Leadership and management in mental health nursing

blegen n.e. & severinsson e. (2011) Journal of Nursing Management 19 , 487–497
Leadership and management in mental health nursing Background Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader’s influence and regard leadership and management as distinct from the nurses’ practical work. Aim The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. Method A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995–July 2010. Results Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships. Conclusion Mental health nurses’ leadership, management and transformational leadership are positively related in terms of effectiveness and nurses’ skills. Implication for nursing management It is important to consider mental health nurses’ management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization.     

Research in intensive care nursing

• • The results of a questionnaire study about intensive care nursing in Finland indicate that the chief problems in intensive care nursing are concerned with staff coping resources, quality development and patient experiences.
• • Questions on staff stress and coping have been researched quite extensively. Earlier studies have described intensive care nursing as highly stressful and pointed to numerous problems related to coping.
• • It is clear that intensive care nursing warrants closer attention in research.

     

It's the Anxiety: Facilitators and Inhibitors to Nursing Students’ Career Interests in Mental Health Nursing

Increasing the rate of recruitment of nursing students into mental health nursing (MHN) is vital to long-term sustainability of health care system support for people diagnosed with mental illness. However MHN is not a popular career path; this raises questions about what attitudes and beliefs may divert or attract students to this specialisation. The current research involved a survey of undergraduate nursing students at a regional university in Australia to clarify the nature of relationships between attitudes (e.g., the value of mental health nursing, stereotypes of people with mental illness) and how they may be antecedents to considering MHN as a career path. Through a structural equation model, it was ascertained that anxiety surrounding mental illness leads to less interest in MHN as a future career and suggests that anxiety is (a) partly due to negative stereotypes, and (b) countered by preparedness for a MHN role. Beliefs on how MHN can make a valuable contribution to people's well-being did not affect interest in pursuing MHN. These findings reconfirm the need to reduce anxiety about mental illness by educational approaches that effectively prepare students for MHN, combined with challenging negative stereotypes.     

The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health

Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants’ experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.     

Leadership qualities when providing therapy for women who suffer from eating difficulties

rørtveit k. & severinsson e. (2012) Journal of Nursing Management  20, 631–639 Leadership qualities when providing therapy for women who suffer from eating difficulties Aim The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED). Background Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes. Methods In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach. Results A main theme ‘The mental health nurse as a formative and mindful leader in a group therapeutic relationship’ and two themes ‘Leading sensitively towards awakening the patients’ awareness of their pre-understanding’ and ‘Leading dialectically towards solving patients’ existential dilemmas’ were developed and comprised two aspects of leadership. Conclusion The nurse–patient relationship is influenced by the patients’ pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research. Implications for nursing management The nurse–patient relationship should focus on clinical supervision, in order to strengthen the nurses’ leadership qualities in terms of being aware and dialectical.     

Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.     

Perceptions from the front line: Professional identity in mental health nursing

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses (MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN.     

Distilling the Antecedents and Enabling Dynamics of Leader Moral Courage: A Framework to Guide Action

Intelligent, robust and courageous nursing leadership is essential in all areas of nursing, including mental health. However, in the nursing leadership literature, the theoretical discourse regarding how leaders recognise the need for action and make the choice to act with moral purpose is currently limited. Little has been written about the cognitions, capabilities and contextual factors that enable leader courage. In particular, the interplay between leader values and actions that are characterised as good or moral remains underexplored in the nursing leadership literature. In this article, through a discursive literature synthesis we seek to distill a more detailed understanding of leader moral courage; specifically, what factors contribute to leaders’ ability to act with moral courage, what factors impede such action, and what factors do leaders need to foster within themselves and others to enable action that is driven by moral courage. From the analysis, we distilled a multi-level framework that identifies a range of individual characteristics and capabilities, and enabling contextual factors that underpin leader moral courage. The framework suggests leader moral courage is more complex than often posited in theories of leadership, as it comprises elements that shape moral thought and conduct. Given the complexity and challenges of nursing work, the framework for moral action derived from our analysis provides insight and suggestions for strengthening individual and group capacity to assist nurse leaders and mental health nurses to act with integrity and courage.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

Utilizing Peplau's psychodynamic theory for stroke patient care

• • A theory which enables the recipient of care to identify health-care needs is paramount.
• • Hildegard Peplau's (1952) theory of psychodynamic nursing enables this process to occur in collaborative identification and resolution of need.
• • The psychodynamic approach can direct the user to focus on the psychosocial problems created by a stroke.
• • The advantages and limitations of the theory are still to be investigated with the continued application to varied clinical situations.
• • There is a need to generate an expanded research-based taxonomy of psycho-social interventions for this client group.

     

Lamp light on leadership: clinical leadership and Florence Nightingale

stanley d. & sherratt a. (2010) Journal of Nursing Management  18, 115–121
Lamp light on leadership: clinical leadership and Florence Nightingale Aims The purpose of the present study was to use the example of Florence Nightingales’ nursing experience to highlight the differences between nursing leadership and clinical leadership with a focus on Miss Nightingales’ clinical leadership attributes. Background 2010 marks the centenary of the death of Florence Nightingale. As this significant date approaches this paper reflects on her contribution to nursing in relation to more recent insights into clinical leadership. Evaluation Literature has been used to explore issues related to nursing leadership, clinical leadership and the life and characteristics of Florence Nightingale. Key issues There are a few parts of Florence’s character which fit the profile of a clinical leader. However, Miss Nightingale was not a clinical leader she was a powerful and successful role model for the academic, political and managerial domains of nursing. Conclusion There are other ways to lead and other types of leaders and leadership that nursing and the health service needs to foster, discover and recognize. Implications for nursing management Clinical leaders should be celebrated and recognized in their own right. Both clinical leaders and nursing leaders are important and need to work collaboratively to enhance patient care and to positively enhance the profession of nursing.     

