Clinical placements

Virtual clinical placement: when practice-based learning goes online

COVID-19 may be halting clinical placements, but practice education can carry on

Technology and partnership working can produce a rich remote learning experience for nursing students

As a practice educator for an NHS trust, my role is to support nursing students training to become adult nurses.

A home nursing placement is a required element of the course, but the current COVID-19 crisis has meant postponing community placements. Although this is necessary to safeguard students, patients and staff, it is challenging for all involved in educating our students, who have been unable to progress their training.

So when staff at our approved education institution, Anglia Ruskin University, approached us about designing and implementing a virtual placement for a cohort of ten degree-apprentice students, we

Technology and partnership working can produce a rich remote learning experience for nursing students

With clinical placements postponed, we had to act to minimise disruption to practice learning Picture: iStock

As a practice educator for an NHS trust, my role is to support nursing students training to become adult nurses.

A home nursing placement is a required element of the course, but the current COVID-19 crisis has meant postponing community placements. Although this is necessary to safeguard students, patients and staff, it is challenging for all involved in educating our students, who have been unable to progress their training.

So when staff at our approved education institution, Anglia Ruskin University, approached us about designing and implementing a virtual placement for a cohort of ten degree-apprentice students, we were keen to make it work.

Taking our first steps into virtual placements

After discussions with university staff, we decided on a week-long programme of blended learning to share insights into the adult community nursing specialty. The university’s community education champion came on board to help facilitate learning and assist with managing the group.

‘The array of information available on the learning platform demonstrated the trust’s commitment to the student learning environment and the value we place on our future generation of nurses’

All the students received an introductory letter outlining what the virtual placement would entail and the equipment they would need, including a laptop with camera, microphone and internet connection.

As we had recently transferred to working remotely, using Microsoft Teams and Zoom, we were aware of some of the issues involved with using this technology; frequent breaks, for example, allow for periods of reflection and screen-free time, and help maximise learning potential.

Students were informed the programme would provide gaps for refreshment, and that extra time away from the screen could be taken as and when required.

Multiple teaching formats were used, to take account of diverse learning styles

The trust’s learning platform was made available to students so they could review the learning resources, research, and guidelines, and download any presentations and documents for later use.

The comprehensive array of information available on the learning platform demonstrated the trust’s commitment to the student learning environment and the value we place on our future generation of nurses.

To enhance learning potential, stimulate interest and cater for different learning styles, teaching took a variety of different formats. This included PowerPoint presentations, staff talking about their roles or an average day, videos, group work, scenarios, and problem-solving exercises.

What the placement involved

Students were assessed on a piece of group work at the end of the placement Picture: iStock

The week-long placement was constructed around Vygotsky’s Zone of Proximal Development concept to enable progressive ‘scaffolded’ learning, broadening students’ knowledge of health provision in the community and ensuring they meet the essential learning outcomes of a community placement.

The week covered:

  • An introduction from practice educators at the trust and the Anglia Ruskin University community education champion.
  • An overview of community nursing
  • Talks from a district nurse, healthcare assistant and advanced clinical nurse practitioner. These illustrated the scope of nursing in the community
  • Dementia, diabetes and respiratory nursing, highlighting the amazing resources available in the community
  • Palliative and end of life care in the community, including the importance of patient choice
  • Trust pharmacy technicians spoke about the challenges with medicines management, including the risk of medication errors and the barriers to medication concordance in the home
  • The importance of communication and referral systems in ensuring appropriate care and management, promoting patient independence and self-care, and supporting patients to reduce unnecessary hospital admissions
  • The placement ended with a virtual day in a GP surgery, including a leg ulcer clinic supported by a virtual consultation and previous theoretical learning

Assessment at the end of the virtual placement

At the end of the week, the students undertook a piece of assessed group work to demonstrate their enhanced understanding of home nursing. This work involved caseload management, workload allocation, and planning of visits according to clinical need and geography.

This was a challenging and demanding assessment, but the students put in a tremendous effort and surpassed our expectations with their ability to consider the needs of individual patients, nurses’ skill levels and competence, and break times. They also factored in time for administration and essentials such as team meetings for patient handover.

Students were able to learn about aspects of practice particular to the community

The virtual placement enhanced students’ awareness of the high levels of autonomy and responsibility that come with practising in the community.

They learned the importance of carrying out comprehensive, patient-centred assessments, developed a heightened awareness of the risks of lone working, learned more about the safeguarding of staff and patients, and the ethos of being a guest in someone’s home.

Some technical difficulties were hard to avoid, but there were advantages too

Some of the problems we encountered during the week were unavoidable, such as issues with technology. With no university access, students were required to use their own equipment, so there were some problems with microphones, internet access and getting into ‘break-out rooms’.

But one of the major advantages of the virtual medium was that it enabled input from specialist practitioners, which would likely not have been possible through an actual placement in a community team.

Student feedback

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Students who took part in the placement completed an online survey. This was used to evaluate the learning experience and provide feedback to inform future projects.

Comments included:

  • ‘I felt like I was working in the community. It seemed very real.’
  • ‘Definitely made me feel like I want to experience district nursing in a real situation’
  • ‘Very good insight into community nursing. Bit overwhelming but good to gain some experience’
  • ‘Gave me a really good insight into diabetes care in the community’
  • ‘Very good discussion around end of life care, just the right amount of information and content’
  • ‘Good way to practise the management skills required in community nursing’
  • ‘Great insight into situations that occur in the community’
  • Kept me engaged throughout. Very knowledgeable and interesting and I am keen to do further research’

Planning and partnership working were essential

Careful planning and preparation were key to the success of the placement. We had a contingency plan in place with back-up resources, including stand-in speakers and alternative learning experiences, but this was only required on two occasions and there was no disruption to learning.

By working in partnership with the university, we were able to make possible a high-quality learning experience for our students, giving them a true taste of community nursing.

The pilot virtual placement exceeded all expectations and there are already plans to use it as a model for future placements and to share the knowledge gained across the educational sector.

NS Student

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