Critical Reflection and Pondering on Clinical Supervision and Learning

Introduction

For the goal of this essay the terms clinical supervisor and coach will be utilized interchangeably because they are seen as essentially the same in this context.

Classrooms and books teach someone to care for an individual whom many a time s/he will never really encounter as hardly ever is such a basic patient seen in reality. One must acknowledge that one needs to know the theory to have the ability to apply the practice when on the scientific area. The educational area of ones learning should not be underestimated by positioning all the value in the sensible encounters one encounters. However the intricacy of making and adding ones knowledge into real life situations may only be known through experiential practice.

As Eraut (2009) mentioned learning in college or university does not supply the same learning contexts as the working environment. Medical has historically attained knowledge through various locations such as practices, trial and error, research, intuition, role modelling and mentorship, reasoning and experience. Therefore experiential learning may play an important part of the basis of genuine education if utilised and developed well. However as will be mentioned in this assignment experiential learning alone at times is inadequate as a basis for education in the complexities of learning used, clinical supervisory functions and being a competent doctor.

1. learning in practice

Eraut (2007) longitudinal analysis concluded that under the correct options new recruits learned more face to face than through formal methods. There's a dependence on apt learning opportunities and a supportive environment to encourage and learning in the supervisee.

The Experiential learning cycle explained by Kolb (1984) combines four elements: doing, reflecting, learning and applying that learning. The circuit then combines four ways of knowing - tacit knowledge which can be viewed as the underpinning of 'doing' in ones work. One recognizes 'automatically' and persists to apply intuitively. Next is reflective knowledge which Mezirow (2000) details as affecting openly reflecting and critically reflecting on one's own practice. The final two are 'knowing that' (propositional learning) which materializes from critical reflection and 'knowing how' is the final section of the Kolbs pattern where one confirms competence. One may wonder if the clinical work environment always improves favourable conditions for experiential understanding how to present genuine education.

1. 1 The Clinical workplace

Glen (2009: pg 498) discussing the apprenticeship model that had been around since Florence Nightingale claims that even though the model entails organised supervision as well as periods for representation the results was more targeted at accomplishing the work projects that on genuine reflection. The benefit for this model is the fact it provided newly experienced nurses that acquired achieved enough experience and regarded as a skilful and experienced novice - therefore one could see the basis of education from experiential learning in this model. However this model is no longer in use and could have been abandoned too early (Mc Cormack, Kitson, Harvey, Rycroft-Malone, Titchen and Seers 2001).

Nowadays nurse education is run diversely but one can still remember the matter in the 'clinic trained' nurses when training for nurses travelled into college or university level. One of the primary issues of matter was that medical is a practice occupation so why the necessity for extra knowledge to become a competent practitioner? Should nurses not be taught more in specialized medical practice and less in the school room? "Knowing and doing won't be the same thing" was voiced out many a time. This increases the belief of many that learning in practice is the foundation of education.

The culture of the clinical practice will also have a vital influence on one's experiential learning result. 'The way things are done here' (which could be in a confident or negative attitude) at either the professional medical practitioners (individual) level or at the organisation level or both levels can result ones successful final result (McCormack et al 2001).

On the other palm numerous other factors such as, the organisation one works in, nurse shortages, working in high patient acuity, limited clinical facilities, patient's having shorter measures of stay, unwillingness by the nursing personnel to provide specialized medical guidance and the a scarcity of nurses in the professional medical area enhance the obstacle of obtaining genuine education through experience.

Supervisees need to be 'armed' with the required skills to analyse problems from varying perspectives. Experiential learning may present the foundation of education if the right concern is provided; that is within the level of the supervisees' knowledge and for that reason presenting a beneficial results. If not the knowledge may finish up being frustrating and alternatively than learning through reflecting on a situation it could result instead in utilising eventually inadequate coping methods.

One has to exploit an event through reflection to be able to straighten out, comprehend, give meaning and therefore make appropriate and proactive use from it. Experiential learning thus must provide the probability of growing reflective and other conveyable learning skills in order to promote the education supervisees need and to learn from the knowledge.

1. 2 Critical representation and thinking

Hunt and Wainwright (1994, p. 84) point out that: "Whatever the time put in in a specific portion of practice, procedures that are devoid of rationale for activities are purely process or method orientated and lack critical inquiry".

