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

Exploring the Needs of Stakeholders For Successful Patient Involvement in Mental Health Education

Objective

This scoping review aims to comprehensively map the existing literature on Patient Involvement (PI) in mental health education (MHE), identify the needs of mental health (MH) educators, students, and patients with lived experiences of MH challenges and develop a checklist for successful implementation of PI in MHE.

Methods

Conducted between November 2023-January 2024, this review followed PRISMA-ScR guidelines in databases PubMed, Scopus, ProQuest Dissertations and Theses, and WHO. Eligibility criteria adhered to PICOS guidelines, and screening was done via Covidence. Content analysis was carried out to develop a checklist.

Results

Eleven qualitative articles were found, revealing two superordinate stakeholder needs categories: Interpersonal and Course Needs. Interpersonal Needs included Self-determination, Communication and Collaboration, Recognition and Support, and Holistic approach. Course Needs comprised Content, Organisational, and Teaching. A checklist was developed to support PI in MHE.

Conclusion

Guidelines for successful PI in MHE should prioritize patient autonomy, foster collaboration, provide support, ensure inclusive course content, and promote patient involvement in educational processes. Study limitations, such as potential bias, underscore the need for future research to enhance evidence-based practices in MHE.

Service Users' Participation in Mental Health Nursing Education: Quasi-Experimental Design With Blended Learning Model

Nursing students' negative perceptions of and reduced interest in individuals experiencing mental health challenges could lead to problems such as deteriorating quality of mental health nursing and lack of competent, qualified mental health nurses. Promoting changes and developments in mental health nursing education for greater effectiveness is pivotal. This study aimed to develop, introduce and validate a blended learning service user involvement programme for mental health nursing education-the first of its kind in South Korea. This study is reported according to TREND guidelines. The experimental group's scores for attitudes and empathy with individuals experiencing mental health challenges increased significantly after taking the 6-week service user involvement class. The experimental group achieved higher scores for knowledge of mental health nursing, satisfaction, and confidence in performance than the control group, which attended a traditional-style class. However, no significant difference was found between groups in changes in attitudes towards and empathy with individuals experiencing mental health challenges. The service user involvement class could improve some students' knowledge of mental health nursing and confidence, but providing the course in a single semester is not sufficient to improve students' attitudes towards and empathy with individuals experiencing mental health challenges. Therefore, an appropriate approach to more systematic long-term planning should be developed, and public perception should be improved. Additionally, long-term studies should evaluate the sustainability and progression of changes in attitudes and empathy over time. We recommend developing mental health nursing education programmes with diverse designs and structures.

Embedding Service User Experience ('Experts by Experience') Into Undergraduate Mental Health Nursing Education: A Co-Production Research Project

Internationally, the need to have service user involvement (the 'voice' of recovery journeys) as an established and significant feature on the landscape of professional development has been widely discussed in the area of mental health nursing (MHN) education for over a decade. Service user involvement contributes to a different understanding, bringing 'new' ways of knowing in nursing education and potentially new ways of practicing within mental health services. The objective of this co-produced research was to investigate the current local 'state of play' of service user involvement in MHN student education in a regional university in the Republic of Ireland. This was not research 'on' participants as conventionally conceived, but rather research 'with' participants as co-researchers. Therefore, a group of people [i.e., 'experts by experience/service users' (n = 2), 'student nurses' (n = 2), 'nurse academics' (n = 2)], came together by agreement in recognition of a problem (service user engagement in education) to seek local knowledge and through 'creative dialogue' to identify potential improvements/developments. The key outcomes concentrated on the need for person-centred care to be more than a one-off lecture in a course, but to be central to MHN education and ongoing practice. The need for MHNs to be educated to grasp that the individual they work with is not 'an island', but is connected to a wider network of family, friends and potentially peer support workers, etc. is highlighted. To enhance MHN education going forward, there is a need for 'lived experience' to be a consistent element of education programmes. Achieving this will require stable working relationships with the establishment of career pathways for 'experts by experience' to develop skills and experience in education settings. The pace of culture change in MHN education is sporadic at best and downright slow at worst. However, a lot has been done, but there is more to do: 'We've come a long way, but we still have a long way to go…'.

