A programme of talking therapy workshops aimed to help student mental health nurses take on a more active role with service users
The Nursing and Midwifery Council Code states that mental health nurses ‘must use different methods of engaging service users to help improve service outcomes’. One way to achieve this is by incorporating training in psychological interventions into mental health nursing courses. This article discusses the implementation of ‘talking therapy’ workshops into preregistration mental health nurse training and their effectiveness.
Citation: Bell B, Bell D (2016) Training student nurses in talking therapies.Nursing Times; online issue 4: 1-3
Authors: Brian Bell and David Bell are senior mental health lecturers at the University of Wolverhampton.
- This article has been double-blind peer reviewed
- Scroll down to read the article or download a print-friendly PDF here
A recent report from the independent Mental Health Taskforce (2016) highlighted a disparity in the delivery of key interventions such as counselling across the NHS.
This is despite the creation of the Department of Health’s Improving Access to Psychological Therapies programme (IAPT), designed to help NHS staff implement the National Institute for Health and Care Excellence (NICE) guidelines for people with depression (NICE, 2009).
Faced with the demands of balancing theory and practice, student mental health nurses often find themselves struggling to apply basic principles of ‘talking therapy’ when they meet service users. Basic principles include active listening, paraphrasing and Socratic questioning.
Informal feedback gathered from second-year student mental health nurses, following their clinical placements, revealed a need for more exposure to, and training in, the application of basic psychological interventions.
While it is important to ensure preregistration students develop the skills to become competent, confident and reflective in the future, we also need to acknowledge the unique opportunities they have to engage in therapeutic relationships while still a student nurse (NMC, 2015).
A new role for student nurses
It is important to recognise that, although students form part of the clinical team, they are unable to take clinical decisions. Despite being guided by professional accountability and competence, they will also at times find themselves outside their prescribed role, such as when talking informally to service users. This role could take the form of ‘confidant’ or ‘helper’. Student nurses must build and maintain therapeutic relationships while incorporating counselling and therapy skills into their practice.
Ballantine Dykes et al (2014) use the term ‘helper’ to describe a person who, while not a fully trained counsellor, has learned some general counselling skills that can be used to enhance or complement the services of another healthcare professional.
Whether we call unqualified nurses on clinical placements ‘student nurses’ or ‘helpers’, one constant remains – an opportunity for them to engage with service users in a structured, evidence-based and caring way.
The talking therapy workshops conducted by University of Wolverhampton had three main aims:
- To enhance student mental health nurses’ knowledge of the underpinning philosophies, history and concepts of solution-focused brief therapy (SFBT) and cognitive behavioural therapy (CBT) (see Box 1 for brief explanation of both);
- To improve their competence by practising specific skills used in SFBT and CBT;
- To increase their confidence by providing a safe experiential learning environment in which to practise these new skills.
Box 1. Brief outlines of solution-focused brief therapy and cognitive behavioural therapy
Solution-focused brief therapy is a type of psychotherapy based on solution-building rather than problem-solving. Although SFBT acknowledges the person’s present problems and the past events that led up to them, it predominantly seeks to explore the person’s current resources and future hopes. The aim is to help them look forward positively and use their own strengths to achieve goals.
Cognitive behavioural therapy is a talking therapy that aims to help people manage their problems by changing the way they think and behave. It is based on the concept that thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap people in a vicious cycle. CBT is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
The workshops were designed to equip student nurses with the ability to offer talking therapy on clinical placements, while encouraging growth and experimentation. The theory and skills teaching took place in a classroom setting and all third-year mental health student nurses (senior students) following the RN DipHE (nursing studies) curriculum were offered the opportunity to learn about SFBT and CBT.
In a workshop structure the ‘norms’ of didactic teaching and learning are replaced with a more collaborative and dynamic ethos, encouraging independent thinking. One technique used in the workshops was role play, which encouraged student nurses to play multiple roles of nurse, service user and observer.
The classroom setting enabled educators to outline specific clinical theory and practice skills (in SFBT and CBT), which would not only provide the students with academic and experiential learning opportunities, but also support their interactions with service users in clinical practice. The format used interactive workshops so each student could challenge current mental health nursing philosophy, practice and roles in a supportive peer environment. The workshops were designed to complement the theory and skill elements of the students’ course. They were delivered over a single four-and-a-half day week, during which two-and-a-half days were allocated to SFBT, followed by two days of CBT. Students were offered a half-day break between the sessions on each therapy.
Each workshop was delivered by two senior lecturers – one qualified in CBT and the other in SFBT – and incorporated a variety of teaching approaches, including specifically designed booklets, group work, role play, case scenarios, video and discussion. Content delivered during the workshops included history, assessment, basic model, problem list, scaling and exception seeking.
Over a seven-year period, incorporating 13 student mental health nurse cohorts, the workshops provided an insight into the skills and techniques required in two specific talking therapies: CBT and SFBT. The workshops were also an opportunity for students to consider how the varying philosophical positions held by both approaches differed from current mental health nursing philosophies. Similarly, the workshops enabled students to discuss, challenge and consider how they would apply these different philosophical positions.
