Using Patient Experience in Nurse Education

Edited By Tony Warne and Sue McAndrew , Palgrave Macmillan , 2004 . PB £19.99 , 208 pp . ISBN 1 403934010 Current UK health policy places an emphasis on the greater involvement of patients and carers in all aspects of their health care. This book is about the involvement of patients in the training and education of health-care practitioners, with a particular focus on nursing. The individual chapters fall into two sections. The first part provides the context for patient involvement: it examines the current policy and rhetoric of patient involvement in health-care planning and delivery of services, and in the education of professionals. The second part describes specific examples of innovative practices that demonstrate the inclusion of patients in education. As a non-nurse I was both fascinated and frustrated by some of the chapters about the philosophy and theory of nursing practice. The one I found most useful was the first, written by the book's editors, which provides the contextual background to the rest of the book by illustrating the complex range of factors that have influenced, and continue to influence, nursing practice and education. It gives a brief history of the development of higher educational approaches to nurse education, the movement from schools of nursing to universities, and current UK and international approaches to professional education. It links the need to involve patients to the patient centred method. It proposes ‘patient experience knowledge’ as the missing link between theoretical and practical knowledge, both of which in their differing ways are general and generalizable. Patient knowledge experience is, by contrast, specific to this patient and ‘forces a shift in gaze from the body to the person living a life.’ As a medical educator, the chapters that describe actual examples from current practice and lessons learned were, for me, the most accessible and useful parts of the book. Costello and Horne describe the involvement of three patients who took part in classroom teaching within a pre-registration nursing programme at the University of Manchester. They discuss some of the practical, ethical and organizational issues, as well as the role of the nurse teacher in organizing and managing the session. The key to manage classroom situations with patients appears to rely on sound teaching principles and the ability of the teacher to deal with both the practical and ethical issues raised by shifting the focus of teaching and sharing the responsibility for teaching with the patient. Three examples are given from initiatives at the University of Leeds. O'Neill provides an overview of a project that aims to identify ways of developing more effective and sustainable ways of involving patients and carers in pre-registration educational programmes for nurses and midwives. This is an attempt to move beyond a reactive ‘tick box’ approach to involvement, to bring patients into the core of the university in contrast to their previous role as occasional visitors. It highlights strategies to effect the institutional changes required for meaningful patient participation in education. Kilminster et al. describe the involvement of different types of patients in the education of medical students: there are ‘simulated’ patients (trained to pay a role), ‘expert’ patients (with chronic or life-threatening conditions) and ‘real’ patients (involved in all the clinical experiences of students and beginning to be involved in assessment); related community-based educational activities are also described. Samociuk and McAndrew describe a project for mental health nursing students in a postgraduate diploma programme that explored the feasibility of a model of sustained patient involvement. The project was designed as action research and involved seven students, five patients, two lecturers and an observer. The chapter summarizes evaluation data from the patients, facilitators and observer and identifies the areas that would need to be addressed if this model were to be adapted for future collaborative work. These include the need to establish clear boundaries for providing a safe environment, support for all participants, and institutional commitment including resources and establishment of systems for remuneration. In contrast to these examples of bringing the patient into the classroom setting, Canham explores ways of involving patients in practice settings in the education of specialist community practitioner students, such as community mental health nurses and school nurses. She argues that in post-registration courses where students are experienced nurses, one should build on ways to enhance patient participation in the community practice setting rather than focus on ways of ‘bringing the patient to the students’ in an institutional (artificial) setting separate from the normal student–patient interface. Ideas for enhancing patient-centred, student-centred learning are provided. These, for me, was the most interesting parts of the book. However, if your interest is the bigger picture of patient involvement, policy development or nurse education there is plenty of additional food for thought in this book. With the exception of mental health nursing, the active engagement of patients/lay people in the education of health professionals is a recent movement. This book reflects the current stage in its evolution. It is strong on rationale – the reasons why it is a good thing to do – but short on evidence – the rigorously evaluated benefits to students, patients and teachers. I look forward to a sequel to this book that focuses on the educational outcomes of using patient experiences in nurse education.

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