Collaboratively planning for medicines administration competency: a survey evaluation

hemingway s., baxter h., smith g., burgess-dawson r. & dewhirst k. (2011) Journal of Nursing Management  19, 366–376
Collaboratively planning for medicines administration competency: a survey evaluation Aims This survey evaluated the experiences of mental health nurses who had undergone assessment of their competence in the administration of medicines using established assessment frameworks. Background Medicines management activities have at times been widely criticized. Joint collaborations between Higher Education Authorities and the National Health Service in education and training can start to address some of these criticisms. Method A questionnaire using 22 closed and open response questions was distributed to 827 practising mental health nurses and 44 graduate mental health nurses. Results A total of 70 registered and 41 graduate mental health nurses who had completed the assessment of administration competency frameworks responded to the survey. Response rates were 24 and 96%, respectively. The assessment frameworks were received positively. Environmental factors were perceived as the main barrier to medicines safety; however, this was not reflected in how this aspect of the competency framework was perceived. Implications for nursing management The administration of medicines is an area of mental health and all fields of nursing practice that needs attention. The use of competency frameworks as outlined in the ‘Medicine with Respect Project’ is one strategy to achieve the improvement in this essential clinical skill.     

Exploring the Views of Nurses on the Cardiometabolic Health Nurse in Mental Health Services in Australia

People with serious mental illness experience premature death due to higher rates of cardiometabolic conditions (e.g. cardiovascular disease, diabetes) than the general population. Mental health services often do not provide sufficient cardiometabolic clinical care to address these risks. The cardiometabolic health nurse (CHN) role has been suggested as a strategy for ensuring integrated care is provided and sustained. The views of nurses in mental health would be essential in informing the viability and development for this initiative. This paper presents the findings of open-ended comments from a cross-sectional online survey of nurses working in mental health in Australia (n = 643) eliciting views about the possible introduction of the cardiometabolic nurse. Thematic analysis was undertaken, of 133 open comments on this topic. The findings suggest that nurses see the specialist role as suitable and valuable for mental health services. Some nurses voiced concern about specialisation leading to fragmentation (e.g. in responsibilities for physical health, division of mental and physical health care, and less emphasis on equipping all nurses with comprehensive care skills), especially for settings where generalist nursing was seen as already available. The findings suggest this role is viewed favourably by nurses, provided that it is consistent with holistic and comprehensive care. Empirical research is needed to see whether this role increases holism (as valued by consumers and nurses) and cardiometabolic outcomes.     

The impact of horizontal violence on the individual nurse: A qualitative research study

AimHorizontal violence (HV) is a familiar term used in nursing. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (nurses within their first 12 months of practice) are widely considered a vulnerable population in the profession and thus more at risk for HV. The purpose of this qualitative study was to explore how HV affects graduate nurses (GNs).DesignInductive thematic analysis was used in the design of this study.MethodsParticipants included eight Canadian GNs or Registered Nurses (RNs), all of whom had experience with HV in their first 12 months of practice. Data collection was done via one-on-one interviews.ResultsTwo main themes were revealed from the data collected - Toxic Nursing Culture and Fear. Several subthemes were also identified – cycle of violence, nurses eating their young, shame, drowning, isolation and vulnerability. The findings indicate that HV is prevalent in the first year of practice and is destructive to the mental health of the individual nurse. Horizontal violence poses a serious challenge for GNs entering nursing and is often touted as the reason new nurses leave the profession altogether.ConclusionThis study highlighted the personal and professional challenges that are heightened for a GN when they experience HV in their first year of practice. These experiences emphasize the impact that HV can have on the mental health of nurses and their ability to deliver safe patient care.     

Modification and Initial Psychometric Evaluation of the Physical Health Attitude Scale for Use in the Canadian Mental Health and Addictions Context

Introduction: The Physical Health Attitude Scale (PHASe) tool was developed to better understand mental health nurses’ attitudes towards their involvement and confidence in physical health care. This tool has been used in the United Kingdom and Australia; however, it has not been used in Canada.

