Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person. Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person‐centred, integrated physical and mental health care. Thus, the aim of this study was to describe mental health nurses’ experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness. Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse’s experiences. Analysis of the interviews generated three categories: (i) to have a health promotion focus in every encounter, (ii) to support with each person’s unique prerequisites in mind and (iii) to take responsibility for health promotion in every level of the organization. The results show the importance of a health promotion focus that permeates the entire organization of mental health care. Shared responsibility for health and health promotion activities should exist at all levels: in the person‐centred care in the relation with the patient, embedded in a joint vision within the working unit, and in decisions at management level.     

Neuropharmacology and mental health nurse prescribers

Aims and objectives. To outline the development and content of a ‘top‐up’ neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Background. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid‐1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Methods. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. Results. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they prescribe coupled with the information they provide to service users can be improved as a result of specific educational support. It would appear that adopting a prescribing dimension to one's role requires nurses to revisit a number of skills that are integral to the work of the mental health nurse, e.g. good communication, establishing empathy, listening to what clients say, responding to what is required and involving clients in their own care. Conclusion. Mental health nurses from one particular Trust in the West Midlands were provided with a ‘top‐up’ course in neuropharmacology and, although they found this challenging, ultimately they found this to be helpful. As nurse prescribing is ‘rolled out’ to other nursing specialities it is important that local Trusts and Workforce Development Directorates maintain a dialogue about nurse prescriber training to ensure that nurse prescribers receive the appropriate time and support for their ongoing Continued Professional Development. Relevance to clinical practice. As increasing numbers of nurses from different specialities qualify as nurse prescribers it is vital that they are supported by their employing organizations and given the opportunity to maintain their competency and confidence in their prescribing practice.     

Nurses’ perceptions of environmental pressures in relation to their occupational stress

Aim. The aim of this paper was to explore nurses’ stress experiences of working under the current health care system in Tawain (the context) using a qualitative approach. Background. Although most global health care institutions have been changing in response to the economic contraction, there is a deficit of information in understanding the changes of the ecology of the health care system in Taiwan from nurses’ perspectives. Design. Grounded theory. Methods. A grounded theory approach was used to collect the data from a sample of 28 critical care nurses from seven hospitals in Taiwan. Data were analysed using a multi‐step analytic procedure, based on the approaches of Glaser, Chesler and Strauss and Corbin. Findings. The health care system changes were found to increase critical care nurses’ occupational stress and work dilemmas. For the purpose of this study, the two categories that emerged in the ‘context’ component of the paradigm model are investigated. They were: hospital reorganisation and cultural burden of the nurse’s role. Conclusions. The findings indicated that hospital organisational changes and people’s own belief of the nurse’s role were recognised as the environmental pressures which increase critical care nurses’ occupational stress. Cultural background may play an important role in influencing nurses’ work atmosphere and their ways of being seen. Relevance to clinical practice. Critical care nurses perceived that their hospitals were under huge demands due to the changes in health care policies; these had subsequently caused them a high level of occupational stress. Beliefs in the embedded culture were also identified as significant factors in causing nurses’ role stress. These findings could enhance the knowledge of critical care nurses’ occupational stress and identify the most appropriate stress management skills available to them. Findings will add to the understanding of Chinese nurses who may work globally.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

Cancer nurses narrating after conversations with cancer outpatients: how do nurses’ roles and patients’ perspectives appear in the nurses’ narratives?