Impact of the role of senior dual disability coordinator on the perceived self-efficacy and job satisfaction of mental health clinicians

Abstract

Purpose: This study aimed to evaluate a new service role in mental health services, namely, the senior dual disability coordinator role (SDDC) for its impact on the perceived self-efficacy of mental health clinicians in managing clients with dual disability (mental illness and acquired brain injury and/or intellectual disability) and their job satisfaction. Method: Mental health clinicians from a health service district in Queensland, Australia who contacted the SDDC for clinical consultation and liaison between July 2011 and July 2013 were asked to complete a questionnaire assessing perceived self-efficacy in working with clients with dual disability as well as their job satisfaction, prior to (T1) and following (T2) their contact with the SDDC. Results: Twenty-five clinicians completed and returned pre- and post-measure questionnaires. Self-reported knowledge of dual disability, clinical skills in dual disability, service knowledge in dual disability as well as perceived self-efficacy, and job satisfaction increased significantly from T1 to T2. There were no significant differences across professional discipline or years of service. Conclusions: The delivery of a clinical consultation liaison service as part of the role of SDDC may assist mental health clinicians with self-efficacy and job satisfaction, regardless of the number of years they have worked in the service or their professional discipline. Mental health clinicians with improved self-efficacy for working with clients with dual disability may be more likely to consider the client suitable for services through mental health and follow-up with treatment and linking the client with other identified suitable services.

• Implications for Rehabilitation

• Dual disability (mental illness and acquired brain injury and/or intellectual disability) presents specific challenges for mental health services Specific strategies are needed to build capacity among mental health practitioners in order to meet the needs of people with dual disability and provide appropriate services.

• Introducing dual disability coordinators as a specific position within a health service district may assist to improve self-efficacy and job satisfaction of mental health practitioners assisting people with dual disability.

     

The Leadership Role of Nurse Educators in Mental Health Nursing

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.     

A qualitative study of mental health nurse identities: Many roles,one profession

The aim of the study was to clarify and build upon current understandings of mental health nurse (MHN) identity. The study adopted a framework of social constructionism and qualitative methodology. Semistructured interviews were conducted, which were thematically analyzed using Nvivo software. Twenty‐five MHN were recruited across three geographical sites in the UK. Participants constructed a cluster of seven MHN identity characteristics that constituted a unique contribution to talk‐based therapies. These themes of characteristics are: (i) the MHN as generic specialist; (ii) the MHN as adopting a service‐user focus; (iii) the MHN as positioning and utilizing the personal self; (iv) the MHN as spending time with the service user; (v) the MHN as delivering talk‐based therapies in versatile ways; (vi) the MHN as having an everyday attitude; and (vii) the MHN as having transferable skills. The distinctiveness, and thus, professional identity of mental health nursing, must be understood as a cluster of capabilities rather than a search for a singular point of difference. The breadth of capabilities employed by MHN highlights the value and worth of their contribution to service‐user care.     

Mental health community liaison in aged care: a service of value to all

Aim.  This paper describes an effective community nursing role in which mental health care is brought to long-term care in a way that restores and promotes mental health wellbeing in the older person, builds understanding between clinicians, and develops staff confidence in attending to the whole needs of residents of nursing homes.
Background.  Mental health is a significant issue in the ageing population and there is much that mental health nurses as well as staff in long-term care can do to promote early detection of problems, facilitate effective treatment and build coping in the older person and family so that they recover from grief or depression issues and go on to make this stage of life satisfying and rewarding.
Conclusions.  The mental health nurse liaison role is a useful contribution to comprehensive aged care in the community. The role provides support to clinicians enabling them to develop skills and expand their area of practice, whilst creating an environment in which the needs of the client may also be better understood and thereby met.     

Views and experiences of mental health nurses working with undergraduate assistants in nursing in an acute mental health setting

Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.     

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy

gifford w., davies b., tourangeau a. & lefebre n . (2011) Journal of Nursing Management 19, 121–132
Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy Background Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. Aim To describe the planning and evaluation of a leadership intervention to facilitate nurses’ use of guideline recommendations for diabetic foot ulcers in home health care. Method Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n = 15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Results Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Conclusions and implications for nursing management Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps.     

The influence of staff nurse perception of leadership style on satisfaction with leadership: A cross-sectional survey of pediatric nurses

BackgroundThere is evidence that transformational leadership style promotes nursing excellence. Differences in how supervisees and supervisors perceive the supervisor's leadership style may also be related to satisfaction with leadership. Research demonstrates that satisfaction with leadership is a critical element in the retention of nurses.ObjectiveTo evaluate staff nurse and nurse leader perceptions of leadership style.Methods16 supervisors and 179 supervisees completed the Multifactor Leadership Questionnaire and a demographic survey. Data were analyzed using parametric statistical techniques.ResultsAlthough staff perceived leaders as employing largely transformative leadership strategies, differences existed in leader-staff congruence in interpretation of leadership style and as related to the role of the leader.ConclusionsDifferences in interpretation of leadership style between supervisors and supervisees were associated with diminished satisfaction with leadership. In addition, those serving in a direct operational role (assistant nurse manager) were viewed as less transformative than leaders who maintained broader administrative responsibilities.