TheUniversity

of Edinburgh

Community

Information

SESSION 2011 – 2012

Jillian TaylorTeaching Fellow

NU

RSI

NG

ST

UD

IES

UNIVERSITY OF EDINBURGH

SCHOOL OF HEALTH IN SOCIAL SCIENCE

NURSING STUDIES

COMMUNITY INFORMATION- SESSION 2011-12

NURSING 1

BN (HONOURS) STUDENT - CLINICAL DAYS

Semester 1- Wednesday OR Friday 19.10.11- 02.12.11Theoretical Content……………………………………………………………………2

Semester 2- Wednesday OR Friday 16.01.12 -23.03.12Theoretical Content……………………………………………………………………4

VISITS TO A FAMILY…...........................................................................................8Aims...................................................................................................................8The student role………………………………………………………………..8Key areas to be covered during meetings……………………………………...8Initial Contact………………………………………………………………….9Subsequent Contacts…………………………………………………………..9Maintaining Contact…………………………………………………………...9Sharing your learning with medical students………………………………...10Written work requirements…………………………………………………...10Evaluation…………………………………………………………………….10

VISITS TO A CHILDBEARING WOMAN………………………………………11Aims………………………………………………………………………….11The Student Role……………………………………………………………..11The Woman’s Role…………………………………………………………...11Initial Contact………………………………………………………………...11Subsequent Contacts………………………………………………………….12Maintaining Contact………………………………………………………….12Ending Contact……………………………………………………………….13Written work………………………………………………………………….13Troubleshooting………………………………………………………………13Evaluation…………………………………………………………………….13Reading……………………………………………………………………….13

COMMUNITY PROFILE………………………………………………………….14

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BN (Honours)Session 2011-12

Nursing 1SEMESTER 1 - clinical day EITHER Wednesday OR Friday during the period:

Academic week 5 to week 1119th October 2011 – 2nd December 2011

Scheduled university study days:

Friday 21st October 2011Friday 18th November 2011

Community Placement

Practice placement experience for first year student nurses is aimed at providing students with opportunities to observe and engage with a variety of nursing interactions and interventions. During their time in community nursing it is hoped that they are introduced to the many different aspects of nursing in a Primary Care setting. As it is the students first practice placement in their 4 year BN (hons) course, students should have the opportunity to explore the community in which they are based, while getting the opportunity to discover, with the assistance of their mentor, what the needs of individuals, families and community are and how this is impacted by the society in which they live. They should use this experience to identify how the role of the Health Visitor, Practice Nurse and District Nurse with the support of Allied Health Professionals promotes and sustains the health of this community.

As a support to the student in line with the recommendations of the Nursing and Midwifery Council ([NMC] 2008) each student will be aligned to a mentor with a community nursing position. They are required to be with their mentor for a minimum of 40% of their time within their placement. To support their learning they are encouraged to identify, with their mentor, ways in which their process objectives for the placement can be meet, which will require them working with the whole primary care team including Practice Nurses, District Nurses and midwifery teams if available. Community groups and voluntary agency can also support this placement.

Students must at all times inform their mentors of all planned activities to ensure NHS Lothian health and safety policy and procedures are adhered to at all times. Theoretical Content

A scenario-based approach to learning in the first semester is adopted to introduce students to their study of Nursing in an interesting and motivating way. Overviews of three real life situations have been devised to reflect specific problems at various stages of the life cycle.

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Students in groups will solve the problems presented with help from the resource sessions. The objectives include encouraging student centred and self directed learning, an introduction to research and inquiry in nursing studies, an introduction to evidence based learning, an introduction to people who need and receive nursing care and an overview of the varieties of roles that nurses undertake.

Students will also have an introduction to infection control, physiology and lectures on the cardiovascular system. In addition to their clinical experience each week practical sessions support the theoretical learning.

Types of experience to be included Contact with a family - see page 9 Contact with a child bearing woman - see page 12 Experience relating to scenario based learning:

Examples of the three scenarios completed during semester 1 are presented below. If available, students are encouraged to engage in practice based experiences relevant to each scenario. This will assist consolidation of the theoretical content of the programme and allow students to appreciate its relation to practice.

NB: It must be highlighted that these are suggestions only. It is acceptable and expected that mentors will facilitate and adapt learning situations in practice depending on the student process objectives and the learning environment.

Scenario 1 (Academic Weeks 3 & 4)

Immunisation decisions, particularly involving MMR. Family also has an older child with Down’s syndrome.

