Film as a pedagogical tool for climate change and mental health nursing education

The relationship between climate change and worsening mental health is of increasing concern globally. Climate change is ubiquitous, yet marginalized populations bear a disproportionate burden of the physical and mental health impacts, while youth are more likely to report mental health concerns related to climate change than older generations. Mental health nurses will inevitably see these impacts play out in their practice, thus it is important to explore innovative tools for teaching about and responding to the emotional and psychological impacts of climate change. This perspective paper presents an educational project that utilized film and structured reflection to engage with the intersecting topics of planetary and mental health. The authors created a documentary film that presents the relationship between mental health and climate change as well as an accompanying reflective toolkit. Both the film and toolkit were integrated into an undergraduate course about the health impacts of climate change. This paper explores the relevance of climate change to mental health nursing education and practice, describes the process of creating and integrating the film and toolkit into a course and advances the position that film is an innovative way to engage individuals and communities (such as student or community groups) with the emotional and psychological concerns that arise in response to complex challenges of climate change. More research is needed to better understand the mental health impacts of climate change and to explore novel approaches to education and advocacy about this topic. We hope that sharing our project and experiences will inspire additional discussion and research related to these emerging issues that are of great relevance to mental health nursing.     

Rethinking mental health nursing education in Australia: a case for direct entry

Desperate times call for creative solutions. The mental health workforce shortage has created an opportunity to rethink current and future education and training needs in order to prepare competent and compassionate practitioners to meet the changing demands of consumers and their carers requiring mental heath treatment and support. This article urges consideration of an undergraduate direct entry mental health programme similar to that of midwifery or the nursing foundation/mental health branch programmes of the UK.     

The Mental health Master Class: An innovative approach to improving student learning in mental health nursing

The Master Class was developed as an additional educational innovation designed to promote learning about mental health and illness and mental health nursing as a career option to 2nd‐year undergraduate nursing students. A number of students had approached the mental health nursing academics expressing two polar views on mental health. They either expressed extreme interest in mental health nursing or significant distress and concern related to studying the core 2nd‐year subject. It was considered that the Master Class could potentially provide students with additional support. It was thought the Master Class may either consolidate their interest in mental health or relieve their stress. This article presents the findings of a pre‐ and postevaluation which was employed to explore the effectiveness of the 5‐day intensive mental health Master Class programme on student's mental health learning and their understanding of the role of a mental health nurse. The findings highlighted that prior to participating in the Master Class, there was a significant sense of uncertainty associated with perceived levels of competence required within the profession of mental health nursing. This was coupled with students expressing they wanted to disengage with the profession even before they had commenced any theory or clinical experience. The post‐Master Class findings illustrated a significant improvement in students desire to consider mental health nursing,     

Nursing in an imperfect world: Storytelling as preparation for mental health nursing practice

Storytelling is a valuable adjunctive method of preparing undergraduate mental health nursing students for practice. To explore the possibilities of this method of teaching, 100 stories were collected from experienced nurses working in mental health and analysed using a case study methodology. The aim was to explore the purpose of clinical anecdotes told by experienced nurses working in mental health settings to undergraduates and new recruits, with an ancillary purpose of looking at the implications of these anecdotes for the exploration of contemporary mental health practice and education. A framework for student discussion of stories is provided. The insights gained illuminate not only the history of mental health nursing and the daily activities of nurses working in mental health, but also some of the deep‐level skills developed and used by these nurses as they work in the complexity and ambiguity of an imperfect world where the job requires managing the unexpected every shift, and where there might not always be a textbook‐perfect solution to clinical situations.     

Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.     

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Developments in mental health nursing: a critical voice

This paper examines stances that are being adopted in relation to the current and future direction of mental health nursing practice. The argument is made that mental health nursing is being pushed into a direction that is essentially positivistic and narrow in its focus, stating that the current hegemony of thinking which dictates that our primary focus of concern should be with individuals suffering from severe or recurring mental illness, allied with the drive towards 'evidence based practice' is symptomatic of wider issues that should be of concern to all parties interested in the issue of mental health care. The authors examine the context and rationale for these developments from socio-political, philosophical and ethical viewpoints, highlighting that their logical outcome is the exclusion of individuals from the right to health care and question the motives underpinning what could be considered a fundamental shift in the provision of mental health services. The argument is then advanced that caution should be adopted by mental health nursing services before abandoning what Gournay (1994) described as 'redundant ideologies' and that a broader view of mental health nursing action should be accommodated. The validity of trying to account for mental nursing action in quantifiable and biomechanistic terms is questioned and an alternative paradigm of accounting for such action is suggested.     

