Learning that cannot come from a book: An evaluation of an undergraduate alcohol and other drugs subject co-produced with experts by experience.

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.

Developing a Trauma-Informed and Recovery-Oriented Alternative to 'Aggression Management' Training for a Metropolitan and Rural Mental Health Service.

For clinicians working in mental health services, 'aggression management' training is generally prioritised, and often mandated. Traditional 'aggression management' training has the potential to reinforce the perception that violence and aggression are inevitable, and thus defensive and coercive practices are needed. This paper outlines the principles and processes that underpinned the development of two training programs designed as recovery-oriented and trauma-informed alternatives to traditional 'aggression management' training. The focus of the paper is on exploring how 'aggression management' training can be aligned with best practice principles. The programs were developed in a metropolitan and rural mental health service and aimed to reduce the need for defensive and coercive practices by promoting therapeutic engagement. A key feature of both programs is an orientation towards safety rather than risk. By embedding the principles of recovery and trauma-informed care in their development and orienting training towards enhancing safety, clinicians are provided with a new way of conceptualising and responding to 'aggression'. Experiential methods in the delivery of the training, and the co-design and co-delivery with peer (consumer) educators were important in supporting attitudinal change. To promote safety, the language and content of training programs must reflect contemporary principles and approaches such as trauma-informed care and recovery. This paper illustrates that to be effective, these principles and approaches must not just be described, but modelled in the development, design, and delivery of the training.

Using naturalistic inquiry to inform qualitative description.

BACKGROUND: Choosing how to answer a research question requires an understanding of philosophical and theoretical assumptions and how these inform a study's methodology and methods. This can be a challenge for all researchers, but for novice researchers, such as doctoral candidates, this can feel like an overwhelming task. Ensuring there is clear alignment between philosophy, theory, methodology and methods is an essential part of the research process, that enables research to be undertaken with clarity and integrity. This alignment must be a good fit for the research aim, and to ensure the researcher's intrinsic values and beliefs do not affect the analysis undertaken. AIM: To describe the alignment between qualitative description and naturalistic inquiry and how it was applied to a doctoral candidate's exploration of the meaning of safety for people with experience of admission to an acute mental health unit. DISCUSSION: Understanding the alignment between qualitative descriptive methodology and naturalistic inquiry provided a clear pathway for the doctoral candidate. CONCLUSION: The assumptions that underpin a methodological approach need to be unpacked to understand how to answer a research question effectively. IMPLICATIONS FOR PRACTICE: Qualitative description, informed by naturalistic inquiry, offers a practical way to explore and answer research questions.

Students' perceptions of belonging in the School of Nursing at a regional university in Australia.

BACKGROUND: Attrition in pre-registration nursing degrees is a global issue. Students' perceptions of belonging is a factor that influences attrition. OBJECTIVE: The objective of this study was to evaluate students' perception of belonging to a School of Nursing, as well as their intention to complete the pre-registration Bachelor of Nursing (BN) program following implementation of the Initiatives for Retention (IR) intervention. DESIGN: A prospective cross-sectional survey of student nurses was undertaken using an online questionnaire. SETTING: A large regional university in Australia. PARTICIPANTS: Pre-registration nursing students. METHODS: Perceptions of Belonging were evaluated using the 24-item Belonging questionnaire comprising three subscales. Data were analysed using SPSS version 25. Pearson's correlation, Student's t-tests and one way ANOVA were used to assess associations and differences in belonging scores and student demographics, study status and participation in the Initiatives for Retention (IR) intervention. RESULTS: A total of 201 students responded to the voluntary questionnaire. The mean score for overall Belonging was 70.5 (maximum obtainable 96), mean Scores for University affiliation, University support and acceptance, and staff relations with students were 34.7, 24.1 and 11.8 respectively. Female students, those who were studying at the university for less than a year and those who participated in the IR intervention activities reported significantly higher University Belonging scores compared to their contemporaries. Logistic regression revealed that students studying the BN course for more than 3 years (OR: 0.43 95% CI 0.20-0.93, p = 0.031), and those employed (OR: 0.435, 95% CI 0.16-0.16, p = 0.022) were significant predictors of not attending the IR sessions. There were no significant differences in overall University Belonging scores based on other demographic characteristics and, study status. The majority of the students (84%) stated that they plan to continue and complete the BN program. CONCLUSIONS: Measures designed to develop student involvement may positively contribute a successful relationship between the institution and the student, increasing the students' sense of belonging and decreasing attrition among student nurses. PRACTICE IMPLICATIONS: Initiatives for Retention (IR) facilitate a greater sense of belonging in nursing students hence Schools of Nursing should consider embedding such strategies.

