Opinion

Making the most of remote learning

22 November 2021

James Salmons and colleagues describe running a remote public health nursing placement for pre-registration students and look at the experiences of placement providers, institutions and learners themselves.

The Covid-19 pandemic caused major disruptions to the placement experiences of many health and social care students.

Pressures on delivery of care due to staff shortages, the converting of services to support Covid patients, and social distancing measures have all reduced the placement opportunities for health and social care students. This has been especially evident in organisations that go out into community settings, where social distancing measures for safe visiting in the home have been introduced. There is also evidence that some clients have been reluctant to accept more than one visitor into their home, thus restricting the number of placement opportunities for students.

The NMC recognised the impact on the education of nursing and midwifery students during the pandemic. It introduced emergency standards in March 2020 and revamped them in January 2021, rebalancing theory and practice in parts of the programme (NMC, 2021). Higher education institutes (HEIs) and placement providers also developed creative solutions in the absence of practice experiences and devised combinations of real visits, case study work, simulations and virtual consultations. 

The literature on virtual or remote placements is scant, and other than a virtual placement project in Essex reported in Nursing Times (Ford, 2020), there is minimal literature from the field of nursing. Looking further afield, a physiotherapy placement provider successfully implemented a virtual placement opportunity, identifying that a robust virtual infrastructure was vital to success, particularly in light of altered communication channels (Twogood et al, 2020). In addition, it was noted that virtual placements allowed students the flexibility to meet the requirements of their placements alongside other demands made on them through the pandemic, such as home schooling (Twogood et al, 2020). Outside healthcare, however, virtual placements have for some time offered students the opportunity to network with employers without the need to commute or for placement providers to find physical space to accommodate an intern.

Virtual internships have existed in technology, business and journalism for some years (Paul, 2015) and are considered to reflect ‘real world’ working within a virtual space. An alternative is the virtual simulated placement, which is either screen-based or uses clinical skills teaching, or telehealth simulation with standardised patients as a replacement for direct patient care (Shea and Rovera, 2021). However, commercially available products are often expensive and have limited application to children and young people’s (CYP) nursing, whereas the resources and time required to write and develop suitable telehealth simulations are often simply not available.


Learning and assessment activities

  • Virtual teaching session to all the students delivered by a school nurse or HV
  • Directed learning activities for example researching key policies/ guidance
  • Observing and participating in face-to-face visits (where safe and appropriate) or video/telephone conversations
  • Joining virtual/multidisciplinary team meetings
  • Roleplay
  • Spending time with other services (either virtually or face to face).

This limited evidence base meant we had little reference material to develop and support placement providers and students. Despite this, placements are a core part of the CYP nursing programme and are widely recognised as aiding the development of healthcare students (Elcock, 2020; Millington et al, 2019; Levett-Jones et al, 2015). Placements allow for the application of theoretical knowledge and to develop competence and confidence in a variety of skills (Millington et al, 2019).

Since September 2020, in collaboration with a local placement provider, first- and second-year CYP nursing students have undertaken a remote placement. As part of this placement students engaged in a variety of different learning and assessment activities (see box, left).

In this article we will reflect on the experiences of this type of placement for placement providers, HEIs and students.

Placement provider reflection

Feedback from the practice assessors (PAs) and practice supervisors (PSs) has generally been very positive. The need to change placement models provided an opportunity for services to reset and adapt placement teaching and assessment methods for a modern public health nursing service. One PA noted: ‘We realised that signing skills off was still aligned with the medical model. It provided a good opportunity to review what students need, and we found that there are lots of skills that can be signed off using a socioeconomic model of health.’

This also fits with a wider view shared by multiple assessors: that students were exposed to and experienced a more holistic view of public health nursing, and as a result were better able to link theory to practice. Students also had a broader placement experience and were able to consider wider aspects of health promotion and health inequalities.

Microsoft Teams (MT) software allowed face-to-face discussions with students and helped them feel part of the team. This platform was also used innovatively by some practitioners, who ‘brought’ the student into the client’s home and were able to participate in the discussions with families. This gave students valuable interactions with CYPs and their families, although, as one practitioner noted, using a laptop to host this meant they couldn’t use it to make notes as they would normally.

Students experienced a more holistic view of public health nursing and as a result were better able to link theory with practice

MT was also used to host virtual teaching sessions for students. This was something newly introduced for this placement type. Students on placement joined together for a one- to two-hour teaching session delivered by internal and external speakers on their area of expertise. This had two benefits: first, it brought all the students together to share their experiences in a way that had not been possible before. Second, it proved more efficient: instead of multiple assessors each teaching their student, one assessor could teach multiple students simultaneously. This in turn freed up practitioner time.

It was acknowledged that developing teaching materials was more resource-intensive in the short term, but these are now being reused with subsequent cohorts of students on placement. Planning and facilitating sessions also provided a development opportunity for a number of HVs and school nurses (SNs). Planning sessions led to greater collaboration, discussion and idea generation between HVs and SNs working in different areas.

An initial hurdle was ensuring that both students and their PA/PS knew what was required of them. Once individualised timetables for each student were developed, this relieved some of the pressure. PAs/PSs knew what was planned for each student and therefore didn’t need to create a plan each day. The timetables also meant learning activities could be planned around any student action plans and their learning/assessment objectives. Students were also able to reflect and evidence their learning, thereby contributing towards their experiences and meeting the required learning/assessment objectives.

In the initial stages, academics were able to support PAs to consider alternative forms of assessment rather than the traditional approach of observing a student and provided suggestions for additional learning opportunities for students.

