Dr Fiona Orr is the Director of International Activities in the Faculty of Health at UTS, and is a lecturer in mental health nursing. She is a registered nurse with clinical experience in hospital-based and community mental health services, and she has extensive experience in the tertiary education and health care sectors. She is also the Deputy Chair of the Board of the Mental Health Services Learning Network (TheMHS), an international network to improve mental health services in Australia and New Zealand.
Fiona has developed innovative approaches to teaching and learning that have transformed nursing students’ experiences in mental health education. For example, she co-designed a live simulation with experts by lived experience of mental disorder to develop students’ therapeutic communication skills. She also co-developed a voice-hearing simulation workshop to develop students’ awareness of the effects of voice-hearing and empathy for people who hear voices.
In 2013 she received a UTS Learning and Teaching award for ‘Strengthening the UTS Model of Learning’, and in 2015 she received an Australian Award for University Teaching, ‘Outstanding Contributions to Student Learning’.
Deputy Chair, The Mental Health Services Board.
Can supervise: YES
- The use of a voice-hearing simulation to increase nursing students’ empathy and self-efficacy to communicate with people who hear voices
- Live simulation for development of therapeutic and recovery-focused mental health nursing practice
- Health and well-being impacts of horticultural therapy
- Indigenous Australian mothers' experiences of extremely premature babies, in relation to their mental health and the impact on their baby’s development.
Can supervise: Yes
Areas of research supervision
- Mental health nursing practice
- Simulation in mental health nursing education
- Mental Health and wellbeing
Undergraduate and Postgraduate mental health nursing.
Dean, S, Levett-Jones, T, Pich, J, Govind, N & Orr, F 2019, 'Simulation for developing healthcare graduates' empathy skills: Virtual Empathy Museum', BMJ Simulation & Technology Enhanced Learning, vol. 5, no. 2, pp. A44-A45.View/Download from: Publisher's site
Hogan, R, Phillips, A, Green, J, Orr, F, Elliott, D & Fowler, C 2019, 'Premature birth and Indigenous Australians – a commentary', International Journal of Birth and Parent Education, vol. 6, no. 3, pp. 27-30.
White, MR, Stein-Parbury, J, Orr, F & Dawson, A 2019, 'Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia.', International Journal of Mental Health Nursing, vol. 28, no. 2, pp. 605-615.View/Download from: Publisher's site
Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.
Hogan, R, Orr, F, Fox, D, Cummins, A & Foureur, M 2018, 'Developing nursing and midwifery students' capacity for coping with bullying and aggression in clinical settings: Students' evaluation of a learning resource.', Nurse education in practice, vol. 29, pp. 89-94.View/Download from: Publisher's site
An innovative blended learning resource for undergraduate nursing and midwifery students was developed in a large urban Australian university, following a number of concerning reports by students on their experiences of bullying and aggression in clinical settings. The blended learning resource included interactive online learning modules, comprising film clips of realistic clinical scenarios, related readings, and reflective questions, followed by in-class role-play practice of effective responses to bullying and aggression. On completion of the blended learning resource 210 participants completed an anonymous survey (65.2% response rate). Qualitative data was collected and a thematic analysis of the participants' responses revealed the following themes: 'Engaging with the blended learning resource'; 'Responding to bullying' and 'Responding to aggression'. We assert that developing nursing and midwifery students' capacity to effectively respond to aggression and bullying, using a self-paced blended learning resource, provides a solution to managing some of the demands of the clinical setting. The blended learning resource, whereby nursing and midwifery students were introduced to realistic portrayals of bullying and aggression in clinical settings, developed their repertoire of effective responding and coping skills for use in their professional practice.
Kelly, MA, Berragan, E, Husebø, SE & Orr, F 2016, 'Simulation in Nursing Education-International Perspectives and Contemporary Scope of Practice.', Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing, vol. 48, no. 3, pp. 312-321.View/Download from: Publisher's site
This article provides insights and perspectives from four experienced educators about their approaches to developing, delivering, and evaluating impactful simulation learning experiences for undergraduate nurses. A case study format has been used to illustrate the commonalities and differences of where simulation has been positioned within curricula, with examples of specialized clinical domains and others with a more generic focus. The importance of pedagogy in developing and delivering simulations is highlighted in each case study. A range of learning theories appropriate for healthcare simulations are a reminder of the commonalities across theories and that no one theory can account for the engaging and impactful learning that simulation elicits.Creating meaningful and robust learning experiences through simulation can benefit students' performance in subsequent clinical practice. The ability to rehearse particular clinical scenarios, which may be difficult to otherwise achieve, assists students in anticipating likely patient trajectories and understanding how to respond to patients, relatives, and others in the healthcare team.
