Can nursing students become agents of change and support their local community in using the Internet for health as part of the nursing curriculum? June 2018 Toni Page, PhD Student Supervisors: Ray Jones¹, Helen Lloyd² and Graham Williamson¹ Advisors: Kim Young¹ and Rachel Carter¹ ¹School of Nursing and Midwifery, ²NIHR CLAHRC South West Peninsula (PenCLAHRC) toni.page@plymouth.ac.uk

Wider Patient Engagement – Kim Young Background This study builds on previous work in the nursing curriculum. Wider Patient Engagement – Kim Young Digital Professionalism – Ray Jones

Background Every nurse an e-nurse (1). More can be done to support nursing students in their journey to becoming an e-nurse. Digital health services have been of benefit (2, 3, 4). General-practice surgeries are encouraged to register at least 20% of patients to access online health services (5).

Opportunity Curriculum revalidation presents an opportunity to explore and develop a feasible model that could become embedded into the new curriculum.

Aim To explore the feasibility of all nursing students visiting carers of or people living with one or more long-term health condition(s), in a non-clinical setting, as part of the nursing curriculum.

Objectives: students …. To practise and develop person-centred skills. To better understand the thoughts and experiences of people living with long-term conditions. To practise and develop their communication skills. To improve their confidence in meeting and interacting with others. To practise and develop their digital skills as an e-nurse

CAR Approach Reflection Constructing and Planning Third Cycle Evaluation Reflection Implementation Evaluation Second Cycle Constructing and Planning Reflection Implementation Evaluation First Cycle Constructing and Planning Implementation

Collaborative Action Research Approach The first cycle explored with academics, health professionals, the public and students the proposed opportunity. The second cycle trialed the model with adult nursing students and citizen contacts. The third cycle will trial two models simultaneously: the home-visit model with volunteer second and third year child nursing students meeting families at home, and a general practice-based model working with Healthwatch with volunteer nursing students.

First Cycle Six workshops were undertaken followed by and on online survey. Digital Professionalism - First year nursing students demonstrated and discussed a digital health site with a friend, relative or neighbour (since October 2016). Student reflections are being analysed.

Findings from First Cycle Findings from Workshops and Online Survey There was general agreement that introducing such an approach was a good idea. Number of perceived benefits for students, citizen contacts as well as the community and the university. Concerns were raised such as, recruitment of citizen contacts, safeguarding of participants, and workloads.

Findings from First Cycle Preliminary Findings from Student Reflective Logs Skills and/or knowledge used by students: Used communication and computer skills. Used knowledge about a site. Students recognised their own abilities. ‘ I used my knowledge about the website to be able to show the citizen around the site and what kind of information and resources are on the site.’ Student

Findings from First Cycle Skills and/or knowledge developed by students: Developed confidence to engage and show others how to use a site. Developed communication skills. Increased knowledge of health sites and services. ‘I have developed communication skills as I feel I am more confident showing someone who has no knowledge or experience of the NHS or the internet this webpage.’ Student

Findings from First Cycle Reflected how they would undertake a similar task in the future: To research a site thoroughly. To think about the patients needs and computer literacy (tailor to individual). ‘If I had shown the website to an elderly (person) or someone who isn't used to using technology, I think I would have had to use my skills to a higher extent to be able to show the citizen how to use the site to their best ability.’ Student Reflected on the site itself (positive, negatives, improvements).

Second Cycle Citizen Contact Project (Home Visit Model for Adult Nursing Students)

Who took part? Three adult nursing students and five citizen contacts took part. Citizen contacts were recruited via Age UK Plymouth. They could be: Any adult living with a long-term physical health condition. Access to the Internet but this can either be at their home, in their local library, or at a local café using wifi.

Overview Nursing students visited a citizen contact in their home, twice, in pairs. The first visit was for students to hear the citizen contacts ‘story’ and learn from it and to signpost citizens to reliable good quality online information. The second visit summarised the previous visit and explored what has happened or changed since. Students did not provide clinical information.

Findings from Second Cycle … being in their home environment was just really good to see how that person lives and makes them feel more comfortable. Student 2 interview A positive eye opener seeing the person rather than the condition. Student 1 interview … hopefully they will benefit from spending this time with me. I also find it of benefit to put my side to them as saying things to the family is more difficult as I don’t want to worry them. Citizen contact 5, third questionnaire

Third Cycle – trialling two models simultaneously i) Implementation Reflection Constructing and Planning i) Home visit model – Citizen Contact Project ii) General practice model – Healthwatch Project i) Evaluation ii) Evaluation ii) Implementation

Conclusions so far Next steps Collaborative action research appears to be a a suitable methodology. The proposed model could be achieved for all nursing students and a large number of citizen contacts. Both students and citizen contacts appear to benefit. Student can become agents of change. Next steps Undertake third cycle. Construct a website to support the partnering of students with citizen contacts. Continue to explore how such a model can be built into the new curriculum.

Do you have any questions Do you have any questions? Do you have any examples of students engaging with their local community in a non-clinical setting? toni.page@plymouth.ac.uk

References Royal College of Nursing (2017) 'Every nurse an e-nurse: Digital capabilities for 21st century nursing'. [Online]. Available at: https://www.rcn.org.uk/clinical-topics/ehealth/current-work (Accessed: 1 September 2017). Portnoy, D., Scott-Sheldon, L., Johnson, B. & Carey, M. (2008) 'Computer- delivered interventions for health promotion and behavioral risk reduction: a meta-analysis of 75 randomized controlled trials, 1988 – 2007'. National Institutes of Health Public Access, 47 (1), pp. 3–16. Moeinedin, F., Moineddin, R., Jadad, A. R., Hamid, J. S., To, T. & Beyene, J. (2009) 'Application of biomedical informatics to chronic pediatric diseases: a systematic review'. BMC Medical Informatics and Decision Making, 9 (22), [Online]. Available at: http://www.biomedcentral.com/1472-6947/9/22 (Accessed: 2 June 2016). Jones, R. B. & Goldsmith, L. (2009) What is the evidence for the benefits and outcomes for digital health services? University of Plymouth Available. Royal College of Nursing (2017) 'Improving Digital Literacy'. [Online]. Available at: https://www.rcn.org.uk/clinical-topics/ehealth/current-work (Accessed: December 2017).