Reflections on mental health nursing online placements
With the Covid-19 pandemic, many mental health nursing community teams are working remotely, which has affected the way services are delivered. Many nursing students are also working remotely, both with their online studies and their clinical placements.
I am a mental health nursing lecturer, having started in this role in June 2020 I have been supporting students working remotely since. The support is provided at class level with opportunities to reflect on clinical experiences. Gathering informal feedback has been one way to assess how students are faring with all the changes. The comments below reflect are two students comments:
“The placement could be improved through better organisation and planning for students however, staff are much more supportive of students now than a few months ago”
“there is less face-to-face interaction due to current pandemic however service provision goes on ensuring continuity of care amidst all the uncertainties”
One of the key issues that has been brought up is the difficulty that students are encountering in filling out their practice assessment documentation when working remotely. Many nursing proficiencies are physical skills such as taking vital signs or venepuncture these are difficult to recreate in an online environment. Much of nursing work is kinesthetic and nursing students are attracted to the course for the practical aspect of the profession. This may be creating a gap in learning some of the more fundamental skills for students on remote placements.
Examples of remote placements are community mental health teams but also acute inpatient wards. The student works from home using platforms such as microsoft teams to attend the morning huddle and then subsequent virtual meetings throughout the day. Consent is obtained before a student attends a meeting with a service user and they are introduced. The student is then encouraged to write care notes under the supervision of the practice supervisor.
As with any changes, some students have adapted well to this. But as the first comment attests there are variabilities within placement provision which creates challenges. Such as a lack of structured time, difficulty having clinical proficiencies signed off and anxiety around expectations, both from the practice assessor and the students themselves. So how can students working remotely be supported in their learning?
Ensuring the student has a timetable for the days they are in placement is a simple and effective way to establish mutual expectations from the placement area and from the student. This doesn’t need to be detailed at first and can be personalised as the student progresses through their placement. The student may express an interest in formulation meetings and can therefore be timetabled to attend weekly formulation meetings. Psychological case formulation meetings are a way in which mental health clinicians discuss service users’ symptoms in the context of their life. While a timetable should be adopted flexibly it is an important step in building routine into the students working day. As we can all appreciate good habits if started early will spell success as the placement continues.
There is no such thing as a digital native and we all need to learn technical skills, such as using an outlook calendar or microsoft teams. Checking in with students that they understand how to use the expected technology and that they have a laptop is crucial for success. This is a simple troubleshooting step that can help build rapport with the student. Placement areas should have induction packs in which they provide a straightforward guide to the use online tools. This can be incorporated into the initial goal step, build students’ digital literacy. Finally, learning etiquette in online clinical meetings is another learning curve for students new to remote placements. For example, the importance of introductions in meetings with service users, muting the microphone and digital confidentiality are all important conversations to have with students that can ease anxieties and help establish professional working practice.
One of the most interesting things about working remotely is the missed transient conversations had between appointments. Often knowledge is transferred from the assessor or supervisor in short but meaningful exchanges. What Lave and Wenger might term peripheral participation. This is difficult to recreate with remote placements, but as with any clinical work, a reflective account by the student can go a long way to assess their understanding of the situation. This can be reviewed in a short meeting at the end of each day.
Positives of remote placements
Despite the challenges, the benefits of online placements shouldn’t be overlooked. For many students, travel to placement is expensive and time-consuming. Remote placements can therefore reduce the burden on nursing student’s expenses while still allowing quality learning experiences that bridge the gap between the theory and practice of mental health nursing. Further, students who are clinically vulnerable to Covid-19 can participate and engage in their placement in a meaningful way, allowing them to progress on the course as expected. In future I foresee several clinical skills such as risk assessment being examined by virtual simulations.
Covid-19 is going to be with us for some time and as a profession we need to ensure students are having high quality learning experiences whether this is in person or remote. Finally, it may well be that following the pandemic some services will continue to work remotely so it is important that we define what good practice resembles now.