Michelle Featherstone
Chair Education Transformation Alliance
Workforce Education & Transformation Lead – Greater Manchester Integrated Care Partnership
In 2020 my father was diagnosed with stage 4 prostate cancer, and for 12 months he managed to cope with hospital appointments, and lots of health-care visits to deliver and administer his treatment. However, Covid restrictions hit the family hard and prevented us from building the special memories that a wife and two daughters had planned. It was a very difficult and emotional time for everyone. Dad had good days and bad days always trying to put on a brave face, which was tough to see, especially as he tried his best with chemotherapy which drained him after every session; however, we were thankful as this gave us extra time with our Dad and we managed to celebrate his birthday, Father’s Day and my birthday knowing it could be the last time. However, he loved his egg custards, and we ate a few of them too!
However, as Dad’s illness progressed, he became very weak and needed to spend some time in a local hospice during his final months. Dad always thought that if you go into a hospice, it was actually the place you would die, but the hospice team explained they would look after him and concentrate on the living rather than the dying. So, Dad agreed to spend a couple of weeks with them. The hospice staff were amazing, my dad’s spirits had been lifted and he was laughing again with the staff and patients. It felt like he was back to his old self (almost). The two weeks Dad spent in the hospice really helped to recover some of my dad’s confidence and in his own words “He hadn’t been written off just yet because he was dying.” I even managed to bring him in his favourite chicken fried rice!
Following his return home, my dad’s condition rapidly took a turn for the worst and his pain began to increase., This really was a roller coaster ride of emotions for the whole family when you just didn’t know what to expect from one minute to the next. My Mum cared amazingly for my dad, but we really knew he needed increased support from social care.
My Mum was introduced to a team of care workers who visited the house 3 times a day providing my dad with all the care he needed such as washing, shaving, dressing, whilst also recognising that my Mum also needed a person to talk to. I remember the staff would come to the house and talk to my dad saying, “Hello Dave, nice to see you.” I could sense that he was listening as there were moments when he smiled. As the illness further progressed it became more difficult emotionally for the family who were trying to come to terms with the outcome that here was a man, a Husband and a dad who didn’t have very long to live. While this remains very raw, it’s also important for me to share my appreciation to the staff who cared for my dad and those individuals who showed great compassion, dignity, patience, and kindness to a family whose ultimate wish was to look after their dad at home in his final days. I therefore dedicate this guide to all the social care and healthcare workforce who provide often unseen yet excellent care to our patients and families.
Abbie Moss
Student nurse on placement at Lakeside Care Home in Wigan
“Before working at Lakeside I had negative perceptions about what care homes were like. I expected the care home to smell, have a depressing atmosphere and be full of residents with a poor quality of life…..”
“However, since spending time at the care home, my views have completely changed! I have seen how important the small things are. Communication between staff and residents is essential to providing the best care and this is seen with all staff including cooks, domestics and office staff not just carers and nurses.”
“I have learnt how to provide true, holistic, person-centred care and will take this with me for the rest of my training and when I become a nurse”
Callum Ashton
2nd-year Adult Nursing Student on placement at Ashton View nursing home in Wigan
I had worked previously in both the NHS and social care and so I had a good insight into both before being allocated my 2nd year placement at Ashton View. I know some students have preconceived ideas about social care and for some reason they can be very negative without knowing the true facts as they haven’t experienced social care! I have spoken to some who believe that being so connected to the NHS would mean they get better support so discount social care right away. They don’t realise the opportunities on offer.
For me, the social care placement was a great confidence booster and I realise the importance of being part of a small and very supportive team to help me learn and develop. I learnt more about personal relationships and putting the resident at the heart of everything I do than I would ever have learnt on a ward in acute services. My communication skills improved, and I really began to understand the ethos of the fact that in social care
The care plans are very in-depth, and you must adapt yourself to fit in with the residents and not expect them to adapt to meet your needs. You begin to learn what they really want and what is important to them.
I also learnt so much about team work from working with multidisciplinary teams, nursing home nurses and care staff alike. It’s a myth that nurses just sit there doing medication
I was fully involved and encouraged to learn and develop. For example, I learnt so much from everyone about Parkinson’s disease and the impact of medication, pharmacology, wound care, dementia, oxygen care, skin care to name but a few.
I had a great PEF who would visit every week to support me in lots of other areas and to recognise and celebrate my own successes – She was marvellous! I was more than able to meet my competencies.
I think it’s important that this handbook could help prepare other students and go some way into influencing them to take note of what a social care placement could be like and how it could be a real positive, in fact a MUST to experience.
Caroline Pressick
Registered Manager, St Georges (Wigan) Ltd. Care home with nursing
Caroline was a nurse in the NHS for over 40 years before she retired – But not for long! She then came back to work as a registered manager in social care. Before working in social care Caroline admits to believing all the horror stories you hear about the sector. She didn’t think for one minute, she would then choose this kind of new role and make the leap from a hospital ward to social care.
How do you actively engage with students?
