Dr Jane Douglas is currently on the QNIS Queen’s Nurse Programme. Jane is the Executive Care Director at Queen’s House, Kelso, and has written us a blog on why care homes can be excellent placements for student placements.
When I was asked to write this blog about care homes as a learning environment, I thought great, that will be easy, but when I came to write it, I actually found it difficult. Where to start? What I found when I thought deeply about care homes as an environment for learning, I found it to be an ‘emporium’ of learning opportunities, a place where students can thrive and develop. So, the next question – What to include?
We have been receiving students for over 3 years and we are very proud to be able to offer an opportunity for students to learn in our care home. Also, we feel extremely privileged to have students come on placement with us. However, the questions that are sometimes raised is ‘what is the benefit of a student placement in a care home? What could a student possibly learn in a care home?’ I am of the view that students benefit from two placements in a care home, first when they start on their journey of learning and development, and second when they are about to complete their placement.
Care homes are communities where people live and people work. As a learning environment for the new learner, they offer an introduction to compassionate, ‘person-centred care’ and ‘person-centred approaches’ care and support that is holistic and rights based. Care homes offer environments that allow the first-year student to consider what it is to be a nurse in a community setting. To start to develop their critical thinking, problem solving through assessment and evaluation, and to work with the people they are supporting to help them to identify what their outcomes are.
Further, they will gain an insight into team work, and how Registered Nurses in care homes provide professionalism, leadership and management. They will learn how care homes are part of the Community Health care teams, how they work in partnership with Primary Care and the Health and Social Care teams, working with GP practices and Social Work teams. They will learn about legislation, such as the Adults with Incapacity (Scotland) Act 2000, and how this is applied, how important it is to understand this and what capacity means. The importance of a rights-based approach and how people who live in care homes are supported to have their rights upheld through the new Health and Social Care Standards – My Support, My Life (2018).
The care home environment is one where a student on their first placement can build their confidence in how care and support is provided for those people who are no longer able to support themselves. How assessment tools are used to ensure that care and support is individualised to each person to ensure that the most appropriate support is provided. Care homes offer a great opportunity to the student nurse to start to learn these skills, in an environment that is less busy, less acute, where there is time to spend with the people who live there. To learn the art of observation – whether assisting a person to wash and dress, or talking with the person, all the time the nurse is observing – Is the person confused? Is their mouth or skin dry? Are their eyes clear? Do they look comfortable? Do they look like they are in pain? Is the person eating and drinking? If not, it is important to learn to question why and try work out what is going on for that person, through observation, listening, watching and communicating.
It is here where the student can learn the importance of communication, in its many different forms, and how to assess while communicating. Such as pain management to assist and promote independence on a daily basis. How to use pain assessment tools to ensure that a person is comfortable and to provide pain management to support someone who is receipt of end of life care. These are the skills that we need to learn, to understand what is being presented by the person. It is the critical thinking, clinical decision making and problem solving that is key to their development. The knowledge that we gain through academic study, learning how to use evidenced based practice to help provide care and support, to learn how to critically evaluate a situation, create a plan and agree outcomes. A care home is a great environment to start learning how to do this, learn the importance of assessment and evaluation.
A student will learn the importance of social and psychological support. The importance of keeping active, feeling competent and having relationships. They will learn about the importance of nutrition and how meals are one of the most important social activities, but equally important is to ensure that the person is well nourished. Learning how to use assessment tools in relation to nutrition and interpreting these to ensure that the person is receiving adequate food, nourishment and hydration. Learning what to do on an individual basis where a person is not eating well.
There are the practical skills that will be observed and also practised, such as assisting a person to wash and dress, ensuring that the person’s dignity and comfort is maintained, a procedure that needs to be completed efficiently and smoothly, compassionately, in the least invasive way. Understanding, through assessment that any care and support should promote choice, dignity and independence. While assisting or observing any procedures the student will see universal regulations for infection control in practice. During such procedures the student will learn the importance of correct moving and handling techniques, and how these are assessed and evaluated. They will learn about skin integrity, why it is important to reposition a person, and what to look for. What assessment tools to use to ensure a person’s skin integrity and to prevent any skin break down, and ensure that an individualised plan is in place.
A first-year student will encounter complex medicine regimes, learn the importance of safety in regard to medication administration, ordering, storage and disposal. They will learn the importance of medication management and review. They will learn how to support people who are living with diabetes, understanding how to test for blood glucose levels. Additionally, they will learn about urinalysis, when to undertake these tests and why, how to interpret results and question what they mean. They will learn how to record vital signs, the importance of recording and reporting abnormal measures, and how to respond and react.
A student coming to the end of their training can hone their leadership skills further, if they undertake a management placement in a care home, where clinical decision making is made by the nurses who draw on a
ll their knowledge and evidence base to ensure that their residents are safe, supported and cared for. Leading a team of Health Care Support Workers, dealing with events that will happen throughout the day. Having to prioritise, organise, respond to emergency situations and manage are a real test of a person’s leadership and management skills. They will get an opportunity to use their knowledge to make clinical decisions, to think critically and have those all-important clinical discussions with their peers to ensure that the people they are supporting remain well, to promote wellbeing and ensure safety.
Nurses in care homes have to be generalist – they need to understand the ageing process and how this can affect a person’s wellbeing – physically, mentally and socially. Further, they need to have knowledge of long-term conditions, and how these are supported, they need to be up to date in pain management and palliative care, as people living in care homes come with many co-morbidities and will need to be supported to live with these, promoting wellbeing and preventing ill health. The nurse in care homes needs to be skilled and have knowledge in end of life care, to ensure dignity in dying. They are skilled in assessment and evaluation, critical analysis and in clinical decision making. They need to be professional at all times and ensure the safety and wellbeing of their residents.
The learning opportunities for students are many and varied, and when considering the Future nurse: Standards of proficiency for registered nurses’ (NMC, 2018), it is clear that a care home offers a very good environment for student nurses to gain experience in these areas. That said, the environment needs to be one that is welcoming, where the standards are excellent and the staff team are well trained, an environment that promotes a learning and development culture for all. As I said at the beginning, we are proud to be able to offer our care home as a learning environment, we are also proud of the experience that student nurses have with us – ‘You are doing what we are being taught, person-centred care in practice’ (Student Nurse 2019).