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SCPHN training: the big switch

19 March 2021

SCPHN learning changed beyond all recognition last year. Nicola Rooke discusses her experiences of undertaking the safeguarding module virtually, and recommendations for safeguarding training for newly qualified HVs.

This piece of work was written and delivered as part of the safeguarding module of the specialist community public health nursing (SCPHN) programme. As part of the practice portfolio, students must undertake a presentation to colleagues and peers on a service development proposal relating to safeguarding children practice. These recommendations may help other health visiting teams/student cohorts who are striving to provide the best possible safeguarding training during the pandemic.


In March 2020, as the Covid-19 pandemic struck the UK in full force, all face-to-face teaching at Cardiff University was suspended. There was an urgent imperative to move teaching to online platforms, enabling teaching and learning to continue while protecting staff, students and their families from the virus.

SCPHN students faced numerous challenges: face-to-face contacts were suspended, core components of the Healthy Child Wales Programme (Welsh Government (WG), 2016) were delivered over the telephone, qualified health visitors redeployed, and health visiting hubs created. Safeguarding meetings were now conducted virtually, and group supervision was temporarily suspended.

However, HVs still had the opportunity to engage in individual safeguarding supervision, and the safeguarding team was available to offer help and support.

At the end of April 2020, SCPHN students began their final module before qualifying. The safeguarding module was delivered virtually, with no face-to-face teaching, and at this time over half of the cohort had been redeployed to their previous jobs.

Sessions were shorter, an acknowledgement that concentration levels online often flag compared with face-to-face teaching

What a difference a year makes

In 2019, students undertaking the module received more than 96 hours of varied face-to-face classroom teaching, including interactive workshops and problem-based learning exercises. Throughout the safeguarding module, students have historically had the opportunity to ask lecturers direct questions, discuss case studies, engage in safeguarding supervision and become more familiar and confident with the safeguarding process through simulation and roleplay.

In contrast, the safeguarding module in 2020 was delivered virtually, via Zoom, Panopto – a platform where sessions are pre-recorded or recorded live and reused if still relevant – Blackboard Collaborate and setting online learning tasks. Several of the lectures were Panopto sessions that had been delivered during the 2019 safeguarding module, reviewed by the lecturing team to ensure that they were up to date and acknowledged any changes in practice. For example, the All Wales Child Protection Procedures (Welsh Government (WG), 2008) were superseded by the Wales Safeguarding Procedures (WG, 2019). This significant change in practice was highlighted in a newly recorded Panopto session, and students were able to access the new procedures via Blackboard, a learning and teaching interface. The remaining sessions were delivered via Zoom, and included several guest speakers and the opportunity to engage in interprofessional collaborative learning with social work students.

Gopee (2015) suggests that learning is a multifaceted process, with students learning through motivation and interest (Yoo and Park, 2015); this requires teaching that addresses individual learning styles and stimulates the learner. Despite the best efforts of the lecturing team and the rapid need to deliver the module virtually, there was little variety in the teaching methods, and no opportunity to engage in roleplay or simulated practice. However, lecturers worked hard to make the live Zoom sessions as interactive as possible. Students were unable to ask questions during the pre-recorded sessions or to clarify the information, but they had access to a discussion board where they could ask questions, with lecturers always responding in a timely manner.

During their live sessions, the module leader always made time to ask if there were any questions, or any information that needed clarifying. Live debriefing sessions also followed some of the pre-recorded sessions, especially for those sessions integral to the module assessments.

Breakout rooms allowed the shyer members of the group to become more interactive and to contribute verbally

The sessions in 2020 were often shorter than those in 2019, an acknowledgement that concentration levels online often flag compared with face-to-face teaching. Quinn and Hughes (2013) note that there are usually one or two dominant members within a group of learners, while Gopee (2015) suggests that some students may struggle to give feedback within a large group. This was clear during the sessions, with a handful of students dominating any feedback or questioning opportunities, while some did not contribute verbally at all. Breakout rooms were successfully used, allowing the shyer members of the group to become more interactive and to contribute verbally. Fitzgerald and Keyes (2014) identify that group discussion can quickly digress from the topic, highlighting the need for facilitators to be present within the breakout rooms to maintain focus. However, this would prove to be labour-intensive for the small lecturing team.

Student feedback

I undertook a scoping exercise with my fellow SCPHN students to inform my presentation. Students were asked to comment on the following:

  • Their experiences of the safeguarding module
  • How much safeguarding exposure they had experienced during their training
  • If they felt adequately prepared for safeguarding on their caseload as a newly qualified HV
  • What further safeguarding teaching they would like as part of the preceptorship programme.