Aim: This study aims to modify and provide an initial psychometric evaluation of the PHASe tool for use in a Canadian mental health and addictions context.

Methods: In Phase 1, clinical experts (n?=?8) were consulted to provide feedback on the content and face validity of the PHASe tool. In Phase 2, the PHASe tool was piloted with nurses at a large urban mental health and addiction organization in Ontario, Canada (n?=?77).

Results: In Phase 1, 4 items were added and 5 items were removed from the tool based on feedback provided by experts. In Phase 2, 12 poorly correlated items were removed. A two-factor solution was identified, with subscales “confidence” and “barriers and attitudes”.

Discussion: Initial psychometric evaluation suggests that a revised 15-item version of the PHASe tool is valid and reliable in a Canadian mental health and addictions context; however, more testing is recommended in larger, more diverse samples.     

The Impact of Mental Health Nursing Education on Undergraduate Nursing Students’ Attitudes to Consumer Participation

Consumer participation in all aspects of mental health service delivery, including the education of mental health professionals, is now a policy expectation in Australia. Whether education programs introducing nurses to mental health nursing lead to more favourable attitudes towards consumer participation is yet to be examined in pre-registration nursing programs in Australia. The current evaluation examined changes in scores for the Consumer Participation Survey for undergraduate nursing students (n = 68) in an Australian University. Data were analysed, using repeated measures t-test, to compare the pre- and post-test scores. There was a significant improvement in views on consumers participating as staff members. There were no statistically significant changes in attitudes towards consumer capacity and consumer involvement in care processes. Consumer participation in mental health care is now clearly articulated in Australian Government policy. For this to be successfully implemented a more comprehensive understanding of the ability of education to influence attitudes is required.     

Choosing and remaining in mental health nursing: Perceptions of Western Australian nurses

Mental health nursing has an ageing workforce with a critical shortage of nurses in Western Australia. Additionally, mental health is not the preferred career for many graduate nurses. Current challenges with recruitment and retention suggest that strategies are needed to address this issue. This research project adopted a novel approach that focused on exploring the positive aspects of why mental health nurses remain, rather than why they leave. A cross‐sectional design was employed comprising a brief interview survey, and nurses working within one public mental health service in Western Australia were invited to participate. A total of 192 nurses participated across 5 months, from adult, older adult, forensic, and education/research programmes. Thematic analysis was conducted from five key questions, and responses from questions one and two are discussed in this paper: ‘Why did you choose mental health nursing?’ and ‘Why do you remain in mental health nursing?’. The main themes extracted in response to choosing mental health nursing were wanting to make a difference, mental health captured my interest, encouraged by others, and opportunities. Subsequent themes extracted from responses to remaining in mental health nursing were facing reality, passion for mental health nursing, patient‐centred caring, and workplace conditions. Findings will be utilized to inform strategies for recruitment and retention of graduate nurses; further development of support systems, such as preceptorship training and improving student clinical experiences; as well as improving professional development opportunities for existing mental health nurses.     

Nurses are the key to improving mental health services in low‐ and middle‐income countries

Mental health nursing is a critical issue for most countries. Nurses in low‐ and middle‐income countries are often the primary providers of care for people with mental disorders. Some are highly qualified professionals who train other providers to identify and treat mental disorders. However, in other instances, particularly in low‐income countries, nurses have had very little or no mental health training and receive no support from mental health professionals. The lack of sufficient mental health professionals in these countries creates an environment where nurses without training are often the only providers available to care for people with mental disorders. In September 2007 the World Health Organization and the International Council of Nurses produced a report summarizing the responses to some of the questions on a survey of nursing mental health practices in 177 countries and territories. The summary of the open‐ended questions (e.g. what are the key issues for nurses providing mental health care in your country?) is reported for the first time in this article. Subsequent to the release of the Nurses in Mental Health Atlas, an online forum was held. There were 615 subscribers to this forum from over 80 countries. This article summarizes the rich insights and recommendations from both the survey's open‐ended comments and the online forum. The issues discussed include: the varied and complex roles for nurses in mental health care; nursing education; prescribing practices; nurse recruitment and retention; human rights; research; and technical expertise.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Screening for Symptoms of Postpartum Traumatic Stress in a Sample of Mothers with Preterm Infants

