Staff at Birmingham & Solihull Mental Health Trust relate how they designed a skills practice course for student mental health practitioners
Practice Placement Managers (PPM’s) are charged with liaising between strategic health authorities, higher education institutions and local NHS Trusts/Foundation Trusts. Part of their remit is to ensure that not only are there enough placements for student mental health practitioners but that these placements meet the quality standards as set by professional regulatory and statutory bodies.
In September 2005, PPM’s from Birmingham & Solihull Mental Health Trust became aware of an impending capacity crisis whereby more than double the usual number of student mental health nurses were expected to be in placement at the same time.
This, combined with evidence from student evaluations; verbal feedback from mentors; the major review process; a literature review of national issues and a SWOT analysis undertaken by the PPM’s with relevant key stakeholders, highlighted the need for the development of a skills practice course to support the capacity issues and to enhance and maintain existing quality standards in placement.
Following this, the SELF-course – a highly interactive and experiential learning framework, was developed and designed along the following objectives and principles:
• Benchmark and standardise the assessment of, and exposure to clinical skills/scenarios in mental health settings
• To provide a package of experiential learning which supports and compliments clinical placements
• To involve service users and carers in the learning process
• To enable the students to reflect upon and develop self-awareness and confidence through participation in the course with clinicians, service users and carers
• Ameliorate some of the capacity issues.
The first pilot was introduced in May 2006 and involved a cohort of approximately 75 students who were split into five smaller groups of fifteen who attended one day per week throughout their six-week placement in their first year of nurse training.
The course itself was designed, developed and facilitated by PPMs, clinicians, university representatives, service users and carers. The priorities were identified as communication skills (including interaction/engagement with service users), development of self-awareness, applied care planning and specific nursing skills and techniques.
All sessions are highly experiential and based on principles of action learning. The intention is to enable students to reflect on practice gained in the clinical area, and to offer additional experiential opportunities utilising clinical scenarios, role-play, practical ethical dilemmas, shared learning opportunities in small groups, self-evaluation and peer review.
Subsequently second and third iterations of the course have been developed, designed and facilitated following evaluation of the prior course. Hence the course is ever-evolving and therefore flexible to the needs and requirements of the students undertaking it.
‘It has lifted my confidence and courage to practice. These sessions have brought to light those important facts which university didn’t offer. I am going to use this knowledge in practice and be a better practitioner in the future’
‘If it wasn’t for this course I’d struggle at placement. The course has improved my confidence greatly’
‘It has been a great help for me to be in the shoes of the service user’
Over the three courses a uniformed response from the students has been that they want to engage with this type of learning on every single placement, not just their first placement.
It is perhaps the inclusion of service users and carers that has been the SELF-course’s unique point. Service users and carers who have been involved will have varying histories of mental distress or contact with it and have been fully involved in all aspects of the course (planning, delivering/facilitating and evaluating).
It was a core requisite that they were involved in a more integrated and holistic way than the usual tokenistic way of purely asking people to describe their experiences. A total of thirteen users and carers contributed to the overall development, facilitation and delivery of the project and participation took many different forms according to the contributors’ wishes.
Aside from the planning of the course there were opportunities to engage in role-play with students; share the ‘lived experience’ of mental distress via story-telling; make audio tapes in the use of simulating auditory hallucinations and the production of training DVDs for use in demonstrating communication skills.
It should perhaps be left to the words of one of the contributors who states:
‘I hope by doing this, the students saw that we weren’t just service users, but people like themselves; that we weren’t just patients, but people who had lives outside the ward; and that we weren’t just case studies but people to learn from.
‘My involvement with SELF wasn’t just a one way street. The support and regard I was given and shown by both the staff and students clearly helped make my part so much easier to do, and the confidence gained within myself has helped me more ways that I thought was possible and has led to further opportunities.’ (Burbridge 2007)
To conclude, the SELF-project has evaluated very positively. Students articulate very clear benefits of being able to practice skills in a safe environment with very strong links to practice and a clear focus on mental health. The overwhelming majority of students appreciated the opportunity to work from an early stage with service users and carers which, they felt, enhanced their ability to empathise and accept people without judging them.
In terms of working in partnership and across traditional boundaries, SELF has bought something very different to the table. At the heart of the project was the PPMs’ belief that involving service users and carers at every stage was of paramount importance. Yes we wanted to meet all the objectives and principles that were set, but we wanted to do this alongside people who need to use services so that some of the determinations about what it takes to be a capable and competent mental health practitioner are made by those who are at the receiving end of service delivery.
Jacqui Gatcombe and Sue Hine
Practice Placement Managers - Birmingham and Solihull Mental Health NHS Trust
Burbridge, C. (2007) Personal communication to S.J. Hine