The Starfish Project: reflections on an interprofessional learning opportunity


In 1860 Florence Nightingale wrote:
The very alphabet of the nurse is to be able to interpret every change which comes over a patient’s countenance without causing him the exertion of saying what he feels.’
Supplementary chapter in Skretkowicz (ed) 1996: 169

More recent experiences suggest the empathy and skills required for such care are often lacking in healthcare staff, (HMSO, 2013).
An interprofessional learning project, inspired by The Patients Association, enabled healthcare students to closely examine communication skills and empathy in clinical practice. The nursing students participated whilst undertaking a ‘volunteering module’ as a course option.


Student Community Engagement (SCE) is an optional 10 credit module at level 5 in a Nursing honours degree programme, (Framework for Higher Education Qualifications (FHEQ), (QAA, 2008)).  Students commit to undertake 30 hours of volunteering in a health and social care project that is agreed with a workplace supervisor in a local not-for-profit organisation.  Concurrent classroom teaching facilitates an inductive process so that students learn about the purpose of their volunteer placement organisation and how this contributes to the health and wellbeing of a community.

The Starfish Project[1] was designed and led by the Patients Association (PA) in a local National Health Service (NHS) acute hospital in the South of England.  Seven nursing students studying the SCE module, seven pharmacy students and four occupational therapy students participated as volunteers working in pairs as PA Ambassadors.  The following is a reflection on this unique project from the four perspectives of the authors: NHS hospital Associate Chief Nurse (CD), PA view (LD), university volunteer manager (BTH) and university academic (DH).  Driscoll’s (1994) reflective model What? So What? Now What? frames the account of this interprofessional learning venture.

The Patients Association are committed to working on projects involving students– if you would like to know more please contact <>Heather Eardley, Director of Development or visit their website


Brighton and Sussex University Hospitals NHS Trust (BSUHT) in collaboration with the Patients Association explored different methods to improve patient experience in the Trust.  One concern was the care of patients with dementia. This had been identified in BSUHT complaints, patient surveys and incident reporting.  Approximately a quarter of patients in acute hospitals are living with dementia and have traditionally been a group more difficult to access for feedback, (Alzheimer’s Society, 2009).

In discussion with the PA it was decided to give students opportunity to develop the appropriate awareness, knowledge, skills and experience that will enable them to develop a patient-centred approach in future clinical work and ensure that compassion and dignity are the cornerstones of their clinical practice.

The project highlighted some areas of skilled patient-centred care but also raised some issues about how nurses and other health care professionals communicate compassionately with patients with dementia.  As a result of this the nationally recognised Butterfly Scheme ( for recognising and communicating with people has been rolled out across the Trust and observations of care are widely used throughout all care settings.

The Trust has since worked in collaboration with the Patients Association on a project with student nurses and pharmacists, interviewing patients at discharge about their knowledge of their medications.  The report will form the basis of further joint nursing and pharmacy development work.


The C.A.R.E. Campaign jointly run by the journal Nursing Standard and the Patients Association (2012) aims to tackle poor care and its causes, based on the four most frequent complaints about patient care received by the PA through their Helpline; these complaints include poor communication. See Box 1.

the C.A.R.E. campaign






Communication with patients and carers is a vital component of delivering patient centred health care and set out in the vision and strategy to deliver a ‘culture of compassionate care’, (Department of Health and NHS Commissioning Board, 2012).  Students used the C.A.R.E. campaign audit documents to achieve the aims and objectives of the project.  See Box 2

Aims and ojbectives of starfish project









Non participant observation and patient and carer interviews demonstrated that the use of such tools provide valuable information about how members of staff communicate, and increase awareness and compassion in student volunteers through the co-production of knowledge with service users, individual and group reflection.

The students described their overall experience of the project as invaluable, giving insight into the work of a busy hospital environment; and although they found the experience difficult at times, it allowed them to gain interviewing skills, confidence in approaching patients, and ‘personal growth’.

The PA was able to recommend the use of non-participant observation and patient and carer interviews on a regular basis with other cohorts of nursing and AHP students, as a learning ‘tool’ to assist understanding of the importance of compassionate communication in clinical practice.


The role of Active Student, the University’s Volunteering Service, was to work with the PA to create a rewarding, safe and supported volunteering opportunity that was mutually beneficial to students, the Trust, the nursing course module and the PA.  Volunteering on this unique project enabled students to develop skills in patient engagement, enhance knowledge of shared decision-making and engage in interprofessional learning.  Reflective learning opportunities were a key part of the volunteering journey and facilitated by BTH and LD.

It created opportunities for students from different disciplines to come together, share their thoughts and experiences and learn from each other.

pharmacy student quoteThe hospital Trust has gained confidence in the merits of involving student volunteers and more projects and new collaborations have since been generated.  Students add value to bespoke projects that otherwise might not have taken place.  Students have referred to their volunteering experiences at employment interviews and reported favourable responses.