Aim: The aim of this study was to contribute to knowledge of nursing practice in the cancer care field by exploring cancer nurses’ perceptions of conversations with cancer outpatients. Background: Current practice at cancer outpatient clinics in Norway is that nurses have planned conversations with patients and relatives as a follow‐up after patient–physician conversations about assessment and medical treatment. Little is known about nurses’ experiences of conversations in the ambulatory context. This study reports the experiences of initial patient–nurse consultations. Data were collected in 2006–2007. Design: A qualitative phenomenological hermeneutic study was performed. A purposive sample of 12 cancer nurses was selected for qualitative interviews where nurses were narrating about conversation experiences. Significance and meaning of conversation experiences were analysed within a hermeneutic perspective, inspired by Ricoeur. Anonymity and voluntary participation procedures were followed. Ethical approval for the study was obtained from the Regional Committee for Medical Research Ethics of the region. Findings: There were plots of nurses experiencing conversations as hard work, routine work or artistry. The nurses’ conceptualizations of their roles as an information provider, or patient‐centred caring role were rooted in rules of the nursing community or in humanistic caring ethics. Differences of nurses’ perceptions and experiences of conversations are explained by different attitudes and role appreciations. Conclusion: Cancer nurses’ role appreciation and meaning horizons are guiding their perceptions of patient–nurse communication. Feeling free to act in interplay with patients’ voices, the patients’ perspectives become foreground. There is an educational challenge here in terms of developing methods to help nurses to discover how their mental work and meaning horizons guide conversational practice.     

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system’s success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: ‘providing environmental prerequisites for safe nursing practice’, ‘uniting and integrating health-care providers’, and ‘creating an atmosphere of safe care’. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses’ working conditions, develop the nurses’ practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers’ professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.     

Student beliefs about their practice within a non-traditional mental health clinical placement

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely ‘who's who’, ‘clinical contrast’ and ‘recreation as practice’. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.     

The role of the inpatient mental health nurse in facilitating patient adherence to medication regimes

Non-adherence to antipsychotic medication is associated with relapse of psychiatric symptoms and readmission to inpatient mental health services. The important role of the mental health nurse in facilitating adherence has been acknowledged, however, there has been little exploration of how nurses themselves perceive this aspect of their role. A qualitative study was conducted to explore the perceptions of mental health nurses employed in inpatient settings regarding their role in facilitating medication adherence. Focus groups were conducted with 22 nurses from three inpatient settings in metropolitan Melbourne. The main themes to emerge from the data were: nurses' responsibilities in medication management; ways in which nurses are educated about antipsychotic medication; barriers to the provision of medication management, and barriers to effective patient adherence. Recommendations for more effective practice are discussed.     

The content of advocacy in procedural pain care – patients’ and nurses’ perspectives

Title. The content of advocacy in procedural pain care ‐ patient’ and nurses’ Perspectives. Aim. This paper is a report of an exploration of the content of nursing advocacy from the point of view of patients and nurses in the context of procedural pain care. Background. Nursing advocacy is every nurse’s professional duty, grounded in patients’ legal and moral rights. Nevertheless, earlier research has approached advocacy as a whistle‐blowing event from the nurse’s perspective. Method. This cross‐sectional study was conducted with a cluster sample of otolaryngology patients (n = 405) and nurses (n = 118) in 11 hospital units in Finland during 2007. The data were collected using an instrument measuring the content of advocacy and analysed statistically. Results. Advocacy in procedural pain care is a process which takes place in the patient–nurse relationship through role identification in decision‐making about pain care. This prompts counselling and responding activities, which in turn lead to some degree of empowerment on the part of both patient and nurse. However, advocacy is partly dependent on the nurse’s own role identification: in the context of pain care it seems that the nurse’s pain care skills and influence over pain care plans are important factors in the decision to advocate or not. At best, patients have some role in decision‐making about their care; at worst, they are subjected to paternalism. Conclusions. Advocacy is an integral part of the nursing care process. It is important that this key ethical aspect of professional nursing is discussed in nursing education and systematically applied in nursing practice through on‐the‐job training, feedback and collaboration.     

