Working together: a joint initiative between academics and clinicians to prepare undergraduate nursing students to work in mental health settings

There is ongoing concern among mental health professionals regarding the recruitment of newly graduated nurses to this specialist nursing area. Many reasons for the problem have been identified, including the perceived inadequate preparation by the tertiary sector, students' prejudices and anxieties about mental illness, a perceived lack of support while undertaking clinical placement, and the quality of the clinical placement itself. This paper describes a collaborative response to these issues undertaken in the Illawarra region of New South Wales, Australia. The implementation of preclinical undergraduate workshops using problem-based learning and role plays were undertaken. Mental health nursing scenarios were developed in association with experienced clinicians to introduce core concepts in a supportive learning environment. Quantitative and qualitative evaluation data were collected immediately following the workshop and again after the students returned to the university following a mental health clinical placement. A further survey of one cohort was undertaken 12 months after initial state registration and the beginning of a career in mental health nursing. Results showed that both students' and clinicians' attitudes to the workshops were consistently positive and indicated that the workshops were beneficial in preparing students for their clinical placement. Importantly, since the implementation of the workshops and other collaborative initiatives, an increasing number of newly graduated nurses from the region are choosing to work in mental health.     

Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses’ careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: ‘fear of the unknown’, ‘reconciling difference between general acute health and mental health settings’ and ‘supporting practice’.     

Preceptors’ perspectives of an integrated clinical learning model in a mental health environment

Supervised clinical practice is an essential component of undergraduate nursing students’ learning and development. In the mental health setting, nursing students traditionally undertake four‐week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors’ experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students’ ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting.     

Mental health stigma and undergraduate nursing students: A self-determination theory perspective

BackgroundClinical placements are essential in preparing students for professional practice. Given the serious negative impact of stigma on people with lived experiences of mental illness, it is essential to explore whether the educational setting of a clinical placement can influence mental health stigma.AimsUsing a Self-Determination Theory lens, this study aimed to examine whether the educational setting of a clinical placemen influences the stigma of undergraduate nursing students toward people with lived experiences of mental illness.DesignQuasi-experimental; pre-test post-test.MethodsNinety-nine undergraduate students enrolled in an accredited nursing program within Australia completed two surveys pre- and post-clinical placement. The surveys measured the educational setting (learning climate) and mental health stigma (social distance).FindingsStudents who partook in an Autonomy-Supportive mental health clinical placement reported a significant decrease in stigma from pre-to-post placement, whereas the Balanced/Neutral group reported a significant increase in stigma from pre-to-post-placement.DiscussionThe findings of this research have considerable implications for nursing facilitators and preceptors. Those that support autonomy amongst future nursing professionals are more likely to positively influence students’ mental health stigma. Those who do not promote an autonomy-supportive setting may actually worsen mental health stigma.ConclusionThe educational setting in which a clinical placement occurs can influence nursing students’ mental health stigma.     

‘Teaching on the Run’ with Australian midwives in a tertiary maternity hospital

Teaching On The Run (TOTR) is an Australian program for health professionals involved in clinical supervision. An amended TOTR program was evaluated with midwives acting as preceptors assisting learners integrate theory with clinical practice. A mixed method study was employed to compare midwives' perceived skills and confidence before and after completion of TOTR workshops. A secondary aim explored midwifery learners' (students and new graduates) perceptions of support from preceptors during the implementation of TOTR. Sixty five midwives completed the TOTR workshops with 46 providing data before program enrolment and 1–3 months after completion of the final TOTR workshop. Significant improvements were found for midwifery preceptors with before and after comparisons using Preceptor Self-Efficacy and Self-Evaluation Questionnaires. Using the Nursing Facilitator Clinical Questionnaire, preceptees or midwifery learners (n = 49) scored the ‘qualities of their preceptors’, ‘their clinical practice’, ‘clinical learning’ and ‘how feedback was provided’ highly with no changes between 2013 and 2014. Nineteen students then participated in three focus group interviews, analyzed using a six step systematic process. One overarching theme, ‘Guiding me through’ emerged with four themes: ‘Getting to know each other’; ‘Willingness to share knowledge’; ‘Leading by example’; and ‘The system acknowledging and valuing the preceptor role’.     