People with serious mental illness are at high-risk for physical illnesses and premature death, and nurses can contribute to ensuring mental health services address these risks. There is very little research examining the role of nurses in mental health who provide physical health care. To identify the levels of participation in physical health care of people with serious mental illness (SMI), a national Internet-based survey of nurses working in mental health in Australia was conducted (n = 643). The survey included an adapted version of the Robson and Haddad Physical Health Attitude Scale. Data were analysed through comparison of frequencies, correlations, principal components analysis, and Mann-Whitney tests. Nurses reported regular physical health care in 12 of the 17 tasks presented to them. The three most common self-reported physical health care activities were inquiring about consumers’ contact with GPs, doing physical assessments, and providing information on drug use and lifestyle. Although some practices were less common (e.g., contraceptive advice) nurses who provided one type of care tended to do other types as well. In addition, credentialing in mental health nursing was associated with slightly more regular engagement in all practice domains except screening and assessments. Nurses in mental health in Australia may be engaged in improving physical health of consumers with SMI more than is assumed.     

‘Violence is Not Part of Our Job’: A Thematic Analysis of Psychiatric Mental Health Nurses’ Experiences of Patient Assaults from a New Zealand Perspective

This paper describes psychiatric mental health nurses’ (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses’ experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings.     

The effect of a training programme on school nurses’ knowledge,attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial

BackgroundMental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role.ObjectivesTo evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses’ knowledge, attitudes, and recognition skills for depression.DesignA cluster-randomised controlled trial.Participants and setting146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme.MethodsSchool nurses from 7 PCTs (n = 81) were randomly allocated to receive the training intervention and from 6 PCTs (n = 65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme.ResultsAt 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained.ConclusionsThis school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.     

Exploration of the graduate nursing program in a forensic mental health setting: A qualitative enquiry

BackgroundForensic mental health nursing is a specialised practice area. Graduate programs are essential for recruitment and retention. There have, however, been very few studies exploring forensic mental health graduate programs.AimThe aim of this study was to explore the experience of graduate nurses who completed a 2-year graduate program in a forensic mental health service in the state of Victoria Australia, and the nurses who support the graduates in the program.MethodsAn exploratory study was conducted gathering data via one-to-one interviews, with purposive sample of 20 forensic mental health nurses.FindingsAnalysis resulted in the interpretation of two themes; essential ingredients and ‘hitting hurdles’.DiscussionGraduate nurses commence with limited knowledge, experience challenges, and organisational pressures.ConclusionTransition to practice was enhanced with consistent support, university education, and program structure.     

Exploration of personal recovery-oriented care on an acute mental health unit

BackgroundPersonal recovery should be the cornerstone of mental health nursing practice. Nursing interventions should build on consumers' strengths to provide hope, so consumers are empowered to achieve their own personal goals.AimThe aim of this study was to explore mental health nurses’ lived experience of their practice, understanding and knowledge of personal recovery-oriented care on acute mental health units.MethodVan Manen's methodology was utilised in this study. Data was gathered through semistructured conversational interviews with mental health nurses working on an acute unit.FindingsParticipants found personal recovery was difficult on an acute mental health unit. Factors that participants identified that impeded personal recovery-oriented care on acute mental health units included: the acuity of consumers in a low dependency area, lack of time to engage consumers, and loss of the therapeutic role for mental health nurses on acute units.DiscussionMental health nurses are expected to focus on the personal recovery needs of mental health consumers while managing clinical risks to consumers and others on the acute unit. This has the mental health nurse navigating a course between two worlds, and results in mental health nurses being confused between concepts of personal recovery and clinical recovery.ConclusionIf acute mental health nurses cannot define personal recovery, they will not be able to effectively implement interventions that support consumers in their personal recovery journey on acute units and will be drawn into the clinical recovery paradigm.     

