Zoe Clark, Louise Barrett, Farrukh Akhtar and Jayne Price used an action research approach to examine the value of a teaching initiative that created a learning experience on safeguarding for children’s nursing and social work students.
Authors:
Zoe Clark, an associate professor of quality and accreditation
Louise Barrett, a senior lecturer in children’s nursing
Farrukh Akhtar, an associate professor of social work
Jayne Price, a professor of children’s nursing
All authors are based at Kingston University London
RESEARCH SUMMARY
> Every professional who provides care to children has a safeguarding responsibility, the government and nursing bodies have stressed.
> It follows that educators in higher education settings must develop innovative teaching and learning strategies to deliver safeguarding teaching in an interdisciplinary way.
> Members of Kingston University’s nurse education team partnered with their social work colleagues to develop an action research project.
> Staff joined children’s nursing and social work students to watch a performance of Matilda the Musical at a theatre.
> Discussions on practice implications were held online, and were then analysed for important themes.
> The findings showed that musical theatre and other performances, could help to deliver safeguarding teaching in innovative and meaningful ways.
> While the data had limitations in terms of the student response rate, the combined views of students and staff strengthened the impact of the findings.
Abstract
Every professional who provides care to children has a safeguarding responsibility. It follows that educators in higher education settings must develop innovative teaching and learning strategies to deliver safeguarding teaching in an interdisciplinary way.
Members of Kingston University’s nurse education team partnered with their social work colleagues to develop an action research project that highlighted how musical theatre could help us to deliver safeguarding teaching.
BACKGROUND
Nursing education has recently been reviewed and modernised (Nursing and Midwifery Council (NMC), 2024). There is an enhanced commitment to provide nursing students with the fundamental skills and knowledge they need to provide collaborative, safe and evidenced- based care to the public. The NMC’s standards of proficiency for registered nurses (NMC, 2023a) stress that today’s nurses must lead, provide and coordinate care. They must also empower patients and support person-centred decision-making.
Educators must be innovative and adaptive when meeting contemporary students’ learning needs. Further, students should be offered learning opportunities in an interdisciplinary and interprofessional context (NMC, 2023b). The health and social professional groups are two main ones that support children in practice settings. It is imperative, therefore, that social work students understand interprofessional working. Guidance on social work education calls on educators to ensure that students are ‘given the opportunity to work with, and learn from, other professions in order that they support multidisciplinary working, including in integrated settings’ (Social Work England, 2021).
The need for interprofessional working in safeguarding children is enshrined in the 1989 and 2004 Children Acts, as well as the Working Together to Safeguard Children (HM Government, 2023) guidance. Despite this, professionals fail to work together on a regular basis.
To work in an interdisciplinary fashion, health and social care professionals must collaborate, rather than operating independently. As a result, mixed health and social care teams have been developed, giving individuals responsibility for making decisions about their own care (NHS Long Term Plan, 2019). The Health and Social Care Act (HM Government, 2012) said the NHS has a duty to endorse and protect interdisciplinary care where it will advance the quality of services available to individuals. The aim is to diminish inequalities and improve health outcomes.
In order to safeguard children, multidisciplinary teams must take decisions that are in children’s and young people’s best interests. Reviews of child deaths – which are statutory in the event of a child’s death – repeatedly find that communication between professionals is insufficient to protect children and young people (Jahans-Bayton and Grealish, 2021; Munro, 2011).
Littler (2020) called for safeguarding education in pre-registration training to be aligned with the safeguarding training offered in practice settings, where there is a strong focus on multi-agency working to achieve the best outcomes for children and young people (HM Government, 2023). Royal College of Nursing (2021) guidance states that children’s nurses must be able to recognise and use clinical knowledge to respond to child maltreatment. This includes being aware of how to identify at-risk children, by spotting warning signs, for example. Children’s nurses must also be able to work effectively in a multi-agency way to safeguard children and young people. Offering students a robust education, combined with an understanding of multi-agency working, strengthens the case for professions working and learning together from as early on in their careers as possible.