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.     

Interprofessional support of mental well-being in schools: a Bourdieuan perspective

There is increasing international concern about the mental health and well-being of school-aged children, and the school is often seen as the optimum setting to deliver interagency interventions. This paper draws on a Scottish study examining the responses of local authorities, schools and other agencies to challenging behaviour related to poor mental health. It explores the ways in which the presence of workers from other agencies had an impact on the capacity of schools to respond to such issues. In Bourdieuan terms, the study showed that non-teaching workers imported into school developed new forms of 'habitus' leading to effective team work to support vulnerable pupils, but that they often operated in isolation from the wider teaching staff. Different professional cultures created significant barriers, which could be exacerbated by active resistance to meaningful engagement. Consequently, parallel working evolved, where staff from agencies other than education supported pupils experiencing difficulties, but there was little evidence of corresponding changes to ethos or pedagogy to meet the needs of pupils in school. Expertise pertaining to the mental well-being of pupils thus tended to be compartmentalized and was not readily transferred elsewhere, and this led to a disjointed experience for pupils. Our evidence strongly suggested that teachers preferred to learn from other teachers. This served to reinforce existing habitus and to isolate them from new ways of thinking. Potential ways of effecting culture change are suggested, through innovative training and development, linked to accountability, to challenge the new mode of parallel working before it becomes the status quo.     

Learning environment and emotional well-being: A qualitative study of undergraduate nursing students

BackgroundStudents can experience multiple stressors during their academic life which have an impact on their emotional health and academic progress.PurposeThis study sought to explore students' understanding of and factors affecting their emotional well-being in an undergraduate nursing programme at a private nursing institution in Karachi, Pakistan.MethodIn this qualitative study, data were collected through individual semi-structured interviews using a self-designed guide from 16 participants in total, drawn from various years of the selected undergraduate programme.FindingsParticipants noted that the quality of the ‘learning environment’ was a key influence on their emotional well-being. They highlighted faculty role and teaching approaches, academic expectations and availability of learning resources as important factors that affected their emotional well-being as well as their academic performance. Institutional support was also deemed important. Factors associated with a ‘hidden curriculum’ were found to be a threat to students' emerging sense of professionalism.ConclusionSuggestions are given as to how the learning environment in the nursing programme under study can be improved to take into account students' emotional well-being. Emphasis needs to be laid on developing supportive faculty role to provide conducive learning environment and professional development of students. Efforts to develop stress-free academic environment with supportive institutional policies need to be considered.     

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing

BackgroundConducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment.ObjectivesTo explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module.DesignA pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale.Qualitative comments in the form of open-ended questions were also collected in this study.SettingsA University offering nursing program from undergraduate to postgraduate level.ParticipantsA convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study.ResultsThe use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills.ConclusionsUsing standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy.     

Indonesian students’ participation in an interprofessional learning workshop

Abstract

Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value <0.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.     

本科护生主观幸福感及其相关因素的研究

目的探讨本科护生主观幸福感的影响因素,为有效开展护生心理卫生干预提供参考和依据。方法采用总体幸福感量表、简易应对方式问卷、自编调查问卷对193名本科护生进行问卷调查,分析其总体幸福感水平以及主观幸福感的影响因素。结果本科护生主观幸福感得分为男性（80．09±9．80）分,女性（80．55±10．20）分,均高于常模（P〈0．05）;不同年级、学习态度的护生的主观幸福感差异有统计学意义（P〈0．05）,1年级的护生主观幸福感得分相对较高（P〈0．05）,乐学又充实的护生的主观幸福感得分高于麻木也还学、无聊不想学、苦学压力大的护生（P〈0．05）;主观幸福感与积极应对方式、良好学习态度呈正相关,与消极应对方式呈负相关;回归分析显示应对方式和学习态度是主观幸福感的主要影响因素。结论本科护生主观幸福感总体水平较高,相比而言,一年级的护生和乐学又充实的护生主观幸福感得分相对较高;应对方式和学习态度对护生主观幸福感具有影响作用。     

