An exploration of the clinical mentoring process in nursing education placements in Hong Kong

Abstract

Background: Clinical mentoring in pre-registration nursing students is an important but under researched aspect, particularly in Hong Kong. A review of relevant literature revealed that clinical mentoring is mainly portrayed from a single perspective of either clinicians, educators or students. Research has been carried out mainly in western settings. Clinical mentoring is co-constructed by the interactions between the people, environment and organisations. It was useful to qualitatively explore the social process of mentoring in hospital placements. Aim: to explore the social process of mentoring within the context of pre-registration nursing clinical placements in hospital settings in Hong Kong Method: This study adopted the methodology of constructivist grounded theory. Participants, including organisers of clinical placements, clinical instructors, clinical mentors and students were recruited by purposive sampling initially; theoretical sampling was adopted later. 19 individual face-to-face intensive interviews were conducted and analysed using constant comparison. Relevant documents sampled from different organisations were also included in the data analysis. Strategies recommended for use in constructivist grounded theory were adopted to ensure the rigour of the study. The study received ethical approval from the relevant authorities and followed the required ethical guidelines to protect participants and assure research integrity. Findings: The social process of clinical mentoring was co-constructed by multiple core interactions process within the organisational and cultural context. Clinical instructors/ mentors and students underwent an expectation-impression-social judgment-feedback cycle within the core interactive mentoring process. Expectations of students were influenced by various official guidelines, clinical instructors'/ mentors' past experiences and the organisational context. Clinical instructors/ mentors assess their students by different assessment strategies and formed their impression of students. They made social judgment and provided feedback accordingly. Feedback was designed to shape students' actions in subsequent interactions. Three types of feedback were identified, and this could bring impacts to students' competence and confidence. Discussion: Clinical mentoring was predominantly influenced by the clinical rather than educational organisations involved. Mandatory clinical assessments were formalised and conducted ceremonially in the form of rituals which emphasised symbolic meaning of action instead of evidence-based practice. Clinical instructors/ mentors used destructive feedback to manage poor student performance, errors and mistakes often with negative consequences. A theoretical framework of clinical mentoring process was constructed based on the data. This could be best understood by using a dramaturgical approach. The current practice of clinical mentoring thus failed to adequately foster critical thinking, produced inadequate clinical mentoring, failed in adequately performing its role as a gatekeeper, and produced negative impacts on students. Conclusion: A theoretical framework explaining the social process of clinical mentoring illustrated how different people interacted in the environment of a hospital setting within clinical mentoring. This study confirmed findings from previous literature and provide new insights about the importance of the clinical learning environment to the development of constructive clinical mentoring.

Date of Award	1 Aug 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Moira Attree (Supervisor) & Hannah Cooke (Supervisor)