Best practice pedagogy underlying mental health and addiction content in nursing curricula is diverse. Some of the diversity is reflected in the nature of the language used to talk about mental health, or psychiatric nursing, or whether a medical model or psychosocial framework is used. The need to prepare nursing students for mental health and addiction practice should motivate and inspire educators’ interest in developing students’ critical thinking and skills in all areas of  mental health. In such, educators should also keep an outlook for new pedagogies to stimulate learning.

Methods of best practice teaching approaches are limited, but some approaches include the following.
1. Blended Learning: There is evidence that the blended learning model, which combines traditional face-to-face learning and e-learning, is an effective structural approach to help mental health nursing students recognize and resolve clinical, theoretical and ethical dilemmas. The practice of blended learning provides students with a useful ability to observe the process of supervision and use information technology to enhance clinical skills (Rigby et al, 2012). 

2. Problem Based Learning (PBL): Learning through the experience of solving an open-ended problem is an active pedagogy shown to be useful for teaching mental health nursing students. It may have the added benefit of impacting practice post-graduation. Furthermore, students who have been exposed to PBL may require fewer hours of theory to attain learning outcomes, such as positive attitudes toward mental illness, among others (Cooper & Carver, 2012; Happell, B., Moxham, L. & Platania-Phung, C (2009). 

3. Inquiry Based Learning (IQL): While similar to PBL in that it is open-ended learning, IQL follows different steps starting with the sudent exploring a theme and choosing a research stream to focus on; formulating a question and pursuing a plan of research that is rooted on critical thinking, which is applied to the central question. Educators play a pivotal role in IQL, assisting in a collaborative manner with planning, assessment for learning and the advancement of individual as well as classwide understanding of personally meaningful content and ideas (Fielding, 2012). 

4. Simulation: Simulation is a pedagogy that involves a range of activities that imitate something real, a state of affairs or a process to achieve educational goals (SIM-one, 2016). The purpose of simulation aims to improve safety, effectiveness and efficiency in healthcare (SIM-one, 2016). Simulation is actively used in some curricula however there is considerable variation in nursing programs in terms of: a) the amount of use; b) how it’s used and c) when in the nursing program SIMS is used. For more information, please see Section 7.2.

A range of teaching and learning opportunities and use of different pedagogy is best to impart mental health, illness and addiction knowledge to students. Some teaching approaches rely heavily on the experiential and relational component of mental health nursing in an effort to understand stigma and other attitudinal factors that are part of the mental health work of nurses (Waugh, McNay, Dewar & McCaig, 2014; Stuhlmiller, 2006). The use of case studies as well as online discussions can help facilitate experiential and relationship components (Silva, Furegato & Godoy, 2008). Most educators would agree that a relational nurse who is aware of the role that stigma plays in the experience and care of individuals with mental health concerns is not enough, and that excellence in mental health nursing includes a sound knowledge base of the current theories and best practices of mental illness, as well as the complex interplay of psycho-social-health determinants on the experience of clients and their treatment.

Nurses have a professional obligation to ensure their practice is consistent with the College of Nurses of Ontario (CNO) or local jurisdictional college standards of practice and guidelines as well as legislation. This includes maintaining competence and refraining from performing activities that they are not competent in (CNO, 2002). As well, nurses need to ensure the appropriate education, support and supervision when acquiring new knowledge and skills to ensure they provide safe,
effective and ethical care (CNO, 2002). The CNO further indicates that nurses must assume responsibility for their own professional development and participate in learning processes to enhance their own practice. In order to meet all of CNO’s requirements, it is recommended that nurses engage in reflective practice and seek opportunities to incorporate reflective practice into their practice (CNO, 2002).

Reflective practice is defined as the ability to examine ones actions and experiences with the outcome of acquiring a new understanding and appreciation of the situation, and developing one’s practice and clinical knowledge (Boud, Keogh, & Walker, 1985; Caldwell, 2013). Reflective practice is associated with positive learner outcomes including but not limited to: improved situational awareness, changed perspectives, and a greater appreciation for the value of their practice (Glaze, 2001). As well, reflective practice contributes to development of new knowledge and skills, and promotes higher levels of understanding, can decrease stigma and increase confidence (RNAO, 2015d and RNAO, 2016e).

Please see Resources in this section for more information and ideas on ways to support self reflection with nursing students. Also, see Section 4.1.