Several creators have emphasized on the actual fact that representation is requisite in bridging the idea and practice difference (Kolb, 1984, McCaugherty, 1992, Sch¶n, 1987). Applying theory into practice necessitates professionals to critically mirror not only on ones own practice but also on the implications of ones interventions. The books has additionally highlighted reflection as imperative when endeavouring to include theory with repetition (Meretoja, Eriksson & Leino-Kilpi, 2002).

Lisko and O'Dell (2010) acknowledged that nowadays working in such a sophisticated clinical environment necessitates one to employ top notch critical thinking, they also add that to offer such experiences for you to learn from and to reflect on has become essential - this is achieved in the countless different experiential learning opportunities one encounters. Therefore one notes that the medical profession is inclining to recognize and encourage reflective practice and critical thinking and that it also offers education from experience for both supervisors and their supervisees.

Baltimore (2004) features that since optimum patient results will be based upon nurses actions, nurses need to wholly understand a situation in order to critically think. Benner (1984) strains that recording of practical activities and reflecting to them is essential in the development and extension of theoretical knowledge. While Kolb's dual knowledge theory (Kolb, 1984) depicts any particular one knows things when you are in a position to do them together with pondering 'reflecting' about them. One can perceive that it's accepted by the books that reflection provides the opportunity to go over decisions taken and assess as well as evaluate ones learning in order to boost not only ones own practice but also whoever they supervise.

Then again will one working environment with its time constraints boost all this? Is it possible to perform reflective practice whenever needed (Westberg & Jason, 2001)? Is representation not a complicated skill that's basis should be taught in the school room too in order to be fulfilled used? Therefore can experiential learning exclusively provide the ability of how to represent and even more critically reflect on ones experience and in the end gain knowledge from them?

In assistance with reflection arrives the necessity for responses and training which have emerged as important aspects in experiential learning while supervising; not only for the supervisee but also for the supervisor.

2. Clinical supervision

Price (2004) highlights the reason why to why the role of an mentor has come into being, illuminating that the learners' (supervisees) requirement to mature into a competent and confident skilled nurse and doing practice astuteness, good professional medical skills, attitudes and professional medical techniques are best attained in the clinical practice environment.

Being designated to a professional medical supervisor may provide the supervisee with opportunities that may not or cannot be portrayed in classrooms or books. One may think about about whether medical supervisors have sufficient morale and positive attitudes left in these to want to carry on providing guidance in such busy working conditions and nurse shortages. Eraut et al's (2007) analysis findings noted that chosen mentors in medical were either excellent in providing a sustenance or pretty much useless. Therefore is Dewey's assertion right in the latter situations? Will experiential learning provide capable practitioners in these situations?

To turn into a 'good' coach/supervisor one reads extra tall lists about the characteristics required. Rowley (1999) offers a set of 'virtues' a good mentor should hold including determination towards mentoring and its own values, acceptance of one mentees no matter ones personal values/likes/dislikes, effective coaching characteristics, good communication skills with the ability to adjust to ones supervisees learning dynamics, and establish the exemplory case of have to be a constant learner and being positive towards ones mentees/supervisees. Then Quinn (2007) identifies the humanistic characteristics necessary, such as understanding, being approachable, supportive and inclusive in addition to being positive towards learners and an excellent management approach to education values. Grey and Smith (2000) put in a sense of humour to their list.

Therefore you can conclude that the supervisor must constantly show high specifications of personal do and an apt approach towards ones supervisees; with the fact that the supervisee will therefore take in and try to end up like what they have observed as acceptable behaviour in the working place.

However Grey and Smith (2000) analysis studies portray another long list of behaviour supervisors may screen to their supervisees - this time around in the negative, to say a few: delegating futile careers, being of any unfriendly characteristics or worse still being unapproachable, exhibiting lack of interest in their own job in addition to the supervisee and even unpopular with the team they work within. Such supervisors certainly diminish the opportunity of transmitting education through experiential understanding how to any supervisee.

Burnard (1998) possessed rightly remarked that being under the wing of a qualified nurse does not necessarily add up to learning. Learning in practice may mean for some as just 'getting the job done' and the issue of focusing on the learning needs of the scholar or new recruit are still left in the shadow (Andrews & Wallis, 1999) and for that reason excluding the importance of applying and integrating ones knowledge (theory) to the professional medical practice. Even worse, this hinders Dewey's opinion of experience being the foundation of all education.