In their triennial review of 368 serious case reviews (SCRs) from 2014-17, Brandon et al (2020) acknowledge that professionals with a remit to support children and families operate in an increasingly complex field. The authors set out a ‘pathways to harm and pathways to protection’ model that spells out the role that a range of professionals can play. Key points include the ‘recognition of the lived experience and the story of the child and their family; greater rigour in information sharing, assessment and planning at all stages of the process; and opportunities for building effective structures and promoting responsive cultures’ (Brandon et al, 2020).
In line with previous analyses of SCRs, the authors recognise that effective multi-agency working is not easy, and that service fragmentation can, at times, lead to professionals working in silos. Many local authorities already use multi-agency safeguarding hub teams to safeguard children. This practice has been recommended by the authors of the national review of the murders of Arthur Labinjo-Hughes and Star Hobson (The Child Safeguarding Practice Review Panel, 2022).
Arts in education can include using ‘literary, visual or drama elements’ (Obara et al, 2022) to address a range of fundamental clinical skills in nursing and allows students the space to gain an enhanced level of self-reflection (Clark et al, 2019). Students’ imagination, confidence, team-working skills and ability to identify risks have been developed through the use of theatre (Ganesh, 2015). This approach allows students to experience visual representations of evolving scenarios while experiencing them physically as well. McKinnon (2018) argues that all teaching and learning domains can be met through using theatre.
Reflective practice is seen as a vital component for professionals working in health and social care (Kinsella, 2010). Brewer and Devnew’s (2022) qualitative study emphasises the importance of reflective practice in nursing, through using theatre arts. They suggest this approach provided students with a positive experience that enhanced their change management ability in clinical practice. This approach was expanded through Clark et al’s (2019) action research that highlighted the benefits of using musical theatre as an educational activity. The authors linked knowledge acquisition while delivering safeguarding teaching to children’s nursing students in their final year. Their findings raise questions over whether the same positive impact could apply in a collaborative context with other professional disciplines. To further extend the knowledge base, research needs to be undertaken in interdisciplinary fields.
MATILDA INTERPROFESSIONAL SAFEGUARD (MIST) STUDY AIM
This evaluative study used an action research approach. It examined the potential value of a new teaching initiative (musical theatre) in creating a meaningful learning experience for an inter-professional group of students (social work and children’s nursing) regarding safeguarding.
METHOD
An action research approach was adopted as it can be used to improve educators’ practice and support change (Efron and Ravid, 2019) and was used by the authors in the interprofessional study (Clark et al, 2019). The improvement/change took the form of a field visit to the theatre to watch the Matilda the Musical as a new way of teaching safeguarding in an interprofessional context. The action research cycle was followed and can be seen in Figure 1.
Figure 1: The action research cycle
The following action research stages were followed as part of MIST study:
- Identification through evaluation of a need for change (decide)
Following the successful completion of the Matilda the Musical project (Clark et al, 2019) and through evaluation and findings from that study, it was clear that the children’s nursing students who attended Matilda the Musical evaluated the experience positively. They said they felt more confident and knowledgeable in matters relating to safeguarding children and young people. There was clear evidence from the evaluations that it would be beneficial to make this a multidisciplinary experience, reflecting the way in which safeguarding works in current practice. It was felt that including social work students in the initiative would give a new dynamic and help to develop their wider knowledge base in readiness for multidisciplinary practice. Hopefully this would, in turn, have a direct impact on the health and wellbeing of the children and young people with whom the students will work. Safeguarding is an important part of the children’s nursing and social work curricula throughout their three-year programmes.
2. Development of innovation to address the gap (plan)
The crucial intervention in this interprofessional innovation was the field trip to Matilda the Musical. It has an underlying child abuse theme that is linked to how the character Matilda is treated by her parents and teachers. After attending the performance, students took part in online group discussions, which included attending small mixed professional group meetings in breakout rooms. The aim was to promote discussions about any safeguarding issues that had been raised during the performance. A lecturer facilitated the groups and encouraged the students to discuss and critically analyse any wider safeguarding and policy issues, highlighting clear links with current working practices.
