Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution.

WHAT IS KNOWN ON THE SUBJECT: ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE: ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT: Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.

Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students.

Expert by Experience involvement in mental health nursing education is increasing in popularity as a teaching technique. The emerging literature attests to its benefits in enriching the educational experience for students. Much less attention has been devoted to the experience from the perspective of the Experts themselves. To address this gap and ensure this important perspective is captured and considered, the aim of this paper is to present the perceptions and experiences of Experts by Experience in delivering an educational module to mental health nursing students. A qualitative exploratory approach was adopted, involving in-depth individual interviews with Experts by Experience who delivered a learning module to nursing students in Australia and Europe. Data were analysed thematically. Analysis produced two overarching themes: Empowerment, and Challenges. Challenges included six sub-themes: Being constructive, not just critical; Time to unpack and reflect; Need for co-production and support from nursing academics; Emotional and practical support; maintaining personal boundaries; and adapting to the audience. These findings make a significant contribution to a broader understanding of Expert by Experience involvement in mental health education. The use of standards to maintain integrity and avoid tokenism is recommended.

[The prevalence of psychiatric diagnoses and psychotropic medication in icelandic nursing homes from 2003 to 2018].

INTRODUCTION: Research shows a high prevalence of mental disorders and psychotropic medication among older people, especially in nursing homes. Knowledge of this concerning issue among Icelandic nursing homes residents is limited, despite its importance for mental health policymaking. Therefore, the aim of this study was to investigate the prevalence of psychiatric diagnoses and psychotropic medication in Icelandic nursing homes, the relationship between these factors and how they have evolved from 2003 to 2018. MATERIAL AND METHODS: The research data comes from interRAI MDS 2.0 assessments for nursing home residents in Iceland, for the period 2003-2018. The study uses the last assessment of each year (N=47,526). RESULTS: Approximately half of the residents were diagnosed with anxiety and/or depression; 49.4% in 2003 and 54.5% in 2018. The use of psychotropic drugs increased from 66.3% to 72.5%. Antidepressants were most commonly utilized, with an increase from 47.5% to 56.2%. The use of antipsychotics drugs has remained nearly unchanged, at around 26%. Inconsistency was found between psychotropic medication and psychiatric diagnoses; on average, 18.2% of the residents took psychotropic drugs without being diagnosed and 22.3% took antipsychotics in other cases than recommended. CONCLUSION: Age related changes influence the effect of psychotropic drugs and studies have not supported their positive long-term effects for older people who are also sensitive to associated adverse effects, especially in cases of polypharmacy. Therefore, it is important that psychotropic drugs use is based on accurate mental health assessment. To reduce psychotropic medication, other mental health interventions need to be developed.

Improving Service User Involvement in Mental Health Nursing Education: Suggestions from Those with Lived Experience.

Service user involvement in mental health nursing education is increasing and a developing evidence base is demonstrating more positive attitudes towards people labelled with a mental illness. To date, most research on this approach has focussed on the perspectives of nursing students, with very limited research drawing on the expertise and opinions of service users. The aim of this study was to explore potential improvements in mental health nursing education, and ways service user involvement can be enhanced as defined by service users themselves. An international qualitative research project was undertaken involving focus groups with service users (n = 50) from Australia and five European countries. The research was coproduced between Experts by Experience (service users) and mental health nurse academics. Data were analysed thematically. Findings reflected two broad themes: (1) improvements to content, including: further emphasis on developing emotional intelligence, understanding mental distress and broader context of care; (2) Improvements to service user involvement, including: support, format, and teaching and learning techniques. These findings provide direction for maximising the benefits of service user involvement and show the value of the expertise of service users.

"But I'm not going to be a mental health nurse": nursing students' perceptions of the influence of experts by experience on their attitudes to mental health nursing.

BACKGROUND: Mental health nursing skills and knowledge are vital for the provision of high-quality healthcare across all settings. Negative attitudes of nurses, towards both mental illness and mental health nursing as a profession, limit recognition of the value of these skills and knowledge. Experts by Experience have a significant role in enhancing mental health nursing education. The impact of this involvement on attitudes to mental health nursing has not been well researched. AIM: To explore the impact of Expert by Experience-led teaching on students' perceptions of mental health nursing. METHODS: Qualitative exploratory study involving focus groups with nursing students from five European countries and Australia. RESULTS: Following Expert by Experience-led teaching, participants described more positive views towards mental health nursing skills and knowledge in three main ways: learning that mental health is everywhere, becoming better practitioners, and better appreciation of mental health nursing. CONCLUSIONS: Experts by experience contribute to promoting positive attitudinal change in nursing students towards mental health nursing skills and knowledge. Attitudinal change is essential for the provision of high-quality mental health care in specialist mental health services and throughout the healthcare sector.

