This article explores how nurses and nurse education can promote social prescribing even when a country is in crisis.
Since 2016, social prescribing has been accepted as an innovative, non-medical approach to supporting citizens and communities. The newly launched National Academy for Social Prescribing (NASP) (2020) defines the process of social prescribing as:
‘Supporting people, via social prescribing link workers, to make community connections and discover new opportunities, building on individual strengths and preferences, to improve health and wellbeing.’
Social prescribing connects people to community groups and statutory services for practical and emotional support.
There are a number of social prescribing models and, according to Kimberlee (2015), these may be:
A community asset is often denoted as anything that can be used to improve the quality of community life.
Typical social prescribing interventions include nature-based solutions such as structured therapeutic horticulture, yoga or arts on prescription and other community-based groups such as ‘knit and natter’ groups. All social prescribing interventions are services that are provided by the voluntary, community and social enterprise sector (VCSE).
The ‘holistic’ social prescribing model promotes personalised care approaches as it considers the individual and uses salutogenic approaches that focus on the wellbeing and not just the ill-health of an individual (Antonovsky, 1979). Thus, social prescribing places a value on what matters to people, as opposed to what is the matter with them, which reflects the key aspirations of the NHS Long Term Plan's personalised care model (NHS England, NHS Improvement, 2019).
The move to consider the needs of the person rather than the needs of the service has been heralded as an effective way to empower people to self-care and self-manage. According to Howarth and Donovan (2019), the health and wellbeing of patients have been promoted by non-medical prescribers through the auspices of community referral. Moreover, health promotion that embeds the wider social determinants of health should be central to nursing practice, ensuring that nurses promote self-care to those in most need. Asset-based community approaches are one way in which nurses can work with communities to support them to improve mental and physical wellbeing and provide added value to a salutogenic model for nursing.
Current challenges arising from the COVID-19 pandemic has led to a proliferation of socially distanced people in the community, with central government lockdown strategies shielding those most at risk. Arguably, COVID-19 presents a significant health risk, but potentially an even greater societal risk through the isolation that lockdown brings. At the University of Salford, our history of working with asset-based community development approaches provides us with some headway in this maelstrom of the COVID-19 crisis, and, in doing so, may shed some light on how we can educate our nurses of the future when promoting social prescribing, even at a time of national crisis. For example, before the COVID-19 pandemic, the university piloted an innovative VCSE learning experience with a group of second-year undergraduate student nurses.
VCSE learning experience
The learning experience provided students with an opportunity to engage with the VCSE sector to learn how personalised care and health promotion is provided through social prescribing, with an outline of the structured learning experience summarised in Box 1. Prior to attending the experience, students completed an e-learning session linked to the All our Health e-learning framework developed by Health Education England, which calls to action all health and care professionals to embed prevention within their day-to-day practice, thus preventing illness, protecting health and promoting wellbeing (https://www.e-lfh.org.uk/programmes/all-our-health/). These e-learning sessions cover diverse topic areas such as: adult obesity, antimicrobial resistance, best start in life, cardiovascular disease, homelessness, physical activity, workplace health, child oral health, childhood obesity, alcohol, mental health and wellbeing, and social prescribing.
The 3-week practice learning experience is situated within a 6-week placement block, with weeks 1, 2 and 6 spent learning from within the traditional healthcare organisation (NHS hub placement). In weeks 3, 4 and 5 students engage with the social prescribing experience from within three VCSE sector organisations in Salford: Inspiring Communities Together (ICT); START in Salford; and Social Adventures.
After completion of the VCSE experience, students articulate the value of the learning for their own professional development and for the community of Salford, for example their increased awareness of the range of community assets available in Salford; and understanding how people live in a community and engage in social prescribing programmes such as art and photography classes. Students witnessed, first-hand, clients' joy when they engaged in activities that reduced social isolation, and how clients were empowered to make friends and reconnect with their community.
| Week | Activity and learning outcomes |
|---|---|
| University induction | Student finds out about the voluntary, community and social enterprise (VCSE) organisation's purpose, function and approach |
| Pre-visit | Student meets with the organisation to determine travel, start times clothing attire and other essential information needed |
| Week 1–2 | Student starts on an NHS ‘hub’ placement, discusses the project at initial interview with the practice supervisor, and explores what health promotion-focused learning opportunities they want to focus on |
| Week 3–5 | Student attends VCSE social prescribing practice placement, gaining an understanding of the work they do, how they support clients and how they can engage with clients to develop this. Activities that students take part in may vary across organisations, depending on organisational client group, philosophy and current projects |
| Week 6 | The student will return to the NHS hub placement to disseminate what they have learned about the third sector experience to the mentor and the practice education facilitator |
The chief operating officers of the three participating VCSE organisations clearly valued the difference that student nurses make when learning, leading and participating within a model of social prescribing.
What students and nurse academics can take forward into a crisis such as COVID-19 is their heightened awareness of the impact that a government's critical requirement for a society in lockdown has on a now socially isolated community. Our student nurses and academics are familiar with the work of Salford community assets and understand how a community can offer the greatest support for those in need. Currently, and because of COVID-19, the VCSE sector is ‘re-purposing’ the models of social prescribing to mobilise the voluntary sector in providing ‘resilience teams’, food collections and deliveries, and online community support, working collaboratively with thousands of volunteers.
Concurrently, Healthwatch Salford, an independent consumer champion for health and social care (Leigh et al, 2019), has also contributed to the Spirit of Salford Helpline, whereby all people who live in Salford can request voluntary and professional support through completing an online form. From here, Healthwatch Salford staff can get people the correct level of support, whatever that might be, such as help with shopping or, if in complete crisis, through their one-stop shop. After talking with people during the national lockdown, they concluded that boredom is creeping in, with people asking if there is anything that they can do from the comfort of their own homes. One idea is to share tips of how people are keeping themselves occupied (links to online games, puzzles and joke pages are provided as examples of things that help others to get through their day—the more interactive the better.
Opening student learning to wider socially prescribed experiences better positions our students to further engage with the VCSE sector and to understand the importance of community engagement and resilience in times of crisis and of stability. The paradox presented here is how nurses, student nurses and academics engaging with social prescribing at a time of crisis can help combat ‘social distancing’ in a system that relies on social contact. In doing so, the NASP (2020) asks ‘how can we help to stop ‘distance’ turning into ‘isolation’?
Conclusions
Nurses represent one of the largest workforces in the UK. We have the capability and capacity to consider a range of ways in which our communities can be supported. Through providing students nurses with social prescribing learning opportunities as part of their undergraduate nursing curriculum, they are in a stronger position to recognise, understand and experience the significance of the third sector in times of normality and of crisis. As described here, the traditional pathogenic model of promoting health plays a pivotal role in a time of health crisis—but as COVID-19 has highlighted, can impact on a wider societal level. Educating our students nurses in strategies that support communities to become resilient is a key part in preventing illness, protecting health and promoting wellbeing, and in supporting a wider community resilience that can help guard against the dangers of social distancing and isolation.