Ward 62 is a gynaecological ward at Darlington Memorial Hospital, and as a result can be emotionally tough for its first, second and third year nursing students.
“Commonly, we’ll see miscarriages and pregnancy loss and sometimes terminations due to abnormalities along with other things that can be upsetting for students,” says Sonya Heath, who is a clinical sister / early pregnancy assessment sister.
For that reason, it’s important that students are prepared early about what they may see.
“Even before they arrive, they have access to an induction pack, which lists the kinds of procedures they may see, the terminology we use and gives them more insight into some of the conditions they will come across while they are with us,” she says.
And then on day one, they are given a thorough induction, and asked how they will feel about seeing some of the procedures or experiences they are likely to witness on placement, explaining exactly what will happen during certain procedures.
“At that point, they may tell us they have had miscarriages themselves or don’t think they can handle the types of things they’ll see. And even if they say they’ll be OK, we keep a close eye on them and support them throughout their time,” says Ms Heath. “Although we encourage them to see everything, sometimes we can’t expose them to every experience all the way through, we can show them certain aspects of care, and then support their understanding by talking about it.”
To achieve this, each of the three students the ward has at any one time, will have a mentor and a back-up or associate mentor to ensure the commitment of taking care of the student is shared.
The nine mentors and three associate mentors are selected depending on their availability and are given regular training and workshops in teaching and mentoring at least annually to ensure they are able to pass on their skills.
Mentors will assess the skills of their students and personalise their programmes of teaching accordingly. “For example, some students are here in their first placement and need to learn basic skills, while others may come having some nursing knowledge as they’ve worked as an auxiliary, or others can be with us in their third years,” says Ms Heath.
The ward makes the most of unscheduled quiet times by creating a quiet library area for students to read up on policies and procedures, or look practice policies up on the intranet, or enhance their reading on the internet. This is also the time when mentors can reflect with students on what they’ve learnt so far.
“We can also send them to other gynae areas so they can work with other nurses or disciplines to see how they work,” says Ms Heath. Student nurses go on ward rounds with doctors, work with physios, dieticians, oncology nurses, pre-assessment nurses and the discharge management team.
As well as working with other team members, the placement arranges for students to see the entire patient journey. “This enables them to see patients at pre-assessment, getting them ready by checking they’re not anaemic or checking ECGs to make sure they are fit for admission; seeing them on the ward and in recovery so they can see where the patient is likely to have pain or bruising and learn how to make them comfortable, as well as seeing how they cope when they go home and perhaps do too much, by working with the outreach team to see post-discharge care. The students love this bit of continuity because of the insight it gives them into the whole patient experience.”
One of the areas that Ms Heath says the students can find challenging is how to handle an emotionally difficult conversation with a patient, who has, say, just had a miscarriage or received bad news.
“They can shadow a nurse when she talks to the patient if the patient gives her permission, but it can be difficult to observe. We noticed that other finalists in the Student Nursing Times Awards used role play, and this is one of the things we are thinking of doing with our bereavement midwife,” she says.
Despite the sadness involved in much of the work, the placement is hugely popular with students. Ward 62 receives far more requests from Teesside University students for elective placements than it can accommodate. Ms Heath believes it’s down to the team spirit. “All members of the team remember how they felt as students, and are very open and keen for their students to learn.”
Tips for providing a great placement
- Create an induction pack that enables students to be familiar with the type of work they will encounter
- Prepare your students by telling them exactly what they will see and how they will be likely to feel
- Give them emotional support throughout the process and a chance to talk
- Encourage them to see everything, but be sensitive if you think they have personal reasons that make it difficult to get involved in a certain aspect of treatment
- Create a quiet area and give students a chance to study, learn and use the trust’s or organisation’s intranet and internet
- Involve students in the entire patient journey so they can see all aspects of care and how the decisions made by other members of the multi-disciplinary team affect the patient
- Make sure students familiarise themselves with the wider multi-disciplinary team so
they understand all aspects of care