28th PANDDAConference2017� WAVES of Change.....

� Undergraduate Nursing Student on placements...

getting them out of their shell

� Natalie Duckworth and Georgina Hoddle

� 11 October

Overview� Background

� Goals of placement

� Universities

� Year of study

� Student readiness and expectation

� Our placement program

� The outcomes

� Learnt during placement

� A future in disability??

� The future

� References

Nurses’trainingindisabilities� No specialty training

� Little to no content in undergraduate courses

� Dependent on individual lecturers’ interest in

disability

Nursessupportingpeoplewithdisabilityinacutesettings� Inadequate knowledge and skills

� Inadequate time to carry out support

� Inadequate time to familiarise themselves with the

person’s individual support needs

� Poor understanding of communication methods

Goalsofplacements� Introduction to people with disability

� Communication

� Lifestyle

� Physical support needs

� Clinical support needs

� Valuing people with disability

TheUniversities� Western Sydney University

� Australian Catholic University

� University of Tasmania

� Notre Dame University

� Avondale College

YearsofStudy� Mostly year 2

� Some 1st and 3rd years

1st year

2nd year

3rd year

Questionone– Towhatextenthasdisabilitybeencoveredduringyourundergraduatecourse?� The maximum number of hours spent on this topic

was 2 – with the focus on down syndrome

� Some did less than this

� This depended on individual lecturers including

disability in wider topics

Questiontwo– Whatpreviousexperiencedoyouhavewithpeoplewithdisabilities?� Some had family members with different degrees of

disability

� Some came from countries where there is no

residential disability support

� Some had never knowingly encountered a person with

disabilities

Questionthree– WhatareaofNursingdoyouaspiretoworkinonceyouhavegraduated?� Mental Health

� Medical Surgical

� Accident and Emergency

� Paediatrics

TheBookletUniversity Learning objectives Activities during placement

1• CodeofEthicalConduct• Confidentialityagreement• DisabilityInclusionAct(2014)factsheet• Disability– NSWHealth/ADHCJointGuidelinetoSupportResidents….

WhoAttendorareAdmittedtoaNSWPublicHospital(April2013)• Inclusivelanguage• Introductiontocommunicatingwithpeoplewithintellectualdisability

2• Infectioncontrol• Directsupportprovision:

o Personalcareo Mobilityo Positioningo Nutritiono Medicationso Gastrostomymanagement

§ Equipment- costeffectiveness§ Stomasitemanagement

3• Syndromesandconditions:associatedconditionsandriskfactors• CasestudyandIn-service• Painrecognition

o Toolsforthis(Disdat etc)monitor1R.• Backgroundsummaryinformationon:

o Seizureresponseo Respiratorydepression:

§ O2 saturations§ Nebuliser§ Suctioning§ Oxygentherapy

Communicatingwithpeoplewithdisabilities

Types of communication Specific Communication examples Written Sentence, phrases and words Verbal Sentences, phrases and words,

vocalisations Sign Signed English, Auslan, Key Word Sign Augmentative or assisted communication devices

- Proloquo2Go (used with IPAD) - PECS (picture exchange

communication system) Gesture Pointing (finger or eyes), waving Body language Tensed muscles, tears Facial expression Smile, grimace Physiological changes Increased pulse, increased blood pressure

Inclusivelanguage

Disabilityterminology

Prior to 1900

• People with intellectual disability were often sent to live in institutions for the duration of their life

• Doctors encouraged parents to send their children to such institutions

• Their were few supports and therefore lack of alternatives to institutionalisation

• In these institutions, people with disabilities and people with mental illness were generally mixed

1974 Declaration of rights of Disabled Persons (united nations)

• a framework intended to be drawn on for the development of

international and domestic law

1981 • International year of disabled persons

• People with disabilities began exhibiting self determination and self-

representation

1983 The Richmond report (Australia) is released

• Recommended people living in institutions (due to disability and

mental illness) should live in community group homes

1986 Introduction of national Disability Services Act:

• The key objective was to de-institutionalise segregated services,

increase the range of service options and to include people with

disability in the wider community life. This resulted in the first

coordinated approach to assisting people with a disability gain and

maintain employment in the open labour market

1989 Guardianship legislation introduced that promoted the welfare and interests

of people with disabilities

Developmental disability services moved from the Department of Health to

the Department of Community Services

2006 Development of the United Nations Convention for the Rights of Persons

with Disabilities

2008 Adoption and ratification by the Australian Government of the United

Nations Convention for the Rights of Persons with Disabilities

2014 The NDIS (National Disability Insurance Scheme) is introduced in launch

sites across Australia. This new legislation is in line with the United Nations

Convention for the Rights of Persons with Disabilities and aims to provide

choice and independence to people with disabilities

HistoryofIntellectualDisabilityinAustralia

Disabilityinclusionact� Fact sheet distributed

� Quick quiz for discussion and understanding

Syndromesandconditions

Conditions� Respiratory illness

� Dysphagia

� Epilepsy

� Constipation

Gastrostomynutritionandmedications

� Introduction

� Demonstration

� Supervised practice

� Competency

ThePlacement– weekone:Gettingtoknowpeoplewithdisabilities� Buddied with AiN

� Learning how to communicate with people with

complex communication needs

� Out and about

� Activities

� Mealtime support

ThePlacement- weektwo:learningtheclinicalskillsneededtoworkwithpeoplewithdisabilityandcomplexhealthneeds� Buddied with RN

