The Wisdom of Hindsight: Allies Reflections on Their Role in Supporting the Implementation of Expert by Experience Positions in Academia.

Experts by experience involvement in mental health education has consistently demonstrated positive attitudinal outcomes including a greater appreciation for recovery-focused practice. Mental health academic allies have played a crucial role in supporting implementation of expert by experience academic positions. To date the inclusion of their views in research is limited. The aim of this study was to explore and present allies' reflections on their involvement in supporting expert by experience academic roles in relation to "hindsight" and "foresight." A qualitative descriptive design was used, involving in-depth semi-structured interviews with allies who had supported the implementation of academic roles for experts by experience. Participants described the wisdom of hindsight. Based on their own experiences they emphasised the importance of, laying the groundwork, facilitating a supportive environment, contributing to meaningful, credible, and sustainable roles, and vision for the future as key to successful implementation. They also described a vision for the expansion of expert by experience roles in mental health education in the future. Allies' reflections suggest the importance of preparation to facilitate a smooth as possible implementation process and enhance the likelihood of successful outcomes. The transition to recovery-focused mental health services requires the attitudes of health professionals to change. The potential of experts by experience to influence attitudinal change can be enhanced by understanding the experiences and reflections of academic allies.

Changing 'the world for the better': motivations of mental health academics for supporting expert by experience roles in mental health education.

BACKGROUND: Despite demonstrating positive outcomes in education, academic positions for Experts by Experience in mental health have not been widely implemented. To date positions have been driven by individual champions (allies). Their motivation for this support has not yet been researched. AIMS: To deepen understanding of motivations of mental health academics who have championed and supported implementation of EBE positions. METHODS: A Qualitative exploratory, study was undertaken involving in-depth individual interviews with 16 academics with experience of actively supporting the implementation of Expert by Experience positions in academia. Data were analysed independently by two researchers using a structured thematic framework. RESULTS: Motivations commonly arose from allies' own experiences of working with or exposure to Experts by Experience. Other motivating factors included: belief in the value of specific knowledge and expertise Experts by Experience contributed to mental health education; and, identifying the essential role Experts by Experience play in meeting policy expectations, and the broader philosophy of the university. CONCLUSIONS: The motivations identified by allies in this study have implications for Expert by Experience roles. Deeper understanding of motivations to support these roles is essential to arguing for their value, and ultimately producing positive outcomes in the education of health professionals.

"Making It Happen": Supporting the Implementation of Positions for Experts by Experience in Mental Health Education.

Significant changes to mental health policy have positioned consumers of mental health services as active participants in all aspects of service design and delivery, leading to the development and expansion of consumer workforce roles (Experts by Experience [EBE]). Negative attitudes of health professions pose a major limitation to the success of these positions. EBE involvement in mental health education has shown favourable outcomes, particularly enhancing more positive attitudes. Unfortunately, these positions remain limited in number and scope and have largely been supported by individual clinical academic champions (allies). This article presents findings from a qualitative study, involving individual interviews that explored the experiences and perceptions of allies who supported the implementation of academic positions for EBE. Data were analysed thematically. "Making it happen" was the overarching theme identified. It comprised the sub-themes: strategic or opportunistic?; developing an argument; using evidence; showing what EBE bring; getting buy-in and utilising existing relationships. The articulation of these processes provides a useful guide to other allies interested in supporting the implementation of these positions. The implementation of further positions will ultimately improve the attitudes of other health professionals towards Expert by Experience roles.

'What's she doing here?' Overcoming barriers to the implementation of Expert by Experience positions in academia.

INTRODUCTION: Experts by Experience involvement in the education of health professionals has gained momentum as an important strategy in ensuring quality, person-centred education. Despite being a requirement for occupational therapy programs in Australia and internationally, involvement is variable and limited. Barriers to the implementation of academic roles have been identified, including negative attitudes of colleagues, systemic barriers, and insufficient evidence of their value. Mental health academics who do not identify as having lived experience (referred to as allies) have provided crucial support for Experts by Experience. Understanding their perspectives on implementation barriers and how they can be addressed is crucial to facilitating a broader level of meaningful involvement. METHODS: A qualitative exploratory research project was conducted, involving in-depth interviews with mental health academic allies (n = 16) from Australia, Ireland, and New Zealand. Participants were from the disciplines of nursing, occupational therapy, social work, and psychiatry. Data were analysed thematically. FINDINGS: Two main themes were identified from the data analysis process: convincing colleagues and dealing with university barriers. Participants described varying attitudes from colleagues towards Experts by Experience, with many not understanding or appreciating their contribution to education and student outcomes. At the university level, reluctance to embrace innovation and funding and other resource shortages presented impediments to the implementation of Expert by Experience roles. Participants described using creative measures to overcome institutional barriers and encourage greater acceptance of such roles by colleagues. CONCLUSION: This research describes how allies experienced and overcame barriers they faced when supporting the implementation of academic positions for Experts by Experience. Allies have an important role to play in overcoming systemic barriers, and the approaches they have taken to achieve this may be an important source of learning for others with similar aspirations.

