Client attachment content: Front page client attachment. The role of the clinical supervisor. The role of the accountable practitioner

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1 Client attachment content: Front page client attachment The role of the clinical supervisor The role of the accountable practitioner The role of the student nurse The role of the personal tutor The role of the route leader The role of the practice education managers Research on client attachment References

2 FRONT PAGE CLIENT ATTACHMENT These pages outline Client Attachment, which is the framework for structuring clinical practice experience for students undertaking Post-graduate Diploma in Mental Health Nursing Year 3 Pre-registration Degree in Mental Health Nursing Year 3 Pre-registration Diploma in Mental Health Nursing WHAT IS CLIENT ATTACHMENT Client attachment is a system that allows student nurses to gain clinical experience through forming longitudinal therapeutic attachments with individual clients, rather than through a series of location based placements ( Jackson and Pogson, 1995). Students gain their clinical experience through developing and working with a caseload of clients in a variety of care settings. The caseload profile is specified according to the student s point in the course and defined by the learning outcomes for that stage of professional development. The client work is negotiated with and directly supervised by the client s accountable practitioner (named nurse, key-worker, care co-ordinator). The student also receives clinical supervision in relation to the profile and management of their caseload. The clinical supervisor monitors the range of clinical experience and skills acquisition. The clinical supervisor also makes an assessment and then validates the achievement of learning outcomes for practice. Client attachment has several advantages for student clinical development over conventional location based clinical placements. The longitudinal therapeutic attachment with clients creates the potential for longer term work, allowing the student to gain an appreciation of the value of extended therapeutic relationships and case work. It also creates the opportunity to observe the development and progress of a range of mental disorders over a period of time and through different phases and settings. The student has the opportunity to engage with clients and their families and gain an understanding of their perspective of the impact of mental illness. The management of a caseload helps to develop a wide range of organisational and clinical skills. The student gains early experience in the assessment and management of conflicting priorities and as a result client contacts become more purposeful. This promotes the development of specific clinical skills through more focused therapeutic interventions. Students are encouraged to take an increased degree of responsibility for their own learning. They are able to gain experience and develop skills according to their particular strengths and learning needs and to negotiate specific clinical learning opportunities that reflect their own strengths and weaknesses in experience and expertise. This enables the student to develop a self motivated, self directed, problem solving approach to learning.

3 THE ROLE OF THE CLINICAL SUPERVISOR Each student undertaking client attachment requires an identified clinical supervisor. The clinical supervisor is a nurse at band 5 or above. The personal qualities of the supervisor are of greater importance than the band and include: commitment to practice development, expertise in their chosen field, and ability to facilitate learning. The clinical supervisor and personal tutor are allocated to the student for the entire period of client attachment. The clinical supervisor is concerned with the student s acquisition of skills and the application of knowledge. He/she will also liaise closely with the student s personal tutor, accountable practitioners, and the route leader. In the event of difficulty the supervisor should contact the student s personal tutor or the route leader. The clinical supervisor is responsible for facilitating the student to gain appropriate client experiences and supervision. A regular, documented meeting will be necessary throughout the clinical experience, and occasional meetings with the student s personal tutor will also be scheduled. Meetings with accountable practitioners may also be necessary to gain an insight into the student progress in working with a specific client. Each identified clinical supervisor will be fully prepared before beginning the role by attendance at a workshop at City University. Before the commencement of a new client attachment year students, clinical supervisors, personal tutors, route leaders and practice education managers will meet to address any last minute questions.

4 THE ROLE OF THE ACCOUNTABLE PRACTITIONER The Accountable Practitioner is the professional who holds the key-worker/ care coordinator responsibility for each of the student s chosen clients. These professionals will be chosen in liaison with the clinical supervisor after the student begins their clinical experience. Accountable practitioners work alongside students with the chosen clients, at the times the student is with the client (probably a few hours per week). The student will negotiate with their clinical supervisor and the accountable practitioner which learning objectives they are trying to meet with the client. The accountable practitioner will oversee the student s work with the client. The accountable practitioner s relationship with the student ends when the student has met their objectives in relation to the client, or the client has been discharged from the service. This can be anything from a few days to the whole client attachment period. Both the clinical supervisor and the accountable practitioner can sign students learning outcomes and portfolio activities when they are completed. A meeting between the accountable practitioner, the clinical supervisor, and the student, before final signing of the learning outcomes/ portfolio is recommended. Where the accountable practitioner is not a mental health nurse the learning outcome/ portfolio activity can be signed by them but must be counter signed by the clinical supervisor. Both clinical supervisors and accountable practitioners may be working with more than one student at a time. In the event of difficulty the Accountable Practitioner should firstly contact the student s clinical supervisor, and then the personal tutor or route leader. The accountable practitioner should be in no doubt that the student remains accountable to them for feeding back the outcome of any engagement with the individual client. All activities undertaken with a client must first be negotiated with the accountable practitioner.

