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INNOVATION

Using placements to teach on children’s development

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An new initiative by a London university has provided student children’s nurses with placements in the community and the chance to observe normal child development

Abstract

Student children’s nurses have limited opportunities to gain practical knowledge in normal child development. An initiative involving local non-healthcare organisations that provide care and education to the under-fives was introduced at a London university. This allowed student children’s nurses to gain practical experience in meeting the needs of the well child, and to understand normal developmental milestones. Feedback from students and the organisations involved showed positive benefit. Plans are under way to extend the initiative to older children and young people.

Citation: Wainwright L, Parry A (2014) Using placements to teach on children’s development. Nursing Times; 110: 47, 16-18.

Authors: Lynne Wainwright is tutor, child and adolescent nursing; Angela Parry is director of clinical education; both at Florence Nightingale School of Nursing and Midwifery, King’s College London.

Introduction

A good knowledge of growth and development is crucial to providing the best care for children and young people; it is also necessary for detection of developmental delay (Ahmed and Richardson, 2013). Many student children’s nurses start their pre-registration nursing programme with limited prior experience of being with children. This is partly due to many student children’s nurses coming straight from school (Pollard et al, 2004), and partly to challenges associated with gaining experience (thestudentroom, 2013).

Most have little knowledge of normal child development and, owing to the nature of the learning experiences available in London teaching hospitals, there are limited opportunities to gain this experience.

From the outset of the children’s nursing programme, students are exposed to acutely unwell children and those with complex ongoing healthcare needs in large tertiary referral hospitals. They have limited contact with the “normal” child, which is important to successfully prepare graduates to work in a variety of settings. Traditional community placements with a greater opportunity to experience normal child development are increasingly accessed by many student groups, including specialist community public health nurses, mental health and learning disability nurses. This restricts opportunities for student children’s nurses.

Students themselves are aware of the theory-practice gap in their knowledge of child development. Recently, one first-year student commented, after her first placement in a children’s neurology and neurosurgical ward, that it was hard to assess the impact of a child’s condition on their development as she was not sure what they “should” be doing, having had no experience with well children.

Recognising this, staff at Florence Nightingale School of Nursing and Midwifery decided to increase the opportunity for all undergraduate student children’s nurses to have a placement outside of healthcare in an under-fives environment. Students would:

  • Gain experience of normal child development during infancy and early childhood, and how long-term illness/disability can affect development;
  • Become aware of how experiences and environmental factors influence child development, with a focus on play;
  • Explore how hospitalisation and/or an episode of ill health affects development.

This learning experience would be followed by a week of simulated practice (details below) focused on normal child development and primary care.

Placement development

One of the team, a children’s nursing tutor, contacted local organisations - collectively referred to here as nurseries - with positive OFSTED reports, providing nursery or pre-school care and education to under-fives.

Nurseries were asked if they would be prepared to provide a placement for a student children’s nurse for one week during a four-week period in the early summer of the forthcoming academic year. No direct financial payment to the nursery was possible, but education on child health issues or mentorship initiatives were offered in reciprocity.

A total of 12 organisations were approached including local and privately run nursery schools; nurseries affiliated to independent day schools; nursery classes in primary schools; and staff nurseries within NHS trusts. All organisations contacted responded with interest and enthusiasm. Depending on the size of the organisation, differing numbers of students could be accommodated ranging from one to four students for each week.

Meetings took place between the children’s nursing tutor and the lead for each of the nurseries. This provided a personal contact for the nursery with the university, helped information exchange and completion of the educational audit (Nursing and Midwifery Council, 2010a). The visit was followed up with a letter of confirmation for intent to offer a placement and a placement agreement form.

Four weeks before the first placement starting, each student was given details of their nursery placement, and support to set specific learning objectives for their individual experience. Representatives from participating organisations were invited to an information-sharing event at the university. This was led by the children’s nursing tutor and the director of clinical education at the university. Providers who were unable to attend the meeting were sent the presentation via email and the children’s nursing tutor followed this up with a phone call to answer any queries.

The event provided the opportunity for nursery representatives to hear in more detail about contemporary children’s nursing education, and how the nursery placement fits with the wider programme of children’s nursing education. Nursery representatives were also able to meet with the students being placed with them. Discussion focused on ways the university could support the nurseries. Some of the organisations identified gaps in their knowledge of caring for children who have ongoing healthcare needs such as epilepsy and asthma. In future the children’s nursing tutor could give teaching, access to information and elearning activities that can be used as part of their inservice education and training (INSET), helping to fulfil staff development requirements.

Student children’s nurses undertook nursery placement, rotating into this as part of a six-week acute hospital placement towards the end of progression point one at the end of their first year of training (NMC, 2010b).

Support from the university for both student and the nursery organisation was provided by the named university children’s nursing tutor. During the placement the students were involved in working and playing with the children and developing their communication skills with children, families and other professionals in an environment other than a hospital or health centre.

Theories of development had been covered before the nursery placement and while at the nursery the students were required to complete three focused learning tasks (Box 1). Feedback from these tasks was incorporated into the simulated practice week.

Box 1. Learning tasks

  • Observe play and behaviours in the age group student nurses were with, and link this to a theorist
  • Consider the services available locally for children and families and how far they appeared to meet needs
  • Select two children and consider their differing needs physically, emotionally and socially

Once all the students had completed the nursery placement they were brought together for a week of simulated clinical practice at the clinical skills centre. The week focused on primary care and covered areas such as expected development, obesity, feeding, weight plotting and giving advice, and accidents in the home. A “community room” was set up to resemble a living room so students could consider the dangers and risks home environments may pose to children and how to give health promotion advice to families.