Patient factors associated with incidents of aggression in a general inpatient setting.

AIMS AND OBJECTIVES: To determine patient factors associated with aggressive (code grey) events in the setting of a metropolitan hospital during a six-month period, to inform screening and prevention practices. BACKGROUND: Patient aggression continues to place nurses and patients at risk. Nurses need to be able to identify situations that are likely to escalate into aggression in order to ensure their own safety and the quality of care they can provide. Research has focussed on emergency departments and psychiatric units. Approaches that are appropriate for these settings may not fit for the general inpatient setting. DESIGN: A structured audit and epidemiological analysis of hospital population, regarding incidence of aggression. METHODS: A retrospective audit of code grey event reports and medical records of patients admitted to 16 general medical-surgical wards, during a six-month period. All available records of 121 code grey events were audited. Demographic factors for patients with code grey events were compared with factors for 6472 patients admitted. Statistical tests included chi-squared, bivariate and logistic regression. RESULTS: Diagnoses associated with increased risk of code grey were the following: delirium (11 times more likely) and dementia (seven times). Patients were more likely to have a code grey event if they were over 65 years of age (more than twice), were male (more than twice), were a recipient of Veterans' Affairs pension (four times), had never been married or had been admitted through the emergency department (almost twice). CONCLUSION: This study adds to the current knowledge of the distinctive profile of patients in medical-surgical settings who are associated with aggressive events. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurses increase their focus on assessment of identified risk factors and documentation of behaviours, to help predict aggressive events, and that this focus be supported by hospital safety and care policy.

'We only come from one perspective': Exploring experiences of allies supporting expert by experience leadership in mental health education.

INTRODUCTION: Academics from health professional backgrounds have a crucial role in supporting the implementation and sustainability of academic positions for experts by experience in mental health education. Perspectives and experiences of these academics have yet to be extensively explored. A deeper understanding will add to our understanding of this important role and provide guidance for academics with similar aspirations. AIM: The aim of the study was to explore the experiences of supporting academic positions for experts by experience in mental health education. METHODS: A qualitative exploratory design was utilised. In-depth interviews were conducted with academics who have actively supported academic positions for experts by experience. RESULTS: Allyship was a key theme identified. Participants described allyship as complex, time-consuming and rewarding, through three sub-themes: the tension of allyship, the impact of being an ally and interpersonal and relational issues with health professional academics. CONCLUSIONS: Allyship was influenced by the negative attitudes of many health professional academics, who do not appreciate the value of this work. IMPLICATIONS FOR PRACTICE: Allyship has a crucial role in enhancing experts by experience leadership in the education of health professionals. Understanding the experience of allyship will assist in further understanding and developing these important roles.

There is something about oppression: Allies' perspectives on challenges in relationships with experts by experience.

The genuine and meaningful involvement of Experts by Experience in the education of health professionals has consistently demonstrated positive attitudinal change in students. These changes are essential if policy goals for recovery-oriented services and service user participation in mental health services are to be realized. To date academic roles for Experts by Experience have often relied on the support of allies. Despite the important role allies play, research investigating their experiences is limited. The aim of this research was to explore allies' views on supporting implementation of the academic positions for Experts by Experience. A qualitative exploratory study was undertaken involving in-depth interviews with 16 allies. Data were analysed thematically. Challenges that can exist between allies and Experts by Experience was one theme identified from the data. Allies described occasional difficulties in their relationships with Experts by Experience where they felt they were perceived as representative of members of their broader profession with whom Experts by Experience had negative experiences. The perspectives of allies are presented in four subthemes: relationships imbedded in history; consequences of interpersonal stigma; supportive, protective or paternalistic?; and the passion remains, which describes allies' ongoing commitment to supporting Expert by Experience involvement. Understanding the challenges can assist allies to respond appropriately in a non-judgemental and supportive manner. Trauma informed practice may provide a useful framework to address conflicts and facilitate more positive relationships between allies and Experts by Experience. These positive relationships are essential to maximize the positive benefits of Experts by Experience on future clinicians.

The impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions: An integrative literature review.

Mental Health Nurse Consultants are advanced practice mental health nurses who consult with nurses and other health professionals in a general hospital setting. The aim of this review was to analyse and synthesize the available evidence related to the impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions. The integrative literature review method was utilized as it allows for the inclusion and integration of quantitative, qualitative, and mixed methods research which produces a synthesized understanding of data to inform practice, policy, and research. The Preferred Reporting Items of Systematic Review and Meta-Analyses guided the search strategy. All published studies examining the impact of clinical consultations provided by Mental Health Nurse Consultants on the mental health care of general hospital patients were included. The 19 selected articles were from North America, Australia, the United Kingdom, and Europe. Fifteen were quantitative, three were qualitative, and one used mixed methods. The findings highlight the role is generally positively received by hospital staff. The results indicate that clinical consultations provided by Mental Health Nurse Consultants (i) may improve patient experiences of mental health conditions, (ii) influence aspects of care delivery, (iii) are valued by staff, particularly nurses, and (iv) increase staff competence and confidence in the provision of mental health care. The review highlighted significant limitations of the available evidence, the need for contemporary discussion and debate of MHNC theory and practice, and further evaluation of the role to inform future service delivery.

Creating or taking opportunity: Strategies for implementing expert by experience positions in mental health academia.

WHAT IS KNOWN ON THE SUBJECT?: Experts by experience involvement in the education of health professionals demonstrate positive attitudinal change. Meaningful positions for Experts by Experience are limited and ad hoc, due to attitudinal and other barriers to innovation within the higher education sector. Experiences of allies who have supported the implementation of Expert by Experience positions have not been researched. This is important knowledge that could be utilized by potential allies. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Academic allies to experts by experience have a crucial role to play in identifying opportunities to establish, implement and sustain expert by experience positions. Allies who have successfully implemented positions for experts by experience have identified influential factors including: right person, right role, collaboration and coproduction, support, and career pathways. Understanding these factors can provide an important basis for other academics to support a widespread increase in academic roles for experts by experience in mental health education. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Establishing and maintaining genuine relationships with service users require significant attitudinal change on the part of mental health professionals. Involving experts by experience in mental health education provides an innovative approach to the challenging of attitudes and the enhancement of more collegial relationships with service users as colleagues in the workplace. This paper demonstrates the importance of allyship to the establishment, implementation and sustainability of expert by experience roles, and highlights critical factors allies have utilized in support of such roles. Nurses and other mental health professional academics have the potential to become allies and support change and innovation. ABSTRACT: Introduction Experts by experience in academia have demonstrated more positive student attitudes towards relationships with service users. Notwithstanding this supportive evidence, academic positions for EBE have not grown substantially. Enhanced understanding of positions that have been implemented is important knowledge for others with similar aspirations. Aim To enrich understanding of the role of allies in identifying and pursuing opportunities to support academic positions for experts by experience. Methods Qualitative exploratory approach, involving In-depth interviews with allies with expertise in supporting academic positions for experts by experience. Results Participants were enthusiastic about creating or taking opportunities to secure expert by experience involvement within their programs. Factors facilitating success included right person, right role, collaboration and coproduction, support and career pathways. Conclusions Significant barriers have prevented proliferation of academic roles for experts by experience. Despite barriers, allies have been successful in supporting the implementation and sustaining of positions, and gained considerable expertise, which may be invaluable to academics with similar aspirations. Implications for practice Realization of policy goals regarding service user involvement in mental health services requires health professionals with the will to embrace partnerships. By creating and taking opportunities, allies have developed expertise to facilitate implementation of positions more widely.

Understanding the impact of expert by experience roles in mental health education.

BACKGROUND: People with lived experience of mental distress and mental health service use (known as Experts by Experience) in mental health education have demonstrated positive outcomes and attitudinal change in students. Despite these findings, academic positions for Experts by Experience remain limited in number and scope, and the implementation of positions has primarily been driven by supportive mental health academics (known as allies). Less is known about the impact on Experts by Experience themselves, their colleagues and the broader organisation. OBJECTIVES: The aim of this research is to better understand the impact of EBE on the universities they work in, from the perspectives of allies who have supported the implementation and sustainability of their positions. DESIGN: Qualitative exploratory. SETTINGS: Academic institutions providing education programs for health professionals, and had implemented academic positions for Experts by Experience, in Australia, Ireland and New Zealand. PARTICIPANTS: Allies involved in supporting the implementation of Experts by Experience roles in mental health education (n = 16). METHODS: Ethics approval was obtained prior to study commencement. Individual in-depth interviews were conducted with 16 participants, based on a broad interview guide. Data were analysed to identify main themes. Analysis was conducted independently by two researchers and reviewed by the team. RESULTS: Participants described the impact of Experts by Experience in mental health education as positively influencing the participants themselves, the Experts by Experience, their colleagues, and the broader organisational culture. CONCLUSIONS: Support for the implementation of Experts by Experience roles must move beyond the efforts of allies alone. Demonstrating the benefits beyond student outcomes is crucial to achieving this goal. The positive impact for a broader range of stakeholders provides further evidence of the value of Experts by Experience and supports the need to develop a more strategic approach to implementation of these roles.

They are a different breed aren't they? Exploring how experts by experience influence students through mental health education.

Experts by Experience (EBE) in mental health are increasingly becoming involved in the education of health professionals. In response, research findings suggest positive attitudinal change towards people who experience mental distress and enhanced appreciation of recovery and person-centred approaches to practice. However, this growing body of evidence has not resulted in the broad adoption of these roles in academia. The perspectives of academics instrumental in implementing academic positions for EBE (referred to as allies) have not yet been articulated. Acknowledging this gap, the aim of this research was to explore experiences of allies involved in implementing EBE positions in academia regarding the impact of EBE led education on students. Qualitative exploratory methods were used involving in-depth interviews with allies. Data were analysed thematically. Participants observed significant positive impacts on students, as evidenced through four themes: contextualized learning, enhancing reflection, feedback from the clinical field, and students' own lived experience. The fifth sub-theme, Challenging experiences were observed to potentially detract from the student experience in some instances. Overall, participants were very supportive of EBE involvement and were confident this approach produced more person-centred and recovery-oriented clinicians, with the skills, knowledge and attitudes needed to work as practitioners. These findings support previous research and suggest positive implications for clinical practice and for students with their own mental health challenges.

Exploratory study of mental health consultation-liaison nursing in Australia: Part 2. Preparation, support and role satisfaction.

Mental health Consultation-Liaison (CL) nursing continues to develop and gain recognition as a subspecialty of mental health nursing. CL roles are particularly important given the significant number of people experiencing mental illness and other mental health problems within the general health-care settings. However, despite the potential value of these roles, the literature provides little information about these roles and about the nurses who work in these roles. This is the second part of a two-part paper describing a survey of CL nurses in Australia. Part 1 describes demographic data and characteristics of the CL role. Part 2 provides an exploration of the following factors: educational preparation, support, and work satisfaction. The findings identified specific educational needs in preparation and ongoing support for the role. However, overall the participants expressed a high level of satisfaction with their work. Given the current recruitment problems in mental health nursing, the promotion of the CL nursing role might enhance a more positive view of this branch of nursing.

Exploratory study of mental health consultation-liaison nursing in Australia: Part 1. Demographics and role characteristics.

Mental health nursing roles in Consultation-Liaison (CL) psychiatry and emergency departments are rapidly developing within Australia since the mainstreaming of mental health services within the general health-care system. Anecdotal evidence suggests that many of these positions have been initiated and developed in relative isolation and with little formalized support. Consequently, a comprehensive understanding of these roles and the nurses who occupy them is limited. A survey was developed and distributed to gather information on CL nurses in Australia. The survey was aimed at CL nurses working in a range of settings and included questions relating to demographics, qualifications, experience, clinical practice, organizational structure, education, clinical supervision, education and training and work satisfaction. This, the first of a two-part paper, will present the key findings relating to demographics and characteristics of the role. Overall, the findings demonstrated that the CL nurses who responded to the survey (n = 56) were experienced psychiatric/mental health nurses working primarily in general hospital wards and/or emergency departments; receive requests for consultation from a range of health professionals but predominantly nurses; provide education to a range of staff groups; and use a range of titles to identify their role.

