A national survey of practice nurse involvement in mental health interventions

BACKGROUND: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. AIM: This study aimed to quantify practice nurses' involvement in delivering mental health interventions in primary care settings. METHOD: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non-eligible respondents were removed an adjusted response rate of 54% was achieved. RESULTS: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side-effects were infrequently monitored and PNs' understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. CONCLUSIONS: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.     

The work of nurses in Australian general practice: A national survey

Background

Following recent reforms to Australia's health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide.

Objectives

This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken.

Design

The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters.

Setting

General practice settings in all regions of Australia.

Participants

108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting.

Methods

Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care.

Results

The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3-41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9-59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1-92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8-39.1), followed by skin-related problems (20.0; 95% CI 17.3-22.8), and cardiovascular problems (11.0; 95% CI 8.7-13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving.

Conclusions

The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses’ work. Whilst nurses’ rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses’ skills in the primary health care context.     

Health screening for women with physical disability in Australian general practice: A survey

BackgroundEarly detection of gynaecological issues improves health outcomes and reduces mortality. Such early detection is best achieved via regular, proactive health screening. Like other disadvantaged groups, women with physical disability have much lower gynaecological screening rates than the general population.AimThe aim of this paper is to explore the current role of general practice nurses in women’s health screening for individuals with physical disability.MethodsA national online survey of Australian general practice nurses was conducted.FindingsOne hundred and seventy-eight general practice nurses completed the survey. Sixty-one percent reported having experience in working with people with a physical disability. Around one third of participants reported having completed specific education about physical disability. Most general practices implemented strategies to facilitate physical access for those with disability. However, few general practices had a medical records system that enabled identification of physical disability. Thirty-seven participants reported providing women’s health screening for 89 women with a physical disability in the 4 weeks prior to the survey. A range of strategies were used to support women during these screening procedures. These could be broadly classified into; a) providing practical assistance to facilitate screening, and b) modifying technique and positioning for comfort.ConclusionsThe limited experience with disability amongst an experienced nursing cohort, and the difficulty inherent in identifying those with a disability within recall and reminder systems, adds complexity to the provision of screening for women with a disability. Whilst participants articulated some innovative and creative strategies to assist women with a disability during health screening, enhanced awareness amongst nurses and proactive strategies would likely enhance service accessibility in this vulnerable group.     

The mental health nurse practitioner in the emergency department: an Australian experience

This paper describes the establishment of a mental health nurse practitioner (MHNP) position in New South Wales, Australia. The authors report on a MHNP role that functions collaboratively within a large inner city emergency department. Attention is centred on what constitutes advanced mental health nursing practice in the emergency department setting. Three areas associated with the work of MHNPs--therapeutic techniques, prescribing and care coordination and referral--are highlighted to explore the scope of the MHNP role. The authors propose that the success of this position is based on a process of consultation and evaluation, partnership between disciplines and clinical services and the role maintaining a truly nursing focus rather than attempting to replace or replicate psychiatric medicine.     

Cough in lung cancer: A survey of current practice among Australian health professionals

BackgroundSystematic reviews and guidelines are available to guide management of cough in lung cancer, but evidence for intervention efficacy is limited, and little research has yet described current practice.AimTo canvass the experiences and perspectives of Australian health professionals with regard to the clinical importance and current management of cough in people with lung cancer.MethodsAn open, online, cross-sectional survey was conducted in 2018. Health professionals of all disciplines were eligible, and recruitment was by direct approach to lung cancer multidisciplinary teams, professional listservs and conferences.FindingsFifty-eight people completed the survey, of whom 26 (45%) were medical practitioners, 21 (36%) registered nurses, and 10 (17%) allied health practitioners. Nearly all (>90%) considered cough to be of clinical concern and welcomed efforts to improve management. In most services, ≤25% of patients with clinically concerning cough receive management. Opiates were perceived to be the most consistently effective pharmacological strategy, with ≥50% participants indicating minimal or variable effectiveness for all others. The few participants who had experience of non-pharmacological strategies perceived these to be only somewhat or variably effective.DiscussionResults from this study identified variability in the management of cough associated with lung cancer, and suggest this problem may be under-treated in most services. Unmet needs identified by this study are likely under-estimated due to the volunteer effect associated with open surveys.ConclusionFurther efforts are needed to raise awareness about the importance of managing cough and provide evidence-based strategies for this population.     

Custody and caring: innovations in Australian correctional mental health nursing practice

The challenges of delivering quality nursing care to incarcerated offender populations are diverse, complex and pressing. Correctional nursing in prison health facilities is a highly specialized area of mental health care. Research findings have identified contextual influences on the nature of practice and practice arrangements in the correctional environment. Implications for practice innovation and role development are explored through milieu factors.     