Elearning activities were used to support the simulation and allow students to undertake further reading/interactive learning activities. Evaluation of both the nursery and the simulation experience took place on completion of the simulated clinical practice. The placement organisations were contacted to obtain their feedback; comments from students and the university were given in writing to each nursery organisation.

Student feedback

Most students found it a positive experience, including those who had prior children’s experience and were seeing a different perspective. Students were able to see the issues faced by families and also professionals, such as teachers and social workers in the community, who are involved for caring for children, some with long-term conditions or social issues, including safeguarding.

Students commented on the fact that many children they saw attended nursery daily, often arriving for breakfast and leaving after tea. They noted attachment issues with staff, voicing sadness that some children “did not want to go home”. They were able to discuss and compare and contrast the needs of some of these children and the types of provision offered, as well as its appropriateness and ability to meet the children’s needs.

The impact of these issues on the child when hospitalised were explored. Students often assumed children are closest to their parents and siblings, but now realised they may have relationships with a wider circle of people, as well as what is “normal” for them. Students were able to see the significance of admission paperwork and the importance of knowing whether a child attends full-time nursery or is in school, and who are the significant adults in a child’s life and the impact of this on their development.

Learning tasks were well completed by the majority of students, although many noted that they had found it hard to determine what services/provision were available to support children and families in the locality. They identified that, if this was a problem for them, parents may also find it an issue, and that support from colleagues such as health visitors and social workers is vital to ensure families in need are able to access appropriate services.

As a result of this experience, some students reported that they would like the opportunity to spend time in a special needs school where children who may have nursing care needs are educated. Many commented that this had increased their experience in nursing in an environment other than an acute hospital setting and that the cross-professional boundary working it offered was a bonus. Some students, especially those with no previous childcare experience, said the placement should come earlier in their training to support them with what they experience in the hospital setting.

A small number of students felt that it would have been beneficial to their learning if staff working at their nursery had a better understanding of why they were on placement. Concerns regarding differing practices across nurseries were also discussed. In most cases these queries were around areas such as physical contact with children, for example, giving cuddles or sitting with the child on a lap, and what was considered appropriate in an educational establishment. Student feedback was given to the nurseries and was positively received. Box 2 gives a sample of student comments.

Box 2. Feedback from students

“It was good to see children who are well”

“I wish this was earlier in the year – it would have helped on placement when looking after neurologically impaired children as I had no idea of ‘normal’”

“Made me think about where the children have come from”

“Nice to see children playing normally – you forget what that’s like”

“Good to be seen as knowing something about children that the staff didn’t”

“We taught them (nursery staff) and they taught us”

“It was hard to see children being left for such long periods”

“The children were often really attached to the nursery staff”

Nursery placement feedback

Nursery staff were also asked to feed back on the experience and all were extremely positive about the students’ enthusiasm and professionalism. They all felt this was a positive experience for both the student nurses and their own staff. It was felt that not only were the students learning, but also that staff had learnt from them. Despite being in the first year of a three-year programme, the students were able to share knowledge and experiences useful to the staff. All the providers have indicated that they wish to receive students again.

University feedback

This initiative was viewed as highly successful. In the past, children’s nursing education focused predominantly on the sick child in hospital. More commonly now, children - especially those with long-term conditions - are cared for or require support outside of the hospital environment, such as at home or in educational settings. Over a decade ago, the Royal College of Nursing (2003) advocated student nurses should receive a common foundation shared with other health and social care professionals involved in the care of children and young people and families. It is essential that children’s nurses are able to work collaboratively with other professional groups, such as social workers and teachers, to ensure children receive appropriate care (Department of Health, 2004; NMC, 2010b).

The placement initiative responded to these important policy messages. Students appreciated not just physical development, but also emotional, intellectual and social development, demonstrating the consideration of the child and family as a whole, taking into account their lifestyle and point in education. We are now exploring how this can be broadened

to include exposure to older children/young people and the impact of their environment on them, and how healthcare needs are managed for this age group outside of the hospital ward and how this may differ to provision for younger children. Informal conversations have commenced with headteachers in primary and secondary schools to determine ways that students may gain experience with these children and young people that will positively support their understanding of development and enhance their nursing practice.

Conclusion

There is a need for creative strategies to enable students to relate theoretical knowledge to practice (Ahmed and Richardson, 2013). Knowledge of child development and its impact on anatomy and physiology is necessary for children’s nurses to underpin practice, enabling holistic assessment of children and their families in any care setting (NMC, 2010b).

Increasingly, the children that student nurses encounter in hospitals and community healthcare settings are acutely unwell. Nursing programmes need to ensure student children’s nurses are equipped to recognise when a child is deviating from normal parameters. Changes within the NMC standards for pre-registration nursing education (NMC, 2010a) provided the opportunity to explore learning opportunities available in institutions with a focus on the well child.

Developing relationships with nurseries and planning placements is initially time consuming. To ensure appropriate provision, preparatory work is required including reviewing OFSTED reports, nursery websites and undertaking visits to meet and discuss placements with senior staff to ensure staff are fully aware of why the students are there and what they need to achieve.

Most providers are used to childcare students whose requirements are very different and usually less academically focused than the student children’s nurses. However, once relationships have been developed, maintaining them is much more straightforward.

Linking with the nurseries in their varied forms has enabled a reciprocal working relationship to be developed, which benefits the student children’s nurses and the nurseries. This ultimately has benefits for those children being educated and cared for, as nursery staff and children’s nurses are better prepared to cater appropriately for their developmental and healthcare needs.

Key points

  • Children’s student nurses have limited opportunity to observe normal child development during training
  • They mainly care for the acutely unwell child and those with complex healthcare needs
  • Changes within the Nursing and Midwifery Council standards for pre-registration nursing education allow placements in different organisations
  • Student placements in nurseries offer benefits to both students and staff
  • Placements allow them to understand how children are attached to people outside of their family
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