From education to employment

Student nurses are the key to transforming health and care in the UK

University of Plymouth

Key to their role is placing the patient at the centre – or person-centred care, and for some time now technology has played an important part.

Whilst caring for a lifelong friend with end stage renal failure and limited sight, I witnessed first-hand how a simple iPad transformed her world by allowing her to speak to loved ones and occupy her long, immobile days through online activities. Similarly, I saw how individuals with brain-acquired injuries were able send emails with the pupils of their eyes or through pressing a voice-assisted ‘possum’ with their big toe.

It is plain to see how these fast-emerging eHealth tools are an increasingly important aspect of offering modern-day, person-centred care. Yet, eHealth systems and tools are not yet integrated systemically. This both baffles and frustrates me as technology can make a real difference to a healthcare professional’s caseload, help conserve vital national resources and improve a patient’s ability to manage their condition more autonomously (NHS Long Term Plan 2019).

“eHealth is here to stay. It is becoming ever more important to dispel the misconceptions that ultimately create barriers to its integration and of technology’s adverse effect on person-centred care.”

Nurses are central to this. They are experts in building patient trust and improving patient care and outcomes. They are perfectly positioned to act as conduits for the implementation of eHealth care pathways that offer patients improved autonomy and empower them to become active partners in their care. Moreover, student nurses are ideally placed to act as change agents, instigators and co-ordinators of eHealth innovation in practice.

We are required to do 2,300 hours in clinical practice –the equivalent of over a year of 40 hour working weeks – regularly moving between placement areas in both acute and primary care settings, presenting opportunities to identify possible eHealth innovations.

To do this we need to change the way student nurses are seen and valued. Sadly, at times, we are used as a spare set of hands or are faced with established health service teams who remain closed to new approaches. “This is how we have always done things” is a familiar phrase. I have been lucky to have worked with some brilliant teams who have embraced change but also encountered some brick walls.

“It is time to both re-evaluate the role of the student nurse and create a learning culture that embraces innovation and new ways of working. eHealth is an ideal way in which today’s nursing students can add value to help improve health and care service provision.”

I have seen this first-hand with my work with Continuous Obstructive Pulmonary Disease (COPD) patients in Cornwall. In one of my early assignments, I had to focus on a case study, a gentlemen known as Bob, whose condition was deteriorating – he became housebound with increased breathlessness, anxiety and fatigue. Home Oxygen Therapy and nursing care planning was required.

Whilst research provided me with ample evidence-based information about COPD and gold standard care, I needed to close the laptop and see first-hand how individuals with the condition are supported in the community.

Student nurses have easy access to learning about conditions and during a local pulmonary rehabilitation workshop I was struck by the sheer volume of content COPD patients needed to absorb in order to manage their condition – emergency antibiotic kits for repeat chest infections, inhaler technique, pulmonary rehab exercises, medications management, mindfulness during breathless and anxiety attacks and more.

I looked into a new eHealth app – MyCOPD – an, evidence-based, NHS-approved management tool for COPD patients, proven to be as effective as pulmonary rehabilitation – the gold standard care for COPD management. It was a turning point. I created a good, person-centred approach for my assignment with Bob that worked well, but during future nursing placements I realised that a valuable tool such as MyCOPD was regularly left out of care pathways for patients in primary and acute settings.

On my first day of placement at a pre-op assessment clinic in an acute hospital, we saw six patients attend with a COPD diagnoses. Patients are often admitted to hospital as a result of exacerbated COPD so patient management and education is key to addressing this. Yet not one of these patients had heard of the MyCOPD app and equally it was relatively unknown by the healthcare professionals – despite it being free and licenced for use in the county. A similar situation was discovered in GP surgeries where COPD patients are often referred.

I worked to address this gap with the support of my University of Plymouth mentor and its Centre of Health Technology team. I accessed their growing network of businesses, GP surgeries, hospitals and other healthcare organisations to ensure nursing and anaesthetic teams were fully conversant with the MyCOPD app as a health optimisation tool.

Introducing the app as a short intervention at pre-op appointments freed up the nursing assessors’ time to review patient medication and overall health and care. This time-saving element is key to new health technology adoption where time is often a barrier for healthcare professionals to embrace new ways of working. Finding ways of integrating within existing care pathways is the solution.

“As a nursing student, I am an asset, one cog in a wider ecosystem within health and care but one that can help to do this.”

In bringing together the hospital trust, The Patient Association, the local council, health and care organisations and local support or ‘breathe easy’ groups, as well as meeting with nurse leaders and specialists, the app is now being embraced as a second tier quality improvement project.

In addition, MHealth, the company that created the app, is now a member of this growing network of researchers, eHealth innovators and collaborators. As a nursing student, I am being supported to take a leadership role in these developments, benefiting my learning experience and as an acknowledgement of my role in driving the project forward from inception.

“Health service leaders would do well to create spaces for innovation where healthcare students can exchange ideas and explore their research during placement experiences. The nursing role as a whole should also be supported by ensuring up–to-date resources and CPD opportunities are made available. More work also needs to be done to ensure eHealth is not an extra-curricular activity for the few, but an integrated module and learning outcome for all healthcare students. Not only will this add value to the patient experience, it will create a positive culture of understanding among students as they transition into their newly qualified roles”

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