Views of the effectiveness of problem-based learning

AIM: To obtain the opinions of a group of mental health students on the effectiveness of problem-based learning (PBL) within a pre-registration nursing pathway. METHOD: Focus groups were used to generate data and the sample consisted of 14 mental health branch students who, within the pre-registration nursing programme, formed a PBL group. The group met on an annual basis at key junctures during the three-year diploma programme. The focus groups were tape-recorded and the data interpreted and organised by utilising an adapted form of content analysis. RESULTS: Four themes were identified regarding the use of PBL: the students' initial adjustment to PBL; the impact of PBL on their secondment status; the application of PBL in clinical practice; and the students' reflective critique of PBL. CONCLUSION: The discussion of the findings makes suggestions for the utilisation of PBL in future reviews of nursing curricula and outlines the implications for clinical practice. This includes the need to carefully plan the students' initial placement experiences and provide extra support at this stage. In addition, mentor preparation on the use of PBL in practice needs to be extended to ensure flexibility in the PBL process. It should be balanced with formal student support and courses must be planned to incorporate the learning needs of all discipline groups.     

Constructivism applied to psychiatric-mental health nursing: an alternative to supplement traditional clinical education

With the popularity of accelerated pre-licensure nursing programmes and the growth in nursing student enrolments, traditional clinical education continues to be a challenge to deliver. Nursing faculty members are required to develop and implement educational innovations that achieve effective learning outcomes, while using fewer resources. The purpose of this qualitative study was to explore the effectiveness of a constructivism-based learning project to achieve specific learning outcomes and to supplement approximately 30 clinical hours in a psychiatric-mental health nursing course. Students participated in a 10-week, multistage project that examined life histories, treatment resources, and evidence-based practice, as applied to a single individual with a mental illness. Students reported increased understanding of mental health and illness, developed personal relevance associated with the knowledge gained, and learned to problem solve with regard to nursing care of individuals diagnosed with mental illness. For many students, there also appeared to be a reduction in stigmatized attitudes towards mental illness. Constructivism-based learning is a promising alternative to supplement clinical hours, while effectively achieving learning outcomes. Future research is needed to further validate the use of this method for the learning of course content, as well as the reduction of stigma.     

Effective collaboration enhances rural preceptorship training

Preceptorship is a valuable strategy largely underestimated in its ability to influence nursing students' attitudes and beliefs about mental health nursing. As a model, it has the potential to influence nursing practice, enhance clinical learning, promote recruitment and retention, and generate a more collaborative approach for nursing student supervision. The relationship is usually for a fixed and limited timeframe where the preceptor inspires and supports the growth and development of the student nurse, and encourages role socialization into the profession (Morton-Cooper & Palmer 2000). The challenge for mental health services is to achieve success in the provision of effective preceptorship, ensure positive and rewarding clinical experiences for nursing students, and improve recruitment and retention rates for the service. These aims are substantially more difficult to achieve in the absence of quality education, training and support for preceptors. This paper describes the use of preceptorship training to address recruitment issues in a rural service, particularly the need for effective preceptorship at undergraduate level, which has been shown to have an impact on the willingness of new nursing graduates to enter the mental health nursing field. The design and delivery of the training programme is outlined, including details of the program evaluation and its subsequent impact on psychiatric nurses' approach to and practice of preceptorship. Finally, the broader issue of the value of training nurses in larger groups, enlisting a critical mass of preceptors within an individual mental health service, is discussed.     

