Mental health deserves better: Resisting the dilution of specialist pre-registration mental health nurse education in the United Kingdom

Critical Thinking and Mental Health Nurse Education

This paper examines critical thinking as a fundamental proficiency essential for inclusion in international mental health nurse education. Pragmatic solutions ensure the ongoing development of critical thinking in mental health nurses. The suitability of current mental health nurse education is under scrutiny globally. Critics claim that regulatory and educational standards have shifted from a focus on mental health-specific skills to generic physical health-based competencies, which do not adequately equip mental health nurses for clinical practice. The vital skill of critical thinking within mental health nurse theory and practice has been diluted (stating that it is a position paper or critical review, for example). This paper is a critical review of mental health nursing education. By summarising the global contextual background of generic-based nursing education, it highlights the impact of the loss of mental health-specific skill sets. Critical thinking is identified as a vital skill for the 21st-century mental health nurse. This paper provides pragmatic suggestions to include critical thinking in nurse education in the absence of global reform and systemic educational change. Personal lived experience is used to illustrate the importance of critical thinking and service users' experience of care. Critical thinking can be a partial solution to the current dilution of mental health nurse education occurring across the global North. Nurse educators should strive to embed critical thinking into mental health nurse education in order to develop lifelong critical thinkers who are not afraid to question the hegemonic perspective and continually ask, "why?" Recommendations are for nurse educators to be consciously aware of methods to encourage critical thinking, such as Socratic questioning, the consideration of epistemic injustice, coproduction, critical reflexivity and including case-based ethical learning.

Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

AIM

An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression.

DESIGN

A single-centre retrospective study was undertaken.

METHOD

Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices.

RESULTS

Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes.

CONCLUSIONS

The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly.

RELEVANCE TO CLINICAL PRACTICE

Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses.

REPORTING METHOD

This study followed the applicable STROBE guidelines.

PATIENT OR PUBLIC INVOLVEMENT

Due to the study's retrospective nature, there was no service user or public involvement.

Graduate Nurses in Acute Mental Health Settings and Their Viewpoints of Nursing Education to Support Their Transition to Mental Health Nursing: A Q Methodology Study

Graduate nurses are now comprehensively prepared in Australia and have limited mental health knowledge and experiences to work in acute mental health settings. As such, graduate nurses would need the support that they can get from their respective mental health services to progress from novice to advanced beginner. Nursing education is an important support for graduate nurses to develop the knowledge and skills required for them to transition successfully into acute mental health settings. This study explored 12 graduate nurses' experiences with the nursing education of one mental health services in Western Australia. Q methodology was the approach chosen to conduct this study as it is a 'ready-to-use' mixed method research approach that can enable the researchers to obtain in-depth and accurate understanding of the researched topic. Data analysis generated four factors which revealed that nursing education needs to: (1) be tailored to the area of speciality for graduate nurses who experience challenges of being accepted by their nursing team; (2) provide advanced specialist mental health training for graduate nurses who have low self-confidence about their mental health nursing knowledge and skills to practice in acute mental health settings; (3) provide clinical supervision for graduate nurses who experience challenges to apply their mental health knowledge and skills to difficult clinical situations; and (4) change the way mental health education and training are delivered for graduate nurses who feel confident with their mental health knowledge and skills and accepted by their nursing team. The findings of this study highlighted the usefulness of Q methodology in nursing research. The findings of this study can be used by nurse educators to provide more individualised education and training for graduate nurses. Future research will be conducted to test the use of different teaching and learning approaches for the different categories of graduate nurses in acute mental health settings and develop evidence-based nursing education.

Communication strategies to support people experiencing mental health issues

This article explores the use of effective communication for nurses when interacting with people experiencing mental health issues. Emphasis will be on the importance of nurses adopting person-centred communication styles that prioritise empathy, with the aim of developing a therapeutic rapport. The article underscores the role of the nurse in promoting positive mental health outcomes through the use of techniques such as active listening, empathy and validation. The author also details some of the barriers to effective communication and how nurses can address them.