Scoping practice issues in the Australian mental health nursing workforce

This is the third of four articles on the scoping study of the Australian mental health nursing workforce conducted on behalf of the Australian and New Zealand College of Mental Health Nurses (ANZCMHN) for the Australian Health Ministers Advisory Council (AHMAC) National Working Group on Mental Health (NWGMH). Its purpose is to focus on factors that significantly affect mental health nursing practice. The issues of advanced practice, regulation of nursing, accreditation, credentialling and demarcation with other disciplines are addressed.     

User involvement in mental health nursing practice: rhetoric or reality?

Following the review of mental health nursing, nurses need to address the dilemma of providing empowering care in a climate of increasing control and stigma. This paper discusses tile background to, and significance for nursing, of the 'user movement' in the UK. A current 'explosion' of user groups does not imply that these form a homogeneous group, nor that they share similar perspectives. Consultation and involvement mean little if unmatched with action. This may be constrained by the 'market' in which the 'true power' is held by the budget holder, and by stigmatizing policy imperatives claimed to be in the public interest. Self-advocacy may be legitimized by the desire to prevent providers 'speaking out'. These difficulties may, however, provide convenient excuses for inaction. A new professional identity may be found in forging political alliances with users, in which a reappraisal of traditional boundaries may go some way towards reducing the stigma surrounding mental health problems.     

实习护生心理健康状况调查分析

[目的]了解实习护生的心理健康状况。[方法]采用卡特尔16项个性因素测查量表(16PF)和精神症状自评量表(SCL -90 )对113名实习护生进行测量。[结果] 16PF心理健康因素得分低于平均分(2 2分) ,SCL -90各因子分均高于全国常模,其中强迫症状、人际关系敏感、焦虑等差异显著。[结论]护生心理健康状况较差,应加强心理健康教育,稳定其专业思想,加强人际沟通能力的培养。     

New Zealand general practice nurses' roles in mental health care

MCKINLAY E., GARRETT S., MCBAIN L., DOWELL T., COLLINGS S., & STANLEY J. (2011) New Zealand general practice nurses' roles in mental health care. International Nursing Review 58 , 225–233 Aim: To examine the roles of nurses in general practice interdisciplinary teams caring for people with mild to moderate mental health conditions. Background: Supporting mental health and well‐being is an important aspect of primary care. Until now nurses in general practice settings have had variable roles in providing mental health care. The New Zealand Primary Mental Health Initiatives are 26 government‐funded, time‐limited projects using different service delivery models. Methods: An analysis was undertaken of a qualitative data set of interviews, which included commentary about nurses mental health work collected from the different project stakeholders throughout a 29‐month external evaluation. Findings: Two main groups of roles for nurses within the general practice interdisciplinary team were identified: specialist mental health nurses working in newly created roles and practice nurses working in existing roles. Barriers exist to the development of the latter roles. Conclusions: Mental health care is a key role in general practice as this is where people frequently present. Internationally, nurses represent a large workforce with the potential to provide effective mental health care. This study found that attitudinal, structural and professional barriers are restricting New Zealand practice nurse role development in the care of those with mild to moderate mental health conditions. There is potential to develop their role within a structured pathway by workforce development and recognition of the value of interdisciplinary care. Given the shortage of mental health professionals this will be an important aspect of the improvement of primary mental health care.     

Consumer participation in nurse education: A national survey of Australian universities

Consumers of mental health services have an important role to play in the higher education of nursing students, by facilitating understanding of the experience of mental illness and instilling a culture of consumer participation. Yet the level of consumer participation in mental health nursing programmes in Australia is not known. The aim of the present study was to scope the level and nature of involvement of consumers in mental health nursing higher education in Australia. A cross‐sectional study was undertaken involving an internet survey of nurse academics who coordinate mental health nursing programmes in universities across Australia, representing 32 universities. Seventy‐eight percent of preregistration and 75% of post‐registration programmes report involving consumers. Programmes most commonly had one consumer (25%) and up to five. Face‐to‐face teaching, curriculum development, and membership‐to‐programme committees were the most regular types of involvement. The content was generally codeveloped by consumers and nurse academics (67.5%). The frequency of consumer involvement in the education of nursing students in Australia is surprisingly high. However, involvement is noticeably variable across types of activity (e.g. curriculum development, assessment), and tends to be minimal and ad hoc. Future research is required into the drivers of increased consumer involvement.