Faculty Teaching Modalities and Reflective PracticeFaculty Teaching Modalities and Reflective Practice
This section provides educators with the knowledge and skills to support collaborative student-centred pedagogies in mental health and addiction nursing curricula. Resources and tools also support faculty to engage in and promote self-reflective practice, as well as highlight how faculty can maintain student safety in the learning environment and promote self-care. Finally, this section also focuses on the role of preceptorship, mentorship as a source of nursing faculty supports.
At the end of this section, the educator will have achieved the following:
- Understand pedagogical approaches to teaching and learning that are student centred, collaborative and consistent with recovery-oriented mental health practice.
- Embrace a collaborative ‘learning together’ approach with students and become increasingly comfortable and competent applying this philosophy to teaching practice.
- Understand the importance and promote reflective practice and self-care for both the faculty and student.
- Adopt teaching and learning strategies, activities and techniques that promote student self-reflection and self-care.
- Understand how to support a positive learning environment that supports student safety (i.e., self disclosure).
- Understand how preceptorship and mentorship can be a source of support and professional development for faculty who teach mental health and addiction.
- Understand how to integrate the lived experience advocate in a non tokenistic manner.
Pedagogy in Mental Health and Addiction Nursing CurriculaPedagogy in Mental Health and Addiction Nursing Curricula
Best practice pedagogy underlying mental health and addiction content in nursing curricula is diverse. Some of the diversity is reflected in the nature of the language used to talk about mental health, or psychiatric nursing, or whether a medical model or psychosocial framework is used. The need to prepare nursing students for mental health and addiction practice should motivate and inspire educators’ interest in developing students’ critical thinking and skills in all areas of mental health. In such, educators should also keep an outlook for new pedagogies to stimulate learning.
Methods of best practice teaching approaches are limited, but some approaches include the following.
1. Blended Learning: There is evidence that the blended learning model, which combines traditional face-to-face learning and e-learning, is an effective structural approach to help mental health nursing students recognize and resolve clinical, theoretical and ethical dilemmas. The practice of blended learning provides students with a useful ability to observe the process of supervision and use information technology to enhance clinical skills (Rigby et al, 2012).
2. Problem Based Learning (PBL): Learning through the experience of solving an open-ended problem is an active pedagogy shown to be useful for teaching mental health nursing students. It may have the added benefit of impacting practice post-graduation. Furthermore, students who have been exposed to PBL may require fewer hours of theory to attain learning outcomes, such as positive attitudes toward mental illness, among others (Cooper & Carver, 2012; Happell, B., Moxham, L. & Platania-Phung, C (2009).
3. Inquiry Based Learning (IQL): While similar to PBL in that it is open-ended learning, IQL follows different steps starting with the sudent exploring a theme and choosing a research stream to focus on; formulating a question and pursuing a plan of research that is rooted on critical thinking, which is applied to the central question. Educators play a pivotal role in IQL, assisting in a collaborative manner with planning, assessment for learning and the advancement of individual as well as classwide understanding of personally meaningful content and ideas (Fielding, 2012).
4. Simulation: Simulation is a pedagogy that involves a range of activities that imitate something real, a state of affairs or a process to achieve educational goals (SIM-one, 2016). The purpose of simulation aims to improve safety, effectiveness and efficiency in healthcare (SIM-one, 2016). Simulation is actively used in some curricula however there is considerable variation in nursing programs in terms of: a) the amount of use; b) how it’s used and c) when in the nursing program SIMS is used. For more information, please see Section 7.2.
A range of teaching and learning opportunities and use of different pedagogy is best to impart mental health, illness and addiction knowledge to students. Some teaching approaches rely heavily on the experiential and relational component of mental health nursing in an effort to understand stigma and other attitudinal factors that are part of the mental health work of nurses (Waugh, McNay, Dewar & McCaig, 2014; Stuhlmiller, 2006). The use of case studies as well as online discussions can help facilitate experiential and relationship components (Silva, Furegato & Godoy, 2008). Most educators would agree that a relational nurse who is aware of the role that stigma plays in the experience and care of individuals with mental health concerns is not enough, and that excellence in mental health nursing includes a sound knowledge base of the current theories and best practices of mental illness, as well as the complex interplay of psycho-social-health determinants on the experience of clients and their treatment.
