Competence in providing mental health care: a grounded theory analysis of nurses' experiences.

OBJECTIVE: In view of the evidence that general nurses have difficulty in caring for patients experiencing mental health problems, the aim of this study was to explore and describe the subjective experience of nurses in providing care for this client group. DESIGN: A grounded theory approach was used. The data were collected via semi-structured individual interviews and analysed using the constant comparative method. SETTING: The study was conducted with nurses from general health care settings that provide medical and surgical care and treatment. SUBJECTS: Four nurses who were completing their second year post graduation participated in the study. MAIN OUTCOME MEASURE: The experiences of providing care for people experiencing a mental illness as described by participants. RESULTS: The findings indicated the nurses were striving for competence in the provision of mental health care. They acknowledged the mental health needs of patients and their right to quality care. CONCLUSIONS: This study supports the notion that general nurses lack confidence when caring for patients with mental health problems in medical and surgical settings. It also highlights a discrepancy between the holistic framework encouraged at undergraduate level and what is experienced in practice.     

Looking backward toward our future: creating the nexus between community health nursing and palliative care

Palliative care literature and practice have historically been dominated by end-of-life discussion, with palliative care often seen as the prequel to hospice care. As the population ages and previously fatal illnesses convert to chronic illnesses, the medically modeled, institutionally based care model is changing. Community health nurses (CHNs) are well equipped to play a role in this arena of care. They have a population-focused practice, experience with care in the community, an orientation to health, and skills related to advocacy and social justice. The authors outline salient issues in palliative care, exemplars of community-based palliative care programs, and the contributions CHNs can make toward development of an integrated model of care. A course of action is outlined for CHNs to pursue in this rapidly developing field and they are urged to participate in the next iteration of palliative care.     

Starting from a blank page: discovering and creating community health nursing in post-Soviet Latvia

Nurses discovering the practice and creating the tradition of community health nursing without mentors or forerunners have to learn from the practice itself and from each other. Data in the phenomenologic study of 17 Latvian community health nurses (CHNs) consisted of group and individual interviews and observation of practice with families. The focus of this article is the situated practice of nurses in the new role of primary care CHN, revealed through clinical stories that give voice to nurses in a particular historical and social context. The stories of the nurses in this article provide evidence of a growing ability to practice from a health promotion/prevention focus and engage with families and neighborhoods. The practice is still developing, and at this point nurses are not drawing on experience with families to identify and care for vulnerable populations.     

Addressing domestic violence through maternal-child health home visiting: what we do and do not know

Domestic violence (DV) has been described as a public health epidemic. Health care providers of all disciplines encounter victims of DV in every practice setting. However, the vast majority of DV health care research has focused on care provided to victims in traditional acute care and clinic settings. Few investigators have conducted studies with community health nurses (CHNs) who visit DV victims in their homes. CHNs, providing preventive maternal-child health (MCH) care through home visits with families, have been described by some as key providers in DV prevention. However, there is a dearth of knowledge about the actual practice and related outcomes of these nurses when working with families experiencing DV. The purpose of this article is to provide a baseline view of the current state of knowledge on which nurses may begin building future research that leads to evidence-based practice. The article describes the potential role of home-visiting MCH nurses in DV prevention and intervention, provides a critical review of the existing research, identifies primary gaps in scientific knowledge, proposes future research priorities, and makes recommendations for practice.     

Student beliefs about their practice within a non-traditional mental health clinical placement

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely ‘who's who’, ‘clinical contrast’ and ‘recreation as practice’. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.     

Touching their lives: North Western Mental Health's approach to practice development in aged mental health

The ongoing development of mental health practice is an important issue for consumers, carers, and clinicians. This paper outlines a practice development project undertaken by North Western Mental Health. The aim of the project was to assist nurses and direct care staff working in a residential facility to provide individualized, sensitive, therapeutic, and responsive care for long-term clients with severe mental illness. A clinical nurse educator was engaged to help facilitate changes to both attitudes and practices in a specialist environment catering to those with psychiatric, cognitive, and physical health concerns. The project identified institutionalized routines and practices that were entrenched within the setting and, with support and guidance from a clinical nurse educator, encouraged enhancement of clients' experience and choice. Nurses' clinical reasoning skills were also extended through this process. The project encouraged all staff to develop and maintain an awareness of residents' experience of receiving care in a potentially disempowering environment. In particular, nurses were challenged to consider how nursing, realized to its full potential, can touch the lives of residents and families.     