� Gastrostomy nutrition and medications

� Clinical skills

Roleoftheclinicalsupervisor� Establish an appropriate clinical-supervisor-supervisee

relationship

� Explore self and supervisee assessment in clinical supervision according to NMBA SfP (2016)

� Identify difficult supervisee attitudes and behaviours and implement appropriate management

� Identify underperformance and manage conflict

� Build resources to support the role

� Complete the Standard for Practice Assessment Tool and associated documentation

� Complete Development Summaries

� Log of Hours completion delegation to preceptor RNs

Questionfour– Whatarethethreemostworthwhilethingsyoulearntonplacement?

0 2 4 6 8 10 12

How to manage gastrostomy tubes

How to communicate with people …

Opportunity to support people with …

Respect for everyone and teamwork

Staff are passionate about their clients

Holistic care for people living in the …

Number of students

Questionfive- Areyoulikelytoseekworkinvolvingpeoplewithdisabilitiesinthefuture?

Yes, 7

No, 0Unlikely, 0

Will

consider, 9

Actualworkwithpeoplewithdisabilities3 students went on to take up AiN jobs in complex

health:

� 1 ACU student spent 1.5 years working in Complex

Health à obtained new-grad position at Westmead

Private

� 1 WSU student (1st yr) 2.5 years working in Complex

Health à awaiting Registration and new-grad position

� 1 WSU student (2nd yr) recently started in Complex

Health

Otherelementsofequippingthemainstreamandtothefuture� The end of ADHC

� Student nurse positions

� Continuing placements 2018 (optimism)

Anderson, C, Moxham, L, and Broadbent, M (2016) Providing support to nursing students in the clinical environment: A nursing standard requirement. Contemporary Nurse 52: 636-642

Bickhoff, L, Sinclair, M, and Levett-Jones, T (2017) Moral courage in undergraduate nursing students: A literature review. Collegian 24:71-83

Brodrick, D., Lewis, D., Worth, A., & Marland, A. (2011). One-page patient passport for people with learning disabilities. Nursing Standard, 25(47), 35-40.

Cashin, A, Heartfield, M, Bryce, J, Devey, L, Buckley, T. Cox, D, Kerdo, E, Kelly, J, Thoms, D, and Fisher, M (2017) Standards for Practice for Registered Nurses in Australia. Collegian 24, 255-266

Gibbs, S.M., Brown, M.J., & Muir, W.J. (2008). The experiences of adults with intellectual disabilities and their carers in general hospitals: A focus group study. Journal of Intellectual Disability Research, 52(12), 1061-1077.

Gillespie, M (2017) Student nurse preferences for their first clinical experience: A thematic analysis Br J Nursing 26: 104-108

Goddard, L, Davidson, PM, Daly, J, and Mackay, S (2008) People with an intellectual disability in the discourse of chronic and complex conditions: An invisible group? Australian Health Review 32: 405-414

Hemsley, B, Balandin, S., & Worrall, L. (2011). Nursing the patient with developmental disability in hospital: Roles of paid carers. Qualitative Health Research, 21(12), 1632-1642.

HETI/Tell Centre Clinical Supervision Workshop (2015)UTas Clinical Supervision Workshops (2016/2017)

Lewis, S., & Stenfert-Kroese, B. (2009). An investigation of nursing staff attitudes and emotional reactions towards patients with intellectual disability in a general hospital setting. Journal of Applied Research in Intellectual Disabilities, 23, 355-365.

McGlade, I, Gallagher, M, Willis, DS (2016) Preparing adult nursing students to be better equipped to work with people with intellectual disabilities and those who support them. Poster presentation IASSIDD World Congress, Melbourne 2016

Nightingale, G. S. (2010). Supporting people with learning disabilities in acute care. Nursing Standard, 24 (18), 42-48.

Ralph, N. Birks, M, and Chapman, Y (2017) “Settling for Less”: Designing undergraduate nursing curricula in the context of national accreditation. Collegian 24: 117-124

San Miguel, C. and Rogan, F, (2015) Assessing students English language proficiency during clinical placement: A qualitative evaluation of a language framework. Nurse Education Today 35: 771-776.

Turner, B, Trollor, J, Goddard, L, Lennox, N, Cashin, A, Alexanderson, K, and Iacono T. (2014) What are Australia’s Nurses taught about intellectual disability? Results from a national curriculum Audit. Oral presentation, 25th PANDDA Conference, Sydney.

Wareing, M, Taylor, R, Wilson, A and Sharples, A (2017) The influence of placement on adult nursing graduate’ choice of first post. Br J Nursing 26: 228-233.