“the social care sector must be part of the narrative and to get the advert out there that good quality, person-centred care doesn’t just start and end with the NHS. We must be an active part of the whole story and show students the real side of our work and what goes on.
“All of our students start with an introductory visit so that this can put them at ease even before day one. Some, (like I did) have preconceived ideas about what working within a social care setting would be like and I’ve students confess they were dreading coming to a nursing home but now can’t wait! That learning stays with them because once they start, they soon realise that social care is a great place to work and build their skills. This soon dispels the myths about not being able to have opportunities to provide evidence of competency.”
What is included in weekly teaching sessions?
When swallowing goes wrong’ or DOLS/MCA. They last about 90 minutes with a Q&A session. Once I am confident, they have understood the sessions the students have a copy of Handout and a Certificate of Attendance for their CPD file. The teaching sessions suit ALL the student disciplines.
Students are a real benefit to us, with, for example, innovations and current research ideas, as much as we benefit them in our practice exposures and support.
I believe that working in social care gives you greater autonomy as a professional and more opportunity to focus on relationships and communication as this is always key with the residents and to work with other multidisciplinary teams. I agree it is hard work and not an easy path, but it forces you to think in innovative ways to help residents get the support they deserve. If anything, the work I do now is far more complex and rewarding than my time spent on a ward.
Christine Musariri
2nd-year Student Nurse on placement at Plane Tree Court Nursing Home in Stockport
I did my 1st placement at the nursing home and honestly it was the best experience I’ve ever had! I had a fantastic practice assessor with loads of experience, and she helped me build my confidence and become the student nurse I am today.
I was an active part of the team, attending and inputting to multi-disciplinary team meetings, working with GP’s and other specialist nurses from the community and learnt a lot about specific conditions such as wound care and diabetes. I had so many opportunities and because the nursing home was relatively small people really invested their time in me. Social care can train future nurses and they can do it well. It doesn’t matter where that student ends up in their career it just goes to make an impact on being part of something – 1 more nurse for people who need it.
I think that all student nurses should do their first placement in social care because what you learn from the start in such a great, supportive environment stays with you forever and you can keep building on this. I was given loads of opportunities but what stays in my mind more than ever was working with one man who was an engineer by trade. I had built up a great relationship with him over time and this meant being able to communicate and show empathy as well as professionalism and skill. He was deteriorating quickly but we still managed to have our conversations about his life and his job as an engineer. This was an important lesson about getting to really know and understand people and giving them time so that a relationship could develop. We all feared he was reaching the end of his life and it was very hard for me. I know about professional boundaries but in a nursing home setting you do develop strong bonds because you have time to care. To my amazement one morning when I arrived, I came in to see him standing up. What!!!! I said. I’ve never felt so good!
He used to call me “My Nurse” and was always pleased to see me.
I wanted to contribute to this handbook because it’s important for other students to hear what a great opportunity social care can offer them. Don’t believe in the myths and don’t miss out by closing your mind to what could be for you, like it was for me the best experience ever!
Gail Howard
Registered Manager, Lakeside Care Home
Gail started her journey as an unpaid personal carer. She then went to study nursing and worked part time in a care home as a student as well as undertaking her various placements. After qualifying Gail worked in a variety of settings including palliative care, working with young adults with challenging behaviours and complex needs for example, drugs, alcohol, Huntington’s disease and learning disabilities before her current role in adult nursing care where she works with an individual with complex clinical care needs such as those with motor neuron disease, strokes, Parkinson’s, cerebral palsy, multiple sclerosis, and dementia
“The care home has welcomed a variety of learners from varying courses including paramedics, sports physios, nurses, speech and language and dietetics. Many learners initially buy into the myths about social care, but it’s great to see the positive feedback from their reflective accounts as the placements progress. In particular, from day one, we really focus on the importance of communication because if learners can’t communicate with people then they won’t get anywhere and this fundamental skill will assist them with whatever they go onto next.”
“I want learners to really get to know the residents so that when family, friends or others enquire about their well-being or progress in a particular area, they can have those meaningful conversations, a truly person-centred approach. I think this is possibly one of the greatest skills of all that learners can get from our environment.”
What are the benefits to the care home from working with students?
“In so much as we want to provide a valuable learning experience for the learners where they can meet all their competencies, we also want to learn from them. They bring fresh eyes, new ideas and make us question the things we do and the ways in which we do things. The learners are looked after and supported but this two-way process of sharing also helps us to develop as a care home and in turn this benefits our residents. The residents enjoy being involved in supporting the learners and being asked for their thoughts and opinions. New people, new personalities and precious 1:1 time that isn’t rushed contributes to our own learning and person-centred approach and so it’s a win:win every time”
Why is this Guide important?
“This Guide is welcome as it will help break down barriers, dispel myths and ultimately go towards helping people to be looked after in their own homes (wherever that may be). People want to avoid going into hospital and prefer to stay “at home” and the more learners that can experience the care home as the preferred environment as residents HOME OF CHOICE HOME has to be a very positive thing”.
