Having felt that pre-registration nurse education should include more on pressure ulcer prevention, one student took action that spawned a series of events nationwide
With support from NHS England, NHS Improving Quality and universities, student nurses have run conferences across the country on pressure ulcer prevention. The success of the events suggests that, as emerging nurse leaders, students recognise they have a key role in educating, motivating and galvanising their peers around a shared purpose.
Citation: Banks S et al (2016) How student nurses can influence care quality. Nursing Times; 112: 9, 12-13.
Authors: Suzanne Banks is chief nurse at Sherwood Forest Foundation Trust, formerly professional adviser, NHS England Midlands and East; Ruth May is nurse director, Monitor; Elizabeth Boath is associate professor and national teaching Fellow, Staffordshire University; Sarah Tilford is improvement manager – patient safety, NHS Improving Quality; Charlotte Johnston is staff nurse – critical care, Papworth Hospital Foundation Trust.
- This article has been double-blind peer reviewed
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Many pressure ulcers are preventable but, when they do occur, they can have a profound impact on the wellbeing of patients – they can be both painful and debilitating (Moore and Cowman, 2009). Education on prevention is essential; both the National Institute for Health and Care Excellence clinical guidelines (2014) and quality standards (NICE, 2015) highlight the importance of training and education. The Department of Health, (2015) highlights the provision of safe care, including pressure ulcer prevention, as a priority for the NHS in England.
In 2012, the then strategic health authority of the Midlands and East launched a high-profile campaign to raise awareness and support the elimination of avoidable pressure ulcers, as one of its ‘five ambitions’. This was an opportunity to work at scale to minimise harm to patients. In April 2013, after hearing about the Stop the Pressure campaign, Charlotte Johnston, then a student nurse, tweeted the regional chief nurse as she felt insufficient time was spent on pressure ulcer prevention in the undergraduate curriculum. This was the catalyst for action. What started as a tweet culminated in a 450-strong student conference and other events held around the country.
The conference aimed to raise awareness of pressure ulcer prevention among students and support the spread of evidence-based practice that was developed as part of the campaign. Objectives were to:
- Enable the future nursing workforce to benefit from knowing about pressure ulcer prevention as early as possible in their career;
- Encourage student nurses to champion the cause when on clinical placement by raising awareness with colleagues, and supporting the spread of information and education.
The conferences were student-led from initial concept through to execution. An organising committee was established, which included NHS England, NHS Improving Quality (NHS IQ), the University of Lincoln and the lead students from the events team. The organising committee was to support and give direction to the events team, which was made up of students.
Planning for the first and subsequent conferences was split into two phases: tasks that needed to be done before and after the event. Pre-event planning involved:
- Preparing a core script with key messages, circulated to stakeholders;
- Sending direct mail-outs to directors of nursing and student-placement areas;
- Submitting a script to stakeholder bulletins;
- Engaging with social media: tweets about the event would feature the agreed hashtag and #stopthepressure;
- Booking and briefing a photographer.
Having patients and carers speak at the event enabled students to hear their compelling stories. Through that emotional connection, it was possible to call on others to take action.
Post-event tasks included:
- Making the presentations from the event available;
- Issuing a press release to ensure media coverage of the event;
- Determining how to capture evaluations from students on the day;
- Capturing the key learning from the event in a follow-up report.
Outcomes and evaluation
The conferences were an opportunity for a day of learning about pressure ulcer prevention. The inaugural conference at Lincoln had a strong social media presence, resulting in a Twitter reach of 330,000 and more than 2 million timeline deliveries. Four further conferences followed across the country; together, these reached more than 2,000 students.
The conferences were lively and a rolling Twitter feed kept the audience – and those unable to attend – engaged. This appeared to support Junco et al’s (2011) suggestion that Twitter can be used to engage students in ways that are important for their development.
At the end, students evaluated each conference according to three themes:
- Inspirational ability: “The best conference I have ever been to”;
- Educational and informative nature: “Enjoyed so much and learned a lot”;
- Professional: “Very well organised and so professional throughout.”
Students said they “feel more confident now that I have knowledge when I go into practice” and “I learnt so much”, suggesting the knowledge gained would be meaningful in their clinical practice.