Emotional intelligence as a mechanism to build resilience and non‐technical skills in undergraduate nurses undertaking clinical placement

The environments in which nursing work is undertaken can be highly stressful and complex with resultant harmful outcomes for the health of both nurses and patients reported. Undergraduate nursing students are particularly challenged when on clinical placement through having only partially developed work capabilities, with wide claims that these nurses remain underprepared for work even upon graduation. Over time undergraduate nursing education has arguably not prioritized developing resilience and other non‐technical skills required to respond effectively to these challenges. This paper reports findings from a qualitative study of student nurses who received training and coaching in emotional intelligence, a well‐established correlate of resilience, just prior to undertaking a mental health or medical/surgical clinical placement. Of that cohort, 12 agreed to qualitative semi‐structured interviews that sought to better understand how these students used the knowledge and capabilities from the training within clinical placement contexts. Four themes emerged from the thematic analysis of the interviews: (1) greater experiences of resilience; (2) responding positively to mental health consumers; (3) experiences of greater empathy and compassion; and (4) experiences of improved non‐technical work skills. Implications from these findings suggest that student and patient experiences of nursing placement, and mental health nursing placements in particular, would be enhanced by pre‐placement emotional intelligence training and coaching. Such training will support nursing graduates to be work‐ready upon entering the workforce.     

Learning from practice? Mental health nurses' perceptions and experiences of clinical supervision

In recent years nursing as a whole has moved from a position of apparently little manifest concern in the issue of 'clinical supervision' to a veritable explosion of interest which is beginning to find expression in the literature. Beginning with a discussion of clinical supervision from within a psychodynamically informed interpersonal nursing framework this paper reports on a small scale qualitative inquiry which aimed to explore mental health nurses' perceptions and experiences of clinical supervision. Analysis of data derived from a series of semi-structured interviews provides very encouraging early indications that mental health nurses are becoming better able to reflect upon the nature of their own formative learning needs and so to take seriously their need for professional support as they strive towards a more therapeutic relationship with their patients. However, whilst all of the participants in the study had a positive perception of the potential value of clinical supervision, there is clear evidence to suggest that their actual experience was that 'good enough supervision' was more the exception than the rule. The participants' perceptions and experiences are described and the implications for research, practice, education and the management of service delivery systems are outlined.     

Lecturers' accounts of facilitating clinical supervision groups within a pre-registration mental health nursing curriculum

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. Since then a body of literature has emerged, largely focusing on students' experiences of a variety of training initiatives in supervision. There is however a paucity of literature exploring the experiences of nursing lecturers engaged in such initiatives. This paper reports the findings from one part of a three-year prospective longitudinal study examining mental health students' and lecturers' experiences of group clinical supervision undertaken as part of a pre-registration course. In this part of the study eight mental health nursing lecturers participated in semi-structured individual interviews in which they discussed their experiences of facilitating student supervision groups. Content analysis of the interview data produced eight major categories: 'attitudes to supervision'; 'perceptions of the student experience'; 'preparation and support'; 'approaches to supervision'; 'the "good" supervisor'; 'the lecturer as supervisor'; 'the structure and process of sessions; and 'the content of supervision'. The findings suggest that the idea of undertaking supervision for students is attractive to lecturers. However, several issues need to be addressed if this type of initiative is to be successful in preparing students for their future role as supervisee.     

The experiences of a group of pre-registration mental health nursing students

Research that only utilises mental health students as a sample group is quite rare. Yet there are many potential stressors that may impact on the experience of these students including; the theory-practice gap, the learning culture experienced in clinical practice, the effects of the programme's assessment and learning strategies and the intentional and unintentional effects of the curriculum. Therefore the aim of this study was to explore the experiences of a group of mental health student nurses by utilising these four concepts as a framework. Focus groups were used to generate data and the sample consisted of fourteen mental health branch students who, within the pre-registration nursing programme, formed a problem-based learning group. The group met on an annual basis at key junctures during the three-year diploma programme. The focus groups were tape-recorded and the data interpreted and organised by utilising an adapted form of content analysis. Three themes were identified; the conflicting pressures of life as a mental health student nurse, adjustment to problem based learning and experiences in mental health practice and views on mentorship. A discussion of the implications of the findings for the planning of nursing curricula and mental health branch programmes is outlined.     

