Eric Lim

Graduate nurses in Australia are now comprehensively prepared and have limited mental health knowledge and experiences to work in acute mental health settings. As such, they would require support from the nursing education of their respective mental health services to support them to progress from novice to advanced beginner. However, there is currently a variation in nursing education that supports graduate nurses in transitioning to mental health nursing. Therefore, it is important to understand graduate nurses’ viewpoints of nursing education and its effectiveness for helping them. This presentation presents a Q methodology study that was undertaken to generate an in-depth and accurate understanding of graduate nurses’ experiences in one of Western Australia's mental health services. The findings revealed four types of graduate nurses, and they were: (1) graduate nurses who experienced challenges of being accepted by their nursing team; (2) graduate nurses who had low self-confidence about their mental health nursing knowledge and skills to practice in acute mental health settings; (3) graduate nurses who felt confident about their mental health knowledge and skills but experienced challenges to apply them to difficult clinical situations; (4) graduate nurses who felt confident with their mental health knowledge and skills and accepted by their nursing team. The findings highlighted that nurse educators might need to tailor education to meet the needs of graduate nurses progressing from novice to advance beginner in mental health nursing.

Introduction and Background: Virtual reality (VR) is an effective way to overcome the cost, time, and logistic problems of planning and delivering education and can be used to simulate high-risk clinical situations without exposing the person to the potential consequences of encountering the event in the real world. Therefore, it is likely that VR could be incorporated into education on aggression management for nursing students without the actual consequences of doing it in real-life clinical settings.

Aims/Objectives/Hypotheses: A pilot study to evaluate an education on aggression management that incorporated VR for teaching aggression management. The research questions guiding this study were to: Determine pre- and post-education differences in nursing students’ attitudes and confidence of managing aggression in clinical settings, and their empathy, knowledge, and attitudes toward persons with a mental illness? Evaluate nursing students’ experiences regarding the use of VR in their education on managing aggression?

Methods: Quantitative pre- and post-education surveys were used to collect data. The surveys included (i) Confidence in coping with Patient Aggression Instrument(CCPA), (ii) Jefferson Scale of Empathy Health Professions Student(JSE-HPS), (iii) Management of Aggression and Violence Attitude Scale (MAVAS), (iv) Mental Health Literacy Scale(MHLS), and (v) Opening Minds Scale for Healthcare Providers(OMS-HC). The collected pre- and post-education measures were analysed using SPSS and the selected statistical significance level for testing the hypotheses were p < 0.05. Basic demographic data were collected pre-education and the Virtual Reality Neuroscience Questionnaire(VRNQ) and session evaluation data were collected post-education.

Outcomes/Significance/Implications for the Profession: Eleven nursing students participated in this study. There was a significant difference in median total scores of MAVAS factors external and situational/interactional, and CCPA scale. However, there were no significant differences between the other pre- and post-education JSE-HPS, MHLS, and OMS-HC measures. Most participants reported that the sessions in the education were conducted in an engaging manner (6.45, SD = 0.820) and that the debrief session was useful for consolidating their learning (6.36, SD = 0.674).

Translation to Practice: The use of VR in nursing education is potentially beneficial to prepare nursing students for real-life clinical challenges and should be further explored to develop evidence-based practice.

This presentation aims to discuss the consumers’ perspectives of comprehensively prepared graduate nurses and their nursing care in acute mental health settings. With the comprehensive nursing program as the gateway for registration to become a nurse in Australia, many nurses are working in acute mental health settings without more specialised mental health knowledge and skills. While there is a myriad of nursing literature highlighting experienced mental health nurses’ perspectives of having comprehensively prepared graduate nurses working in acute mental health settings, the perspectives of consumers are lacking.

The objective of this presentation is to report on the findings of a completed exploratory qualitative study with consumers to explore their experiences of being cared for by comprehensively prepared graduate nurses. Purposeful sampling recruited 12 consumers who were admitted to the inpatient mental health units in Western Australia. Data were collected using semi-structured interviews and data saturation was achieved. Braun and Clarke's method of thematic analysis was used to analyse the collected data and three themes emerged. The emerged themes were: You got what it takes to be a mental health nurse; slow down and spend quality time with us; and read in between the lines when we share our negative lived experiences.

The findings highlighted that there was no significant difference between the level of quality of care provided by experienced mental health nurses and comprehensively prepared graduate nurses to support their clinical and personal recovery. Areas highlighted by the consumers that comprehensively prepared graduate nurses may need to develop include confidence, professional identity, micro-communication skills, and the ability to travel alongside consumers with negative lived experiences.

Poor or ineffective management of the aftermath effects of consumer aggression can cause nurses to experience psychological and emotional responses, which can lead to higher sick leave, medical claims, and in some cases, resignation. These can result in higher healthcare costs, poorer quality care, increase use of restrictive measures, and increase nursing shortage to maintain milieu in inpatient mental health units. A systematic review was done to identify best evidence-based practices for managing the aftermath effects of consumer aggression on nurses.

The inclusion criteria for review are (i) interventions managing aftermath effects of consumer aggression; (ii) empirical researches on interventions managing aftermath effects of consumer aggression; and (iii) qualitative studies and systematic review on managing aftermath effects of consumer aggression. A search was conducted across six databases using keywords: debriefing, counselling, support, PTSD, assault, aggression, violence, and nurse victim, which are found in relevant articles and after consulting experts of the field.

The search yielded a total of 3475 articles, but only 10 articles fulfilled the inclusion criteria. Excluded articles were mainly related to the management of consumer aggression, risk assessment, management of negative reactions not related to consumer aggression, enhancement of reporting system of consumer aggression, horizontal and/or vertical aggression, and all other types of aggression not related to healthcare.

Although this literature review found a paucity of empirical studies, it identified three interventions (i) formal crisis management; (ii) informal peer support; and (iii) staff training for managing the aftermath effects of consumer aggression on nurses. Formal crisis management is appreciated by nurses as support from organization. Informal peer support is the most widely utilized by nurses when formal support is unavailable. Staff training is expected but with no empirical evidence available to support its effectiveness for managing aftermath effects of consumer aggression on nurses. All these interventions are subjected to the timing delivered, staff attitude and coping mechanism, and working environment.

Despite the lack of empirical data, three interventions were identified and recommended for managing the aftermath effects of consumer aggression on nurse. More empirical research is needed to lead change, shift culture, and improve workplace health effectively.