When we designed our BSc (Hons) Paramedic Practice Pre-Registration programme at Teesside University, we looked far and wide to ensure the profession, the NHS (the major employer) and policy directions from Government and patients' views were embedded. One of the elements that caught our eye were the values and behaviours of the 6Cs of nursing, which we were familiar with as it is a cornerstone of our nursing programmes here at Teesside. Perceived as the quality markers of a quality nursing service they are Care, Compassion, Competence, Communication, Courage and Commitment (NHS England, 2016). These key messages are not just for nurses but should be for everyone, and all of the Cs could relate to every area of our practice as paramedics.
Sharing the vision
After taking it to the wider team, we could see where it linked to each area of practice we were teaching and set about embedding it into all of our practice placements and linking it to our teaching sessions around patient care. Paramedics' work is >95% urgent, unscheduled care which includes minor injury, illness and other things that do not require us to transport patients immediately to hospital. However, these patients still need the care, compassion, commitment, competency, courage and communication skills of paramedics to help them navigate the care system, refer them to an appropriate provider, or help them to self care at home. We decided to ‘adopt’ these as our core values for every placement that our students attend and state them clearly in their assessment documentation.
How were the students prepared?
Students were prepared to adopt these values through the introduction of caring skills. This was done through exercises such as brushing each other's teeth and washing each other's feet, to let them experience what it is like to care and be cared for. This was followed with their first placement—fundamental care—in a nursing environment. Although this is not what you would expect as a first placement for paramedic students, those key skills are fundamental to paramedic practice and students quickly discovered they could see them and recognise them in practice.
What impact did it make?
The results have been quite simply inspiring from the placement providers, who were unsure why paramedics were in caring environments. However, they quickly realised they shared the same passion as the students, and the feedback from practice staff, students and practice staff has been better than we ever expected.
We are looking forward to continuing to embed those qualities and skills with every intake to enhance the 6Cs and ensure being a care maker is a fundamental value of being a paramedic for all our students, regardless of how long they are with their patients.
Students' thoughts
James Wren, year 3 student
I am a third year BSc Paramedic Practice student studying at Teesside University and am thoroughly enjoying and embracing the student lifestyle. Being a paramedic has always been a lifetime ambition for me as I have always been interested in caring for those in need. What matters most to me is the concept of positively impacting on a person's wellbeing and improving their quality of life.
Two years later and I am equipped with 40 weeks' worth of hospital and ambulance placement experience, and bags full of exciting stories and proud moments. I have also completed 40 weeks' worth of theory and practice at university, which provided the underpinning knowledge needed to provide care. The paramedic lecturer team at the university organise the placements to coincide with whichever topic you are learning, in order to allow the student to practice their newly learned skills.
Our first module of the year involved learning how to provide basic care for patients, i.e. assisting with personal care, feeding, washing and communicating. I will be honest, I thought this was something that did not require much thinking about. I presumed caring for a person was simple and just required a smile and a friendly approach. It was not until my lecturers introduced the concept of the 6Cs that I thought more about it. My lecturer at the time organised for us to practise our 6Cs skills by brushing each other's teeth and washing each other's feet. After practising, it soon became apparent my preconception of care seemed minimalistic and that providing good care to the patient is fundamental to everything a paramedic does. It seemed strange to me that nobody had thought of this before.
Following this topic I was sent out on placement within a hospital to practise my 6Cs caring skills on real patients. This was very daunting at the time but looking back now I am so grateful that I had the opportunity to practise and reflect upon my preconception of care. I made sure the 6Cs underpinned everything I did for the patient and by doing so was able to interpret the patient's needs and provide a better care experience. Although this was at the very beginning of my course, I still find myself ticking off each of the 6Cs in my head while out on the ambulance and dealing with patients in all sorts of situations. I also use the 6Cs when writing assignments and they often provide me with the framework to reflect upon things I might have done differently in care scenarios.
I am a big fan of the 6Cs as they provide a framework for good care that is easy to remember. After being on placement I have found that in some scenarios the medical treatment of the patient was only half of the battle. The other half requires the good care, compassion, communication, competence, courage and commitment underpinning the 6Cs that more often than not enables the healthcare provider to deliver a better patient experience. Again, nothing feels better than walking away from a patient knowing that you have had a positive impact on their life and knowing that you have done all that you can for them.
The 6Cs have challenged my preconception of what care is and have greatly improved the quality of care I can provide to patients. I think after learning about the 6Cs that reflection upon caring skills and practice is essential to all healthcare providers and staff. It is inspiring to know that health and care organisations around the world are incorporating the 6Cs within the training of their staff and I believe this could positively improve the public's opinion of the health service available to them.
I look forward to placing the 6Cs at the forefront of the care that I provide within the near future and will keep in mind that the one topic I considered to be ‘common knowledge’ has challenged me and developed me in a way in which I could not have imagined.
Darren Hawes, year 2 student
I am a second year BSc Paramedic Practice student at Teesside University. Before starting university I did not know what the 6Cs were, but having no prior experience in any healthcare environment, I had no reason to come across them.
I have had a lot of lectures about the 6Cs and now fully understand the meaning of each of the individual values and fully acknowledge why they are important within health care. We were given the opportunity to meet professional practitioners and other healthcare students to discuss and share views and opinions on the matter.
It was great to listen to the views of other students besides paramedics for a change. Reading from journals and presentations are great; however, that is only the start, and the concept amplifies and develops once you get to the fun stuff: placements.
I have covered four weeks' worth of placements. This consisted of two weeks of fundamental care on a hospital ward and two weeks of shifts on an ambulance, which were absolutely fantastic and an impressive eye opener. It was great to see the 6Cs being implemented within practice by a range of healthcare staff and knowing that the patients' lives are being impacted for the better.
During these placements I have seen and been part of a range of healthcare provision, from little episodes of care and compassion to ongoing commitment of providing the best care possible. I have witnessed competent staff within their clinical profession showing courage, coupled with communication, to flourish successful caring relationships.
Having the 6Cs fully integrated in my degree, particularly at such an early stage, has provided me with the experience to provide care to patients in an additional way to just physical intervention and the use of equipment. I now have the ability to continuously practice the 6Cs in a confident and professional manner throughout all my future placements.
Saying the 6Cs are key to the development and progression of the care that is being provided for patients is a substantial understatement. I cannot emphasise enough how this should be the core structure for professionals in all aspects of healthcare, and I for one want to be at the forefront.
Summary
The 6Cs have been incorporated into the Practice Assessment Document at Teesside University and feature in every placement objective and learning outcome. The feedback from the placement mentors and our colleagues in other practice areas such as nursing has been amazing. They tell us how caring and compassionate our students are, and are confident they will bring those values—key values of the NHS (Health Education England, 2016)—to every service user, starting care where it should be: at home.