Mental and physical health comordibity: political imperatives and practice implications

Insufficient priority is being given to meet the physical health-care needs of people with mental illness. Mental health nurses, as the largest professional group working in mental health care, have a pivotal role in improving the physical health and well-being of people with mental illness. Through health-promotion strategies, alongside recovery-focused support aimed at avoiding deteriorating physical health, mental health nurses can significantly contribute to improving the current rate of premature death experienced by people with enduring mental illness. Drawing from contemporary policy, alongside practical examples taken from the published literature, this paper considers what constitutes recommended best practice in dealing with the physical health-care needs of people with mental illness. The role that UK-based health-care policy plays in shaping care delivery that meets the needs of people with mental illness is explored and placed within the context of global health concerns. Recommendations are made on how mental health nursing can work to provide evidence for a reassertion that nurses are well placed to work across organizational and professional boundaries to deliver person-centred care and a holistic approach to population health and well-being.     

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.     

Developing resilient children and families when parents have mental illness: a family-focused approach

There is substantial evidence supporting the need for effective intervention for children and families living with parental mental illness. However, translation of this knowledge into mental health workforce practice remains variable, with a range of clinical practices and models of care evident. Nurses, who constitute the majority of the mental health workforce, are in prime positions to support children and families and provide preventative measures, identify those at risk, and intervene early. In this paper, we provide a framework for practice for nurses working with consumer parents. We contend that traditional models of nursing practice concentrating on the consumer are insufficient in meeting the needs of children and families living with parental mental illness. A focus on families needs to be core business for mental health nurses. A family-focused approach can be used to prevent problems for children and their families, and identify their strengths as well as vulnerabilities. Family-focused care is a useful framework from which to support families and address the challenges that might arise from parental mental illness, and to build individual and family resilience.     

Mental illness and Egyptian families

ABSTRACT:  People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians' beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians' experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others' beliefs, values, and practices.     

Faculty mentorship: support for nurse practitioner students and staff within the rural community health setting

As pointed out in the introduction, there are certain practical concepts within our base of nursing knowledge that can only be taught through experience. Many things are easier to teach by example. As we turn back the clock in nursing, we can see how Florence Nightingale, Clara Barton, and Lillian Wald were role models to their nursing peers in their era. They taught nursing by example, by role modeling their clinical expertise. Today, this model is still effective and faculty mentoring of nurse practitioner students and CHNs in a compassionate and collegial leadership results in higher quality of health care for our nation's needy clients and their families. But greater yet are the opportunities for flexible nurse practitioner faculty practice and personal interactions on many levels for nursing faculty who wish to share their expertise. Mentorship by nurse practitioner faculty for nurse practitioner students and CHNs in a rural clinical setting has revealed many positive aspects in providing quality care for rural clients and growth for nurses. Exposure to the rural community health system helps us, as nurses, to identify the many strengths it possesses for innovative rural nursing practice.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Attitude Disentangled: A Cross-Sectional Study into the Factors Underlying Attitudes of Nurses in Dutch Rehabilitation Centers toward Patients with Comorbid Mental Illness

In rehabilitation centers, many patients suffer a comorbid mental illness. Nurses have different attitudes toward these patients. A cross-sectional, questionnaire-based study among nurses in Dutch rehabilitation centers was undertaken to clarify the factors that underlie attitudes toward patients with comorbid mental illness. The main factors associated with attitudes were feelings of competence and experiences with dealing with patients with mental illness. Other associations were perceived support; frequency of caring for patients with comorbid mental illness; work experience in mental health care; additional psychiatric training; and the personality traits “extraversion,” “emotional stability,” and “openness to experience.” Perceived support had the strongest association with feelings of competence.     

Mental Health Nurses' Work with Family Caregivers of Older People with Depression: Review of the Literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Mental health nurses' work with family caregivers of older people with depression: review of the literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants

People with serious mental illness are at high-risk for physical illnesses and premature death, and nurses can contribute to ensuring mental health services address these risks. There is very little research examining the role of nurses in mental health who provide physical health care. To identify the levels of participation in physical health care of people with serious mental illness (SMI), a national Internet-based survey of nurses working in mental health in Australia was conducted (n = 643). The survey included an adapted version of the Robson and Haddad Physical Health Attitude Scale. Data were analysed through comparison of frequencies, correlations, principal components analysis, and Mann-Whitney tests. Nurses reported regular physical health care in 12 of the 17 tasks presented to them. The three most common self-reported physical health care activities were inquiring about consumers’ contact with GPs, doing physical assessments, and providing information on drug use and lifestyle. Although some practices were less common (e.g., contraceptive advice) nurses who provided one type of care tended to do other types as well. In addition, credentialing in mental health nursing was associated with slightly more regular engagement in all practice domains except screening and assessments. Nurses in mental health in Australia may be engaged in improving physical health of consumers with SMI more than is assumed.