A report discussing the development of a series of film resources for use in undergraduate nurse educatio

Cavanagh, AJ

Croughan, CE

University of Salford Institutional Repository

Article for Diabetes UK for Health Professionals Published in Autumn 2016 Authors:  Alison Cavanagh and Catherine Croughan, Lecturers in Nursing at the University of Salford Now you see me…….. Development of a visual resource to support Undergraduate Nurse Education in Type 1 diabetes  August 16th At the University of Salford we recognise the importance of delivering quality diabetes education for the nursing community. This article discusses how a group of Nurse Educators, a Paediatric Diabetes team and people living with the condition created a unique visual resource to deepen understanding of Type 1 diabetes, focusing on a family centred perspective. We have adapted a written patient case study into series of six short films illustrating a young person’s journey from early symptoms through to confirmation of type 1 diabetes and their adjustment to the condition in the early months. ‘Sammie Bem’ is eleven years old at diagnosis. Nurse educators have used anonymised or composite patient case studies as a teaching strategy for many years and these have been shown to promote learning that will enable students to link theoretical concepts to their work in clinical settings (1).  Most commonly, case studies are presented to students as written rather than bespoke filmed resources. There can be a variety of factors meaning that filmed case studies are underused, including confidence, time, financial restraints and anxieties about consent and copyright (2). There is good evidence to support the value of using films in health education environments which underpinned our preference to utilise the medium for teaching purposes (3).   Our remit underpinning this work was the promotion of knowledge and understanding of long term condition management within a large cohort of undergraduate nursing students. Within our team we decided to seek to capture the ‘real world’ experience of type 1 diabetes as our primary focus and the effects this may have on a contemporary family. It took time to make the decision to focus on diabetes specifically but the evidence was strong; the incidence of diabetes is increasingly significantly and the majority of our students will come into contact with people living with diabetes whether as a presenting problem or as a co-morbidity. Indeed, recent figures identify that a third of all people admitted to hospital at any one time will have diabetes. (4).In addition, complications are significant and well documented (5). Furthermore, writing in a national nursing journal, O’Neill has recently raised concerns that health professionals may have gaps in their knowledge of this complex condition (6) Justifiably, O’Neill argues that people with diabetes have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in organisations that meet required levels of safety and quality. Recent paediatric diabetes recommendations(7) have focused on the importance of providing a training programme for health care professionals on wards where children with diabetes are admitted with the aim of improving nurses  knowledge of diabetes and ultimately improving care delivery for children and families with the condition. Student Nurses are key players in providing care as they progress towards qualified nurse status; indeed, they are the nursing workforce of the future. Sammie Bem is first introduced to our students as a vibrant eleven year old school aged child entering puberty; she is enjoying school, dancing & is a goal keeper for a local football team. As she begins to experience tiredness, thirst and nocturia, our first film allows the student to follow her family journey into a local paediatric Medical Assessment Unit and subsequently through to her diagnosis.  Each of the six films developed are intentionally less than five minutes in length and are intended to be a trigger for a rich range of learning opportunities. Sammie is interviewed alone three months after diagnosis, as are her parents and grandfather, each giving their own perspectives on adapting to living with the condition. Each film reveals a new piece of the jigsaw as the Bem family’s individual experiences; wants and health needs are identified. In essence, a journey with Sammie and her family through storytelling gradually emerges for the students.  Bowles (8) describes storytelling in healthcare education as a powerful tool giving context to nursing knowledge and deeper understanding of the experiences of others, which was fully our intention. We were fortunate to attract funding from the University to develop our own narrative in this visual way and were encouraged in part through research that had illustrated the potential in film to increase the empathy nurses feel for patients experiencing health problems (9). It was incumbent on the teaching team to ensure that the films were authentic so that students could truly empathise with them whilst building their evidenced based knowledge and understanding of the condition. We also needed to use the expertise of colleagues who could empower us to protect all the participants in our films, one of whom was a child and also the University from improper use or distribution of its materials.  