Transition to mental health nursing through specialist graduate nurse programs in mental health: a review of the literature

Specialist graduate nurse programs (GNPs) in psychiatric/mental health nursing have been widely implemented across public healthcare services throughout Victoria, Australia. Broadly, these programs aim to assist newly graduated nurses during the transition from nursing student to registered nurse. This paper presents a review of the literature relevant to GNPs; specifically focusing on graduate transition. An adequate orientation to clinical areas and ongoing support throughout the transition process were identified as significant determinants of new graduates" satisfaction with the initial post-qualification period. However, the literature suggests that the inadequacy of psychiatric/mental health nursing content in undergraduate nursing courses creates additional difficulties within this specialty area of practice. Moreover, the current literature review emphasises the need for further research to evaluate the effectiveness of GNPs for nursing in general and for psychiatric/mental health nursing in particular.     

Round the Bend: A Brief History of Mental Health Nursing in Victoria,Australia 1848 to 1950's

This paper presents a history of mental health nursing in Victoria, Australia from 1848 to the 1950's, or the asylum years to the era of the mental hospital. The research for this historical overview was conducted as part of a literature review for a mental health nursing doctoral thesis, which included an account of the evolution of the profession from asylum attendant to the present time. The literature reviewed for this project revealed a distinct lack of a coherent, chronological account of the historical development of mental health nursing in Victoria, and this paper seeks to address that knowledge gap.     

Psychiatric/Mental health nursing education in Victoria, Australia: barriers to specialization

The introduction of undergraduate comprehensive nursing education in Victoria, Australia, during the 1990s has resulted in significant changes in undergraduate preparation for psychiatric/mental health nursing. Comprehensive programs became charged with the responsibility of preparing graduates to provide care for people experiencing a mental illness across a broad range of health-care settings, as well as providing a pathway for graduates with an interest in specialist practice in this field. The aim of this article is to clearly articulate the issues associated with psychiatric/mental health nursing education at the undergraduate level, including prevalence of mental illness, the inadequacy of psychiatric/mental health nursing theory and practice at undergraduate level, the negative attitudes of students toward this field of practice, and the subsequent failure of nursing education and practice initiatives to provide a clear mechanism for specialization in this important area of nursing practice. Throughout the article, the distinction between generalist and specialist preparation is argued and accompanied by a call for nursing education to recognize and address the issues associated with both domains.     

Mental health triage: towards a model for nursing practice

Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.     

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.     

The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction

There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.     

The Centre for Psychiatric Nursing Research and Practice: an innovative approach to enhancing clinical nursing research in the psychiatric/mental health field

The available nursing literature suggests that nurses engaged in clinical practice hold a somewhat ambivalent attitude towards nursing research. On the one hand, its value is acknowledged, but on the other, its relevance to clinical practice is questioned. This situation poses a significant barrier to the involvement of clinicians in research and the utilisation of findings in practice. This paper describes the implementation of a model to facilitate the development of a systematic research approach at the Centre for Psychiatric Nursing Research and Practice in Victoria, Australia. The development of strong relationships between the Centre and the clinical field was considered crucial in determining the success of this initiative. The introduction of a number of programs to foster the conduct and utilisation of clinical research are described, including: The Nursing Clinical Development Unit Program, the Clinical Research Fellowship Program, clinical research projects, the Collaborative Psychiatric Nursing Conference and strategies to encourage the dissemination of research information. In combination, these initiatives are expected to contribute to a systematic approach to engendering a research culture within psychiatric nursing in Victoria, Australia.     

THE CENTRE FOR PSYCHIATRIC NURSING RESEARCH AND PRACTICE: AN INNOVATIVE APPROACH TO ENHANCING CLINICAL NURSING RESEARCH IN THE PSYCHIATRIC/MENTAL HEALTH FIELD

The available nursing literature suggests that nurses engaged in clinical practice hold a somewhat ambivalent attitude towards nursing research. On the one hand, its value is acknowledged, but on the other, its relevance to clinical practice is questioned. This situation poses a significant barrier to the involvement of clinicians in research and the utilisation of findings in practice. This paper describes the implementation of a model to facilitate the development of a systematic research approach at the Centre for Psychiatric Nursing Research and Practice in Victoria, Australia. The development of strong relationships between the Centre and the clinical field was considered crucial in determining the success of this initiative. The introduction of a number of programs to foster the conduct and utilisation of clinical research are described, including: The Nursing Clinical Development Unit Program, the Clinical Research Fellowship Program, clinical research projects, the Collaborative Psychiatric Nursing Conference and strategies to encourage the dissemination of research information. In combination, these initiatives are expected to contribute to a systematic approach to engendering a research culture within psychiatric nursing in Victoria, Australia.     

Psychiatric nursing in Victoria, Australia: a profession in crisis

The introduction of the Nurses Act in 1993 resulted in the cessation of separate undergraduate education as preparation for psychiatric nursing practice in Victoria, Australia. The focus of this paper is to present the nature and implications of the current legislation in light of the relative size of the psychiatric component within Victorian courses and the relevant literature and research findings regarding the position of psychiatric nursing within comprehensive courses. The potential crisis faced by the psychiatric nursing profession in securing a viable workforce for the future will be highlighted.     