5 THE ROLE OF THE STUDENT NURSE The student nurse will be undertaking the Post Graduate Diploma in Mental Health or the Pre-registration Degree/ Diploma in Mental Health (Year 3). Students will be fully prepared for their client attachment practice before it commences. At their first meeting with the student clinical supervisors can expect their student nurses to have ideas about the client group/needs/issues they wish to address during their period of client attachment. Degree/ diploma students are encouraged to identify their own clinical supervisor prior to commencing client attachment. Post-graduate students will be introduced to their clinical supervisors prior to commencing client attachment. The student nurse will be expected to attend regular supervision with their clinical supervisor and build a caseload of clients/ learning opportunities according to their prescribed learning outcomes/ portfolio activities. Students will need to gain the support and agreement of each accountable practitioner before undertaking any work with an identified client. Where the accountable practitioner for the client changes, e.g. when a client moves from one service to another, the student must identify themselves to the new accountable practitioner and seek their support to continue working with the client. The student nurse will work closely with the accountable practitioners of these clients, who will be assessing their skills. The student nurse should be in no doubt that they remain accountable to the accountable practitioner for feeding back the outcome of any engagement with the individual client. All activities undertaken with a client must first be negotiated with the accountable practitioner. Students should also attend the reflective groups offered by the clinical education team for the three localities of East London. The student should make contact with their accountable practitioner if they have any concerns about their work with a client and also relay this information to the clinical supervisor. The student should endeavour to keep their personal tutor up to date with their progress during client attachment. Students should only make contact with the Route Leader if they have been unsuccessful in resolving an issue via the accountable practitioner, clinical supervisor and personal tutor. The Route Leader should not be the first port of call. Students must ensure that a data sheet detailing their current clients is kept up to date and held by all the appropriate people and that their client attachment placement details sheet listing their key contacts is kept up to date and also held by all the appropriate people. It is absolutely VITAL that students keep written records of their practice to be used in reflection, personal learning, and for discussion with their supervisors to facilitate the assessment of learning outcomes. This material will also be invaluable for various academic assignments. Clinical hours It is the student s responsibility to ensure that their clinical hours sheet is signed and up to date. This will involve many different clinicians signing for the hours students have spent with them rather than shifts or days. Students will be advised to have a good supply of clinical hours sheets. It is also recommended that students

6 carry a copy of the Client Attachment Handbook with them at all times so as to explain client attachment to clinicians unfamiliar with this system. In addition it is more than ever necessary to carry student identification.

7 THE ROLE OF THE PERSONAL TUTOR The personal tutor is the student s tutor at University. This person will already be liaising closely with their student prior to the start of the client attachment. Before the commencement of a new client attachment year the personal tutors will be part of the meeting of students, clinical supervisors, personal tutors, route leaders and practice education managers in order to address any last minute questions. At this meeting further meetings between the supervisor, student, and tutor, can be arranged. The personal tutor will have regular meetings with the student to ensure the integration of theory and practice, and to support the student through the experience. If there are any problems the personal tutor should be involved immediately along with the route leader. Meetings between the tutor and supervisor should take place at least once per semester (every six months), and more frequently if necessary. The personal tutor is the first point of contact for the clinical supervisor if there are queries about a student s progress on client attachment.

8 THE ROLE OF THE ROUTE LEADER There are two route Leaders: Post-graduate Diploma in Mental Health Nursing Soo Moore, Senior Lecturer Year 3 Pre-registration Degree/ Diploma in Mental Health Nursing Lynny Turner, Senior Lecturer L.Turner@city.ac.uk The Route Leader (previously known as a Programme Director) is responsible for over seeing the whole student experience during their mental health training. This includes having an overview of the curriculum content and the clinical experience that students can/ should gain during their training course. In the case of client attachment Soo Moore and Lynny Turner are overseeing the development of client attachment in their respective courses. Students and potential clinical supervisors are contacted and client attachment is explained well in advance of the beginning of the clinical experience. They will also organise a meeting before the commencement of a new client attachment year for all students, clinical supervisors, personal tutors, and practice education managers. This meeting helps to address any last minute questions. The Route Leaders, Soo and Lynny can be contacted about any queries regarding client attachment on their specific courses where the clinical supervisor or personal tutor has been unable to help with the query. THE ROLE OF THE PRACTICE EDUCATION MANAGERS (PEMs) Betsy Scott (Tower Hamlets and Newham) and Stephanie Tannis (Hackney) are our Practice Education Managers. They are the bridge between clinical areas and the University. One of their primary roles is currently the support of all East London and City Mental Health Trust staff who supervise our student nurses in traditional placements. Betsy and Stephanie will be supporting the clinical supervisors and accountable practitioners through client attachment. They are happy to receive calls about any client attachment issues and will redirect you to the clinical supervisor, personal tutor, student or route leader if that seems more appropriate. Betsy and Stephanie will liaise closely with our Route Leaders, Soo and Lynny, to ensure that client attachment runs smoothly. Betsy Scott Stephanie Tannis

9 RESEARCH ON CLIENT ATTACHMENT In 2002 a pilot study was undertaken at City University and East London and the City Mental Health Trust. Twelve students undertook their clinical practice experience via client attachment for a six month period within their pre-registration training programme. Using a qualitative design 12 students, 2 service users 12 supervisors and 10 accountable practitioners were interviewed. The study reported that client attachment had a positive effect on student s approaches to learning and studying, helping them to identify their own goals and increasing their motivation to study. Students reported that client attachment allowed them more freedom to identify their own goals and pursue their own areas of interest. They described being able to focus more on one client, having to think harder about how to meet objectives and feeling more like an adult learner. They also reported having more time to study and being more independent. Clinicians found that while the supervision was both more formal and structured it required less time than the usual student mentor commitment. Students commented positively on the adult to adult nature of the supervision (Turner et al 2004). REFERENCES Jackson, N. & Pogson, D. (1995) Client attachment in learning disabilities nurse education, Nursing Times 91, Turner, L., Callaghan, P., Eales, S. & Park, A. (2004) Evaluating the introduction of a pilot client attachment scheme in mental health nursing education, Journal of Psychiatric and Mental Health Nursing, 11,