Personal Professional Development (PPD) Groups for Mental Health Nursing Students

1. Personal Professional Development (PPD) Groups for Mental Health Nursing Students Sarah Campbell, Senior Lecturer. s.campbell@city.ac.uk

2. Purpose of PPD groups - 1 To enquire into how working with patients impacts emotionally on you and others.

3. Purpose of PPD groups - 2 To promote the understanding of ‘Relationship Centred Practice’ through its application within the PPD Group

4. Rationale for PPD groups • Mental health services are potentially stressful environments • Our reactions to stress are often defensive • Defensive nurses may not make therapeutic relationships with patients • Defensive nurses may not make constructive relationships with colleagues • Our society is quick to judge emotions, which inhibits people from accepting and exploring them

5. PPD group methods • Group discussions of emotional responses to events in practice, university or the PPD group • These will highlight the different ways in which people recognise and experience them • Individuals can learn more about how to identify and manage their own emotional responses to work

6. Confidentiality • You don’t have to make personal disclosures • But some people may choose to • Therefore, what is said in the group is confidential, unless there is a particular concern about your well-being

7. What PPD groups are not... • Problem-solving • Therapy • Judgmental • Voluntary

8. Other benefits of PPD groups • Getting to know each other • Somewhere to meet when on placement • A chance to learn about groups and group processes

9. Scenario A 19 year old student nurse is on a 6 week placement on a mental health acute admissions ward. A young male patient strokes the back of her ankle smiling into her eyes. The student nurse giggles and moves away spending the rest of her time trying to avoid having contact with this patient.

10. Focus for discussion • How do we understand the behaviour of the – • patient? • student nurse? • Do you think this coping strategy was successful for the student? • Do you think the student’s response enabled a therapeutic interaction? • How do we understand – • Therapeutic engagement • Safe environments • Relationship centred practice • Team working and staff support

11. End of programme PPD group evaluation 2016 – the student’s voice • This internal report systematically details the findings of an evaluation questionnaire regarding Mental Health Student nurses views of the Personal Professional Development Groups (PPD) at the end of their training. • The questionnaires used a mixed methodology; a combination of questions designed to collect both qualitative and quantitative data (Flick, 2015). There were five questions in total; three asked the students for description and comments, two used a Likert scale to ascertain how useful the group was and how satisfied they were with it and the final question asked the students to tick all items on a list that applied to them, in regard to what PPD has helped with.

12. Thematic analysis – four themes (Creswell, 2007) • Students’ experience of being in the PPD group. • Students’ experience of Facilitators and their role. • Students’ comments in relation to personal feelings and professional practice. • Students’ comments regarding the practical implementation of the PPD group.

13. Theme 1: Students experience of being in the PPD groups The critical comments focused on lack of fellow student engagement as ‘not giving it a chance’ in relation to contribution. Several students remarked that some of their peers did not understand what the PPD groups are about and this could be frustrating when in the group. Further comments surrounded time and there was never enough time to explore everyone’s issues. …students remarked upon how they felt more affiliated to their group through PPD and felt that this helped them to understand the group experience more. This was reported to be a benefit. Students commented upon how valuable that there was a confidential private space provided for discussing placement issues with peers. They “gain from others wealth of experience”.

14. Theme 2: Students Experience of Facilitators and their role A few students commented that they felt forced to talk…feeling that the group was ‘over controlled‘ by the facilitators. … criticism about one of the facilitator’s constant lateness…a recurrent message indicates student communication between groups about their facilitators whom are carefully observed- “If you have good facilitators and an energetic group it will be a good experience to reflect and grow as a mental health nursing student” Overwhelmingly most of the comments are positive ranging from the facilitators being brilliant, excellent at leading the group, great and encouraging, with a wealth of knowledge. Mostly the students felt that the facilitators were supportive and good at their role. These remarks may indicate how the facilitator is also a role model for leadership and containment.

15. Theme 3: Students’ comments in relation to personal feelings and professional practice Student comment – “Constructive advice: Make all PPD leaders undergo robust training prior to taking on groups.” Some comments indicted that interesting clinical discussions resulted from discussing what went on in placement, whilst many comments also remarked that they (the student) had learnt from reflection through the PPD groups.

16. Theme 4. Students comments regarding the practical implementation of the PPD groups Students commented negatively regarding having to travel in for the groups in the middle of the day or that it was the only activity that they had to come n to University for during theory blocks as there were no other lectures on that day. Students stated that they liked the size of the groups, but felt the continuity of the facilitators is important.

17. Lessons learnt… • A Facilitators role needs to be voluntary rather than instructed and managed into a lecturers timetable • PPD groups works best when students are in practice, although essential to ‘grow the group’ prior to placement. • Regular facilitator supervision is essential • Training and education on working in groups is vital

18. Students voice… “PPD is a space to talk about any concerns, reservations, anxieties you might have about your chosen profession. It also provides a safety net and confidential space to discuss specific issues from placements.” “Invaluable! I didn’t find the benefit until we started placement- but I am so glad we had this support network. I would be a mess without it”

19. The future… • Ethics approved evaluation study currently underway. • Expansion of activity to Adult & Childrens’ student nurses

20. References and Bibliography • Cameron, D., Kapur, R., Campbell, P. (2005) Releasing the therapeutic potential of the psychiatric nurse: a human relations perspective of the Nurse - Patient relationship. Journal of Psychiatric and Mental Health Nursing, • Creswell, John (2007). Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage Publications, Inc. pp. 178–180 • Darbyshire P and McKenna L (2013) Nursing’s crisis of care: what part does nursing education own? www.nurseeducationtoday.com/article/S0260-6917 (13)00084-1/full text • Evans, M. (2006). Making room for madness in mental health: the importance of analytical- informed supervision of nurses and other mental health professionals. Psychoanalytic Psychotherapy. 20:16-29. • Evans, M. (2007) Being driven mad: towards understanding borderline and other disturbed states of mind through the use of counter-transference. Psychoanalytic Psychotherapy, 21:216-232 • Flick, U (2015) Introducing Research Methodology second edition London: Sage Publications • Menzies Lyth, I (1959) The functions of social systems as a defense against anxiety. A report on a study of the nursing services of a general hospital. Human Relations, 13, 95-121.

21. City, University of London Northampton Square London EC1V 0HB United Kingdom T: +44 (0)20 7040 5060 E: department@city.ac.uk www.city.ac.uk/department