Clinical placements

When clinical placements don’t meet students’ learning needs

How a frailty service refined its programme and the benefits for students and supervisors

How a frailty service refined and tailored its programme and the benefits for students and practice supervisors

Improving care for older people living with frailty or multiple long-term conditions was identified as a priority in the NHS Long Term Plan, published in January 2019.

East Sussex Healthcare NHS Trust had introduced a frailty practitioner service three years earlier, after the East Sussex Better Together Programme a health and social care transformation programme that ran from 2014 to 2018 supported the need for a dedicated frailty service.

Our first frailty student placement

In 2017, we introduced

How a frailty service refined and tailored its programme and the benefits for students and practice supervisors

Working in collaboration enables supervisors and students to prioritise the individual’s learning needs on placement
Working in collaboration enables supervisors and students to prioritise the individual’s learning needs on placement (picture taken pre-COVID-19) Picture: John Houlihan

Improving care for older people living with frailty or multiple long-term conditions was identified as a priority in the NHS Long Term Plan, published in January 2019.

East Sussex Healthcare NHS Trust had introduced a frailty practitioner service three years earlier, after the East Sussex Better Together Programme – a health and social care transformation programme that ran from 2014 to 2018 – supported the need for a dedicated frailty service.

Our first frailty student placement

In 2017, we introduced community-based frailty clinical placements for nursing students, with our first student starting her five-week placement in November that year.

This was the first time the service had taken a student on placement, so it was a learning experience for us all. The student spent a week with each of five different teams – proactive care, Health and Social Care Connect, crisis response, joint community rehabilitation and the frailty team.

However, feedback from the student was that the placement was over-complex and was not meeting her learning needs, either through lack of time in each area or the setting not offering experience in the skills she was required to learn.

What is frailty?

Frailty is a clinically recognised state of increased vulnerability resulting from ageing and associated with a decline in the body’s physical and psychological reserves.

It is not an inevitable part of ageing, but is a long-term condition, like diabetes or Alzheimer’s disease. In the UK, about 10% of people aged 65 or older are living with frailty, rising to 25-50% for those aged over 85.

Source: Age UK

Using feedback to create a bespoke experience

Taking the student’s feedback on board, in 2018 we refined the placement to focus primarily on frailty.

We now offer a 'bespoke' community-based placement that enables students to experience the many different aspects of frailty as a long-term condition, and understand what it is like for older adults living with frailty and other multiple co-morbidities.

Students are contacted before the start of the placement so we can identify their learning needs and discuss potential learning opportunities, with each student allocated a dedicated work-based supervisor and practice assessor to help ensure continuity of support.

What our community-based frailty placement offers

During the placement, which now lasts between 11 and 13 weeks, students’ experiences include:

  • Learning about the biology, anatomy and physiology of frailty
  • How to complete the comprehensive geriatric assessment (CGA) process with patients in a variety of clinical and non-clinical settings, including frailty practitioner-led clinics, residential and nursing homes and the patient’s own home
  • How to complete the Rockwood Clinical Frailty Scale
  • Attending weekly ‘virtual ward rounds’, facilitated by a consultant geriatrician. Patient caseloads are presented and discussed at the multidisciplinary rounds, providing an ideal opportunity for shared learning, and students also have the opportunity to take on their own patient and present the case to the consultant
  • Spending time with the practitioners in the team, who come from a range of clinical backgrounds and disciplines, including intensive care, palliative care and physiotherapy
  • Spending time with our medicines optimisation pharmacist, who joined the team to address the needs of older adults living with frailty and polypharmacy
  • Three weeks with the community crisis response service, visiting people in their homes to prevent unnecessary hospital admissions and spending time on the inpatient acute frailty unit. This ensures students’ experiences reflect the trust’s frailty pathway
  • Under the close supervision of the frailty practitioner, students learn how to write GP letters, make decisions regarding future care, liaise with family members, and about the medications prescribed for people with frailty

Any spoke placements are discussed with the student at the start of the placement to ensure the spoke placement fits the student’s learning needs and can be organised in time.