A Scoping Review of Australian New Graduate Nurse Preparation to Work in Mental Health Settings

Objectives: The review explores current evidence on Australian pre-registration nurse education in preparing graduates to work in mental health settings, from the perspectives of the graduates. Design: A scoping review using the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was undertaken. Results: There were 31 eligible publications, reporting 12 qualitative studies, eight surveys and 11 quasi-experimental studies. All were in English language peer reviewed journals, published between 2000 and July 2023. Five themes emerged: 1. Well-organised and supported clinical placements can reduce stigma; 2. Student concerns regarding mental health clinical placements can be lessened when placements are well-designed; 3. Well-organised and resourced clinical placements can increase interest in mental health nursing; 4. Simulation learning can increase confidence during clinical placements; 5. Teaching by Experts By Experience (EBE) can reduce stigma and improved student attitudes. Conclusion: Evidence from 31 eligible publications indicated that properly resourced, purpose-designed theoretical and clinical learning experiences can be effective in reducing stigmatising attitudes and behaviours in pre-registration nursing students. Involving EBEs in mental health teaching is an important, but so far under-utilised, development in pre-registration nursing programmes in Australia.

How to Partner With Persons Living With Mental Health Conditions: A Guide for Meaningful Simulation Cocreation

SUMMARY STATEMENT

Screen-based simulation is an effective educational strategy that can enhance health care students' engagement with content and critical thinking across various topics, including mental health. To create relevant and realistic simulations, best-practice guidelines recommend the involvement of experts in the development process. We collaborated with persons with lived experience and community partners to cocreate a mental health-focused screen-based simulation. Cocreating meant establishing a nonhierarchical partnership, with shared decision-making from start to finish.In this article, we present 8 principles developed to guide our cocreation with persons with lived experience: person-centeredness, trauma-informed approaches and ethical guidance, supportive environment, two-way partnership, mutual respect, choice and flexibility, open communication, and room to grow. These principles provide practical guidance for educators seeking to engage the expertise of persons who have been historically disadvantaged in society. By sharing these principles, we strive to contribute to a more equitable process in simulation development and promote meaningful, respectful, and safer collaborations.

Consumer Involvement in Psychiatric Nursing Education: An Analysis of South Korean Students' Experiences

This study examined the experiences of South Korean nursing students in a psychiatric nursing class with consumer involvement. Data on 98 nursing students were collected in June 2021 and analysed using content analysis of participants' journals. Our qualitative study design adheres to the COREQ checklist for qualitative studies. Four main categories and subcategories were identified: (1) reflection, (2) learning, (3) preparation for the future, and (4) requirements. The findings demonstrated that applying consumer involvement to psychiatric nursing education is an innovative and effective strategy to correct negative prejudices among nursing students against people with mental illness.

Embedding lived experience expertise across the mental health tertiary education sector: An integrative review in the context of Aotearoa New Zealand

WHAT IS KNOWN ON THE SUBJECT?: An important step towards improving mental health outcomes is the realignment of tertiary mental health education and research in a way which places strategic value on experience-driven involvement in mental health and addiction-related care. One of the most widely recognized ways of achieving this is by increasing representation of individuals with first-hand experience of mental health and addiction distress (also known or referred to as Experts by Experience or EBE) within the tertiary sector. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Benefits of tertiary EBE representation such as improving student's preparedness for practice and the empowerment of mental health consumers are consistently reported throughout the literature. In striving towards these outcomes, it is crucial we remain mindful of relevant and often-reported hurdles such as stigma and improper implementation. By using Aotearoa New Zealand as a case study, the need for approaches to increasing EBE representation which is conscious of diverse cultural contexts, perspectives and identities is highlighted. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review draws together a broad range of factors associated with improving clinical practice. These include the potential for EBE representation to improve outcomes for trainee clinicians, and the incorporation of consumer-driven perspectives into evidence-based practice. This review further highlights the need for EBE representation to be implemented in a way which is responsive to the cultural needs and nuances of mental health education and practice in Aotearoa New Zealand, and, similarly in other countries. ABSTRACT: Introduction There is potential value in increasing representation of expert by experience (EBE) involvement in mental health education sectors. This approach to improving mental health outcomes is here explored in the context of Aotearoa New Zealand's tertiary education sector. Aim/Question This review sought to identify potential outcomes, benefits and barriers associated with EBE representation in tertiary institutions, whilst critically analysing these strategies in the context of Aotearoa New Zealand's mental health education sector. Method Data retrieved from electronic databases were subjected to critical appraisal and thematic analysis. The integrative review drew from a final data set of 113 articles. Results An integrative review of our search results indicated that moving towards a tertiary mental health model in which lived experience plays a central role has the potential to benefit both teaching and research in the tertiary sector. Discussion The interplay between contemporary perspectives on tertiary EBE representation and the cultural needs and nuances of Aotearoa New Zealand's tertiary sector highlights the need for critical and careful approaches to EBE representation. Implications for clinical practice Findings surrounding tertiary EBE representation have direct implications for the training of mental health practitioners and the evaluation and development of clinical practice outcomes and procedures.

