Brighton Journal of Research in Health Sciences

Supporting Research in the School of Health Sciences


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.


Love Not Money – Experiences of volunteering at non-League football clubs through personal narrative and photography


Fred Randall 2004On 16 October 2004 I attended a match between Rustington and Bosham in Division Three of the Sussex County Football League. Due to the low level of this fixture there was no official admission charge, but instead an elderly gentleman walked around the perimeter of the pitch offering a battered wooden collecting box towards the small number of spectators, with ‘Thanks from Rustington FC’ written on it. The gentleman’s name was Fred Randall, and he was the Club President. At that moment I began to wonder what motivated Fred, and others like him, to volunteer at thousands of other similar clubs up and down what is referred to as the ‘Non League Football Pyramid’ – the term ‘non-League’ referring to those clubs that do not comprise the 92 that constitute the Premier and Football Leagues.

I have been photographing and writing about non-League football and its culture for over a decade, and my initial contact upon turning up at a ground with a camera, invariably a couple of hours before kick-off, is often with whoever happens to be around at the time. I find myself chatting with someone who has a story to tell: about the history of the club, their own involvement, and how there are always odd jobs to do, especially during the close season.

These people are the lifeblood of non-League clubs everywhere, without whom many simply would not be able to function, and would cease to exist. They give their time willingly and voluntarily, and ask for little in return. They do what they do for the love of ‘their’ club, not for any monetary reward, often taking on multiple roles for many years. This study aimed to explore the experiences of a fairly random sample of club volunteers, through the medium of personal narrative and photography.


Between June 2010 and October 2012 I photographed and recorded a total of 94 interviews with club officials and volunteers, 74 of whom were featured in the resulting book, ‘Love Not Money’ (Bauckham, 2012). A small proportion of those interviewed were already known to me, or were individuals I was already aware of through various sources. These I contacted in advance and they agreed to participate. The vast majority however, were simply individuals I struck up a conversation with on visiting a club: if I felt they might be worthy of inclusion I explained the project and asked if they would mind me recording our conversation and posing for a photograph. The interviews were largely unstructured and of variable duration, I had no prompts written down, but did ask about how they first got involved with the club, and how their volunteering evolved. I also wanted to know what motivated them to persevere and what non-League football meant to them. The interviews were later transcribed and roughly ‘coded’ for any themes that emerged from them. I won’t pretend that my sampling or analysis was particularly rigorous, but I did nevertheless gather a large amount of useful qualitative data.


Those interviewed had begun volunteering via a variety of routes, and many had been involved for a significant period of time, often decades. One interviewee for example, had been involved for 65 years and the ground had been named after him:

“This club means everything to me; it’s been my life, and still is my life … We brought this new ground and they were thinking about a name. Someone came up with the idea of calling it ‘Bloomfields’ after me, and away it went. It’s quite a legacy” (Derrick Bloomfield, President, Needham Market FC)


Overwhelmingly, the majority of those interviewed stated that they loved Football. Several had previously played for the club, whilst others had familial connections: perhaps having been first taken to watch their local club by a parent and/or grandparent. A number were supporters who had originally been asked to ‘help out’, perhaps initially by selling raffle tickets or manning the turnstiles, and their role had developed from there. Some had first got involved through their children, playing for one of junior teams run by many clubs. In some instances there was evidence of a reaction to the commodification of Football, and the Premier League in particular. Non-League football – “real football” – was viewed as unpretentious by comparison, where supporters were more valued and not isolated from the players and club officials. An overwhelming sense of solidarity was also evident.

“If anything needs doing we all turn our hands to it. It’s like all clubs at this level; everybody does a bit of everything. People muck in and if you’re prepared to do a little bit, they warm to you. It’s a great atmosphere and you get the football thrown in for free” (Neil Speight, Secretary, East Thurrock United FC)

Other motivations were largely altruistic: wanting to make a difference for example, and “give something back”; whilst one volunteer described his “civic pride” when the club he volunteered for enjoyed a good run in the FA Cup. A couple of interviewees had been officially recognised for contributions within their local community: Mamun Chowdhury (Sporting Bengal United FC) and Lincoln Moses (Continental Star FC) both having received MBEs for their work with Asian and Black communities in East London and the West Midlands respectively. Continental Star for example, is a Social Enterprise and Registered Charity, using football as a vehicle to help those often marginalised and considered by others as hard to reach. As Moses himself stated: “At Continental Star, the ‘FC’ stands for Family Club”.


