Teaching and Learning During the Pandemic
Alicia Stringfellow RN (Mental Health), MSc, PGCE, PG Cert (CBT), PG Dip (THORN)
Lecturer in Mental Health Nursing, Cardiff University, Wales, UK.
[email protected]
Georgia Hedges, final year Undergraduate Student Mental Health Nurse
Cardiff University, Wales, UK.
Catherine Williams, final year Undergraduate Student Mental Health Nurse
Cardiff University, Wales, UK.
The International Year of the Nurse 2020 saw the World Health Organisation (WHO) publish its first State of the World’s Nursing report. The report highlighted a need for an acceleration of nursing education to address global need, domestic demand and respond to changing technologies and advancing models of integrated health and social care (WHO, 2020). In the context of a worldwide pandemic, never has this global spotlight on nursing been so significant or the recommendations made so poignant.
This article provides an insight into the role of undergraduate student mental health nurses in the United Kingdom (UK) and how they helped support the National Health Service (NHS) in the context of COVID-19 and the global pandemic. It is written in collaboration with two of my final year Personal Students, Georgia and Catherine, who have provided personal insights into their experience and taken the opportunity to share this with ISPN members.
In the UK, Nurse Education allows prospective student nurses to choose the field of nursing they wish to specialise in prior to commencement of their undergraduate degree. The 3-year Bachelor’s programme in either Adult, Mental Health, Child (Children and Young People) or Learning Disability fields of nursing focusses from the outset on the generation of field specific knowledge, understanding, application and experience and is complimented by generic content from all other fields. The degree programme is comprised of 50% theory and 50% clinical experience working in partnership with a range of NHS providers, Private Hospitals and third sector (charitable) organisations. Education fees are either met by Welsh Government in Wales or through the UK student loan system. Students maintain supernumerary status throughout the course and are not paid for their clinical work – some receive a small bursary to help with living costs. On successful completion of the degree students become registrants of the Nursing and Midwifery Council (NMC) and once registered can practice as a Registered Nurse in their specific field.
As a Lecturer in Mental Health Nursing at Cardiff University in Wales and a Registered Mental Health Nurse in the UK, my role is primarily focussed on the provision of both undergraduate and postgraduate nurse education, as well as the necessary scholarly and research activity that comes with working in an academic setting. As part of my role, I support a number of undergraduate mental health student nurses as Personal Tutor and/or Academic Assessor, working closely with these students during their 3-year programme. In light of COVID-19, however, this role has become more complex as the global pandemic has evolved and the situation regarding student nurses in the UK changed.
It goes without saying that COVID-19 is the worst public health crisis in a generation. In response to the sharp acceleration of cases in the UK, all student nurses were called upon to assist the NHS in meeting the demands of the pandemic and help ensure that front line services were fully supported. As a result, UK Universities were instructed by the regulator, the Nursing and Midwifery Council (NMC), as well as other key stakeholders to adapt their undergraduate nursing programmes and invite student mental health nurses to opt-in to an arrangement where 80% of their time would be spent in clinical practice and where the students would be remunerated for their time.
Overwhelmingly, the majority of student mental health nurses opted-in, with the fast deployment and mobilisation of these students into mental health clinical areas presenting a series of opportunities and challenges for Educators, the NHS, Stakeholders and student mental health nurses. Theoretical assessments were paused and students effectively ‘stepped off’ the programme to assist in providing healthcare in a range of mental health settings. This included clinical placements in both mental health hospitals and within mental health community teams.
Reflecting on this mobilisation into clinical mental health areas in the UK, Georgia captures the experience of her cohort:
The role of student mental health nurses shifted dramatically during the coronavirus pandemic. Student mental health nurses were placed in clinical areas, and consequently, all academic assessments were postponed. During the coronavirus crisis, student mental health nurses were deployed to high pressured clinical environments to support the health service’s frontline staff in delivering care to patients.
Being a student mental health nurse during the pandemic posed significant challenges to both the staff and patients in the clinical area. Reduced staffing numbers due to sickness heightened the pressure in the clinical area. Therefore, many nurses and healthcare support workers undertook overtime, in addition to their contracted hours, to fulfil the staffing levels required to safely maintain the standards of patient care. However, having non-supernumerary status provided me with invaluable and plentiful opportunity to work more collaboratively with many healthcare professionals and patients in comparison to previous clinical placements.
Catherine adds:
Student mental health nurses were given the opportunity to “opt-in” and work as a member of a team in clinical areas that required more staffing support. We were no longer supernumerary members of the team; therefore, our attendance was crucial in maintaining the safety of patients through use of safety checks and other recorded systems.
During this period, there were many challenges that we faced when delivering person-centred mental health care. This included a limited ability to work with patients therapeutically due to staffing pressures and reduced staff-to-patient contact from all areas of the multidisciplinary team, resulting in a lack of stimulation and boredom for patients.
Personal Protective Equipment (PPE) also posed a barrier to effective engagement with patients due to increased difficulty in communicating. Patients reported that they were unable to read non-verbal cues (facial expressions) and often struggled to hear and understand staff with a mask on. Some patient’s suffering from paranoid thoughts and suspicious ideation also found it difficult to work with staff that were wearing PPE, because it reinforced these thoughts and made them feel uncomfortable. This barrier was reduced by educating patients and making them aware of the current news and restrictions implemented outside of the clinical area as well as inside. Also taking more time to ensure that patients understood what staff were saying and giving patient’s more contact time with nurses helped to reduce the tension and confusion between staff and patients in the clinical area.
Both Georgia and Catherine clearly found the sudden and unexpected move into clinical practice challenging, yet both students also found the experience deeply rewarding. It is evident that assisting clinical areas to deliver high quality mental health care during a global pandemic has enriched their undergraduate student experience and provided unique opportunities for personal and professional growth. Whilst a challenging component of nurse education is often securing adequate time and exposure for students in clinical practice settings, the unprecedented ‘call to arms’ amidst a global pandemic provided student mental health nurses with a unique, varied and exceptional experience that will shape the future nursing workforce beyond all expectations and where the WHO’s (2020) recommendations can come to fruition.
References
Nursing and Midwifery Council (2020) Stakeholder Information Pack from the Nursing and Midwifery Council on our response to COVID-19.
World Health Organisation (2020) State of the World’s Nursing. Online access: https://www.who.int/publications/i/item/9789240003279
