By Christopher Patterson @ChrisFPatterson and Lorna Moxham @LornaMoxham
Evidence-based practice (EBP) is a fundamental aspect of nursing education and informs safe and effective nursing practice. However, it is well documented that nurses are not implementing EBP at the ‘levels considered desirable and recommended by scientific and international organizations [such as the International Council of Nurses and World Health Organization]’, (Baixinho et al. 2022, p. 6784). This is a cause for concern for all nursing, and in the context of mental health care, particularly where recovery-oriented practice, which is founded on evidence, and is considered best practice, it sets alarm bells ringing
MENTAL HEALTH RECOVERY
Patricia Deegan’s (1993, p. 8) seminal definition of recovery reminds us that, ‘the concept of recovery is rooted in the simple yet profound realization that people who have been diagnosed with a mental illness are human beings’. Davidson et al. (2010, p. 3) define recovery as the ‘restoration of a meaningful and productive life for the person living with a mental illness’. Recovery-based practice then seeks the provision of relational care that promotes a person’s realisation of meaningful self. This evidence based caring approach is therapeutic in the way that it provides opportunities for people to explore their strengths and capabilities in a supported setting to help develop greater perceived control (of self and illness), social connectedness and self-determination.
A recovery-orientated therapeutic approach for people living with mental health issues and mental illness has come to be seen as the current best practice in a range of fields including psychology, psychiatry, social work, counselling, occupational therapy, and nursing (Jorgensen, Hansen, Karlsson 2022; Davidson, Rakfeldt & Strauss 2010). However, while services are expected to provide this, research on how recovery occurs in mental health services, is lacking (Jorgensen, Hansen, Karlsson 2022). Further, for pre-registration nursing students, although recovery-oriented practice is theoretically taught as best practice for mental health, their experience on clinical experience placement is described as being different, often negative, and replete with attitudes that reek of stigma (Moxham, Taylor, Patterson, Perlman, Brighton, Sumskis, Keough & Heffernan, 2016)
Heard the phrase “clinical is pinnacle”? That’s because, clinical placement is a core component of pre-registration undergraduate health programmes and it’s where students get to be ‘in the real world’, applying what they learn in the classroom. Using the Australian context as an example, Bachelor of Nursing (BN) students are expected to undertake 800 hours of clinical placement experiences across a range of nursing disciplines including mental health. Evidence-based, best-practice models that delivery recovery-oriented care are needed. And one such example of an evidenced based clinical placement is – Recovery Camp.
RECOVERY CAMP: CLINICAL PLACEMENT
Recovery Camp is an innovative, evidence-based program that has been shown to be effective in improving the mental health and well-being of people with mental illness (Picton et al, 2018), reduce stigmatizing attitudes of nursing students (Moxham et al, 2016), and the mental health competence (and confidence of nursing students (Cowley et al, 2016). The core purpose of the Recovery Camp model is twofold: to provide an immersive, recovery-orientated clinical placement experience for health students; and, to provide a recovery-orientated experience for people living with a mental illness.
Recovery Camp is a four-night, five-day immersive program that is led by a team of experienced mental health professionals and academic researchers. The program has received a national teaching award and its pedagogy is based on the principles of recovery-oriented mental health care – which emphasizes the importance of empowerment, hope, and self-determination – and on the principles of therapeutic recreation – which facilitate therapeutic gain through the implementation of leisure and activity. The structured program includes a variety of activities that are designed to move students into the zone of proximal development (Vgotsky, 1978). That is, to move them into the space just beyond their independent ability, but into a space that they can find success with the support of a more capable other. In this instance ‘other’ being, specialist facilitators and experts by experience. To do this, learning opportunities that promote team problem solving, social connection and community, as well as physical and mental health and recovery are scheduled. Learning activities include hiking, camping, team sports, art therapy, and music therapy.
As well as providing clinical placement experience for pre-registration health science students TR provides significant benefits for both people with a lived experience of mental illness (consumer) and professional staff.
