Handover | Issue 35 – July 2016 – Equally Well update
by Catherine Fuller, Liz Day and Katie Owen from Whitireia New Zealand

Using simulation to increase mental and physical health assessment skills in new graduate mental health nurses

The postgraduate mental health and addiction programme at Whitireia uses a context based learning (CBL) approach to support new entry to specialist nursing practice students (NESP) transition successfully in their first year. The programme philosophy is enacted through the use of the clinical judgment model. This model comprises noticing, interpretation, responding and reflection and is used to guide both the teaching/learning and the nurse/service user relationship. CBL supports learning as the process encourages learners to develop self-knowledge by drawing on past experience (Adil, Khan & Sobani, 2012).

Equally Well

Within Aotearoa/New Zealand research has demonstrated major disparity in positive physical health outcomes for individuals who have a history of mental distress and/or substance use compared to the general population. In 2014 Te Pou produced an evidence summary that highlighted poorer health outcomes, higher morbidity and mortality rates and the need to develop policy and services to support the physical health of people experiencing mental distress and/or addiction. Equally Well, a collaborative national programme that aims to improve physical health outcomes, was developed to support and improve physical wellbeing of people who experience mental distress and/or addiction.

The Equally Well initiative provides an opportunity for the health sector and people who use mental health and addiction services to  work together to address this disparity. In response to the evidence summary and the Equally Well initiative, nurse educators at Whitireia NZ developed a context based learning package using simulated scenarios requiring nurses to undertake physical and mental health assessment and formulate a plan of care. This article provides an educator perspective of how we can assist nurses to strengthen awareness of the holistic service delivery required to better respond to the needs of service users in relation to their overall mental wellbeing and physical health needs in an integrated way

Context based learning

Context based learning supports new learning as the process encourages participants to develop self-knowledge by drawing on past experience (Adil, Khan & Sobani, 2012). CBL is used across many different disciplines and is well suited to nursing as modern nursing practice  is complex and requires nurses to think critically and develop sound evidence based clinical judgement (Tanner, 2006; Worell et al, 2006). The process of context based learning requires teamwork from participants and supports the development of critical thinking (Worrell & Profettio, 2006). Students actively participate in their own learning and this supports application of theoretical knowledge to sound clinical judgement within the clinical environment (Rogal & Snider, 2007). Learning in a simulated environment provides new graduate nurses with the opportunity to respond to unique situations in a safe environment, developing their ability to respond to situations that have no clear nursing response. Research indicates the use of simulation would be beneficial for nurses in mental health and addiction areas of practice however there is little evidence to support this method is being used as effectively as other speciality areas in nursing.

Co-designing an interactive simulation workshop

Using a CBL approach, scenarios were designed to promote critical thinking and increase confidence in providing nursing intervention based on their comprehensive physical and mental health assessments. New Zealand policy indicates the importance of having the voice of people with lived experience included in developing future health care services and education. To support this, nurse educators from Whitieria NZ collaborated with Caro Swanson, Te Pou service user lead, to develop scenarios which would reflect responsiveness to people who use mental health and addiction services. Working in consultation with service users when developing new curriculum ensures that curriculum aligns itself with programmes such as ‘Like Minds, like Mine’ and reflects strategic documents such as Rising to the Challenge and aims of the Equally Well initiative. Furthermore Turnbull and Weely (2013) indicate that involving health consumers in education programmes enhanced patient care and enabled students to view health care from the perspective and lived experience of consumers.

Using the Equally Well framework, and additional research, an interactive simulation workshop for new graduate nurses was developed using these scenarios to raise awareness of the complex issues that contribute to poor health outcomes for people experiencing mental distress/and or addiction. Through this simulated learning environment participants were encouraged to critically analyse their practice in relation to strategic documents relating to mental health and addiction nursing. Following the workshop there was a debriefing session to provide a safe environment to analyse different nursing responses and explore what went well and what might be done differently to reflect best practice. Kolb’s learning cycle (1984) was used so facilitators were able to prepare for when participants were actively transferring the skills learnt into their clinical practice areas. Debriefing after simulated sessions is an important aspect of CBL (Cant & Cooper, 2011) and can help to embed new learning.

Evaluation and outcomes

Participants were asked to evaluate the CBL experience. As educators we knew that there was evidence to support the development of this workshop using simulated scenarios and as a team we were motivated to measure the participants experience and also respond to feedback on any improvements that could be made in the future. Some participants reported feeling uncomfortable with the simulation – they felt they were being assessed on their skills and knowledge. The educators will aim to address this for next time. However, all participants felt challenged by the scenarios, feeling they had benefited and developed skills they would take into their practice. Overall participation in the workshop appears to have strengthened the awareness of new graduate nurses to better integrate the needs of service users in relation to their overall mental wellbeing and physical health needs.

For further information please contact Catherine Fuller, programme coordinator Postgraduate Certificate in Nursing - Mental Health Te Kura Hauora, Catherine.Fuller@whitireia.ac.nz.