Teaching and measuring compassionate care in pre registration

Making compassionate nursing practice explicit within the pre registration curriculum: Two educational practice developments Liz Adamson Lecturer Edinburgh Napier University ( Scotland)

Aim of presentation • To share two educational practice developments

The developments 1. Recording patient, relative, staff and student stories and using them as a teaching recourse within the curriculum 2. Embedding compassionate care within a level 9 module within the bachelor of nursing programme of study

Team Development 1

Team Development 2

Liz Adamson: Lecturer Belinda Dewar: Senior nurse Leadership in Compassionate Care Programme Anne Waugh: Senior Lecturer Christine Pollock: Senior Lecturer

Liz Adamson: Lecturer Belinda Dewar: Senior nurse Leadership in Compassionate Care Programme Wilma Thomson: Student nurse Edinburgh Napier University. Richard Mackay: Charge Nurse Western General Hospital, Edinburgh. Arlene Horsburgh: Charge Nurse, Royal Infirmary Hospital, Edinburgh.

Leadership in Compassionate Care Programme ( LCCP) Joint venture between Edinburgh Napier University and NHS Lothian (Scotland) Funded by an external benefactor A 3-year action research programme that is underpinned by principles of appreciative inquiry and relationship centred care.

The Vision: To embed compassionate care as an integral aspect of all nurse education and practice in Edinburgh Napier University, NHS Lothian and beyond

Undergraduate curriculum

Supporting NQ nurses

Beacon/development Wards/Sites

Supporting the development of leadership skills

Stories

Patient, relative, staff and student stories were gathered as part of the Beacon Wards / Development Sites LCCP

Themes • • • • • • • •

A deliberate welcome and a smile costs nothing Helping others connect Being kept in the loop Knowing how people are feeling acting and responding Knowing the little things that matter Feeling you have been heard Considering when you can and can’t do person centred care Being open and real about expectations

Example 1: Helping others connect •

It makes a difference if you try to find out something about the person. There is a man in bay 2 and even although it’s hard to talk to him – I’ve managed to have a wee bit of a conversation with him – he likes Hearts – I told him what the Hearts score was yesterday. I look in the notes or speak to the relatives to try to find something– this man had a hearts strip – so I knew. It’s good to have common ground to work with. I always try to do this. I’ve never come across a time when I couldn’t make some connection. [Staff comment]

Example 2:Being kept in the loop • It was important to us that any decisions about my father’s care or simple changes to his treatment were communicated to us and the staff did keep us fully updated. Minor alterations in medication or change in the use of equipment could assume huge significance to our untrained eyes, which could be alarming without any real need to be, e.g. the intravenous infusion machine would suddenly beep repeatedly and no-one would come rushing to attend to it. We were at first quite alarmed by this until a nurse explained that it was just a warning that the bag was running low and would need changed. It would have been very easy for the doctors and nurses to bamboozle us with all the medical terminology but they were very good at keeping us informed without the use of jargon or confusing abbreviations (Relative)

What next? • The data and emerging themes were available • Patient, relative, staff and student narratives

• How to make these available to lecturing staff? • How to use this valuable insight to influence the nursing and midwifery curriculum?

Audio files and Podcasts •

Podcast: An audio or video file that is made available on the Internet for download and playback using a computer or a mobile device such as an Ipod

The Process • • • • • • •

Funding: Edinburgh Napier Teaching Fellows Development Fund Planning: Theming the stories, key words, categories Recording studio and recording expert Inviting participation: Staff and relatives read own story Recording: photographs, reading the stories Editing: music and ident Setting up and customizing the podcast site, uploading

Sharing the resource

Listen to a story • http://www.patientstories.podbean.com

How to use these in the curriculum Could be • Used within lectures • Uploaded to WebCT for discussion • Shared during reflective sessions

What we did: One example • Action project • Collaborative approach: Senior nurses, Lecturer, Student, Charge Nurse Combined Assessment & Acute Medicine for Older People

The Module: Recognising acute illness and deterioration • Teaches students to recognise and respond to acute illness and deterioration • Blended learning: Theory through WebCT then application during practical simulation sessions • Practical sessions use patient scenarios followed by a debrief/reflective session. Lecturers participate as members of the MD team. • Practical assessment and written exam

On of the patient scenarios •

A young man is in his first week of a new job. He is a type 1 diabetic. He accompanies his colleagues to a wine bar and has a few drinks. He expects to have something to eat but the kitchen has closed as the chef walked out. He appears to be a little agitated. His friends find him collapsed in the toilet and call an ambulance. They report to the paramedics that they think he may have been fitting. He has small cut in his bottom lip.

Information/guidance for the actor patient • Vital to success of the exercise • Statements/questions that required a response for the student “ You won’t leave me will you? ” • Challenging the use of jargon “I just do your obs now”

Reflective session (Debrief) • Student have an opportunity to reflect on What they have done, What they missed What they would have done differently • What is required to ensure patient safety • What is important to the patient • Actor feedback

Podcasts • A story will be released with each unit of online study • Podcasts will be selected that relate to the topic taught within this unit

• http://www.raidmodule.podbean.com

Assessment • • • •

Formative: Peer assessment Summative: Invigilated practical assessment Criteria: Essential and non essential Aspects of compassionate care

Section of practical assessment criteria Criteria Provides patient with regular relevant information Explains procedures and rationale for actions Provides information about sequence of events. What he/she can expect

Achieved

Reflective practice: WebCT CC theme: Being kept in the loop “It would have been very easy for the doctors and nurses to bamboozle us with all the medical terminology but they were very good at keeping us informed without the use of jargon or confusing abbreviations” (Relative) Reflect on an occasion when you have been aware that jargon has been used when communicating with a patient or relative,. How could this have been explained differently?

Evaluation • Students, lecturers and actors will evaluate the module in its new form in December 2010 • Lecturers will evaluate the audio and podcasts resource through online comments and questionnaires

Summary • Care can be compassionate even in emergency situations • Patient stories provide real experiences that can influence the curriculum • Listening to a story can bring it alive • Compassionate care can be assessed