Mental health nursing policy — an exploratory qualitative study of managers'' opinions

Mental health nursing policy — an exploratory qualitative study of managers’ opinions During the 1990s, much of the legislation and policy that pertains to mental health services has sought to direct them towards a virtually exclusive concern with the seriously mentally ill, typified by the following recommendation from a recent Department of Health review of mental health nursing that stated: ‘The essential focus for the work of mental health nurses lies in working with people with serious or enduring mental illness’. On the other hand, pressure from the primary health care sector suggests the need for services to be provided for the less seriously mentally ill, particularly through the auspices of general practice fundholders. Following a review of the literature, a small-scale, exploratory study was initiated to seek answers to the following research question: How is the policy focus urging reorientation to the severely mentally ill viewed by nurse managers who have a responsibility through Mental Health Resource Centres and Community Mental Health Teams, to provide mental health services? The study was based within a Welsh National Health Service (NHS) Trust that employed six nurse managers of Community Mental Health Teams (CMHTs). Four of the managers additionally had responsibility for Community Mental Health Resource Centres (CMHRCs). Of the population of six managers, four composed the sample for the investigation. A qualitative research approach was employed, utilizing semistructured interviews as the data collection tool. Analysis of the data revealed that managers were finding creative solutions in order to meet the conflicting demands placed upon them. The research findings also indicated that many of the obstacles to providing a needs-led service were structural in origin, and could be resolved by central strategic intervention.     

The value of community mental health nurses based in primary care teams: 'switching the light on in a cellar'

This paper explores the impact of placing Community Mental Health Nurses (CMHNs) at two primary care practices in South Staffordshire. Data were collected by means of a questionnaire which was sent to primary care personnel at these practices, to ascertain their opinions with respect to the contribution of practice-based CMHNs. Overall, primary care personnel were satisfied with the quality of the service received from the CMHNs, especially in terms of improved communication. They felt that the new arrangements enabled a quicker and more efficient access to the services of the CMHN. The results are discussed in terms of the value of having CMHNs within the primary care setting, and in terms of service planning and future recommendations for mental health services within primary care.     

关于强化老年护理工作的思考

随着老龄社会的提前到来 ,加强我国老年护理工作成为一个重要课题。今后一个时期 ,要以科学发展观为指导 ,在老年护理工作中实现三个战略转变 ;在工作的重点上 ,医疗护理扩内涵 ,社区护理抓并轨 ,心理护理搞细化 ,临终护理要起步 ;在措施上重点抓好“四个一” ,突出一项改革 ,加快一支队伍建设 ,完善一个体系 ,建立一个机制 ,把老年护理工作提高到一个新水平。     

Validation of the Chinese version Scale of Needs (SON) for caregivers of mentally ill patients

The purpose of this study was to develop the Chinese version Scale of Needs (SON) for Caregivers of Mentally Ill Patients. There were 23 items designed for the initial scale, and 250 Taiwanese caregivers of mentally ill patients were recruited in the study. Exploratory factor analysis and principle component analysis were conducted. The 23 items of the SON for Caregivers of Mentally Ill Patients were classified into four factors and accounted for 66.12% of the variance. Factor I was assigned as Information need, Factor II was named Supportive need, Factor III was named Break need and Factor IV was called Emotional Releasing Service.     

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.     

Nurse education yesterday? A memoir of experiments in mental health nurse education (1987–96)

After a decade of community mental health care, the time is ripe for critical evaluation not only of the policy itself, but also of appropriate nurse education. This paper fills some gaps in the historical record of the early years of community care by describing some educational innovations within one of the earliest services to abandon mental hospitals. Whilst it is accepted that the libertarian, experimental nature of the courses described may be accused of contributing to the alleged early failings of community care, it is also suggested that such educational experiences may assist the establishment of positively therapeutic nursing relationships. Current modular courses are generally more tightly structured, highly assessed, research-based and technical. Recent claims suggest that whilst nurses are more highly educated, there may be a reduction in the quality of the caring relationships they establish. This account of largely unreported, process-based courses implicitly suggests that mental health nurse education might be better as a creative synthesis of such theoretical principles with today's more science-based, content-driven courses.     

