Therapy supervision: the phenomena and the need

Nursing has lagged behind in development, utilization, and valuing of therapy supervision. Nevertheless the mental health nursing clinical specialist is expected to be supervised and to be a supervisor of other professional staff. The integral nature of supervision in mental health nursing practice is demonstrated when one defines "therapy supervision," identifies its characteristics, and studies its clinical phases. As the role of the mental health clinical nurse specialist continues to expand, the importance of supervision in developing high level therapeutic skill has become more evident. In this paper various meanings of the concept of supervision and its similarities and differences with associated concepts, such as teaching and therapy, are explored. Essential characteristics are identified, and the application of the concept in practice and research is discussed. The inclusion of supervision training in graduate nursing curriculum, continuing education and in-service programs is advocated.     

Introducing clinical supervision across Western Australian public mental health services

Retention and recruitment of the mental health nursing workforce is a critical issue in Australia and more specifically in Western Australia (WA), partly due to the isolation of the state. It has been suggested that these workforce issues might be minimized through the introduction of clinical supervision within WA mental health services, where, historically, it has been misunderstood and viewed with caution by mental health nurses. This may have been partly due to a lack of understanding of clinical supervision, its models, and its many benefits, due to a paucity of information delivered into initial nurse education programs. The aim of this pilot project is to explore and evaluate the introduction of clinical supervision in WA public mental health services. A quantitative approach informed the study and included the use of an information gathering survey initially, which was followed with evaluation questionnaires. The findings show that education can increase the uptake of clinical supervision. Further, the findings illustrate the importance of linking clinicians from all professional groups via a clinical supervision web‐based database.     

Perspectives of Australian Nursing Directors Regarding Educational Preparation for Mental Health Nursing Practice

There is an ongoing global shortage of mental health nurses. Within Australia, the principal strategy of offering a postgraduate education programme with various incentives to encourage nurses back to study has not been successful. This has led to the consideration of radical alternatives, including the return to pre-registration specialisation in mental health. The successful introduction of this strategy would require the full support of industry partners. To date, the voice of industry has not been heard in relation to this issue. The aim of this paper is to present the views of an Australian sample of mental health nursing directors regarding the resources and other factors required, should undergraduate specialist programmes in mental health be developed, to ensure they are relevant and likely to be successful. A qualitative exploratory research project was undertaken to explore the perspectives and opinions of industry partners. In-depth interviews were conducted with nursing directors (n = 12) in Queensland Australia. Five main themes were identified: relationships with universities; clinical placement preparation and support; workplace culture; facilitators and preceptors; and practical student learning. Genuine collaboration between the two organisations was considered crucial for delivering a quality programme and providing the required support for students. Transformative leadership could inform this collaboration by promoting acknowledgement of and respect for differences.     

Peer supervision: an experimental scheme for nurse lecturers

This paper reports on the implementation of a scheme of peer supervision in a team of mental health nursing lecturers working within a university setting. The rationale for the introduction of this scheme was the implementation of clinical supervision in nursing nationally and the role nurse education can play in this. Supervision is advocated as a way of providing education, support and quality checks for lecturers involved in supervising students. The peer supervision scheme is described and the experience of the lecturers involved discussed. The authors stress the value of this innovation to their professional lives and promote it as a good way of contributing to the implementation of clinical supervision in mental health nursing.     

Stress and burnout in forensic mental health nursing: a literature review

Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training.     

Cost and resource implications of clinical supervision in nursing: an Australian perspective

AIM: The aim of this article was to explore the resource and management issues in introducing and maintaining a clinical supervision programme for nurses. BACKGROUND: A number of federal, state and non-governmental agency reports have recently indicted the quality of present-day mental health service provision in Australia. Clinical supervision in nursing has been widely embraced in many parts of the developed world, as a positive contribution to the clinical governance agenda, but remains largely underdeveloped in Australia. METHOD: Using data derived from several empirical clinical supervision research studies conducted in mental health nursing settings, preliminary financial modelling has provided new information for Nurse Managers, about the material implications of implementing clinical supervision. FINDINGS AND CONCLUSIONS: It is suggested that, on average, the cost of giving peer group one-to-one supervision to any nurse represented about 1% of an annual salary. When interpreted as a vanishingly small cap on clinical nursing practice necessary to reap demonstrable benefits, it behoves Nurse Managers to comprehend clinical supervision as bona fide nursing work, not an activity which is separate from nursing work.     

CLINICAL SUPERVISION OF NURSES WORKING WITH PATIENTS WITH BORDERLINE PERSONALITY DISORDER

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.     

Clinical supervision of nurses working with patients with borderline personality disorder

Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (Pesut & Herman, 1999). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.     

