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Essence of care: involving nursing student

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VOL: 98, ISSUE: 18, PAGE NO: 36

Allan Jolly, ARRC, MSc, MA, RMN, RGN, CPNCert, is a lecturer at the School of Nursing and Midwifery, University of Southampton

Last year the government set out a qualitative approach to benchmarking that aims to provide a structure within which all health care employees can share and compare good practice. The document, The Essence of Care (Department of Health, 2001), recommends that the following steps are taken before its principles are applied to your workplace:

Last year the government set out a qualitative approach to benchmarking that aims to provide a structure within which all health care employees can share and compare good practice. The document, The Essence of Care (Department of Health, 2001), recommends that the following steps are taken before its principles are applied to your workplace:

- Agree an area of practice;

- Establish a comparison group;

- Agree best practice;

- Keep score;

- Compare and share;

- Act on/disseminate the results.

Nursing students have a significant presence and role in practice areas. They observe patients or clients in a variety of health care settings and are well placed to identify and gather evidence of good practice. Their observations can feed directly into the local NHS trust's process of assessing, planning and implementing The Essence of Care. The challenge is to find a way to formally involve them in this process.

When West Hampshire NHS Trust began to implement The Essence of Care guidelines it created an opportunity to find out how a good practice evaluation tool for students would work. The trust, which hosts a large number of students from the University of Southampton's mental health and learning disabilities branches, had already decided to start with a 12-site pilot programme that concentrated on record-keeping, so the evaluation tool was designed to contribute to the trust's objectives.

Developing the evaluation tool
In the initial phase a working draft of the tool needed to be developed. Student feedback revealed that including all eight key aspects of care from The Essence of Care documentation (Box 1) would make the form unwieldy and complicated, and therefore less likely to be completed by the students. For this reason 'Principles of self-care', 'Continence and bladder and bowel care' and 'Pressure ulcers' were excluded.

The students, who are already required to submit an evaluation form after each clinical placement, have to complete a substantial amount of paperwork to provide adequate feedback and maintain records of good practice, so it was important to prevent duplication.

A group of seven first-year volunteers completed the first draft and commented on the content, layout and structure of the document.

After discussions with academic and clinical colleagues on the outcome of the first draft, a second simple-format draft was compiled. This was given to a group of 18 third-year students who were charged with evaluating it. They felt that a covering letter was needed to explain the context and purpose of the form.

Further revisions were made after the document had been presented to the mental health team and the West Hampshire NHS Trust's steering committee, and a final format was agreed. The good practice evaluation tool (Fig 1) can be used in any area, ranging from a ward or local unit to the trust directorate. Also, the content of the document can be altered to suit the needs of the user.

It has been endorsed by the head of the School of Nursing and Midwifery at the University of Southampton and the director of nursing and performance at West Hampshire NHS Trust.

The University external users and carers reference group was also involved in the process. Its members were enthusiastic about the focus on good practice and saw no reason why the evaluation tool could not be used by patients or clients and their relatives.

The final stage of the pilot project will be to ask students at the trust's 12 pilot sites to complete the tool.

The tool will be evaluated by assessing the response rate of students completing it and through the use of focus groups. These will be drawn from permanent members of staff at the pilot sites and students who attended those sites during the pilot.

Feedback from the students will enable the tool to be refined or adjusted, if necessary, before it is made available for wider distribution. The nursing students' involvement in the good practice evaluation pilot is now seen as a fundamental aspect of the trust's implementation of The Essence of Care.

Potential benefits
This project is an example of how a government initiative can be integrated into the nursing curriculum, involving students in the process. It has many advantages for academics, students, practitioners and patients or clients (Box 2).

By recording examples of good practice in a formalised and structured way, students will be able to review, reflect on and share their observations with colleagues in other clinical areas, encouraging good practice. Observations of good practice can also be used to fuel discussion and debate in the classroom, developing the students' understanding of the relationship between theory and practice.

Practitioners will also benefit from increased understanding of the nature of The Essence of Care and will gain evidence of good practice in their clinical areas in a structured and formalised way through the feedback contained in the evaluation forms.

Collecting completed evaluation forms from each clinical area that a student attends on placement will highlight the structures and processes of good practice and develop the student's insight into how it comes about.

Such a change in attitude, where the focus is no longer on documenting poor practice and complaints but rather the acknowledgement and exploration of good practice, is likely to boost morale. It is also one of the building blocks for practice development based on high levels of challenge and support (Garbett and McCormack, 2002).

As students become more focused on identifying, discussing and reflecting on specific examples of quality practice their knowledge and skills base will increase. They will assimilate their recorded observations of good practice in one setting and try to emulate them in future practice settings, with a positive impact on the patients or clients in their care.

The good practice evaluation tool is being trialled at the trust's 12 pilot sites. A final evaluation will be carried out in June this year. It is intended that the good practice evaluation tool will become an integral component of the student portfolio, providing both the student and the clinical practice area with a permanent record of good practice.

However, there is no reason why this evaluation tool should be used only by nursing students. The philosophy underpinning The Essence of Care is based on the inclusion and involvement of everyone who has an impact on the patient/client experience - from health care workers and professionals to representative and user groups - and its strength is based on the cooperation of all. With minimal adaptation anyone who has contact with the patient or client, irrespective of professional boundaries or role, may find the tool of use in identifying good practice.

According to Making a Difference (Department of Health, 1999): 'Clinical practice benchmarking is a process through which best practice is identified.' This tool could play a part in encouraging a fundamental change in attitude among those of us who are involved in the care experience. It is hoped that we at West Hampshire NHS Trust will now routinely begin to identify and celebrate good practice in our health care system rather than focusing on negative incidents.

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