Suggested placement experience from academic week 5 onwards when placement commences –

Attend an immunisation clinic. Discuss the role of the HV in giving immunisations. Consider information given to parents who may or may not have concerns. Discuss what informed consent is. Look at immunisation protocols and become familiar with the immunisation

programme. Discuss with the HV, issues concerning immunisations and in particular MMR If suitable talk to parents on how they feel about their child getting immunised

(Opportunities to discuss this with parents could be achieved by attending parent and toddler groups, new parent or breast feeding support groups)

Find out what information the parent(s) of children less than 5 years old have on MMR, and where they received it from.

If the HV is in contact with a family with a child with a learning disability, particularly Down’s syndrome, discuss the role of the HV and what other services are available in the community.

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Scenario 2 (Academic Weeks 7 & 8)

An older person with a stroke (CVA) following hospital dischargeSuggested placement experience –

Undertake a post hospital discharge visit with the district nurses to a person who has experienced a stroke (CVA)

Discuss, and where available undertake a home assessment with an occupational therapist.

If possible visit an aids and equipment centre. Discuss with the District Nurse what equipment they can order. Visit a day centre, rehabilitation centre or a lunch club to meet and talk with older

people who have had a stroke and find out what impact this has had on their lives

Scenario 3 (Academic weeks 10 & 11)

An adolescent with alcohol problems

Suggested placement experience –

Completion of a community study looking at the availability of alcohol within the area of the health centre i.e. public houses, off- licence, supermarkets etc.

Look also at the advertising of alcohol within the area. (Students will then compare availability and types of advertising within the different areas)

Explore whether teenage alcohol is an issue for the primary health care team? Are there any deterrents to teenagers drinking excessively? E.g. police presence in

local parks etc. Discuss with a GP the impact of alcohol on his/her patients’ health. To what extent

is excessive alcohol intake a problem amongst his/her patients? How is the information obtained and recorded concerning patients’ alcohol intake

by the primary health care team. If possible speak to a secondary school nurse who may be aware of health education

messages in the curriculum on alcohol, or speak to a specialist nurse involved with any patients with alcohol problems.

Practical Sessions during semester 1

Vital Signs

Students have had a practical session on measuring vital signs. Suggested community experience could include a morning /afternoon session with the practice/treatment room nurse to gain experience in taking blood pressures and pulses with discussion about why accurate blood pressure measurement is important.

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SEMESTER 2 Clinical days Either Wednesday OR Friday during the period:

16th January 2012 – 23rd March 2012

Scheduled university days:

Friday 3rd February 2012Wednesday 7th March 2012Friday 9th March 2012

Theoretical Content

During semester 2 part of the theoretical content of the Nursing 1 course will encompass a more bio-physiological content particularly concentrating on major body systems framed within a holistic construct of persons as complex but integrated bio-psycho-social-spiritual systems.

Additional course material supports and complements the biophysiology with an introductory examination of the nature of nursing. This part of the course begins by looking at the different aspects of caring for a patient such as planning, assessment and evaluation, introduction to inter professional working, further development of communication skills and the development of the nursing profession.

Key nursing concepts and principles are introduced including: equity, standards, ethics, rights, responsibilities, roles and relationships with patients, co- workers and the public.

The organisation of health and society continues in the concurrent course Health and Society 1 enabling a greater understanding of the nature of nursing within the wider context of a multi professional, multi agency healthcare system. The content of the course includes theories of health, lifestyle, health inequalities, health education and health promotion, gender and health, health and ethnic minorities, health indicators, role and stigma and life transitions which includes child development.

The student’s clinical experience should reflect some of the theoretical content outlined above. Students continuing to visit their family and their child bearing woman will support this. In addition students will spend two placement sessions as detailed above (2nd & 4th

March) with the learning disability nurses. This experience has been arranged by the university.

Further practice experience examples that relate to the taught component are suggested below-

Maternity Care (Academic Week 15 & 16)

Suggested placement experience- Contact a midwife to discuss their role. Where possible undertake an antenatal or postnatal visit with the midwife or attend

an antenatal clinic in the health centre.

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Explore the supports offered in the community to women who breastfeed, and where possible attend an infant feeding or post natal support group.

Consider postnatal depression and discuss its management with the midwife, health visitor and GP as appropriate.

Observe the health visitor complete a visit to a post natal mother to screen for Postnatal Depression. If an Edinburgh Postnatal Depression screening tool is used discuss interpretation of the results with the health visitor and discuss/observe any follow up care to be given.

Infection Control protocol and policies in the community (Week 17)

Suggested placement experience- Look at and discuss relevant documents. With a District Nurse consider and observe the management and treatment of

wounds (infected or not) Discuss with the District Nurse the management of hospital acquired infections such

as MRSA within the community setting. If available visit a specialist nurses or discuss with the practice nurse how contact

tracing happens in community. Contact tracing, for example known contacts of a person diagnosed with TB, meningitis or sexually acquired infections.

