Enhancing Mental Health Nurse Student Learning in Groups through Occupational Therapy

(Left to right.. Lizi Brown (Third Year Mental Health Nursing Student) Annette Feakes (Senior Lecturer in Occupational Therapy) Lucy Colwell (Senior Lecturer in Mental Health Nursing))

In this blog Lizi Brown (Third Year Nursing Student) and Annette Feakes (Senior Lecturer in Occupational Therapy) consider and reflect upon the process of working with occupational therapy students to enhance mental health nurse student learning in groups

The arguments for using psycho social groups within nurse education are well founded. Nursing students who engage in activity-based group work are more able to develop interpersonal relationships, have enhanced learning of problem-solving skills, practice cooperation and altruism, develop insight into healing and experience interdependent growth in self-confidence (Yun-Jung 2018).  Moreover,  there are benefits for practice as nursing students nearing Future Nurse NMC registration are required to demonstrate efficacy in leading and managing care for diverse groups and to apply experiential and theoretical knowledge to team-working and decision making.

Mental Health nursing students during all three years of the degree programme at Brighton attend experience based learning groups which use a facilitated group reflective process to consider practice. During the third year students also participate in an eight session closed group mindfulness practice alongside smaller group project work for leading and developing group nursing interventions for marginalised groups. Students feedback positively on the effects of this work on self care, self-confidence and in developing group interpersonal skill. There is also comment on how in practice groups are often facilitated inter-professionally with occupational therapists. As part of third year practice  learning, the mental health nursing students this year attended an occupational therapy student led activity group for anxiety based problems. The aim was to facilitate understanding of the occupational therapy role and how occupation can be used as therapy whilst experiencing and gaining insight into being a participant in an activity.

Lizi Brown reflects….

I worked very closely with an OT on my last placement and found the experience really positive, not only in terms of developing my understanding of the role, but also in getting the chance to practise planning and delivering care for service users drawing on knowledge and understanding from a variety of perspectives. Having seen first-hand some of the benefits of effective multi-disciplinary working, and coming to understand the value of bringing a range of knowledge to the table, I was happy to be offered an opportunity to continue my learning in this area.

We were told beforehand that we would be acting as participants in group occupational therapy-based activities delivered by OT students, designed to support people with difficulties around anxiety.

The process of finding my way to the venue and room felt mildly stressful, not wanting to be late, trying to navigate my way to a new place, and then not being able to get through the front door. I have heard myself say to service users that getting ‘through the door’ is often one of the hardest bits of engaging in support and this experience really made me reflect on that. I wondered what my journey into the room might have been like if I was highly anxious, about to participate in something completely unknown, how I might have coped with it all, and what I would have needed to help me manage.

Although deep down, probably like many of us to an extent, I find walking into a room full of people I don’t know pretty anxiety provoking, I’ve developed ways of coping with this over the years and am able to remind myself that I normally settle in pretty fast, and anxieties are fairly quickly forgotten. Still though, the dynamics of being the only unknown person in a room can be tricky to figure out initially, and going through the process really reiterated the courage of our service users in allowing themselves to be vulnerable in this way.

Doing art-based activities alongside interacting with new people really helped take the pressure off, as it gave a focus, and made those potentially awkward moments of silence feel more ok. It also gave a nice safe way to talk to other people, through providing a shared focus and a direction for potential conversations. Being in a group with other students, who wanted to help people in the same ways, also gave us a lot of common ground. I found that the conversation flowed naturally, and there was opportunity for learning outside of the focus of the group, just in getting to hear about their experiences of studying and hopes for the future.

Being part of this process has really helped me to understand the many ways in which activity groups might be useful in terms of someone’s recovery. The ways in which the group facilitators focused on the purpose of the activity, i.e., asking what the art was meant to represent, rather than how ‘good’ it was, really helped silence my inner critic (who was appalled by my art skills) and reminded me that sometimes there can be joy just in the process of doing. This is certainly something I will try and take forward in the way I use activity in my own work with service users. Additionally, the learning from being in and adapting to the challenges of engaging in a new group, but in a safe space where there is choice around how to participate, in my opinion, has huge potential for developing confidence, self-esteem and skills for managing interpersonal relationships.

Annette Feakes describes and reflects upon the process…

The year 2 occupational therapy students plan and facilitate a simulated therapeutic group for 5 case study clients with needs relating to anxiety. The group’s aim is to use occupation to enhance wellbeing via addressing issues related to anxiety. The occupational therapy students deliver a shortened practice group one week in which their tutor is present to provide feedback; the following week is a tutor less session in which the student nurses were invited to join as participants. The hope is that as well as developing relationships, the nursing students have the opportunity to consider the value of using occupation as an intervention within a group focused on managing anxiety. The occupational therapy students have an opportunity to develop their skills in conveying the aims of the group to all group members. They needed to consider that the participants may not have the awareness of how the chosen activity can be used therapeutically to manage anxiety within a group setting.

Following provision of the groups the nursing students were invited to join the post group reflection with the occupational therapy students and to offer written feedback to the student group facilitators. The nursing students were then invited to join a reflection alongside Lucy and myself to consider the experience. I was impressed with the depth of reflection this generated, initially the self awareness regarding how it is to be a group participant and the thoughts and feelings that emerged from this. Insight had developed regarding how occupation was used to facilitate the group effectively and the skills in facilitation that were used to enhance the group process.

I found this Interprofessional Learning (IPL) opportunity to be a powerful  experience. Witnessing the occupational therapy students apprehension as well as their enhanced reasoning in the knowledge that unknown participants would be in the group. Additionally the nursing students enthusiasm, openness and learning in relation to the therapeutic potential of using occupation to enhance well being was a privilege to witness.

Yun-Jung Choi (2018) The value of psychosocial group activity in nursing education: A qualitative analysis. Nurse Education Today 64:65-70