Perceptions of service user and carer involvement in healthcare education and impact on students' knowledge and practice: a literature review

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers.

ABSTRACT

Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators.

EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning

WHAT IS KNOWN ON THE SUBJECT?: UK NHS policy highlights the importance of user and carer involvement in health professional training. We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals. 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses. There is limited data on how best to prepare and support potential service user and carer trainers. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals. Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others. A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future. Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff. It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties. Training for service users and carers must be offered alongside ongoing support and supervision. Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning. Service users and carers may feel more involved in care planning in future.

ABSTRACT

Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training.

Expert patient illness narratives as a teaching methodology: A mixed method study of student nurses satisfaction

OBJECTIVE

To evaluate nursing students' satisfaction with Expert Patient Illness Narratives as a teaching and learning methodology based on patient involvement.

METHODS AND DESIGN

Mixed methods were used in this study: online survey with quantitative and qualitative items designed by researchers.

SETTINGS AND PARTICIPANTS

Sixty-four nursing students of the Universitat Autònoma de Barcelona, attending a Medical Anthropology elective course.

RESULTS

Women more frequently considered that the new learning methodology was useful in developing the competency "to reason to reason the presence of the triad Health-Illness-Care in all the groups, societies and historical moments" (p-value=0.02) and in that it was consolidated as a learning outcome (p-value=0.022). On the other hand, men considered that this methodology facilitated the development of critical thinking (p=0.01) and the ability to identify normalized or deviant care situations (p=0.007). Students recognized the value of Expert Patient Illness Narratives in their nursing training as a way to acquire new nursing skills and broaden previously acquired knowledge. This educational innovation improved nursing skills and provided a different and richer perspective of humanization of care.

CONCLUSIONS

The results of the present study demonstrate that nursing students found Expert Patient Illness Narratives satisfactory as a learning and teaching methodology, and reported improvement in different areas of their training and also the integration of new knowledge, meaning, theory applicability, as well las critical and reflective thinking. Involvement of patients as storytellers also provides a new humanizing perspective of care. Nonetheless, further studies of Expert Patient Illness Narratives are needed in order to improve its benefits as a teaching and learning methodology.

Does hearing the patient perspective improve consultation skills in examinations? An exploratory randomized controlled trial in medical undergraduate education

PURPOSE

Medical education increasingly includes patient perspectives, but few studies look at the impact on students' proficiency in standard examinations. We explored students' exam performance after viewing video of patients' experiences.

METHODS

Eighty-eight medical students were randomized to one of two e-learning modules. The experimental group saw video clips of patients describing their colposcopy, while the control group viewed a clinician describing the procedure. Students then completed a Multiple Choice Questionnaire (MCQ) and were assessed by a blinded clinical examiner in an Objective Structured Clinical Examination (OSCE) with a blinded simulated patient (SP). The SP scored students using the Doctors' Interpersonal Skills Questionnaire (DISQ). Students rated the module's effect on their skills and confidence. Regression analyses were used to compare the effect of the two modules on these outcomes, adjusting for gender and graduate entry.

RESULTS

The experimental group performed better in the OSCE than the control group (odds ratio 2.7 [95%CI 1.2-6.1]; p = 0.016). They also reported significantly more confidence in key areas, including comfort with patients' emotions (odds ratio 6.4 [95%CI 2.7-14.9]; p < 0.0005). There were no other significant differences.

CONCLUSION

Teaching that included recorded elements of real patient experience significantly improved students' examination performance and confidence.

The role of service-user feedback in undergraduate nursing courses

There is an increasing expectation that service users should contribute in a meaningful way to student nurse education courses. This article describes how service-user feedback on undergraduate student nurses' performance during practice learning opportunities (PLOs) gives an insight into the qualities service users value in student nurses. At Cardiff University, the new Bachelor of Nursing course, launched in September 2012, took into account the Nursing and Midwifery (NMC) standards for preregistration, implementing a mechanism for service users to feed back on students' clinical performance. To facilitate this service, user/carer feedback pages were inserted into the students' bound clinical practice portfolio. A large sample of the clinical portfolios (n=100) from one cohort across adult, child and mental health nursing fields were examined at the end of year 1, year 2 and again at the end of year 3, and service users' comments collated. In considering the words used by service users, the authors propose that they reflected the six fundamental values-or 6Cs-of care, compassion, competence, communication, courage and commitment that underpin the delivery of excellent care. Conclusions drawn from the feedback were that students exhibited the caring and professional qualities that service users value, and indeed showed the dignity and respect for patients and people that the profession demands.