Orr, FR, Kellehear, KJ, Armari, E, Pearson, A & Holmes, D 2013, 'The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education', Nurse Education in Practice, vol. 13, no. 6, pp. 529-535.View/Download from: Publisher's site
Role-play scenarios are frequently used with undergraduate nursing students enrolled in mental health nursing subjects to simulate the experience of voice-hearing. However, role-play has limitations and typically does not involve those who hear voices. This collaborative project between mental health consumers who hear voices and nursing academics aimed to develop and assess simulated voice-hearing as an alternative learning tool that could provide a deeper understanding of the impact of voice-hearing, whilst enabling students to consider the communication skills required when interacting with voice-hearers. Simulated sounds and voices recorded by consumers on mp3 players were given to eighty final year nursing students undertaking a mental health elective. Students participated in various activities whilst listening to the simulations. Seventy-six (95%) students completed a written evaluation following the simulation, which assessed the benefits of the simulation and its implications for clinical practice. An analysis of the students' responses by an external evaluator indicated that there were three major learning outcomes: developing an understanding of voice-hearing, increasing students' awareness of its impact on functioning, and consideration of the communication skills necessary to engage with consumers who hear voices.
Orr, F 1993, 'From the schizophrenic mother to the contemporary role of carer: women's responsibility for mental disorder', Australian Journal of Mental Health Nursing, vol. 2, no. 7, pp. 306-314.
Orr, F 2018, 'A voice-hearing simulation to enhance empathy and self-efficacy to communicate', International Meeting Simulation in Healthcare, Los Angeles USA.
Orr, F & Wilkinson, S 2017, 'A little sanctuary': An evaluation of the impact for participants of a rooftop horticultural therapy program in inner Sydney', The Mental Health Services Conference, Sydney.
Wilkinson, S & Orr, FR 2017, 'The Impact Of Horticulture Therapy On Mental Health Care Consumers On A Retrofitted Roof', Proceedings from the PRRES Conference - 2017, ANNUAL PACIFIC RIM REAL ESTATE SOCIETY CONFERENCE, PACIFIC RIM REAL ESTATE SOCIETY CONFERENCE, Sydney, pp. 1-13.
With increasing urbanisation and population growth, the potential for social isolation within urban
settlements including central business districts (CBDs) grows. Mental health and related illnesses are
determined by multiple, interacting social, psychological, and biological factors. Mental health may be
impacted by individual or societal factors, including economic disadvantage, poor housing, lack of social
support and the level of access to, and use of, health services. Living arrangements give some indication of
the level of social support that a person is able to access. Interaction with people is vital to human
development and social relationships and networks can act as protective factors against the onset or
recurrence of mental illness and enhance recovery from mental disorders (WHO, 2005). It is possible that
retrofitted rooftop gardens and green roofs could provide an environment whereby people can engage though
a structured program of horticulture therapy. This research analyses a horticulture therapy program in
Sydney in 2016 and this paper concentrates on the question; what is the impact of a rooftop horticulture
therapy on mental health consumers? An illustrative case study approach was the framework around data
collected via a semi structured focus group interview for this qualitative research. The findings reveal
positive outcomes, including improved health and well-being, social interaction and skill development.
Orr, F, Gill, K, Gallagher, I, Heffernan, T & Stein-Parbury, J 2015, 'Facilitating recovery-focused nursing practice through consumer participation in the development of innovative learning experiences for nursing students', The Mental Health Services Conference, Canberra.
Orr, F, Kelly, M & Stein-Parbury, J 2015, 'Making it real: Bringing mental health simulations to life'', International Nursing Association for Clinical Simulation & Learning, Atlanta USA.
Orr, FR, Pearson, A & Kellehear, K 2013, '`It was like opening Pandora's Box': Researching the use of a hearing voices simulation to develop nursing students' confidence to talk with consumers who hear voices', World Hearing Voices Congress, Melbourne.
