#HelloMyNameIsAli. I am one of the teaching fellows in the children’s nursing team and my background is children’s nursing and health visiting. I want to explore the importance of public health placements (Health Visiting HV and School Nursing SN) as I feel they are often undervalued by students.
As part of my role, I am heavily involved in organising placements for our child branch students and one of the most common placement concerns raised to me is around community placements and what there is to gain from them. I often hear comments about them being less worthwhile with little to learn as these placements tend to be less ‘hands on’ than those in acute settings. On the whole it is true that there is generally more observation than practical participation for students in community placements, particularly Health Visiting and School Nursing; but there is still so much for you to learn and experience, all of which will enhance and develop your own practice.
The first thing to note, with all placements, is that you don’t have to love all of them. Some of you thrive on the fast pace of A&E, some have a passion for supporting children with complex needs and others want to work with families in a more holistic sense in the community. Within the child team, we all have different specialities and recognising and appreciating these are what make us work together so effectively. Even if you are on a placement that you are not blown away by, focus on the positives of that experience rather than getting bogged down with unconstructive thoughts and attitudes. There is always something to learn, even if it is the way someone has communicated with a family and how you may model your own practice on it (or not!) or what is the role of this service so that you know when you would need to contact them when working in a different area. Always look for the silver lining as it will make your placement experience and that of the people you’re working with much more enjoyable.
So why am I so passionate and protective about public health placements?! I believe that public health placements give you the opportunity to learn a lot of the foundations that are important to be an exceptional and effective children’s nurse.
Community nurses are often lone workers, marking them are arguably some of the most autonomous practitioners. Much of their work is carried out in people’s homes without the safety net of a team of healthcare professionals present, as in acute settings. As a result, their observation, assessment and decision making skills are refined as aside from maintaining their own safety, they also need to be confident in protecting and promoting the health and wellbeing of the family they are visiting. Community nurses not only assess the child, but the family as a whole including external support, previous histories and the home environment to build up a comprehensive and holistic view of the family.
Public health placements are likely to be the only practice area where you see well children. ‘So what?’ you may ask, thinking that your focus is on helping sick children to get better. Well if you don’t know what children should be doing in terms of child development, nutrition, play, sleeping etc. how will you be able to recognise anything concerning in your assessments as well as providing the most appropriate care in an acute setting? Would you be confident in supporting a mother who is struggling to breastfeed or know what kind of food a 7 month old who has recently started weaning should have? Could you truly understand what it is like for a three year old to be in a hip spiker if you don’t know what a three year old would normally be doing developmentally? Could you appropriately explain to a seven year old what is going to happen when they go down to theatre if you have not gained an insight into the cognitive abilities and behaviours of seven year olds in their normal environment at school? Would you be able to recognise a mother who is suffering from postnatal depression and know how to speak to her about it, or truly be able to appreciate what a 12 year old with recurrent admissions may feel they are missing out on? When you are out with health visitors and school nurses, take time to just watch babies, children and young people doing what they do in ‘normal’ life.
All nurses have a significant role to play in health promotion and you will have learnt about a number of health promotion messages in your first year public health module. To become a health visitor or school nurse, you must complete a BSc or MSc in Public health so naturally, these professionals are experts in advising on health promotion. Take the opportunity to listen to them and learn not only the current advice but how do they talk about some of the more sensitive issues. How do they talk to naturally anxious first-time parents about reducing the risk of sudden infant death syndrome? Or advise a parent that their child is obese? How do they address smoking cessation with the parents of a wheezy baby or advise a teenage girl about an unwanted pregnancy?
Then there are the even trickier conversations. Evidence says that a woman has to be asked 35 times before they will disclose domestic abuse and so all practitioners should be comfortable with talking to patients about it but realistically, it is still uncomfortable for most. Health visitors and school nurses do it all the time so listen to how they broach it. Similarly, how do they tell a family that they are referring them to children’s services or speak to a mother with severe postnatal depression. I vividly remember visiting a family with a new baby and the father was sat down smoking cannabis – now I imagine that is not a conversation you would have to have in an acute setting!
Even when you are ‘just sat in the office’ listen to the conversations going on around you and how they speak to clients and other professionals over the phone. You will hear some conversations that went well and some that felt more uncomfortable and in absorbing all of these different communications, you will begin to formulate your own style.
The other amazing learning opportunity with health visiting and school nursing placements (and my other passion!) is around safeguarding. Community nurses hold caseloads, meaning they are allocated certain families to ‘look after’. That means they will see a safeguarding case through from beginning to (hopefully) end. In the hospital, you may make a referral to children’s services but that is likely the end of the process for you. HVs and SNs nurses will often see a family prior to a referral, complete reports and attend regular case conferences, be part of creating the child protection plan, attend core group meetings and support the family in between. This is your chance to really understand the safeguarding process in practice and see how all those parts of that renowned safeguarding jigsaw fit together to protect children.
In our recent simulation days with the September 2018 cohort, we had a child health clinic for the first time. In the feedback, many of the students acknowledged how valuable it had been and were surprised that they had not previously considered their lack of knowledge around children in general, specifically child development, nutrition and health advice. Additionally, they found the most challenging part of the simulation was unsurprisingly, having the difficult conversations with actors around domestic abuse, unexplained injuries and parents not coping.
Many of you will only get one public health placement across the three years, that’s one chance to learn a lot of amazing things that you will not get the opportunity to experience elsewhere. Don’t waste it!
Disclaimer: This blog contains personal opinions of students and teaching fellows only and does not necessarily represent the views of the Children’s Nursing team, School of Health Sciences or the University of Surrey.
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