Patients with COPD tell their stories about living with the long-term condition: an innovative and powerful way to impact primary health care professionals' attitudes and behaviour?

BACKGROUND

Sub-optimal adoption of evidence based practice by primary health care professionals (PHCPs) is affecting the health of people with chronic obstructive pulmonary disease (COPD). This paper shows how 'patient stories' were used to engineer professional and organisational change.

METHODS

'Stories' were transmitted via a pre-planned question and answer session involving patients and carers. The impact on PHCPs' attitudes and behaviour was explored through observing the session, open-text questionnaires completed by the PHCPs at the end of the session and clinician interviews.

FINDINGS

The stories about living with COPD, told by patients and their carers, were found to be an innovative and powerful way to impact PHCPs' attitude and behaviour. Strong motivational context was created, in which clinicians were able to see the relevance of learning through active engagement with real people.

CONCLUSION

Long term conditions such as COPD have long term implications for the daily lives of patients and their carers. Hearing about these consequences in 'the first person' is an influential training tool with a powerful impact on PHCPs' attitudes and behaviour.

From Surviving to Advising: A Novel Course Pairing Mental Health and Addictions Service Users as Advisors to Senior Psychiatry Residents

OBJECTIVE

The authors describe a novel course that pairs service users as advisors to senior psychiatry residents with the goals of improving the residents' understanding of recovery, reducing negative stereotypes about people in recovery, and empowering the service users who participated.

METHODS

Service users who had experience working as peer support workers and/or system advocates were selected for a broad and deep understanding of recovery and an ability to engage learners in constructive dialogue. They met monthly with resident advisees over a period of 6 months. They were supported with monthly group supervision meetings and were paid an honorarium. Quantitative evaluations and qualitative feedback from the first two cohorts of the course, comprising 34 pairs, are reported here.

RESULTS

The first cohort of residents responded with a wide range of global ratings and reactions. In response to their suggestions, changes were made to the structure of the course to create opportunities for small group learning and reflective writing and to protect time for residents to participate. The second cohort of residents and both cohorts of service users gave acceptably high global ratings. Residents in the second cohort described gaining a number of benefits from the course, including an enhanced understanding of the lived experience of recovery and a greater sense of shared humanity with service users. Advisors described an appreciation for being part of something that has the potential for changing the practice of psychiatry and enhancing the lives of their peers.

CONCLUSIONS

Positioning service users as advisors to psychiatry residents holds promise as a powerful way of reducing distance between future psychiatrists and service users and facilitating system reform toward person-centered recovery-oriented care.

The patient ' s voice in health and social care professional education

Purpose

– The purpose of this paper is to present a statement about the involvement of patients in the education of health and social care professionals developed at an international conference in November 2015. It aims to describe the current state and identify action items for the next five years.

Design/methodology/approach

– The paper describes how patient involvement in education has developed as a logical consequence of patient and public participation in health care and health research. It summarizes the current state of patient involvement across the continuum of education and training, including the benefits and barriers. It describes how the conference statement was developed and the outcome.

Findings

– The conference statement identifies nine priorities for action in the areas of policy, recognition and support, innovation, research and evaluation, and dissemination and knowledge exchange.

Originality/value

– The conference statement represents the first time that an international and multidisciplinary group has worked together to assemble in a single document specific priorities for action to embed the patient’s voice in health professional education.

Partage du savoir expérientiel : regard sur la contribution des patients partenaires d’enseignement en sciences infirmières

L’article vise à répertorier les principaux écrits scientifiques portant sur la contribution du patient partenaire d’enseignement dans les cours de professionnels de la santé. Cette recension des écrits ciblant 26 articles permet d’identifier les différents rôles du patient partenaire, ainsi que les retombées et les défis de son introduction dans le continuum de formation selon la perspective des patients partenaires, des étudiants et de l’équipe professorale. En discussion, les éléments de la recension sont mis en relation avec les réflexions des auteurs sur leur propre expérience d’enseignement.