We therefore initially pitched our ideas to lecturers and students within our school of Media and Performance and attracted an experienced film crew, several of whom had a personal interest in diabetes. Together, we then took our ideas to a Paediatric diabetes team, fellow lecturers and families living with diabetes providing a real world basis to the films that the students could identify with. Peter Carruthers*, a professional filmmaker/ scriptwriter worked in partnership with us all, writing the scripts and assisting the crew with the production.    The resulting films are now fully in use, providing a springboard for an abundance of varied and deep learning opportunities about diabetes and its management. Opportunities range from colleagues who have type 1 speaking about positive living with the condition through to detailed learning including physiology of fuel metabolism, adolescent development and importantly, transition of Sammie Bem to adult services. Further to this, expert colleagues join the students to discuss the benefits of good management in preventing complications of the condition, for example; podiatry and ophthalmic colleagues and Diabetes Nurse Specialists all support us willingly. Thus far student evaluations have been encouraging as given in the example below: ‘The Bem family case study was engaging and allowed you to feel empathy for the family in getting to know them.  I found it very useful to visualise not only what the Bem family were experiencing but the way the health Professionals in the films worked in partnership with them’. Student Nurse June 2016 Pleasing feedback has also extended to our clinical colleagues, who see improved links between student learning in theory and practice: ‘ ‘It is clear that students are now coming to placements with a deeper interest in, and knowledge of, diabetes and its impact on families’.  Jude Campbell, Advanced Practitioner Paediatric Diabetes (2016) Simmons and Loughan (2013) argue that provision of good, safe, quality [diabetes] care lies within the foundations of healthcare education, continuing professional development and evidence-based practice (10) and this should extend across the spectrum of health professionals working with people with the condition. We are mindful of our part in contributing to that education with our focus on the Undergraduate nursing Community. Many of our student nurses will have contact with people living with diabetes whilst in training or as qualified nurses and they appreciate their increased confidence and ability to develop fruitful, respectful partnerships with people living with the condition.   Ultimately we are proud of the resources that we have developed to this point and very keen to receive continued commentary and critique of our project. We have plans to develop further filmed material in diabetic ketoacidosis and look forward to that eagerly. Most importantly, beyond our physical material is our hope; hope in our small contribution to student nurse education to improve the experience of care for people with diabetes. This continues to drive us forward to make a difference.    Text Box: ‘As a family living with Type 1 we are thrilled that the University have taken this innovative approach to educating health professionals and undergraduate students. As part of the team developing the materials we were delighted to be asked to contribute to making the films authentic. It is a great help to know that health professionals have knowledge and insight into our circumstances. Indeed, it forms the basis of an effective partnership’. (R Family, Manchester.)   Acknowledgement:  We acknowledge the most generous support of Jude Campbell; Advanced Practitioner in Paediatric Diabetes at Royal Manchester Children’s Hospital, both in developing our ideas to fruition and in contributing to this article.   References:  (1) Yoo MS and Park JH (2014) Effect of case–based learning on the development of graduate nurse’ problem solving ability. Nurse Education Today (34) 47-51  (2) Herman J (2008). Using Film Clips to Enhance Nurse Education. Nurse Educator 31(6) 264-269 (3) Stone TE and Levett-Jones T (2014) A comparison of three types of stimulus material in undergraduate mental health nursing education. Nurse Education Today (34) 586-591 (4) NaDia (2013) National Diabetes Inpatient Audit available at: jttp://digital.nhs.uk/diabetesinpatientaudit.   (5) https://www.nice.org.uk/guidance/ng18 (6) O’Neill S (2015) A knowledge gap. Nursing Standard 29(20) 28 (7)  DQuINS(2015) Measures for Children and Young People’s Diabetes. Available from https://www.dquins.nhs.uk (8) Bowles N (1995) Story telling: a search for meaning within nursing practice. Nurse Education Today (15) 365-369 (9) Briggs C, Crista L, Fox L et al (2012) The Influence of Film on the Empathy Ratings of Nursing Students on the Empathy Ratings of Nursing Students International Journal for Human Caring 16(2) (10) Simmons D and Loughlan C (2013) Survey of English CCGS’ Diabetes Education for Healthcare Professionals. Available from: www.diabetes.org.uk/Professionals/Training--competencies/Survey-of-English-CCGs-Diabetes-Education-for-Healthcare-Professionals/   *Peter Carruthers can be contacted via info@petercarruthers.co.uk  Alison Cavanagh at: a.j.cavanagh@salford.ac.uk Catherine Croughan at: c.e.croughan@salford.ac.uk      

Now you see me...

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Now you see me...

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