Exploration of personal recovery-oriented care on an acute mental health unit

BackgroundPersonal recovery should be the cornerstone of mental health nursing practice. Nursing interventions should build on consumers' strengths to provide hope, so consumers are empowered to achieve their own personal goals.AimThe aim of this study was to explore mental health nurses’ lived experience of their practice, understanding and knowledge of personal recovery-oriented care on acute mental health units.MethodVan Manen's methodology was utilised in this study. Data was gathered through semistructured conversational interviews with mental health nurses working on an acute unit.FindingsParticipants found personal recovery was difficult on an acute mental health unit. Factors that participants identified that impeded personal recovery-oriented care on acute mental health units included: the acuity of consumers in a low dependency area, lack of time to engage consumers, and loss of the therapeutic role for mental health nurses on acute units.DiscussionMental health nurses are expected to focus on the personal recovery needs of mental health consumers while managing clinical risks to consumers and others on the acute unit. This has the mental health nurse navigating a course between two worlds, and results in mental health nurses being confused between concepts of personal recovery and clinical recovery.ConclusionIf acute mental health nurses cannot define personal recovery, they will not be able to effectively implement interventions that support consumers in their personal recovery journey on acute units and will be drawn into the clinical recovery paradigm.     

Becoming a Psychiatric/Mental Health Nurse in the UK: A Qualitative Study Exploring Processes of Identity Formation

Identity studies are well established across the social science literature with mental health nursing beginning to offer evidenced insights into what may, or may not, constitute key identity performances. For mental health nursing these performances remain contested, both from within the profession and from international contexts that favour generic constructions of mental health. This paper offers findings from a qualitative study that focused upon the process of how mental health nursing identity development is influenced, rather than what that identity may or may not be. These findings highlight that mental health nurses (MHNs) not only form their identity around service user centred education and training, but that many also use the education as a means to leave the profession. Through highlighting the impact of informal education (i.e., through work), formal education, and training upon the formation of mental health nursing identity, nurses are potentially alerted to the importance of clinically focussed mental health being prominent within curricula, rewarding mental health nursing skills specialisation, and the importance of the role of the service user in mental health nurse education and, hence, identity formation.     

Spiritual Interventions and the Impact of a Faith Community Nursing Program

Faith community nursing had its formal beginnings in the Midwestern United States in 1984 when six nurses received financial support from a local hospital to work in churches. Over time, the churches assumed increasing responsibility for the nurses’ salaries. The success of this initiative was associated with the understanding that faith communities are dedicated to keeping people well. The number of programs increased over the past 30 years and now there are thousands of faith community nurses serving populations around the world. Research for this specialty practice has not experienced comparable growth, and is needed to further develop faith community nursing science. This study, based on the Roy Adaptation Model, used a qualitative design to identify spiritual nursing interventions that faith community nurses use in their practice, and to examine the spiritual impact of a faith community nursing program. Data were collected from faith community members, clergy representatives, and faith community nurses with a researcher-developed demographic tool and a six-item open-ended questionnaire that were both mailed to participants (N = 112; n = 52; response rate = 46%) and analyzed through content analysis. A variety of spiritual nursing interventions were identified. Themes related to the spiritual impact included the physical, mental, and spiritual health connection, caring, hope, spiritual support and benefits, and religious concepts.     

Correctional Nursing Interventions for Incarcerated Persons with Mental Disorders: An Integrative Review

The authors explore the current state-of-the art of correctional nursing by summarizing the types of interventions employed by nurses, across studies, designed to assist this challenging group of patients. This examination of evidence-based interventions implemented and tested by correctional nurses provides a better understanding of their role and function. Correctional health is a nurse driven system, yet a minimal amount is known about the nurses who practice in these environments or about their contributions to the practice of mental health nursing in correctional environments. An integrative review utilizing PRISMA guidelines examined five databases (Medline/PubMed, PsycInfo, PsychArticles, Sage Criminology, and Academic Search) for peer-reviewed articles that fit selected criteria. Of 324 references identified, 16 studies met criteria. Following assessment of strength of evidence, only eight studies offered scientific proof of the effectiveness of nursing interventions. Nursing interventions implemented in correctional settings targeted incarcerated persons with behavioral and psychological symptoms. Interventions included psycho-education, environmental adaptations, and behavior therapies. The centrality of nurses in correctional health care emphasizes the significance of understanding their role and function in this setting. This integrative review revealed that correctional nurses are actively engaged in providing therapeutic, evidence-based interventions in the health care of incarcerated persons. Of interest, seven of the eight studies focused on incarcerated persons with mental health or substance use issues. Nurse led interventions such as CBT, labyrinth walking, and yoga aim to improve coping and adaptation of incarcerated persons.     

