Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Facilitating parent–child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers’ recovery. The aim of the present qualitative study was to explore nurses’ practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family‐focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family‐centred relational recovery approach is recommended for mental health services, which is underpinned by family‐focused policies and processes, and supported at an organizational, managerial, and local‐unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence‐based brief family interventions.     

Practitioners’ application of Let’s Talk about Children intervention in adult mental health services

Family‐focused interventions can improve outcomes for families where a parent has a mental illness. One such intervention, Let’s Talk about Children (Let’s Talk), is a series of parent–practitioner conversations in adult mental health with demonstrated improved outcomes for child, parent, and family well‐being. This study used a questionnaire to understand the application of Let’s Talk by n = 73 trained practitioners from eight adult mental health services who were previously involved in a randomized controlled study in Victoria, Australia. Data were analysed to establish the application of Let’s Talk, and statistical analyses were undertaken to identify what influenced practitioners’ delivery of Let’s Talk. The study details how practitioners used Let’s Talk and indicates that most used it as designed, with the majority offering it to parents and approximately 40% delivering it. The findings indicate there is a decline over time in both the number of practitioners using Let’s Talk and the number of deliveries over time. Practitioners’ use of Let’s Talk was influenced by their gender, profession, access to support, time since training, and caseload. The article discusses the implications of these results for sustaining Let’s Talk in adult mental health services. While this study gives a baseline of practitioners’ application of Let’s Talk, further exploration of the experience of practitioners and parents as well as other system factors will be helpful to understand barriers and enablers to continued practice.     

Predictors of parenting self‐agency among mothers receiving substance abuse or mental health treatment

Mothers' mental health or substance use disorders impact the behaviours of their children both short‐term and long‐term. There is increased concern for mothers with mental health or substance use disorders to effectively handle parenting challenges. Children of these mothers are at risk for emotional and behavioural adjustment problems as well as poor academic performances. Parenting self‐agency refers to parents' perceptions of their confidence and ability to overcome barriers and manage issues in parenting. Examining the factors that predict parenting self‐agency aids in understanding how nurses can assist mothers and families. The purpose of this study was to explore predictors of parenting self‐agency among mothers who are impacted by mental health or substance use disorders. A secondary analysis was conducted using the baseline assessment data of a randomized trial that examined the efficacy of a nurse‐led family‐strengthening home‐health intervention. The data were obtained from 172 mothers who were receiving outpatient treatment for substance use or other mental health disorders and had children under 18. A multivariate linear regression analysis was conducted to find predictors of parenting self‐agency among participating mothers. The authors found that increased children's externalizing problems and intensity of hassle predicted lower parenting self‐agency, and family cohesion predicted higher parenting self‐agency. The authors conclude that treatments need to address family as a whole to increase mothers' parenting self‐agency, thus assisting these mothers in raising their children in the best possible environment.     

Implementing child-focused family nursing into routine adult psychiatric practice: hindering factors evaluated by nurses

Aims and objectives. The aim of this study is to describe nurses’ evaluations of factors that are hindering implementation of child‐focused family nursing (CF‐FN) into adult psychiatric practice. In addition, it explains the nurses’ evaluations of the hindering factors related to the hospital organizational structure, the individual nurse, nursing and family. Background. There is an increasing amount of families with dependent children in adult psychiatry. Although these families have long‐term benefits from preventive family interventions, implementation of CF‐FN is not routine mental health practice. Design and methods. Data were collected via a questionnaire‐survey completed by Registered Psychiatric Nurses (n = 223) and practical Mental Health Nurses (n = 88) from 45 adult psychiatric units in five Finnish university hospitals. The response rate was 51%. Results. Family‐related factors, such as families’ fears and lack of time, were considered as ‘most hindering’ to CF‐FN. Nurses who used a family‐centred approach and had further family education considered most of the factors as ‘less hindering’ in comparison to other nurses. Conclusion. To meet the needs of the families in mental health services, it is essential to develop nursing intervention methods such as CF‐FN. There is a need for further education and use of family‐centred care to develop this preventive approach. Relevance to clinical practice. The results of this study could be considered when developing mental health services and family interventions for families with parental mental illness.     

Mental health nurses’ contributions to community mental health care: An Australian study

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses’ experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15‐min intervals over a 4‐week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.     

