Anne Felton

Participation In Nurse Education: the Pine project

Service user involvement is called for at every level of NHS delivery in the United Kingdom (UK). This article describes a model of service user participation in the development of mental health nurse curricula in a UK university. Using a research model of participatory action research, the Participation In Nurse Education (PINE) project has now become mainstream in the mental health branches at the university. Service users led the design and implementation of the teaching sessions and led the data collection and analysis. Research participants were the service user trainers and the student nurses who were involved in being taught in the early stages of the project. The benefits of the work to both trainers and students are identified as well as some of the difficulties.

A critical narrative analysis of shared decision-making in acute inpatient mental health care

ABSTRACT Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Simulation: A shared learning experience for child and mental health pre-registration nursing students

Learning through the use of simulation is perceived as an innovative means to help manage some of the contemporary challenges for pre-registration nurse education. Mental health and child nurses need to have the knowledge and skills to effectively address the holistic needs of service users. This article reports on a pilot simulated learning experience that was designed with key stakeholders for pre-registration child and mental health nursing students. This involved young actors playing the role of someone who had self-harmed to help students develop their skills for working with young people who experience emotional distress. Focus groups and a questionnaire were used to evaluate the pilot. Students valued the practical approach that simulation entailed and identified the benefits of the shared learning experience across the different fields of practice of nursing. However, some students reported anxiety performing in front of peers and indicated they would perform differently in practice. The pilot identified simulation as a potentially useful approach to help child and mental health student nurses develop skills for caring for young people. However, there is a need for caution in the claims to be made regarding the impact of simulation to address gaps in nursing skills.

Thinking the unthinkable: does mental health nursing have a future?

We would like to revisit the discussion articulated by Holmes (2006) from an Australian perspective and more recently by Hurley & Ramsey (2008) regarding the potential demise of mental health nursing. Currently in the UK, the Nursing & Midwifery Council (NMC) is reviewing nurse education. The NMC state that the review is required because: Changes in policy and delivery of healthcare will allow us to ensure that nursing education across all four countries enables nurses to meet the future needs of patients. (NMC 2008a)

Skills for nursing practice: Development of clinical skills in pre-registration nurse education

Rapid changes during the past two decades have seen a growing challenge to prepare newly qualified nurses who are clinically competent and confident to meet the demands of contemporary healthcare. Recent publications emphasise the need to prioritise clinical skills in nurse education (DH 2012a, Francis, 2012). This discussion reports on a project scoping the clinical skills required within pre-registration nursing curricula and considers how this has influenced curriculum development at one Higher Education Institution in the UK. This paper reports on the project analysis of nursing and healthcare policy, identifying six core themes of skills relevant for nursing practice. Furthermore it explores the findings of a series of focus groups with nursing practitioners and managers identifying priorities for clinical skills in the pre-registration curriculum. These highlighted a broad range of skills required of newly qualified practitioners, which pose a challenge for integration within nurse education. How this challenge has been addressed through the incorporation of these skills themes throughout a new pre-registration curriculum is also examined.

Masters at work: a narrative inquiry into the experiences of mental health nurses qualifying with an undergraduate Masters degree.

The University of Nottingham provides a unique course in the UK that enables undergraduate students to obtain a Masters degree and registration with the Nursing and Midwifery Council (NMC). The curriculum equips graduates with the skills to practice nursing with an analytical attitude and adopt both professional and humanistic values. This research aims to explore significant experiences of graduates, from the undergraduate Masters course, relating to their education and nursing practice in mental health care. A narrative approach to data collection was employed using unstructured individual interviews. Participants worked through a process of contemplation. Their commitment to working with people in a relational manner and studying at graduate level were of high importance. The process continued with assimilation to a philosophy which was intrinsic to the course, including developing therapeutic relationships, self awareness and critical thinking. Participants encountered conflict relating to a perceived dissonance between this philosophy and nursing practice. As a consequence, participants questioned mental health nursing and their abilities as nurses. Resolution occurred when participants were able to work within the constraints of the system whilst effectively realising their philosophy. The findings demonstrate the importance of supportive networks to maintain values and criticality.

