Treading lightly: spirituality issues in mental health nursing

ABSTRACT: Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, ‘What does spirituality mean for people with a mental illness?’ Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life‐sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients’ spiritual needs in the context of their health concerns.     

Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study

The aim of this case study was to describe and analyse the basic pre-conditions for an intervention programme focusing upon mental health promotion and prevention of depression in an elderly community group and to discuss the psychiatric nurse's community-oriented health promotion work. The intervention programme, which was led by a psychiatric nurse, was built on intersectorial co-operation between public and voluntary organizations, development of social networks to promote social support, and target group participation. The nurse's function in the community-oriented work was to act at the individual, group and society level, as well as to mobilize resources among individuals and organizations, in order to create a favourable interaction, resulting in health and empowerment for the individual. Pre-conditions for leading this work were: knowledge of health and mental all health among the elderly, investigation methodology, knowledge about the local society, as well as pedagogical, supervisory and social competence.     

Myth of mental health nursing and the challenge of recovery

Although the concept of 'mental health nursing' has grown in popularity over the past 35 years, it remains a myth. People believe that they know what it is and value it highly, but cannot describe or define it other than in vague terms. This paper briefly charts the rise of 'mental health nursing', emphasizing its political implications, and in particular, the drive towards an embrace of a person-centred, recovery-focused approach to care. If nurses are to realize such ambitions, they must resolve their historical association with psychiatric nursing. The concept of the 'mental health nurse' might signal the emergence of a new vision for human services, but might also signal the need for 'mental health nurses' to negotiate a formal separation from the traditional 'psychiatric' family.     

Problem based learning in mental health nursing: the students' experience

Problem based learning (PBL) is well established within the field of health-care education for professionals worldwide, although little has been done to explore the experiences of students undertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL, educationalists in mental health might be reluctant to view it as an option in curricula design. This U.K. study examined the experiences of pre-registration post-graduate mental health student nurses undertaking a 2-year educational course in which all teaching and assessment followed a PBL philosophy. Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed by applying a constant comparative method. The analysis of the data uncovered the following broad themes: 'moves to autonomy, 'surviving the groups' and 'the impact of PBL'. The findings show that participants had mainly positive experiences and gained a range of study and interpersonal skills central to mental health nursing. Participants described initial anxieties resulting from engagement in PBL. However, they increasingly gained confidence in this approach, exercising increasing control over the PBL process. Despite this increased autonomy, participants continued to value the input of skilled facilitators. A recurring issue centred on the potential for interpersonal conflict within the student group and its impact on their learning. It is suggested that more research is needed examining the use of PBL in mental health nursing.     

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.     

Quality and substance of educational strategies for mental health in undergraduate nursing curricula

In Australia, there is a workforce shortage of nurses in the mental health sector, and it is essential that universities play a part in the recruitment of nurses to work in this area. In this article, we present a literature review of educational strategies for mental health in undergraduate nursing curricula and how these align with the recommendations of the Mental Health Nurse Education Task Force. We reviewed quantitative and qualitative research from 2005 to 2012. Twelve studies from Australia and elsewhere of different types of educational courses and strategies were included for this review. The key topics identified were in relation to a general overview of programmes outlining the content and outcomes, clinical placement strategies, involvement of consumers and mental health nurses in curriculum delivery and oversight, e‐learning strategies, and implementation of mental health majors. Finally, limitations with considering the literature as a whole were highlighted, and recommendations made for future changes and research.     

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.     

Mixed methods research in mental health nursing

Mixed methods research is becoming more widely used in order to answer research questions and to investigate research problems in mental health and psychiatric nursing. However, two separate literature searches, one in Scotland and one in the USA, revealed that few mental health nursing studies identified mixed methods research in their titles. Many studies used the term 'embedded' but few studies identified in the literature were mixed methods embedded studies. The history, philosophical underpinnings, definition, types of mixed methods research and associated pragmatism are discussed, as well as the need for mixed methods research. Examples of mental health nursing mixed methods research are used to illustrate the different types of mixed methods: convergent parallel, embedded, explanatory and exploratory in their sequential and concurrent combinations. Implementing mixed methods research is also discussed briefly and the problem of identifying mixed methods research in mental and psychiatric nursing are discussed with some possible solutions to the problem proposed.     

Hope and interpersonal psychiatric/mental health nursing: a systematic review of the literature--part two

This is the second of a two-part article which reports on a systematic review of the literature that focuses on hope (inspiring hope) within interpersonal (counselling) focused psychiatric/mental health (P/MH) nursing. Part one focused on the first three substantive areas, whereas this article focuses on the remaining areas and the discussion points arising out of the review. The discussion points arising are: (1) despite the increasing attention to hope over the last three decades, there remains a distinct paucity of research pertaining to P/MH nurses and hope, hoping and hopelessness; (2) the research that has been undertaken thus far lacks a cumulative, sequential progressive focus and has more of a sporadic, disparate look to it; (3) there is a dearth of empirical work to underpin specific interventions; (4) this relative absence of empirical work means that P/MH nurses often have to look to allied and/or related disciplines for their hope-related research; (5) there appears to be a disparity between the alleged importance of hope and the subsequent research activity; and (6) the research that does exist across different substantive areas appears to indicate that there might be common or shared basic psychosocial processes of hope inspiration, and thus the probability of a formal grounded theory; and this allows for idiosyncratic psychosocial processes for each substantive area. As a result of this review, the authors tentatively suggest that the inspiration of hope in P/MH nursing is grounded in the relationship established between nurse and person in need of hope, an emerging empirical finding that has obvious congruence and synchronicity with the philosophy and theory of a Peplauvian-based approach to P/MH nursing.     