To date, 391 mental health students have participated in the workshops. After completion, students received an evaluation document comprising six numerical questions (with the answers provided on a scale of 1–5) (Table 2) and five open questions (Table 3). Across the 13 nursing cohorts there was a 95.3% completion rate.
Overall, the workshops resulted in positive outcomes for students. Their experience of the workshops – both individually and collectively – showed that their understanding of new skills and techniques had been enhanced by the opportunity to take ownership of their learning in a collaborative environment.
In the workshop structure itself, the integration of new philosophies, theories and skills from the two psychological approaches encouraged students to reflexively challenge their position.
Evaluation comments from students were consistently positive, supporting the numerical data provided. Table 3 shows some of the comments from students, which broadly highlighted the importance of the following themes:
- Collaborative working;
- Deeper learning;
- Extending useful clinical skills;
- Challenging their role or position;
- Need for mandatory module and/or continuing professional development.
Table 2. Numerical questions
1. How well did the course help in meeting your training needs?
2. Level of course
3. Course material
4. Trainers’ style
5. Training methods
The workshops were designed to address the increasing requirement (and opportunity) for mental health nurses to be trained in the delivery of basic psychological interventions. Before the workshops began, third-year student mental health nurses had received little (if any) theory or practice in the delivery of these therapies and their training had focused on nursing skills underpinned by person- centred care and humanistic philosophy. It was thought that introducing these students to other philosophies and skills would be vital to their professional development.
Although the students raised some initial reservations (primarily concerning the introduction of new philosophies), they collectively embraced the opportunity to redefine and extend their roles, as well as learning useful new skills. The introduction of new philosophies in the workshops enabled the student’s role to become more informal, fluid and changeable. Feedback from students who had completed the workshops included comments on their increased confidence and competence when supporting service users in distress.
The use of workshops resulted in a far deeper learning process, which most, but not all students, embraced. Students who found this deeper level of learning challenging or difficult were supported through the collaborative nature of the workshops by their peers.
Through the delivery of a series of educational workshops, the authors have significantly increased the numbers of senior mental health student nurses accessing training in psychological interventions, specifically SFBT and CBT. They have also shown the value of senior student mental health nurses being able to provide service users with immediate, low-intensity psychological interventions, further underpinning the importance of ‘making every contact count’.
The students appreciated the workshops, indicating that they were different from any teaching methods they had experienced before (within modular teaching), while the authors of workshops were able to bring about change in areas of clinical practice within pre-registration mental health nursing. Feedback received from student nurses and clinical practice partners clearly demonstrated the usefulness of the new knowledge and skills provided by the workshops and the programme was supported by further collaborative partnership working with a local NHS trust.
Feedback from the 391 students who participated in the workshops supported the continuation of the programme. As a result the workshop structure has been further developed and validated as a module for the BSc Nursing (mental health) curriculum at the University of Wolverhampton. The authors are currently gathering and collating feedback from mental health nursing students taking the new module and this will be used to provide an updated review of the training.
|Table 3 Open questions|
Selection of student responses
Q1. Do you feel the training could have been improved? If so how?
To have a module on SFBT and CBT
This should happen every year; increase the difficulty each year
If it could, I am not aware of how. It was informative, useful and delivered in a way I can use and apply in my practice
Needs to be mandatory
Q2. How will training help in your day-to-day practice?
As a base to learn from; to put into practice
Lots; it will help me get closer to clients and support them to get back ‘on the right track’
Provided me with tools and skills I can use in my own life and in practice
All new things for my professional toolbox
A valuable ‘personal quality’ and an asset in nursing practice
Helps to place the client at heart of the conversation
Q3. As a result of the training, what specific actions are you planning to take into your workplace?
Work in the ‘here and now’
Use the past; to highlight success and for evidence
Skeleton keys : interventions within SFBT
Socratic dialogue and questioning
To think about ‘Who I do?’ (roles and positions)
Q4. How will you introduce SFBT or CBT to your colleagues, service users and cares?
By switching from the role of knowledgeable nurse to non-expert
Encourage team to be curious
Use the process; not to be afraid of starting something newBy educating them; ask them the questions
Q5. Following completion of this training, do you have any future training needs in this area? Please specify
I would like to obtain a qualification and to do this maybe as a therapist with longer time for clinical practice
Longer enhanced courses
Practice, practice, practice
Really interested in the course at degree level
Maybe supervision while using it
- There is a disparity in the delivery of key psychological interventions across the NHS
- Mental health student nurses are in a unique position to provide early engagement with service users
- Student mental health nurses need to receive more training in the application of basic psychological techniques
- There is the potential for a new informal role for student mental health nurses in clinical practice — that of ‘confidant’ or ‘helper’
- Introducing mental health nurses to other philosophies and skills is vital to their professional development
Ballantine Dykes F et al (2014) Counselling Skills and Studies. London, Sage
Mental Health Taskforce (2016) The Five Year Forward View for Mental Health. London, NHS England.
NICE (2009) Depression in adults: recognition and management.
NMC (2015) The Code: Professional standards of practice and behaviour for nurses and midwives. London, NMC.