Ensuring placements meet students’ needs

Quality improvement and evidence-based decision-making underpin all work undertaken by the frailty practitioner service, including student placement and support.

In October 2019, I undertook a quality improvement project to explore students’ experiences of clinical placements and their learning needs. A group of second and third-year students from the University of Brighton, who I teach part-time, were asked to complete a placements questionnaire comprising four questions:

  1. What is the most valuable experience to you as a student (holistic assessment, physical assessment, medication knowledge)?
  2. When starting a new placement what is the one thing that is most important to you as a student?
  3. Would it benefit you as a student to receive a learning styles questionnaire about how you learn prior to placement so that your supervisor can offer you a better learning experience suited to you?
  4. Have you had placements that have not met your learning needs?

What students say matters most to them

Of the 31 students who completed the questionnaire, 65% said that holistic assessment was the most valuable skill they could learn while on a hub placement, while 20% said physical assessment and 15% medication knowledge.

When starting a new placement, the initial welcome and being made to feel part of the team was most important to 48% of students, with 13% identifying orientation to the new environment.

‘With students spending 50% of their degree time on clinical placements, and with many now self-funding their studies, it is important to explore the reasons why placement shortcomings occur, and what can be done to improve this’

Research shows that orientation to clinical placements can enhance learning by helping students to feel they ‘fit in’, reducing anxiety and increasing motivation to learn through early identification of learning outcomes.

Students are then more likely to feel receptive to the learning environment, which increases their confidence to request additional specific learning opportunities, such as ‘spoke’ placements related to the hub.

Students said the most valuable lesson on placement was in holistic assessment
Students said the most valuable lesson on placement was in holistic assessment (picture taken pre-COVID-19) Picture: iStock

When asked whether completing a learning style questionnaire prior to their placement would be beneficial, 87% said it would.

The Honey and Mumford learning styles questionnaire identifies four learning styles – activists, reflectors, theorists and pragmatists – and can be used to help students identify their own learning style.

Identifying students’ preferred learning style can help optimise learning opportunities, enabling them to recognise their strengths and areas for development in the way learning takes place.

Practice supervisors can then identify where additional learning activities are required to ensure the student has a quality learning experience.

Results from the survey led to the introduction of a resource to help consolidate students’ learning while on placement with the frailty practitioner service, addressing transferable skills and strengthening their knowledge for future placements.

Why placements sometimes fail to meet learning needs

The RCN says practice placements are a vital component of the student experience, and a quality practice placement has a direct bearing on the student’s ability to work effectively and integrate theory into practice. Yet more than half of the students surveyed said they have had clinical placements that have not met their learning needs.

With students spending 50% of their degree time on clinical placements, and with many now self-funding their studies, it is important to explore the reasons why such placement shortcomings occur, and what can be done to improve this.

Ensuring students complete the Honey and Mumford learning tool before their placement is a good start. Completing an initial assessment on the first day or within the first week of the placement can also ensure timely identification of students’ learning needs. An action plan can then be put in place and evaluated throughout the placement.

‘Students will become practice supervisors themselves one day, and will look to emulate their own positive placement experiences’

Students’ attitudes and approaches to learning also determine the success of placements. An understanding of the supervisor’s clinical role and competing demands helps students balance their own learning needs with the ‘right’ to expect input and support from their supervisor.

Ultimately, supervisors need to work in collaboration with students to identify and address poor quality learning environments. Students will become practice supervisors themselves one day, and will look to emulate their own positive placement experiences.

We are striving to ensure the frailty practitioner service placement is an exemplary one, where learning opportunities and needs are recognised and students can continue their training to become outstanding practitioners in their chosen field.

We all need to be the best we can be for the nurses of tomorrow.


 Nik Frankis is a frailty practitioner nurse specialist at East Sussex Healthcare NHS Trust

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