Knowledge,attitude and behaviours toward people with mental illness among Tunisian nursing students and nonhealth care students: A cross-sectional study

BackgroundAlthough being in the frontline of healthcare and having a crucial role in the reduction of stigma, evidence has shown that nurses and undergraduate nursing students hold unfavourable attitudes toward mental illness. There is, to our knowledge, no previous study that explored attitudes toward mental illness among nursing students in Tunisia, nor in North African countries.AimWe aimed to assess stigma in nursing students as compared to nonhealth care students, and the relationship between stigma and education variables in the nursing students group.MethodsThe 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and 'Reported and Intended Behaviour Scale' were administered to 255 nursing students and 332 nonhealth care students.FindingsDespite nursing students being more knowledgeable about mental disorders than nonhealth care students; they held significantly more stigmatising attitudes toward people with mental disorders in two dimensions: Authoritarianism and Community mental health ideology. After controlling for confounders, we found that having taken mental health courses significantly predicted more favourable attitudes toward people with mental disorders and better knowledge of mental health stigma. Being interested in working in psychiatric wards helped predict more favourable attitudes and intended behaviours.DiscussionIn general, results from this study are of concern as it presents evidence of an overall similar or even greater tendency to negative attitudes toward mental illness among nursing students than among nonhealth care students.ConclusionThere is an urgent need for antistigma interventions in nursing schools. These interventions should target nursing students with the most negative attitudes, including male students and those who have never had personal experience with mental illness. Interventions should also work to build up nursing students’ interest in mental health nursing during their undergraduate years.     

Interventions to improve mental health nurses’ skills,attitudes, and knowledge related to people with a diagnosis of borderline personality disorder: Systematic review

ObjectivesThere is some evidence that mental health nurses have poor attitudes towards people with a diagnosis of borderline personality disorder and that this might impact negatively on the development of helpful therapeutic relationships. We aimed to collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards this group of people.DesignSystematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement.Data sourcesComprehensive terms were used to search CINAHL, PsycINFO, Medline, Biomedical Reference Collection: Comprehensive, Web of Science, ASSIA, Cochrane Library, EMBASE, ProQuest [including Dissertations/Theses], and Google Scholar for relevant studies.Review methodsIncluded studies were those that described an intervention whose aim was to improve attitudes towards, knowledge about or responses to people with a diagnosis of borderline personality disorder. The sample described had to include mental health nurses. Information about study characteristics, intervention content and mode of delivery was extracted. Study quality was assessed, and effect sizes of interventions and potential moderators of those interventions were extracted and converted to Cohen's d to aid comparison.ResultsThe search strategy yielded a total of eight studies, half of which were judged to be methodologically weak with the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge; smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioural change in the form of increased use of components of Dialectical Behaviour Therapy following training in this treatment was associated with moderate effect sizes. The largest effect sizes were found among those with poorer baseline attitudes and without previous training about borderline personality disorder.ConclusionsThere is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes; this should involve trials of interventions in samples that are compared against adequately matched control groups.     

Authenticity,Creativity and a Love of the Job: Experiences of Grassroots Leaders of Mental Health Nursing in Queensland

The strength of mental health nursing and its potential contribution to improved consumer outcomes depends upon strong and clearly articulated leadership. However, studies of leadership have tended to focus on nurses holding senior positions rather than exploring the leadership embedded in clinical work. A qualitative exploratory study was undertaken with identified mental health nurse leaders in one Australian state, in order to explore their experiences and what they found to be most meaningful in their work. This article reports the findings from this study. The data was analysed thematically to yield insights significant to mental health nursing and identity. The findings suggest these leaders find intrinsic rewards in the role; aspire to making authentic connections with consumers; appreciate the position of trust that they hold in bearing witness to individuals’ distress; and use creative means to solve problems and achieve therapeutic outcomes. Sharing these themes builds knowledge on values that are embedded in mental health nursing practice and offers scope for integrating leadership attributes into the education, supervision and development of all mental health nurses. These findings also reveal the complexity of mental health nursing as a profession and the difficulties that might be encountered in attempts to define it in terms of its component tasks and functions.     

