PAEDIATRIC COMMUNITY
SOCIAL CARE: DEVELOPING A DIETETIC WORKFORCE FOR THE FUTURE Evelyn Newman Nutrition and dietetics advisor: care homes NHS Highland Award winning dietitian, Evelyn Newman, is well known throughout the profession for her writing, volunteering with the BDA and innovative work. She currently holds a unique role in The Highlands. @evelynnewman17
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In the summer of 2014, NES (NHS Education for Scotland) were looking for someone who might be interested in developing and piloting alternative dietetic placements in social care settings. I immediately responded and set about gathering partners to help me take social care placements forward in Highland. Initial scoping meetings proved very positive and so, the first ever innovative dietetic social care placement in the UK was created, tested and evaluated in October 2014. Further details of all Highland dietetic social care placements are available on the NES website.1 The development of innovative social care dietetic placements2 supports a changing workforce profile for the future and has allowed a greater appreciation and understanding of residents’ lives and their rich histories. It has helped students to understand a social model of care, which is asset based, using co-production methods, putting the resident in control. This is in contrast to the conventional clinical model, which directs care and is dominated by organisational standards, protocols and regimented routines. The success of this innovative, multiagency/professional approach has been widely recognised and promoted across the dietetic profession and beyond.3,4 In 2015, we were delighted to come runners up in the Social Care category of the Advancing Healthcare Awards. We went on to win the BDA’s prestigious Dame Barbara Clayton award in the summer; before finishing the year as runners up in the Innovative Partnership category of the Scottish Dementia Awards.5 I had the pleasure of presenting our work at the Scottish BDA conference (‘Dietitians leading the future of Scotland’s health’) in September 2016. This generated greater interest from other boards and from
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practice education facilitators (PEF) across Scotland, supported by NES. Since then, there has been an increase in the numbers of opportunities for student dietitians to fully experience working and exploring nutritional care in social care settings. In November 2017, NES ran a monthlong social media campaign to promote and encourage the development of social care placements across Scotland. Later that month, I participated in a multi-agency event that focused on supporting PEFs to build capacity and create more Allied Health Profession (AHP) student placements within the wider Scottish care sector. This was followed up in April 2018 with a national conference exploring how Scottish Boards might create capacity for AHP student practice-based learning events (#AHPPrBL). In NHS Highland, we have had the opportunity to test and evaluate A, B, C and masters placements in social care settings. We have shown that peer-assisted learning (PAL) also works well, but the opportunities to deliver this is reliant on having two students on placement at the same time, which rarely happens because of how placements are allocated to each board. We are currently looking for opportunities to have dietetic students alongside nursing and other professions who are also on placement. Evaluations from all participants (staff, students and HEI) have demonstrated that evidence for all
Students demonstrated
good communication and organisational skills by talking with care home staff, kitchen staff,
residents and family
members, to gather the essential information
before making proposals. placement competencies can be easily achieved in these settings. Supervision is arranged within the care setting and therapeutic input is only offered when a community dietitian is present. Examples of work, which students have completed across Highland, Glasgow and Lanarkshire include the following: • Asset mapping for individual care homes to look at what services and facilities are available for the service users within the care home environment and local community. • Quality improvement projects, including a Continence Audit and the importance of hydration for staff. The aim was to encourage staff to measure both input and output. Students in Lanarkshire also wanted to raise awareness of the importance of hydration for both residents and staff by getting them to calculate their own fluid requirements and monitor their intake over a three-day time period. Staff in one Highland care home were shocked to realise that they were only consuming half of their daily requirement. • Reviewing care home menus to ensure that residents were receiving nutritious food and drinks. Students demonstrated good communication and organisational skills by
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talking with care home staff, kitchen staff, residents and family members, to gather the essential information before making proposals. This allowed social care settings to evidence delivery of national health and care standards.7 • Completing an audit of all MUST scores with the care home nurse; checking accuracy and reporting on variance before jointly agreeing and presenting recommendations for improvements and training to care staff. • In care at home placements, students spoke with service users, documenting the challenges to eating, shopping and cooking. A review of limited food stocks raised concerns for some. Students were subsequently invited, to present their insights of this PAL placement to the senior social work team. In conclusion, social care placements have been positively evaluated and are valued by service users, care staff, students and HEIs. They will only succeed with attention to thorough pre-placement planning and a positive inquiry approach to understanding, delivering and improving nutritional care.
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