Cognitive integration in health professions education: Development and implementation of a collaborative learning workshop in an undergraduate nursing program

Cognitive integration is integral to health professions education as it facilitates the ability to synthesize various types of knowledge and apply them in a clinical context. Nursing education is one main field of study that is subsumed under the umbrella of health professions education. Future nurses require learning, not just of skills but also of the knowledge that underpins those skills. They need to be able to cognitively integrate various forms of content and skills so that they can translate them to actual patient management and care during clinical practice. Several educational strategies have been implemented and have been shown to be effective in promoting cognitive integration in health professions learners, both individually and as a group. One of these strategies is collaborative learning. This study describes how a developed collaborative learning workshop was implemented to aid cognitive integration in year 1 undergraduate nursing students prior to their clinical postings. It also looks into the perceptions of students through qualitative findings from focus group discussions. Generated themes include ‘integrating and bridging knowledge for practice’, ‘having tutors with different and complementing expertise’, ‘preparing mindsets by clear objectives’ and ‘timing and case variability’.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

合作办学护理本科生异校学习期间心理状况调查与分析

目的了解合作办学中护理本科生异校学习期间的心理状况及相关因素。方法采用焦虑自评量表、抑郁自评量表、UCLA孤独量表等进行问卷调查。结果护生异校学习期间焦虑、抑郁、孤独得分均明显高于常模,一、二年级无明显差异(P>0.05),主要与来自学习、人际交往等方面的压力有关。结论护生在异校学习期间存在一定程度的心理问题,应针对其面临的压力采取个体化管理措施,提高护生的适应能力,以更好地适应异校学习生活。     

Using simulation to improve the capability of undergraduate nursing students in mental health care

IntroductionMental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment.InterventionUndergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges.MethodsUsing a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting.ResultsStudents who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting.DiscussionThis study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.     

Core topics of health care ethics. The identification of core topics for interprofessional education

OBJECTIVES: The aim of this project was to identify core topics of health care ethics that could be taught through an inter-professional approach to undergraduate education. DESIGN: Five nominal group technique workshops. Setting and participants: Teaching staff from different professional disciplines in our university (nursing branches, occupational therapy and physiotherapy). RESULTS: Seven core topics of health care ethics that are common across all disciplines were identified. However participants in all workshops identified the need for case studies used in teaching and learning to be specific to the clinical setting encountered by the student. CONCLUSION: Despite the identification of core topics that apply to all disciplines, caution should be taken when seeking to integrate these into an inter-professional undergraduate programme. There is evidence from other studies that students have difficulty in transferring knowledge from one context to another. In view of this, an inter-professional approach to health care ethics teaching to a group, members of which do not encounter shared clinical ethical problems may be inappropriate. It is suggested that inter-professional learning in undergraduate health care ethics should focus on facilitating learning in the clinical area with students who share similar ethical encounters, in which case the learning will be truly inter-professional.     

Assessing students’ and health professionals’ competency learning from interprofessional education collaborative workshops

Interprofessional education (IPE) is a key element in preparing current and future health professionals to function in a collaborative practice-ready workforce. California State University, Fresno’s College of Health and Human Services and Valley Children’s Healthcare have partnered together to create an IPE collaborative that organizes and provides interagency-sponsored workshops that align learning objectives of relevant healthcare topics with 2016 IPEC core competencies for university students and health professionals. Using a pre/post design with the IPEC Competency Self-Assessment Tool, two cross-sectional studies were conducted to measure whether interprofessional learning of core competencies improved after participation in IPE workshops, and if such improvements were different between students and health professionals. In Study 1, 67 participants attended a Pediatric Head Injury IPE workshop. Of these, 19 students and 22 health professionals consented to participate and complete the IPEC survey. In Study 2, 99 participants attended an Error Disclosure IPE workshop. Of these, 26 students and 29 health professionals consented to participate and complete the IPEC survey. This investigation showed that the IPEC Competency Self-Assessment Tool discriminated competency ratings between students and health professionals in both studies and demonstrated a positive impact of IPE workshops on students’ and health professionals’ self-assessment of interprofessional competencies.