‘There's more to a person than what's in front of you’: Nursing students’ experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care.     

Implementing a major stream in mental health nursing: Barriers to effectiveness

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In‐depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy – in some instances, leading to the programme's termination – and must be assertively addressed to maximize the potential of the major in mental health nursing.     

Teamwork in mental health: rhetoric and reality

This paper offers a discussion of team-working in mental health. It is based upon a 2-year study funded by the English National Board for Nursing, Midwifery and Health Visiting. The authors advocate that team-working should be studied situationally. The paper begins therefore by highlighting contextual tensions and paradoxes that create potential problems for effective team-working. It is argued that team-working is better caught as opposed to being taught. This involves a layered reading of vignettes and case studies, as well as 'hands on' experiences of team-working. Such an approach foregrounds for inspection the complexities and dilemmas of policy, models of practice and team-working patterns. As a result, the students build their own evidence-base, which is not built on the ideal (or optimal) but is located in the real everyday habitus of individuals in healthcare settings. This, the authors feel, is more likely to shift terms such as team-working, partnerships and so on, from merely remaining a healthy rhetoric.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Towards a Foucauldian reading of the Australian mental health nursing workforce

This article reflects on the findings of the recently published Scoping Study of the Australian Mental Health Nursing Workforce from the perspective of Foucault's work on 'governmentality'. First, the policy background to the scoping study is described. This is followed by a discussion of Foucauldian concepts and method that will be used to explore selected aspects of the scoping study. The related concepts of 'governmentality' and 'technologies of the self' are used to begin a theoretically grounded analysis of mental health nursing education and practice, with particular attention to discourses of 'change' and 'survival'. The examples chosen are used to support the argument that competing discourses order multiple 'readings' of Australian mental health nursing, including whether or not it is thriving or surviving. The article ends with comments on whether a Foucauldian analysis adds anything to what has been reported in the scoping study.     

Service user involvement in pre-registration mental health nurse education classroom settings: a review of the literature

ACCESSIBLE SUMMARY: ? Service user involvement is an important part of pre-registration nursing programmes, as it can give students the opportunity to learn from users about their experiences of health and illness, but so far there have been limited studies in this area. ? This literature review provides an opportunity to explore how service user involvement in classroom settings can impact on student learning, and describes methods of best practice. ? Further research is needed to understand the influence of service user involvement on student nurses' clinical practice. ABSTRACT: Service user involvement in pre-registration nurse education is now a requirement, yet little is known about how students engage with users in the classroom, how such initiatives are being evaluated, how service users are prepared themselves to teach students, or the potential influence on clinical practice. The aim of this literature review was to bring together published articles on service user involvement in classroom settings in pre-registration mental health nurse education programmes, including their evaluations. A comprehensive review of the literature was carried out via computer search engines and the Internet, as well as a hand search of pertinent journals and references. This produced eight papers that fitted the inclusion criteria, comprising four empirical studies and four review articles, which were then reviewed using a seven-item checklist. The articles revealed a range of teaching and learning strategies had been employed, ranging from exposure to users' personal stories, to students being required to demonstrate awareness of user perspectives in case study presentations, with others involving eLearning and assessment skills initiatives. This review concludes that further longitudinal research is needed to establish the influence of user involvement in the classroom over time.     

Police and mental health responses to mental health crisis in the Waikato region of New Zealand

New Zealand police report a high level of involvement with people in mental health crisis, something that has been reported in the international literature in recent decades. Involvement of police represents a coercive pathway to care and is likely to be associated with use of force. The aim of this study was to investigate the clinical, legal, and social characteristics of individuals subject to police response in the Waikato region of New Zealand. Data were also collected on characteristics of police response, including use of force, time of day, and disposition. Use of force, most commonly use of handcuffs, occurred in 78% of cases involving police. The study showed that Māori were overrepresented in police responses, but no more likely than Europeans to experience use of force. Almost half those subject to police response were not subsequently admitted to hospital, raising questions about the need for and nature of police response in these cases. Because mental health nurses are often part of police response, nurses need to take cognisance of their relationship with police and contribute to any initiatives that can reduce coercion in the pathway to care, and improve service users' experience in mental health crises.     

Process consent: a model for enhancing informed consent in mental health nursing

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting.