Healthcare staff's views on responding to suicide and self-harm: Part II.

PURPOSE: To report on healthcare staff's views of the barriers to preventing suicide and self-harm. DESIGN AND METHODS: Using a qualitative approach, data were collected through "World Café" discussion forums and written submissions, and analyzed using reflexive thematic analysis. FINDINGS: Healthcare staff, including psychiatric nurses, perceived that a whole of society approach was needed for suicide and self-harm prevention. Support for those at the front line is needed as well as clear referral pathways and interagency working. PRACTICE IMPLICATIONS: Formalized support for staff working in healthcare should be given with a flexible and inclusive approach to service delivery adopted.

Healthcare staff's views on responding to suicide and self-harm: Part I.

PURPOSE: To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm. DESIGN AND METHODS: A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis. FINDINGS: There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes. PRACTICE IMPLICATIONS: Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed.

"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.

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.

'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.

Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review.

BACKGROUND: Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. METHODS: Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. RESULTS: Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. LIMITATIONS: The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. CONCLUSIONS: Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.

"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.

Mental Health-Related Digital Use by University Students: A Systematic Review.

Introduction: Mental health problems are common among students at university, representing a major public health concern. The internet and new technologies are widely used by students and represent a significant resource to them for mental health information and support. Aim: The aim of this systematic review is to summarize and critique studies of mental health-related digital use (including purposes, advantages, and barriers) by students worldwide, to support the implementation of future digital mental health interventions targeting university students. Methods: We searched for peer-reviewed articles published between January 2008 and May 2018 by using Pubmed, Google Scholar, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, research design, recruitment and sampling, data collection, analysis method, key findings, and mean quality score. Outcomes were synthetized through the textual narrative synthesis method. Results: Of the 1,487 titles and abstracts screened, 24 articles were critically reviewed. Sample sizes ranged from 19 to 6,034 participants. The two key findings were that students worldwide have a high need for mental health information and are prepared to use digital tools for their mental health and well-being. However, they are currently struggling to discern trustworthy information online and are expressing a desire for reliable devices handling their sensitive data. Conclusions: Through the description of patterns in university students' mental health-related digital use, this review outlines important features for potential web- and mobile-based interventions for promoting mental health and preventing mental illness at the university.

'There need to be a balance': Mental health nurses' perspectives on medication education in university and clinical practice.

Working with medication is an important role of the mental health nurse. However, little research has focused on staff nurses' perspectives on where the responsibility lies for preparing student nurses for safe, competent medication management. This study investigated mental health nurses' perspectives on medication education. An interpretive descriptive approach was used. Two focus groups were conducted, and data were analysed using inductive content analysis. It was found that participants embraced a medical approach to servicer user care, with less positive attitudes demonstrated towards psychosocial approaches. There were also tensions expressed between clinical practice and the university, with uncertainty voiced about whose responsibility it was to educate students about medication management. It is important that both environments complement each other in order to enhance the student nurse educational experience. While mental health nurses should be educated in this area to practice in a safe and competent manner, it is also key that a holistic approach to care is considered.

Perceived importance and performance of clinical leadership in practice: A cross-sectional study of nurses and midwives of all grades.

AIM: To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice. BACKGROUND: Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice. METHODS: Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross-sectional study design (n = 324). The clinical leadership needs analysis instrument was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager. RESULTS: Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p < .01) and Financial & Service Management (p = .02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p < .01]. CONCLUSION: There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.

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.

"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.

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.

'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.

"A great stress among students" - mental health nurses' views of medication education: A qualitative descriptive study.

BACKGROUND: Registered mental health nurses report dissatisfaction with the level of medication knowledge demonstrated by undergraduate nurses. However, little is known about which particular areas staff nurses are concerned about, and how they feel education can be enhanced in both academic and clinical settings. OBJECTIVE: To investigate the views of staff nurses on the delivery of medication education to undergraduate mental health nurses. DESIGN: A qualitative descriptive design was adopted. METHODS: Two focus groups were held with registered nurses in two acute mental health facilities. Data were analysed using qualitative content analysis. RESULTS: The first theme reports on the difficulties staff nurses observed with both undergraduate and newly qualified nurses around medication. It was noted that these individuals had difficulties interpreting medication charts/Kardexes, and were unable to provide medication-related education to service users. The second theme reports on strategies to enhance medication education, as recommended by participants. It was suggested that more practical education should be delivered in academic settings, with a focus on simulation and presentations from clinical staff. In the clinical settings, it was suggested that preceptors should provide education at less busy times on the ward. CONCLUSIONS: This study gives insight into areas in which education needs to be strengthened, in order to improve the medication knowledge of undergraduate and newly qualified nurses. Further research is needed to develop evidence-based strategies to enhance this education.

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.