A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim

The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the interprofessional education (IPE) and collaborative practice empirical literature from 2008 to 2013 focused on the impact of this area of inquiry on the outcomes identified in the Triple Aim. The preferred reporting items for systematic reviews and meta-analyses methodology were employed including: a clearly formulated question, clear inclusion criteria to identify relevant studies based on the question, an appraisal of the studies or a subset of the studies, a summary of the evidence using an explicit methodology and an interpretation of the findings of the review. The initial search yielded 1176 published manuscripts that were reduced to 496 when the inclusion criteria were applied to refine the selection of published manuscripts. Despite a four-decade history of inquiry into IPE and/or collaborative practice, scholars have not yet demonstrated the impact of IPE and/or collaborative practice on simultaneously improving population health, reducing healthcare costs or improving the quality of delivered care and patients' experiences of care received. We propose moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.

Service user involvement in practitioner education: Movement politics and transformative change

This paper will attempt to celebrate both key developments and best practice involving the users of health and social care services in programmes of practitioner education in a UK context, and offer a critical appraisal of the extent to which such initiatives meet some of the more transformative objectives sought by service user activists for change. The approach is largely that of a discussion paper but we will illustrate some of the themes relating to movement activism with selected data. These data relate to earlier research and two specially convened focus groups within the Comensus initiative at the University of Central Lancashire; itself constituted as a piece of participatory action research. We conclude that universities represent paradoxical sites for the facilitation of debate and learning relevant to key issues of social justice and change. As such, they are places that can impede or support movement aims. Particular strategic responses might be more likely to engender progressive outcomes. These ought to include the presence of critically engaged academic staff operating within a scholarly culture that fosters forms of deliberative democratic decision making.

Patients' approaches to students' learning at a clinical education ward--an ethnographic study

BACKGROUND

It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting.

METHODS

An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach.

RESULTS

The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students.

CONCLUSIONS

Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients actively participating in students' learning and they both experience it as a joint action. An attending relationship is based on a one-way relationship between patients and students resulting in patients passively participating by letting students to practice on their bodies but without engaging in a learning dialogue with the students.

Medical students' learning from patient-led teaching: experiential versus biomedical knowledge

The aim of this study was to explore how medical students perceive the experience of learning from patient instructors (patients with rheumatism who teach health professionals and students) in the context of coupled faculty-led and patient-led teaching session. This was an explorative study with a qualitative approach based on focus group interviews. Analysis was based on a prior developed model of the characteristics of learning from patient instructors. The authors used this model as sensitizing concepts for the analysis of data while at the same time being open to new insights by constant comparison of old and new findings. Results showed a negotiation both between and within the students of the importance of patients' experiential knowledge versus scientific biomedical knowledge. On one hand students appreciated the experiential learning environment offered in the PI-led sessions representing a patient-centred approach, and acknowledged the importance of the PIs' individual perspectives and experiential knowledge. On the other hand, representing the scientific biomedical perspective and traditional step-by step teaching, students expressed unfamiliarity with the unstructured experiential learning and scepticism regarding the credibility of the patients' knowledge. This study contributes to the understanding of the complexity of involving patients as teachers in healthcare education and initiates a discussion on how to complement faculty-led teaching with patient-led teaching involving varying degrees of patient autonomy in the planning and delivering of the teaching.

A patient-led educational program on Tourette Syndrome: impact and implications for patient-centered medical education

BACKGROUND

Graduate medical education about Tourette Syndrome does not typically focus on understanding the perspectives and perceptions of individuals with the condition.

PURPOSES

Explore the impact of patient-centered, patient-led education programs on participant knowledge and empathy for patients.

METHODS

Seventy-nine medical residents and students at five training sites in New Jersey attended patient-led presentations. Results were obtained using a pretest-posttest design assessing physician empathy, using the 10 perspective-taking items from the Jefferson Scale of Empathy. Additional understanding of residents' experience was obtained by analyzing participant generated reaction statements.

RESULTS

A factorial ANOVA (pretest, Posttest × Gender × Specialty) revealed a significant increase (p < .05) from total pre-presentation scores to total post-presentation scores indicating that participants endorsed a more empathic view following the patient-led presentation. Participant statements revealed themes concordant with the practice of patient-centered medicine.

CONCLUSIONS

Providing patient-led educational presentations to medical residents can increase physician empathy, increase knowledge of Tourette Syndrome, and support the advancement of patient-centered medical education.

Service user and carer participation in an endoscopy nursing programme

This article reports an initiative to improve students' insight into service user and carer experience of endoscopy, particularly those with severe disability, such as spinal cord injury. This insight has the potential to improve the information provided and level of person-centred care in an endoscopy service. It was evident in the feedback from the classroom encounter that the teaching and learning strategy had a positive outcome, which will allow us to integrate the approach into future curriculum development and delivery, bringing the lived experience from the service user and carer perspective into the classroom. Students engaged in discussion and used their reflective skills to develop sensitivity to those with physical disability and complex needs requiring endoscopy procedures.

A systematic review of the evidence on service user involvement in interpersonal skills training of mental health students

Service user involvement has become a common feature of education programmes for mental health students. However, little is known about the effects of this type of education on the interpersonal skills of students taking part. This paper reports findings from a systematic review that formed part of a wider investigation into service user involvement in teaching interpersonal skills. The review aimed to locate and assess the quality of the published evidence relating to the effects of service user involvement on mental health students interpersonal skills and to synthesize results, using a definition of interpersonal skill that includes attitudes, empathy and skills as its key components. Results from this study indicate that the quality of evidence in this area is poor. However, sufficient synthesis of the evidence base was possible to allow conclusions and recommendations for both research and practice. Conclusions were that the involvement of service users in this area is both acceptable and valuable for students and had specific impacts on attitudes, empathy and skills. Some difficulties and reservations about the style of involvement are discussed. Recommendations for the conduct of future research are also made.

Service users' perceptions regarding their involvement in a physiotherapy educational programme in the UK: a qualitative study

BACKGROUND

The impact of user involvement in allied healthcare education is complicated by a lack of understanding of this concept both practically and ideologically. It is important to analyse whether service users perceive taking part as an 'honour' or as 'agents of change'.

OBJECTIVE

This study explored service users' perspectives of their involvement in a UK college-based physiotherapy educational programme.

METHOD

A Grounded Theory approach utilising semi-structured interviews was conducted with eight of the service users who took part in the physiotherapy programme. The analysis of the interviews was carried out according to a grounded theory framework.

RESULTS

All the service users wished to foster a sense of a partnership and communicate what it was like on the 'other side'. Their personal agendas and possible motivation for taking part were to challenge the students assumptions regarding disability, to give something back for their healthcare and to communicate their dissatisfaction with present healthcare provision.

CONCLUSION

The participants felt that they could be instrumental in a process of change. One way to address this is to include this programme as an integral element of the current move towards life-long learning that supports their professional development in a range of authentic situations. Their reflexive dialogues with the service users can be documented as part of a reflexive portfolio with the service users as mentors.

Pitfalls, perils and payments: service user, carers and teaching staff perceptions of the barriers to involvement in nursing education

BACKGROUND

There is an impetus to involve service users and carers in the education of nurses and a general consensus in the literature about the benefits that this brings to all involved. Whilst these benefits are well rehearsed in the literature there is little written about the potential barriers to service user and carer involvement in nurse education.

OBJECTIVE

The objective of this study was to investigate service users, carers and staff views on the potential barriers to becoming engaged in nurse education.

DESIGN

A qualitative study using focus group discussions (FGD) was used to canvas the views of service users, carers and teaching staff.

SETTING

A large school of nursing in the North West of England.

PARTICIPANTS

38 service users and carers recruited from the North West of England and 23 nursing and midwifery teachers and lecturers.

METHODS

Focus group discussions were employed as the main data collection method. The data were analysed using thematic analysis.