Despite the many positive points about the conference, there were some challenges. A difficult aspect of the students’ campaign for pressure ulcer prevention was not just the planning, but also gaining support from their student body in the initial stages. Most people could not understand why the students were running a conference on pressure ulcers; it was not until after the event that the mindset started to change, as students realised the importance of this patient-safety issue.
Students found it difficult to challenge the practice of more experienced nurses when on placement, but this became easier as their knowledge and confidence increased from the conference and subsequent engagement with the clinical environment around pressure ulcer prevention.
The Stop the Pressure website is a hub of helpful materials, tools and resources; in addition, a toolkit is being developed by the Stop the Pressure national campaign team to help students host future events (Box 1). The social media campaign has mobilised students to start their own interventions to improve pressure ulcer awareness, so they can share their knowledge with staff in their clinical placements.
The conferences enabled students to gain knowledge about risk factors and early warning signs, and take the opportunity to hear from leading experts, patients and carers. Those who led the conferences have been champions and role models to their fellow students, inspiring them to step up to support the campaign.
Using social media at the events resulted in more conferences taking place across the country, which built greater momentum for the Stop the Pressure campaign. Students were committed to building alliances across universities and organisations. Junco et al (2011) found that using Twitter in student engagement for educationally relevant purposes prompted active learning by helping students relate to their own experiences, both inside and outside the classroom.
Students from the initial conference have been influential in taking up the issue of raising awareness of pressure ulcer prevention in education with key stakeholders, such as Health Education England and the Nursing and Midwifery Council.
Charlotte, the student who sent the initial tweet, said: “Continuing to raise the topic and speaking out when we see issues of poor pressure ulcer prevention will always be a challenge, but it is up to us as individuals to put in the time to inform our own practice and keep on top of the emerging evidence base, to enable us to inform and educate others.”
The model of the conference has been a good test case as it became clear there was an appetite for events to take place across a wider community of students, connecting with health professionals and sharing good practice on pressure ulcer prevention. Not only is planning the conferences an opportunity to promote patient safety, but it is also instrumental in empowering the next generation of nurses to make a difference. Tips on organising a similar conference are outlined in Box 1.
Campaigns are not easy to organise and require dedicated time and resources. Measuring the efficacy of a small campaign can also be a challenge. Developing strong metrics for social media activity does not provide concrete results and these are often a proxy of actual activity. Equally, the impact on clinical outcomes is extremely difficult to measure, especially when the campaign is about prevention. However, the fact that so many students attended the first conference, and took it upon themselves to arrange other, similar events, in a bid to positively influence knowledge, education and practice, illustrates the value of the initiative.
Box 1. Tips on running an event
- Approach the university senior leadership team, identify a sponsor and get the go-ahead
- Establish an events team and allocate roles and responsibilities
- Identify funding and look externally for sponsors
- Plan the date – consider lead-in time, clashes with academic calendar and any national or regional events
- Identify venue requirements
- Involve external partners and key stakeholders – don’t struggle on your own
- Decide on your target audience
- Design the event – what is your key message and what outcomes do you want to achieve?
- Identify which social and traditional media outlets reflect your key message
- Establish your evaluation criteria and consider how you will measure what you set out to do
- Discuss after the event what went well and what could have gone better, to improve future events
- Student nurses can make a difference and become agents of change
- Use of social media should be maximised when targeting a younger audience
- Conferences should be explored further to assess their impact as education
- Interactive and innovative learning is key to effective pressure ulcer education
- Student nurses should feel able to challenge the practices of qualified health professionals
Department of Health (2015) The Mandate: a mandate from the government to NHS England: April 2015 to March 2016.
Junco R et al (2011) The effect of Twitter on college student engagement and grades. Journal of Computer Assisted Learning; 27: 2, 119-132.
Moore Z, Cowman S (2009) Quality of life and pressure ulcers: a literature review. Wounds UK; 5: 1, 58-65.
National Institute for Health and Care Excellence (2015) Pressure ulcers.
National Institute for Health and Care Excellence (2014) Pressure ulcers: prevention and management.