Enhancing psychological safe spaces in mental health: Teaching undergraduate nurses recovery-oriented practice skills to support mental health service users

Abstract

Recovery-orientated practice is a challenge for nurses working within acute mental health wards (McKenna et al., 2014). Although the experience and meaning of recovery-focused care varied, there were common elements in the practice accounts. The undergraduate nurse’s role in creating different therapeutic spaces to promote safety, relational commitment, and healing for service users was paramount to supporting the service user’s recovery journey (Waldemar et al, 2016). The importance of building safe, committed and healing relationships to ensure the psychological safety of service users was highlighted within this study, and how worthwhile it is for nurses to let go, to a certain extent, of the traditional boundaries that may create barriers to building recovery. There has been growing concern that people accessing mental health services are not receiving an inclusive, recovery-focused service due to barriers that include health professionals’ attitudes, skills and knowledge in practice. By exploring the experience and meaning of recovery-oriented practice for ten nurses working with service users in an acute mental health inpatient service in Aotearoa New Zealand, this study aimed to understand how nurses experience practising recovery in clinical practice, and to transfer the outcomes of the findings to enable lecturers to teach undergraduate nurses recovery-oriented practice skills to support mental health service users. Individual interviews were undertaken with participants and data analysed through a phenomenological and hermeneutic lens. The study findings could be used to inform best practice and changes to the nursing curriculum to inform and provide a platform to enable integrating recovery-orientated practice into the core mental health undergraduate curriculum (Haywood et al., 2020). This is conducive not only to recovery, but, essentially, to building a future nursing workforce that is appropriately skilled, equipped, supported and resourced for recovery-oriented practice (Solomon et al., 2021). Building safe, committed or shared space and healing relationships, and creating psychological safety, are crucial determinants of safe and effective care in mental health; and have implications for how nurses learn to manage new ways of working alongside service users and integrate recovery oriented practice within the reality and challenges of practice (Jackson-Blott et al., 2019). Highlighted within the research is the importance of education for both post- and undergraduate nurses regarding providing therapeutic safe spaces as an integral part of the service user’s recovery journey and undergraduate nurses’ learning. This study contributes key insights that are encapsulated in three core elements within relational space provision; these include safe, shared and healing spaces. This provides the key steps for providing a therapeutic safe space, as well as the tools and skills that should be integrated into education for undergraduate nurses. It is important that psychological and therapeutic safety is taught and woven through the entire three-year nursing degree course, as it has significant implications for mental health recovery-focused education in undergraduate student nurses. It can inform practice and support nursing students within clinical placement to more effectively work with mental health service users.