Acute Mental Health Wards Research Articles

The admission and integration model: first‑hand experiences of staff admitted to a mental health ward

Background/Aims Over a period of 6 months, four staff members were admitted on separate occasions to a male acute mental health ward for 1 day. The purpose was for participants to gain personal insight into the experiences of patients on the ward. This study aimed to explore the experiences of staff admitted onto the ward and provide a conceptual model to describe the admission process. Methods Feedback was obtained from the study participants via pre- and post-admission questionnaires and a focus group discussion. These qualitative data were thematically analysed to generate the steps in the admission and integration model. Results Admission to the mental health ward was a useful learning experience for staff members in terms of improving empathy for their patients. A model of ward admission and integration based on these experiences was also developed. The model adhered to Maslow's hierarchy of need, where participants had to re-establish deficiency needs following admission onto the ward. Conclusions The study findings have been shared with other hospital staff, and will be used by a new working group to implement improvements in patient care.

Ensuring that psychological interventions are delivered as intended on mental health inpatient wards.

Talk, Understand and Listen for InPatient Settings (TULIPS) was a multi-centred randomized control trial of an intervention that aimed to increase patient access to psychological therapies on acute mental health wards. This paper aims to: (i) describe a strategy for designing a psychological intervention that is implementable in inpatient mental health settings; (ii) describe methods for assessing the fidelity of interventions within these settings; (iii) report on the extent to which fidelity was achieved in the TULIPS trial. The TULIPS intervention was designed using information from a systematic review, stakeholder interviews, pilot work and a consensus workshop. We assessed fidelity to the model in terms of the delivery and dose of essential elements of the intervention, quality of intervention delivery, engagement of participants with the intervention and differentiation between the intervention and usual care. Although the TULIPS intervention targeted known barriers to the delivery of psychological interventions on mental health wards, we found issues in implementing aspects of the intervention that were dependent upon the participation of members of the multidisciplinary team. Psychologists were able to overcome barriers to delivering individual therapy to patients as this provision was not reliant on the availability of other staff. The intervention period in the study was 6 months. A greater period of time with a critical mass of psychological practitioners is needed to embed psychological interventions on inpatient wards. Our fidelity framework and assessment methods can be used by other researchers implementing and testing psychological therapies within inpatient environments.

Improving the Use of Sensory Approaches in an Acute Inpatient Mental Health Unit Using a Co-Designed Multifaceted Implementation Strategy.

Despite the therapeutic benefits of sensory approaches being well documented, little research has focused on improving their implementation in acute mental health units. The use of implementation frameworks to improve the use of evidence-based practices has shown promising results in healthcare; however, there is little evidence for their use in acute mental health units. A pre-post comparison design was used to determine the effect of an 11-month co-designed theory-informed multifaceted implementation strategy on the use of sensory approaches and the use of seclusion/restraint in one acute mental health ward. This study was guided by Integrated Knowledge Translation (IKT) and informed by the Behaviour Change Wheel (BCW) approach. Implementation strategies were co-designed and included provision of sensory materials/resources; education/training; prompts/reminders; modelling; audit and feedback; workplace coalition; and facilitation. Data were collected through pre- and post-project questionnaires (pre- n = 37, post- n = 40) and routine clinical data. Data were analysed using SPSS and thematic analysis. Data for matched pairs (n = 19) revealed significant improvements between pre- and post-perceived levels of knowledge and confidence in using sensory approaches. Significant increases were found in the use of sensory kits, weighted modalities and sensory assessment/plans. Post participants' recommendations to sustain the use of sensory approaches in their unit included ongoing training; funding; maintenance and supply of sensory equipment; increased staffing; and support from colleagues. This is the first study to use the IKT and BCW to design, facilitate and evaluate a co-designed, theory-informed implementation strategy to improve the use of sensory approaches in an acute mental health unit.

Machine Learning Model Reveals Determinators for Admission to Acute Mental Health Wards From Emergency Department Presentations.