'You don't talk about the voices': voice hearers and community mental health nurses talk about responding to voice hearing experiences

Aims and objectives. To explore service user and community mental health nurses views on responses to voice hearing experiences. Background. People who hear distressing auditory hallucinations (voices) are often in contact with mental health services. Nursing responses to this experience have been limited, although emerging evidence suggests some utilitarian alternative interventions, such as discussing the content and meaning of the voices. Design. Using exploratory interviews, this study investigated the response to voice hearing, with a purposive sample of community mental health nurses (n = 20) and service users (n = 20). This paper reports on a thematic content analysis of transcribed interviews, which highlighted differences in perspectives of voice hearers and the nurses supporting them. Results. Voice hearers reported that interventions from community mental health nurses were limited to reviews of medication, access to the psychiatrist and non‐directive counselling. They identified alternative needs, which involved talking more about the content and meaning of their voices. Conversely, community mental health nurses regarded their responses to voice hearing as being considered, titrated and demonstrating an awareness of the personal contexts of service users. These responses were however restricted by their perception of skill limitations. Conclusions. The contrasting views of nurses and users of services demonstrated in this study, reveal multiple social realities that represent a challenge to accepted professional responses in the provision of mental health care. Relevance to practice. People who hear voices express an interest in more helpful responses from community mental health nurses. The findings of this study indicate that nurses must begin to orientate themselves towards a more critical practice stance that encompasses available knowledge on the voice hearing experience.     

Forensic mental health: Perceptions of transition and workforce experiences of nurses

BackgroundWith the growing need for nurses in forensic mental health settings, understanding the experiences of transition and perceptions of the setting is important to support staff retention.AimTo explore registered nurses’ experiences of working in a forensic mental health setting. In particular, to understand their transition experience, perceptions of the practice environment and intention to stay within the setting.MethodsRegistered nurses employed in a high-secure forensic mental health hospital in New South Wales, Australia, completed an online survey including the Revised Professional Practice Environment Scale and Nurse Retention Index.FindingsSixty-nine participants responded to the survey. During the first year of their employment, participants reported feeling isolated, lacking support and being anxious when providing patient care. In terms of the environment, participants perceived ‘internal work motivation’ as positive in the environment when compared to ‘handling disagreement and conflict’. While many intended to continue their nursing careers for the foreseeable future, 45.3% of participants were undecided about whether they would leave the forensic setting.DiscussionDue to the complexity of forensic mental health practice, the reporting of poor experiences of transition and issues regarding support and conflict is concerning. Considering the importance of workplace culture and teamwork in forensic mental health, strategies to enhance positive interpersonal relationships is essential.ConclusionGiven the predicted future workforce shortages, this study highlights a need for appropriate supports for nurses’ transitioning into forensic mental health employment to enhance workplace satisfaction and retention.     

Mental well-being of intensive care unit nurses after the second surge of the COVID-19 pandemic: A cross-sectional and longitudinal study

ObjectivesTo determine the impact of the second surge of the COVID-19 pandemic (October 2020 to June 2021) on mental well-being of intensive care unit nurses and factors associated with mental health outcomes.MethodsAn online survey was available for Dutch intensive care unit nurses in October 2021, measuring mental health symptoms; anxiety, depression (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of Event Scale-6). Additionally, work-related fatigue was measured using the Need For Recovery-11 questionnaire. Previous data from the first surge (March until June 2020) were used to study mental well-being longitudinally in a subgroup of intensive care unit nurses. Logistic regression analyses were performed to determine factors associated with mental health symptoms.ResultsIn total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) participated, of whom 164 also completed the questionnaire in 2020. After the second surge, 225/589 (38.2 %) nurses experienced one or more mental health symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the first measurement, the occurrence of mental health symptoms remained high (55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted holidays as requested (aOR, 0.54; 95 % CI, 0.37–0.79), being more confident about the future (aOR, 0.59; 95 % CI, 0.37–0.93) and a better perceived work-life balance (aOR, 0.42; 95 % CI, 0.27–0.65) were significantly associated with less symptoms.ConclusionThe second surge of the COVID-19 pandemic further drained the mental reserves of intensive care unit nurses, resulting in more work-related fatigue.