Thinking families: A study of the characteristics of the workforce that delivers family‐focussed practice

Parenting with mental illness is not uncommon and is often associated with a range of challenges for parents, children, and the family unit. Family‐focussed practice involves the provision of services to the wider family system, including children. While family‐focussed practice is important to consumers and their families, adult mental health practitioners do not routinely discuss parenting or children with their clients, nor work closely with the whole family. In the present study, we aimed to examine the characteristics of practitioners from Australian adult mental health services associated with family‐focussed practices. Characteristics included sex, years of experience, location, and previous training in child and family‐focussed practice. A total of 307 adult mental health practitioners from Victoria, Australia, responded to the Family Focused Mental Health Practice Questionnaire and a series of demographic items. The results indicated that particular practitioner characteristics predicted the delivery of family‐focussed practice. Practitioner experience, sex, working in a rural location, and previous family‐ or child‐related training were found to be important in the provision of family‐focussed practice. More experienced, female, rurally‐located, and well‐trained practitioners undertake most family‐focussed practice. These results suggest that training in family‐focussed practice needs to be promoted, with considerations made for differing needs according to the characteristics of the adult mental health practitioner.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Family‐focused practice with EASE: A practice framework for strengthening recovery when mental health consumers are parents

This paper provides a framework for essential family‐focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses’ and other clinicians’ capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence‐informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care.     

Mental health nurses’ views of recovery within an acute setting

How the principles of a recovery‐oriented mental health service are incorporated in the day‐to‐day nursing practice of mental health nurses in inpatient settings is unclear. In this study, we interviewed 21 mental health nurses working in acute inpatient mental health units about a range of recovery‐focused topics. Three overlapping themes were identified: (i) the perception of recovery; (ii) congruent humanistic approaches; and (iii) practical realities. Only four interviewees had some formal training about recovery. Most respondents recognize that positive attitudes, person‐centred care, hope, education about mental illness, medication and side‐effects, and the acknowledgement of individual recovery pathways are necessary to prevent readmission, and are central to a better life for people who live with a mental illness. This research supports the view that ideas and practices associated with the recovery movement have been adopted to some degree by nurses working at the acute end of the services continuum. However, most saw the recovery orientation as rhetoric rather than as an appropriately resourced, coordinated, and integrated program. These nurses, however, speak of much more detailed aspects of working with patients and being required to prepare them for the exigencies of living in the community post‐discharge.     

Telephone survey of service‐user experiences of a telephone‐based mental health triage service

The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service‐user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service‐users' (consumers and informal carers) experiences of a telephone‐based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone‐based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision‐making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self‐referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer‐focused care.     

Addressing the support needs of families during the acute hospitalization of a parent with mental illness: A narrative literature review

Hospitalisation of a parent with acute mental health problems impacts the consumer, their extended family/carers and children. Mental health nurses are at the forefront of promoting recovery for consumers in an acute inpatient setting. Recovery‐oriented care can include provision of family‐focused care which supports recovery of the parent‐consumer and their family members and contributes to prevention of intergenerational mental illness. The aim of this narrative literature review was to explore existing knowledge regarding the experiences, care and support needs of parent‐consumers, their family members/carers and children during the parent's acute mental health hospitalisation. It also aims to explore existing knowledge about the practices of mental health nurses providing care to this consumer group, to inform future healthcare practice and strengthen parent, child and family outcomes. Nineteen published studies addressed the review questions. In the context of hospitalisation, the majority of research regarding parenting with a mental illness is focused on mothers. Parents reported experiencing stigma during their hospitalisation. Separation from children was a concern for parents and their extended family, but admission provided an opportunity for the parent to receive treatment and for the family to receive support. Mental health nurses did not always identify parental status on admission. When parental status was identified, nurses reported issues regarding logistics and practicalities of using family rooms, children visiting the unit, and their own professional knowledge and organisational support regarding familyfocused care. Implications for practice are identified, highlighting how mental health nurses can develop their practice to support the recovery of parent‐consumers.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

An exploration of whether mental health nurses practice in accordance with The Family Model

BackgroundThe Family Model is increasingly used as a framework to promote a whole family approaches in mental health services. The purpose of this qualitative study was to (i) explore whether nurses practice in accordance with the Model when providing services for parents who have mental illness, (ii) determine whether components of the model are employed more in some workplaces (i.e. acute in-patient units versus community settings) and (iii) ascertain reasons as to why this may be the case.MethodA purposive sample of 14 nurses from eight mental health services in Ireland, completed semi-structured interviews.ResultsFindings indicated that nurses' practice incorporated most key components of The Family Model, including supporting service users' dependent children. However, some practices were not explicit in the Model, such as supporting other adult family members (i.e. grandparents). While nurses' practice in community settings was more aligned with The Family Model than in acute in-patient units, there was a notable absence of reference to domain six (cultural considerations) in both settings. A holistic and family-centered philosophy, coupled with collegial and managerial support and a focus on prevention were the main features that enabled family focused practice in community settings.ConclusionAs only a subgroup of nurses practice in accordance with The Family Model, efforts are required by nurses, their organisations and the broader system to promote family focused practice. The Family Model may be a useful framework, with further refinement, for guiding nurses' practice.     