In order to effectively support nursing students in acquisition of knowledge that is evidence- and best practice-based, nursing faculty themselves must receive adequate professional development and support to be up to date on the evidence (RNAO, 2016e). Faculty and educator perceived knowledge and expertise in the subject area has been linked to playing a key role in the optimal promotion of mental health knowledge (Lang & Hahn, 2013). Educational institutions should be aware of the extent of clinical experience and education among faculty, understand whether theoretical and clinical education is current and provide ongoing professional development opportunities either through the practice setting or educational institution to promote the continued transfer of theory to practice (RNAO, 2016e).

Successful preparation of nursing educators requires a combination of education, experience, knowledge and assessment skills that must be supported through allocated time for initial and ongoing professional development (RNAO, 2016e). Professional development opportunities should incorporate education regarding best practices in theoretical components of nursing education, provide opportunities to enhance leadership skills, and provide best practices on clinical teaching strategies, adult learning theories and strategies for student evaluation. Such educational opportunities ensure faculty has the competence and confidence necessary to support students and has been demonstrated to improve quality of work satisfaction (RNAO, 2016e). Effective models of professional development can include preceptorship and mentorship for nursing faculty.

Preceptorship:

• Is assigned to facilitate a preceptee’s learning goals.
• Is assigned for a set period of time, usually short-term.
• Is assigned with a focus on learning related to knowledge and skill.
• Is acting as a role model, during regular working hours.
• Can evolve into a mentorship relationship.

Who is the preceptee?

A preceptee can be a nurse with five, 10 or even 15 years’ clinical experience, but who is new to a different teaching area, unit and to caring for a different population of patients. A preceptee may have limited clinical experience and most of those experiences are in the more supported student/school role.

Preceptor responsibilities

Preceptors act as guides or mentors to the preceptee. To facilitate the learner’s acquisition of the nursing knowledge and skills for safe, competent and ethical practice, preceptors must display certain characteristics and be able to demonstrate the competencies required to teach and role model professional behaviours, nursing skills and values.

Key characteristics of effective preceptors include:

1. Competence in the practice role.
2. Experienced in the role.
3. Strong leadership and conflict management skills.
4. Enthusiasm.
5. Strong teaching, role-modeling and facilitation skills.
6. Patience and a positive attitude.
7. Excellent oral and written communication skill.
8. An ability to coach and provide constructive feedback.

Preceptors and Clinical Supervision

Preceptors may provide clinical supervision and have a responsibility to provide clinical teaching, instruction and formal evaluation (RNAO, 2016). Clinical supervision is “a formal process of professional support and learning, which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” (Department of Health, 1993, p.15). It provides regular protected time for health-care practitioners to come together to reflect on clinical practice and examine areas of personal and professional growth and work towards achieving these goals. It can occur using a variety of models that include, one-on-one support, peer support, groups and include use of technology such as online supports and telephone supports. For more information on clinical supervision, please see Resources in this section.

Mentorship:

• Is chosen or selected by the mentee.
• Is usually selected by the mentee to support their professional advancement for an extended period of time.
• Focuses on individual growth and development.
• Is a nurturing and role-modeling relationship, usually during personal time.

For additional tools and resources please refer to Resources in this section.

It is important for educators to be aware of the various educational approaches and the risks they may pose to student safety and mental health. Since 20 percent of the Canadian population will experience a form of mental illness in their lifetime, this is also true for nursing students. In recent years, some social science and child education practitioners have begun to recognize the detrimental role that trauma can play in learning (Crosby, 2015). To that end, an emerging trend in education are trauma-informed educational practices that recognize the role that trauma plays in learning.

The development and application of pedagogies consistent with a ‘caring curriculum’ and with collaborative, student-centred approaches to teaching and learning, serve to promote student mental health and safety while modelling processes basic to collaborative, strengths-based clinical practice and recovery-oriented mental health care.

For more information, please see Resources in this section.

Nursing faculty should integrate persons and families with lived experience or support groups in theoretical and clinical education to understand how to meaningfully engage with these persons and their families. Lived-experience involvement has an important role to play in the education of nurses in addressing fear and demystifying the experience of mental illness (Happell, Gaskin & Byrne, 2015).

For more information, see Appendix H, which aims to support faculty in integrating lived experience.