Critical Perspectives in Mental Health Nurse Education

This is the 3rd of the workshop reports from our recent conference. Here, Jim Chapman and Anne Felton summarise and reflect on the discussions that they facilitated in a workshop designed to help people think about MH nurse education. There were other parts of the day in which people considered education too, and as the previous post about the UnRecovery Star shows, other members of the network are considering ways to bring more critical ideas into mental health nursing education. One of the suggestions from the floor discussed on the day was about whether this website can develop a section specifically to resource university tutors and student nurses. In a sense, this is the aim of the website anyway, but it may be that members would like to develop a set of references and resources which may be of particular use to tutors and students, and if this is something which interests you, and if you have experience teaching or learning critical mental health nursing at university and would like to share that, then please make yourself known to us.

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The workshop used a world café approach to pose some key questions for mental health nursing education:

  • Does the Shape of Caring Review support or hinder the development of critical perspectives on mental health in nurse education?
  • What is the difference between critical perspectives and critical analysis – can we teach both? 
  • How do we support nursing students who adopt critical perspectives to avoid becoming isolated and disillusioned? 

There was a mix of perspectives over whether the Shape of Caring Review is a good thing for mental health nursing. Some people felt that mental health nursing was already seen as second-rate in relation to other fields of nursing, and that the proposed 2+1+1 model would amplify this inequality. Others saw opportunities within the new proposals – firstly, here would be a chance to give non-mental health nurses the essential skills to care for those in distress, whatever the care environment; secondly, the extra year devoted to preceptorship could help qualified nurses to pend good quality time role-modelling excellence in mental health nursing.

Some people felt that giving 2 years over to a core curriculum is a step too far, in that it would hinder the creation of the professional identity of the mental health nurse, as well as the passion for the job.

Most people agreed that this could once again give us the chance to challenge the content of an undergraduate nursing curriculum, that it should be based as much on values as competencies and that we need to increase subjects such as sociological explanations of health. It was pointed out, however, that the existing NMC standards for pre-registration nurse education are open to wide interpretation from higher education institutions and that the curriculum they design is often driven by the prevailing belief systems of academic nursing staff responsible for the programme.

The discussion around whether critical analysis and critical perspectives were the same thing was summed up neatly by one participant, who wrote:

A critical perspective is a ‘way of being’ that can develop in a person – the desire to question, deconstruct, unpick. Critical analysis is a skill, but may not be based in a broader critical perspective.

Other comments reflected this view. One person commented that critical perspectives may not always have a strong ‘evidence base’ whereas critical analysis needs to be driven by good evidence. This, of course, opens up the debate about what we mean by evidence and good evidence.

There was an interesting thread of conversation in that maybe our critical discussion should start with our own professional identity, in that we find it hard to define ourselves. We need to have some challenging and difficult conversations to arrive at a consensus about what mental health nursing is. Or, conversely, we accept that we are comfortable with a range of theories and ideas, and embrace them all.

Many people who attended the workshop had experienced the feeling of disillusionment at some point in their careers. For the students who attended, this was particularly raw. Some felt that the inability to express critical perspectives was rooted in the hierarchical structure of the NHS (both within and across professions), and that it was particularly difficult to challenge ideas from the bottom-up.  In fact, some students felt that it was unfair for them to hear the message from academic staff that they must be the catalyst for change when they have been given very little power to do so.

There was a lot of debate about the need for a parallel curriculum that centres around peer support, promoting values, creating group identity and hence power to influence change. The process of change needs to occur not just within the health system but within society, so that people re-learn the meaning of mental healthiness .

Summary of Discussion

We know that nursing is caring but is currently experienced by users of the mental health system and nurses as “managing”.  Time with service users – contact, building relationships –  is vital to challenge this position. There was debate as to whether nurses have the opportunity to influence the organisation of their work though meaningful nursing leadership was recognised as important.

We all know that what we need to do is care but we get shifted towards task-orientated, non-person focused activities.  We need to understand – how does this happen and how can we change it?

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