This research addresses the critical issue of identifying factors contributing to admissions to acute mental health (MH) wards for individuals presenting to the emergency department (ED) with MH concerns as their primary issue, notably suicidality. This study aims to leverage machine learning (ML) models to assess the likelihood of admission to acute MH wards for this vulnerable population. Data collection for this study used existing ED data from 1 January 2016 to 31 December 2021. Data selection was based on specific criteria related to the presenting problem. Analysis was conducted using Python and the Interpretable Machine Learning (InterpretML) machine learning library. InterpretML calculates overall importance based on the mean absolute score, which was used to measure the impact of each feature on admission. A person's 'Age' and 'Triage category' are ranked significantly higher than 'Facility identifier', 'Presenting problem' and 'Active Client'. The contribution of other presentation features on admission shows a minimal effect. Aligning the models closely with service delivery will help services understand their service users and provide insight into financial and clinical variations. Suicidal ideation negatively correlates to admission yet represents the largest number of presentations. The nurse's role at triage is a critical factor in assessing the needs of the presenting individual. The gap that emerges in this context is significant; MH triage requires a complex understanding of MH and presents a significant challenge in the ED. Further research is required to explore the role that ML can provide in assisting clinicians in assessment.

Keeping Up Standards: An Audit of Adherence to Admission Standards on Acute Mental Health Wards in NHS Lanarkshire

Keeping Up Standards: An Audit of Adherence to Admission Standards on Acute Mental Health Wards in NHS Lanarkshire

RETRACTION: Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

M. Kekic, A. Rose, C. Baker, and D. Bayley, 'Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts,' Journal of Psychiatric and Mental Health Nursing (Early View), https://doi.org/10.1111/jpm.13036. The above article, published online on 05 March 2024 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Hugh McKenna, and John Wiley & Sons Ltd. The retraction has been agreed due to an undisclosed conflict of interest by the authors, which was reported in a complaint by a third party. Following an investigation, it was confirmed that, while the authors reported their employment status with Oxehealth Ltd. in their personal affiliations section, they failed to do so in a conflict of interest statement as required by the journal. Because the journal uses a double-blind peer review process, neither the names of the authors nor their affiliations were visible to the reviewers and editors during evaluation of the manuscript. Had an employment status disclosure been made clear in a conflict-of-interest statement in accordance with the journal's submission guidelines, the Editor-in-Chief and all associate editors would have considered author employment by Oxehealth Ltd., the developer of the technology evaluated by the authors, as a major competing interest and would have rejected the manuscript without peer review. Therefore, the article must be retracted. Dr. Kekic disagrees with the retraction, on behalf of all the authors.

A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study.

Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. This study is registered as ISRCTN14470430. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool.

Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.

Exploring The Impact of Positive Behaviour Support Plans on Adult Acute Mental Health Staff Practice

IntroductionThere is a national movement to reduce restrictive interventions due to the harm and distress they can cause which has been reflected in NHS trust policies and practices. NHS trust policies state that all in-patients who may require restrictive interventions must have a Positive Behaviour Support Plan (PBSP) based on a functional analysis of what drives and triggers their behaviour. A PBSP is intended to facilitate understanding and help manage behaviours that challenge by teaching new skills and ways to communicate a person’s needs. Previous research on the use of PBSPs on adult acute mental health wards is limited but research on PICU wards has shown PBSPs have not been implemented into mental health care as intended.Objectives Trust policies identify that PBSPs should be implemented to reduce the use of restrictive interventions. However, it is unknown whether PBSPs are being used as part of routine practice on the acute mental health ward. The degree to which staff are aware of patients PBSPs and how they use them to guide their practice is unclear. The service evaluation aims to understand the perspectives, attitudes, and experiences of staff who are responsible for using and implementing PBSPs on the ward. The evaluation aims to investigate how PBSP informs practice and to identify the barriers and facilitators to implementing PBSPs on the ward.MethodsA volunteer sample of clinical staff members (including Doctors, Nurses, Psychotherapists, Occupational Therapists, and Clinical Support Workers) who are responsible for implementing PBSPs on an acute mental health ward in the East of England took part in a focus group which lasted up to an hour. There were four focus groups with between two and four participants per group. A total of thirteen staff members participated in the focus groups. The focus groups lasted up to one hour and were guided by a topic guide. Two members of the project team facilitated the group. Focus groups were audio recorded.ResultsThematic synthesis will be the overarching approach used to synthesise the qualitative data from the focus groups. The audio recordings will be transcribed. Analysis will be conducted on a within-case basis prior to cross-case analysis aimed to identify common themes. Two evaluators will work together to code, analyse, and synthesise the extracted data.ConclusionsBased on the results, training may be developed to improve the understanding and implementation of the PBSPs on the ward. The findings may also result in changes to the way PBSPs are used. The results will be presented to the trust chief executives and used to inform how to best support individuals who may be at risk of requiring restrictive interventions.Disclosure of InterestNone Declared

