Sample and Method of Recruitment

Inclusion criteria comprised:

 3rd/4th year undergraduate mental health nurses.

 Mental health service users who have been involved in teaching on the undergraduate mental health nursing programme.

Purposeful sampling a strategy which deliberately selects participants for the information that they can provide that cannot be gotten as well from alternative choices (Patton 1990), was used in this study. Phase one identified that students were more likely to experience service user involvement later in the programme. For this reason 3rd/4th year student mental health nurses were the target sample in Phase 2. Also, it was expected that the students would have had sufficient clinical exposure at that stage in the programme, thus enabling the students to contextualise their experience of service user involvement, in terms of the perceived effects, if any on their clinical practice. Drawing on the information from the questionnaires in phase one, which mapped out the extent of service user involvement in the undergraduate mental health nursing programme, participants were sought from all of the 12 Schools of Nursing in the Republic of Ireland which provide undergraduate mental health nurse education. This included six Universities and six Institutes of Technology.

A number of processes occurred to secure this sample. Firstly, the mental health branch co-ordinators were asked if they would circulate a recruitment letter which explained the nature and purpose of the research (Appendix D, E). All mental health branch co-ordinators agreed. The recruitment letter invited them to participate in an individual interview. The letter stated that if participants were interested in participating in the study they could contact me directly. Although the majority of the participants contacted me directly, some of the participants expressed an interest

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directly to the mental health branch co-ordinator who subsequently passed on their contact details to me. The recruitment of participants was a lengthy process and took a number of months. At the time of recruitment some students were on clinical placement and consequently they were not checking their email as frequently. Four weeks after the initial recruitment letter was circulated, the branch coordinator sent a reminder about the study.

It is important to acknowledge that method of recruitment via the mental health branch co-ordinator might have had some potential drawbacks. As the mental health branch co-ordinators circulated the recruitment letter and information regarding the nature of the study to the students and service users, therefore there is a possibility that the participants might have felt obliged to participate in the study, rather than express a genuine interest of their own accord to participate. A further issue to be mindful of was the mental health co-ordinators may have been selective in who they circulated the letter to. However, this may have been countered by highlighting to them the importance of including participants with a range of experiences and diverse viewpoints. Considering that the branch co-ordinators are employees of Institutes of Education and familiar with the ethical practices regarding the conduct of research, it is assumed that the branch-coordinators adhered to the ethical protocols. All four of the service users‘ who participated sent their replies directly back to principal investigator, and although the majority of the students‘ sent their replies directly back to the principal investigator, the contact details of six of the students‘ were passed on to the principal investigator via the mental health branch coordinator. A total of 18 students and four service users volunteered to participate in the study.

All Schools of Nursing in the Republic of Ireland participated in phase 1 of this study. In Phase two of the study, a total of eighteen students were interviewed; 16 female and

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2 male. Fourteen of the students had experience of service user involvement and four of the students had not experienced user involvement. A total of six 3rd year students and twelve 4th year students participated. As the students were either in 3rd/4th year of their training they had all been exposed to clinical practice settings in each academic year of their training. At this stage in training, students would have been exposed to a wide variety of mental health settings ranging from; acute care in hospital settings, psychiatry of old age, child and adolescence, to community setting i.e. day hospitals, day centres, high support hostel or placements with community mental health nurses.

The fourteen students who had experienced service user involvement represented seven institutions (four universities and three institutes of technology). The four students who had not experienced service user involvement represented two institutions (one university and one institute of technology) and the four service users represented three institutions. Overall, out of the twelve Schools of Nursing in the Republic of Ireland, interviews were conducted with people from nine of the educational institutions. Three out of the twelve Schools of Nursing are not represented in this phase of the study. Out of the three not represented, one was a University and two were Institutes of Technology

Four service users were also interviewed. These service users were male. Out of the four service users who were interviewed, three of the service users were employed by the educational institution and are involved in nurse education. Of these, one service user was employed in an ‗expert by experience‘ role and therefore their role expanded beyond the scope of classroom teaching sessions. The remaining service user was basing his experience of involvement on a single session with students.

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It is evident from the results that emerged from phase one, that the involvement of service users has evolved at different rates in the various educational institutes. Three out of the four service user that voluntarily participated in an interview were employed by the educational institution. Considering the statistics relating to the experiences of mental difficulties, the World Health Organisation (WHO 2003), reports the following information in relation to mental health in Europe. In Europe, one in five persons will develop a depressive episode during their lifetime. Bearing this in mind, there is the chance that a lecturer is in fact a service user who could share their personal experiences of mental illness with students. However, they would be operating from a different agenda compared to a service user or an ‗expert by experience‘, as they are employed and contracted as a mental health lecturer. They have gained their position as a lecturer through both clinical and academic qualifications and achievements. On the other hand, the service users who are employed as ‗experts by experience‘ have gained their position primarily because of their lived experience of mental illness, not because of academic or clinical success. The justification for employing ‗experts by experience‘ in an academic environment is to bring real life experience to aid in the understanding of mental health difficulties from the perspective that is steeped purely in the lived experience.