Alan Simpson and Lisa Reynolds outline how mental health nursing students learned about users’ experiences through an innovative e-learning projec

Reynolds, L. M.

Simpson, A.

City Research Online

Simpson, A. & Reynolds, L. M. (2008). Consulting the Experts. OpenMind, 152, City Research OnlineOriginal citation: Simpson, A. & Reynolds, L. M. (2008). Consulting the Experts. OpenMind, 152, Permanent City Research Online URL: http://openaccess.city.ac.uk/7253/ Copyright & reuseCity University London has developed City Research Online so that its users may access the research outputs of City University London's staff. Copyright © and Moral Rights for this paper are retained by the individual author(s) and/ or other copyright holders.  All material in City Research Online is checked for eligibility for copyright before being made available in the live archive. URLs from City Research Online may be freely distributed and linked to from other web pages. Versions of researchThe version in City Research Online may differ from the final published version. Users are advised to check the Permanent City Research Online URL above for the status of the paper.EnquiriesIf you have any enquiries about any aspect of City Research Online, or if you wish to make contact with the author(s) of this paper, please email the team at publications@city.ac.uk.Consulting the Experts  OpenMind Page 1 of 4 Consulting the Experts     Alan Simpson & Lisa Reynolds  Alan Simpson and Lisa Reynolds outline how mental health nursing students learned about users’ experiences through an innovative e-learning project            words/ 1,345       Contact details:   Alan Simpson City Community and Health Sciences City University  Philpot Street  London E1 2EA     Tel: 020 7040 5937   A.Simpson@City.ac.uk    Consulting the Experts  OpenMind Page 2 of 4 Consulting the Experts  It is always a challenge trying to come up with ways to encourage mental health nursing students to think about what it is like to be a mental health service user.   How do you get them to try and understand what it is like to have a mental health problem or to be admitted to a psychiatric hospital? And more importantly, how do you get those students to reflect on their own attitudes and behaviour and encourage them to have positive, constructive relationships with users?  Increasingly, this is addressed by inviting service users to take part in the education and training of healthcare students and staff through a variety of waysi. So we were very excited when we had the idea of getting our students to communicate online with people who had personal experience of mental health problems and services.   We knew a lot of people, including service users, used online discussion and message boards to discuss things, but could we make it work as part of an educational project? As far as we could find out, this had not been tried before, so we couldn’t nick anyone else’s ideas.   A small group of us, including a service user lecturer, created a restricted-access project site complete with sample discussion threads on the university’s website and put together some publicity materials before making contact with local user groups.  After giving presentations at three mental health day centres, we recruited 12 users keen to take part. About half of them already used the internet, the others were new to computers and emails but training, support and payment were all part of the deal. Around the same time we invited a group of 34 second year mental health nursing students to take part and all agreed.   As we intended to evaluate the project, everyone was given printed information and provided written consent to take part.  Information about the amount of time spent online, and the number of email messages read and sent was automatically recorded. Ten of the 12 users (83%) and 13 of the 34 (38%) students (selected by age, gender, ethnicity and level of participation), were interviewed by an independent researcher at the end of the project.  Once everyone had been trained and knew how to use the discussion forum, the students sent email questions to the service users on six topics linked to a scenario they had been given. The users were encouraged to respond to the questions and it was hoped that spontaneous discussions would develop between and amongst the participants. The students also had to use traditional library resources to research their subjects.  All contributions were monitored by the project team, who very occasionally intervened to encourage participation. After six weeks, the users were invited to attend presentations by the students on what they had learnt. Consulting the Experts  OpenMind Page 3 of 4   The project was an overall success with all students and service users interviewed overwhelmingly positive about the online discussion forum. They valued the discussions, would happily take part in a similar project again and would recommend it to others. They supported increased use of online discussions in healthcare education and had suggestions for topics that could be covered.   Students described the contributions of the users as ‘responsive’, ‘brilliant’, ‘excellent’, ‘fantastic’ and ‘effective’. Their learning had clearly been influenced to some extent in that four of the six groups of students drew on the discussions in their presentations, with two groups specifically focusing their work on the online interactions. They found that the online forum gave them an insight into users’ experiences, improved their communication skills and provided motivation to work on psychiatric wards.   Above all they had acquired an understanding of the users’ experiences of admission to hospital and about the feelings aroused by being spoken to or interacted with in a particular way.   I think just an idea of, just an impression of how it is to be on a  psychiatric ward, that’s mainly what kind of things I asked about … how  they found the atmosphere.  What were their fears and what they found  to be… the most worrying aspects of being in hospital. (Student).  Others identified hearing first hand experiences of the impact of mental illness and distress and reflected on how this could influence their clinical practice.    I’ve learnt that maybe in future when I go on my placements, to put some  of the things I’ve learnt on board … communication skills or during  admission… that kind of a thing, so these are the kind of things I’ve  learnt and I try as much as possible to implement in practice and improve  more. (Student).  Over half the students (58.8%) logged on and read messages from users and fellow students. However, it became clear that there was a ‘visible’ group of 15 (44%) contributing to discussions, with 14 (41%) playing no active part online, despite using the technology during the practice weeks. The tendency not to post emails reflects the common experience of any online discussion forum, where ‘passive’ membership (‘lurking’) often outweighs active participation, but it also reflected concerns expressed during the study that students lacked confidence in communication.   In contrast, the majority of the service users played an active role online. On average they sent more messages than the students and were more confident in using computer technology than most students. They were keen to take a leading role in the online community and valued contributing to the education of future nurses and of challenging stereotypical and stigmatising views of people with mental health problems. They also learnt things themselves from taking Consulting the Experts  OpenMind Page 4 of 4 part in the discussions and developing open dialogue with the students and each other.  The users were generally positive about the input of the students and thought they asked some good questions, but would have appreciated more discussion on a range of other topics. Others expressed frustration with the limited way in which students asked questions and failed to follow-up responses, although they also cited positive examples.     But then you had some who were really good, like the one about being  admitted onto an acute ward and your experiences and I said about  mine and someone wrote saying well how could it have been better,  what would you have liked to have happened, which I  thought was really  positive. (User)  There was an awareness that some of the students were hesitant about probing too far, which had led some users to offer encouragement.   I know there was one or two students that felt they weren’t confident  enough to ask us, or they didn’t want to cause us any offence and we  emailed back, don’t worry about it cos like we’ve had worse… I can  understand where they were coming from but I think we’re made of  tougher stuff than that, yeah? (User).  Users spoke of gaining confidence in using computers. Being valued and taken seriously was in itself rewarding and empowering, but above all was a hope that they might be contributing towards positive change in the attitudes of staff and the delivery of mental health services.   Some of the discussions were very emotive for the users but they were able to positively reframe their survival of difficult life experiences. Several explained how they had benefited from talking about their experiences online as the distance and anonymity afforded by the forum was an advantage, perhaps suggesting the therapeutic potential of online communities.  The use of an online discussion forum involving mental health service users and students is both possible and highly desirable. Online interactions enabled users to discuss their previous experiences, explain the impact of their care and treatment and encouraged students to consider and reflect on the implications for their own practice.   There is considerable scope to develop similar initiatives across health and social care education and it is clear that service users could and should be at the forefront of that development. Future joint projects between service users and educational researchers might attempt to analyse the impact of online discussions on attitudes and healthcare behaviours in the workplace, because that, of course, is where it really matters.                                             i Simpson, A. (2006) Involving service users and carers in the education of mental health nurses. Mental Health Practice, 10 (4), 20-24.  

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