Can mental health nurses diagnose in Australia?

The naming of health related conditions has been the traditional province of the medical profession. Occasional concessions have been made in specific narrow domains, such as psychology or speech-related pathology, but diagnosis typically has been seen as medical practitioner business. "Ownership" of language is worthy of critical discussion. The answer to why the tradition has persisted, and nurses have invested lots of energy within the established rules of who can say what, may well be found through the lens of psycholinguistics. Nurses can name states of health and ill health using the currently accepted nomenclature. The authors argue that there is an unconditional "yes," to the question of can nurses diagnose, as long as they are not holding themselves out to be a medical practitioner by doing so. Additionally it is argued that advanced practice nurses must diagnose in order to fulfill their role as advanced practice clinicians.     

Where does mental health nursing fit in primary care?

The introduction of the Improving Access to Psychological Therapies scheme in primary mental health care has raised questions about mental health nurses' role and function. This article considers some of the key questions around where and indeed whether nursing continues to have a place within primary mental health care.     

Social determinants of mental health: the missing dimensions of mental health nursing?

In this paper we explore how aspects of the social world may be linked to mental health and psychiatric morbidity and propose that conditions should be created which allow individuals and communities greater opportunities for self-care and self-management. Specifically the focus is on social connections, disability and homelessness and work stress. There is a clear policy direction pursued by many national governments and international organizations such as the World Bank to build healthy communities. The environment as it relates to health and well-being can be thought of in terms of physical and social dimensions. We will argue that self-care and self-management at both the individual and the community level, in partnership with economic and health policies, are necessary to effectively address social determinants. It will also be suggested that although many in the profession will make the usual refrain that this has little relevance to mental health nurses, the opposite may be the case as mental health nurses have an important, albeit ill-defined, role to play in tackling social determinants.     

Does seclusion have a role to play in modern mental health nursing?

The seclusion of patients with mental health problems is a controversial and emotive subject, and is a practice that was condemned by the Ashworth Inquiry (Department of Health (DoH), 1992). Despite this condemnation, it is still widely practised today. Opinions on the practice of seclusion vary greatly. Consequently, there is a need to review the theoretical and empirical literature regarding the use of seclusion in order to gain an understanding of the current state of the knowledge base in this substantive and controversial area. This article systematically reviews research published between 1994 and 1999 and discusses the findings under three headings: staff/patient attitudes to seclusion; the alternatives to seclusion; and the efficacy of seclusion. The reviewed material shows that seclusion is seen as a legitimate intervention by some hospital staff, but is "dreaded" by mental health patients. What is also evident is that seclusion is largely believed to be effective and that no true alternatives to its use exist. However, there appears to be no formal means of determining what constitutes an effective intervention in the management of violent incidents. Implications for practice and areas for future study are also discussed.     

Observation: the original sin of mental health nursing?

The assessment and management of 'risk' has become a focal aspect of contemporary mental health practice. Given their proximal relationship with service users, nurses most often represent the 'front line' of risk management, typically expressed in hospital settings through the bureaucratic process of 'observation'. Much of the available 'evidence' is highly critical of this practice and service user researchers, in particular, have repeatedly called for alternatives. This paper reviews the historical and inter-professional dimensions of the practice of observation, contrasting this with mental health nursing's search over the past two decades, at least within the UK, for professional autonomy. Contemporary mental health nursing is trapped in an anachronistic relationship with psychiatric medicine. If nursing is to prosper, nurses must address the complex issues underlying this inter-professional relationship. The authors describe the development of 'bridging'--a radical alternative to observation practice, which represents a means of managing 'risk' and a way that nurses might develop their interpersonal relationships with people deemed to be at risk, thereby asserting the power of 'caring'.