The Impact of Patients and Student Mental Health Nurses Sharing Time Together in Forensic Units

ABSTRACT

Student mental health nurses have greater patient contact than registered nurses, and this is appreciated by patients. This phenomenological study explored the impact of patients and student mental health nurses' time shared on forensic units for men carrying a personality disorder diagnosis. Phenomenology was the underpinning philosophy of this research. Patients and student mental health nurses in forensic hospitals participated in unstructured hermeneutic interviews. The time students and patients shared together was considered a gift, enabling them to feel that they were "just people" and valued, strongly impacting on their sense of person. The impact the students have on patients' quality of life is meaningful. When the students and patients connected, it had powerful implications for their sense of humanness and value, highlighting the reciprocal impact they each have on another and the importance of having student nurse clinical placements in forensic wards and facilities.Implications for Clinical Forensic Nursing Practice: This article offers a unique contribution to forensic practice by exploring the experiences of the time patients and students share together in forensic units. Students, who often have the greatest contact with patients, represent the present and future of nursing, and their time is appreciated by patients. Previous research focuses on attitudes and therapeutic relationships, rather than the impact of shared contact. In addition to this, patients in forensic services with personality disorder diagnoses can be the most stigmatized group in mental health care, and exploration of their experiences is lacking. These experiences must be shared.

"It's really important work…and celebrating that, I think, is really important" - co-produced qualitative research into future of mental health nurse education

The education of mental health nurses has long remained a contentious topic in the UK and internationally. This research seeks to gather the perspectives of those directly affected by mental health nurse education. To investigate what knowledge, skills and values current mental health nursing students, graduate mental health nurses and people with lived experience of accessing mental health services believe should be paramount within pre-registration education. Data was gathered through focus groups involving a mix of pre- and post-qualified mental health nurses and people with lived experience of accessing mental health services. Data was collected through audio recordings, which were transcribed and subjected to thematic analysis. The analysis generated four themes of: (i) Values and ethics-based education, (ii) Self-awareness, (iii) Understanding and therapeutically being with others and (iv) Specialism versus Genericism. The findings speak to the special nature of mental health nursing and the need for students to develop specialist mental health knowledge and skills, alongside self-knowledge. The findings provide a unique insight into the aspects of pre-registration nursing felt to be most valuable by the three participant groups in this study. The findings reiterate the importance nurse education celebrating the specialism of mental health nursing and adds to the growing weight of literature for increased specialism with future education standard reviews.

The Memoir of a Ghost: The Invisible Plight of Mental Health Nurse Education in the United Kingdom Following the Nursing and Midwifery Council's Move Towards Genericism

The aim of this paper is to identify barriers to quality mental health nurse education in the United Kingdom and show these through the sharing of personal experiences of working as a mental health nurse academic. Since the Nursing and Midwifery Council introduced their 'future nurse' education standards in 2018, mental health content for mental health nurses has been argued to have been marginalised. The sense of a diluted mental health nurse education was supported by an open letter, signed by over 100 mental health nurses, with representation across 33 universities. Nonetheless, the approach taken by the NMC has been defended. Meanwhile, mental health nurse academics all over the United Kingdom are having varying experiences, some of incredible discomfort and invalidation. The movement 'mental health deserves better' arose through many of these mental health nurses feeling they had no representation or channel to voice their concerns. This is a personal position paper which outlines barriers to autonomy for mental health nurse academics, and shares personal opinion on experiences which have impacted the ability to deliver a depth of knowledge, skill and critical thinking to students, impacting the quality of new mental health nurse graduates. The issue is discussed using contemporary literature to support lines of argument, which are augmented by personal experiences of working in nurse education. There are complex interconnected issues within nurse education which can hinder the autonomy of mental health nursing to decide its own future. This paper recounts a personal journey. Often we cannot understand the failings of a system until we try to navigate it from the inside.

Mental health nursing students and generic proficiencies: how educators can support assessment

Recent shifts in nursing education towards generic proficiencies pose challenges to the unique demands of mental health nursing education. Student mental health nurses at the authors' higher education institution (HEI) have provided service feedback that has expressed the difficulties they have encountered. This article examines the issues faced by students, assessors and educators in interpreting and applying the proficiency standards set by the Nursing and Midwifery Council. Addressing the complexities of mental health nursing education, as well as the barriers to learning and attainment, requires a collaborative effort and innovative solutions if HEIs are to successfully prepare future mental health nurses to meet the evolving demands of their role. The proposed solution is a 'Proficiency Directory', which provides structured resources for mental health nursing students to align learning experiences with assessment criteria, facilitating a more comprehensive and meaningful learning journey.

Analysis of England's incident and mental health nursing workforce data 2015-2022

WHAT IS KNOWN ON THE SUBJECT?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer-reviewed evidence examining recent trends. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service-provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: English mental health services report greater levels of patient-related factors such as self-harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic.