Screening in the community (week 18)

Suggested placement experience- Consider the implications of screening for various conditions, from hearing

screening to cervical screening. Discuss or/and observe the role of the Primary Health Care Team in screening for

endocrine conditions e.g. diabetes mellitus or hypo/hyper thyroid. Explore the symptoms that would alert a community practitioner suspect an

endocrine condition like diabetes mellitus or hypo/hyper thyroid Experience performing a urinalysis test for a patient if available

Cardiac care and rehabilitation (week 19 – 16th & 18th Feb 2011)

Suggested placement experience- Concentrate on health promotion and primary and secondary prevention of cardiac

problems as well as rehabilitation. Look at lifestyle management in the community with particular reference to the

advice provided to patients about diet and exercise. Become aware of the health messages and advice that all community nurses and

health visitors give to their patients and clients, particularly those of relevance to preventing heart disease.

Attend if available groups aimed at health improvement e.g., smoking cessation, weight reduction.

Discuss and observe the role of the Cardiac Rehabilitation link nurse, if available.

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Meet or make contact with allied professionals in the community e.g., dietician, physiotherapist and discuss the role they play in cardiac rehabilitation.

Meet and talk to any patient who has experienced cardiac problems and discuss the impact this had on their lives as well as what changes they have had to make in their lifestyle.

Students are with learning disability Nurses (week 22)

Students will attend pre arranged practice sessions with the Learning Disability Team on

Wednesday 7th March 2012 & Friday 9th March 2012

Respiratory System and Pain (week 21 & 22) Suggested placement experience-

Spend a morning /afternoon session with the practice/treatment room nurse to gain more experience in taking blood pressures, pulses and monitoring respiration e.g. peak flow,

Discuss with the nurse the appropriate action required or not from the recorded results of the testing.

Consider the assessment and management of pain and discuss with the district nurse in relation to her/his clients.

Explore the variety of methods used to manage pain, i.e. medical and/or alternative and complementary

If possible discuss with the GP how he/she manages analgesic prescribing with patients and any issues encountered.

During weeks 23 & 24 students receive lectures on grief theories, facing mortality & loss dying & bereavement. At this stage linking clinical experience to this would not be appropriate therefore it is suggested that placement experiences offered could relate to earlier lectures that the student has had on the respiratory system and on the observation and recording of vital signs and also on the concept of and assessment of pain.

Reflection on the community experience (week 24 – 23rd & 25th March 2011)

During the Easter vacation, 2nd April – 20th April students will spend a self directed learning week (Monday to Friday), negotiated with the mentor, based at the health centre. It could provide an opportunity to observe activities in the health centre that occur on days (Monday, Tuesday and Thursday) that have been out with student’s clinical experience to date and give students the opportunity to finish gathering information for their community profile assignment.

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Visits to a Family

During alignment to a health centre the student will engage with a range of activities, including making a series of contacts with a family with young children. This experience offers the opportunity for the student to develop, through observation and discussion, an understanding of concepts and theories involving the family, health and illness beliefs and child development as highlighted throughout Nursing1 and Health and Society 1. In this experience the student will assume responsibility for the quality of their learning.

Aims To enable students to develop a knowledge and understanding of the factors that

influence people’s health and illness behaviour To enable students to develop interviewing, observation and communication skills,

while appreciating the ethical issues of consent and confidentiality To encourage students to reflect on their knowledge of people’s health and illness

behaviour, their interviewing skills, and their attitudes towards what people tell them about their health and illness behaviour

To give students an opportunity to observe children and support their knowledge acquisition and understanding of normal childhood development.

To give students an opportunity to observe and discuss the realities of, and approach to, child care by parents and family

The student roleThrough this experience students are required to establish a professional relationship with a family that will permit them to achieve these aims. It must be acknowledged that this is a voluntary arrangement and that the family can discontinue visits/contacts at any time. Therefore students should ensure that they are considerate and sensitive to the wishes of the family.

Since students at this stage have limited experience and skills in nurse education, they will not be able to provide any form of care or advice. If a family ask for advice, students should explain their limitations but offer to ask their health visitor to contact the family to provide the required professional information /advice.

Key areas to be covered during meetingsThe students role during each family meeting involves talking to the family, listening to the views of parent(s)’ on the health and development of their children. Students should also gain their views on parenting.

During the initial meetings, students are encouraged to focus on the parent(s)’ beliefs, anxieties and expectations for their children’s health, how they interpret their children’s behaviour, how they recognise signs/symptoms of illness and what their response is to such symptoms. Students should also explore their experience of lay, complementary and professional consultations.

