Mental health care for generalist nurses – an ESimulation resource

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In this guest post, Scott Lamont and Scott Brunero write about
their
interactive ESimulation learning resource for generalist nurses, called Mental Health Liaison in General Hospitals. Lamont and Brunero are Mental Health Liaison Clinical Nurse Consultants at the Prince of Wales Hospital in Sydney.

Both Scotts are also PhD candidates at the University of Sydney.
Scott Lamont is investigating the concept, origins and understanding of Duty of Care and the use of the Mental Health Act 2007 (NSW) and Guardianship Act 1987 (NSW) in patients diagnosed with delirium in acute care settings, where either they have refused treatment or their capacity is perceived to be compromised.

Scott Brunero is investigating the individual, organisational and
socio-political processes involved in the provision of mental health care for
people with mental illness in general hospital settings.

Our current roles and studies led to the development of a NSW Ministry, Nursing and Midwifery Office-funded interactive multimedia learning resource for generalist nurses entitled Mental Health Liaison in General Hospitals.

We provide a service to all the inpatient medical and surgical units in a large metropolitan hospital where the need to build the capacity of generalist health staff in relation to care of patients with mental health problems or challenging behaviours has increased in recent years.

There are challenges in staff leaving clinical areas to attend training/education, so we sought to develop a resource which takes the learning to the learner and which can be individually accessed and returned to at a time of the learner’s convenience.

The Mental Health Liaison in General Hospitals resource is aimed at developing the skills of generalist nurses in caring for patients who exhibit psychological, emotional and behavioural difficulties in hospital.

Although developed specifically for nurses, the learning within each scenario may be relevant to a range of healthcare professionals. Completion of the resource attracts eight CPD hours for professional portfolios.

The feedback so far has been positive and the resource is currently being used within undergraduate nursing curricula at five universities in New South Wales and Queensland and numerous Local Health Districts across the country.

Background to the resource

Healthcare professionals within a general hospital setting are increasingly being required to assess for mental health symptoms and deliver mental health care, despite having no specialised training in this. Mental health clinical services in generalist settings have traditionally been provided by mental health liaison or consultation liaison psychiatry services, yet the growing need is not being maintained by the current level of services. Improving the knowledge, skill and confidence of other healthcare professionals in providing mental health care is one way of addressing this gap.

The provision of mental health care requires being able to critically reason a complex range of intellectual, ethical and practical challenges. The use of simulation as an educational tool has gained in popularity due to its ability to foster skill acquisition and the practice of decision-making within a safe contextual environment.

In a recent review of Mental Health Education Programs for generalist healthcare professionals, supervised clinical experience, role plays and case scenarios were reported as being more effective than traditional didactic methods. The didactic model has largely been diluted by the introduction of simulation-type learning. However, despite eSimulation having great potential within nursing, it is understudied and underused.

The Mental Health Liaison in General Hospitals eSimulation resource presents the following four clinical scenarios:

1) This patient doesn’t belong here: explores issues relating to recent behavioural changes in a patient on a surgical ward who is experiencing psychotic symptoms.

2) Consent to treatment and associated legal issues: explores the legal and ethical framework around consent to or refusal of treatment and related professional decision-making within generalist health care.

3) Skye is back again: introduces a 16 year old female who has presented to an adult emergency department twice within the previous week following deliberate self-harm.

4) Difficult nurse-patient relationship: explores difficult patient behaviours in the generalist setting such as manipulation, splitting and demanding behaviours.

Using a highly interactive and engaging approach, the resource has begun to bridge the gap in engaging clinicians in topics that they may not ordinarily have a primary interest in or be familiar with, engaging in a clinical decision pathway and making decisions in an environment where the fear of making mistakes is mitigated by the simulation.

Here are some quotes from a published evaluation paper about the resource:

– It was realistic and interactive… I felt myself involved in the scenario … great use of multimedia

-Much more interactive, captures your interest … traditional learning is less engaging and boring

-I liked the way reflective feedback provided learning when a wrong response was chosen … as opposed to other online learning systems which simply tell you that your response is incorrect

-Pausing the scenario for questions and feedback allows opportunity to practice decision-making during the learning … unlike other learning where you need to wait for an opportunity after the learning has taken place.

The software can be made available on health service intranet systems, CD and DVD as well as the Internet, thus individuals can use it at any convenient time.

Developed by Scott Lamont and Scott Brunero of Mental Health Liaison Nursing at the Prince of Wales Hospital Sydney, in conjunction with inkysmudge.com.au; with funding from the Nursing and Midwifery Office of the New South Wales Ministry of Health.

The Mental Health Liaison in General Hospitalsresource.

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