Tamahere Eventide - Dedicated Education Unit

Tamahere Eventide resident Jo Mellar talks to Wintec nursing student Megen Peckham

Tamahere Eventide Home & Retirement Village located in Hamilton, New Zealand have been providing residential care services since 1965 ranging from rest home beds, a dementia unit, respite care and independent living options. In 2015 Tamahere, Wintec (Waikato Institute of Technology) Centre for Health and Social Practice and the Waikato DHB Professional Development Unit entered a collaborative partnership with the goal of enhancing clinical teaching and learning in an Aged Care environment specific to Rest Home and Dementia Care. In July 2015 Tamahere opened a Dedicated Education Unit (DEU) as a joint venture pilot becoming the first rest home to incorporate a DEU into their facility in the Waikato area.

Why a DEU?

A Dedicated Education Unit (DEU) creates a collaborative teaching and learning environment for clinical practice that fosters interaction and sharing of knowledge amongst students and clinical staff. The student centred clinical learning environment is supported by both the educational institution and the clinical provider, with both parties contributing to the provision of quality best practice teaching and learning opportunities.

The DEU at Tamahare aimed to achieve the following;

• To improve the quality and quantity of Wintec Undergraduate Nursing student placements with Tamahere Eventide.
• To provide a collaborative teaching and learning environment in a focused situation.
• To make education a seamless progression from student to new graduate (in the Nursing Entry to Practice (NETP) program).
• To encourage nurses into the field of Gerontology and Mental Health through a better understanding of these fields and providing continuity in their education.
• To provide a constructive learning atmosphere for peer learning.

What is a DEU?

A DEU is a pre-existing clinical unit of a health facility, such as a hospital ward or community clinic that is transformed into an optimal teaching and learning environment for students through the collaboration of the educational institution and the clinical provider.

The staff in a DEU are heavily focused on teaching and learning and both unit staff and students are assisted and supported by an appointed Clinical Liaison Nurse (CLN) and Academic Liaison Nurse (ALN).

• The CLN - is an experienced registered nurse from the clinical unit who is the key point of contact for students, acting as a liaison between staff, Clinical Nurse Manager (CNM), students and ALN, are responsible for the coordination of the student experience, orientation, staff support, the provision of ongoing feedback to students and undertaking student assessments in partnership with the ALN.
• The ALN - is a member of the educational institution providing academic advice and support to students, the CLN and unit staff, orientation, coordinates student assessments, provides a key link between theory and practice and contributes towards education and research.

A DEU provides the following student learning opportunities;

• Skill acquisition to meet service demands,
• Peer teaching between students,
• One-to-one support,
• Diversity,
• Incidental learning.

How it works - our Journey?

Tamahere provided a Clinical Liaison Nurse for 20 hours per week to liaise between the facility staff, the Clinical Nurse Manager and the Academic Liaison Nurse who was provided by Wintec. The ALN’s main role was to provide for the students.

Meetings were held with the General Manager for Care Services (GMC), the CLN and the ALN to establish some routines and develop the program prior to commencement. Meetings were also held with Tamahere Eventide Home (TEH) staff to help them understand the concept and get them on board.

The staff from TEH, DHB & Wintec visited Howick Baptist and time was spent with their CLN discussing any pitfalls we should avoid and how they found the implementation of their DEU in general. This allowed us to gain some insights into their experience and was very valuable in the development of our DEU.

On the 27th of July 2015 the DEU was launched with a luncheon at the cherry Blossom Café at Tamahere which was attended by staff of all partners, students, the Waikato times and a staff member from the Waiariki.

An orientation day was developed to give the students the best possible introduction to TEH and to be incorporated into the team. This day included meeting key personnel, Health & Safety, Risk Management, Fire Safety, tour of the premises followed up in the afternoon with student expectation and rosters. The students were then presented with a clear name badge so they were easily identifiable to both staff and residents.

10 nursing students were rostered within the Rest Home and Dementia Wings and worked 8 hour shifts of varying times (i.e. am and pm for semester 3 students, and am for semester 2 students) and were on site for 4 days a week. We have had 4 placements of 4 weeks – not all with 10 students.

Every fortnight the team (CLN, ALN, GMC & Wintec staff member) met to discuss any concerns and issues and to gain regular feedback to ensure we were moving forward.

The DEU required TEH to have Registered Nurses on each shift that the students were present. I.e. 2 on each AM & PM shift in each wing. We had to be able to accommodate a maximum of 10 student nurses.

When nurses have been off sick this has sometimes meant that the students have had to either double up or work with the caregivers. This in itself was not an issue as it gave them more opportunities to advance their practical skills. During this time we utilised the skills of the Clinical Nurse Manager to provide the students with specific learning experiences for example: dressing, catheterisation, assessment skills, admissions and documentation.