RETRACTED: Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well-known risk factors for self-harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in-person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision-based patient monitoring system (VBPMS) is a contact-free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self-harm after the tool was implemented at one NHS mental health trust. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self-harm on acute mental health wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Managing self-harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough - staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. ABSTRACT: Introduction Self-harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision-based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self-harm warrants further exploration. Aim This research investigated whether implementing a VBPMS-as an adjunct to existing clinical practice-within acute inpatient services at five NHS England mental health trusts led to reductions in self-harm. Method Five quasi-experimental studies assessed the number of bedroom self-harm incidents, across 12 adult wards, before and 5-12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed-effect meta-analysis. Results In the meta-analysis, a significant inverse-weighted average relative risk percentage change of -38.9% was recorded. For the study with no control groups, reductions in self-harm were seen across all wards (range: -9.1% to -29.8%). Discussion This research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self-harm from occurring. Implications for Practice The results provide preliminary support for wider rollout of the technology on acute mental health wards.

Implementing and evaluating patient-focused safety technology on adult acute mental health wards.

Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views. Patients and staff are experts and should be included in discussions about how to make wards safer. We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought. The app was easy to use and most people liked the look of it. Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down. To make the most of the app, staff need to get used to it and bring it into ward routines. INTRODUCTION: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. Implementation and evaluation of 'WardSonar', a digital safety-monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real-time safety perceptions to staff. Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post-COVID-19 context. The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real-time data to inform proactive safety interventions.

Reducing violence and aggression: a quality improvement project for safety on an acute mental health ward

Violence and aggression (V&A) are identified as an issue on mental health wards that negatively affect staff, patients, care delivery and safety. This project took place on a male acute...

Applying the theory of planned behaviour to understand mental health professionals’ intentions to work using a human rights-based approach in acute inpatient settings

Background There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person’s human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding. Aim To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals’ intentions to work using a human rights-based approach. Method Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals’ intentions to use human rights-based approaches. Results Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables. Conclusion There could be factors outside of the individual clinician’s control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

Non-contact monitoring to support care in acute inpatient mental health

Background Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. Aim To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. Methods A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. Results A −44% relative percentage change in bedroom self-harm incidents and a −48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. Conclusion The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.

Preliminary evaluation of a multidisciplinary pathway for people who self-harm in acute inpatient mental health care

Background/aims Inpatient mental health settings are required to provide biopsychosocial interventions to support service users who self-harm. This is important as self-harm has been associated with increased admissions and risk of suicide. A multidisciplinary self-harm pathway was developed in an acute inpatient mental health ward for adult women to help staff support patients who self-harm. The aim of this project was to evaluate the pathway in relation to service user distress, confidence in managing mental health, therapeutic alliances with the ward team and self-harm incidents on the ward. Methods Data were collected from the record-keeping systems and from questionnaires completed before and after the pathway was introduced. Results The pathway was well received by service users and contributed to improvements in distress, confidence and to more effective management of self-harm. Conclusions The self-harm pathway was found to be a useful framework within which to structure psychosocial interventions for self-harm and least restrictive practice.