Lip service: Public mental health services and the care of Aboriginal and Torres Strait Islander peoples

The failure of public mental services in Australia to provide care deemed culturally safe for Aboriginal and Torres Strait Islander people has persisted despite several national reports and policies that have attempted to promote positive service change. Nurses represent the largest professional group practising within these services. This article reports on a multisited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about public mental health services and the services they provided to Aboriginal and Torres Strait Islander people. During the fieldwork, mental health nurses described the constricting effect of the biomedical paradigm of mental illness on their abilities to provide authentic holistic care focused on social and emotional well‐being. Despite being the most numerous professional group in mental health services, the speciality of mental health nursing appears unable to change this situation and in many cases maintain this status quo to the potential detriment of their Aboriginal and Torres Strait Islander service users.     

Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty‐two nurses were recruited from one Australian forensic mental health service. Data were collected using semi‐structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high‐risk patient cohort.     

Saudi service users’ perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): A qualitative inquiry

This paper presents, as part of a larger mixed‐methods design, a study generating a theoretical understanding of issues pertinent to the quality of mental health care in the KSA from the perspective of those using services. Semi‐structured interviews were undertaken with thirty service users admitted to inpatient psychiatric wards, using an interview guide developed by the researchers, based on relevant literature. Findings from the thematic analysis showed five themes: (1) The hospital as a prison: a custody versus care dilemma, (2) quality of interactions between staff and service users, (3) quality of services, (4) staff qualities and (5) suggestions for achieving quality of care. A theoretical model drawing upon Donabedian Health Care Model for Evaluating quality of care and the Andersen Behavioural Model of Health Service Use is evident from the data. Structural aspects of care include staff experience and qualifications and key enablers around social and financial support, service users’ health needs and status and the physical infrastructure and ward rules. These drive processes of care based upon robust rates of interaction between staff and service users and appear central to quality of mental health care in KSA. Quality of mental health care in KSA is manifested by a therapeutic ethos with a high degree of interaction between professional carers and service users, with the former being highly educated, competent, compassionate, with a high degree of self‐awareness, and specialized in mental health. We have uncovered elements of Fanon and Azoulay’s ‘Cultural Originality’ as well as contemporary examples of Goffman’s mortification of the self.     

Assessing parenting capacity: are mental health nurses prepared for this role?

Mental health nurses in the UK are involved in the assessment of the parenting capacity of mothers with a serious mental illness in psychiatric facilities. There is evidence that child and family social workers, as the frontline professionals in safeguarding children, rely heavily on the mental health parenting assessment. Parenting assessments have potentially major implications for mother and baby and can lead to the separation of mother and baby. However, there is little or no provision for mental health nurses to undertake this role. In the UK, as in many other countries, there is currently no data as to which psychiatric facilities are conducting parenting assessments nor about the quality of the assessment. There are significant tensions for mental health nurses undertaking parenting assessments and there is no specific training for the role. This paper challenges existing practice, highlights the need for an audit of the current services and recommends the development of a recognized training programme.     

Qualitative exploration of family perspectives of smoke‐free mental health and addiction services

The significant health disparities experienced by people with mental illness indicate the need for mental health service improvement. This qualitative study explored family and whānau (Māori family group) perspectives of smoke‐free mental health services. Thematic analysis found that family and whānau identified a number of barriers to the implementation of successful smoke‐free policy, including lack of coordination and consistency, and limited, if any, family and whānau inclusion. Family and whānau discussed smoking as a strategy for coping with anxiety and boredom; therefore, the need for other activities and strategies to replace smoking was identified as necessary in effective service delivery. The attitude that mental health service policy should be different from general health policy, due to the experience of mental distress, was also identified. In this paper, we argue that the development and implementation of quality mental health services would be strengthened by involving family and whānau in smoke‐free initiatives. Furthermore, the provision of relevant information to family, whānau, and service users would help dispel myths and stigma associated with tobacco and mental health.