The impact of knowing your child is critically ill: a qualitative study of mothers' experiences

Discussion in this paper is drawn from an exploratory study designed to elicit mothers' lived experiences of crisis and coping, and their experiences of nursing following the unexpected emergency admission of their child to the paediatric intensive care unit (PICU). An in-depth critique of literature supporting this study has been published. Two theoretical perspectives serve as a basis for this exploratory study: firstly, the idea that in a crisis situation, a mother's ability to cope and function is influenced by therapeutic interventions of nurses by meeting her needs in a holistic way; and secondly, symbolic interactionism, that focuses on the meaning of events to mothers. Data were elicited through focused interviews with 10 mothers of children aged between 3 months and 15 years who had been admitted unexpectedly to the PICU with a life threatening condition. Findings reveal the major impact of crisis on mothers immediately following their child's critical illness and admission to PICU, and this specific aspect therefore warrants in-depth discussion and analysis. The study did not generate a theory; however, important recommendations are made for nursing practice and research in relation to the impact of crisis experienced by mothers. Nursing practice issues include meeting the psychosocial needs of parents prior to and immediately after admission, and the importance of family-centred nursing care. Issues for nursing research include exploring how families cope with the impact of crisis and critical illness.     

Conflict, enactment, empowerment: conditions of independent therapeutic nursing intervention

The purpose of this qualitative study was to describe the use of independent therapeutic nursing interventions by registered nurses in a variety of health care delivery agencies The process used to integrate nursing interventions into the daily routines of agencies that did not formally require their use, the conditions in which they were implemented, and the consequences of their use, were examined Data collection methods included observations and interviews of 36 participant nurses, employed in five health care agencies, for 1 year The organizational culture of each environment was observed and its impact on the enactment of independent therapeutic nursing interventions was evaluated Data analysis, done by using the constant comparative method, generated a proposal of a substantive theory that integrates conditions and consequences of therapeutic nursing intervention Intra-role conflict, the product of incompatible expectations of the professional conception of nursing and task oriented/medically controlled work environments, served as the motivating force behind strategies of enactment utilized to overcome barriers to implement therapeutic nursing interventions As a consequence of using therapeutic nursing interventions, participants perceived empowerment in relation to clients, peers and other health care professionals     

Contradictions between Ideals and Reality: Swedish Registered Nurses’ Experiences of Dialogues with Inpatients in Psychiatric Care

This study explored ten registered nurses’ experiences of dialogues with inpatients in psychiatric care. Data were collected through four focus group discussions, and two individual interviews. The nurses described contradictions between their nursing ideals about dialogues and the reality faced in psychiatric inpatient care, resulting in an unsatisfactory work situation and feelings of insufficiency. We conclude that in order to improve quality of care and increase well-being for both patients and health care workers, nursing interventions, such as dialogues and meaningful activities, need to be offered to patients. A management that is visible and present on-site should encourage and facilitate health care workers’ participation in clinical supervision.     

Factors in the practice environment of nurses working in inpatient mental health: A partial least squares path modeling approach

BackgroundDeveloping a therapeutic relationship with consumers is considered as the central aspect of nursing work in mental health. The importance of this relationship stems from its association with enhanced patient care and improved patient outcomes. Factors within the practice environment may influence the nurse's ability to engage effectively in this relationship.ObjectiveThis study explored a model that added characteristics of the individual and practice environment to a central framework incorporating therapeutic commitment: a nurse's ability and willingness to engage in a therapeutic relationship.Setting and participantsData were collected at six mental health nursing units in five public general acute hospitals in New South Wales, Australia for 14 days per unit, between 2005 and 2006. All nurses in participating wards were invited to partake in the study. Seventy-six (51%) responses were analyzed.MethodThe data were collected using a Nurse Survey inclusive of the Practice Environment Scale of the Nursing Work Index (NWI-PES), and the Mental Health Problems Perception Questionnaire (MHPPQ). A Unit Profile form was used concurrently to collect staffing, skill mix and patient turnover data. Partial least squares path modeling (PLS-PM) was chosen as the analytical method to test the model and identify the most influential factors.ResultsExperienced nurses who perceived themselves to be competent and supported were more likely to express a willingness to engage therapeutically with patients. Environmental factors associated with these perceptions included foundations of quality nursing care, opportunities to participate in hospital affairs and clinical supervision. Not all elements in the proposed model were supported.ConclusionPositive hospital practice environments can improve the capacity of nurses working in mental health to engage therapeutically with patients. Specific approaches may include access to preceptorship, continued education and career development opportunities, together with clinical supervision, improved continuity of care, and the involvement of mental health nurses in the governance of the hospital.     

