Overview of the RNAO Nurse Educator Mental Health and Addiction ResourceOverview of the RNAO Nurse Educator Mental Health and Addiction Resource
Resource Purpose and Target Audience
The purpose of the RNAO Nurse Educator Mental Health and Addiction Resource is primarily to support educators with effectively integrating mental health and addiction knowledge and skills into the undergraduate nursing curriculum. The resource is based on the Canadian Association of Schools of Nursing (CASN) and the Canadian Federation of Mental Health Nurses (CFMHN) Entry- to-Practice Mental Health and Addiction Competencies for Undergraduate Nursing Education in Canada (2015) and supporting research. Each section of the resource has been intentionally aligned with the competencies. Please see Appendix A for a chart showing this alignment. Integration of core concepts, competencies and best practices found in this resource will raise the profile of psychiatric and mental health practices for nurses as an essential component and integral part of holistic person-and family-centred care across all sectors.
As such this resource is also relevant to nurse educators working in clinical environments to support nursing students, new graduate nurses and other nurses in integrating best practices related to mental health and addiction. Other beneficiaries of this resource include nursing students, nurses, other health care providers, and, ultimately, the person and their family receiving care.
How to use the RNAO Nurse Educator Mental Health and Addiction ResourceHow to use the RNAO Nurse Educator Mental Health and Addiction Resource
The resource is divided into nine sections. Most sections are structured consistently, with some exceptions, to provide:
- Corresponding CASN/CFMHN (2015) Entry-to-Practice Mental Health and Addiction Competencies and Indicators;
- Outcomes to assist faculty with learning goals;
- Teaching and learning activities to support curricula design;
- Learner engagement questions to spark dialogue and knowledge advancement;
- Evaluation suggestions to ensure quality knowledge and skill development;
- Self-reflection suggestions and tools to ensure development of new knowledge and skills, and to promote higher levels of understanding, decrease stigma and increase confidence; and
- Resources to provide additional materials to support curricula development.
Faculty are invited to use this document for:
- Self assessment to determine their mental health and addiction knowledge and skill levels;
- Curriculum and specific course assessment to determine the type and amount of mental health and addiction content and any gaps;
- Development of specific curriculum, year, course, and lesson plan objectives;
- Development of in-class application sessions, in particular using the case studies;
- Preparation of content and application sessions in courses and specific classes;
- Development of the clinical practice component of the curriculum including design of specific clinical placements and simulation experiences; and
- Development of evaluation indicators, tools and strategies.
In using this resource, educators will be able to support nursing students, new graduates and nurses to:
- Meet the CASN/CFMHN Entry-to- Practice Mental Health and Addiction Competencies (2015);
- Bring mental health, illness and addiction knowledge and skills to clinical practice;
- Understand the nurse’s role across care setting in supporting persons’ mental health, illness and addiction needs;
- Support persons and their families experiencing mental health, illness and addiction issues to receive optimal care in their encounters with the health-care system;
- Contribute to decreasing stigma and improving the health-care environment milieu with regards to mental health, illness and addiction;
- Contribute to the creation of a clinical culture of evidence and knowledge-based practice;
- Contribute to person- and family-centred care that is timely, informed and responsive to their mental health needs; and
- Improve the overall outcomes of clinical care.
The resource is designed to be user-friendly with topic areas easily accessible for review and use. Tools can be completed online or in a paper version and reproduced for curriculum and day-to- day use.
It is recommended to review this resource by examining the table of contents and bookmarking areas for further review or use at critical points in education and practice activities. On the other hand one may identify key areas right away to review in more depth and get started. Others may wish to use the resource as a reference and/or a validation resource. Regardless of how this document is used, there is much satisfaction to be found in expanding knowledge and skill levels in mental health and addiction and working to enabling others to do the same.
SECTION ONE: Introduction
Section one provides the user with the background information for the creation of this resource for nurse educators in entry-level nursing education programs, as well as nursing educators in clinical environments. The section also facilitates understanding of fundamental concepts to mental health and addiction.
SECTION TWO: Learning and Teaching Resources to Support Integration of Mental Health and Addiction in Curricula
Section two includes pre-planning assessment tools that enable educators to assess and identify areas for improvement and ongoing development of their teaching practice in a mental health context.