'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse.

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.

"It is much more real when it comes from them": The role of experts by experience in the integration of mental health nursing theory and practice.

PURPOSE: To examine nursing students' perceptions of Experts by Experience impact on theoretical and practical learning. DESIGN AND METHODS: Qualitative exploratory study involving focus groups with undergraduate nursing students from five European countries and Australia. Data were analyzed thematically. FINDINGS: Participants described positive impacts as: bridging the theory and practice gap through first-hand experience, including sub-themes: bringing theory to life; can't be taught any other way, and innovative teaching methods fueling curiosity. RELEVANCE TO CLINICAL PRACTICE: Integrating theory and practice is key for quality mental health nursing practice. Experts by experience can potentially contribute to reducing this enduring gap.

Expert by experience involvement in mental health nursing education: The co-production of standards between Experts by Experience and academics in mental health nursing.

WHAT IS KNOWN ON THE SUBJECT: Expert by Experience (EBE) involvement in mental health nursing education has demonstrated benefits, including enhancing understanding of holistic and recovery-focused practice and enhanced application of interpersonal skills. Structure and support for EBE involvement is lacking; often resulting in inadequate preparation and debriefing and tokenistic involvement. Service user involvement in mental health nursing education should be underpinned by lived experience perspectives. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: An exploration of EBE involvement in nursing education from the perspective of those with lived experience. The development of standards designed to provide structure to better support future EBEs involved in higher education. An exemplar for co-production of standards between EBE and nurse academics which has applicability for other contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The standards could potentially strengthen EBE involvement in mental health nursing education, enhance their confidence and increase the retention of EBEs by creating an inclusive working culture. By increasing support for EBEs, the benefits to mental health nursing practice are likely to be maximized. ABSTRACT: Introduction Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods Phase one used qualitative descriptive methods, involving focus groups with service users (n = 50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilized these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, "intervision," mutual mentorship, pre- and post-debriefing, role clarity and equitable payment. Conclusions These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education.

Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements.

Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.

'It is meant to be heart rather than head'; International perspectives of teaching from lived experience in mental health nursing programs.

Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co-produced between 'Experts by Experience' (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: 'there wasn't a barrier' described how personal narratives enhanced relationships between Experts by Experience and students; and 'made the human being visible', described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio-political, humanistic focus in mental health nursing, congruent with rights-based reform agendas.

Assessment of the Opening Minds Scale for use with nursing students.

PURPOSE: Evaluate the validity of the Opening Minds Scale (OMS) for nursing students via Rasch models and confirmatory factor analysis (CFA). DESIGN AND METHODS: Undergraduate nursing student responses to OMS (n = 423). Validity was evaluated via CFA and Rasch analysis. FINDINGS: CFA results were strongest for a three-factor 13-item version of OMS. Rasch modeling supported sound properties for two of three scales. Internal reliabilities ranged between 0.6 and 0.7. PRACTICE IMPLICATIONS: OMS has potential as a valid measure for stigma research and antistigma program evaluation. Rasch analysis suggest it is inappropriate to use a total OMS score for nursing student populations.

"I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience".

WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.

Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care.

Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial well-being and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.

'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education.

Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.

Nursing student attitudes to people labelled with 'mental illness' and consumer participation: A survey-based analysis of findings and psychometric properties.

BACKGROUND: Understanding student attitudes towards people diagnosed with mental illness is central to realising evidence-based nursing education and policy at an international level. Redressing stigmatised views can assist in preparing nursing students to work in mental health settings and support the active involvement of consumers in all aspects of mental health service delivery (known as: consumer participation) at individual and systemic levels. Accurate research on nursing student attitudes is dependent on the availability of valid and reliable measures. OBJECTIVES: Using data from and international study, this research sought to: (1) evaluate two measures of nurse student attitudes, and (2) explore whether attitudes to people labelled with a diagnosis of mental illness and who use mental health services is associated with more positive attitudes to consumer participation in mental health services. DESIGN: Self-report quantitative data gained via the Consumer Participation Questionnaire (CPQ) and Mental Health Nurse Education Survey (MHNES). SETTING AND PARTICIPANTS: University nursing students in Australia and Western Europe. DATA: Pooled CPQ and MHNES data from Australia, Ireland, Finland, Norway and the Netherlands. METHODS: The MHNES and CPQ were evaluated via exploratory factor analysis and Rasch modelling. Hierarchical regression was applied to see whether attitudes to mental illness and mental health practice relate to attitudes to consumer participation after addressing demographic differences. RESULTS: Refined MHNES scales demonstrated overall fit on Rasch models. Reliabilities for MHNES ranged from 0.82 to 0.73. Perceived value of mental health nursing to consumers and lower negative stereotypes were associated with positive attitudes to consumer participation independent of age, gender and country [F (9, 381) = 15.78, p < .001]. Students who considered mental health nursing made a valuable contribution represented the strongest association with a positive attitude towards consumer participation. CONCLUSIONS: Differences in openness to consumer participation are partly attributable to views about people diagnosed with mental illness and the perception that mental health practice makes a positive difference to these people within health service contexts.

Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study.

Reform to nursing education is essential to ensure future generations of nurses are strongly positioned to value, know, and deliver strength-based, recovery-oriented mental health practice. A promising pathway to effectively drive reform is the coproduction of curricula by nursing academics and people with lived experience of recovery from mental distress referred to as Experts by Experience. The Co-production in Mental Health Nursing Education (COMMUNE) project is an international collaboration for development and implementation of consumer coproduced curricula. This study evaluated the inclusion of Expert by Experience-led mental health nursing education on nursing students' attitudes to people labelled with mental illness, mental health nursing, and consumer participation. A repeated self-report measures design was implemented in Australia, Ireland, and Finland to ascertain level of generalizability of consumer involvement within undergraduate nursing programmes. Data were collected from nursing students (n = 194) immediately before and after the education module, using three self-report instruments on attitudes (Mental Health Nurse Education Survey, Consumer Participation Questionnaire, and Opening Minds Scale). Data were analysed using descriptive and inferential statistics. Eighty-nine per cent of the 27 points of change reflected more favourable and accepting attitudinal change. Of these, 41% were significant at Bonferroni adjusted alpha of 0.0025. There was a statistically significant increase in preparedness for practice in the mental health field in each of the three countries. The most pronounced change is related to the social and systemic inclusion of people with a diagnostic label and recovery-oriented care more broadly.

Nursing Students' Attitudes Towards People Diagnosed with Mental Illness and Mental Health Nursing: An International Project from Europe and Australia.

The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students' attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim.

The attributes of successful de-escalation and restraint teams.

Inpatient violence is a widespread problem on psychiatric wards often with serious consequences, and psychiatric hospitals have set up teams to de-escalate and restrain patients with aggression (D-E&R teams) which are specially trained to respond to it in a safe manner. Successful de-escalation and restraining of patients with aggression depend not only on the methods learned in training but also on the confidence of the team. Therefore, it is of great importance to understand the factors that enhance D-E&R teams' competence in managing patients with aggression in a successful and safe manner. The aim of this hermeneutic study was to identify and understand those factors. Purposive-expert sampling was used and twelve D-E&R team members with significant experience participated in the study. The central theme found was a safe team. Ensuring the safety of the team and its members was found to be a prerequisite for successful teamwork in managing patients with aggression in a safe manner. This central theme falls into two interacting domains: the internal dynamics of the team and the team's interaction with patients. Several themes, such as mutual trust, flexibility, and knowing one's role, influence these domains and hence strengthen or weaken the confidence and safety of the team. The findings of the study will contribute to a better understanding of these factors; understanding which could be used to improve the training, supervision, and quality assessment of D-E&R teams and hence lead to more safety in psychiatric wards.

'To be treated as a human': Using co-production to explore experts by experience involvement in mental health nursing education - The COMMUNE project.

Increasingly, experts as deemed by personal experience or mental health service use, are involved in the education of nurses; however, accompanying research is limited and focuses primarily on opinions of nurse educators and students. The aim of this study was to develop an understanding of the potential contribution to mental health nursing education by those with experience of mental health service use. The research was part of the international COMMUNE (Co-production of Mental Health Nursing Education) project, established to develop and evaluate co-produced mental health content for undergraduate nursing students. A qualitative descriptive design was adopted with data collected through focus group interviews in seven sites across Europe and Australia. Experts by experience (people with experience of distress, service use, and recovery) co-produced the project in partnership with nursing academics. Co-production enriched the process of data collection and facilitated the analysis of data from multiple perspectives. Two themes are presented in this paper. The first focuses on how experts by experience can enhance students' understanding of recovery by seeing the strengths inherent in the 'human' behind the diagnostic label. The second highlights the importance of communication and self-reflection on personal values, where students can explore their own thoughts and feelings about mental distress alongside those with lived experience. Interacting with experts by experience in the classroom can assist in challenging stigmatizing attitudes prior to nursing placements. These findings can be used to inform international nursing curricula by increasing the focus on nursing skills valued by those who use the services.