Love Not Money - Table 1 RolesThe number of roles was varied, with some taking on multiple tasks (Table 1). One volunteer described himself as a “General Dogsbody”. Whilst such a comment may have been tongue-in-cheek to some extent, it might also be interpreted as a sense of being under-valued and taken for granted.

There was evidence of volunteers ‘donating’ existing skills, ranging from administrative to groundkeeping and construction, to assist in the day-to-day running of the club. In some cases, new skills had been acquired through volunteering, arguably none more so than in the case of twins Brian and Roger Phillips of Corinthian-Casuals FC, who despite working for the Inland Revenue, and having no building experience, virtually built the Club’s ground single-handedly. Their story also highlights how individuals can be left to carry on once others lose interest:

“We were asked to come and give a hand one weekend, putting up a post and rail around the pitch. Then other jobs developed and we were roped in to help out with those. Everybody was very enthusiastic at the start but after a year or two it fell away and we were left to get on with it”.

The Phillips twins still volunteer seven days a week and take on multiple tasks on matchdays: “We do it because it makes a difference, but at the end of the day we wouldn’t do it if we didn’t enjoy it”.

Despite the general consensus that those who continued to volunteer did so because they enjoyed it, this was not universal, and for some that original motivation had diminished. Some described themselves as “being lumbered”; whilst another described his role as a “life sentence”. Certainly there was a feeling, albeit amongst a minority, that they felt unable to step down from their role because there was no-one to take their place. In some cases this resulted in a ‘disagreeable obligation’, leading to stress, and in one notable case, ill-health.


Love Not Money - Table 2 ValuesMotivations for volunteering

Rochester et al. (2012) cite Halman & Moor (1994) who identified four key values that underpin volunteering, namely Altruism or Beneficence; Solidarity; Reciprocity; and Equality and Social Justice (Table 2). It was the Solidarity value that appeared most prevalent amongst those interviewed: a feeling of identification with a group or society; and a responsibility to contribute to the well-being of the group and its other members.

Volunteering as leisure

It seems logical to consider volunteering as a leisure time activity, and there is a general assumption that leisure activities carry positive benefits in terms of health, quality of life, and well-being (Caldwell, 2005).

“Leisure is uncoerced, contextually framed activity engaged in during free time, which people want to do and, using their abilities and resources, actually do in either a satisfying or a fulfilling  way (or both)” (Stebbins, 2013)

The above definition of ‘Leisure’ by Robert Stebbins, is merely one of many. He refers to leisure being uncoerced, and with free time being given voluntarily. However, it is also important to consider ‘obligation’ – after all in order to volunteer one is obliged to give up a portion of free time, and it is assumed that such an obligation is therefore an agreeable one. Nevertheless, it is worth considering the following questions, and aspects of volunteering that might have negative consequences:

  • Is all leisure (and volunteering) uncoerced?
  • Are there circumstances when it may be considered ‘work’?
  • When does an agreeable obligation become a disagreeable one?
  • When does ‘leisure’ become ‘semi-leisure’ … and even ‘anti-leisure’?

Stebbins (2000) notes that key volunteer roles often consist of major responsibilities, which often consume considerable time. Those who fill them sometimes become weary of such demands, but whilst they might like to abandon the role for a less hectic and demanding activity, they realise that in some instances there is no-one to replace them. As a consequence they become: “stuck, possibly burnt out, forced by obligation to remain indefinitely in what has by this time turned into anti-leisure”. This certainly appeared to be the case in a couple of examples from this study, highlighting that as well as the often cited positive rewards associated with volunteering, there are also costs, particularly with organizations reliant on a relatively small number of individuals.

The Serious Leisure Perspective

Love Not Money - Table 3 Serious LeisureThe Serious Leisure Perspective (Stebbins, 2007a) actually incorporates three forms of leisure activity: Serious, Casual, and Project-based (Table 3). Volunteering can take any of these three forms, and often volunteering activity ‘zig-zags’ between the three.