The Centre for Psychiatric Nursing Research and practice: promoting excellence in psychiatric nursing

The Centre for Psychiatric Nursing Research and Practice (CPNRP), is funded by the Department of Human Services Victoria, as an initiative to support psychiatric nurses throughout the State of Victoria. At the time of the CPNRPs inception in 1999, psychiatric nursing had been affected by widespread changes in the delivery of mental health services and nursing education in Victoria. The aim of this paper is to provide an overview of the development of the CPNRP and how this development reflected the significant issues of the time. The CPNRP introduced a number of programs and other initiatives in response to six primary issues: recruitment, retention, leadership, professional development, research: practice gap and communication.     

Influencing Undergraduate Nursing Students' Attitudes Toward Mental Health Nursing: Acknowledging the Role of Theory

Most research designed to explore undergraduate nursing students' attitudes towards mental health nursing tends to uphold clinical experience as the decisive factor, with much less attention paid to the theoretical component. This paper presents the findings of a state-wide study conducted with undergraduate nursing students in Victoria, Australia. A pre- and post-test design was used to measure students' attitudes toward people with a mental illness and toward mental health nursing and their sense of preparedness for mental health practice. A questionnaire was administered at two time points; the first time point was following completion of the mental health nursing theoretical component, and the second was following the completion of clinical experience. An additional scale was added at the second time point to evaluate students' opinions about their clinical placement. The findings indicated significantly different attitudes and opinions depending on the university students attended. The amount of theory undertaken in the course accounts for some, but not all, of this variance. However, generally the students taking courses with a larger theoretical component tended to demonstrate higher scores (suggestive of more favourable attitudes) on all of the subscales, and that these differences were sustained following the completion of the clinical placement. These findings suggest that the amount of theory students receive in mental health nursing may be more influential than the relevant literature suggests.     

Issues and challenges in international doctoral education in nursing

Education is a driving force in improving the health and welfare of communities globally. Doctoral education of nurses has been identified as a critical factor for provision of leadership in practice, scholarship, research, policy and education. Since the genesis of doctoral education in nursing in the USA in the 1930s, this movement has burgeoned to over 273 doctoral programs in over 30 countries globally. The present article seeks to identify the issues and challenges in nursing doctoral education globally, and those encountered by doctoral program graduates in meeting the challenges of contemporary health care systems. Information was derived from a comprehensive literature review. Electronic databases and the Internet, using the Google search engine, were searched using the key words "doctoral education"; "nursing"; "International Network for Doctoral Education in Nursing"; "global health"; "international research collaboration". Doctoral education has been a critical force in developing nurse leaders in education, management, policy and research domains. An absence of consensus in terminology and of accurate minimum data sets precludes comparison and debate across programs. The complexity and dynamism of contemporary globalized communities render significant challenges in the conduct of doctoral programs. Addressing funding issues and faculty shortages are key issues for doctoral programs, especially those in developing countries, to achieve an identity uniquely their own. These challenges can also afford considerable opportunities for discussion, debate and the formulation of innovative and collaborative solutions to advance nursing knowledge and scholarship. In spite of discrete differences between countries and regions, the similarities in the issues facing the development of doctoral programs internationally are more striking than the differences. The harnessing of a global collective to address these issues will likely serve to not only forge the future viability of doctoral education of nurses but to improve the health and well-being of communities. This paper proposes international collaborative strategies to address a number of the challenges identified.     

Consumer and carer participation in mental health care: the carer's perspective: part 1 - the importance of respect and collaboration

The role of family carers in the delivery of mental health services in Australia has become more than an advantage over not having this sort of participation. Increasingly the involvement of non-paid carers (family members and significant others) has been recognised as central to the smooth delivery of care and treatment. Notwithstanding this acknowledgment, there is very little discussion of carer participation in mental health care delivery within the literature. The limited research in this area suggests that carers recognize very little opportunity for genuine participation, even less than is available to consumers. This paper presents part 1 of the findings of an exploratory, qualitative study seeking an in-depth understanding of the attitudes of carers from rural Victoria, Australia toward opportunities for participation with specific emphasis on the role of psychiatric nurses in encouraging or discouraging participation. The themes of respect and communication will be described in this paper. These findings demonstrate the variable experiences of carers in their opportunities to participate and the important role nurses can assume in supporting both carers and consumers through this process.     

Clinical experience in mental health nursing: determining satisfaction and the influential factors

Clinical exposure to the mental health environment has been identified as a major factor in promoting a more favourable attitude towards mental health nursing. However, little attention has been devoted to measuring specific aspects of the clinical placement experience. This paper presents the findings of a survey of 703 undergraduate nursing students designed to measure satisfaction and identify factors influencing satisfaction (length and type of placement, time spent with a preceptor). A questionnaire was administered to undergraduate nursing students in Victoria, Australia, at the conclusion of their clinical experience in mental health. The findings demonstrate a high level of satisfaction, particularly in feeling welcomed, well oriented and supported, and opportunities for patient care. Students' views were influenced by the duration and type of placement and time spent with a preceptor. These findings provide valuable information about characteristics of a positive clinical experience that should be considered in structuring clinical placements in the mental health field.     