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.

Co-production in nursing and midwifery education: A systematic review of the literature

OBJECTIVES

Co-producing aspects of nursing and midwifery education is increasingly being used in higher education to try to improve student learning and meet standards set by some professional accreditation bodies. This review aims to identify and synthesise evidence on this pedagogical approach.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in CINAHL, ERIC, MEDLINE, and PubMed.

REVIEW METHODS

Four bibliographical databases were searched using relevant search terms between 2009 and 2019. Titles, abstracts, and full text papers were screened. Pertinent data were extracted and critical appraisal undertaken. Data were analysed using the framework approach and findings presented in a narrative summary.

RESULTS

Twenty-three studies were included. Two overarching themes emerged. The first focused on the impact of co-production on nursing and midwifery students, service users, and carers which had five subthemes; 1) acquiring new knowledge and skills, 2) gaining confidence and awareness, 3) building better relationships, 4) feeling vulnerable, and 5) attaining a sense of pride or enjoyment. The second theme centred on factors affecting how co-production was delivered which had three subthemes; 1) human interactional approach, 2) pedagogic quality, and 3) organisational environment.

CONCLUSION

This review provides a comprehensive update of the literature on co-production in nursing and midwifery education. Tentative evidence exists that participatory approaches could improve learning and positively impact on nursing and midwifery students, service users, and carers. Educators should consider adopting co-production and including students, service users, carers, practice staff, and other relevant stakeholders in this pedagogical process. However, more rigorous research examining how effective co-production is in improving learning over traditional methods is warranted given the additional resources required to deliver it.

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.

Exploring pedagogies used in undergraduate mental health nursing curriculum: An Integrative Literature Review

The growing demand of mental health services among the population and the stigma associated with mental health conditions have resulted in a shortage of skilled nurses competent in delivering quality care to persons experiencing mental health conditions. This suggests the need to develop a systematic and comprehensive curriculum to prepare nursing students for a career in mental health nursing. An integrative review on empirical studies was conducted based on Cooper's five-stage integrative review framework to investigate the different pedagogies and to highlight the elements of an effective curriculum for teaching mental health nursing. All quantitative, qualitative, and mixed-method studies published between 2009 and 2019 that examined pedagogies in mental health nursing for nursing undergraduates were included in this review. Databases of interest included PubMed, Cochrane, PsycINFO, Embase, Scopus, Web of Science, and ProQuest Dissertations and Theses. To ensure methodological rigour and validity, the 23 included studies were independently evaluated by two authors through critical appraisal tools developed by Joanna Briggs Institute for quantitative and qualitative studies. Results from this review were categorized into three themes: (i) the deployment of simulation; (ii) pedagogies in enhancing critical thinking; and (iii) importance of consumer-oriented educational experiences. These results suggested that students would benefit substantially from in-depth discussions, critical reflections, and real-life experiences. Mental health nursing curricula should incorporate simulations, pedagogies for critical thinking, and consumers' lived experience to supplement the clinical rotations.

Outcomes of Consumer Involvement in Mental Health Nursing Education: An Integrative Review

This integrative review analyzed the research on consumer involvement in mental health nursing education in the last decade. We aimed to derive the main contents, methods, and outcomes of education using consumer involvement for mental health nursing students. We searched six electronic databases using English and Korean search terms; two authors independently reviewed the 14 studies that met the selection criteria. Studies on the topic were concentrated in Australia and some European countries; most of them used a qualitative design. The main education subject was recovery, and consumers tended to actively participate in education planning. Moreover, students’ perceptions about education using consumer involvement and people with mental health problems changed positively, as well as their experiences of participating in mental health nursing education. There is a lack of interest in the topic in Asian countries, including Korea. Thus, future studies in Asian countries are needed to conduct qualitative and in-depth explorations of students’ experiences regarding an educational intervention that uses consumer involvement as a tool rigorously designed for mental health nursing education. Consumer involvement can be an innovative strategy to produce high-quality mental health nurses by minimizing the gap between theory and practice in the undergraduate program.