By attending Matilda the Musical in the theatre and engaging in interprofessional discussion it is hoped that all students would be able to:
- Demonstrate the ability to use their observation and assessment skills to identify safeguarding issues as they relate to the child.
- Appraise the wider safeguarding issues for the child and family.
- Critically discuss the impact of family life on the child’s wellbeing.
- Critically analyse the role of multiagency working in safeguarding children.
3. Delivery and evaluation of the innovation (act)
February 2020: 56 children’s nursing and social work students and eight staff members attended performances of Matilda the Musical. The post-performance discussions were held online due to the Covid-19 related ‘lockdown’ rules that were announced shortly afterwards.
Plans for project were delayed due to theatre closures during and following the pandemic.
April 2022: After 48 children’s nursing and social work students and five staff members attended performances of Matilda the Musical discussions took place online.
Approval was granted by Kingston University’s research ethics committee. As part of this process, students and staff completed questionnaires, comprised of open-ended questions, to evaluate the innovation.
Children’s nursing and social work students who had attended the performance and the online discussion (see appendix 1) were invited by email to complete a questionnaire to express their opinion on the learning experience. A new staff member of staff was chosen to email the invitations to students as it was felt this might reduce the likelihood that they would feel coerced to take part.
Of the 104 students and 13 members of staff who attended a performance of Matilda the Musical, 20 students (19%) and six staff members (43%) responded to the questionnaire. The student response rate was disappointing.
4. Analysis of the evaluation allowing for reflection (observe)
Data was collected from students and staff using an online questionnaire. The students’ version had nine questions and included an ‘any other comments’ section. The staff version had six questions and an ‘any other comments’ section. Open questions were used to elicit data that would help us better understand student and staff perceptions. Following the data collection, a thematic analysis of the open-ended questions was carried out by the lead researcher (ZC). The lead researcher also conducted thematic analysis of the questionnaire to identify patterns which was then divided into themes and subthemes. These were cross checked by another member of the research team to ensure rigour. This process allowed for reflection on the positive and negative aspects, and any potential benefits, of the innovation.
FINDINGS: ANALYSIS OF QUESTIONAIRRE DATA
The questions posed to participants yielded data, giving us useful insights into experiences of both students and academic staff.
Student responses/data
The students’ responses to all the questions were analysed and are presented below. Reading and re-reading the data gave an overwhelming sense that the students felt that attending Matilda the Musical in an interprofessional group enabled them to consider child safeguarding and professional roles from a wider perspective.
3 the themes that arose were:
- Awareness observing different types of abuse
- Multiagency involvement
- Seeing the ‘bigger picture’
Awareness observing different types of abuse
In this analytically derived theme, students indicated that watching, reflecting on and discussing Matilda’s story helped them to gain confidence in noticing safeguarding issues through using their observational skills. Some students particularly mentioned emotional abuse: making them more aware of ‘obvious signs of neglect and emotional abuse’.
Matilda’s story aided them in ‘seeing behind closed doors’, reflecting the fact that emotional abuse is often hidden. One student mentioned the ‘hidden’ nature of emotional abuse and linked this to a professional’s responsibility to report it. This was explored further with the theme that focused on the range of professionals involved in child safeguarding.
Multiagency involvement
This theme was strong and permeated many responses. Although a distinct theme, it also interrelated with the other themes and appeared to be central to the students’ beliefs about safeguarding practice and their learning from watching the performance and taking part in the ensuing discussion.
Professional roles and responsibility arose as key issues for the students, who referred to the number of professionals involved in Matilda’s care and the idea that each had a responsibility to report the abuse seen in the child’s best interests. In terms of professional roles, that of teacher Miss Honey was most often analysed and commented on. For example, one student said: ‘Miss Honey visited Matilda’s family and saw how they treated her, she should have made a referral right then.’
While the teacher’s delay and lack of power was commented on so was her kind, compassionate attitude towards Matilda. As one student put it: ‘All you need is a teacher like Miss Honey to make a difference.’
The fact that Miss Honey listened to Matilda showed the importance of professionals listening to a child. One respondent said: ‘I was able to see how power can be misused and the importance of making sure children’s voices are heard.’
