Global issues in mental health across the life span: challenges and nursing opportunities

This article describes what is known about mental health in children, adolescents, adults, and the elderly globally in high-, middle- and low-income countries. The social determinants of health are described as well as the paradigm shift from focusing on psychopathology to looking at ways in which individuals and communities can embrace mental health promotion to decrease stigma and provide care for all individuals in resource-rich and resource-poor environments. The need to expand the content in nursing curricula to include mental health concepts at all levels of training, foster mental health research, and promote international collaboration around best practices is also discussed.     

Employment, social inclusion and mental health

Whereas unemployment is clearly linked to mental health problems, employment can improve quality of life, mental health, social networks and social inclusion. Yet in the UK only 15% of people with serious mental health problems are employed--despite an overwhelming consensus from surveys, case studies and personal accounts that users want to work. This paper aims to challenge common misconceptions surrounding employment, work and mental health problems. Drawing on a range of research evidence and legislative guidance it discusses significant barriers to work and proposes feasible solutions. The need for mental health staff and services to become involved in the provision of work opportunities is considered, as is the vital role they can play in changing communities. The potency of work as a vehicle for improving the social inclusion and community tenure of people with mental health problems is highlighted.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

The challenges of mental health care reform for contemporary mental health nursing practice: relationships,power and control

This ethnographic investigation was concerned with the way mental health nurses' construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reforms of the 1990s. The setting for this study was a 22-bed acute inpatient mental health facility. Over a 5-month period, data were collected through fieldwork observations, focused interviews and discussion groups. In this article, common cultural practices in relation to the imperatives of relationships, power, restrictions and safety are discussed. The findings demonstrate how the client stabilization role of the unit locates these imperatives as central to the delivery of nursing care. The discussion reveals nurses negotiating relationships that are contradictory and challenging in ordinary and everyday ways within the exigencies of daily practice.     

Greek psychiatric care reform: new perspectives and challenges for community mental health nursing

The purpose of this article is twofold: (1) to explore the main issues of psychiatric care reform in Greece and outline the operating way of the new residential structures of psychiatric care and rehabilitation; and (2) to focus on the implementation of mental health nursing roles in the primary care services such as supervisor-therapist, liaison, coordinator-crisis interventionist and counsellor-trainer within the context of a multidisciplinary therapeutic team. Given that multiple professionals are involved in mental health care in primary care, issues of role are likely to be crucial to the effective implementation of new workers. Moreover, there is existing evidence of ambiguity in the roles of different mental health professionals in primary care, relating to the problems they manage and the treatments they provide. The authors believe that more emphasis needs to be given to the mental health nursing specialty in Greece, because the large majority of patients requiring mental health care should have the possibility of taking better quality of care as the psychiatric structures at community are continuously developing.     

Youth employment, mental health and substance misuse: a challenge to mental health services

Employment is the cornerstone of social inclusion, the means by which individuals play a full and active part in society and has a pivotal role in helping young people to negotiate the transitional period between the child and adulthood. Employment therefore should be seen as a right and given a higher priority by health and social care agencies. There are numerous difficulties preventing some young people from achieving full employment and these are compounded for young people with concurrent mental health and substance misuse problems (dual diagnosis). The coexistence of these two problems is on the increase and they are recognized as significant barriers to employment. Unemployment may lead to social alienation, criminal or other antisocial activity and a higher incidence of suicide. Consequently, there is a danger of young unemployed people slipping into a spiral of self-defeating, antisocial and risky behaviour. There is little evidence of health and social care agencies working in partnership with voluntary sector organizations to tackle the growing problem of dual diagnosis and youth unemployment, although there are obvious linkages between employment, psychological health, social inclusion and substance misuse. It is therefore worth exploring the issues surrounding work, mental health and substance misuse in young people if we are to generate new ways of thinking about and responding to the needs of this target group. This presents a challenge to mental health services, particularly nurses who face the impact of these issues in their day to day practice but often lack the preparation and support to adequately address them.     

Interpersonal mental health nursing: research issues and challenges

Since Peplau outlined her perceptions of psychiatric/mental health nursing in (1952) interpersonal relationships has been considered by many as the core of practice. In the intervening period of almost a half century many researchers and theorists have endeavoured to develop and integrate Peplau's framework into day-to-day nursing activity. However, more recently, as a result of the fusion between the professional nursing agenda and the wider political agenda, the importance of interpersonal relationships and the individuality of psychiatric/mental health nursing is being questioned. This questioning is represented in the debate about the aetiology of mental illness, the choice of research methods to determine treatment outcomes and by association the role and value of the psychiatric/mental health nurse. This paper will focus on the interpersonal nature of psychiatric/mental health nursing and explore possible research approaches aimed at explicating its core. Attention will be given to the necessity of using pluralistic methodology in order to do so.     