Participation in clinical supervision (PACS): An evaluation of student nurse clinical supervision facilitated by mental health service users

This paper discusses an innovative learning approach in which people having experience of mental health services facilitated humanistic clinical supervision with groups of student nurses in the classroom. A four-day course of preparation for the role of supervisor is described and the results of subsequent clinical supervision sessions are analysed. Seven service users who had previous experience of teaching students in the classroom and fifty students on a Diploma/BSc in mental health nursing course participated in the project, which was evaluated through focus groups.The results indicated that the service user supervisors appreciated the skills they had gained on the course and felt that they were more appropriate than lecturers to facilitate clinical supervision sessions. Some students expressed initial uncertainty about the appropriateness of service users as supervisors but as changes to the pedagogical process of supervision were made and the supervisors gained more experience and confidence, students expressed greater satisfaction. The authors conclude that clinical supervision facilitated by service users who have preparation and continual support can add considerable value to the learning experience of student nurses.     

Student characteristics and subculture trends in interpersonal skills workshops

The aim of this study was to explore the experiences of student nurses when learning interpersonal skills and to examine the impact of small group work. A qualitative methodology was used. The sample comprised 50 student nurses who were undertaking the preregistration diploma course. In-depth interviews were employed to collect the data. The findings indicated that many students resisted learning owing to a range of personal characteristics that influenced the learning process. A student typology was constructed which highlighted four types of student characteristics that emerged from the data. Significant characteristics relating to each type of student behaviour are emphasized. This report also combines the student typology with the emergence of three distinct subcultures that frequently both interrupt and enhance learning. In presenting the subcultures the implications for group work are considered in conjunction with study limitations.     

Lived‐experience participation in nurse education: Reducing stigma and enhancing popularity

Mental health nursing consistently emerges as less popular than other specialties, and both service users and mental health practitioners are affected by negative attitudes. Education is fundamental to attracting students to the field of mental health nursing. The aim of this study was to determine the impact of undergraduate mental health curricula on student attitudes to people with mental illness, and career interest in mental health nursing. A traditional mental health course was compared to a course delivered by a person with lived experience of mental illness (and mental health service use) for its impact on student attitudes and career intentions in mental health nursing (cohort 1: n = 70, cohort 2: n = 131, respectively). In both cohorts, attitudes were measured via self‐report, before and after the course, and changes were investigated through within‐subjects t‐tests. The lived experience‐led course demonstrated statistically‐significant positive changes in intentions to pursue mental health nursing and a decrease in negative stereotypes, which were not observed in the traditional course. The valuable contribution of mental health nursing emerged in the traditional, but not lived‐experience‐led, programmes. These findings support the value of an academic with lived experience of mental health challenges in promoting attraction to mental health nursing as a career option.     

In search of evidence: a small scale study exploring how student nurses accessed information for a health needs assignment

To help students develop the knowledge and skills necessary to provide evidence-based practice in nursing, a health needs analysis assignment is incorporated within a pre-registration nursing programme. As student nurses have reported difficulties in accessing and utilising some of the information needed for this assigned task, the aim of the study was to explore their experiences of undertaking this assignment. Using a qualitative methodology data was collected from focus groups and categorised under three main themes: the challenge of evidence gathering; the nature of the support students needed and understanding the importance of evidence for practice. This paper illustrates that although accessing and utilising material was demanding and required more guidance, the biggest challenge lay in making judgements about it and there was a clear indication of the need for further support in developing their critical and evaluative skills. The quality of debate within the focus groups also led the research team to question whether educationalists are making the most of capitalising on the rich learning gained from students sharing their experiences of undertaking assignments.     