The mental health nurse: a valuable addition to the consultation-liaison team.

Nurses, particularly those working in non-psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation-liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff. The impact of the introduction of a nursing position into an established consultation-liaison psychiatry service was evaluated using an activity audit, a staff attitude survey, and staff focus groups. The findings demonstrated that the addition of the nursing role to the consultation-liaison psychiatry service improved access of general hospital patients to specialist mental health care. It also provided valued expert assistance to staff in the provision of care to this patient group, particularly those with complex problems and significant psychiatric comorbidity. The study found that the nursing consultation was particularly helpful because of its focus on practical and care-orientated interventions. The model of practice that evolved out of this project is described and the findings support the use of both direct and indirect patient interventions as important psychiatric consultation-liaison nurse activities.

The psychiatric consultation-liaison nurse: thriving in a general hospital setting.

One outcome of mainstreaming of psychiatric services into the general health system is that nurses working in general hospitals now have increased contact with patients experiencing mental health problems. The literature suggests that general and comprehensive nurses do not believe they have the skills, confidence and knowledge to care adequately for patients in their care who have a mental health problems. The Psychiatric Consultation-Liaison Nurse (PCLN) can assist and educate general nurses in the care of patients with mental health problems who are receiving care in a medical/surgical setting. This study is based upon the findings of a Nurse Practitioner Pilot Study funded by the Department of Human Services (Victoria). In this paper the authors will present a brief overview of the role and model of practice of the PCLN, the means of referral, a profile of consultations and an overview of educational and policy development activity. The findings of the evaluation based on a combination of a Health Professional Satisfaction Survey and Focus Group Interviews will also be presented. The positive contribution of the PCLN to the confidence of nurses and how this might impact on patient outcomes will be highlighted. The value placed on the PCLN role by general hospital staff is evidence of psychiatric nursing not just surviving but thriving.

Clinical supervision for transition to advanced practice.

PURPOSE: This reflective paper offers a conceptual framework of clinical supervision that assists supervisors to create supportive relationships necessary for advanced practice development. CONCLUSIONS: Combining established concepts of clinical supervision with systems psychodynamics enhances the supervisory experience. It is useful to supervisors to understand role transition as it sensitizes them to what their supervisees experience. PRACTICE IMPLICATIONS: Nurses require support in role transition, especially when the systems into which they are introduced can struggle with new advanced roles. This framework offers a broadened lens that allows for the richness and complexities that go with the development of advanced practice to be explored and better understood.

Competence in providing mental health care: a grounded theory analysis of nurses' experiences.

OBJECTIVE: In view of the evidence that general nurses have difficulty in caring for patients experiencing mental health problems, the aim of this study was to explore and describe the subjective experience of nurses in providing care for this client group. DESIGN: A grounded theory approach was used. The data were collected via semi-structured individual interviews and analysed using the constant comparative method. SETTING: The study was conducted with nurses from general health care settings that provide medical and surgical care and treatment. SUBJECTS: Four nurses who were completing their second year post graduation participated in the study. MAIN OUTCOME MEASURE: The experiences of providing care for people experiencing a mental illness as described by participants. RESULTS: The findings indicated the nurses were striving for competence in the provision of mental health care. They acknowledged the mental health needs of patients and their right to quality care. CONCLUSIONS: This study supports the notion that general nurses lack confidence when caring for patients with mental health problems in medical and surgical settings. It also highlights a discrepancy between the holistic framework encouraged at undergraduate level and what is experienced in practice.

The role of a psychiatric consultation liaison nurse in a general hospital: a case study approach.

Growing support for the role of the psychiatric consultation-liaison nurse in assisting general nurses in caring for patients experiencing mental health problems in the general hospital environment is evident from the relevant literature. However, there remains a paucity of research which examines the process of this nursing role or its impact on outcomes for nurses and patients. This paper seeks to contribute to the literature in articulating the role of the psychiatric consultation-liaison nurse using a case study approach to describe the role of the nurse in assessing the needs of, and, planning and providing care to two general hospital patients experiencing mental health problems, and the general nurses caring for them.