The module is assessed by written report analysing the skills the student has used and developed, and reflecting on the transferability to nursing.  Students must consider the wider implications of volunteering and future design of integrated health and care services given the increasing number of people with long term needs (Naylor et al, 2013).

Patient and carer involvement is a regulatory requirement in the preparation and education of health care professionals, (NMC 2010, HCPC 2013 and GMC 2011).   ‘Starfish’ was an opportunity for nursing students to participate in a patient and carer-led project whilst working with and learning from other health care students as well as patients and their carers.  It enabled learners to improve their listening, close noticing and thoughtful communication skills:

nursing student quote






OT student quote






In addition, it honed data collections skills integrating learning from other course modules and improved understanding of the patient experience:

Now What?

The University’s Volunteering Service has initiated further opportunities for interprofessional learning whilst volunteering on local community engagement projects.  Pharmacy and nursing students took part in another programme with The Patients Association to look at patients’ experiences of knowing their medicines on discharge from hospital.

The university’s new curriculum design framework indicates 20 credits as the smallest denominator for module credit from 2017/18.  Together with new developments for interprofessional integrated care teams in the workplace, the next step for the SCE module team is to make the case for greater and more formal assessment within the curriculum in recognition of student community engagement, (Millican and Bourner, 2014).


The Starfish Project provided a novel opportunity for learning from patients and carers, (experts by experience – see ), and about the work of a not for profit user-led organisation in health and social care.  The nursing students benefitted from working with pharmacy and occupational therapy students.  They gained insight into the disciplinary perspectives and knowledge base whilst affirming their own skills.

Partnership working is central to new models for integrating health and care services.  The People and Communities Board led by National Voices, a coalition of health and care charities in England, has set out six principles for engaging people and communities, one of which is volunteering and social action as a key enabler.   The Board is one of seven governance boards for planned changes to health care and social care services set out in Five Year Forward View, (NHS England, 2014) that heralds a more engaged relationship with patients, carers and citizens.  Therefore, it has never been more timely for health care students to gain an enhanced understanding of the value of working in partnership with each other and not for profit user-led organisation such as The Patient Association.

[1] The name of the project is derived from the anecdote of a small child throwing beleaguered starfish washed up on the beach back into the sea, and when told by a passerby that his efforts would not make any difference was heard to say, “Made a difference to that one” with each starfish that he threw back into the sea.

Debbie Hatfield, Senior Lecturer;  Beth Thomas-Hancock, Volunteering Manager, University of Brighton; Lynn Dunne Macmillan Cancer Care Facilitator, South West Ambulance Services NHS Foundation Trust & Caroline Davies, Deputy Chief Nurse – Patient Experience, Brighton and Sussex University Hospitals NHS Trust


Alzheimer’s Society 2009.  Counting the cost. Caring for people with dementia on hospital wards. London: Alzheimer’s Society

Department of Health and NHS Commissioning Board.  2012.  Compassion in Practice Nursing Midwifery and Care Staff.  Our Vision and Strategy.  Leeds: Department of Health and NHS Commissioning Board.NHS England 2012

Driscoll, J (1994)  Reflective practice for practise – a framework of structured reflection for clinical areas.  Senior Nurse 14 (1): 47 – 50

General Medical Council 2011. Patient and public involvement in undergraduate medical education.  Advices supplementary to Tomorrow’s Doctors 2009.  Available on line at:  [Accessed 20 December 2016]

Health & Care Professions Council.  2013.  Service user and carer involvement in education and training programmes.  Executive summary and recommendations.  Available on line at:  [Accessed 20 December 2016]

HMSO  2013.  Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.  London: The Stationery Office

Millican, J and T Bourner.  2014.  Learning to make a difference.  Student-community engagement and the higher education curriculum.  Leicester: National Institute of Adult Continuing Education

Naylor, C et al. 2013.  Volunteering in health and social care.  Securing a sustainable future.  London:  the King’s Fund

NHS England, Care Quality Commission, Health Education England, Monitor, Public Health England, Trust Development Authority.  2014.  Five Year Forward View.  Available online at: [Accessed 20 December 2016]

Nursing & Midwifery Council.  2010.  Standards for Pre-registration Nursing Education, Standards 5 and 8.  Available online at:   [Accessed 20 December 2016]

The Patients Association (2012)  The Practices in C.A.R.E. Review.  Available online at:   [Accessed 20 December 2016]

People and Communities Board and National Voices.  2016.  Six principles for engaging people and communities.  Available online at:  [Accessed 20 December 2016]

The Quality Assurance Agency for Higher Education 2008.  The Framework for Higher Education Qualifications in England, Wales and Northern Ireland.  London: QAA

Skretkowicz, V.  (ed) 1996Florence Nightingale’s Notes on Nursing.  London: Ballière Tindall.