Art & science
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The synthesis of art and science is lived by the nurse in the nursing act
Josephine G Paterson
Mentoring nursing students in the sexual health setting Brown K, Plant S (2014) Mentoring nursing students in the sexual health setting. Nursing Standard. 28, 35, 37-39. Date of submission: January 13 2014; date of acceptance: February 17 2014.
Abstract The sexual health setting provides many opportunities for nursing students to meet the competencies set out in the Nursing and Midwifery Council’s Standards for Pre-Registration Nursing Education. However, students who are daunted by the setting may adopt a passive, observer role. Mentors may find it a challenge to facilitate the learning of pre-registration nursing students in this setting. This article explores several strategies that mentors can adopt to make learning active and relevant for nursing students. These strategies may also be relevant to other nursing fields and to midwifery students.
Authors Kate Brown Principal lecturer in primary care and child health, School of Health and Education, Middlesex University, London. Selina Plant Charge nurse/lead nurse, Camden Provider Services, Central and North West London NHS Foundation Trust, London. Correspondence to: [email protected]
Keywords Mentors, nurse education, nursing students, sexual health
Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software.
Online Guidelines on writing for publication are available at www.nursing-standard.co.uk. For related articles visit the archive and search using the keywords above.
© NURSING STANDARD / RCN PUBLISHING
IT HAS BEEN SUGGESTED that many nurses may have limited formal pre-registration nurse education in sexual health (Evans 2013). However, even when nursing students have the advantage of experiencing a placement in a sexual health setting, they may adopt a passive stance, believing that all they are able to do is observe. In the authors’ experience, students’ reasons for adopting a passive, observer role included feeling overwhelmed by an environment that is different to a ward placement, believing that people who attend the sexual health clinic do not need the practical clinical care they are used to giving, or feeling that they do not have the specialist knowledge required. Kong et al (2009) conducted a survey of nursing students’ knowledge, attitude and readiness to work with people who have sexual health concerns. They found that while students’ knowledge of sexual health was satisfactory, they were hesitant about taking an active role in relation to sexual health needs and were anxious about colleagues’ and service users’ adverse reactions. It has been highlighted that many registered nurses feel ill-equipped or unprepared to explore private or intimate aspects of a patient’s sexual health or relationships, or may be too embarrassed to talk to someone about the side effects of medical conditions or treatment regimens relating to their sexual health (Gott et al 2004, Evans 2013). Therefore, a placement in a sexual health setting could help nursing students gain the confidence to address patients’ sexual health needs in general settings. Mentors may also find it challenging to facilitate learning in the sexual health setting. In annual NMC-required update sessions, the authors have heard mentors explaining that they accept the students’ view of the specialist nature of sexual health, rather than promoting their setting as a april 30 :: vol 28 no 35 :: 2014 37
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Art & science nurse education valuable area in which students can develop a professional approach to talking to patients about sexual health. Evans (2013) explained that the sexual health setting can provide learning opportunities relevant to three domains of sexual health: sexual wellbeing integral to holistic care, sexual wellbeing associated with other health conditions, and insight into specific sexual problems and infections traditionally referred to as sexual health. The sexual health setting has the potential to provide learning opportunities relevant to all four domains that underpin the Nursing and Midwifery Council’s (NMC) (2010) Standards for Pre-Registration Nursing Education: professional values; communication and interpersonal skills; nursing practice and decision making; and leadership, management and team working. The mentor has an important role in helping students to make connections between their pre-registration nursing programme requirements and the experience available on their placement. This article describes some strategies that the authors have found successful in supporting mentors to aid the learning of students in the sexual health setting.
Learning styles Honey and Mumford (1986) described four common learning styles, with most learners using more than one style: Activists – prefer doing and experiencing. Pragmatists – like to ‘have a go’ to see if things work. Reflectors – like to observe and reflect. Theorists – want to understand underlying reasons, concepts and relationships. Activists will enjoy the new experiences of the sexual health setting, but may easily become frustrated if they are not offered the opportunity to practise their skills. Pragmatists will also want an opportunity to practise and may struggle unless they can see an obvious application for the learning. Reflectors will welcome the opportunity for reflection in the sexual health setting, but they may not appreciate the opportunity to gain other generic skills unless directed to do so. One of the strengths of theorists is their ability to ask logical probing questions, and they will appreciate understanding the systematic structure of a sexual health assessment. However, they may have a low tolerance for the uncertainty and ambiguity that can be features of a sexual health consultation (Honey and Mumford 1986).
