Thriving, not just surviving: award-winning toolkit supports the mental health of student nurses and midwives in Manchester

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Tracy Claydon, PEF

As we highlighted earlier this week, Tuesday 10 October marked World Mental Health Day, an annual, global event recognising the impact of mental health on the lives of many and the importance of showing compassion to those struggling with mental ill heath, as well as looking after our own mental wellbeing. As student nurses and midwives, we may experience a broad range of mental health issues throughout our training as we adjust to our role; juggle placement, academic work and our personal lives; and because of the distressing experiences we may be exposed to on placement. Thankfully, the wonderful team of practice education facilitators (PEFs) at the newly formed Manchester Foundation Trust  (formerly CMFT) have our backs, creating an award-winning toolkit for mentors to enable them to better look out for and support our mental health in practice. We are delighted to share this Q&A with Tracy Claydon (pictured above), PEF for the Division of Specialist Medicine and the Corporate Division at Manchester Foundation Trust and project co-founder. She gives us an overview of the Mental Health and Wellbeing Toolkit and how it aims to support students and mentors in practice.

Firstly, what is the Mental Health and Wellbeing Toolkit?

We identified that there was no specific practical guidance to help mentors in supporting students who may be in emotional distress and/or be experiencing issues relating to their mental health when on placement; the Royal College of Psychiatrists’ (2011) indicated that as many as 29% of students may experience mental health difficulties at some point during their studies, while the National Union of Students (2015) have this figure as high as 78%. The toolkit was developed to support not only current nurses and mentors but also of course to support students to better manage the emotional demands of the role and feel supported to carry out their job confidently.

It is possible and also likely that a significant proportion of the students presenting in distress will not have a diagnosable mental illness but will be experiencing distress related to ‘life stresses’ and will need support to allow them to cope effectively with these rather than seeking to be prescribed an antidepressant or similar medication (NHS Choices, 2016). The provision of a toolkit that would provide a structure and framework for mentors to better support their students was clearly needed. The toolkit includes:

  • Tips for mentors including advice on how to discuss and identify concerns
  • Algorithms for accessing support
  • ‘Having the Initial Conversation’ guidance for mentors
  • Top Ten Tips for students to look after their own mental wellbeing
  • Agency Directory

The toolkit was launched in November 2016 and re-launched in May 2017 to coincide with World Mental Health Awareness Week which had a theme of ‘thriving or surviving’ which reinforced our message… we don’t just want our students to survive, we want them to thrive!

Where did the idea for the toolkit come from?

Students will often experience quite harrowing situations during one single placement that possibly other members of the public will go through their entire lives without seeing.

We talk often about resilience, but how do we build this? And crucially, what can we do when anxiety becomes more than a transient emotion? From a practical guidance we recognised that there were gaps in our support mechanisms within the organisation and also that we had the underpinning literature to evidence this.

The Nursing & Midwifery Council and the Royal College of Nursing recognise the potential for students to experience difficulties in their mental health and yet surprisingly neither agency has/had provided any guidance for nurses or mentors to support them.

At Manchester Foundation Trust (MFT) we wanted to fill this gap and the toolkit was developed as a resource to address this. Equally, it was also incumbent upon us to acknowledge how anxiety or a sense of isolation when not managed in the early stages can then escalate into something more concerning.

The goal was to support our students at the beginning, end and at all points in between on their placement and learning journey, so that they will recognise and regard MFT as a caring and compassionate organisation that enables students to thrive and not just survive and that they would wish to return as qualified staff.

How did you go about developing the toolkit?

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Ant Southin, Specialist Mental Health Liason Nurse

It came as a result of a real life situation where I as a PEF was supporting a compassionate and kind mentor who was struggling to support a student on placement struggling with mental health issues. Myself and my PEF colleague Sharon Green, began working on the toolkit as a resource however, the toolkit only truly started to develop when we were able to access the knowledge and skills of Specialist Mental Health Liaison Nurse, Ant Southin (based at MRI, pictured right) who was able to provide the expertise that we as registered adult nurses by background lacked. This enabled it to have a real MDT approach and became a wonderful collaboration!

How has the toolkit been used in practice so far?

For some students the situations they observe or are involved in will be the most distressing thing they have experienced. It is important that they have a means of communicating and understanding these feelings and recognising that there is help available. The Toolkit has been used in a number of situations where students were struggling to cope emotionally: including supporting students who were affected by this year’s Manchester Bombing.

What are your plans for the future of the project?

Despite having been awarded the MRI Fellowship Award at the recent Nursing and Midwifery Conference and also having been acknowledged as an example of Best practice by Health Education North West (available as an E-Win) we feel this work is still in its infancy; while it is currently aimed at students, we recognise that the messages are important for all of our staff. We hope that we can develop it to be used to support any member of staff experiencing distress. The Human Resources department have requested a meeting to begin discussions around achieving this within the wider organisation. We will be presenting at the upcoming Midwifery Forum at St. Mary’s Hospital and we have also had heard nationally from other NHS Trusts interested in adopting the toolkit within their own organisations.