Using focus groups and photography to evaluate experiences of social inclusion within rehabilitation adult mental health services

Tackling the social exclusion of people with mental health problems is a primary concern for contemporary mental health services. A social inclusion network was developed to co‐ordinate a small participatory project arising as part of a practice development initiative. It aimed to examine the experiences of involvement in the community from the perspectives of those using and working in rehabilitation adult mental health services.To gather information three different approaches were used. Networks between rehabilitation services and community resources were identified using a mapping tool whilst focus groups were used to gain more in‐depth perceptions from rehabilitation staff. Finally, a participatory photo project was conducted which involved working with people who use services to capture images of their involvement in their local community. This article reports on the outcomes of the focus groups and photography project.Findings suggested that services reported some success at developing partnerships within the community, but discrimination still remained a significant obstacle. For those people living in the units, social inclusion was an acutely subjective experience in which people continued to experience acceptance and inclusion within mental health services and had made active choices in defining this as their community.

Rethinking risk: a narrative approach

Purpose The assessment and management of risk is central to contemporary mental health practice. The emergence of recovery has contributed to demands for more service user centered approaches to risk. This paper examines the potential of narrative as a framework for understanding risk and safety in mental health care. Design/methodology/approach Narrative theory is adopted to structure a debate examining the potential role of a narrative approach to risk assessment and inform future practice. Findings There is a danger that even within services, people with mental health problems are understood in terms of their riskiness perpetuating an image of service users as ‘dangerous others’. This is confounded by a disconnection with individual context in the risk assessment process. Narrative centralizes the persons’ subjective experience and provides a contemporaneous self-account of their identity. This situates risk within a context and creates possibility for greater understanding of coping, strengths and resilience. Originality/value There has been a call for new ways of working with risk in mental health which facilitate safety and recovery. There is limited examination of what this might actually look like. This paper presents narrative as an approach that may achieve these aims.

Preparation for safeguarding in UK pre-registration graduate nurse education

Purpose – It is now widely acknowledged that health care professionals on the front line of care delivery will often be among the first to whom patients or clients who have experienced abuse will present or disclose abuse in a clinical context. It is therefore of pivotal importance that all health care professionals, including nurses, are adequately prepared at the earliest opportunity to effectively respond to a disclosure of abuse or identify where abuse may be suspected. The paper aims to discuss these issues. Design/methodology/approach – In order to address this contemporary challenge within health care the authors present a model, developed in the UK, for the embedding of safeguarding knowledge, skills and attitudes within undergraduate pre-registration nursing curricula. This model is integrative and focuses on the acquisition of knowledge and skills in the field of safeguarding vulnerable adults and children. Findings – Student evaluation to date has been extremely positive with the majority of st...

Therapeutic risk taking: what is it?

Therapeutic risk taking is a collaborative process in which people with mental health problems are supported to make decisions regarding safety and opportunities. Taking risks is an important part of the human experience and can promote growth, self-determination and self-confidence. Research on voluntary risk taking provides useful insights into the social and psychological benefits taking a risk can bring. The development of therapeutic risk taking has been influenced by a normative understanding of risk in society as the prevention of harm. Therapeutic risk taking recognises that risks can be about achieving gains to support people with mental health problems to work towards recovery. However, therapeutic risk taking may be limited as a means to challenge the impact of risk management approaches that promote restrictive practices. L’atto di prendere rischi terapeutici si inserisce in un processo collaborativo in cui le persone con problemi di salute mentale sono sostenuti nel prendere decisioni riguardanti sicurezza e opportunita. L’assunzione di rischi costituisce una parte importante dell’esperienza umana e puo promuovere crescita, autodeterminazione e fiducia in se. Le ricerche sull’assunzione volontaria di rischi forniscono interessanti ipotesi sull’utilita sociale e psicologica del prendere dei rischi. Il prendere dei rischi terapeutici e il suo sviluppo sono stati modellati da una comprensione normativa del rischio nella societa come prevenzione del danno. Prendere dei rischi terapeutici puo promuovere dei miglioramenti che sostengono le persone con problemi di salute mentale verso la recovery. Tuttavia, la pratica di prendere dei rischi terapeutici puo anche avere dei limiti come mezzo per opporsi all’impatto di approcci di gestione del rischio che incoraggiano pratiche restrittive.