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Further meetings should focus on the parent(s)’ beliefs and expectations for their own health. Students should also gain a picture of the parents’ behaviour in relation to health and illness.

Discussions and observation concerning their children’s development should include language, motor ability, play and socialisation with other children. Consider the child’s ability to cope with various life experiences such as separation from parents for a variety of reasons, and such life realities as sibling rivalry.

Discussions about the realities of and approach to child care by parents and family should support students to develop an understanding of patterns of communication, organisation of daily routines and the parenting skills involved. Students should enquire how parents cope with difficulties such as temper tantrums, sibling rivalry, sleep disturbance and problems with feeding while trying to gain an insight into how parents feel about these issues.

Initial ContactThe mentor or health visitor involved in the health centre will identify a family from his/her case load and will introduce the student to the parent(s) in either the health centre or their home. The university will provide the student with a letter for the family explaining the visits and their purpose. The student should seek to make contact with the family in October/November.

The following criteria will support the identification of an appropriate family:- The family should have 2 or more young children, preferably under 5 years The family should not be considered by the health visitor to be ‘at risk’ or particularly

vulnerable The family should be contactable by telephone The family should be agreeable to being involved in this scheme

Subsequent ContactsWhile being as flexible as possible to minimise disruption to a busy family life, you are expected to make at least five contacts with the family at times that are mutually suitable to yourself and the family. In order to make it easy for you to develop a relationship with the family which will aid talking and get to know each other, at least three visits should be made to the parent(s) in their home. Other visits can happen with other members of the primary health care team e.g. During a child’s developmental assessments by the health visitor or GP.

Maintaining contactIt is suggested that contacts with the family are spread over the period of time you are based in the health centre.

Sharing your learning with medical studentsTowards the end of the spring semester an opportunity may be organised for nursing students to meet with some first year medical students who also visit families for a very similar learning experience. This provides an opportunity to discuss how students found the

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experience and explore similarities and differences in how they were received as student nurses and medical students.

Written work requirements A brief record in the form of a list of all contacts including the date, the duration and

the topics and/or experiences covered. (10%) NB Both sets of visits require a record of your visits to be submitted, but a reflective journal is only required for your visits to the family OR childbearing woman.

A reflective journal of 1,500 - 2,000 words (90%) of the contacts. This is the alternate for the Visits to a Childbearing Woman Reflective diary. This should include a brief profile of the family visited plus a small number of particular topics that relate to the taught course work and reading that were discussed.

The account should focus on self-reflection, detailing how students found the meetings, how well the student communicated, what the student thought was both difficult and what was easy.

All work should be referenced.

Remember that no family should be identifiable, the use of pseudonyms are required for the family and their address should not be included.

Date of submission: to be confirmed.

Any concerns about the series of visits, should be discussed between you and your mentor and/or with Jillian Taylor, Teaching Fellow, University of Edinburgh. Details: Tel. 0131 650 3888 or email: jilly.taylor@ed.ac.uk

EvaluationYou will be asked to complete an evaluation of these series of visits after they are complete.

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Visits to a Childbearing Woman

During alignment to a health centre the student will engage with a range of activities, including making a series of contacts with a childbearing woman. This experience offers the opportunity to learn in detail about the ‘altered state of health’ which is pregnancy, birth and the early postnatal period. In this experience the student will assume responsibility for the quality of their learning.

Aims Learning from the woman herself about uncomplicated childbearing, as experienced by

the majority of childbearing women. Observing the care provided by health care professionals Sharing the woman’s view of that care

The Student roleThrough this experience students are required to establish a professional relationship with a woman which will permit the student to achieve the aims above. Throughout contacts with the childbearing woman, her decision about the presence and continuing contact with the student is final. Thus, students should appreciate the women’s generosity in allowing the meetings. Students are encouraged to ensure that they show every consideration for her this includes being sensitive to her wishes.

Because of the limited experience the students has, they will not be able to provide any form of care or advice. If the woman does happen to seek this advice, the student should explain their limitations and discuss with the women who would be the best professional to support her.

The students role involves observing the woman’s care and listening to her views on that care and on any other issues. The student may also ask relevant questions about the woman’s experience of childbearing.

In the early stages of the relationship the student will introduce themself by giving the woman some limited information about themself. The students role in this situation may be summarised as being a ‘temporary friend’.

The woman’s roleThe woman should not be unduly inconvenienced by the presence of the student. It is hoped that the contacts will not intrude on the woman’s busy life. Students should use their communication skills to encourage the woman to talk about herself, her family, her aspirations and her experience.