More Satisfying Than Factory Work: An Analysis of Mental Health Nursing Using a Print Media Archive

The move towards comprehensive nurse training in Australia thirty years ago continues to trouble many of its mental health nurses. It has been viewed as a failure by many and the profession has been judged by some commentators to have lost its preparedness for specialist care. Discourse put forward to support this negative evaluation usually centres on the recruitment of mental health nurses and a limited interest among student nurses to undertake mental health nursing because of their negative opinions towards it. Emerging from a larger ethnographic research project focused on mental health nursing practice in Australia, this article presents an analysis of the profession's current circumstances using historical print media. As we move further from the era of direct entry, specialist training, the article notes the development of assumptions within the profession. These include the idea that mental health nurses received better training in direct entry, specialist programs, and therefore were better prepared for their specialist roles. The article puts forward a critique that challenges this. The article argues the most profound change faced by the profession is the erosion of the mental health nursing identity in Australia. The loss of the stand-alone hospital system, direct entry specialist training, and specialist professional registration have left mental health nursing with a growing uncertainty about itself as the profession evolves into its (mostly) post-mental institution world. At a time when the specialty of mental health nursing is experiencing serious staff shortages throughout the developed world, the article points to the importance of using historical sources to contextualize our present circumstances.     

Establishing Clinical Supervision in Acute Mental Health Inpatient Units: Acknowledging the Challenges

After decades of discussion about clinical supervision and mental health nursing, the reality is that many acute mental health inpatient settings continue to struggle with the notion of clinical supervision and the implementation process. In this article we delineate the key elements of clinical supervision, explore practical and dynamic difficulties associated with clinical supervision and question whether too much is being asked of this one process, especially in acute inpatient settings. For many mental health nurses, existing practices offer many of the purported benefits of clinical supervision. Ultimately, unless clinical supervision is better understood and implemented effectively, it is unlikely to meet expectations. Clinical supervision should ultimately be defined by the nurses participating in it. This article contributes to current discussions regarding the purpose of clinical supervision, the realities of its implementation, and in particular considers the role of clinical supervision relative to existing professional support opportunities.     

The use of clinical supervision in secure environments

It is probably still fair to say that clinical supervision is not widely implemented throughout the nursing profession. Indeed, Butterworth (1998) has implied that the notion that clinical supervision is widespread in mental health nursing is an assumption. This article draws upon the findings of two recent studies that examine the availability and acceptance of clinical supervision in forensic mental health settings. The findings indicate that there is a low level of acceptance of clinical supervision both within the prison service and also in forensic settings. Following an exposition of the findings, this article will discuss some of the practical difficulties encountered in the systematic implementation of clinical supervision across this professional group who work within conditions that test their professional resilience.     

Realities of Mental Health Nursing Practice in Rural Australia

Mental health nursing as a distinct speciality has been in decline in New South Wales (NSW), Australia, for two decades. Arguably, this decline has worsened both consumer outcomes and the workplace experiences of mental health nurses. This article reports on a study designed to ascertain the nature of contemporary mental health nursing practice in New South Wales. The study utilised focus group research methodology, with participants recounting the realities of their day-to-day professional practice and perceptions of their professional identity. The findings indicate a contracting, if not moribund, profession; a decrease in the value attached to mental health nursing; and a pattern of persistent underfunding by successive governments of mental health services. An analysis of present and historical trends reveals there is a pressing need for a restructure and re-formation of mental health nursing in rural areas. This article links the shortage of mental health nurses in NSW to the closure of the mental health nursing register, a shift to comprehensive/generalist nurse education models, a perceived lack of nurses’ professional standing, and natural attrition without suitably qualified replacements. Mental health nurses in this study perceived that they were not valued by other health professionals or by their own managers. Participants in this study reported mental health nursing in rural areas was an unattractive career choice. These findings are important to the understanding of recruitment and retention issues in rural mental health nursing in Australia.     

Australian Bachelor of Midwifery students' mental health literacy: An exploratory study

Many pregnant and post-partum women experience mental health problems, but midwives are frequently ill-equipped to provide support. The purpose of this study, conducted in Melbourne, Australia, was to examine first-year Bachelor of Midwifery students' mental health literacy about post-partum women with schizophrenia, using the vignette of "Mary". A non-probability sample of 38 commencing students was used. The results showed that the students had a mainly lay person-informed conceptualization of mental health interventions for post-partum women. They acknowledged that Mary had a mental health problem that might have a more favorable outcome with professional support, but this agreement did not extend to their understanding of the consequences of the failure to receive professional help. They believed that negative outcomes were less likely and positive outcomes were just as likely for Mary than for others in the community. The findings highlight the need for mental health theory and clinical subjects to be incorporated in midwifery curricula.     

