Features

MacQueen: a pioneering placement

20 March 2020

Rachel Carter and Rebecca Reynolds describe plans to help improve knowledge, skills and understanding in key aspects of public health and health inequalities.

Following our successful MacQueen bursary award, we have planned an exciting, innovative community health promotion initiative led by undergraduate child health nursing students. This sees us in collaboration with the local health visiting service, which is keen to develop both the student placement experience and the universal offer to the local community.

Despite a strong sense of professional responsibility within the nursing population to promote health, the evidence suggests it is difficult to translate this into practice (Walthew and Scott, 2012). There is a need for earlier intervention, with a focus on prevention, to address health inequalities. Health visitors have a key role to play in achieving this initiative (Public Health England, 2016), but they face a major challenge in the lack of resources to support it (Bryar et al, 2017).

An opportunity for innovation

However, this can be seen as an opportunity for innovation and change, relationship building and new ways of working (Horton et al, 2018). Therefore this student-led community health promotion intervention, designed in response to identified local community health needs, has been piloted.

Upon completion, this intervention will be evaluated to identify its impact on the knowledge and skills of the student nurse participants and to determine whether there is scope for wider implementation within the undergraduate nursing programme at the University of Plymouth.

Building the capacity of the public health workforce has been identified as a priority in order to deliver behaviour change interventions and programmes (McManus et al, 2018), and HVs are uniquely placed to lead on, and act as role models for, the delivery of health promotion (Whitehead, 2009).

This is supported by the new standards of proficiency for registered nurses, which also promote health as a core platform (NMC, 2018).

Health equity in England: the Marmot review 10 years on (2020) continues to state the need for early intervention to prevent health inequalities, with a balance of universal and targeted services as the way forward to improved child health. The Royal College of Paediatrics and Child Health in its State of child health report (2017) and the NHS Long-term plan (NHS, 2019) also recommended increased engagement with public health activities. The Health and Social Care Select Committee (2019) highlighted the need to invest in a holistic workforce plan to support local areas. This is reinforced by a report from The King’s Fund, which recommends place-based systems, arguing that these should be developed at neighbourhood-level (Ham and Alderwick, 2015). Therefore, in order to develop the workforce of the future, it is important to engage community partners in developing the curriculum (Myers et al, 2018).

Boost Learning through practice

Evidence suggests that, in order to enhance learning and future health promotion, students need to take a stronger lead in undertaking health promotion practice (Lane-Martin, 2019). This has been supported by the development of the new undergraduate nursing curriculum at the University of Plymouth, in 
line with the new NMC standards (NMC, 2018).

Role models have also been found to be fundamental in engaging nursing students in health promotion practice (Walthew and Scott, 2012) and this can be uniquely supported by the specialist knowledge of the HV. The development of health promotion practice is currently supported in practice placements, although the evidence suggests that there is scope for enhancing the learning opportunities available within community public health placements. Several studies that have explored the experience of student nurses on HV placements found a number of students had a poor learning experience (Murphy et al, 2012; Ridley, 2012) and that they would prefer more hands-on experience (Ridley, 2015).

Role models have been found to be fundamental in engaging nursing students in health promotion practice

Taking responsibility

HVs have expressed concerns over their capacity to support student learning (Ridley, 2012) as supervising a student can increase workload and create tension caused by competing needs of the student versus the clients (Perrin and Scott, 2016). In 2015, local government became responsible for commissioning health visiting services, which has led to cuts as a result of a reduction in the public health budget (Bryar et al, 2017).

Active learning strategies can help to develop student independence and responsibility when improving population health in response to these complex issues (Callen, 2013). Evidence indicates that dynamic learning activities, in relation to contemporary epidemiology, deepen learning (Kerkering and Novick, 2008), whereas public health teaching by traditional didactic methods have the potential to be quickly outdated (Winskell et al, 2014). This can improve student engagement by giving ‘task relevance’ (Herrington et al, 2003) and is supported by recent UK Engagement Survey data showing that student engagement is strongest for activities connecting learning to real-world problems (Neves, 2016).

Students and supervisors will utilise the local joint strategic needs assessment to inform the choice of health promotion required. Students will then plan and deliver the health promotion intervention session based on current public health campaigns and strategies (PHE, 2019). These will be based around health education and practical skills such as healthy eating, dental health and exercise. The sessions will be supervised by an HV within a community group setting, and the proposed pilot initiative will expand the student nurse’s public health expertise. This initiative will provide a unique, ground-breaking student placement with opportunity for future collaborative learning.

A look to the future

The aim of the proposed project is to investigate whether a collaboration between child health nursing students, child health nursing lecturers and HVs increases student learning in the planning and delivery of health promotion activities. Lead practitioners from the local service provider have identified appropriate placements and HV supervisors, in addition to recruiting 12 child health nursing students to undertake the initiative.

The undergraduate nurse participants will be asked to self-evaluate their knowledge and skills pre- and post-intervention. This data will be collected using an anonymous online questionnaire developed from the NMC standards of proficiency (2018) to evaluate the impact of the intervention. The second survey will also explore the student’s experience of the intervention, while focus groups will be carried out with the HV supervisors to explore their experience of taking part in the pilot initiative with the view to expanding the project.  

Rachel Carter and Rebecca Reynolds are both lecturers in children’s nursing at the University of Plymouth.

Image credit | Ikon


References

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Herrington J, Oliver R, Reeves TC. (2003) Patterns of engagement in authentic online learning environments. Australian Journal of Educational Technology 19(1): 59-71.  

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Marmot M. (2020) Health equity in England: the Marmot review 10 years on. See: http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf (accessed 26 February 2020).

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Whitehead D. (2009) Reconciling the differences between health promotion in nursing and 'general' health promotion. International Journal Nurse Studies 46(6): 865-74. 

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