Introduction:

Working in co-production is a relatively new aspect of healthcare simulation, but evidence shows that participatory learning alongside Experts with Lived Experience has a positive impact on the learning of healthcare students [1]. Co-production enhances knowledge, safety, empathy, appreciation of disciplines, and recognition of lived experience’s value. [2]. As homeless people are statistically much more likely to experience ill health, improving staff training is a key way to ensure their needs are safely and holistically met [3].

A week of simulation was designed and delivered for 70 second year nursing students from Adult, Child and Mental Health branches at the University of Greenwich. The outcomes for this week included working across disciplines to learn from each other, to carry out in depth social histories for a variety of patients, recognise the nuances involved with caring for homeless patients and to exercise good communication skills when discussing sensitive information.

Methods:

Students engaged in four days of in-person simulation scenarios spanning various nursing disciplines to achieve their learning goals. Each day focused on a different aspect of nursing, complemented by contextualising activities. The week emphasised homelessness, with three experts contributing insights: two with personal experience of homelessness and one, a nurse leading a homelessness charity. Their input shaped scenario design and activities. They also participated in talks with students and staff on the final day, sharing their backgrounds and stories. Feedback was gathered using Google Forms at the end of the week.

Results:

Of the 70 students who took part in the simulation week, 41 provided feedback (58% response rate). The students were asked to rate their learning for the simulation sessions and activities, using a Likert scale from 1-5. They were also asked more specific text-based questions regarding their experiences. The results are presented in Table 1-A86, with the number of responses and in brackets, the percentage.

Table 1-A86.

Question:		Answers:Yes	No	I was not in attendance
Did you find the simulation sessions interesting?		40 (98%)	0	1 (2%)
Did you learn from the simulation sessions?		40 (98%)	0	1 (2%)
Were the simulation sessions relevant to your learning?		38 (93%)	2 (5%)	1 (2%)
Did you find the activities interesting?		34 (83%)	5 (12%)	2 (5%)
Did you learn from the activities?		34 (83%)	5 (12%)	2 (5%)
Were the activities relevant to your learning?		34 (83%)	5 (12%)	2 (5%)
Did you find the talks from Experts with Lived Experience interesting?		38 (93%)	0	3 (7%)
Did you learn from the talks?		38 (93%)	0	3 (7%)
Were the talks relevant to your learning?		38 (93%)	0	3 (7%)
Question:		Answers:Fair	Good	Excellent
How would you rate the Interdisciplinary aspect of the week?		4 (10%)	12 (29%)	25 (61%)
Free text responses:
Please provide further comments regarding the talks from experts with lived experience.	“It was good seeing people who has experienced such situations sharing their stories and helping others” “Fantastic and insightful” “It was useful getting information from someone that has had experience” “Really opened my eyes and makes me want to do more to help” “I didn’t know nurses could get jobs working with homeless people so it was good learning about how I can apply this when I finish uni” “I learned a lot from them.” “These people are amazing and so strong” “I loved hearing their experiences and asking questions because it’s not something we get to do often” “I found it educational, interesting and challenging”
Do you have any further comments or feedback around the week as a whole?	“It was interactive and I learned a lot” “Learnt new information and gave me an insight to how people are affected when it comes to being homeless” “Very informative week, however, straight after a 6 weeks placement was too much for me personally to take in.” “Thank you for all of your hard work in organising this week, it has been very fun and informative. I appreciate the effort it must of taken to organise. I especially liked the talks this afternoon which really touched me.” “I just wanted to personally thank you guys for orchestrating this wonderful simulation it has really helped open my eyes to the homeless situation and it has helped me how I can help them whilst they are in hospital as I didn’t really know about all these kind of support pathways for homeless people in terms of my role as a student adult nurse. I enjoyed interviewing the patients within the different discipline’s and understanding different interview techniques and the external expert speakers it was really refreshing to hear their stories and it helped me to put things in perspective especially with understanding that some people just don’t want any help.”

Discussion:

The simulation sessions, activities and talks received overwhelmingly positive feedback, with at least 83% of students reporting that they learned from these sessions and that they were able to build a better understanding of how they can support and work with homeless people in practice. Working in co-production allowed the scenarios and activities to relate to the real-life experiences of the patients that our students might encounter, and the talks from the Experts at the end of the week enabled the students to consolidate this learning and view their patients holistically.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. O’Connor S, Zhang M, Trout KK, Snibsoer AK. Co-production in Nursing and Midwifery Education: A systematic review of the literature. Nurse Education Today. 2021;102:104900.

2. Clarke I, Philpott L, Buttery A. Pilot study: Design, delivery and evaluation of a co-produced multi-agency Mental Health Simulation-Based Education Programme. International Journal of Healthcare Simulation. 2023.

3. McNeill S, O’Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the UK and Ireland: A scoping review. BMC Health Services Research. 2022;22(1).