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

It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education

WHAT IS KNOWN ON THE SUBJECT?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery-oriented practice. Service users as experts by experience have not been embedded within pre-registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre-registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential.

ABSTRACT

INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date.

AIM

To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education.

METHODS

A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically.

RESULTS

Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth.

CONCLUSIONS

Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring.

IMPLICATIONS FOR PRACTICE

Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.

Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study

Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n  = 9 and male n  = 20); the comprised Māori (n  = 5), NZ European (n  = 5) and Asian (n  = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.

From a Single Voice to Diversity: Reframing 'Representation' in Patient Engagement

There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.

Lived experience narratives in health professional education: educators' perspectives of a co-designed, online mental health education resource

INTRODUCTION

Meaningful involvement of people with lived experience is an invaluable approach to education that facilitates the development of knowledge, skills and attitudes for collaborative, compassionate and person-centred healthcare practice. The purpose of this evaluation was to gain health professional educators' perspectives of an online learning resource that presents the lived experiences of people who have been consumers of the Australian mental health system.

METHODS

A cross sectional study design was used to survey educators who had registered to use the online education resource. Data were collected using an online survey and follow-up interviews. Two lived experience researchers were involved in the research. Quantitative survey data were analysed descriptively, and qualitative data were analysed thematically.

FINDINGS

The Listening to Voices online education resource is being used in a range of settings. Educators perceived the content facilitated achievement of learning outcomes related to understanding the experiences of people with mental health issues. The free, online, and flexible design of the resource promoted access and helped overcome barriers to including lived experience experts in education. The powerful impact of the resource and importance of creating safe learning environments when using the resource were highlighted. Suggestions for future developments were provided.

CONCLUSION

Involving people with lived experience in education of healthcare students and professionals can assist in developing skills for collaborative, compassionate, and person-centred care. Implementation of co-design principles and the use of creative pedagogical approaches can contribute to the development of impactful educational resources that foreground lived experience. Making these resources flexible and freely available online improves their utility.

Learning that cannot come from a book: An evaluation of an undergraduate alcohol and other drugs subject co-produced with experts by experience

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.

Learning from lived experience: Outcomes associated with students' involvement in co-designed and co-delivered recovery-oriented practice workshops

INTRODUCTION

Learning from individuals with lived experience is considered an important element of developing recovery-oriented practice capabilities in mental health contexts. Additionally, service user involvement in the education of occupational therapy students is a requirement in accreditation standards. Despite this, many barriers to meaningful inclusion of Lived Experience Educators have previously been identified.

METHOD

This study evaluated the outcomes achieved by students who were involved in a unit of study that incorporated four recovery-oriented practice workshops that were co-designed and co-delivered by Lived Experience Educators and an occupational therapy academic. Change over time was measured using the Recovery Knowledge Inventory (RKI) and the Capabilities for Recovery Oriented Practice Questionnaire (CROP-Q). Change over time was evaluated using paired t-tests. Students also provided qualitative feedback at the conclusion of the workshops. These comments were analysed using interpretive content analysis.

RESULTS

Students' scores on the RKI and CROP-Q both demonstrated statistically significant improvements from the beginning of the semester to the end of semester (RKI: 53.6-57.7, t = 6.3, P < 0.001; CROP-Q: 75.6-77.0, t = 2.4, P = 0.019). The most common categories included in the qualitative comments were: "Learning from real experiences"; "Learning about how to be a better clinician"; "See the strength and resilience of the educators, reduce stigma"; "Learning about the negative aspects of the mental health system"; and "More effective than other types of learning".

CONCLUSION

This study has demonstrated that students who engaged with the co-designed and co-delivered workshops improved their recovery knowledge and recovery-oriented capabilities over the course of the semester. Qualitative feedback also suggests that students' attitudes and skills for future practice were also influenced in positive ways by engaging with Lived Experience Educators.