Promote self-awareness Placement in a sexual health setting provides an opportunity for nursing students to become aware 38 april 30 :: vol 28 no 35 :: 2014
of their attitudes to sexuality, and to be open to hearing the views of others. In particular, as Evans (2013) explained, it provides an opportunity to explore what is involved in giving non-judgemental care and to be introduced to frameworks that can assist the practitioner to discuss sexual health issues in general settings. This strategy to develop self-awareness can help nursing students to ‘practise in a holistic, non-judgemental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity’ (NMC 2010). If this learning opportunity is highlighted at the first meeting between the student and mentor, then an objective relating to this can form part of the learning contract. This means that even when the student takes on a passive, observer role, he or she can be encouraged to reflect on practice and actions taken to develop self-awareness (Schön 1983).
Use of a workbook All nursing students will be given an introduction to anatomy and physiology of the reproductive system in the first year of their pre-registration nurse education programme. However, unless they have the opportunity to undertake a gynaecology or urology placement before they are placed in a sexual health setting, they may have had limited opportunity to apply their knowledge to practice. Therefore, as a joint venture between Middlesex University, London, and relevant sexual health clinical placement areas, a workbook was developed by the university and sexual health practitioners to help students make links between their anatomy and physiology knowledge and apply this to practice. All second-year students are given a workbook when they arrive at their placement, and it begins with a section containing simple diagrams of the male and female reproductive systems, along with relevant questions and a section on the menstrual cycle. Students are encouraged to bring their workbooks to their placements so that they have diagrams to refer to and practical activity to do if an opportunity for self-directed study arises. The workbook can be complemented by the use of three-dimensional anatomical models. Such models can enhance student learning in the same way that they are used to help service users understand important information such as condom application or intrauterine device insertion. After a consultation, asking a student to explain the anatomy or a particular process with the aid of a model can provide the mentor with feedback on the student’s understanding. Other sections of the workbook direct students to information sources, such as Sexual Health for Non-Experts (Royal College
© NURSING STANDARD / RCN PUBLISHING
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of Nursing 2014), which encourage self-directed learning in relation to sexually transmitted infections and methods of contraception.
of Health 2013). Using antibiotic-resistant gonorrhoea as an example, students can gain insight into the reasons for resistance.
Increase practical clinical care
Develop health promotion skills
Nursing students should be involved in all aspects of clinic organisation, including setting up rooms, preparing equipment and clearing equipment or instruments away at the end of clinics. This expectation should be set at the first meeting of the student and mentor and related directly to NMC (2010) standards. In addition to important learning about managing systems and gaining organisational skills, students’ involvement in these processes provides them with opportunities to engage actively with colleagues and service users as well as to increase their confidence in sexual health. Often, the time spent tidying away after a clinic will provide the mentor with an opportunity to discuss difficult topics or situations that might have arisen. This also gives the student an opportunity to ask questions that he or she might find embarrassing. As students become accustomed to the clinical environment, the mentor can assist them with a plan to practise their clinical skills. Students should be encouraged initially to observe and then to undertake skills under direct supervision, including, for example, specimen collection, pregnancy testing and demonstrating condom application on a model.
Nursing students beginning a placement in a sexual health setting are unlikely to have the skills to offer service users health promotion advice. However, it is important to communicate to students that confidence develops with knowledge. In the authors’ workplace, students have access to health promotion materials at the start of their placement and mentors include a knowledge aim such as ‘by the end of week one, you will be able to answer six quiz questions on the Family Planning Association leaflet on chlamydia’. This simple strategy, repeated weekly, may encourage the student to read actively (Cottrell 2013). Once the mentor has confidence in the student’s knowledge, it can be developed in subsequent weeks with a view to the student providing information to a service user under supervision. It is best to begin with simple topics such as vulvar hygiene, which allow the student to increase his or her confidence in talking about sensitive topics. It is useful to involve students in contributing to a ‘topic of the month’ noticeboard aimed at all staff. Initially, students can gain health promotion knowledge by reading the board. Active involvement in sourcing information can provide further learning opportunities.