Educators should utilize ‘learning together’ approach with students where educators use active and experiential learning, keeping an open mind when educating nursing students. Teachers are also learners, they learn from students, clients and family.
Educator learning approaches checklist
- Adopts and develops a collaborative, strengths-based, student-centred “learning together” approach to teaching (Gros, 2007).
- Acts as a facilitator, stimulator, coach, motivator of student learning.
- Creates an open, supportive and safe learning environment: “My role is to help you learn and succeed.”
- Uses interactive teaching approaches to make learning fun and engaging.
- Supports student life, outside interests/recreation; attends student/faculty social events.
- Fosters self-awareness, insight, self-assessment for themselves and the student, supports student initiative, autonomy and decision-making.
- Is sensitive to student work load/stress levels and responds accordingly.
- Keeps readings and course work to a minimum.
- Sets realistic expectations (collaborates with students to set goals).
- Offers choice/self-selection of clinical placements.
- Remains available and accompanies students throughout the course and clinical stage: “This is a journey; We’re in this together.”
- Acknowledges student stressors and work load issues; responds accordingly.
- Acknowledges uncertainty and anxiety re: clinical stage; focus on learning process.
- Begins where students are “at”; proceeds at student pace; breaks down learning objectives into small, achievable goals.
- Fosters co-operative peer learning and support, and a non-competitive class environment.
- Remains flexible and works to accommodate student needs and interests.
- Supports student self-reflective practice.
- Supports students active participation in class activities, understanding students’ comfort level while further developing students’ skills.
The Importance of Reflective Practice for Educators and StudentsThe Importance of Reflective Practice for Educators and Students
Nurses have a professional obligation to ensure their practice is consistent with the College of Nurses of Ontario (CNO) or local jurisdictional college standards of practice and guidelines as well as legislation. This includes maintaining competence and refraining from performing activities that they are not competent in (CNO, 2002). As well, nurses need to ensure the appropriate education, support and supervision when acquiring new knowledge and skills to ensure they provide safe,
effective and ethical care (CNO, 2002). The CNO further indicates that nurses must assume responsibility for their own professional development and participate in learning processes to enhance their own practice. In order to meet all of CNO’s requirements, it is recommended that nurses engage in reflective practice and seek opportunities to incorporate reflective practice into their practice (CNO, 2002).
Reflective practice is defined as the ability to examine ones actions and experiences with the outcome of acquiring a new understanding and appreciation of the situation, and developing one’s practice and clinical knowledge (Boud, Keogh, & Walker, 1985; Caldwell, 2013). Reflective practice is associated with positive learner outcomes including but not limited to: improved situational awareness, changed perspectives, and a greater appreciation for the value of their practice (Glaze, 2001). As well, reflective practice contributes to development of new knowledge and skills, and promotes higher levels of understanding, can decrease stigma and increase confidence (RNAO, 2015d and RNAO, 2016e).
It is important that nursing faculty as well as nursing students engage in reflective practice and provide opportunities to integrate the use of reflection. Furthermore, it is imperative that educational institutions promote opportunities for faculty to engage in reflection related to the development of their teaching experiences and expertise, and that they support the ongoing development of teaching and learning activities that integrate use of reflection with students (RNAO, 2016e). Faculty can promote self- and student-reflective practices through a variety of ways, including the use of journaling, learning circles, peer sharing.
Preceptorship and Mentorship for Nursing FacultyPreceptorship and Mentorship for Nursing Faculty
In order to effectively support nursing students in acquisition of knowledge that is evidence- and best practice-based, nursing faculty themselves must receive adequate professional development and support to be up to date on the evidence (RNAO, 2016e). Faculty and educator perceived knowledge and expertise in the subject area has been linked to playing a key role in the optimal promotion of mental health knowledge (Lang & Hahn, 2013). Educational institutions should be aware of the extent of clinical experience and education among faculty, understand whether theoretical and clinical education is current and provide ongoing professional development opportunities either through the practice setting or educational institution to promote the continued transfer of theory to practice (RNAO, 2016e).