RESULTS

Six themes occurred in the data as being negatively associated with potential and actual involvement: not knowing the context of the group, lack of preparation of the group, not being supported, not being allowed to be real, not receiving feedback, not being paid appropriately.

CONCLUSIONS

The process of involvement is not without difficulties. These data show that some consideration needs to be given to the potential barriers to involvement if the engagement of service users and carers is to be effective.

User involvement in health and social care education: a concept analysis

This paper presents an evaluative discussion of the literature, and findings from a concept analysis which explores user involvement in the context of health and social care higher education in the United Kingdom. User involvement is increasingly a requirement in higher education and the purpose of the concept analysis was to clarify and elucidate the meaning and nature of the concept. Walker and Avant's (2005) eight step framework for concept analysis was used to provide understanding of the underlying attributes and a model for critique and meaningful evaluation and research. A structured search and discussion of contemporary literature was undertaken. A model case is identified along with antecedents, critical attributes and consequences. The complexities of involvement are delineated with a recommendation for robust research that explores the benefits of involvement.

Patients assessing students' assignments; making the patient experience real

The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work.

Involving people with learning disabilities in nurse education: towards an inclusive approach

There is limited evidence that explores how to effectively include people with learning disabilities in nurse education in the U.K. The majority of reported work relates to mental health nursing and social work training (Morgan and Jones, 2009). This paper specifically reports on the processes and activities undertaken by the authors with people with learning disabilities in the development of a new BSc learning disability nursing programme, a specific branch of nursing in the U.K. In doing so, findings and discussion from two separate projects involving students and people with learning disabilities will be integrated into the paper. EPICURE (Engagement, Processing, Interpretation, Critique, Usefulness, Relevance and Ethics (Stige et al. 2009) is adopted as a qualitative framework throughout the paper to evaluate the reported work that took place between September 2006 and October 2010. Suggestions are therefore made regarding the benefits and challenges of striving towards an inclusive approach to user involvement in nurse education, with particular reference to learning disability. The work presented in the paper demonstrates how through careful involvement of this population, deeper learning opportunities for all nursing students can be created.

Service user involvement in nurse education: a report on using online discussions with a service user to augment his digital story

Service user involvement is a key element within current pre- and post-registration nurse education in the U.K. but achieving this is challenging. Most service user involvement is through classroom visits. Digital stories, film and audio are alternatives but lack the interactivity and development of reflection that can be achieved through face-to-face contact. This report reviews the background to service user involvement in healthcare professional education then provides a reflective account of a novel initiative whereby a spinal-injured patient was involved in creating a digital story around some of his in-hospital experiences and then engaged in online discussions with post-registration nursing (degree) and practice educator (masters) students. These discussions provided a richer experience for the students enabling them to reflect more deeply on how nursing care is delivered and perceived by service users. The report concludes that digital stories can be used with repeated groups to inspire discussion and reflection. Augmenting such digital stories with online discussions with the service user whose story is told helps practitioners develop greater empathy, insight and understanding which are beneficial for improving service delivery and nursing care.

The value of involvement from the perspective of service users and carers engaged in practitioner education: not just a cash nexus

This paper presents qualitative findings emergent from a participatory action research (PAR) study focused on developing service user and carer involvement in a university setting. The involvement of these experts by experience in practitioner education for health and social care, and nursing in particular, is now an international phenomenon. Adhering to the philosophy and practices of PAR, the project and the writing of this paper have been collectively produced. Data has been organised using simple thematic analysis into three broad themes accounting for different ways in which participating service users and carers obtain a sense of value from their involvement. We have titled these themes: a more positive sense of self; social and relational benefits; altruism in activism. Drawing on these participant narratives we develop an understanding of the relationship between involvement and reward that does not simply reflect value in payment.

Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm

OBJECTIVE To engage a group of people with relevant lived experience in the development of a text-messaging intervention to reduce repetition of self-harm. BACKGROUND Contact-based interventions, such as follow-up letters, postcards and telephone calls, have shown potential to reduce repetition of self-harm in those who present at Accident and Emergency departments. Text messaging offers a low-cost alternative that has not been tested. We set out to develop a text-based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. METHOD We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. RESULTS Service users rejected both the idea of a generic, 'one size fits all' approach and that of 'audience segmentation', maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self-efficacy messages and store them in a personal message bank for withdrawal at times of crisis. CONCLUSIONS This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design.

The relationship between the genetic counseling profession and the disability community: a commentary

Since the inception of the field of genetic counseling, the profession has had a tenuous relationship with the disability community. Genetic counselors both offer prenatal diagnostic testing that allows individuals the opportunity to avoid the birth of a child with a disability and they advocate for the rights of individuals who have a disability. Some in the disability rights community have argued that they feel their lives and the lives of the disabled individuals in their families judged by the offer of prenatal genetic diagnosis and by the attitudes of genetic service providers they encounter in clinical settings. Select voices from the disability community fear that the result of developing technologies may contribute to a world less tolerant of disabilities. The available empirical data suggest that genetic counselors do little to counteract these perspectives. Although limited, investigations into the attitudes and practices of genetic counselors suggest that they have a more negative perspective on disabilities than individuals whose lives are directly affected by them and these attitudes may affect their description of disabling conditions in a prenatal setting. The National Society of Genetic Counselors, the organization that represents the profession in the US has more publicly aligned itself with abortion service providers over disease advocacy organizations, thus subjecting itself to the perception of bias. We suggest possible solutions to these criticisms and argue that individually and collectively, genetic counseling professionals should develop and identify opportunities to more fully support and advocate for the needs of a broader spectrum of clients.

An evaluation of students' perceptions of a college-based programme that involves patients, carers and service users in physiotherapy education

BACKGROUND

There is little evidence of the integration of UK physiotherapy university education into clinical practice, and some students say that they are not adequately prepared for professional life. This was addressed by a college-based programme involving patients, carers and service users as facilitators of learning to enhance the partnership between health professionals and patients.

PURPOSE

This programme has been running for 2 years, and this paper is an evaluation of the students' perceptions of it, appraising the outcomes of their learning in order to discover the ways in which it can be enhanced, improved or changed.

METHODS

A grounded theory approach utilizing focus groups and semi-structured interviews was conducted. Three focus groups representing the higher educational levels 4-6 in pre-registration physiotherapy were carried out. Following the analysis of the focus groups, seven interviews reflecting the three educational levels were conducted in order to explore in greater depth the findings from the focus groups. The analysis of the focus groups and the subsequent interviews were carried out in accordance with a grounded theory framework.

RESULTS

The students perceived the programme as a context in which to think how their learning needs could be met within a 'real' framework but on their own territory. Equally, it created feelings of anxiety at being given such an open forum that created a challenge to their communication skills. Many expressed a wish for a more explicit mentoring-learning environment. They also perceived a tension between the technical-rational demands of academia and social practice and a need to view this as a basis for critical appraisal and self-awareness.

CONCLUSION

This programme appeared to be integral to the students' development as future physiotherapists.

Involving patients in clinical education

The interdependent relationship between the clinical teacher, the learner and the patient is a vital part of clinical education. Changing health services and patient expectations have stimulated the need for teachers to consider patients' rights and needs as active participants and partners in clinical teaching.

Service user and carer involvement in learning and teaching: a faculty of health staff perspective

As part of a larger evaluation study, 20 members of staff in a Faculty of Health were interviewed about the impact of service user and carer involvement on learning and teaching. A qualitative approach was adopted and semi-structured interviews were used to explore current levels of involvement, barriers and solutions. The data generated was analysed using the principles of grounded theory. Findings suggest respondents recognised the requirement to involve service users and carers in their learning activities. Most wanted to develop this aspect of their educational provision but a number of barriers were described. Strategic and operational solutions were proposed to overcome these and respondents were positive about achieving meaningful involvement.

Active patient involvement in the education of health professionals

CONTEXT

Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care.

METHODS

We reviewed and summarised the literature on active patient involvement in health professional education.

RESULTS

A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are 'one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as 'patient'!) that are contentious and confusing.

CONCLUSIONS

We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services.