Whereas Project-based leisure tends to related to short-term, time-constrained volunteering and therefore not particularly relevant to those participating in this study; examples of both Casual, and particularly Serious leisure were evident. Most of those interviewed had begun volunteering in a casual manner, but in a number of cases this had progressed to the serious form, and they had found what Stebbins describes as a ‘leisure career’ through their volunteering activity.

Love Not Money - Table 4 Distinguishing QualitiesMany certainly met the ‘Six Distinguishing Qualities’ of Serious leisure defined by Stebbins (Table 4). Moreover, just as any career ultimately comes to end, a minority were clearly approaching the end of theirs, as they felt the need to step back, “wind down”, reverting to a more casual approach or ‘retiring’ altogether, even if they found it difficult to do so. Such movement, back and forth along a casual-serious leisure continuum, is described by Patterson (2001).

Stebbins (2007b) has also defined a leisure-based theoretic typology of volunteers and volunteering incorporating all three forms of the Serious Leisure Perspective. It centres on both formal and informal volunteering – usually non-organisational volunteer activity. He suggests that volunteer activities are motivated, in part, by one of six types of interest in activities, but that are also ‘mixed types’: where volunteer activities bridge two or more of these types. A significant number of non-League football volunteers appeared to meet the mixed type descriptor: in particular a combination of the ‘People/Popular’ (e.g. volunteering with people, fund-raising) and ‘Things/Material’ (e.g. donation of trade and skills; building things) type volunteers described by Stebbins.


The personal narratives from this study on non-League football volunteers certainly appear to conform to several theoretical perspectives of volunteering, particularly those as a leisure activity. There are clearly many positive attributes and ‘rewards’ that come through volunteering, and associated benefits to health and well-being beyond the scope of this article. Nevertheless, it is equally important to recognise that there can be ‘costs’ and negative consequences, particularly where individuals feel unappreciated and unsupported; and where what was once an agreeable obligation, has become a disagreeable one.

David Bauckham, 
Senior Lecturer, School of Health Sciences
The book ‘Love Not Money’ (2012) is available from Centre Circle Publishing:


Bauckham DH, 2012. Love Not Money. Eastbourne: Centre Circle Publishing.

Caldwell LL. 2005. Leisure and health: why is leisure therapeutic? British Journal of Guidance & Counselling. 33 (1) 7-26.

Patterson I. 2001. Serious Leisure as a Positive Contributor to Social Inclusion for People with Intellectual Disabilities. World Leisure Journal. 43 (3) 16-24.

Rochester C, A Ellis Paine, and S Howlett. 2012. Volunteering and Society in the 21st Century. Basingstoke: Palgrave Macmillan.

Stebbins RA. 2000. Obligation as an Aspect of Leisure Experience. Journal of Leisure Research. 32 (1) 152-155.

Stebbins RA. 2007a. Serious Leisure: A Perspective for Our Time. New Jersey: Transaction Publishers.

Stebbins RA. 2007b. Leisure Reflections, No. 16: A leisure-based, theoretic typology of volunteers and volunteering. Leisure Studies Association Newsletter 78.

Stebbins RA. 2013. Unpaid work of love: defining the work-leisure axis of volunteering. Leisure Studies. 32 (3) 339-345.


The Impact of Volunteering on Nurse Education


This article describes some of the experiences of a small group of second year adult nursing students during an optional module – Student Community Engagement (SCE), at the School of Health Sciences, University of Brighton.  Their experience was reflected on in the context of being a volunteer and working with socially excluded groups of children and young people. Their reflections are discussed in relation to the importation of new skills into their wider course work and are interpreted using educational and communication theory.


In year two of the BSc Nursing undergraduate curricula students are able to choose between a range of optional modules.  Students electing to participate with the SCE module are then invited to a ‘matching event’ which is jointly coordinated by staff from the Active Student Volunteering Service, based with University of Brighton’s Careers Service.  Local voluntary organizations are invited to discuss potential learning opportunities within their organizations and to attract motivated volunteers.  Significantly, many of the volunteering placements are not for profit organizations with a social care orientation, this offers the students a distinct change from their usual health based organizations.