ABSTRACT

INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain.

AIM

Comparison of English national data for incidents and nursing workforce to examine recent trends.

METHOD

Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022.

RESULTS

A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals.

DISCUSSION

Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports.

IMPLICATIONS FOR PRACTICE

Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.

From self-reflection to shared recognition: Reconceptualising mental health nursing as an intersubjective phenomenon

Existing challenges to the legitimacy of mental health nursing in the United Kingdom and beyond have stimulated a critical self-reflection and discourse around the mental health nursing role, forcing the profession to question its identity and critically re-evaluate its position within the wider healthcare arena. In this discussion paper, I suggest that the current difficulties in conceptualising mental health nurse identity arise from our role being inherently interwoven with distinctive challenges and unique needs of our service users. Emerging from this idea is that the 'being' (and the 'doing') of mental health nursing is firmly situated within the sphere of intersubjective relations. Drawing upon Hegel's ideas of reciprocal recognitive relations, to support the notion that our profession's role and purpose are better understood when defined in relation to the work that we do with our service users, I argue that it is in the understanding (and even embracing) of intersubjectivity as a core principle of mental health nursing, where we might not just better understand ourselves but also know how to shift asymmetric relations with our service users towards those which are more commensurate and mutually beneficial.

Nurses' career choice and satisfaction with mental health transition-to-practice programs: A cross sectional study

WHAT IS KNOWN ON THE SUBJECT?: There are significant issues recruiting nurses into mental health due to several reasons such as dilution of curriculum, and mental health being an unpopular career choice Transition programs provide nurses entering mental health with orientation, academic and clinical skills, and knowledge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Transition programs need to be nuanced to specialty areas (e.g. community) to ensure nurses are given the support necessary to remain working in the field. Many nurses choose to work in mental health due to a lived or personal experience and as such strengthening wellbeing supports for transitioning nurses is an important role in retention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Tailored transition programs can help strengthen mental health nurse role clarity, and support staff retention. Transition programs should be a segue to formal postgraduate studies in mental health nursing to strengthen professional practice and retention of nurses.

ABSTRACT

INTRODUCTION: Globally, there are consistent issues recruiting staff into the mental health nursing workforce. In Australia, recent efforts to expand the workforce include recruitment of a wider range of nurses in addition to new graduates into mental health transition-to-practice programs. Understanding the career motivations of nurses entering the field is an important element of recruitment and retention.

AIM

To describe nurses' satisfaction with their mental health transition program and identify factors influencing their choice of mental health as a career.

METHODS

An online cross-sectional survey with questions on program satisfaction and career choice was responded to by n = 55 enrolled and registered nurses in a mental health transition program.

RESULTS

Nurses reported overall high satisfaction with their program and identified increased time release for professional development and being supernumerary as necessary to support role development. Almost 25% of nurses reported personal experience of mental illness as an influence in choosing a mental health career.

DISCUSSION

Mental health transition programs are important in recruitment and retention and need to be tailored to the needs of a wide range of nurses and include support for staff wellbeing.

IMPLICATIONS FOR PRACTICE

Tailored transition programs can help strengthen role clarity, and support staff retention.

Standards of proficiency for registered nurses-To what end? A critical analysis of contemporary mental health nursing within the United Kingdom context

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of 'proficiency' in nurse education-prescribed by the regulator-impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self-determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain.

What is the purpose of nurse education (and what should it be)?

Can we take the purpose of nurse education for granted, and, more importantly, should we? That is the issue at stake in this paper. The question of purpose is conspicuously absent in the nursing literature; our aim here is to urge that it not be overlooked by demonstrating its importance to the future of nursing. We approach the question of nurse education's purpose in concrete and speculative terms through two distinct yet interrelated questions: what is the purpose of nurse education? and what should it be? Amidst the complexity and uncertainty of our time, we cast doubt on the adequacy of manualised and regulated approaches-ubiquitous in nurse education-to prepare nurses who can meet the challenges of contemporary practice. We also assert that transgressive approaches to education, as the antithesis of manualisation, reach the same impasse by (over)predetermining what the educational 'output' will be. To move beyond this impasse, we draw on the theory of Gert Biesta and Ron Barnett to contrast cultivation and existential-type education. In so doing, we do not seek to provide 'answers' to nurse education's purpose but, rather, raise the profile of what we believe is a right and proper question for the discipline to grapple with.