The Allied Health Team and Village staff were invaluable in providing a holistic view of aged care to the students. By having the students participate in daily activities, that are part of the life in an aged care facility, this enriched their learning.

Outcomes of DEU;

Residents:

The residents enjoyed having the time with students and feeling the importance of adding to their education. In one wing residents became directly involved in the teaching of the students giving empowerment to the residents feeling they were adding to the future workforce. Village residents expressed their enjoyment at the contact and conversation with the students. This provided enrichment to the village residents and the students alike.

Of note one resident who would not feed herself, made such a connection with the student that following prompting she picked up the spoon and continued to feed herself due to the surprise of the staff.

Aggressive behaviours reduced due to early interventions with more personnel on the floor. The behaviour of a resident who was inclined to display aggression would change on seeing the white uniform of the students.

Aggression dropped by 57.89% over the initial three months of the DEU period (August-October) and there have been nil challenging behaviours over the last 6 months within the general unit.

Figure 1: Aggressive Episodes - General - Trend Graph

When evaluating the falls over the initial DEU period a reduction of 20% was also noted and falls within the general unit have continued to decline over the past 9 month period.

Figure 2: Resident Falls (TOTAL) General - Trend Graph

Staff:

Registered Nurses were enrolled with Wintec to do their Preceptor Course – 3 attended. The Nurses who were doing their NETP training this year will be enrolled for next year. Our aim is to be 100% preceptor trained.

Tamahere staff gave presentations during the 1.30pm – 2.30pm time slot that was allocated for extra tuition. This time included many tutorials including; Death & Dying, Manual Handling, Social Determinants of Nutrition in aged Care and Strength Assessments. RN’s who presented had the opportunity to develop their teaching skills, improve their knowledge which supported them with their competencies and portfolios.

The CLN role has continued to develop over the past 4 months supporting all staff and our CLN is currently undertaking the preceptor training.

Students:

Dedicated Space was provided in the DEU to allow for confidentiality and privacy for one on one time with the tutors. This space has proven to be essential.

All parties valued an open door policy which this environment facilitated. TEH staff and students were able to drop in anytime allowing for instant feedback on issues and compliments when necessary.

The training room has been invaluable in providing an environment that allowed for extended education, providing current technology and a quiet space for further study.

The ALN & CLN worked shifts accordingly to accommodate student needs.

Input from CNM, GM Care and Training Coordinator all added to the students learning experiences.

In the last rotation students attended hospital appointments. This provided not only support for the residents but an insight into difficulties the elderly encounter.

To accommodate student ethnicities having a multi-cultural staff workforce has been found to be beneficial in supporting language and cultural practice.

Conclusion;

This DEU would not be possible or successful without the cooperation and support of every team member. TEH staff have grown in their roles as educators and mentors in developing our future workforce. They have adjusted well to the increase number of students.

The Wintec ALN was previously attending students at Tamahere and had already built a relationship with Tamahere which proved to be of great benefit in establishing the DEU. This enabled the ALN & GM Care to build and plan until the CLN was appointed.

Daily informal contact and regular formal fortnightly meetings with Wintec and TEH have shown to be strategic to the success of the DEU.

Having the Waikato times present at the launch was beneficial for Tamahere and Wintec’s profile. It raised public awareness of our facility and as a result prompted more enquiries both from the public and other facilities regarding developing a DEU. It also highlighted to the wider community the progressing partnership between the DHB, Wintec and TEH in presenting the future of nursing training in NZ.

Further Planning:

1. Register remaining RN’s for the Preceptor Course,
2. Increase attendance at hospital appointments for students,
3. DEU planning prior to placement with CLN & ALN,
4. Develop partnership between CLN and TEH Training Coordinator to identify and develop clinical practice for all staff including students,
5. Develop Registered Staff portfolios through education & presentations.

The Future;

Currently we provide education placements for semester 2 students on a Friday (6) during the academic year and 10 Semester 3 students for their Mental Health placements. As the hospital is developed it is planned that TEH will be able to progress to providing education for other students doing Long Term Care Placements through the DEU. We see this as ongoing where we will be able to provide quality education placements from Semester 1 through to the completion of their studies with the transition semester and NETP.

Best Clinical Placement Award;

On the 22nd of March 2016 Tamahere Eventide were awarded “Best Clinical Placement Award, Bachelor of Nursing” by Wintec, Centre for Health and Social Practice at the Special Awards 2016. The award was generated by student comments regarding their clinical placement which demonstrates Tamahare’s commitment to both the DEU concept and active participation in the students learning;

“An absolutely amazing placement, 100% recommend”

“Students should be fighting over spaces in this placement”

“Amazing learning opportunities, the DEU was so good”

“The fact that this placement had a DEU made learning that much easier”

“It helped me become more confident in applying my knowledge to practice”

“A very good place to send students to”

Louis Fick, Chief Executive Officer