Mental Health Nursing
Ailsa Haxell
AUT University
ailsa.haxell@aut.ac.nz

Context
This was taught at AUT University for students undertaking a BHSc in Nursing. The subject involved Mental Health nursing.

Change Drivers
To provide a critical imagination of lives and experiences that would otherwise be unknown. Going into clinical contexts to work with people with mental illness when it has never been a part of students prior experiences, was unethical on students and clients alike. In response to a student expressing concern regarding experiential learning in class, it seemed that simulated role plays for which students had no prior experience had a detrimental effect.

In providing realistic scenarios (on CD-ROM), prior to a role play activity, students could come to class following preparation regarding communication skills, knowledge of mental illness and of relevant legislation, and local context knowledge. The demand was about having a more ethical approach in a sensitive area of learning.

Change Narrative
Resources were designed and created to develop critical thinking skills and to encourage students to learn with technology, by creating their own artefacts.

Firstly, a 3-CD-ROM set, containing realistic scenarios of critical incidents, typical of people undergoing an acute phase of mental illness, were developed. This includes the admission phase, implementation of the Mental Health Act, and discharge planning. The types of illnesses portrayed included a person undergoing an acute psychotic episode, a person living with bipolar disorder, and a person who is involved in high risk behaviours and self-harm.

The real value of the CD-ROM scenarios were that they provided the basis for a problem based learning approach, directing students to build on current knowledge to assess the scenario and discuss critically the significant learnings through a discussion forum. Students were then guided to where more relevant and New Zealand specific information could be gained.

Students had a choice to access CD-ROM scenarios from the Blackboard LMS or directly from a computer.

Secondly, students who had previously undertaken the course, developed their own multimedia examples, which portrayed the experiences of mental illness. A good example of learning with technology.

Students engaging with a graphic and oral multimedia portrayal of hearing voices, prompted an online discussion of command hallucinations.

Excerpts from Janet Frame’s novel - Faces in the water, was developed in multimedia format, and used as the basis for a debate regarding the criteria of the Mental Health legislation.

Website links were utilised to encourage self-directed learning, and the knowledge gained from these could be checked with formatively assessed, self-paced tests.

Key Outcomes
In gaining an understanding of what mental illness is like and how one might personally respond to a variety of realistic scenarios, students had an opportunity to be well prepared prior to clinical placements. This resulted in a more authentic learning, and a more ethical learning environment. Students could go into placement in mental (ill)health clinical settings having a greater appreciation of the complexities involved.

The scenarios were developed using role players who were staff in workplace clinical settings, resulting in greater ‘buy in’ from staff regarding the expectations of students on placement. Thus increasing the value of having internet access for staff within such facilities and a utilisation of the CD-ROMs for their own staff development.

Keeping the CD-Rom scenarios short and generic enabled them to be utilised for different levels of learning, from undergraduate through to post graduate, as well as within formal education contexts, professional clinical settings, and voluntary agencies.

Disadvantages included a small number of students who were not used to driving their own computers, for example, understanding how to download software to play a QuickTime movie. A fear expressed by some students was about access to computers, and this was avoided by ensuring all students would have timetabled computer access.

Consideration was given to time release of one of the movies involving self harm, as it was not appropriate that students watch this without lecturer support. Updates of the Blackboard LMS and staff movements led to students being advised to view the CD-ROM directly from their computer, rather than through the Blackboard LMS, this then circumvented the time delay on this scenario. In future, copies of the CD-ROM will have this part of the self-harm scenario removed and students will only be shown this part of the scenario within timetabled classes.

Transformability/Sustainability
The CD-ROM set has been utilized in the education of nursing students, medical translators and psychotherapists within the tertiary sector, as well as by clinical educators in mental health contexts and telephone counsellors in the voluntary sector.

The potential exists for developing similar scenarios suited to other aspects of nursing.

The CD-ROM set has currently been utilized for 3 years. Sustainability is dependent on staff valuing the method of teaching, but it has also proved adaptable to different models of teaching and learning.

Where to Next?
I intend making similar scenarios for a communications paper - Interpersonal Skills for Health Professional Practice. I would like to pursue marketing of such scenarios with publishing companies as support material to accompanying textbooks. For students, I am looking at the potential of their demonstrating their understanding of key concepts utilising e-technologies within professional (e)portfolios.

Guidelines relevant to this case study
Developing understanding critical for employment
Problem based learning
Technology benefits students
e-portfolios