Develop generic healthcare knowledge The sexual health environment provides a range of learning opportunities concerning general healthcare knowledge that are transferable to other placements. However, students sometimes need explicit guidance as to how useful this knowledge can be for them in the future. For example, there are many aspects of infection control that can be illustrated in the sexual health clinic, such as understanding the distinction between viruses and bacteria. Likewise, one of the most significant challenges for health care in the future will be antimicrobial resistance (Department
Conclusion Sexual health settings provide learning opportunities for nursing students that can be applied to general settings and can enable students to address patients’ sexual health needs without embarrassment and while reducing stigma. However, students and mentors can be daunted by learning in this setting. The strategies suggested in this article aim to support the mentor in helping the student acquire skills that will enable him or her to meet NMC (2010) standards NS
References Cottrell S (2013) The Study Skills Handbook. Fourth edition. Palgrave Macmillan, Basingstoke.
health and wellbeing: the role of the nurse. Nursing Standard. 28, 10, 53-57.
Department of Health (2013) Annual Report of the Chief Medical Officer. Volume Two, 2011. Infections and the Rise of Antimicrobial Resistance. The Stationery Office, London.
Gott M, Galena E, Hinchliff S, Elford H (2004) “Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care. Family Practice. 21, 5, 528-536.
Evans DT (2013) Promoting sexual
Honey P, Mumford A (1986) The
© NURSING STANDARD / RCN PUBLISHING
Manual of Learning Styles. Peter Honey Publications, Maidenhead.
Pre-Registration Nursing Education. NMC, London.
Kong SK, Wu LH, Loke AY (2009) Nursing students’ knowledge, attitude and readiness to work for clients with sexual health concerns. Journal of Clinical Nursing. 18, 16, 2372-2382.
Royal College of Nursing (2014) Sexual Health for Non-Experts. tinyurl.com/odpb99y (Last accessed: April 10 2014.)
Nursing and Midwifery Council (2010) Standards for
Schön DA (1983) The Reflective Practitioner: How Professionals Think in Action. Temple Smith, London.
april 30 :: vol 28 no 35 :: 2014 39
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If you would like to contribute to the Art & science section, email [email protected]
The synthesis of art and science is lived by the nurse in the nursing act
Josephine G Paterson
Mentoring nursing students in the sexual health setting Brown K, Plant S (2014) Mentoring nursing students in the sexual health setting. Nursing Standard. 28, 35, 37-39. Date of submission: January 13 2014; date of acceptance: February 17 2014.
Abstract The sexual health setting provides many opportunities for nursing students to meet the competencies set out in the Nursing and Midwifery Council’s Standards for Pre-Registration Nursing Education. However, students who are daunted by the setting may adopt a passive, observer role. Mentors may find it a challenge to facilitate the learning of pre-registration nursing students in this setting. This article explores several strategies that mentors can adopt to make learning active and relevant for nursing students. These strategies may also be relevant to other nursing fields and to midwifery students.
Authors Kate Brown Principal lecturer in primary care and child health, School of Health and Education, Middlesex University, London. Selina Plant Charge nurse/lead nurse, Camden Provider Services, Central and North West London NHS Foundation Trust, London. Correspondence to: [email protected]
Keywords Mentors, nurse education, nursing students, sexual health
Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software.
Online Guidelines on writing for publication are available at www.nursing-standard.co.uk. For related articles visit the archive and search using the keywords above.