There is some evidence that nurses do not routinely discuss voice-hearing experiences with consumers who hear voices, despite consumers requests to do so. One way to address this limitation and prepare nurses for practice with consumers who hear voices is through the use of a hearing voices simulation (HVS) whereby students are exposed, briefly to what it might be like to hear voices. The aim of this study was to investigate the usefulness of a HVS workshop to increase nursing students confidence to discuss consumers' voice-hearing experiences. The workshop was a collaboration between consumer consultants and mental health nursing academics. The consumer consultants trained the academic staff in the use of the simulation, which was originally developed by consumers who are voice-hearers. 90 final year nursing students listened to a 45-minute recording of simulated sounds and voices on mp3 players whilst they participated in various every-day activities. Self confidence was measured immediately before (pre) and after (post) the HVS using an eight-item, self-efficacy to communicate scale. The post survey also contained three open-ended questions related to the students experiences of undertaking the HVS. The results of the pre and post measure of students confidence to communicate with consumers who hear voices revealed a significant increase in confidence post the HVS. This paper will present the findings of a consumer-led HVS to increase nursing students confidence to discuss consumers' voice hearing experiences.
Kelly, M, Orr, FR & Stein-Parbury, MJ 2012, 'Engaging the health care consumer as part of the team: Creating realistic live simulations with actors', Sim Health 2012: Education, Innovation and Research, Sydney.
To provide experiences and demonstrate the benefits of using professional actors within live simulations in contrast to traditional role plays using staff or students for the purpose of learning communication skills that engage the consumer as a team member.
Orr, FR & Kellehear, K 2012, 'I Thought I was in Their Shoes': The Use of a Voice-hearing Simulation to Develop Nursing Students' Understanding, Empathy and Confidence', 4th International NET/NEP Conference, Baltimore USA.
Role-play scenarios are frequently used in undergraduate mental health nursing subjects to simulate the experience of voice hearing. This collaborative project aimed to evaluate simulated voice hearing as an alternative learning tool that could provide a deeper understanding of the impact of voice hearing, whilst enabling students to consider the communication skills required when interacting with voice hearers. Final year nursing students undertaking a mental health elective attended a three-hour voice hearing workshop. The students listened to simulated sounds and voices recorded by voice hearers on mp3 players whilst they participated in various every-day activities. On completion of the simulation, the students completed a qualitative evaluation to assess their experiences and consider the subsequent implications for communication with voice hearers. An analysis of the students responses by an external evaluator identified three major learning outcomes: developing a greater understanding of voice hearing, increasing students awareness of the impact of voice hearing on functioning, and developing empathy for voice hearers. The qualitative evaluation will be presented in conjunction with the results of a pre and post measure of students confidence to communicate with voice hearers.
Orr, FR, Kelly, MA, Stein-Parbury, MJ, McGarry, D & White, HL 2012, '"It was real": Use of actors in simulation to learn therapeutic communication', Society in Europe for Simulation Applied to Medicine (SESAM), Stavanger, Norway.
The students' evaluations of role plays with actors were rated as slightly higher than those with fellow students. Analysis of self-efficacy scores showed mixed results; some students reported increased confidence with therapeutic communication, while others reported a decrease. When aggregated, the results demonstrated that students' confidence increased, related to 'uncovering strong feelings' and 'ending a conversation by summarizing'. Nursing focus group results revealed that role plays with actors created emotional arousal that 'felt real' and 'put me under pressure', whilst role plays with students were limited by 'knowing each other' and 'not taking the emotion too far'.
Orr, FR, Kellehear, K, Pearson, A & Holmes, D 2010, 'The Distress of Hearing Voices: Collaboration for Mental Health Practice', The Mental Health Services Conference, Sydney.
The need to engage and work with consumers who are voice hearers is frequently experienced in mental health practice, yet the whole encounter is generally unfamiliar to, and at times daunting for, students of nursing. The purpose of this paper is to showcase an innovative approach to mental health care and highlight how the collaboration of the authors has resulted in the development of a highly successful teaching and learning program that is at the cutting edge of practice. This paper provides an opportunity for those involved in mental health services to come together to witness accounts of the success of this collaboration, to discuss ideas and to explore possibilities for the future of mental health care.