficient attention to the var- ious communications (e.g. policy and practice documents, academic texts, tele- phone calls, instructions, emails, lectures, group presentations) they could come unstuck. Also, if the communications to the learner are not clear the student could be disadvantaged. The diagram helps us appreciate the demands on the learner and the potential intensity of their experience. It highlights the need for learners and teachers to engage in a dialogue so that miscommunications and misunderstand- ings are minimized and shared meanings established. This may include mutual understanding of what is required, in terms of learning outcomes and standards to be achieved, documents to be completed, types of work to be undertaken and what to do if things start to ‘go wrong’. These understandings and expectations are often managed through a learning contract, which might already be formatted
by a learning programme. However, learners and teachers still need to bring their own ‘stamp’ to learning contracts to facilitate preferred learning styles, previous learning experiences and ‘world views’ or ‘lifeworlds’ (Barrington and Street 2008;
Ekeburgh 2009).
Vignette Negotiating a learning contract
Aashi is a second-year student nurse. The ward-based placements of the first year suited her as she was easily able to balance her family life and the course.
She has now been placed in a community team and feels nervous. Aashi is aware that she will have to take more responsibility for her time management in the community, a setting that is more fluid than the familiar routine of the wards.
Although she has transferable knowledge and skills, it has been recommended that she familiarizes herself with at least two other conditions that are managed in the community. There is documentation to be signed during the placement, but Aashi is not sure of her mentor’s availability to supervise, monitor, assess and sign the paperwork. Tomorrow she meets her mentor to discuss the learning contract and placement experience.
Activity
r Consider the complexity of the learning environment and think about the roles and responsibilities of the learner and mentor in Aashi’s situation.
r How can Aashi best prepare for the meeting with her mentor? What sort of role could she adopt in this meeting (e.g. should she be a more or less passive or active learner)?
r How could the mentor best prepare for the meeting? What would be a good approach to supporting her in the placement?
r What do you think might be the most important points to emphasize in the learning contract?
Once practice supervisors and students have established basic understandings, more complex, negotiated meaning-making can ensue and this is often concerned with the patient experience and local clinical practices. Learning regarding the service user and clinical environment is usually developed through discussions in both the university and practice settings. A student will discuss practice with clinical colleagues and also with university tutors and peers. In this discussion the learner has to manage the boundaries of confidentiality between the two spheres in which they are working and learning. The challenge lies in taking the experience from the practice environment into the learning environment, while maintaining the dignity, anonymity and confidentiality of service users and colleagues.
Vignette Managing confidentiality
Geoffrey has just returned to university after a placement on a medical ward working with older people. To help him remember the practice issues, he kept a reflective diary and also took photos of ward situations and patients with his mobile phone. As well as bringing these to share with the tutor group he has included them in his e-portfolio as he thinks it lends authenticity to his work, an important aspect in portfolios. Geoffrey’s peer group are very impressed with his materials and there is a lot of discussion, especially as a group member recognizes one of the patients from a previous placement. The conversation focuses on the details of this patient’s situation. When the tutor arrives she stops the exercise and asks the group to stay behind over lunch.
Activity
r Thinking about the complexity of the learning environment and the relation- ships between all those involved, how do you understand what is happening in the last vignette?
r If you were the patient under discussion, or a relative, what might you think about this situation?
r How do the principles of the Nursing and Midwifery Council (NMC) Code (2008) help you to understand the issues raised in this scenario?
r As the tutor, how would you approach this situation with Geoffrey and the student group?