IN 1999, one of the UK government’s responses to the shortage of qualified nurses was to significantly increase the number of student nurses (DoH 1999). This led to an increase in demand for clinical placements, at a time when the nature of care in the trust hospitals was becoming increasingly acute and short-stay. Qualified nurses, already in short supply, were under pressure from staff shortages and the push to reduce waiting lists, demanding a rapid throughput of patients. This situation was not conducive to the support of student nurses, particularly at the beginning of their pre-registration programme, when time and the reiteration of first principles in practice are required. Changing demographics have resulted in older people becoming the most frequent users of healthcare facilities (DoH 2000). In 1999, not all students at the Institute of Health and Community Studies at Bournemouth University (IHCS) had the opportunity to develop specific skills and knowledge in relation to the care of this increasingly large client group. Students often have negative attitudes towards older people adding disinclination to lack of opportunity (Hinchliffe 1980, Roberts and Powell 1978). The media portrayal of the nurse is generally of a dynamic actor in an acute setting where technical skills are paramount. Images of nurses caring for older people in a long-term setting, where nursing problems might be complex and change is slow, are rarely used. This has been emphasised by Nazarko (1999), who pointed out that nurses believe that nursing care of older people is ‘basic care’ with no specialist skills required. Experience has shown that although older people can be found in any hospital’s acute wards, skilled nursing is best practised in longstay residential nursing homes. Nursing homes also provide care for terminally ill people, respite care and care for the younger physically disabled and those who need rehabilitation. In such settings, the students’ understanding of older people as individuals with feelings and needs can be enhanced, and there is a more supportive environment with fewer pressures on staff. There is time to build relationships through which evaluative skills can develop. For these reasons, nursing home placements for first-year nursing students provide an ideal basis for developing their fundamental skills. Sheffer’s (1998) study conducted with first-year baccalaureate students in the US was convincing in its assertion that, due to the high acuity level of hospitalised clients, clinical placements for beginning students should continue to be with older patients in a nursing home setting. This study also showed that positive attitudes to older people occur as a result of this type of clinical experience. Similarly, Fuggle (1999), in a study of IHCS students after one year in a nursing home placement, found that ‘the perceived benefits of the placement... were the development of their basic nursing skills giving them a broad base upon which to build future skills’.
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