Hope and interpersonal psychiatric/mental health nursing: a systematic review of the literature--part one

Psychiatric/mental health (P/MH) nursing is inherently an interpersonal endeavour; one that includes a broad range of 'helping activities'. The interpersonal activities and skills are enshrined in our underpinning philosophy, explored and learned in our curricula (all around the world) and enacted in our everyday clinical practice. Within this interpersonal context and framework, it is heartening to see that understated, abstract and yet-lasting concepts such as hope are gaining more acknowledgement, recognition and subsequently attention. While it is recognized that hope in mental health care is increasingly becoming the focal point of disciplined inquiry, the authors believe it is perhaps necessary and timely to re-examine these two concepts, namely: interpersonal P/MH nursing and hope/inspiring hope in people with mental health problems. Accordingly, this two-part article reports on a systematic review of the literature that focuses on hope (inspiring hope) within interpersonal (counselling) focused P/MH nursing. Part one focuses on the method used and the results, indicating that a total of 57 articles were included in the review: 39 were categorized as empirical studies involving either a quantitative or qualitative methodological design, and 18 were considered theoretical/clinical/review articles. Though not a product of an empirical investigation per se, it was clear that many of the articles shared and covered common ground. Thus, these were arranged into six 'loose' thematic groupings. The first three of these areas, schizophrenia, suicidality and depression form the remainder of part one of this article, and the remaining areas are included in part two.     

Making a spectacle of herself: Reading community mental health nursing assessments

The metaphor of mapping is used in this paper to examine the discursive construction of women whose nudity in public places (making a spectacle of herself) provides dilemmas for community mental health nurses required to make assessments of these women's ability to function in die community. Excerpts from stories provided by die nurses are used to demonstrate the complexity of die decision-making processes and the limits to die choices they perceive they can make.     

Exploratory study of mental health consultation-liaison nursing in Australia: Part 2. Preparation, support and role satisfaction

Mental health Consultation-Liaison (CL) nursing continues to develop and gain recognition as a subspecialty of mental health nursing. CL roles are particularly important given the significant number of people experiencing mental illness and other mental health problems within the general health-care settings. However, despite the potential value of these roles, the literature provides little information about these roles and about the nurses who work in these roles. This is the second part of a two-part paper describing a survey of CL nurses in Australia. Part 1 describes demographic data and characteristics of the CL role. Part 2 provides an exploration of the following factors: educational preparation, support, and work satisfaction. The findings identified specific educational needs in preparation and ongoing support for the role. However, overall the participants expressed a high level of satisfaction with their work. Given the current recruitment problems in mental health nursing, the promotion of the CL nursing role might enhance a more positive view of this branch of nursing.     

Evaluating the impact of a preceptorship course on mental health nursing practice

The crisis in the recruitment of nursing graduates into the mental health nursing field dictates the need for assertive and innovative strategies to promote the positive aspects of this field of nursing. A positive clinical experience has been identified as one of the most important determinants of nursing students' attitudes towards mental health nursing. The Centre for Psychiatric Nursing Research and Practice implemented the course "Preceptorship in Psychiatric Nursing" as a means to increase the skill level within and interest towards the preceptorship role in clinical practice. This paper presents an evaluation of courses conducted between 2000 and 2002. The findings suggest that participants (n = 150) were highly satisfied with the content and delivery of the course, and that it is likely to affect their attitude towards and fulfillment of the preceptorship role.     

A systematic review of the psychiatric/mental health nursing research literature 1982–1992

The purpose of this study was to assess the quality of quantitative psychiatric/mental health nursing research articles published in English between 1982 and 1992, worldwide. Criteria for selection of articles included nurse authorship or co-authorship, use of a quantitative design and pertinence to an aspect of the nursing process with psychiatric/mental health patients. One hundred and ninety-four articles met these criteria. The quality of each article was assessed by two nurse experts using Duffy's Research Appraisal Checklist (RAC). Forty-six point nine per cent of the articles were rated as superior, 50% as average and 3.1% as below average. Other findings identified journals that published research articles, countries in which research was completed, applicability of funding and qualifications of the authors. The major implications of this study are that nurses can be directed to superior articles; more publication of research by nurse authors is warranted, research is being completed with little financial support, highly rated research publications tend to get funding and editorial policies affect the quality of publication.     

Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.