The MRI Fellowship Award 2017 included a £1000 monetary prize which will be used to support ward areas to develop their own ‘buddy box / soothe box’ resource which they can then continue to develop to meet the needs of their students and staff.

…and finally, what advice would you give to student nurses and midwives to take care of our mental health while on placement?

Student nurses and midwives need to feel prepared and supported for the career they are about to embark upon. The profession is challenging and demanding but with huge personal and professional rewards. Mental health issues can affect any of us at any time in our careers and should be considered a priority for all of us whatever stage of our career we are at. By making them a priority for students it is hoped that they will continue to see this as a priority as they progress through what we hope will be successful nursing/midwifery careers. Using our dedicated #icareforme approach we will continue to maintain the profile of the huge importance of self-compassion for staff working within such challenging and complex environments. It is vital that mental health has the same parity with physical health and we can only achieve this by making it the priority it deserves and needs to be.

Thank you Tracy!! If you’re interested in learning more about the toolkit, you can find it here – in particular, take a look at the ‘Top Ten Tips for Good Mental Health’ on pages 8-9 for simple ideas that we can all use to look after our mental health.

Remember that if you are struggling with your mental health or feeling anxious, worried or depressed then don’t try and suffer on in silence. If you feel confident to do so, speak to your mentor, PEF or academic advisor (AA) or the University of Manchester has a fantastic confidential Counselling Service. Often speaking with your peers can ease the burden – you may find that others are feeling the same – or if you simply want a kind, listening ear then Nightline is another brilliant option, you can find the contact number on the back of your student card.

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Raising Concerns

Whilst in practice, unfortunately, sometimes we can witness bad practice. It’s not a situation I would wish upon any student nurse or registered nurse for that matter as it immediately puts you in a very difficult position.

Yes, in the perfect world, there would be no internal conflict, you would identify the issue, escalate it to your manager or mentor and trust that it will be dealt with appropriately and with discretion and professionalism. However I know in my circumstance, I was/am struggling to trust that sharing my concerns will not impact upon my learning and education within this ward. This isn’t based upon anything other than my own fear of self-preservation, which makes it harder.whistleblowing

You’re faced with a decision, to voice your concerns and risk an uncomfortable and strained time in practice or say nothing and risk patient safety/dignity/pride. It really isn’t a toss up in my opinion.

The process is intended to be as pain-free as possible. Speak to the relevant individual, be it PEF, Ward Manager, Academic Advisor or Mentor and your concern should be dealt with in a professional and serious manner befitting the circumstance.

I have to say that as soon as I raised my concerns I felt an immediate sense of relief and confidence. Confidence that I had done the right thing for my patient, patient’s to come. I had 3 weeks remaining in my practice area and this was rather terrifying as I thought I would be identified somehow and treated poorly for raising concerns in practice, this I am very happy to report WAS NOT THE CASE. I wasn’t treated any differently whatsoever, I felt supported, trusted and above all I felt like the University was proud of me speaking up when I did.

This feeling was reinforced on Monday when placement allocations came out. A very close friend of mine has been allocated the same placement in which I experienced poor practice. I could have easily ignored the issues in the ward. Easily put them to the back of my mind and they would have continued and other Students would have struggled and felt as conflicted as me but because I spoke out – those issues have been resolved.handshake

I was able to say to my friend in confidence that any obstacles I encountered in practice have been resolved. No placement is perfect but if each student that encounters issues keeps quiet – they will never be perfect.

It can be very easy for student nurses to lay the blame for poor practice areas at their mentor’s feet but we have our part to play as well. Be honest in your placement evaluation and be honest with your mentor throughout your training – if they know what works well and what doesn’t that can only lead to improvements in how they teach and how you learn. So BE BOLD and SPEAK UP, who knows the number of people that will benefit from your honesty in the future.

PEF contact details can be found via this link:

http://sites.bmh.manchester.ac.uk/nursing-mentors/contacts

PEF’s corner: Lisa Brown, MHSC

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At a recent PEF forum we asked some of your friendly neighbourhood PEFs some short interview questions to help you get to know them better and pass on any wise words of wisdom! First in this series is Lisa Brown, PEF and OT at Manchester Mental Health and Social Care Trust, Thanks Lisa!

 


What is your background in Nursing? 
I don’t have one! I am an Occupational Therapist by professional background and have worked on acute mental health wards since I qualified in 2005. I currently work 2 days a week as a PEF and have done since April 2015 and 1 day a week as an OT.

What do you enjoy most about your role as a PEF?
I really enjoy getting the students feedback from placements and helping students get the most out of their placements. I’ve also enjoyed implementing inter-professional learning sessions in our trust so that students from different professions can learn to work together better in practice.

What is the most challenging part of being a PEF?
The most challenging aspect tends to be the administrative / organisational issues, ensuring we have enough good quality placements available and enough educators to accommodate the students.

What does Occupational Therapy mean to you?
Occupational therapy to me means helping people to help themselves. I enjoy finding out an individual’s story and tapping into their interests and values to enable them to live more independently and achieve their goals.