Students also said that Matilda’s story made them consider how easy it would be for a child such as Matilda to be overlooked, even today.
Multi-agency working was linked to the performance and the discussion afterwards. Students reflected on this aspect and concluded that the Matilda project had enhanced their knowledge of the roles of the various professionals in the multidisciplinary team. For example, one student said in the post-performance online discussion: ‘I had the opportunity to see how the medical perspective of nurses gives social workers a different insight to the harm abuse can cause.’
Another student highlighted the challenges of multi-agency working by stating: ‘We all came to different conclusions of when Matilda should have got help.’
The challenges of multi-agency working, and the often-hidden nature of abuse, led students to see what was analytically termed the ‘bigger picture’.
Seeing the ‘bigger picture’
The data gathered from students demonstrated that seeing the Matilda the Musical live improved their ability to appraise the wider safeguarding issues.
Interestingly, they were able to link the performance to practice and discussed how their awareness of the wider family issues were affecting Matilda, as evidenced in the following two quotes: ‘I am more inclined to look at the whole family’ and ‘Matilda’s brother being the star of the family’.
Within the ‘multiagency working’ theme students indicated that working together in the child’s best interests is critical and that child should be referred immediately if any form of abuse is suspected. They also showed an awareness of the complexity of the issues in safeguarding. For example, the issue around power imbalance was raised by students who identified that Miss Honey, being a teacher, lacked the ‘power’ to refer Matilda to the appropriate services and provide the support that she clearly needed, without the headteacher’s support.
Including the arts as a teaching method was overwhelmingly seen as being a positive step by students. Attending the performance and then discussing Matilda’s situation enabled them to ‘see the bigger picture’ in a new and meaningful way. One said: ‘It widens someone’s perspective by seeing it demonstrated in an easier way…’. Another described the experiences as being ‘very good for visual learners as this brought it to life’.
In a further comment on the initiative, one student referred to ‘multiprofessional working and being able to engage with students from a different profession in order to understand and make a plan for Matilda’.
Some students suggested that the learning experience could have been enhanced if the post-performance discussion was held in a face-to-face setting, rather than online. They felt that this setting would enable every participant to engage in the discussions.
Staff responses/data
The responses to all questions posed to academic staff were analysed and will be presented below.
Four staff respondents came from the school of nursing and two from the social work/social care department. They had spent from nearly two years (22 months) to 10 years working in higher education.
In reading and re-reading the data, there was an overwhelming sense that staff members also felt that attending the show with an interprofessional group helped the students to work together, while building their academic learning and reflecting on their role as part of a multidisciplinary team in a creative way.
Three distinct though interconnected themes arose from the data generated from the staff responses, as follows:
- Engaged enthusiasm.
- Seeing other professional perspectives.
- Bringing humanity into teaching.
Engaged enthusiasm
Engaged enthusiasm was the theme that arose from responses about accompanying students to the performance. The staff respondents suggested that the theatre setting promoted impromptu discussions among students and staff. They felt that students engaged with the performance and were keen to discuss what they had seen. One said the students were ‘enthusiastic about attending the theatre with their lecturers and peers’.
Staff members felt that the discussions at the performance and immediately afterwards provided a firm foundation for further discussion during the online event. One said: the students ‘were able to share their thoughts and opinions directly after the show and it later transpired into rich discussions in the discussion groups’.
One staff member felt that further engagement at the theatre performance could have been achieved by meeting during the interval to discuss what had happened up to that point.
With safeguarding being a very emotive topic to teach, all staff felt the arts was beneficial to staff as well as helping students to ‘bring to life’ what would otherwise be learning from a case scenario in class. There was also a consensus that the ‘fun’ element of the performance motivated students to learn and apply knowledge. Staff also felt that using the arts to bring safeguarding to life had a beneficial effect on learning, critical thinking and knowledge application. One said: ‘Musical theatre has given these students an opportunity to apply knowledge in a safe way and to grow confidence.’
During the theatre attendance staff reported that the students were immediately engaged to share their thoughts and experiences as professionals, which then ‘transpired into rich discussion’.