Early in the placement students are asked to complete a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis and a learning agreement which are later reflected upon.  One of the key aims of the module is the recognition and importation of transferable skills and knowledge back into their existing repertoire of professional nursing skills.   The module’s summative assessment constitutes a short report describing the host organization and its function, an account of how they have spent their time, an impression of their effectiveness in their volunteering role, the benefits of their activity to the community and the skills and attributes developed while volunteering within the organization.  The module is supported by six theoretical sessions looking at volunteering, active citizenship, relevant social policy and project planning.   Two action learning sets are facilitated by senior lecturers, making use of narratives, story-telling and the use of reflective dialogue.

The Volunteering Learning Opportunity

At our matching event a range of volunteering options was presented, including the opportunity to volunteer with CCHF – All About Kids (previously Children’s Country Holiday Fund).   As students training in the adult branch of nursing we rarely get to work with directly with children, this experience was viewed as an opportunity to broaden our skill-set with this specific group and to challenge ourselves by working with children from disadvantaged backgrounds with potentially difficult behavior.

CCHF was established in 1884 and is a registered charity.  It aims to give disadvantaged children respite and residential breaks in order to improve their quality of life and to help them to recognize their own potential (CCHF 2013).  It focuses on children aged seven to eleven living mainly within London or the immediate surrounding areas; it relies totally on donations from the public and corporate partners to fund their activities. Children can be referred by anyone who works with disadvantaged children such as teachers and social workers; their eligibility is then assessed against the CCHF criteria.  This criteria includes a range of factors such as poverty, abuse, low self-esteem, children that care for a family member, or other family factors such as having a parent who abuses substances or who has a mental health issue.  Each child is gently monitored for the duration of the camp due to their circumstances.  CCHF works closely with statutory organizations in order to address any issues or concerns encountered throughout the duration of the camp.  As such the experience represented our first opportunity to patrol the tensions of a safeguarding role.

It is estimated that of the 1.1million families living on low income in London in 2010 / 11; 60% could not afford to take their children away for a week’s holiday (London’s poverty profile, 2011). Cummins et al (2013) suggest that children that are brought up in poverty can be at greater risk of suffering from low self-esteem. This is one of the key areas that the charity works to improve. Their annual report demonstrates that many of the children that arrive on camp with low self-esteem and leave feeling much happier and far more confident (CCHF All About Kids, 2013).

The wider community also benefits from those accessing the opportunity as children with greater confidence and self-belief are more likely to have better health and are also less likely to engage in criminal activities (Chen et al 2013).  Knapp et al (2011) supports this notion by suggesting that individuals who suffer from low self-esteem in childhood are likely to have worse economic prospects in adulthood.  Conversely research by the Child Poverty Action Group (2013) using Department of Education data, suggests that children receiving free school meals attain an average of 1.7 grades lower than wealthier students.

A King’s Fund report (Buck et al 2013) suggests that in our modern society volunteers are sometimes under appreciated and used instead of paid workers – however this was found not be the case at CCHF where they have always relied upon the goodwill of volunteers to enable their existence.  The role of the volunteer in society has become ever more important as a result of reforms put in place by the Health and Social Care Act, 2012, (Naylor et al 2013).  As such, volunteering is now a key part of the current governmental strategy, and is included in their ‘Big Society’ vision. This aims to encourage people to participate in local projects, by giving them more power to influence the running of services and facilities in their community (Cabinet Office 2010).  It believes that the inhabitants of communities understand the needs of the local area most, and this will help create “attractive and thriving” neighbourhoods.

Volunteering is traditionally associated with the concept of altruism (Haski-Leventhal 2009) – the motivational selfless desire to increase the wellbeing of others.   Alternatively, Carpenter and Myers (2010) argue that the main drive for volunteering is not altruism, but the perceived benefits, whether these are career benefits or purely self-satisfaction.  Sigmund and Hauert (2002) take this point further, suggesting that any act in which both parties gain is more co-operation than altruism, as both the volunteer and the organization benefit from the partnership. CCHF utilize this sense of co-operation in their organization; the vast majority of the workforce is made up from volunteers.   Most of them are students who are hoping to both enjoy the experience and improve their future career prospects.