Impact of theory and clinical placement on undergraduate students' mental health nursing knowledge, skills, and attitudes

Mental health issues are common and contemporary nursing students need to be well prepared to meet the mental health care needs of Australians. This study explored the influence of the mental health component of a Bachelor of Nursing course on second-year undergraduate nursing students' self-reported knowledge, skills, and attitudes in relation to mental health nursing. The study used a quasiexperimental research design involving questionnaires and individual interviews to determine nursing students' self-reported knowledge, skills, attitudes. Questionnaires were administered prior to undertaking the mental health theory, repeated prior to undertaking a clinical placement in either a community or inpatient mental health setting, and again after the clinical placement. The findings of the study indicated that a positive clinical placement had the greatest influence on nursing students' self-reported knowledge, skills, and attitudes and interest in nursing people experiencing mental health problems; however, the quantity of theoretical education also emerged as an influencing variable.     

Undergraduate nursing students’ views of mental health nursing in the forensic environment

The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students’ attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students’ understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.     

An Educational Strategy for Teaching Standardized Nursing Languages

PURPOSE.  The aim of this paper is to describe an educational strategy for teaching standardized nursing languages (SNL) used in both the classroom and clinical components of a psychiatric–mental health nursing course at the associate degree level.
DATA SOURCES.  Data included a review of the relevant literature, teaching experiences, and faculty and student experiences.
DATA SYNTHESIS.  Enhancing associate degree student nurses' competency regarding diagnosis and interventions is essential to influence positive health outcomes. Use of diagnostic, outcome, and intervention classifications for learning nursing care promotes critical thinking, individualization of nursing care, and students' fluency with SNL. One possible teaching strategy to assist students to learn and use SNL was implemented through the use of a faculty-developed Student Nurse Documentation Packet.
CONCLUSIONS.  The educational strategy provided students opportunities to enhance their experience with the SNL to plan and document care of individuals experiencing psychiatric–mental health problems.
IMPLICATIONS FOR NURSING.  The educational strategy used in this program was judged to be successful. Research is needed to provide empirical evidence of the efficacy of this pedagogical strategy for increasing knowledge and enhancing students' competency.     

Promoting reflection in mental health nursing practice: a case illustration using problem-based learning

Reflective practice in nursing has been shown to improve both client care and nurses role satisfaction. Students require regular and guided opportunities to learn the necessary reflective skills that underpin best practice. Problem-based learning (PBL) processes based on comprehensive learning packages developed from actual clinical cases provide a contextualized and realistic means for students to develop and hone their reflective skills for use as mental health practitioners. This paper uses a case illustration to demonstrate the usefulness of PBL as a mechanism for developing reflective practice in the mental health context. Students analysed five cases drawn from actual documented clinical materials that included nursing, medical and allied health professionals' assessments, treatment regimes, and progress notes. One student's written analysis of the five cases and an interview with the student is presented as a case illustration. The case illustrates the student's reflections on the theme of 'hope' for the clients and identified three obstacles. These were: (i) a lack of acknowledgement by health professionals of traumatic life events; (ii) overlooking less tangible losses; and (iii) a central focus on drug treatment. Reflective learning strategies can be incorporated in on- and off-campus learning environments and used to assist the learner to practise critical reflective skills in a controlled and safe manner. Reflective processes are more meaningful if the PBL package that students encounter represents real clinical scenarios with comprehensive resource materials.     

Testing the water – problem-based learning and the cultural dimension

This study reports the findings of a small case study using problem-based learning (PBL) as a teaching and learning strategy in a cultural awareness module, which forms part of a pre-registration diploma in nursing course.The study was carried out using a qualitative research methodology. It aimed to describe and explore 20 diplomat student nurses and their lecturers’ experience of undertaking PBL. The categories that emerged from the analysis were: knowledge development and PBL process. A selection of these categories and their sub-categories are described and discussed in relation to the literature on problem-based learning.The study concluded that undergoing PBL as a teaching and learning strategy had positive outcomes for the students. Prior knowledge was utilised in knowledge development in relation to the problem and was seen as beneficial. Students reported that they felt more confident and used the knowledge gained to care for patients’ cultural needs in practice. Students also identified lack of knowledge amongst staff in the clinical area in relation to cultural awareness. There were however some challenges in the transition to a PBL strategy from the perspective of the students and lecturers. Issues that were found to be difficult include the change to a different teaching and learning strategy, the implications of self-direction for the student and the role of the facilitator as a non-directive guide. The study recommends that the findings may be of use for other nurse educators implementing PBL as a teaching and learning strategy.     