As illustrated in Figure 1 the design, development and implementation of learning experiences can be viewed as the ‘engine’ of the program that generates a range of benefits. The aim is to provide a pleasurable, recreational experience for consumers that can assist with the functional management of their condition. Staff scaffold activities to meet the needs of each participant based on the theoretical underpinnings of personal recovery. Alongside this staff perform a mentoring role for pre-registration students, reflecting on their own practices and attitudes and considering how this impacts on the professional learning of students in relation to future career paths.
Additionally, the Recovery Camp model provides an opportunity to undertake focused collaborative inquiry, educational evaluation and scholarship. The multi-method research design involves both qualitative research of the experience students and consumers, and quasi-experimental investigation of outcomes.
Recovery Camp enables nursing students to witness firsthand how research evidence translates into practice. Engaging in activities and interventions grounded in evidence-based practices, means that students observe the impact of these interventions on participants’ mental health outcomes. This experiential learning bridges the gap between theory and practice, enhancing students’ understanding and confidence in applying EBP.
At the core of Recovery Camp, however, is the utilisation, and teaching of students about, a central component of EBP. Harnessing this component also has the impact and benefit of promoting mental health recovery.
That component is lived-experience as evidence. The knowledge and wisdom that people with mental illness have gained from their own experiences. Experts by experience, and this is how they are positioned.
MENTAL HEALTH LIVED-EXPERIENCE AS EVIDENCE
Mental health lived-experience is a significant form of evidence from which nursing students can learn. It is also an essential form of evidence for nursing practice, and integral in the delivery of recovery-oriented practice.
This knowledge is invaluable to nursing students, as it can help them understand the challenges and triumphs of living with mental illness. Students understanding the importance of lived-experience is essential learning to ensure they deliver future EBP.
Baixinho, C. L., Ferreira, O. R., Medeiros, M., & Oliveira, E. S. F. (2022). Participation of nursing students in evidence-based practice projects: Results of two focus groups. International Journal of Environmental Research and Public Health, 19(11), 6784. doi:10.3390/ijerph19116784
Cowley, T., Sumskis, S., Moxham, L., Taylor, E., Brighton, R., Patterson, C. & Halcomb, E. (2016). Evaluation of undergraduate nursing students’ clinical confidence following a mental health recovery camp. International Journal of Mental Health Nursing, 25(1), 33-41. doi: 10.1111/inm.12188
Davidson, L., Rakfeldt, J. & Strauss, J. (2010).The Roots of the Recovery Movement in Psychiatry: Lessons Learned. Wiley Blackwell: UK.
Deegan, P. E. (1993). Recovering our sense of value after being labeled mentally ill. Journal of Psychosocial Nursing and Mental Health Services, 31(4), 7-11. doi:10.3928/0279-3695-19930401-06
Jørgensen, K., Hansen, M., & Karlsson, B. (2022). Recovery-oriented practices in a mental health centre for citizens experiencing serious mental issues and substance use: As perceived by healthcare professionals. International Journal of Environmental Research and Public Health, 19(16), 10294. doi:10.3390/ijerph191610294
Moxham, L., Taylor, E., Patterson, C., Perlman, D., Brighton, R., Sumskis, S., Keough, E. & Heffernan, T. (2016). Can a clinical placement influence stigma? An analysis of measures of social distance. Nurse Education Today, 44, 170-174. doi:10.1016/j.nedt.2016.06.003.
Picton, C., Patterson, C., Moxham, L., Taylor, E. K., Perlman, D., Brighton, R. & Heffernan, T. (2018). Empowerment: The experience of Recovery Camp for people living with a mental illness. Collegian. 25(1), 113-118. doi:10.1016/j.colegn.2017.04.005
Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
Christopher Patterson and Lorna Moxham are founders and directors of Recovery Camp Pty Ltd, a research impact project established at the University of Wollongong, Australia.