Gemma Stacey

The practice assessment of student nurses by people who use mental health services

This paper reports on a participatory action research project focusing upon service-user involvement in the assessment of student mental health nurses in practice. The principle of student nurses being assessed by service-users was found to be desirable in theory. However, its implementation proved to be fraught with difficulty especially with regard to the concerns about increased workload and feelings of vulnerability amongst students. It is recommended that the model of assessment should be adjusted to that of review and that a program of service-users reviewing student nurses on placement be implemented and evaluated.

The meaning of art to people who use mental health services

Aims: This article reports upon a research study which explored the significance of art to people who use mental health services. Method: A narrative approach to data collection was chosen as the most appropriate method of gaining in-depth stories regarding the significance of art to the person. This involved the implementation of arts based workshops and in-depth individual follow-up interviews. Results: The study offers a contribution to the debate surrounding the most appropriate research methods for identifying the relationship between the arts and health. The findings give an indication of the unique and complex meaning attached to art. It is evident that creativity represents an integral aspect of the person’s perception of themselves and that for many it is an essential component of the way they wish to live their life. The multiple benefits described by participants suggest the need for the development of creative resources within statutory mental health care, thus complementing medically based interventions. Conclusion: A research approach that is creative and consistent with empowering and inclusive practice has been employed in this study. Furthermore, greater attention in research methods to the often neglected area of people’s stories is advocated. Historically, in mental health care, people have felt oppressed by statutory service providers. Narrative approaches in research enable the person to become centre-stage, and, as a parallel to creative expression, the person is given a voice.

Service user involvement in the assessment of student nurses: A note of caution

In the UK, the Nursing and Midwifery Council (NMC, 2010) have called for service user involvement in nurse education including the assessment of student nurses. As researchers and educationalists we have supported service user involvement in nurse education at the University of Nottingham, Division of Nursing for over a decade (Hanson and Mitchell, 2001; Collier and Stickley, 2010; Repper et al 2001; Rush and Barker 2006; Rush 2008; Stickley et al 2009; Stickley et al., 2010; Stickley et al., 2011) and so we are keen to explore to further development in this area. However, what is noticeable in the NMCs requirement for involvement is the lack of acknowledgement that meaningful involvement may be problematic. In this commentary, we focus on one aspect of service user involvement in order to raise some debate about this very important topic. We have chosen to specifically focus upon service user involvement in the assessment of student nurses as this is an area that we have researched at our institution. What has become evident in our research is that this laudable initiative should be carefully contemplated before being implemented; in fact we question whether it should implemented at all without the required evidence-base.

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.

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)

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.

Introducing skills for psychosocial interventions into undergraduate mental health nurse education

This paper describes how psychosocial interventions (PSI) have been integrated into an undergraduate mental health nursing programme. The first part of the paper provides the broad context of PSI in nurse education and justifies the need to incorporate skills for PSI into the undergraduate nursing curriculum. A variety of educational theories and research are presented, which have informed the development, structure and delivery of the skills programme underpinned by PSI into the undergraduate programme. The successes and limitations of this skills programme are considered in light of the key issues and challenges concerning the integration of PSI skills into undergraduate nursing education.

Evaluation of the Chief Nursing Officer's Review of mental health nursing in England: findings from case studies in mental health trusts

This study is an evaluation of the implementation of the Chief Nursing Officer for Englands Review of mental health nursing in mental health trusts (MHTs). The authors employed instrumental case studies in six MHTs. The results showed evidence of acceptance of the Review and some evidence of subsequent actions to implement the Review recommendations, but these were not widespread. A lack of an evidence-based implementation plan hampered the implementation as did an apparent lack of strategic nursing leadership in many MHTs. In conclusion, the vision for mental health nursing reported in the Chief Nursing Officer Review prompted various changes, directly and indirectly, among mental health nurses and the development of areas of good practice in education, practice and leadership. The positive changes evident in some areas may become widespread by a systematic policy implementation plan from the centre, supported by local leadership in practice.

The Shock of Reality: Digital Storytelling with Newly Qualified Nurses

Dr Stacey describes the experience of working with a group of newly qualified mental health nurses to develop digital stories about their early experience of the transition from study to practice, sometimes referred to as ‘the shock of reality.’ The stories that emerged consider the implications of exposure to traumatic events, poor resources and support, conflicts in personal values and expectations of self. The chapter then discusses the experience of making the stories and how they have influenced others preparing for the transition to practice. Consideration is given to the ways in which stories can be used to minimise the reality shock associated with the transition to practice with a view to influencing the stories of future newly qualified nurses.

Exploring the influence of feedback given by people with lived experience of mental distress on learning for preregistration mental health students

WHAT IS KNOWN ON THE SUBJECT?: The involvement of those with lived experience is broadly understood to be beneficial to student learning. The consequence of the process and implications for learning are predominantly unexplored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper explores an innovative co-produced model of involving people with lived experience in the assessment process of mental health nursing students. This method of assessment enables students to further critically analyze the application of humanistic skills and theories of person-centred care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The involvement of people with lived experience in the assessment process of students promotes self-awareness and empathy. It is questionable if learning which is potentially troublesome should act as a form of academic assessment which is exposed to the external judgement of another and awarded a credit-bearing grade. ABSTRACT: Introduction Despite a positive and established perception of people with lived experience of mental distress contributing to the assessment of healthcare professionals, the consequence and implications for learning are predominantly unexplored. Aim To gain a greater understanding of the influence of feedback given by people with lived experience, in the role of formative assessor, on student learning. Method Qualitative analysis, underpinned by the theory threshold concepts, was conducted on the written reflective assessments, submitted by students, following engaging in an assessment with a lived experience assessor. Results Student learning was influenced positively by the involvement of lived experience assessors in relation to person-centred care. However, students reported the experience to be anxiety provoking due to the desire to seek external approval and conceal personal challenges. Discussion The results indicate that the feedback from those with lived experience promotes greater self-awareness and empathy amongst students. The perceived expectation to present a competent and professional performance acts as a barrier to authentic person-centred practice. Implications for practice It is questionable if learning which is potentially troublesome should act as a form of academic assessment, which is exposed to the external judgement of another and awarded a credit-bearing grade.