Given the challenges of having to very quickly adapt a usually very interactive face-to-face module to a virtual mode of delivery, the students mostly felt that their learning needs had been met and that the content of the safeguarding module had been relevant to practice. The interprofessional learning sessions were well received, and students valued the sessions delivered by guest lecturers as they were able to share experiences from practice. Competent healthcare professionals are required to collaborate in teams within a complex and dynamic healthcare environment (Hood et al, 2014). The Royal College of Nursing (2013) and Gregory et al (2014) also acknowledge that the delivery of care and positive learning outcomes can improve because of interprofessional learning.

Several students struggled with the format of the teaching, the lack of face-to-face interaction and the demands of redeployment and home schooling their children while trying to engage with the module. All students had been involved in safeguarding cases during their training, with some students having more exposure than others. Several students commented that safeguarding exposure as a student is vastly different from dealing with it first-hand as a qualified HV, and that there can never be enough exposure as a student. Others questioned if they felt adequately prepared for managing safeguarding cases, while other students commented that they felt adequately prepared, were confident that they would be well supported by their colleagues and knew where to access further information and support.

While acknowledging that, due to the constraints of Covid-19, these sessions couldn’t be facilitated, most students identified the benefits of engaging in safeguarding scenarios, and how these would be escalated and followed up, showing each step of the process. Students also said they would like to engage in safeguarding roleplay, especially in relation to case conferences.

Because of Covid-19, the soon-to-be-qualified HVs had received a modified safeguarding module with no face-to-face classroom teaching, with some students having limited exposure to safeguarding during their training. Several students did not f eel adequately prepared to manage safeguarding on their caseload, and all expressed the need for further training to include scenario and roleplay sessions.

I conducted a further scoping exercise with HVs within the health board that had qualified in September 2019. They were asked:

  • How much safeguarding they had initially been allocated on their caseload
  • What safeguarding training and supervision they had received during the preceptorship programme.

Generally, the newly qualified HVs had not been allocated any safeguarding on their caseload for at least six months, or only as it arose. There had been no specific safeguarding study days on the preceptorship programme. However, prior to Covid-19, they had had the opportunity to engage in regular group and one-to-one safeguarding supervision.

Enhancing safeguarding

Safeguarding is everyone’s responsibility (WG, 2019; 2014; HM Government, 2018), and HVs have a duty to keep up to date with safeguarding practice, as laid out in The code (NMC, 2018). I suggested, based on the findings of the scoping exercises, that newly qualified HVs have enhanced safeguarding training as part of their preceptorship programme, including safeguarding scenarios and roleplay. A simulated learning environment would enable the artificial representation of real practice scenarios (NMC, 2019) resulting in meaningful and authentic learning opportunities (Nicola-Richmond and Watchorn, 2018) and a greater personalisation of the learning process (Alfred et al, 2018) within a safe, controlled environment. This would enable HVs to build confidence and competence, and equip them with the necessary skills to effectively manage safeguarding on their caseload.

Safeguarding supervision is an integral part of public health nursing practice (Appleton and Peckover, 2015; Powell, 2015). It allows practitioners to reflect, which is a useful process when evaluating an experience (Howatson-Jones, 2013) as it enables individuals to examine and challenge practice (Coleman and Willis, 2015), and enhance their effectiveness and confidence together with problem-solving skills (Howatson-Jones, 2013). Safeguarding supervision enables participants to receive emotional and practical support as well as identifying their training needs (Warren, 2018). It can be conducted in groups or as one-to-one sessions (Moseley, 2020). However, Moseley (2020) acknowledges that newly qualified HVs found one-on-one safeguarding supervision more effective than group supervision, even though group supervision was found to be enjoyable, and HVs benefited from sharing knowledge and experiences. Newly qualified HVs should therefore be given the opportunity to engage in both one-to-one and group safeguarding sessions as it enables them to practice effectively while preserving the safety of others (NMC, 2018), and is recommended in local safeguarding procedures (WG, 2019; 2014).

Although HVs are accountable for staying up to date with practice (NMC, 2018), if they are not allocated safeguarding cases when newly qualified, there is a risk of deskilling in practice and an associated lack of confidence. Through exposure to safeguarding in their caseloads, newly qualified HVs are going to have the opportunity to build competence and confidence, and develop the necessary skills in practice. Together with the engagement in safeguarding education, supervision and reflective practice, newly qualified HVs have the potential to enhance their practice through improving their knowledge and skills to facilitate early prevention and intervention in safeguarding practice (WG, 2019; 2014).

Building skills and confidence

These recommendations are based on the findings of a brief scoping exercise conducted as part of a service improvement presentation during the safeguarding module.

To achieve the recommendations, the training needs in relation to safeguarding practice have been shared with the named HV responsible for practice development within the health board, the safeguarding team and the management team. I am recommending that a safeguarding training programme is developed as part of the preceptorship programme that encapsulates the training needs of the newly qualified HVs, secondary to training during the Covid-19 pandemic.