Community mental health nurses, caseloads, and practices: a literature review

Deinstitutionalization, and more recently, earlier discharges from psychiatric inpatient units, have created and intensified the need for case management in community mental health. Nurses have been at the forefront of providing this case management. This literature review provides a synthesis of research and policy on the contribution of mental health nurses to community case management. The focus of this review is on the proportion of case management that mental health nurses undertake, the caseloads of case managers, and the interventions that mental health nurses most frequently perform in the community. The professional compositions of mental health case management workforces have been associated with economic imperatives, professional priorities, and the choice of case management models. The influence of mental health nurses in the case management workforce is particularly strong in the U.K. and Australia, but less so in the U.S.A. where social workers and people without mental health qualifications perform similar roles. Although heavy caseloads seem to be common among case managers, the research in this area is quite weak. The interventions that mental health nurses perform most often include case management (e.g., coordinating care), counselling, and medication management. Caring for the physical health of consumers might often be overlooked.     

社区空巢老人心理健康状况调查及对策

目的调查杭州市北山社区空巢老人心理健康状况,并提出对策。方法采取随机抽样的方法抽取北山社区60岁以上的空巢老人121人和非空巢老人160人,采用一般情况调查表和心理健康自评问卷、社区老年人抑郁筛查量表、简易应对方式问卷、总体幸福感量表进行调查,并对结果进行分析。结果空巢老人与非空巢老人年龄、性别、受教育程度、婚姻状况以及经济状况比较差异无统计学意义(P0.05)。空巢老人心理健康自评问卷、抑郁情绪总平均分较非空巢老人高,差异有统计学意义(P0.05);应对方式中积极应对维度平均分较非空巢老人低,消极应对维度平均分较非空巢老人高,差异有统计学意义(P0.01);总体幸福感平均得分较非空巢老人低,差异有统计学意义(P0.01)。结论社区空巢老人心理健康水平偏低,社区卫生服务中心在积极关注空巢老人身体健康的同时,应做好心理健康促进工作。     

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.     

发挥护理专业优势强化"四个贴近"夯实新世纪城市卫生服务基础

介绍了大庆市卫生局发挥护理专业优势 ,把护理工作延伸到社区 ;发挥护士素质特长 ,把健康理念落实到社区 ;发挥护士特有的潜能 ,全心全意服务于社区。通过社区护理工作 ,使卫生服务更加贴近社区、贴近家庭、贴近百姓、贴近生活。保证全市人民“生能顺利、病能医治、老能康乐、死能安息。”的具体做法和成效。     

The impact of team processes on psychiatric case management

Title. The impact of team processes on psychiatric case management Aim. This paper is a report of a study to identify the structures and interactions within community mental health teams that facilitate or impede effective teamwork and psychiatric case management. Background. Effective case management requires close collaboration between case managers or care co‐ordinators and other members of the multidisciplinary mental health team, yet there has been little research into this relationship. Method. A multiple case study of seven United Kingdom community mental health teams was conducted between 1999 and 2001, using qualitative methods of participant observation, semi‐structured interviews and document review. Findings. Factors were identified that impacted on the ability of care co‐ordinators to act effectively: ‘structure and procedures’; ‘disrespect and withdrawal’; ‘humour and undermining’; ‘safety and disclosure’. Care co‐ordination was enhanced when team structures and policies were in place and where team interactions were respectful. Where members felt disrespected or undermined, communication, information sharing and collaboration were impaired, with a negative impact on the care provided to service users. Conclusions. Teams require clear operating procedures alongside interprofessional trust and respect to ensure that there is open, safe and reflective participation. Further research is required to identify how best to bring about collaborative, effective teamwork in mental healthcare.     

Identification of nurses' competencies in primary health care through a Delphi study in southern Brazil

ABSTRACT Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil.
Design: The Delphi Technique was used as the method of study.
Sample: 2 groups of participants were selected: One contained primary health care nurses ( n =52) and the other specialists ( n =57), including public health nurses and public or community health faculty.
Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1–5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted.
Results: In the nurses' group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists' group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences.
Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.     

3315例精神病人的社区防治护理

目的探讨精神病人社区防治护理方法,促使社区精神病人尽快康复,重返社会。方法采取防治结合,配合各种各样的社区康复护理。结果经过一年多的社区防治护理后,3315例患者中,好转2486例,显好率达75%。同时资助927位特困患者每月的药品费用,实施了23位患者的“解锁工程”。结论住院化管理不是精神病人康复的唯一方法,应积极推广“开放式、社会化、综合性”的社区防治护理。