For the last 30 years, Nursing has been a major programme both at undergraduate and post graduate level at Whitireia New Zealand, and the polytechnic has developed a national reputation for producing work ready nursing graduates highly regarded by industry. The integrated Bachelor of Nursing (BN) programme reflects current national health priorities, the clinical environment and contemporary nursing practice. The curriculum ensures nursing education is centred on people who access services rather than people who provide services. There is a strong focus on the potential of communities and all new graduate nurses being able to recognise and respond holistically to mental distress and addictions in a range of settings. Whitireia NZ made formal commitment to Equally Well in 2015, joining others with the common goal of achieving physical health equity for people who experience mental health and addiction issues.
The evidence base and principles from the Equally Well initiative are embedded into the theory content of the second year of the programme.
The Equally Well content in the BN Programme involves ensuring learning opportunities reflect current clinical realities. Equally Well clearly demonstrates the extent of health issues and disparity for people who experience mental health and addiction issues. System issues relate to the separation of mental health and addiction services from physical health services and stigma and discrimination apparent within health services.
A range of activities, simulated scenarios and online content has been introduced to explore the relationship between mental health and addiction diagnosis, pharmacological treatment, inequity of service provision and poor health outcomes.
The research from members of the Equally Well collaborative makes transparent the impact of inequities in the structure of society and the health system while at the same time demonstrates how as graduate nurses they can make a difference.
Developing activities around the principles of Equally Well gives nursing students opportunities to explore how the structure of health service delivery, including nurses’ attitudes, impacts on individual access to services and health outcomes. Fear, negative bias and ignorance have been identified as key barriers to achieving better nursing care. There is a focus on recognising and addressing stigma and the potential causes of discrimination towards people experiencing mental distress and addictions. Addressing these barriers is an important requirement of comprehensive nursing education.
These activities have been developed alongside the Consumer Academic within the School of Health at Whitireia NZ and invited external Consumer Advisers and Experts by experience. Alongside simulated activities all theoretical content includes either live or video narrative accounts from people with lived experience of mental distress and/or addictions.
Co-production of this curriculum with people with lived experience is seen as essential to support a greater understanding of the impact of stigma and discrimination and promote attitude change.
The inclusion of the Equally Well initiative supports discussion about where people gain their messages about mental distress and how this understanding fits with student’s own attitudes and experience. Negative clinical experiences, with nurses seen as a primary contributor to discriminatory practice, and restrictive environments can have a detrimental effect on attitudes and perception. The outcomes of embedding Equally Well within the BN curriculum supports our nursing students to reflect on their own bias and attitudes towards people who experience mental distress and/or addiction, demonstrate an increased knowledge and awareness of structural inequities and develop the skills to challenge this inequity and poor health outcomes.
Katie Owen, Senior lecturer, Bachelor of Nursing Programme, Whitireia NZ
Liz Day, Senior Lecturer, Bachelor of Nursing Programme, Whitireia NZ