Personal Reflections

Amy’s reflection  Before camp I had little experience of working with children or even managing large groups of people.  At one point I managed a group of 15 challenging children for an hour with another first time volunteer.  The children were well behaved, safe and actually enjoyed themselves, and at no point did I find myself worrying or panicing.  Later on in the day, the senior leader praised at CCHF this activity, which helped to build my confidence for future situations on camp. Although these individuals were children, my confidence in leading larger groups of adults has definitely improved and this has made a noticeable difference in clinical practice, for example, when managing a bay of patients in a ward.

A potential weakness that I discovered during the camp that I had not previously identified in the SWOT analysis was my hesitance when trying to find the words to set and enforce interpersonal boundaries with the children and young people.   As the week progressed I began to see the consequences of not doing so, I therefore realized that I needed to take some advice from our senior leader, who encouraged a certain amount of careful risk taking.  This gave me the confidence to gradually experiment by trying different approaches within the interaction’s, in doing so I eventually over-rode my fears of causing offence or humiliating myself.  I found that upholding boundaries did not alter the relationship that I had with the child, nor reduce their respect for my position; it was mostly accepted and often helped to harmonize power structures in the group.  Reflecting on this process has helped me in subsequent nursing roles, for example, at timely moments I am more confident when offering health promotion advice, such as advice to reduce smoking, drinking or other harmful activities that I anticipated I would be perceived in an authoritarian or negative light.

One of the most significant experiences that occurred to me during the camp was dealing with a disobedient child and their parents.  A particular child had consistently demonstrated aggressive behavior towards others in the early days of the camp.   Bullying is not tolerated and so it became my responsibility to liaise with the parent about the child’s behavior and return them to home ahead of schedule. The parents were understandably upset and concerned when I contacted them; I myself felt awkward and did not want to exacerbate the situation further.   I tried to remain calm, be professional and listened attentively to the parents; eventually we came to a mutual agreement.   The way in which I dealt with this situation and the camp as a whole, reinforced my own ‘self-efficacy’, this is the belief in one’s own capabilities to produce a desired effect by one’s own actions (Lopez and Snyder 2011).

Laura’s reflection  Although quite personal, my experience and subsequent reflections have helped me to surface, confront and alter some unconscious attitudes, raising my self-awareness in the process.  The demographics of children on the camp was incredibly diverse as was their range of ethnicities and socio-economic backgrounds.  This was in contrast to my own quite stable upbringing and I felt a little under confident in my abilities to engage and relate to them.  One of the competencies for entry to their register, the NMC requires that:

“All nurses must practice in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognizes and respects individual choice; and acknowledges diversity.” (NMC 2013)

At first I found the encounters quite difficult, I just wasn’t consciously judging the children and young people, just uncertain as whether they would accept me and how the interactions would go.  However, after I had spent some time with the children I realized that most of my pre-conceived fears were in fact unfounded, and by the end of the camp my I sensed that my confidence had changed.  During my nursing career I will encounter people from all walks of life; this episode forced me to think about  my own attitude and values.   I believe this realisation equates to a shift in values which will stay with me for years to come.

I feel that working with children that may be distressed or upset during the camp has improved my communication skills, insight and confidence in clinical areas where I might encounter and treat children on a regular basis.  Having not previously worked with children, I found being able to interact and to make appropriate interventions, a valuable leap for me which in turn forms a valuable part of a child’s development.

Sam’s reflection  By the end of the camp I felt proud to be a part of each child’s accomplishments and saying goodbye to them was one of the hardest things that I experienced.  As a caring professional it is vital to maintain healthy relationships with the patients and people that you work with.    Making use of attachment theory Skovholt and Trotter-Mathison (2011), helpfully describe the ‘caring cycle’ as consisting of four stages: Empathetic Attachment, Active Involvement, Felt Separation and finally, Re-creation.  I related this model to the time with the children and it is directly transferable to the relationships I form in my nursing practice.

