It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education.

WHAT IS KNOWN ON THE SUBJECT?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery-oriented practice. Service users as experts by experience have not been embedded within pre-registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre-registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. ABSTRACT: INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date. AIM: To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. METHODS: A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically. RESULTS: Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. CONCLUSIONS: Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. IMPLICATIONS FOR PRACTICE: Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia.

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

Helpful encounters with mental health nurses in Australia: A survey of service users and their supporters.

WHAT IS KNOWN ABOUT THE SUBJECT?: Most nurses who work in mental health in Australia have completed a comprehensive nursing programme at a university. This training has been widely criticized and has not produced "job-ready" graduates. Public inquiries into mental health services have highlighted the need for transformation of mental health services and concern about future nursing shortages. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This survey highlights what service users and supporters perceive are useful nursing skills and capabilities. The characteristics of helpful encounters with nurses are also described. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Helpful nursing practice is aligned with traditional nursing values and theory, rather than the performance of specific tasks. Improving the retention of nurses to this specialty area of practice requires educational processes to enable nurses to enact values, develop their therapeutic potential and undertake facilitative and supportive practices which are helpful to service users. ABSTRACT: INTRODUCTION: Successive inquiries into mental health services in Australia have identified the need for major reform of services and proposed a return to direct-entry nursing training. AIM/QUESTION: To identify what service users, family and supporters have found helpful in their encounters with nurses in mental health settings. METHOD: A survey of 95 service users and supporters rated the importance of the capabilities and competencies of nurses. They also shared examples of helpful encounters with nurses which were subject to thematic analysis. RESULTS: The most highly rated competencies were around demonstrating caring, empathy and understanding, and responding effectively in crisis situations. Helpful encounters involved enacted values, highly skilful interpersonal and psychotherapeutic engagement and practices that were facilitative and supportive. DISCUSSION: The process and content of pre-registration nursing training needs to refocus on the nurse meeting the needs of service users and supporters, rather than the instrumental needs of services today. IMPLICATIONS FOR PRACTICE: Educational reform may be necessary but insufficient to address anticipated nursing workforce shortages. Policymakers and health service directors need to align services with mental health nursing values and promote practices aligned with what service users and their supporters report as helpful.

Antecedents and precipitants of patient-related violence in the emergency department: Results from the Australian VENT Study (Violence in Emergency Nursing and Triage).

INTRODUCTION: Workplace violence is one of the most significant and hazardous issues faced by nurses globally. It is a potentially life-threatening and life-affecting workplace hazard often downplayed as just "part of the job" for nurses. METHODS: A cross-sectional design was used and data were collected using a purpose developed survey tool. Surveys were distributed to all members of the College of Emergency Nurses' Australasia (CENA) in 2010 and 537 eligible responses were received (RR=51%). RESULTS: Patient-related violence was reported by 87% of nurses in the last six months. Precipitants and antecedents for episodes of violence were reported in three categories: nurse-related; patient-related and emergency-department specific factors. Triaging was identified as the highest risk nursing activity, and the triage area identified as the highest risk location in the department. Patients who presented with alcohol intoxication, substance misuse or mental health issues were identified as the groups at greatest risk for potential violence. DISCUSSION: Patient-related violence was reported by the majority of emergency nurses surveyed. A number of precipitants and antecedents perceived to be risk factors by participants were found to be significant and are unavoidable in the working lives of emergency department nurses.

An overview of swearing and its impact on mental health nursing practice.

Swearing is a subject largely ignored in academic circles but impossible to ignore in the workplace. Nurses encounter swearing from patients and their carers, staff and managers and use swearwords in communication with each other. Language is the major tool of the mental health nurse and swearing an aspect of language frequently used in situations of intense emotion. This paper provides an overview of the historical, legal and cultural aspects of swearing in an Australian context in order to assist nurses in their practice.

Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder.

Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants' demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectical behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article provides a brief overview of the findings of the survey, the main purpose is to report the findings of the focus group interviews.

Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.

OBJECTIVE: To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes. DESIGN: Longitudinal panel design. SETTING: District general hospital in a semi-rural region of Australia. NUMBERS: Two matched groups (n = 37 in each group) MAIN OUTCOME MEASURE: These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report. RESULTS: The study found that the introduction of the new service resulted in few significant differences in consumer outcomes. CONCLUSIONS: The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care. WHAT IS ALREADY KNOWN: Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia. WHAT THIS STUDY ADDS: This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.

A comparison of patient clinical and social outcomes before and after the introduction of an extended-hours community mental health team.

OBJECTIVE: The aim of this study was to assess the effectiveness of the addition of standard community treatment to a hospital-based service in a regional district of Australia. METHOD: The study was a naturalistic investigation of a routine clinical service and utilized a longitudinal panel design. Two matched groups of seriously mentally ill patients were recruited,one before the addition of the community mental health team (CMHT)and one after. Each sample was followed up for one year using a semistructured questionnaire and instruments including the Brief Psychiatric Rating Scale, the Global Assessment Scale, the Life Skills Profile and the Rosenberg Self-Esteem Scale as well as hospital records. RESULTS: Patients in both groups showed similar patterns of improvements. Although the aims of the new service included reducing in-patient utilization and improving social functioning,there were few significant differences between the two groups. While the number of admissions and length of stay were lower in the post-CMHTsample most were admitted rather than treated in their homes by the CMHT. CONCLUSION: The study concludes that better outcomes might have been achieved if the aims of the CMHT had been limited to either crisis or rehabilitation interventions, but not both. More attention needs to be paid to the service context in which model programmes are introduced so that new developments can be more closely tailored to the realities of what is likely to be achievable.