SECTION THREE: Nurse Faculty and Nurse Educator Teaching Modalities and Reflective Practice
Section three includes a discussion of common collaborative, student-centred and strengths- based pedagogies. This section also addresses teaching activities for mental health and addiction nursing that promote reflective practice, as well as techniques to facilitate preceptorship and mentorship.
SECTION FOUR: Student Reflective Practice and Self-Care in Mental Health and Addiction Nursing Education
Section four focuses on incorporating self-reflective practice and self-care into mental health and addiction content.
SECTION FIVE: Foundational Concepts and Mental Health Skills in Mental Health and Addiction Learning Advancement
Section five highlights mental health, illness and addiction foundational concepts and skills for incorporation into undergraduate nursing curricula.
SECTION SIX: Legislation, Ethics and Advocacy in Mental Health and Addiction Nursing Practice
Section six provides educators with information about key concepts related to mental health and addiction legislation in Canada. Aspects addressed include the relationship of legislation, human rights and autonomy within an ethical framework.
SECTION SEVEN: Clinical Placements and Simulations in Mental Health and Addiction Nursing Education
Section seven provides educators with evidence-based insights into mental health and addiction practice and simulation learning modalities.
Section eight provides the bibliography as a supplement to those references cited throughout the document.
SECTION NINE: Appendices and Case Studies
Section nine includes appendices, a glossary of terms and case studies. This section provides the educator with tips and tools to integrate best practices related to mental health, illness and addiction into curricula. Case studies represent a spectrum of mental health and addiction scenarios, including individuals of various ages and genders, in a range of clinical settings with an array of mental health, illness and addiction conditions.
Background of the RNAO Nurse Educator Mental Health and Addiction ResourceBackground of the RNAO Nurse Educator Mental Health and Addiction Resource
Understanding the Link Between Mental Health, Illness and Addiction
Mental health and illness affects all Canadians of all ages, education, income levels and culture. According to the Mental Health Commission of Canada (MHCC), mental illnesses are more common than heart disease and cancer (MHCC, 2013). In fact, in Canada 2.2 million individuals are living with Type 2 diabetes while 6.7 million people are living with a mental illness (MHCC, 2013).
The impact of mental health and illness is complex and far-reaching. A report from the Canadian Chronic Disease Surveillance System (CCDSS): Mental Illness in Canada (2015) demonstrates a relationship between mental illness and chronic diseases (CCDSS, 2015). For example, a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD), ischemic heart disease, diabetes and hypertension, were observed among people using health services for a mental illness than among those using services for other diseases or conditions (CCDSS, 2015). Furthermore, 20 percent of individuals who experience mental illnesses are also experiencing addiction, indicating a high rate of concurrent disorders (mental health and addiction) that presents a further complexity in care (Rush et al, 2008).
The relationship between mental illness, chronic disease and addiction is still poorly understood, despite the fact that individuals with mental illness (e.g., depression, anxiety) are more likely to have a co-morbid chronic condition (e.g., asthma, cardiovascular disease) and that individuals affected by chronic diseases are more likely to experience anxiety and/or depression (CCDSS, 2015).
WHO’S AT RISK
- One in five Canadians experiences a mental health problem or illness, with the cost to the economy of more than $50 billion (Smetanin P., et al 2011).
- Eight percent of adults will experience a major episode of depression once in their lifetime (Pearson et al, 2013); five percent will experience anxiety disorders; one percent will experience bipolar disorder; and another one percent, schizophrenia (CMHA, 2016).
- Up to 70 percent of young adults living with mental illness report that the symptoms appeared in childhood (Public Health Agency of Canada, 2006).
- Suicide accounts for 24 percent of all deaths among 15-24 year olds; 16 percent among 25-44 year olds (Open Minds, Healthy Minds, 2011).
- Most of the 4,000 Canadians who commit suicide every year are coping with a mental health problem (Statistics Canada, 2011).
- Eighty percent of employers claim that mental health and illnesses are among the top three drivers of both short- and long-term disability claims (Sairanen. Matzanke & Smeall, 2012; Towers, Watson, 2012).
- The life expectancy of people with severe mental health problems is 25 years less that of adults in the general population. The cause of death is most often cardiovascular disease (Laurence, D.Kisely & Pais, 2010).
