There is a continuing need to prepare a nursing workforce that is adaptable within a range of care settings. The fa…
VOL: 103, ISSUE: 10, PAGE NO: 30
Kay Norman, MSc, PGDHE, BSc, RGN, is principal lecturer in primary care
Melanie Parker-Norton, BSc, DipHE, RMN, Cert HP, is senior lecturer and project lead; Melanie Ranford-Mills, BSc, DipN, RN, is MS nurse specialist and has a secondment as lecturer practitioner; all at the faculty of health at Staffordshire University
There is a continuing need to prepare a nursing workforce that is adaptable within a range of care settings. The faculty of health at Staffordshire University seconded a lecturer practitioner for a 12-month period to conduct an audit on primary care placements. Mentors were involved in the audit in order to include their views and opinions alongside those of students.
The overall aim of the audit was to assess the current effectiveness of primary care placements of pre-registration nursing students. The objectives were to:
- Ascertain whether students and mentors feel prepared for primary care placements;
- Determine the type and format of primary care information that students and mentors would like in preparation for primary care placements;
- Provide recommendations.
Thirty pre-registration nursing students at various stages of their training and 30 mentors from primary care settings affiliated to Staffordshire University were randomly chosen to participate. A postal survey was chosen to ensure anonymity.
Some 53% (16) of nursing students and 50% (15) of mentors returned completed questionnaires. More than half of the students questioned stated that they did not feel prepared or were unsure whether they felt prepared for primary care placements:
‘I had little knowledge of the roles of the primary care team …’
‘I did not feel prepared as I didn’t have any knowledge about my community placement …’
Asked when it would be most useful for information to be delivered, the majority of respondents stated that they would like it before the placement. They were also asked in what format they would like this information. Both students and mentors said they would like an information package that could be referred to within the placement area, supported by taught sessions within the university. Suggestions from respondents relating to information that may be appropriate included:
- Information about agencies/social care within primary care;
- Structure of the NHS within primary care;
- Roles and responsibilities of the primary care team and students;
- Collaborative working, practice environments, communications network;
- Legal and ethical issues pertinent to primary care;
- Clinical skills in wound management.
This audit had limitations - most notably, the sample size of respondents - and therefore the results cannot be widely generalised. However, it did highlight areas for improvement in preparing pre-registration students for primary care placements.
SETTING UP THE PROJECT
A coordinator for primary care development within the pre-registration programme was appointed in the faculty to contribute to curriculum development. A project lead was also appointed to develop a primary care information package/workbook for pre-registration nursing students. A variety of relevant stakeholders were consulted, including mentors, community placement facilitators, nursing students and academic staff from the faculty of health.
DEVELOPING THE WORKBOOK
Community placement facilitators (CPFs) were a key link in formulating the content and structure of the workbook. The CPFs formulated mentor packs and encouraged placement areas to have induction packs for students. Although many placement areas had achieved this, there was a wide variation in the content and quality of such packs within the various placements/PCTs. In delivering an effective workbook, disparity in the placement induction packs was addressed via discussions with the CPFs.
Listening to stakeholder views, using recent relevant literature available and referring to the previous audit results helped to structure the format and topic areas that were to be included in the workbook. This also needed to encompass areas identified as useful by the stakeholders who developed the students’ learning during the placement.
During the first three months of the project much time was afforded to networking and research. Regular monthly meetings with line management on the progress of the workbook also helped to identify areas that needed amending (either inclusion of topics or omitting areas) from the various meetings with stakeholders. Through this ongoing consultation process with the stakeholders, the final topic areas included within the workbook were:
- An introduction on using the workbook;
- Preparing for placement - a placement induction checklist, learning outcomes, student responsibilities, mentor responsibilities and learning opportunities;
- Professionalism in primary care - NMC Code of Conduct, issues of confidentiality, consent and ethics;
- What is primary care? - defining primary care, roles and responsibilities, the role of PCTs and strategic health authorities,
and information on practice-based commissioning and the General Medical Services contract;
- The primary care environment - what to expect, promoting health, communication and cultural awareness;
- The primary care team - roles of the multidisciplinary care team with a focus on the various professions of nurses in primary and community care (including role profiles from specialist primary care nurses, for example health promotion/public health specialist and community matron);
- Useful contacts, resources and a full reference list.
As the workbook developed, advice and guidance was sought from key academic staff within the faculty. Senior lecturers with particular expertise in their field (for example practice nursing, district nursing, health visiting, school nursing, community mental health nursing, legal aspects in healthcare) were approached to contribute to specific areas. These staff members were involved in curriculum development and teaching on adult and mental health branches, and were able to offer practical advice on the content and level of activities developed within the workbook.
Third-year students were selected to appraise the drafts as they had gained experience in primary care and were in a useful position to reflect on what they had learnt during these placements and where they felt the gaps were in their knowledge base. They also offered useful insight into the ‘user-friendliness’ of the workbook.
Throughout the workbook, activities and case scenarios for students to engage in, particularly during periods of self-directed study, are interwoven. These are designed to reflect the learning outcomes throughout the three years of the pre-registration nursing programme.
As this workbook is not summatively assessed, all activities are voluntary. It must, however, be available for use each day of the placement. Students are encouraged to use relevant activities to help achieve their learning outcomes, to support their clinical assessments and help develop their portfolio. The workbook can be used by mentors to facilitate directed study/activity for further discussion and can be used as a tool/element within each student’s portfolio to present at future interviews for primary care roles.
Collaboration with the CPFs was also vital when finalising the launch of the primary care workbook. Their network with mentors, the PCTs and other stakeholders within the primary care environment will help prepare primary care staff for the implementation of the workbook.
With the final details established, lecturers and CPFs will launch the workbook within the university to ensure a thorough explanation of its usage and expectations. This will give students an opportunity to ask questions and clarify any issues that arise. CPFs will ensure that clinical placement staff and mentors are introduced to the workbook before this to ensure continuity of the information given.
The workbook is to be made into a PDF document and a link will be established on the university website so that mentors and students will be able to access the material online. Hard copies were distributed to 124 students within their first six months of pre-registration nurse training in January 2007 as a pilot scheme. The pilot of the workbook will be evaluated in July this year.
FUTURE PLANS FOR THE PROJECT
This project has attempted to fill an identified gap in the pre-registration programme and to support students in preparing for their primary care experience. The workbook will have served its purpose if students gain:
- A better understanding of the dynamic nature of primary care and their own role within it;
- An awareness of the focus on the current health agenda for delivering care in a community setting;
- Increased enthusiasm to progress to a potential career in this unique and challenging area of nursing care.
- Approximately 15 million people now live with a long-term condition that will require support with self-management or continuous care in the primary care setting (DH, 2006).
- Many nursing students continue to visualise ‘nursing’ as focused on hospital/acute care, with clinical placements traditionally focused in acute nursing services (Phillips et al, 2000).
- Gopee et al (2004) suggested there is an extensive range of healthcare facilities available that could be used for learning opportunities for students in the primary care setting.
IMPLICATIONS FOR PRACTICE
- The audit showed that half of nursing students felt unprepared for a placement in primary care.
- Nursing students would like information about the primary care setting before undertaking a community placement.
- The information that nursing students were interested in receiving covered a range of topics including the roles and responsibilities in primary care.
- Increasing understanding of primary care will hopefully encourage nursing students to consider working in the community when qualified.
This article has been double-blind peer-reviewed.