Preparation For Practice: Service User and Carer Involvement in the Curriculum The involvement of service users and carers in curriculum development is still a developing

area in many areas of healthcare education. In mental health however, this has been significant (Hanson & Mitchell 2001, Rush & Barker 2006, Lathleen et al 2006, Speers 2008), and good practice in this was acknowledged in the publication of the Review of Mental Health Nursing in Scotland (SEHD 2006a). One example of a ‘positive practice example’ was that of the mental health team at Napier University, which has:

Worked with service users and carers to develop a strategy for user and carer involvement in their programmes. This included the appointment of a dedicated development worker. Education is being used as a means to bring about changes in practice that improve experiences and outcomes of care for service users and their families and carers. The value of meaningful service user and carer involvement is a central part of education at Napier and influences all classroom teaching and learning. The strategy has now grown to include working among informal partnerships of lecturers, service user and carer groups, practitioners and students. The 'partnership' is working on two specific projects:

• attitudes and responses to self harm workshops for student nurses

• developing service user and carer-defined proficiencies that will be used to assess students during practice.

The partnership approach is also helping all involved to continue to learn about involvement and is bringing about positive change in practice through joining forces to work together. (SEHD 2006a)

This report, however, highlighted amongst its key actions that ‘we need to actively involve service users, families, carers and practitioners in the design and delivery of education programmes for mental health nurses’. In this research study, the case study sites reported a wide variation in service user involvement in the curriculum:

We have brought them... (Referring to mothers and families) into the classroom and what we particularly did was involved mothers and user groups in the development of the curriculum…. So we had representatives of the midwifery committee services …National Childbirth Trust, their local resource centre and other sorts of people …. It’s been very, very good, very helpful. (Midwifery academic Case study D)

They would link with the carers when they are on placements with us in the community through the Prince’s carers trust, so when they are down in the centre

they could have the opportunity to meet the carers there, obviously when they are on placement with the district nurse they would be meeting carers when they are out meeting patients as well so they get involved in meeting with carers and identifying what their needs are and looking at how they can support them, what information they require.(Community lead nurse Case study C)

The comments from students, however, focused more on the actual experience of patients coming into the classroom to talk to them about their illness experiences, as the following student indicates:

I’m half way through my degree module just now and its upper cancer—so a speaker is coming in to talk to us about his experience of nursing (Student nurse Case study F)

As part of the project methodology users and carers were involved in a Scotland-wide ‘Open space’ event in November 2007. The majority of comments focused on the actual experiences of being cared for by nursing or midwifery students, both positive and negative:

my son in law was diagnosed with cancer and together with my daughter and granddaughter received excellent support. To my surprise my husband and I were also offered support (Carer – Open space event)

Communication between carers and individuals with profound and multiple learning disabilities and the professional is often not good (Carer – Open space event)

When invited to comment on the essential knowledge, skills and attitudes required of the students, the participants felt that knowledge of the roles of carers was important as was knowledge of the impact of illnesses on the carer; skills required were pressure area care, skin, mouth and eye care, injections, infection control procedures, listening and good verbal and written communication, attitudes were empathy, confidence, competence, recognition of limitations, compassion and being non-judgemental. In being asked to comment on how users and carers should be involved in planning and delivery of nursing and midwifery education, the participants felt on the whole that rather than being invited to share their experiences of being a carer or a patient with a long-term condition on a one- off session, that they would like to be involved from the curriculum design stage. Areas they felt they could contribute to were in relation to issues around advocacy, legal rights of carers, stress and anxiety and disease process and management of this process.

At a subsequent stakeholder event, a carer presented feedback from the focus group event and called the session ‘Equal partners in caring’. Her focus was that carers have a wealth of ‘insider knowledge and experience’ regarding the patient/client which nurses and others need to utilise for the benefit of delivering effective care, as well as enabling them to recognise that carers themselves have needs regarding their health and well-being. This was an excellent insight and value for the project team in terms of contextualising the user- carer involvement in preparing students for practice.

6.6 Summary

This chapter has focused on four main overarching themes for the purpose of this report: drug administration and venepuncture; clinical skills; working in a diverse and multicultural community; and service user and carer involvement in the curriculum

It is suggested, however, that to prepare student nurses and midwives for practice and, therefore, ‘fit for practice’, encompasses significantly more than these four areas and cannot be separated out from the actual experience of the real world of practice discussed in the following chapter.

There is sufficient evidence to suggest that even though there is a need for further and ongoing development, a positive picture is emerging in relation to the preparation of student nurses and midwives across Scotland in the four theme areas discussed.