Initial Contact You should seek to make contact in October with a woman who is about 20-24 weeks pregnant. The initial contact will happen in the health centre with the help of the staff, particularly the mentor, who should help identify and make contact with a woman who fits the following five criteria. The woman should:

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-be experiencing a ‘low risk’ pregnancy previously have had at least one successful pregnancy. -be due to give birth during February 2012. The expected date should be no later than this, as there may be difficulty fitting in the later visits. It should not be much earlier, to allow for sufficient visits to get to know the woman.-have a telephone so that you are able to maintain contact with her.-be agreeable to being involved in this scheme of visits.

The student will be provided with a letter by University staff explaining this scheme which is to be given to the woman.

Subsequent ContactsWhile being as flexible as possible to make allowance for the woman’s busy life, students are expected to make about five contacts with the woman. One of these should be as early as possible in the pregnancy. Another will be shortly before the birth is due.

Students should visit the woman within the first week after birth. This visit will probably be in the woman’s home. Students should be present when the health visitor makes her/his first visit and should also be present for the six week check.

In order to make it easier for the women to talk and to help support a relationship, it is encouraged that at least three visits to the woman are in her home. Other contacts may happen when she attends, for example, for any investigations which may be necessary, any educational opportunities or classes, such as physiotherapy, or any support groups.

Maintaining contactStudents are responsible for ensuring that contact is maintained with the women. In the event that any contacts are missed you are expected to write a 1,000 word account of what is likely to have happened or did happen at that point in the childbearing cycle.

Near the time of the birth, the woman should decide whether she is prepared to allow you to visit her while she is in labour. This will be the woman’s decision and will be decided by how she is feeling and how comfortable she is with this. Whether students are permitted to visit her at this very sensitive time and, if so, for how long, is the woman’s individual decision. Students should bear in mind, though, that her decision is likely to be affected by the relationship that has been established.

Ending contactAfter the completion of these visits you will conclude your relationship with the woman.

Written work Students are expected to keep a brief personal log of all contacts. This will include

details of the date, the duration, the topics and/or experiences covered. Also keep a reflective diary of about 1,500-2,000. This is the alternate for the

Family Visits Reflective diary. As well as personal reflection, the Childbearing Woman Reflective Diary will

include a research-based account of any: investigations

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interventions complications

In these records no person should be identifiable. Pseudonyms should be used.

Date of submission of this/these documents: to be confirmed.

TroubleshootingAny concerns about the series of visits, should be discussed between you and your mentor and/or with Jillian Taylor, Teaching Fellow, University of Edinburgh. Details: Tel. 0131 650 3888 or email: jilly.taylor@ed.ac.uk

EvaluationYou will be asked to complete an evaluation of this series of contacts after it is complete.

ReadingDOWNE S (2004) Normal Child Birth: Evidence and debate, Churchill Livingstone, EdinburghMANDER R (2001) Supportive Care and Midwifery Oxford Blackwell Science MANDER R (1989) A maternity care course component and evaluation Nurse Education Today 9:4 227-35MARSH G & RENFREW MJ (Eds)(1999) Community-based Maternity Care Oxford Medical Publications RG940 Com

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Community Profile

During the clinical experience students are expected to produce a profile of the community where they are based. Length: 1500 -2000 words.

It is suggested that the community profile include: a brief historical and geographical account of the community location a demographic profile (age groups, social class, housing types, local economy etc.) an outline of some of the problems of the community e.g. unemployment, poor public

transport, lack of public facilities, pollution. an outline of some of the resources of the community e.g. employment, shops,

transport, leisure facilities, children’s play areas, local community groups, facilities for older people

a discussion on the potential impact of the above on health whether a negative or positive relationship

a consideration of the role of the professionals in your health centre in addressing and promoting the health needs of the community.

an identification of any instances of professional partnership with the local community in health projects (this may not be apparent in some areas)

The health centre may have some statistics that reflect the local population, that the student is able to set against Lothian, Scottish or UK data such as mortality and morbidity rates, hospital admissions, accident rates, number of low birth weight babies, breast feeding rates, uptake of screening services, immunisation rates, prevalence of alcohol and drug dependency, ethnic minority groups.

Other potential sources of health data could include census figures, the local department of employment office, information from the benefits agency, education department (free school meals figures) area child health statistic figures, area immunisation uptake figures etc.

Mentors are encouraged to help students access any information and statistics that the practice has and may wish to discuss the student’s progress. A copy of the completed profiles will be submitted to your mentor as well as to Jillian Taylor following the normal university submission procedure.

Date of submission: to be confirmed.

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