“I Just Had No Idea What It Was Like to Be in Prison and What Might Be Helpful”: Educator and Learner Views on Clinical Placements in Correctional Health

Abstract

Phenomenon: Correctional health services can provide quality learning experiences for medical students and graduate medical trainees, including through motivating learners to work with people involved with the justice system, and promoting understanding of the social determinants of health. Approach: We conducted 38 semi-structured interviews to examine the views of learners and educators on how to promote high quality clinical learning in correctional settings, with a focus on the Australian context. Participants included medical students; general practitioners who had undertaken graduate trainee placements; clinical staff involved in teaching and clinical supervision; and graduate program medical educators and university teachers from Australia, New Zealand, and Canada. Data were analyzed thematically. Findings: Clinical placements in correctional settings provided learning about the health of people involved in the justice system, but also beneficial clinical learning for working with a wide range of patients with complex health needs. Valued learnings included managing complex consultations, mental health and substance use disorders, and overcoming anxiety related to interacting with people in prison. Learner concerns included limited patient contact time, apprehension prior to placements, and stress related to experiences during the placements. This apprehension and stress could be mitigated by orientation and debriefing, and by appreciating healthcare professionals in correctional settings as advocates for their patients. Clinical supervision was perceived to be demanding in this context. Independent patient interaction was not usually possible for students and there could be short windows of time in which to provide direct patient care, making pauses for teaching difficult. Insights: Clinical placements in correctional health services provide experiential learning of direct relevance to medical student, and potentially to general practice trainee, curricula which is valuable even when learners do not have particular interest in correctional health. Furthermore, these placements may increase the capacity of the medical workforce to provide skilled care to other underserved populations. High quality learner and clinical supervisor experiences, and program scale and sustainability, require enhanced learning support systems through partnerships between correctional health services and education institutions. Required supports for learners include orientation to security arrangements, debriefing sessions which assist learners to distill their learning and to reflect on challenging experiences, and alternative learning opportunities for when direct patient consultations are not accessible. Supervisor teaching supports include shared teaching approaches in the correctional health clinics and added student support from university-based staff.     

Recognizing the talent within: preparing clinicians for a role in professional development

BACKGROUND: Ongoing professional development is recognized as crucial to the psychiatric and mental health nursing profession; however, implementing effective professional development programs has proved problematic. The Centre for Psychiatric Nursing Research and Practice in Victoria, Australia, developed a clinician-trainer course to overcome some of the identified problems. METHOD: An evaluation was conducted to measure participant satisfaction with the program. RESULTS: The initial evaluation suggests the course delivery and content were considered useful and relevant to participants, although areas for improvement were identified. CONCLUSION: The model developed is potentially effective but a longitudinal evaluation is required to determine the impact of the course on the implementation of professional development in the clinical domain.     

A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision

Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n = 601) and Area Health Services (n = 17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle-aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.     

An examination of the last 10 years of mental health nursing

This article offers an examination of the mental health nursing articles published in the British Journal of Nursing during the last 10 years, and a commentary on how these reflect developments within this specialism. It identifies a number of clinical and professional issues, which have emerged over the last decade, including: community care; concerns over the quality of acute inpatient services; clinical supervision; and the integration of schools of nursing into higher education. Finally, the article identifies some clinical areas which it suggests warrant attention in the next decade such as child and adolescent mental health and mental health care for older people.     

Exploratory study of mental health consultation-liaison nursing in Australia: Part 1. Demographics and role characteristics

Mental health nursing roles in Consultation-Liaison (CL) psychiatry and emergency departments are rapidly developing within Australia since the mainstreaming of mental health services within the general health-care system. Anecdotal evidence suggests that many of these positions have been initiated and developed in relative isolation and with little formalized support. Consequently, a comprehensive understanding of these roles and the nurses who occupy them is limited. A survey was developed and distributed to gather information on CL nurses in Australia. The survey was aimed at CL nurses working in a range of settings and included questions relating to demographics, qualifications, experience, clinical practice, organizational structure, education, clinical supervision, education and training and work satisfaction. This, the first of a two-part paper, will present the key findings relating to demographics and characteristics of the role. Overall, the findings demonstrated that the CL nurses who responded to the survey (n = 56) were experienced psychiatric/mental health nurses working primarily in general hospital wards and/or emergency departments; receive requests for consultation from a range of health professionals but predominantly nurses; provide education to a range of staff groups; and use a range of titles to identify their role.     

Progression of the mental health nurse practitioner role in Australia

The guiding principle of health care is to serve the needs of the public. Healthcare services are therefore required to be increasingly flexible and open to new approaches to meet changing demands. They must also adjust and expand as new challenges are presented. Public awareness of mental health issues and the current demands placed on health services for access to affordable and appropriate mental health care have never been so great. The introduction of nurse practitioners (NPs) in Australia is a proud and long-anticipated moment for the discipline of nursing. However, a major challenge for the introduction of NPs in Australia will be to reassure medical colleagues, allied health professionals and the public that NPs are able to deliver high-quality primary care. This paper elaborates on the progress of the mental health NP role in Australia. Attention is centred on the characteristics the mental health NP role, the maintenance of professional competency to practise at an advanced clinical level, and the prospects and potential significance of NPs for mental health nursing practice. The nurse-led clinic, implemented through the process of consultation and systematic evaluation, is identified as an avenue for the extension of mental health NP practice in the delivery of autonomous primary care.