Multiple stakeholder perspectives of factors influencing differential outcomes for ethnic minority students on health and social care placements: a qualitative exploration.

BACKGROUND: Despite considerable efforts there continues to be a degree awarding gap within the United Kingdom (UK) between the proportion of White British students receiving higher classifications, compared to ethnic minority UK-domiciled students. Practice placement elements constitute approximately 50% of most health and social care programmes, yet surprisingly little research exists related to the factors which may contribute to ethnic minority student placement outcomes or experiences. This study bridges this evidence gap by exploring factors influencing differential placement outcomes of ethnic minority students from the perspectives of key stakeholders. METHODS: The study followed a descriptive qualitative research design and was multi-disciplinary, with participants drawn from across nursing, midwifery, social work and the allied health professions. Participants from four stakeholder categories (ethnic minority students, academic staff, placement educators and student union advisors) were invited to join separate focus groups. Focus groups were recorded and transcribed and analysed thematically. RESULTS: Ten separate focus groups [n = 66] yielded three primary themes: 1) recognition, which highlighted stakeholder perceptions of the issues [sub-themes: acknowledging concerns; cultural norms; challenging environments]; 2) the lived experience, which primarily captured ethnic minority student perspectives [sub-themes: problematising language and stereotyping, and being treated differently]; 3) surviving not thriving, which outlines the consequences of the lived experience [sub-themes: withdrawing mentally, feeling like an alien]. CONCLUSION: This study presents a rich exploration of the factors affecting differential outcomes of ethnic minority students on practice placements through the lens of four different stakeholder groups. To our knowledge this is the first study in which this comprehensive approach has been taken to enable multiple viewpoints to be accessed across a wide range of health and social care professions. The issues and challenges raised appear to be common to most if not all of these disciplines. This study highlights the urgent need to value and support our ethnic minority students to remove the barriers they face in their practice learning settings. This is a monumental challenge and requires both individuals and organisations to step up and take collective responsibility.

Co-production: what it is and how it can ensure inclusive practice for service users and staff.

Co-production is a process adopted in health, social care, research, policy development and higher education that aims to bring together the skills and experiences of service users and professionals. It has a range of advantages, such as enabling users of a service to have a voice and to equalise power among service users, professionals and leaders. Co-production is continually developing and is often referred to in contemporary health and social care policy. When designed well, co-production can create a variety of advantages for service users, professionals and the wider community. This article demonstrates that co-production can be an effective framework to improve experiences for service users and healthcare staff. It is an empowering process that can happen in varying degrees and can be a key part of nurse managers' practice. The article explores how co-production can be successfully used in a range of healthcare and higher education environments. Ideas about how nurse managers can use co-production to address diversity and inclusion in services are explored.