Mental Health Learning Needs Assessment: Competency-Based Instrument for Best Practice

A learning needs assessment focused on psychiatric/mental health nursing competency development is a central component of nursing education in specialty mental health nursing practice. The provision of education for mental health nursing relies on the underlying assumption that the learning needs of experienced mental health nurses have been assessed and educational programs implemented to address educational needs for competency in professional practice. Few professional learning needs assessments have been developed to identify learning needs in mental health nursing practice. The majority of available professional learning needs assessments focus on medical nursing practice applications rather than the psychosocial aspects of a mental health assessment. The mental health field addresses very different assessment criteria such as knowledge of suicide assessment and therapeutic interventions. The purpose of this article is to present and describe the process of developing a learning needs assessment focused on competency development for the specialty practice of mental health nursing that addresses and resolves complex learning needs.     

Family intervention sessions: one useful way to improve schoolchildren's mental health

This study examines the effectiveness of therapeutic conversations with families (through family sessions) in alleviating health complaints among adolescent girls in a school setting. Four girls with recurrent, subjective health complaints and their families were included in the study. Three sessions were held with each family, using genograms, ecomaps, interventive questions, and other family nursing interventions; practicing school nurses were also present. A therapeutic letter was sent to each family at the end of the sessions. The Strengths and Difficulties Questionnaire was used as a pre- and posttest measure. Evaluative interviews were carried out with the families and with school nurses. The families reported feeling relief and described positive affective, behavioral, and cognitive changes as a consequence of the interventions. The school nurses experienced the family sessions as time-saving and easy-to-use tools in their work. Involving the family when schoolchildren's recurrent mental health problems are addressed may reduce future suffering.     

Exploring the role of the mental health nurse in community mental health care for the aged

There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.     

Sexuality and Consumers of Mental Health Services: The Impact of Gender and Boundary Issues

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses’ attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses’ attitudes towards discussing sexuality with consumers as part of their practice.     

The impact of horizontal violence on the individual nurse: A qualitative research study

AimHorizontal violence (HV) is a familiar term used in nursing. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (nurses within their first 12 months of practice) are widely considered a vulnerable population in the profession and thus more at risk for HV. The purpose of this qualitative study was to explore how HV affects graduate nurses (GNs).DesignInductive thematic analysis was used in the design of this study.MethodsParticipants included eight Canadian GNs or Registered Nurses (RNs), all of whom had experience with HV in their first 12 months of practice. Data collection was done via one-on-one interviews.ResultsTwo main themes were revealed from the data collected - Toxic Nursing Culture and Fear. Several subthemes were also identified – cycle of violence, nurses eating their young, shame, drowning, isolation and vulnerability. The findings indicate that HV is prevalent in the first year of practice and is destructive to the mental health of the individual nurse. Horizontal violence poses a serious challenge for GNs entering nursing and is often touted as the reason new nurses leave the profession altogether.ConclusionThis study highlighted the personal and professional challenges that are heightened for a GN when they experience HV in their first year of practice. These experiences emphasize the impact that HV can have on the mental health of nurses and their ability to deliver safe patient care.     

Therapeutic Interventions in Perinatal and Infant Mental Health Services: A Mixed Methods Inquiry

Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.     

Reflecting on Holistic Nursing: The Contribution of an Academic With Lived Experience of Mental Health Service Use

The educational preparation of registered nurses is presumed to reflect a holistic approach with emphasis on the bio-psycho-social model of care. The broader literature suggests this goal is not always realised. The aim of this study is to present the views, experiences, and perceptions of undergraduate nursing students who were taught by an academic with a lived experience of mental health service use. In particular, we wanted to look at the expected impact of this approach to learning on their nursing practice. A qualitative, exploratory approach was used, involving in-depth individual interviews with 12 undergraduate nursing students completing the course, “Recovery for Mental Health Nursing Practice,” as part of a major in mental health nursing in a university in Queensland, Australia. Students were asked to reflect upon and discuss their experiences of being taught by a person with lived experience of mental health service use. Data were analysed following Colaizzi's steps to identify the main themes. The three main themes were (1) Recovery—Bringing Holistic Nursing to Life; (2) Influencing Practice; and (3) Gaining Self-Awareness through Course Assessment: Challenge and Opportunity. These themes suggest an appreciation for holistic nursing and an increased capacity for reflective understanding. The responses from participants suggest the Recovery course had a significant impact on their attitudes to nursing and that their nursing practice would be positively enhanced as a consequence.