Impact on Nursing Education
Given the prevalence of mental illness across the age spectrum and the relationships associated among mental health, illness, addiction and other related conditions, it is evident that nurses across all practice settings will care for clients with mental health and illness conditions (Nadler-Moodie, 2010). Nurses are ideally situated across the continuum of care, to provide timely assessments and evidence-based interventions to individuals who may have either a diagnosed or undiagnosed mental illness.
As referred by CASN/CFMHN, “The complexity of concurrent disorders supports the need for entry-level undergraduate nursing education in Canada to prepare all new RNs to identify, care for and manage these disorders” (Kent-Wilkinson, Blaney, Groening, Santa Mina, Rodrigue & Hust, 2016, p. 8). This resource is designed to help make that a reality.
The following timeline shows the key stakeholder and interest groups keenly involved in championing and developing this resource.
Mental Health Nurses Interest Group developed and presented resolution (#4) at
the Annual General Meeting of the Registered Nurses’ Association of Ontario. The resolution spoke to the significant impacts of mental health on the lives of Canadians and spoke to the need to strengthen undergraduate mental health and addiction education, including: development of core competencies, consistency in mental health and addiction theory and clinical practicum in psychiatric/mental health nursing.
Canadian Federation of Mental Health Nurses (CFMHN) released a Position
Paper entitled, “Core Competencies in Psychiatric Mental Health Nursing for Undergraduate Nursing Education,” (Tognazzini, Davis, Kean, Osborne, & Wong, 2009) to provide context of the current Canadian nursing education system with respect to mental health and addiction nursing curricula. The Federation also recommended that all undergraduate nursing programs include a required stand- alone theory course in psychiatric and mental health nursing with clinical experience in a psychiatric or mental health/addiction care setting.
RNAO’s Mental Health and Addiction Initiative commissioned an Environmental Scan. The environmental scan found that supports were needed among nursing faculty to integrate best practices related to mental health and addiction care. Furthermore,
it was recommended that core competencies should be developed to support a consistent approach to mental health and addiction undergraduate nursing education. Findings from the environmental scan also demonstrated that RNAO should work towards increasing supports and enhancements to undergraduate mental health and addiction nursing education by developing an evidence-based resource to support the uptake and implementation of best practices.
RNAO initiated a systematic literature review with the Nursing Best Practice Research Centre to determine the most effective ways to deliver mental health education in undergraduate nursing programs to support clinical excellence. RNAO also engaged in conversations with the CASN to discuss these issues and what could be done to support nursing students and faculty.
CASN partnered with the CFMHN to develop a national, consensus-based framework of essential discipline-specific, entry-to-practice mental health and addiction competencies and indicators. The purpose of the framework is to promote the integration of core content related to mental health and addiction.
RNAO and CASN co-hosted an Educator Stakeholder Forum in Toronto, ON with nursing faculty, nursing students, nurses and people with lived experience across Canada. The stakeholder forum provided an overview of best practices in mental health and addiction education for undergraduate nurses and reviewed the CASN/ CFMHN Entry-to-Practice Mental Health Competencies for Undergraduate Nursing Education in Canada (2015). The forum provided clear direction to RNAO on how to support the implementation of the competencies in undergraduate nursing programs.
RNAO formed an expert panel to support the development of a Nurse Educator Mental Health and Addiction Resource to support the uptake of the CASN/CFMHN Entry-to-Practice Mental Health Competencies for Undergraduate Nursing Education in Canada (2015).
CFMHN released its third position statement with respect to mental health and addiction nursing curricula in Canada which: “Recommends that the curricula of all undergraduate nursing programs in Canada include entry-to-practice mental health and addiction competencies in both theoretical knowledge and clinical practice. The CFMHN recommends delivering mental health and addiction core competencies through a designated (stand-alone) theory course and a dedicated clinical experience. Regardless of pedagogical method, the obligatory outcome for undergraduate nurses is a strong knowledge-base in mental health and addiction as outlined in the CFMHN practice standards [CFMHN, 2016]” (Kent-Wilkinson et al, 2016, page 17).
Publication of the RNAO Nurse Educator Mental Health and Addiction Resource to assist educators to develop a current, relevant, evidence-informed curriculum to support integration of the competencies. This resource is the result of collaborative efforts of RNAO, educators and practitioners who shared the goal of enhancing mental health and addiction practice and education in keeping with the work of CASN/CFMHN, health-care system realities, needs of the population and best evidence.