Having the ability to coordinate the delivery of care and attention in sync with ones teaching and assessing responsibilities, perhaps a prerequisite for a supervisor/coach however as one notices from the books is not a easy task. On the other hand one must keep in mind that equally the newcomers may feel unsafe to apply because they lack knowledge so do a few of the senior staff; some people are not capable (or think it is extremely difficult) of learning, changing or moving on (Eraut, 2002).

Clinical supervisors as all humans vary in the way they present their significant attributes and may need to develop and improve their qualities. This will likely also provide the assistance needed in favour of experiential learning as a basis to education. Identifying and working on these key characteristics should assist one in enriching ones supervisees learning environment. Then again the supervisee could also grab the mal-practices of the supervisor, giving one with the issue of who should be providing professional medical supervision? Who provides Dewey's belief in of education through experience?

3. Competence and Evidence Centered Practice

Nurses' clinical experience is presumed to be an important factor related to quality of attention in the scientific practice. Expert practitioners are seen as fundamental along the way of working out and the professional development of supervisees in addition to the efficient everyday working of a scientific area. Therefore it is necessary to articulate what exactly are the particular prerequisites of one's portion of practice in order to provide beneficial experiential learning opportunities to ones supervisees. Through expert practice the experts talk about experience, knowledge and skills throughout teaching and mentoring not only students and fellow workers but also patients and their families; that happen to be or should be an everyday practice to clinical supervisors, and therefore adding to offering an expert practice and better service to meet up with the patients' needs.

Excellence in health care is vital, as excellence pertains to carrying on learning and research that will augment and additional develop nurses in their profession and give a boost to the medical methods (Castell, 2008). Nowadays lifelong learning and research in nursing practices are acknowledged as prerequisites in order to maintain and move forward nursing competence (Avis & Freshwater, 2006; Westberg & Jason, 2000). Therefore even if experiential learning can be an important basis of learning in practice and is the how, what, why so when all gathered jointly there still remains the prerequisite of up to date evidence based knowledge/practice.

Avis and Freshwater (2006) state that Evidenced structured practice EBP is regarded as a significant principle in skilled professional medical practice and is also assessed by one's capability to assimilate EBP in the treatment on is to provide. EBP is acknowledged as an indispensable factor of nursing competence. But is EBP supplying too much importance to scientific evidence and therefore underrating the role of specific nursing expertise and its clinical judgement (Hardy, Garbett, Titchen & Manley 2002)?

Supervisees need specialized medical supervisors with the apt level knowledge, skills and training not only in their practice but also in their coaching/learning approach and environment to be able to enhance and steady the supervisees' individual improvement and education.

4. The learning environment - 'learner centeredness'

Another aspect books has shown is the fact scientific supervisors should move to the value of providing a learner methodology rather than the more customarily utilised teaching approach. By using a learner centred approach one will in addition need to inspire a feeling of attention that will drive the supervisee to soak up everything s/he can see or listen to or read about nursing in order to improve the efficiency and performance of his/her eventual proficient practice. This will necessitate the supervisor to have the supervisees' needs at the hub of the actions being performed - not a fairly easy task within medical areas and their always increasing workloads and enough time factors of any scientific environment (Waldock 2010).

Learners obtain knowledge from experience that they then incorporate into their own system of principles; and thus the reason why one should emphasise on the value of the supervisee's energetic talk about in learning. Supervisees in order to learn from their experience have the duty to discover their own clinical educational needs through their personal company and discover ways how they may retrieve these specialized medical needs; which may be through their supervisors or others in the specialized medical area that may provide assistance (Eraut 2008).

One must definitely provide a significant experience for the supervisee which ends product will be what the supervisee will understand to be relevant to their learning needs (Wlodowski 1999). Learning centeredness sometimes appears as being beneficial to the supervisee as it will provide opportunities that may well not be came across during formal coaching surroundings (McKimm and Jolie 2003). Therefore emphasizing on the notion that experiential can offer the foundation to education particularly if one notes that fundamentally everything that occurs in the clinical area; whether it is at a client's bedside, in a center, ward or operating theatre and the desires, provides a learning opportunity.