Knowledge and use of the model has helped me to think differently about the process of attachment.  Failure to reach the recreation stage of the caring cycle may indicate an unwanted level of attachment or unprofessional attitudes.  My belief is that I will now be able to take part in further camps, being able to recreate healthy, professional relationships again and again.

My experience of volunteering has brought to the fore many considerations into my own education as a student nurse and responsibilities as a future health care practitioner and leader.   Due to the personal circumstances of the children at CCHF, I became more aware the importance of safeguarding practices, namely remaining vigilant for possible signs abuse and malnourishment.  Being responsible for a group of children meant observing for any issues and reporting them immediately; this aspect of social care applies more broadly to nursing and the responsibility nurses have to the wellbeing of their patients. I have found this experience correlates with my current placement in a Community Nursing Team as we regularly see vulnerable adult patients in their own homes.

Facilitator’s reflection  Having supported the students during other academic sessions over the previous year I felt I understood the students well enough to sense the impact that volunteering had on them personally and on their learning.  Their sheer enthusiasm evoked a positive sense of dissonance which inspired me to try and capture and analyse their experiences.  In our action learning set I probed their narratives, asking what it was about the experience that so differed to other experiences on their course.  My overriding sense was that it was the immersive nature of the summer camp combined with their interactions with the young people that had helped to transform their attitudes towards themselves, their practice and their ability to form and maintain relationships.
To interpret the students’ experience I have found it helpful to locate their experience on a two dimensional map of ‘reality’ and ‘learning outcomes’, created by Morgan and Burrell, (1979, cited by Brockbank and McGill, 2006).  It is my view that their collective experience moved the group away from the objectivism and towards the subjectivism end of the reality dimension, and from the equilibrium towards the transformation end of the learning outcomes dimension.
Arguably, much of the learning taking place on the adult pre-registration nursing programme, such as clinical skills or anatomy and physiology, depends heavily on notions of an objective reality and maintaining the equilibrium of power structures, as per the conceptual dimensions.   Such learning reflects ‘imposed objectives, based on perceived objective reality’ (Brockbank and McGill, 2006).   At the ‘equilibrium’ end of the dimension, the status quo and ‘taken for granted’ ideas go unchallenged and are therefore upheld by the prevailing discourses and scripts.

My analysis is, the summer camp experience nudged the students towards the subjectivist end of the continuum as they were immersed in a new social world and a common language became ‘understood and continuously reconstructed, reproduced and transformed through interaction’ with the children and young people, (Brockbank and McGill, 2006).   The students’ perspectives appear to have been altered as a consequence of the developmental experience, pushing them away from the stability of the equilibrium element towards the transformative end of the scale.

This is consistent with a symbolic interactionist perspective on perceptions of self and on developing relationships.  Symbolic interactionism can be defined as ‘a theory of human communication that can account for the process by which everyday nursing situations become defined and redefined’, (Stevenson, Grieves and Stein-Parbury, 2004). Symbolic exchanges occurred during their interactions and these appear to have shaped understandings and cemented social relationships.  For a short time they had been thrown off their usual student nurse ‘script’ (Stevenson, Grieves and Stein-Parbury, 2004), into a completely different domain and the students had adapted to the challenge and risen to the responsibility.  In doing so they had achieved new understandings by being part of the young people’s world, using their language, interpreting and making meaning of their communication.


Johnson and Webb (1995, cited by Stevenson, Grieves and Stein-Parbury, 2004) found that ‘nurses do judge the social worth of people and that such judgments do have moral consequences’. However, in our students’ case we have seen these relatively negative evaluations were negotiated and renegotiated throughout their interactions.  Once such attitudes are brought into awareness through the process of reflection, corrective thoughts were assumed.   In thinking about the collective experience of the group, all three students have processed their experience and engaged with their inner dialogue to make meaning of what occurred in their week with CCHF.  Significantly, by processing the subjective cues that occurred, small and hopefully lasting shifts and transformations of attitude occurred impacting on their outlook and learning.

Warren Stewart Senior Lecturer School of Health Sciences, University of Brighton, Laura Brown Adult Nursing BSc (Hons) student, Sam Harris Adult Nursing BSc (Hons) student and Amy Isaac Adult Nursing BSc (Hons) student


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