Key to learning turns out to be a real fine mess

Roisin-Alana Di Giacomo talks to Alan Middleton about the importance of giving students real-world experience and how it led his team to a Herald Higher Education Award.


Entering the lives and homes of people is a daunting task for any health practitioner who is just starting out, and with more care being delivered in the home and community settings, learning-disability nursing students need to be more prepared for the challenge than ever before.

To prepare students, the Department of Nursing and Community Health in the School of Health and Life Sciences has created Chaotic Environment, a simulated learning experience designed to test final-year students before they meet the demands of modern-day nursing practice.

“We wanted to immerse our students in a challenging environment, albeit a safe one, while at the same time causing an impact,” explains Alan Middleton, Senior Lecturer in Learning Disability Nursing. “By simulating chaos, students can better understand a person’s deteriorating physical and/or mental health while testing their capabilities and how they should respond.”

Alan admits he doesn’t want to give too much away as the scenario is a crucial part of students’ final clinical assessment, but credits its success to the team which includes his colleagues Mark Gallagher, Chris Darbyshire, Isla McGlade, Wendy Smith and Liz Simpson.

The Chaotic Environment engages the students in scenario-based learning, with a member of the team taking on the role of a person with learning disabilities within the confines of a small purpose-built room. Students must identify and prioritise for the person’s health and wellbeing needs and overcome a number of obstacles and challenges.

Though clinical simulation is not a new teaching technique and has been used in nursing education for some time, what is innovative is the environment which has been created within the University and the use of state-of-the-art mobile cameras to analyse and assess the students’ work. Its success was recognised at the most recent Herald Higher Education Awards, when, in July last year, it received the Enhancing Student Learning Award, with judges praising the team for contributing positively to the student experience.

“By using clinical simulation in a meaningful way and listening to student feedback, many of whom wanted to practise and test their skills in a safe space, we have been able to provide them with practical training,” says Alan. “What they have to think about is, ‘If I was knocking on that door for real, what are the risks? How does the evidence support my recommendations?’”

Following in his mother’s footsteps, Alan entered the nursing profession in which he had a keen interest from a young age, volunteering at school to help children with severe and profound learning disabilities. He completed his general/adult nursing and learning-disability nursing programmes before practising as a specialist community learning-disability nurse with a caseload that ranged from children as young as four to older people. He then moved into nursing education and, as an academic, Alan is interested in the additional and unmet health needs of people with learning disabilities in relation to sexual health.

“It was, and it still is, a taboo subject but it is certainly better than it was. As a community nurse, part of my role was delivering sexual health support and education. With the lives of people with learning disabilities controlled by others, particularly if you have severe or profound learning disabilities, the opportunity to have meaningful relationships can be difficult.”

Alan explains that addressing the sexual health needs of vulnerable people is often met with obstacles, either from families or within communities, which he says is understandable, as, statistically, people living with learning disabilities are more likely to be abused physically or sexually. That said, he insists it is necessary to positively contribute to the sexual health needs of every individual.

Challenging perceptions of disabilities is something Alan has been able to take further afield, as he is also responsible for creating international opportunities for students and staff within nursing and learning-disability nursing programmes. This has allowed lecturers and students within the department to help change attitudes in developing countries and contribute to emerging healthcare systems.

“In one rehabilitation centre, which our learning-disability nursing students volunteer in, a child was identified as having behaviours that were perceived as challenging as they were constantly unsettled and leaving the classroom. Our students investigated and found that the problem was, in fact, the pupil had a urinary tract infection which needed antibiotic treatment.

“It is a small example of how differential diagnosis can impact on a child’s life and, through effective communication; our nursing students can contribute and play their part in transforming lives through education.”

For Alan as a lecturer, he says teaching the next cohort of students allows him and the team to continue to do what they can for the health and wellbeing of people with learning disabilities.

“As a society, we need to do more. We need to discuss, to debate, to create some argument, to tackle the issues that people don’t want to address, and to listen to all viewpoints.

“By bringing issues of healthcare to the fore, only then can we move forward and meet the needs of all within our society.”

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