The supervisor must however concentrate on the supervisees' learning needs and by working jointly, given that this is a two-way discussion, s/he will gain the data and skills required and therefore boost his/her knowledge. As a result this may provide experience as a basis to education.

Providing a learning centeredness environment provides the chance for the supervisee to work together with their supervisor and at the same time presenting the opportunity for the supervisee never to only be involved in the activities but also to learn new skills, techniques, perceptions, to recognize all of the knowledge and skills others behold and also to even witness tacit knowledge.

4. 1 Tacit knowledge

Observing provides the opportunity to understand quicker and therefore demanding briefer explaining. Another benefit for this frame of mind of learning through observation and talk is the fact that it can display the tacit knowledge a supervisor holds on day-to-day and intuitive and instinctive decisions that are difficult to explain (Eraut 2009).

Epstein & Hundert (2002) recognise tactical knowledge as intuition and pattern acknowledgement they continue to add that intuition performs a component in acquiring qualified practice. Epstein et al's analysis in addition exposed that doctors now believe their competence is reliant also on tactical knowledge - a fact that nurses have valued for years and believe competence is not only based on explicit knowledge but also tactical knowledge. Certain skills can't be disseminated by formal teaching together. Skills are therefore defined in terms of knowing how to do things, an example being Polanyi's (1958) Balance Rule which could apply to nursing skills where the beginner will watch and then practice. Hence the importance of learning methods

4. 2 Learning methods

Providing the right learning method is so sophisticated. From the literature one notices that there is no perfect menu to learning ideas. A specialized medical supervisor educating supervisees in the medical setting has a major impact on those supervisees' end result performance. The supervisor's methods may have the influence to improve and help the supervisees learning and provide new learning in specialized medical practice if not to curb the supervisees' capability to use knowledge and skills.

Frankel (2009) highlights that the premise to clinical learning methods may be ineffective if they are not tailored to the supervisees learning style and continues to highlight that learning methods fluctuate to the individual and thus the value in providing the most appropriate for that individual to learn appropriately. Everyone has some particular favoured method of collaborating with and handling knowledge. That is one of why one may consent to Eraut (2002) discussion that you need to not concentrate on which learning theory is right or incorrect but on the other hand one should give importance about how to obtain obtain the most through the learning process. You can add the utmost benefit to be able to provide from competent practitioners.

The supervisees may be at different levels in their course or novices to certain specific areas of their office and so learning from experience should not be provided or provided as a 'one size meets all' situation (Quinn 2007). When providing experiential learning as a basis to clinical learning the clinical supervisor must consider the supervisees previously gained skills and knowledge and also the expectations they may have brought along.

As it's been observed there is no strict recipe to adhere to in order to make a 'right' coaching/learning strategy. As well as theoretical education as soon as you have found the right environment, the 'right' strategy for both the supervisee and one that the skilled supervisor is apt at undertaking, what is still left is both the supervisees and supervisors self motivation to learning, their sense of attention and inquisitive brains, willingness never to only knowing more but also to change (Khomeiran, Yekta, Kiger, & Ahmadi 2006).

5. Competence

It is vital that specialized medical supervisors make use of well-established scientific skills and a higher standard of experienced nursing practice that will support effective facilitation of student learning (Gaberson & Oerman, 2007).

Rutkowski (2007, p. 37) represents evaluating competency as complicated and being predicated on direct observations as well as entailing ones thoughts and opinions of values, which are subjective and keep personal beliefs which might vary from someone to another. For experience to be the basis of education one must understand what competency really is and what it signifies. When one thinks of all the controversies on competence one may find it complicated to agree that experience alone provides competent practitioners.

Conclusion

Although experiential learning may definitely have its importance in providing a basis for education one involves the conclusion that so do theoretical learning and personal traits of both the supervisor and supervisee. These are essential factors to learning in addition to motivation, attention, an inquisitive head and the drive to continue learning. To know and not to act is never to know. Experiential learning is both transformational and transmissional; it offers changes in ones attitude and behaviour and really should not be observed as only as the change of ideas or knowledge.

The useful and academic attributes of the supervisor and supervisee are both important. The academic aspect provides knowledge, broadens ones horizons and exams ones manner of considering. Experiential and academic learning compliment one another thus the abilities gained from both learning styles should bring into being a safe, capable and knowledgeable specialist and all this may assist Dewey's perception of experiential learning being the basis of education.

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