Seeing other professional perspectives
This phrase captured one of the key values of interprofessional learning in relation to understanding each other’s roles. In terms of students learning and insight into other professional roles, the post-performance discussion was seen as helping students to gain contrasting professional perspectives. Staff members overwhelmingly felt that the innovation enabled students to think more widely and develop a better understanding of other professionals’ roles. This encouraged deeper reflection and to ‘think beyond their own professional remit’, as one put it.
Having well-structured discussions and smaller breakout rooms helped with student engagement and gave many of them a voice in the discussions. One staff respondent said: ‘Smaller breakout rooms really helped students to delve deeper.’ Another stated: ‘I found it very helpful, I wish there were more collaborative discussions.’
There was a staff consensus that the discussions were child- focused and that the students were engaged, using policy and their knowledge to identify how Matilda’s wellbeing could be supported and developed from various professional perspectives. ‘Students were able to see things from the perspective of other professionals for example children’s nurses were heavily focused on the child development and the health and wellbeing of the child.’
In addition, working together to meet Matilda’s needs was seen as preparing students for their professional careers in the ‘real world’. ‘I think teaching social workers, nurses, teachers together is necessary and then mirrors how the professions have to work together once students move into employment,’ was one comment.
Staff members also saw benefit of the interprofessional project for their own academic practice, helping them to think differently and work in new ways. One said: ‘It engages staff in thinking differently about the topic they teach, and it also inspires scholarship and creativity, essential to academic practice.’
There was a social element in getting to know colleagues based in another school, as one staff member pointed out: ‘I got to know others from a different school as we work in silos quite a bit.’
The final theme arising from academic staff data related to the future of interprofessional learning following the Matilda project.
Bringing humanity into teaching
This phrase captured the sense that educators saw the project as potentially being a catalyst for future interprofessional learning opportunities, using the arts. One said: ‘I feel building experiences into the programmes across any health and social care programmes brings more humanity into learning and teaching.’
Interestingly, they mentioned using various art forms, such as films or other shows, to enhance the teaching and learning of students. One said: ‘I would be interested in exploring other theatre productions’ while one suggested the use of ‘other methods such as film’.
Overall, the positive experiences of the academic staff and their views on witnessing student engagement and development has given a firm foundation on which to build curricula in London and further afield. One stated: ‘I think the Matilda IPL initiative is an excellent way for students across nursing and social work to learn with and from each other.’ Another said: ‘I loved the experience.’
DISCUSSION AND REFLECTION
Decision to implement innovation and change current teaching/discussion (reflect)
The current literature supports the use of musical theatre in developing skills and knowledge around safeguarding children and young people in children’s nursing (Clark et al, 2019). This action research study further supports the value of musical theatre, such as Matilda the Musical, to enhance learning experiences regarding child safeguarding among interprofessional audiences. Attending the performance and the post-attendance discussions helped to meet learning objectives while bringing learning to life and making it fun. Similarly, students and staff said that this approach promoted learning across children’s nursing and social work and fostered working together and interprofessional learning.
This process occurred following reflection of the findings of the action research. While the data had limitations in terms of the low and disappointing student response rate, the combined views of students and staff (who also commented on student engagement and interaction) strengthened the impact of the findings.
Future interprofessional opportunities will be explored following the completion of this project and action research study. The potential of adding other professional groups of students will be explored, such as student health visitors, student school nurses and student teachers. Consideration will also be given to holding the post-performance discussion in a face-to-face meeting rather than online, as suggested in the feedback.
CONCLUSION
The findings from this teaching innovation demonstrate the impact on students and their ability to develop their knowledge of other professionals, understand their own roles within safeguarding, share knowledge between professions and work collaboratively in the child’s best interests. Furthermore, members of staff said that, from a theoretical perspective, they valued this approach to safeguarding teaching and specifically mentioned the interprofessional aspect.
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Appendix 1:
Questions used to aid discussion at the online post performance session:
What were the main safeguarding issues relating to Matilda from birth throughout her life within the story told in the performance?
Consider the impact of family life on Matilda’s Health and wellbeing.
What other safeguarding issues were present in the story?
Think about what services and professionals would have been involved with a child such as Matilda today.