Twenty-five years of critical care nursing scholarship in Australia

BackgroundAustralian Critical Care has been published since 1988 and has been an important medium for the development of critical care nursing scholarship in Australia over 25 years.PurposeTo review scholarship in critical care nursing in Australia since 1988 and record its progress in the context of developments in nursing education and intensive and critical care practice.ApproachAustralian Critical Care issues since 1988 were reviewed, and abstracts from the Australian and New Zealand Annual Scientific Meeting on Intensive Care published in Australian Critical Care since the 1991 Meeting. Available evidence for the contribution of this body of scholarship to critical care nursing practice and patient care was considered.ResultsOriginal research reports and review articles have steadily increased from 1988 to 2012. The peak years for research publications were 2001, 2005 and 2012, and for reviews 2010 and 2011. Approximately 760 abstracts were presented at the Annual Scientific Meeting from 1991 to 2010; overall 24% were found lead to peer-reviewed publications, with an increase to 30% in recent years.SummaryOver 25 years, the scholarship of critical care nursing in Australia has evolved into an established area of disciplinary knowledge, based firmly in practice. Our discipline has witnessed the opportunity for PhD training, the introduction of professorial positions, a knowledge base built on original research and rigorous reviews, and sustainable dissemination. The challenges are to further strengthen this development, increase publication of research that is done, to demonstrate the influence on practice and to develop sustainable research funding.     

Employment through residency programs: a strategy to address the workforce crisis in psychiatric nursing

Australia, like most countries in the world, is facing a crisis regarding the recruitment and retention of nurses. This situation is particularly notable for psychiatric nursing, a specialty not generally popular among undergraduate nursing students. To date, the nursing literature has tended to identify the problem, with less attention to the exploration of possible solutions. The aim of this article is to explore the literature concerning residency programs for nursing students. Although limited, the literature suggests potential benefits to this program, including improvements in competency and confidence, resulting in reduced need for lengthy orientation for new graduates and overall improvements in recruitment and retention rates for psychiatric nurses. In conclusion, residency programs for undergraduate nursing students could provide a useful strategy to improve the image of psychiatric nursing and attract new graduates. Further research is required to assess the applicability of this model in Australia.     

The psychiatric consultation-liaison nurse: thriving in a general hospital setting

One outcome of mainstreaming of psychiatric services into the general health system is that nurses working in general hospitals now have increased contact with patients experiencing mental health problems. The literature suggests that general and comprehensive nurses do not believe they have the skills, confidence and knowledge to care adequately for patients in their care who have a mental health problems. The Psychiatric Consultation-Liaison Nurse (PCLN) can assist and educate general nurses in the care of patients with mental health problems who are receiving care in a medical/surgical setting. This study is based upon the findings of a Nurse Practitioner Pilot Study funded by the Department of Human Services (Victoria). In this paper the authors will present a brief overview of the role and model of practice of the PCLN, the means of referral, a profile of consultations and an overview of educational and policy development activity. The findings of the evaluation based on a combination of a Health Professional Satisfaction Survey and Focus Group Interviews will also be presented. The positive contribution of the PCLN to the confidence of nurses and how this might impact on patient outcomes will be highlighted. The value placed on the PCLN role by general hospital staff is evidence of psychiatric nursing not just surviving but thriving.     

Who wants to be a psychiatric nurse? Novice student nurses’ interest in psychiatric nursing

Available research findings suggest that nursing students do not regard psychiatric nursing as a desirable future career option. This paper addresses the results of a research project conducted by the author. This research addresses the relative popularity of psychiatric nursing in comparison to other nursing specialties, within Victoria, Australia. The research was conducted by use of a questionnaire in which commencing undergraduate nursing students were asked to rank nine areas of nursing specialty in order of preference and provide some explanation for their choices. The results indicate that psychiatric nursing emerges as the second least popular career choice for student nurses at this stage of their education.     

The importance of clinical experience for mental health nursing - part 2: relationships between undergraduate nursing students' attitudes, preparedness, and satisfaction

Clinical experience is consistently emphasized in research findings as the primary influence in encouraging more positive attitudes to mental health nursing. The available research, however, presents two major limitations. First, it does not measure the specific factors that might contribute to a positive clinical experience. Second, it does not consider the relationship between clinical experience and attitudes towards people experiencing a mental illness or towards mental health nursing. This is the second of a two-part paper presenting findings from a statewide survey of undergraduate nursing students in Victoria. A pre-/post-test design was used to measure the impact of clinical experience on the following subscales: (i) attitudes towards people experiencing a mental illness; (ii) attitudes toward mental health nursing; and (iii) preparedness for mental health practice. Subscale (iv) satisfaction with clinical experience was also measured in the post-test phase. The findings demonstrated an improvement on all three subscales in the post-test phase and a high level of satisfaction with clinical experience. Furthermore, a relationship between all four subscales was evident.