Problem-based learning in a new Canadian curriculum

Problem-based learning (PBL) is a method of group learning that uses true-to-life problems as a stimulus for students to learn problem-solving skills and acquire knowledge about the basic and clinical sciences. This article documents the design and implementation of PBL in a second year course in the new curriculum of the University of Ottawa School of Nursing's Generic Program. The learning and teaching experiences of students and facilitators in this PBL course are described. As a way to determine students' perception of their learning using PBL, they were asked to respond to four questions. The most frequently described thinking processes were problem solving, nursing process and group process. When asked to describe the learning they derived from PBL, as differentiated from other instructional methods, students identified group process and problem solving most often. The most frequently identified factors that influenced performance and learning in PBL were positive attitude and group effort. The factors that affected the facilitators' performance of their role were large group size, insufficient practice of facilitator skills and PBL preparation. To enhance group process, facilitators modelled and shared roles. They fostered student motivation and development through formative evaluation. PBL produced clear benefits for students, such as increased autonomous learning, critical thinking, problem solving and communication. For facilitators, PBL was a liberation from the traditional role of 'content expert and super consultant'.     

Evaluating the use of developmental action inquiry in constructing a problem-based learning curriculum for pre-registration nursing education in Hong Kong: a student perspective

BACKGROUND: Developmental action inquiry (DAI) was chosen as the change strategy for introducing problem-based learning (PBL) in a pre-registration nursing programme. The central task was to transform the tutor and student participants to become collaborators in this curriculum reconstruction project. AIM: This paper expounds the way in which the action inquiry was constructed and in light of students' feedback analysis, the way in which PBL has made a difference in student learning was evaluated. DESIGN: Taking into consideration the change context and different group characteristics, the DAI was conducted in terms of two dynamically interlinked circles that formed partnerships between PBL core group members and tutors, and between tutors and students in coconstructing knowledge useful for PBL curriculum development. FINDINGS: The findings of the student evaluation questionnaire reveal that the majority of students felt PBL made a difference to their expectations of self, the student group and the teacher role in creating a facilitative environment to enhance learning. However, there was a significant difference among individual student group responses. The students' positive and negative PBL experience in self-learning, tutor-student interaction, and group-learning were identified as crucial factors contributing to these group variations. CONCLUSION: The evaluation findings show that a paradigm shift from teacher-centred to student-centred learning, from valuing self-learning to co-operative group-learning, and from theory-based to practice-based learning occurred among the students. DAI was found to be an effective change strategy for transforming participants to become collaborators in searching for useful knowledge and coconstructing the PBL learning context.     

The distress of voice-hearing: The use of simulation for awareness,understanding and communication skill development in undergraduate nursing education

Role-play scenarios are frequently used with undergraduate nursing students enrolled in mental health nursing subjects to simulate the experience of voice-hearing. However, role-play has limitations and typically does not involve those who hear voices. This collaborative project between mental health consumers who hear voices and nursing academics aimed to develop and assess simulated voice-hearing as an alternative learning tool that could provide a deeper understanding of the impact of voice-hearing, whilst enabling students to consider the communication skills required when interacting with voice-hearers. Simulated sounds and voices recorded by consumers on mp3 players were given to eighty final year nursing students undertaking a mental health elective. Students participated in various activities whilst listening to the simulations. Seventy-six (95%) students completed a written evaluation following the simulation, which assessed the benefits of the simulation and its implications for clinical practice. An analysis of the students' responses by an external evaluator indicated that there were three major learning outcomes: developing an understanding of voice-hearing, increasing students' awareness of its impact on functioning, and consideration of the communication skills necessary to engage with consumers who hear voices.