Nurses’ clinical reasoning concerning management of peripheral venous cannulae

Aim. The aim was to describe nurses’ clinical reasoning regarding peripheral venous cannulae management by focusing on the clinical information and circumstances considered during the decision‐making process. Background. On every shift nurses make several decisions, among others concerning the management of peripheral venous cannulae. Thrombophlebitis is a common complication associated with its use, although more severe complications can arise. There are clinical practice guidelines within the area, but they are not always adhered to. Previous studies have examined decisions related to the management of peripheral venous cannulae, but did not include observations in a naturalistic setting. Design. A qualitative study combining observations and interviews. Methods. Participant observation facilitated open interviews about the clinical reasoning behind decision‐making in observed situations, as well as semi‐structured interviews regarding clinical reasoning about the general management of peripheral venous cannulae. Transcribed interview texts were analysed with content analysis. Results. Three main categories describe clinical information and circumstances: the individual patient situation, the nurse’s work situation and experience of peripheral venous cannulae management. The overall theme of the interview texts was that the clinical reasoning was a balancing act between minimising patient discomfort and preventing complications from the peripheral venous cannulae. Conclusions. At all times the patients’ well‐being was considered, but the ways the nurses approached this differed depending on how they considered clinical information in the individual patient situation, circumstances in their own work situation and their experience of peripheral venous cannulae management. Relevance to clinical practice. Knowledge of the clinical information and circumstances considered in naturalistic settings, is valuable when implementing and adjusting clinical practice guidelines to local settings. This knowledge is also useful in nursing education as student nurses’ and nurses’ ability to balance between preventing complications and avoiding discomfort is important for enhancing patient care.     

Becoming a mental health nurse: a qualitative study [Part-2

This is a two-part commentary reporting on a qualitative piece of research concerning the experiences of student nurses and the processes involved in becoming a mental health nurse (Morrissey 2003). It is really an attempt to describe, connect, discuss, and understand the process of becoming a mental health nurse in theory and practice using a qualitative approach (Holliday, 2002; Field & Morse, 1994; Hammersley, 1992; Burnard, 1991; Glaser & Strauss, 1967;). A questionnaire and semi-structured interviews were employed to examine the student nurses experiences prior to and one year into their first staff nurse post. The term psychiatric nurse and mental health nurse continue to be used interchangeably in practice and in written texts. However for simplicity the term mental health nurse is used for this text.     

Psychiatric-mental health head nurse management concerns

Psychiatric-mental health head nurses supervise and direct patient care, and therefore, possess a critical, front-line perspective of nursing practice problems. This article explores this perspective by interviewing four head nurses about patient care, staffing, and organizational management concerns. Interestingly, some of the findings of the study, such as head nurse concerns regarding retaining, recruiting, and motivating staff, and increasing patient acuity, already have been supported in the general nursing literature. Other concerns, including the need to clarify the role of the nurse and to define areas of responsibility with other mental health professionals, seem unique to mental health nursing.     

Mental health nursing: Daring to be different,special and leading recovery‐focused care?

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.     

Becoming a mental health nurse: a qualitative study [Part-1

This is a two part article reporting on a qualitative piece of research on the experiences of student nurses in order to consider the process involved in becoming a mental health nurse (Morrissey 2003). It is really an attempt to describe, connect, discuss, and understand the process of becoming a mental health nurse in theory and practice using a qualitative approach (Holliday, 2002; Field & Morse, 1994; Hammersley, 1992; Burnard, 1991; Glaser & Strauss, 1967;). A questionnaire and semi-structured interviews were employed to examine the student nurses experiences prior to and one year into their first staff nurse post. The term psychiatric nurse and mental health nurse continue to be used interchangeably in practice and in written texts. However for simplicity the term mental health nurse is used for this text.     

‘There's more to a person than what's in front of you’: Nursing students’ experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care.     

Contextual Barriers to the Successful Implementation of Family-Centered Practice in Mental Health Care: A Hong Kong Study

This article presents findings from an exploratory study to identify nurses' perspectives on factors that hinder the implementation of family-centered practice in mental health settings in Hong Kong. Thirty-four nurses participated in the study by completing the pre- and post-questionnaires. Ten nurses were invited to participate in focus group and case interviews. The analysis identified knowledge–practice gap, role of psychiatric nurses, professional identity of psychiatric nurses, and management support as negatively affecting the nurses in implementing a family-centered approach to mental health care. Suggestions about facilitating the implementation of the family-centered approach into clinical practice are offered.     

Mental health nurses’ attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery‐focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses’ attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single‐group pre‐post‐test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016–2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi‐media education handover package. We found that training had a significant influence on mental health nurses’ attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well‐planned education can influence nurses’ attitudes about involving consumers in the nursing handover processes.