© NURSING STANDARD / RCN PUBLISHING
IT HAS BEEN SUGGESTED that many nurses may have limited formal pre-registration nurse education in sexual health (Evans 2013). However, even when nursing students have the advantage of experiencing a placement in a sexual health setting, they may adopt a passive stance, believing that all they are able to do is observe. In the authors’ experience, students’ reasons for adopting a passive, observer role included feeling overwhelmed by an environment that is different to a ward placement, believing that people who attend the sexual health clinic do not need the practical clinical care they are used to giving, or feeling that they do not have the specialist knowledge required. Kong et al (2009) conducted a survey of nursing students’ knowledge, attitude and readiness to work with people who have sexual health concerns. They found that while students’ knowledge of sexual health was satisfactory, they were hesitant about taking an active role in relation to sexual health needs and were anxious about colleagues’ and service users’ adverse reactions. It has been highlighted that many registered nurses feel ill-equipped or unprepared to explore private or intimate aspects of a patient’s sexual health or relationships, or may be too embarrassed to talk to someone about the side effects of medical conditions or treatment regimens relating to their sexual health (Gott et al 2004, Evans 2013). Therefore, a placement in a sexual health setting could help nursing students gain the confidence to address patients’ sexual health needs in general settings. Mentors may also find it challenging to facilitate learning in the sexual health setting. In annual NMC-required update sessions, the authors have heard mentors explaining that they accept the students’ view of the specialist nature of sexual health, rather than promoting their setting as a april 30 :: vol 28 no 35 :: 2014 37
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 17, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Art & science nurse education valuable area in which students can develop a professional approach to talking to patients about sexual health. Evans (2013) explained that the sexual health setting can provide learning opportunities relevant to three domains of sexual health: sexual wellbeing integral to holistic care, sexual wellbeing associated with other health conditions, and insight into specific sexual problems and infections traditionally referred to as sexual health. The sexual health setting has the potential to provide learning opportunities relevant to all four domains that underpin the Nursing and Midwifery Council’s (NMC) (2010) Standards for Pre-Registration Nursing Education: professional values; communication and interpersonal skills; nursing practice and decision making; and leadership, management and team working. The mentor has an important role in helping students to make connections between their pre-registration nursing programme requirements and the experience available on their placement. This article describes some strategies that the authors have found successful in supporting mentors to aid the learning of students in the sexual health setting.
Learning styles Honey and Mumford (1986) described four common learning styles, with most learners using more than one style: Activists – prefer doing and experiencing. Pragmatists – like to ‘have a go’ to see if things work. Reflectors – like to observe and reflect. Theorists – want to understand underlying reasons, concepts and relationships. Activists will enjoy the new experiences of the sexual health setting, but may easily become frustrated if they are not offered the opportunity to practise their skills. Pragmatists will also want an opportunity to practise and may struggle unless they can see an obvious application for the learning. Reflectors will welcome the opportunity for reflection in the sexual health setting, but they may not appreciate the opportunity to gain other generic skills unless directed to do so. One of the strengths of theorists is their ability to ask logical probing questions, and they will appreciate understanding the systematic structure of a sexual health assessment. However, they may have a low tolerance for the uncertainty and ambiguity that can be features of a sexual health consultation (Honey and Mumford 1986).
Promote self-awareness Placement in a sexual health setting provides an opportunity for nursing students to become aware 38 april 30 :: vol 28 no 35 :: 2014
of their attitudes to sexuality, and to be open to hearing the views of others. In particular, as Evans (2013) explained, it provides an opportunity to explore what is involved in giving non-judgemental care and to be introduced to frameworks that can assist the practitioner to discuss sexual health issues in general settings. This strategy to develop self-awareness can help nursing students to ‘practise in a holistic, non-judgemental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity’ (NMC 2010). If this learning opportunity is highlighted at the first meeting between the student and mentor, then an objective relating to this can form part of the learning contract. This means that even when the student takes on a passive, observer role, he or she can be encouraged to reflect on practice and actions taken to develop self-awareness (Schön 1983).
Use of a workbook All nursing students will be given an introduction to anatomy and physiology of the reproductive system in the first year of their pre-registration nurse education programme. However, unless they have the opportunity to undertake a gynaecology or urology placement before they are placed in a sexual health setting, they may have had limited opportunity to apply their knowledge to practice. Therefore, as a joint venture between Middlesex University, London, and relevant sexual health clinical placement areas, a workbook was developed by the university and sexual health practitioners to help students make links between their anatomy and physiology knowledge and apply this to practice. All second-year students are given a workbook when they arrive at their placement, and it begins with a section containing simple diagrams of the male and female reproductive systems, along with relevant questions and a section on the menstrual cycle. Students are encouraged to bring their workbooks to their placements so that they have diagrams to refer to and practical activity to do if an opportunity for self-directed study arises. The workbook can be complemented by the use of three-dimensional anatomical models. Such models can enhance student learning in the same way that they are used to help service users understand important information such as condom application or intrauterine device insertion. After a consultation, asking a student to explain the anatomy or a particular process with the aid of a model can provide the mentor with feedback on the student’s understanding. Other sections of the workbook direct students to information sources, such as Sexual Health for Non-Experts (Royal College
© NURSING STANDARD / RCN PUBLISHING
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 17, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
of Nursing 2014), which encourage self-directed learning in relation to sexually transmitted infections and methods of contraception.
of Health 2013). Using antibiotic-resistant gonorrhoea as an example, students can gain insight into the reasons for resistance.