How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study.

AIMS AND OBJECTIVES: To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. BACKGROUND: Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. DESIGN: The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. METHODS: Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. RESULTS: Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. CONCLUSIONS: Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. RELEVANCE TO CLINICAL PRACTICE: Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.

Understanding how personhood impacts consumers' feelings of safety in acute mental health units: a qualitative study.

Being admitted to an acute mental health unit can lead to feelings of shame, and loss of personhood for some consumers. Promoting safety for consumers is a function of acute mental health units. This paper explores how consumers' personhood influences their perception and experience of safety in acute mental health units. Semi-structured interviews were conducted with 15 participants who had previously been admitted to an acute mental health unit. Thematic analysis was used to analyse the data. Participants perceived safety as being intrinsically linked to their personhood. When participants' innate worth was affirmed in their interactions with staff, participants felt safe. Three subthemes were identified: 'Seen as an equal', 'Being respected', and 'Able to make choices'. These findings can be used to inform nursing practices that enhance consumers' sense of personhood and, in so doing, promote consumers' safety and recovery in acute mental health units.

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study.

AIMS AND OBJECTIVES: To explore how nurses influence the perceptions and experience of safety among consumers who have been admitted to an acute mental health unit. BACKGROUND: Safety is a priority in acute mental health inpatient units, yet consumers do not always experience acute units as safe. Despite being primary stakeholders, little is known about what safety means for consumers in acute mental health units. DESIGN: A qualitative descriptive study informed by naturalistic enquiry was conducted and is reported using the COREQ checklist. METHODS: Fifteen consumers with experience of mental illness participated in semi-structured individual interviews. These interviews explored what safety meant for them during their acute mental health unit admissions. Thematic analysis was used to analyse the data. FINDINGS: The theme Influence of Nurses reflected that the way nurses engaged in acute mental health units had a profound impact on participants' sense of safety. Three sub-themes emerged as follows: (a) Availability: "It's about nurses spending time with you"; (b) Being responsive: "They would listen if you had a concern"; and (c) Caring: "Little acts of kindness." CONCLUSIONS: These findings challenge the dominant discourse around safety in mental health organisations, in which nursing practice is often oriented towards the management of risk, rather than the promotion of safety. The findings demonstrate that, through their clinical practice, nurses can enhance consumers' feelings of safety in the acute mental health unit. RELEVANCE TO CLINICAL PRACTICE: Nurses play a key role in providing care within acute mental health units. It is vital that the behaviours and actions nurses can enact in order to promote feelings of safety among consumers in this setting are enabled at individual, unit and organisational levels.

Review of transnational nursing education programme curricula: process, findings, and recommendations.

BACKGROUND: The University of Wollongong (UOW) delivers two Transnational International Programmes (TNEP) in Hong Kong (HK): a 1-year undergraduate Bachelor of Nursing (Conversion) degree and a 2-year postgraduate Master of Nursing degree. A curriculum review of these programmes has been undertaken to ensure the quality of the programme remains consistently high and competitive in an international environment. AIM: The aim of the Curriculum Review Project was to utilise the experience of expert academic staff to review the TNEP curricula delivered by an Australian University in Hong Kong (HK) to ensure it met contemporary needs of students, the university, and the Hong Kong Authority. METHODS: The curriculum review projects followed a qualitative research methodology. Thematic analysis was undertaken utilising Braun and Clarke's six-phase method (2006), as this method facilitated an inductive semantic approach where themes are strongly linked to the data and sourced from the explicit meaning of the discourse within the interview (Braun and Clarke, 2006). RESULTS: In total, there were 6 participants who were all permanent academic staff members within the School of Nursing at the UOW. The results of this project have been reported within a strengths, weaknesses, opportunity, and threats (SWOT) framework. Participants recognised the value and challenges to both individual students and the broader nursing profession in HK. Overall, there was a perception that being involved as an academic staff member in a TNEP developed both their subject knowledge and teaching skills. CONCLUSIONS: This project has demonstrated that the TNEP makes an important contribution to the nursing profession in HK, while also facilitating the growth and development of academic staff at UOW.