The growing role of football as a vehicle for interventions in mental health care

In recent years there has been a growing interest in the use of football as a vehicle for mental health interventions. This paper outlines some of the ways that mental health service providers have begun to develop strategies with football clubs, the Football Association and government departments that involve playing or watching football and placing mental health services in football clubs. The paper also looks at how some attempts are being made at regional and national levels to develop and bring together services that use football as a vehicle for mental health service delivery.     

Cancer clinical trials in the new millennium: novel challenges and opportunities for oncology nursing

Because oncology nurses in day-to-day practice are key to clinical trial conduct, current dynamics impacting drug development and the clinical trials community must be delineated and understood. Increasing cancer clinical trial complexity raises concerns for the preservation of appropriate roles and responsibilities of oncology nurses while ensuring quality care for those trial participants. Oncology nurses have the unique opportunity to lead the way by developing and embracing creative, innovative strategies to orchestrate clinical trial complexities and thus preserve the future of these trials and the ongoing development of chemopreventive and anticancer agents.     

Working in the real world: a review of sociological concepts of health and well-being and their relation to modern mental health nursing

Since 2008, the world has witnessed several socio-economic upheavals that have fundamentally changed the global economy. Within the UK, these upheavals have coincided with a change in political administration and thus a new approach to managing the volatility of economy. This change has resulted in root and branch reform of service provision that is based around a model that incorporates a shrinking public sector coupled with an increase in civic participation (i.e. 'The Big Society' espoused by the UK-governing coalition). It is also unlikely that healthcare provision on a global level will remain unchanged in such turbulent times. It would therefore seem a useful time to review how socio-economic forces are believed to affect the health and well-being of an individual. These forces include social inequality, the mechanisms of social inclusion and exclusion, social role and the erosion of resilience. This paper will then conclude by offering some potential avenues that nurses can explore to make these forces less damaging for their clients. These avenues include developing a clinical focus based around positive psychology, well-being and some novel ways that nurses can help overcome the maintenance cycles that perpetuate inequality and exclusion.     

Engaging with nature to promote health: new directions for nursing research

Title.  Engaging with nature to promote health: new directions for nursing research.
Aim.  The aim of this paper is to offer a conceptual framework for nature-based health promotion in nursing and provide related recommendations for future nursing research.
Background.  Empirical data suggest that interaction with nature has direct health benefits. When people attend to outdoor habitats, gardens and other forms of nature, they are more likely to engage in physical activity and other behaviours that improve health. Engaging with nature can even cultivate ecological sensibilities that motivate us to protect the health of our planet.
Data sources.  Multidisciplinary theoretical and research publications from 1985 to 2008 were examined in the development of the framework.
Discussion.  As the health of our planet continues to deteriorate, there is a pressing need for theoretically informed, ethical, sustainable ways of engaging with nature to promote human and environmental health. We adapt principles and socio-ecological thinking from the fields of nursing, health promotion and ecological restoration to delineate the essential elements of the proposed framework.
Implications for nursing.  Although evidence-based knowledge about nature-based health promotion is not readily used in nursing and health care, its development and application are critical to designing effective strategies to strengthen both human and environmental health.
Conclusion.  Nurses can use nature-based health promotion concepts to work with citizens, health practitioners and policymakers to explore and optimize reciprocal, health promoting relationships among humans and the natural environment. To the extent that nurses integrate nature-based health promotion into their research efforts, we can expect to contribute meaningfully to both environmental and human health in communities across the globe.     

Qualitative convergence of three nursing concepts: art of nursing, presence and caring

Title.  Qualitative convergence of three nursing concepts: art of nursing, presence and caring.
Aim.  This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring.
Background.  Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified.
Data sources.  Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated.
Results.  A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses.
Conclusion.  Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse–patient relationships that exist.     

Developments in nursing practice in primary health care in Hong Kong: opportunities and challenges

The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings. This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems. Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions.     

我国本科护理教育发展的概况、面临的机遇及挑战

回顾我国大陆地区本科护理教育发展历史,描述发展现状及其在社会发展中的作用。指出我国本科护理教育存在的主要问题：培养目标不明确、学制和学位不统一、培养过程不衔接及教学质量无法保证等问题。国家宏观政策的保障及临床护士紧缺的现状为我国本科护理教育的发展提供了机遇,也提出了挑战。护理教育者应把握机遇,群策群力,努力促进我国本科护理教育的发展。