Increase practical clinical care
Develop health promotion skills
Nursing students should be involved in all aspects of clinic organisation, including setting up rooms, preparing equipment and clearing equipment or instruments away at the end of clinics. This expectation should be set at the first meeting of the student and mentor and related directly to NMC (2010) standards. In addition to important learning about managing systems and gaining organisational skills, students’ involvement in these processes provides them with opportunities to engage actively with colleagues and service users as well as to increase their confidence in sexual health. Often, the time spent tidying away after a clinic will provide the mentor with an opportunity to discuss difficult topics or situations that might have arisen. This also gives the student an opportunity to ask questions that he or she might find embarrassing. As students become accustomed to the clinical environment, the mentor can assist them with a plan to practise their clinical skills. Students should be encouraged initially to observe and then to undertake skills under direct supervision, including, for example, specimen collection, pregnancy testing and demonstrating condom application on a model.
Nursing students beginning a placement in a sexual health setting are unlikely to have the skills to offer service users health promotion advice. However, it is important to communicate to students that confidence develops with knowledge. In the authors’ workplace, students have access to health promotion materials at the start of their placement and mentors include a knowledge aim such as ‘by the end of week one, you will be able to answer six quiz questions on the Family Planning Association leaflet on chlamydia’. This simple strategy, repeated weekly, may encourage the student to read actively (Cottrell 2013). Once the mentor has confidence in the student’s knowledge, it can be developed in subsequent weeks with a view to the student providing information to a service user under supervision. It is best to begin with simple topics such as vulvar hygiene, which allow the student to increase his or her confidence in talking about sensitive topics. It is useful to involve students in contributing to a ‘topic of the month’ noticeboard aimed at all staff. Initially, students can gain health promotion knowledge by reading the board. Active involvement in sourcing information can provide further learning opportunities.
Develop generic healthcare knowledge The sexual health environment provides a range of learning opportunities concerning general healthcare knowledge that are transferable to other placements. However, students sometimes need explicit guidance as to how useful this knowledge can be for them in the future. For example, there are many aspects of infection control that can be illustrated in the sexual health clinic, such as understanding the distinction between viruses and bacteria. Likewise, one of the most significant challenges for health care in the future will be antimicrobial resistance (Department
Conclusion Sexual health settings provide learning opportunities for nursing students that can be applied to general settings and can enable students to address patients’ sexual health needs without embarrassment and while reducing stigma. However, students and mentors can be daunted by learning in this setting. The strategies suggested in this article aim to support the mentor in helping the student acquire skills that will enable him or her to meet NMC (2010) standards NS
References Cottrell S (2013) The Study Skills Handbook. Fourth edition. Palgrave Macmillan, Basingstoke.
health and wellbeing: the role of the nurse. Nursing Standard. 28, 10, 53-57.
Department of Health (2013) Annual Report of the Chief Medical Officer. Volume Two, 2011. Infections and the Rise of Antimicrobial Resistance. The Stationery Office, London.
Gott M, Galena E, Hinchliff S, Elford H (2004) “Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care. Family Practice. 21, 5, 528-536.
Evans DT (2013) Promoting sexual
Honey P, Mumford A (1986) The
© NURSING STANDARD / RCN PUBLISHING
Manual of Learning Styles. Peter Honey Publications, Maidenhead.
Pre-Registration Nursing Education. NMC, London.
Kong SK, Wu LH, Loke AY (2009) Nursing students’ knowledge, attitude and readiness to work for clients with sexual health concerns. Journal of Clinical Nursing. 18, 16, 2372-2382.
Royal College of Nursing (2014) Sexual Health for Non-Experts. tinyurl.com/odpb99y (Last accessed: April 10 2014.)
Nursing and Midwifery Council (2010) Standards for
Schön DA (1983) The Reflective Practitioner: How Professionals Think in Action. Temple Smith, London.
april 30 :: vol 28 no 35 :: 2014 39
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