Students really enjoyed the teaching sessions, feeling that their skills and knowledge were enhanced

Throughout the placement, the PA/PS had access to either the student’s academic assessor or the academic in practice (a link role between the HEI and practice) for troubleshooting and ongoing support.

The way in which students were prepared for placements required a different approach. Normally, students receive a generic lecture preparing them for placements that informs them of the necessary requirements. It became apparent that this generic approach did not meet the needs of students on placements that were unlike anything they may have been expecting. Therefore, a bespoke preparation for practice session was hosted by the academic in practice for these students. This allowed a space where concerns were addressed, and more localised information on expectations was given – for example, on what they might need to produce as evidence for their PA. This has led to a reduction in student anxiety about this placement type.

Student experience

The student experience and feedback on this type of placement has been mostly positive. Overall, satisfaction with placements remains broadly the same as in pre-Covid-19 times. Both HEIs and placement providers have become more accustomed to meeting student need, while satisfaction has increased and anxiety has decreased.

At the same time, feedback from practitioners indicated that the anxiety felt by the PS/PA in being allocated a student was reduced because the responsibility of having a student was shared more formally with colleagues. It was felt by practitioners that there was a team approach to supporting students that was new, and this was welcomed by the allocated PS/PA.

Similarly, students enjoyed the teaching sessions because of the variety of the material taught and the feeling that their skills and knowledge were enhanced. Some students had IT issues in accessing sessions, but these were mostly resolved. One said: ‘The teaching sessions I attended were very interesting and relevant for my learning development. I learned a lot about the public health issues that children are currently facing.’

Despite the limitations of the mostly or entirely online setting of placements, students reported a better understanding of the role of HVs and SNs. The students reported that they could see how these roles fitted into the wider context of both children’s nursing and CYP health. Some students found that the online nature of placements enabled them to develop skills they might not have acquired otherwise. ‘I got good at communicating with a multi-agency team regularly due to the online nature of my placement,’ said one.

A recurring theme from students was gratitude for the support that their PA/PS had provided them with, and the feeling that they had made the best out of the current situation. One student said: ‘My PA and PS were very supportive. They did their absolute best to allow me to get the most experience I could out of this placement.’

Students enjoyed any interaction they were able to have with CYPs and their families, especially so when it was deemed safe enough to do this face to face.

The most valuable experience, they said, was ‘going to virtual contacts with families and health visitors in homes and the clinic’ and ‘the interaction with patients’.

What next?

Exactly what will happen next will depend on whether any further Covid-19-related restrictions are imposed or whether society continues to open up.

Regardless of the circumstances, some elements of virtual placements will undoubtedly remain. The teaching sessions have been well evaluated by both practitioners and students, and have demonstrated a range of benefits to both groups as well. The idea of having a greater structure to placements has anecdotally been shown to reduce stress and confusion for both students and practitioners, so this will continue.

The feedback, insights and comments used as part of our reflection on this experience have been gained through informal discussions with staff and students, while some comments came from placement evaluations. To explore this experience further, we intend to produce follow-up research that will explore the experience of practitioners and students to get a more detailed insight to inform future practice.

Conclusion

Despite some of the hurdles encountered in setting up this innovative approach to practice, we have still been able to provide students with valuable placement experiences where they have been challenged and learnt more about the roles of HVs and SNs.

Staff have reported some positive changes with virtual placements in comparison with an exclusively face-to-face approach. As discussed, it is likely at least some of these changes will remain a feature of student experiences, regardless of what the future holds for virtual placements. 


James Salmons is senior lecturer in CYP nursing, University of the West of England (UWE); Stephen Booth is director of professional placements, UWE; Zoe Veal is senior lecturer in CYP nursing, UWE. For Sirona care & health, Sarah Clarke is clinical lead (health visiting); Georgina Frost is a school nurse; Penny Hazelwood is head of health visiting (South Gloucestershire); Andrew Luff is placement expansion lead; and Faye Murtagh is a school nurse.


References:

Elcock K. (2020) How to Succeed on Nursing Placements. Learning Matters: Exeter.

Ford S. (2020) Virtual placements helping student nurses who are Covid-19 ‘shielding’. Nursing Times. See: nursingtimes.net/news/education/virtual-placements-helping-student-nurses-who-are-covid-19-shielding-30-06-2020/  (Accessed 28 September 2021).

Levett-Jones T, Reid-Searl K, Bourgeois S. (2015) The Clinical Placement: An Essential Guide For Nursing Students. Elsevier: Amsterdam.  

Millington P, Hellawell M, Graham C et al. (2019) Healthcare Practice Placements: Back to the Drawing Board? British Journal of Healthcare Management 25(3):145-53. 

NMC. (2021) Recovery and emergency programme standards. See: www.nmc.org.uk/standards-for-education-and-training/emergency-education-standards/ (Accessed 18 November 2021).

Paul P. (2015) Virtual Placements to Develop Employability Skills for Civil and Environmental Engineering Students. Education Sciences 5(2): 47-4. 

Shea KL, Rovera EJ. (2021) Preparing for the COVID-19 Pandemic and Its Impact on a Nursing Simulation Curriculum. Journal of Nursing Education 60(1): 52-5. 

Twogood R, Hares E, Wyatt M et al. (2020) Rapid implementation and improvement of a virtual student placement model in response to the COVID-19 pandemic. BMJ Open Quality 9(4): e001107. 

Image credit | Shutterstock

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