The documentation and delivery of psychological support in acute adult mental health wards

The documentation and delivery of psychological support in acute adult mental health wards

The Acceptability of a Recovery Group Intervention in Acute Inpatient Mental Health Wards.

The aim of the present study was to evaluate the feasibility and explore the service user experience of a recovery-focused group intervention delivered in acute inpatient wards in a National Health Service (NHS) Trust in England, United Kingdom. Feedback from the Recovery Group Questionnaire given to patients who had attended the Recovery Group whilst admitted to acute inpatient wards was collated and analysed. The results suggest that patients found the group useful and supportive, as well as easy to follow. Themes which emerged from the content analysis included, value, challenges, support and understanding. The feedback also showed that patients found having an Expert by Experience co-facilitating was beneficial. The Recovery Group is an acceptable and feasible group intervention for those who are admitted to acute inpatient wards. Further research examining the clinical effectiveness of the intervention may be considered, however there are some barriers to doing so given the open-access format of the group.

Exploring the use of body-worn cameras in acute mental health wards: A qualitative interview study with mental health patients and staff

BackgroundBody-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there is a dearth of research on their use in these settings, particularly when it comes to patient perspectives. ObjectiveThis study aimed to explore the perspectives of patients, mental health staff, and senior management on body-worn cameras to identify the possible impacts of this technology in inpatient mental health settings. DesignThis was an exploratory qualitative study. SettingWe undertook interviews online and in-person on a number of acute inpatient wards across five mental health hospitals in England. Participants were recruited in-person, online via social media, and through professional networks. ParticipantsThis study recruited 24 patients from acute wards, 25 staff from acute wards, six Mental Health Nursing Directors, and nine community-based patients. MethodsSemi-structured interviews were conducted online and in-person. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. ResultsThe subjective nature of how violence and aggression is defined shapes how staff and patients view the prospect of using body-worn cameras. Both staff and patients cited issues resulting from an underlying culture of mistrust in inpatient settings that leave staff and patients feeling unsafe. Body worn cameras may intensify power dynamics and undermine therapeutic relationships. Participants felt that engaging existing interventions and addressing systemic causes of violence and aggression should take priority over introducing body-worn cameras. ConclusionsThere is no indication that staff or patients believe body-worn cameras will deter violence and aggression on inpatient mental health wards. They may serve as a tool for safeguarding and staff training, but there are still unexplored ethical concerns about their use and a lack of evidence to support use of this technology to deter violence in NHS mental health settings. Tweetable abstractMental health patients & staff have complex perspectives on controversial body-worn camera technology @thekeiranwilson @unafoye @maddych4dwick @gbrennancafc @cityalan.

Experimental Staffing Models in Inpatient Acute Mental Health Services : A Longitudinal Comparative Study of Occupational Therapy Services

Introduction: An NHS Mental Health Trust in England recently used an experimental staffing model by including Occupational Therapists (OT) in the staff numbers on ten working age adult acute inpatient wards. Aims: This study aims to compare different staffing models involving occupational therapists and make recommendations for preferred staffing models. Methods: This is a longitudinal comparative study of archived patient and multi-disciplinary electronic records and data collected from Kent and Medway NHS and Social Care Partnership Trust. Areas of analysis included quantitative data and qualitative coding and theming, covering the period February 2016-June 2019 during the experimental staffing model, and July 2019-March 2021, when the model ended and teams were Occupational Therapy-led. Full ethical approval and consent was gained in 2020 from the Trust and University to request and access data to complete this research. Results: This experimental staffing model resulted in less delivery of Occupational Therapy specific interventions, resulting in poorer retention rates and impacting on patient and student experiences. Since working in Occupational Therapy led teams, the quality of Occupational Therapy interventions, job retention, student experiences, patient care and safety have improved. Conclusions: The recommended staffing model for working age acute mental health wards has Occupational Therapists embedded in OT-led teams. Staffing tools need to be developed that involve Allied Health Professional leaders and this field needs more research.

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care. BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards. DesignExplorative qualitative focus group study. MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation. ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity. ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.