The preceptorship programme should acknowledge that newly qualified HVs had a vastly different training experience to previous cohorts, especially in safeguarding and experiences within practice. This has left potential deficits in their knowledge, skills and safeguarding exposure. The inclusion of the personalised training programme based on the newly qualified HVs’ identified training needs will enable the development of safeguarding knowledge and skills for safe and effective practice, while building confidence in safeguarding.

Nicola Rooke completed the SCPHN course last year. She is now a Flying Start health visitor at Cardiff and Vale University Health Board.


Learning points

  • Even with remote learning, students mostly felt their learning needs had been met and that the content of the safeguarding module had been relevant to practice.
  • Students felt that there could never be enough face-to-face training in safeguarding, and that undertaking a virtual module, alongside the demands of home schooling and redeployment impacted negatively on their learning experience.
  • A personalised preceptorship programme based on need will enable the development of safeguarding knowledge.
  • It is necessary to acknowledge that newly qualified HVs have had significantly different training experiences from their predecessors.
  • Enhanced safeguarding training should be integrated into the preceptorship programme, including safeguarding scenarios and roleplay.

References

Appleton J, Peckover S. (2015) Child protection, public health and nursing. Dunedin Academic Press: Edinburgh.

Alfred M, Neyens DM, Gramopadhye AK. (2018) Comparing learning outcomes in physical and simulated learning environments. International Journal of Industrial Ergonomics 68: 110-7. See: sciencedirect.com/science/article/abs/pii/S0169814116303043 (accessed 16 February 2021).

Coleman D, Willis D. (2015) Reflective writing: the student nurse’s perspective on reflective writing and poetry writing. Nurse Education Today 35(7): 906-911. 

Fitzgerald K, Keyes K . (2014) Instructional methods and settings. In: Bastable S (ed). Nurse as educator: principles of teaching and learning in nursing practice (4th edition). Jones and Bartlett Learning: Burlington.

Gopee N. (2015) Mentoring and supervising in healthcare (3rd edition). London: Sage.

Gregory L, Hopwood N, Boud D. (2014) Interprofessional learning at work: what theory can tell us about workplace learning in an acute ward. Journal of Interprofessional Care 28(3): 200-5.

HM Government. (2018) Working together to safeguard children: a guide to interagency working to safeguard and promote the welfare of children. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard-Children.pdf(accessed 16 February 2021).

Hood K, Cant R, Baulch J, Gilbee A, Leech M, Anderson A, Davies K. (2014) Prior experience of interprofessional learning enhances undergraduate nursing and healthcare student’s professional identity and attitudes to teamwork. Nurse Education in Practice 14(2): 117-22.

Howatson-Jones L. (2013) Reflective practice in nursing (2nd edition). Sage: London.

Moseley M. (2020) An evaluation of groupsafeguarding supervision in health visiting practice. Primary Health Care (online only). See: https://journals.rcni.com/primary-health-care/evidence-and-practice/an-evaluation-of-group-safeguarding-supervision-in-health-visiting-practice-phc.2020.e1611/abs (accessed 16 February 2021).

Nicola-Richmond K, Watchorn V. (2018) Making it real: the development of a web-based simulated learning resource for occupational therapy students. Australian Journal of Educational Technology 34(5). See: https://ajet.org.au/index.php/AJET/article/view/3196 (accessed 16 February 2021). 

NMC. (2019) Different learning opportunities. See: nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/learning-environments-and-experiences/types-of-learning-experiences/different-learning-opportunities (accessed 16 February 2021). 

NMC. (2018) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. See:nmc.org.uk/standards/code (accessed 16 February 2021).

Powell C. (2015) Safeguarding and child protection for nurses, midwives and health visitors: a practical guide (2nd edition). McGraw-Hill Education: Edinburgh.

Quinn F, Hughes S. (2013) Quinn’s principles and practice of nurse education (6th edition). Thomson Learning: London.

RCN. (2013) Guidance for mentors of students and midwives: a toolkit. RCN Publishing: London.

Warren L. (2018) Role of leadership behaviours in safeguarding supervision: a literature review. Primary Health Care 28(1): 31-6. 

Welsh Government. (2019) Wales safeguarding procedures. See: safeguarding.wales (accessed 16 February 2021).

Welsh Government. (2016) An overview of the Healthy Child Wales Programme. See: https://gov.wales/sites/default/files/publications/2019-05/an-overview-of-the-healthy-child-wales-programme.pdf (accessed 16 February 2021).

Welsh Government. (2014) Social Services and Wellbeing (Wales) Act. See: legislation.gov.uk/anaw/2014/4/contents (accessed 16 February 2021).

Welsh Government. (2008) All Wales Child Protection Procedures. See: childreninwales.org.uk/policy-document/wales-child-protection-procedures-2008 (accessed 16 February 2021).

Yoo M, Park H. (2015) Effects of case-based learning on communication skills, problem solving ability and learning motivation in nursing students. Nursing and Health Sciences 17(2): 166-72.

Image Credit | iStock

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