Successful preparation of nursing educators requires a combination of education, experience, knowledge and assessment skills that must be supported through allocated time for initial and ongoing professional development (RNAO, 2016e). Professional development opportunities should incorporate education regarding best practices in theoretical components of nursing education, provide opportunities to enhance leadership skills, and provide best practices on clinical teaching strategies, adult learning theories and strategies for student evaluation. Such educational opportunities ensure faculty has the competence and confidence necessary to support students and has been demonstrated to improve quality of work satisfaction (RNAO, 2016e). Effective models of professional development can include preceptorship and mentorship for nursing faculty.
What is preceptorship?
Preceptorship is a formal process of providing guidance and support to another. The relationship is led by an experienced and competent nurse who facilitates the learning and development of the learner (Canadian Nurses Association [CNA], 2004). A preceptor is a one-on-one relationship of a predetermined length, between two individuals designed to adjust to and perform a new role (CNA, 2004).
- Is assigned to facilitate a preceptee’s learning goals.
- Is assigned for a set period of time, usually short-term.
- Is assigned with a focus on learning related to knowledge and skill.
- Is acting as a role model, during regular working hours.
- Can evolve into a mentorship relationship.
Who is the preceptee?
A preceptee can be a nurse with five, 10 or even 15 years’ clinical experience, but who is new to a different teaching area, unit and to caring for a different population of patients. A preceptee may have limited clinical experience and most of those experiences are in the more supported student/school role.
Preceptors act as guides or mentors to the preceptee. To facilitate the learner’s acquisition of the nursing knowledge and skills for safe, competent and ethical practice, preceptors must display certain characteristics and be able to demonstrate the competencies required to teach and role model professional behaviours, nursing skills and values.
Key characteristics of effective preceptors include:
1. Competence in the practice role.
2. Experienced in the role.
3. Strong leadership and conflict management skills.
5. Strong teaching, role-modeling and facilitation skills.
6. Patience and a positive attitude.
7. Excellent oral and written communication skill.
8. An ability to coach and provide constructive feedback.
Preceptors and Clinical Supervision
Preceptors may provide clinical supervision and have a responsibility to provide clinical teaching, instruction and formal evaluation (RNAO, 2016). Clinical supervision is “a formal process of professional support and learning, which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” (Department of Health, 1993, p.15). It provides regular protected time for health-care practitioners to come together to reflect on clinical practice and examine areas of personal and professional growth and work towards achieving these goals. It can occur using a variety of models that include, one-on-one support, peer support, groups and include use of technology such as online supports and telephone supports. For more information on clinical supervision, please see Resources in this section.
What is mentorship?
According to the CNA (2004) definition, mentoring involves a voluntary, mutually beneficial and usually long-term professional relationship. In this relationship, one person is an experienced and knowledgeable leader (mentor) who supports the maturation of a less-experienced person (mentee) with leadership potential.
- Is chosen or selected by the mentee.
- Is usually selected by the mentee to support their professional advancement for an extended period of time.
- Focuses on individual growth and development.
- Is a nurturing and role-modeling relationship, usually during personal time.
For additional tools and resources please refer to Resources in this section.
Student Safety and Mental HealthStudent Safety and Mental Health
It is important for educators to be aware of the various educational approaches and the risks they may pose to student safety and mental health. Since 20 percent of the Canadian population will experience a form of mental illness in their lifetime, this is also true for nursing students. In recent years, some social science and child education practitioners have begun to recognize the detrimental role that trauma can play in learning (Crosby, 2015). To that end, an emerging trend in education are trauma-informed educational practices that recognize the role that trauma plays in learning.
Given the potential for trauma in course work and clinical placements and the risk for vicarious trauma or retraumatization (Carello & Butler, 2015) among nursing students, the emotional safety of students is paramount. The art for nurse educators is balancing the need to hold students accountable to meet the necessary professional competencies, while at the same time creating learning environments that are safe for learning.
The development and application of pedagogies consistent with a ‘caring curriculum’ and with collaborative, student-centred approaches to teaching and learning, serve to promote student mental health and safety while modelling processes basic to collaborative, strengths-based clinical practice and recovery-oriented mental health care.
For more information, please see Resources in this section.