Rowena Bolton
Home Manager, Cheadle Manor Care Home in Stockport
Rowena qualified in 1995 as one of the first Project 2000 diploma nurses and then worked for the NHS before moving into care homes in 2007. She has worked in a clinical lead role since 2017. Her background and passions are within stroke care, end of life care and looking after people living with dementia.
Although passionate about the role of social care and the dedicated professionals that work within it now, Rowena remembers her own preconceptions and opinions prior to her shift from student nurse then working in the NHS to when she commenced work in a care home.
MYTH “Nurses working in care homes aren’t good enough to work in the NHS.”
How wrong was I! Nurses working in care homes/nursing homes work within a different culture than those working within a ward. They deal with people all the time that have a range of very complex clinical needs. They make clinical judgements that would normally be made by junior doctors on wards to ensure residents receive the best care available. This can often mean avoiding hospitalisation which can be very traumatic or working within a multi-disciplinary team to ensure a smooth hospital discharge back to their home.
MYTH “Nurses in care homes are cutting back and preparing for early retirement.”
If the job role is too demanding, then take a rest from the NHS and wind down? Again, this is a myth as many of my colleagues and peers are young, energetic career professionals that recognise the career development opportunities that social care setting may offer. I personally developed from nurse to manager and am by no means planning to take it easy and to sit and wait for retirement.
MYTH “Student nurses draw the short straw if they must do a placement in a social care setting.”
An active part of my role is that of supporting learners to undertake learning opportunities within Cheadle Manor. We have had some fantastic feedback over the years from 2nd and 3rd year learners and it has really opened their eyes as to the real plethora of opportunities to grow, develop and gain competencies. However, as I shared my own initial views above the myths surrounding the value and worth of social care as a clinical learning environment still prevail and much more needs to be done to dispel the myths and celebrate successes in this area.
MYTH “Nurses working in social care become deskilled.”
Quite the opposite! The sheer diversity of individuals with a mix of chronic or specialist conditions living in residential care offers students and professionals the opportunity to become multi-skilled and expert within a range of diverse areas. They get the experience of working within multi-professional teams and build real relationships with people that they care for and their families often up until end of life.
Final words
The relationship between the NHS and social care needs to be better understood if we are to be working towards a truly integrated and innovative offer. A greater understanding of social care settings and services means greater respect, cooperation, and collaboration. The end user be it a patient or resident will benefit in terms of person-centred care and support and quality of life. Working closely with educators we need to ensure that the real benefits of learner placements within social care are accurately understood, widely celebrated, and become commonplace. There should be a requirement to experience a wide variety of settings that come together to make the systems work.
Tanya Taylor
2nd Year BSc Adult Nursing Student Bolton Hospice placement
My final placement of the first year was at Bolton Hospice. When I was first informed of the placement area I had mixed emotions, firstly I was excited to learn from the nurses who had originally inspired me to study to be a nurse. But I was also apprehensive that I might find it upsetting and a gloomy place to be.
Fortunately, I couldn’t have been more wrong! The hospice itself is a light and welcoming, the staff are amazing and show how to provide holistic care to the patients and their loved ones.
I have learnt lots of clinical skills including catheter care and syringe driver use. All the members of the MDT at the hospice are willing to teach students their valuable roles in person-centred end of life care. The hospice has inspired me to involve not only the patient but in their own care but their friends/families who are often effected negatively when their loved one is unwell.
I will take so many skills forward into my future role as a nurse learnt at the hospice and which can apply to endless areas of nursing.
One resident’s story
John participated in the interprofessional education (IPE) pilot initiative in 2021. Having lived in a care home for three years, John felt he was experiencing ongoing challenges associated with transitioning from independent living to a care facility. Reflecting on this significant change, he remarked: “I never thought I’d finish up in a home. I’ve been on my own 12 years since my wife died and I was doing alright but suddenly I …wasn’t.”
John decided to take part in the initiative because he wanted help with his mobility and emotional well-being. Learners from Podiatry, Mental Health Nursing and Sports Rehabilitation worked with him over the course of 6 weeks to support him with these goals as part of a collaborative team. John attended weekly meetings with the learners to develop action plans and they spent time working with him outside of the meeting. From the start, John described benefitting from spending time with the learners and enjoying the social aspects of participation: “Them two lads were so cheerful you felt better just in their presence.”
The collaborative team worked together with John on various activities, addressing different aspects of his well-being. They worked on improving his sleep patterns and establishing healthy routines. Regular exercise sessions also became an integral part of John’s routine, helping him improve his balance and overall mobility. Massage therapy was introduced, and mental health support was integrated to ensure John’s emotional well-being was taken into account. John reported that these changes had a positive impact: “They taught me quite a bit about my balance and the exercises and things. And I’ve done more walking since…I do feel better.”
This holistic approach to John’s well-being not only enhanced his physical and emotional health but also provided valuable learning experiences for the students involved in the initiative. The learners recognized the importance of effective communication and learned to consider the complexity of the resident’s individual well-being, better appreciating the multiple factors that impact their overall health. One learner said: “I’ve learned you’ve got to take into consideration how they’re (the residents) feeling, how everything is affecting them, even just how they are that day emotionally.”
