What impressed the judges looking at Aintree’s entry to the Student Nursing Times Awards was its creativity.
Despite being the regional trauma critical care unit providing care to critically injured patients across the Cheshire and Mersey region, the busy placement goes out of its way to provide innovative solutions dedicated to helping students learn in a realistic and memorable way.
“We collaborated with our local hyperbaric unit, which ran a three-day pre hospital trauma life support (PHTLS) course for healthcare professionals and emergency services, and arranged for our students to take part,” says Ann Butler, practice education facilitator for Aintree NHS FT.
“The students played the parts of victims in a mock car crash. One has a fractured neck, one has a broken arm and so on. We tell the “victims” about their conditions, respiratory rate and heart rate and they work with the multidisciplinary team who are trying to treat them. While they are acting, they get to learn from the teams managing their care and see first hand what they do.
“They get really involved and, for example, will alert the team if someone has moved the patient inappropriately as this could have paralysed them in real life. They really learn from what
goes on around them.
“And at the end of the day, there is a debrief so they can see which teams work best and how they can carry what they have learnt through to their nursing.”
Learning in simulated real-life situations enables the students to appreciate the trauma that patients experience and how this affects them.
According to Ms Butler, “The beauty of critical care is that students learn by the bedside and see a huge variety of medical conditions”
Preparing students by discussing the potentially difficult or tragic situations they may encounter whilst working in Critical care is an important element of the student induction day.
“We spend time talking to them about what they will see to gauge whether they will need additional emotional support,” says Ms Butler.
Students can gain information about the clinical area prior to the placement. The Placement Learning & Support System (PLSS) holds information describing the unit and suggested learning opportunities. Mentor details and contact phone numbers for the department are also provided. “We also produce a student guidebook, which gives them information about the trust, library opening hours, car parking, as well as guidance on infection control in this high risk area maintaining a professional image.”
“The induction day is a 9 to 5 full day, run by the practice educator or one of the link nurses. The students are given an introductory lecture which covers the history of Critical Care and describes the patient’s journey. If possible the PEF and the link lecturer meet the students on this induction.
All students are allocated a designated locker and, although a small thing, it is an important element of making sure the student feels “a part of things” is essential to creating a good experience, according to Ms Butler. The students are given a tour of the clinical area and shown the bedspace and introduced to all the equipment used at the bedside.
Students are encouraged to familiarise themselves with basic equipment before looking after a patients. The sheer number and complexity of devices in use can be very overwhelming.
Each student is allocated a mentor. Ms Butler says that giving them support throughout their time is vital. “We give them a one to one mentor and a back up mentor, whom they work
closely with. They may well work with other nurses and other members of the multi-disciplinary team but we try to ensure that at least 40% of their time is spent with their mentor.”
That nurse is selected on the basis of how suitable their shifts and working patterns are to that of the student as well as their personal style. “We try to match the student’s needs to the
mentors work pattern as much as possible to accommodate other jobs and also try to match the student’s learning style to that of the mentor”
“One of the real bonuses of one to one mentorship is that the mentor gains an in depth insight into the student’s learning and progress. The mentors are also able to identify learning
opportunities as they occur on the unit and can make sure they get to see everything they need to understand the unit.”
If the mentor identifies that a student is not coping, I am always on hand Monday to Friday to help if they feel a student needs extra support.
“We train our mentors regularly to enable them to help students meet their learning outcomes and support them. We run a quarterly mentor support day. It’s multidisciplinary for half a day, and the other half is NMC related and we educate them about anything new they need to know. These days are also attended by HEI representatives ensuring collaborative
approach to supporting the students” says Ms Butler.
“Registrants also attend a one-day workshop because we know that supporting students in practice is about the whole team. The workshop explores how to support students and produce a good learning environment and match their learning needs to their outcomes.”
Understanding the patient journey in its entirety is also vital.
Student nurses are able to have a spoke placement with paramedics, follow the patient into A&E and may also go through to theatre. They may also meet former patients who
return to attend the unit follow up clinic.
Integrating the students into the placement is as much about understanding as it is belonging.
Gaining feedback is a priority in understanding how we could do better as a placement. Feedback is gathered by the universities and fed back to the unit who respond with an action plan if required. Critical Care also gives their students another questionnaire while they are still on placement.
“This gives us instant feedback and enables us to capture what are the most appropriate day to day learning opportunities, especially if they go to spend their time with other teams. We want them to feel that they have gained the most from their visits.”
This has taught Aintree to change certain aspects of the placement.
“For example, in response to a student feeling very upset when caring for a young patient who had been admitted to the unit and subsequently died, we have had to consider our counselling and supportive measures more closely” says Ms Butler. Learning from student experience is not only enriching future students’ time with the trust, it is also enhancing practice.
“We support a North West student quality ambassadors (SQA) scheme, where every six months students who have completed a change management project share their project with practice, highlighting areas where they think improvements can be made. This encourages them to think about change management and innovative new practice.
“One of our students identified that a checklist for start of shift checks would be useful at the bedspace. It was familiar to us but unfamiliar to them and so we’ve taken that on board, it will be useful for new staff as well as students.
“They alert us to the areas to be developed and help us to identify solutions,” says Ms Butler.
She knows that providing a placement enables two-way learning for both student and staff, and does everything she can to support that through creating the right environment.
Tips for providing a great placement
- Provide a proper induction - a full day if appropriate. It should be structured to give students a tour, introduce them to key personnel and familiarise them with procedures and patient conditions they may see
- If you can’t offer them a broad range of experiences in your setting, think about transferring them to spend time with other multi-disciplinary members of the team to get a wider view
- Be creative in the way you approach learning - would role playing where they act the part of the patient enable them to pick up more?
- Expose them to training scenarios and situations that your qualified staff are taking part in
- Conduct your own student questionnaires to ensure you understand how well the placement is doing and evaluate where you can improve it
- Use the objectivity and the fresh perspective that students have to ask them what things need to change to improve the way you run things - don’t be afraid to learn from your students
- Recognise that they will not have been exposed to as much as you and will need more emotional support if they see particularly difficult situations or traumas