Engaging Lived ExperienceEngaging Lived Experience
Nursing faculty should integrate persons and families with lived experience or support groups in theoretical and clinical education to understand how to meaningfully engage with these persons and their families. Lived-experience involvement has an important role to play in the education of nurses in addressing fear and demystifying the experience of mental illness (Happell, Gaskin & Byrne, 2015).
For more information, see Appendix H, which aims to support faculty in integrating lived experience.
Teaching and Learning Activities
See Teaching and Learning Activities in Section Four: Student Reflective Practice and Self-Care in Mental Health Nursing Education.
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to understand and promote the importance of reflective practice and self-care for both the faculty and student. These questions can be used either to stimulate discussion with colleagues or in reflection exercises.
- What are my beliefs, ideas and experiences regarding mental health and mental illness?
- What specific challenges am I facing in nursing studies and practice?
- What are my strengths?
- What areas of practice do I feel most confident in? Least confident in?
- What are my learning needs and goals?
- What would be most helpful to me at this time/in this situation?
Evaluation and Self-reflection
- Faculty will engage in self-reflection on an a regular basis.
- Faculty will integrate student feedback into their practice – be open to it and seek it.
This guide contains an Educator Self-Assessment Tool for faculty to evaluate their knowledge and skills regarding mental health, illness and addiction in nursing education and practice. Faculty may also wish to consider the Learner Engagement Questions (on this page) upon completing the tool.
- College of Nurses of Ontario. (2002). Professional standards.
- Registered Nurses’ Association of Ontario (RNAO). (2016). Practice Education in Nursing. Toronto, ON: Registered Nurses’ Association of Ontario.
- RNAO. (2014). Developing and Sustaining Nursing Leadership: Tips and Tools
- Harris, M. (2008). Scaffolding reflective journal writing -- negotiating power, play and position. Nurse Education Today, 28(3), 314–326.
- McMillan-Coddington, D. (2013). Reflection through journal writing to educateregistered nursing students on patient care. Teaching and Learning in Nursing, 8(2),63–67.
- Usher, K., Tollefson, J., & Francis, D. (2001). Moving from technical to critical reflection in journaling: An investigation of students’ ability to incorporate three levels of reflective writing. Australian Journal of Advanced Nursing,19(1), 15–19.
TEACHING AND LEARNING RESOURCES
- Perese (2002). Integrating psychiatric nursing into a nursing curriculum.
- Warelow, P., & Edward, K-L. (2009). Australian nursing curricula and mental health recruitment. International Journal of Nursing Practice, 15(4), 250–256.
- Merriam, S. and Bierema, L. (2014). Adult learning: Linking theory and practice. San Francisco: Jossey-Bass.
- St Marys Hospital Centre. (2016). Health Experiences Website. Retrieved at: http://www.healthexperiences.ca/en/
PRECEPTORSHIP AND MENTORSHIP FOR NURSING FACULTY
- Bernard, J. M., & Goodyear, R. K. (2013). Fundamentals of clinical supervision (5th edition). Boston, MA. Pearson Education.
- Campbell, J. (2006). Essentials of clinical supervision. New Jersey, NY: John Wiley & Sons Inc.
- Canadian Nurses Association. (2004). Excellence in professional practice: A guide to preceptorship and mentoring. Ottawa, ON.
- Centre for Addiction and Mental Health. (2008). Clinical Supervision Handbook. Toronto, ON: CAMH.
- College of Nurses of Ontario. (2002). Professional standards.
- College of Nurses of Ontario (2015). Quality Assurance Program.
- Foundation of Nursing Studies. (2013). Guidance for critical reflections on practice development. London: FoNS.
- Crosby, S.D. (2015). An Ecological Perspective on Emerging Trauma-Informed Teaching Practices. Children & Schools, 37(4), 220-230.
- Carello, J., & Butler, L. D. (2015) Practicing what we teach: Trauma-informed educational practice. Journal of Teaching in Social Work, 35(3), 262–278,.
- Elliot, D., & Guy, J., (1993). Mental health professionals versus non-mental-health professionals: Childhood trauma and adult functioning. Professional psychology: Research and Practice, 24(1), 83–90.