The COVID-19 pandemic has meant that 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 took up the role of mental health nursing lecturer at the University of Bedfordshire in June 2020 and have been supporting students working remotely. 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 two students' experiences:
‘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 raised 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, and these are difficult to recreate in an online environment. This may be creating a gap in learning for students on remote placements.
Examples of remote placements are community mental health teams and 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 that create 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 does not need to be detailed at first and can be personalised as the student progresses through their placement. A student may express an interest in psychological case formulation meetings and can therefore be timetabled to attend these weekly. These meetings are a way in which mental health clinicians discuss service users' symptoms in the context of their life. A timetable is an important step in building routine into a student's working day. Good habits, if started early, will spell success as the placement continues.
We all need to learn technical skills. Checking that students understand how to use the expected technology and software and that they have a laptop ensures success and can help build rapport with the student. Placement areas should have induction packs including a straightforward guide to using online tools. Learning online clinical meeting etiquette is another learning curve. This includes the importance of introductions in meetings with service users and ensuring digital confidentiality. These are all important conversations to have with students that can ease anxieties and establish professional working practices.
One aspect of working remotely is missing the transient conversations between assessor or supervisor and student where knowledge is transferred in short but meaningful exchanges. 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 a situation. This can be reviewed in a short meeting at the end of each day.
Despite the challenges, online placements have benefits. For many students, travel to placements is expensive and time-consuming. Remote placements can reduce this burden on students, while still allowing quality learning experiences. Further, students who are clinically vulnerable to COVID-19 can participate and engage in their placement in a meaningful way. 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 remotely. It may be that some services will continue to work remotely after the pandemic, so it is important that we define what good practice looks like now.