One piece of advice you would give yourself as a student…
Take full advantage of all your placement opportunities , ask lots of questions and ask if you can take the lead in things – I often waited to be asked and missed out to some extent by not taking the initiative.

How can students get in touch with you?
I am available by email via the form below. You can also follow our trust twitter account @PEFMMHSCT for updates or my personal account @OT_LisaB for general musings on mental health, occupational therapy and education.

Please use the form below to contact the author of this post with your comments and questions:

Out on Placement

Guest Blog written by Emma Wilkes


I think it’s fair to say that most student nurses are nervous before starting a new placement, however LGBT students may feel extra nervous. Whether it’s awkward conversations about your love life, or a worry about what toilets it’ll be ok to use, it’s totally understandable. As a student nurse every new placement involves another coming out and this can be nerve wracking and emotionally difficult.

So here are five tips to survive coming out at placements:11049526_536723163136072_4031043654954708270_o

  1. Don’t feel you have to out yourself immediately – there is no need to introduce yourself as Emma the lesbian and you shouldn’t feel under pressure to do so
  2. But also don’t feel you can’t come out, everyone talks about their partners and children and you should be able to do the same.
  3. You don’t have to tell everyone, it’s ok to just tell people in conversation and leave those who weren’t there to work it out for themselves
  4. If you have any problems or concerns talk to your AA, mentor or PEF, they are there to support you and you should never face any discrimination on the grounds of your sexuality or gender identity
  5. Don’t be embarrassed, be proud of who you are, you have a unique life experience which will be valuable to you in nursing

The University LGBT society have lots going on, although it won’t always be possible to make their Wednesday group they also have things going on in the evenings and weekends. In Manchester you’ll also find the LGBT Foundation who have lots going on and can offer lots of support.FENT__1432160698_here-if-need-us

Learning Curve

Your first placement as a student nurse is meant to give a taster of what your career could be. It’s designed to inspire, help you find your feet and learn some of the basic skills. So what happens if that’s not the case?

There is a known fact amongst student nurses/midwives that everybody has a bad placement, whether that means it’s too intense, not what you expected, or not as exciting as you hoped.

For me, it was very much not what I expected. I was placed on an outpatients’ department. It was incredibly diverse in that I worked alongside many different healthcare professionals and was able to observe a wide range of clinics- which all helped my A&P knowledge a lot! But apart from that, I felt a bit shortchanged. Whilst all my colleagues and friends were off being thrown in at the deep end, I was endlessly calling patients in and observing doctors’ clinics. This wasn’t exactly the way I saw my first experience as a student nurse panning out, and I felt completely hopeless. Fellow students and staff would give me a look of sympathy and tell me it gets better when I told them where I was. I would dread going there, because I wasn’t being challenged. I felt that my time wasn’t being spent in the best way possible.

The best thing to do in a situation like this is to make the most of it. It’s hard, I know. You think “what could I possibly get out of this” but you’d be surprised! A placement like this is a great chance to brush up your knowledge, and it’s fabulous for reflective accounts! I have spent countless hours observing every moment in a consultation, thinking about what went well, what could have been better, and how I could improve that when I am put in a similar situation. You’ll also spend a lot of time talking to patients, which can make all the difference to them. A memorable patient for me was a young woman with a rather excitable young child came into the clinic. I played with the child (using only a curtain, which I’m quite proud of) whilst she discussed her medical problem. When she left, she thanked me so graciously that I knew I’d done her a huge favour. Its moments like that I have to remember that nursing isn’t all exciting stuff and clinical skills. Sometimes it’s about those moments when you make someone’s life just a little bit easier.

 

Note: if you ever feel unsure about your placement, no matter what the problem, talk to somebody! Whether that be your mentor, PEF, friend, AA or another member of staff. Someone can help.

PEFs: An Underestimated Force of Nature

Placeholder_couple_superheroPractice Education Facilitators (or PEFs as they’re commonly known) are the bridge between University and Placement and are there to help YOU.

Too many times I’ve heard students complain about really valid issues in placement such as not having an identified mentor or struggling with their allocated working hours only for them to say “Oh no I haven’t mentioned it to the PEF”

Each practice area has a designated PEF who’s details will be available to you on Blackboard, via your trust’s intranet and are often plastered all over the student noticeboard at your placement. These details are there to be used! From my experience the sooner an issue is raised with a PEF the more options they will have to improve not just your practice experience, but the experiences of those to follow you as well.

I thought my current placement was dire when I started, I really struggled to get to grips with the layout of the clinics, the working hours were strange and the procedures seemed so abstract and removed from the Nursing I was used to in my previous ward. I was close to asking to be moved when I spoke to my PEF.

She listened to my concerns, understood them and then fired back about 10 different solutions to the issues I had been struggling with for weeks.

After a few days of implementing these suggestions I started waking up excited to get into placement. The wealth of knowledge these members of staff are privy to can completely change your placement and they’re also able to raise concerns with other members of staff if there is a real issue in placement.

So PEFs; teachers, advisors, counselors at times but first and foremost Nurses who’s main goal is to ensure you are as supported and happy as you can be in practice.