Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses

This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.     

Multiprofessional clinical supervision: challenges for mental health nurses

Recent reform and developments in mental health care provision have increasingly espoused the value of multiprofessional teamwork in order to ensure that clients are offered co-ordinated packages of care that draw on the full range of appropriate services available (DoH 1999a; DoH 2000). Supervision in some form is seen as a key part of all professional practice to provide support to practitioners, enhance ongoing learning, and, to a greater or lesser degree, offer some protection to the public (Brown & Bourne 1996, UKCC 1996). Clinical supervision has gained increasing momentum within the nursing profession, but to a large extent this has been within a uni-professional framework -- nurses supervising other nurses. This paper seeks to explore the ways in which multiprofessional working and clinical supervision interlink, and whether supervision across professional boundaries might be desirable, possible, and/or justifiable. Whilst our own view is that multiprofessional supervision is both possible and desirable, we seek to open up a debate, from our perspective as mental health nurses, about some of the issues related to the concept. Our motivation to explore this topic area emanates from our experiences as supervisors to colleagues within multiprofessional teams, as well as the experiences of those attending supervisor training courses. Following a brief overview of the development of clinical supervision in mental health care and recent policy guidelines, some models of clinical supervision are reviewed in terms of their suitability and applicability for multiprofessional working.     

Who benefits from clinical supervision and how? The association between clinical supervision and the work-related well-being of female hospital nurses

Aim and objectives. The aims of this study were (1) to identify which nurses benefitted most from clinical supervision and (2) to explore whether they were healthier and more satisfied with their work than their peers who did not attend clinical supervision. Background. To maintain quality nursing, there is currently a social call to improve the well-being of nurses at work. Restoring nurses' well-being is one of the main purposes of clinical supervision. However, research evidence on the effects of clinical supervision is scarce. Design. Survey. Methods. Questionnaires were distributed to female hospital nurses (n?=?304), about a half of whom (48·7%) had attended clinical supervision. Perceptions of work and health among the nurses who gave the best evaluations of clinical supervision (n?=?74) were compared with those of their peers who gave the worst evaluations (n?=?74) or who had not attended clinical supervision (n?=?156). Results. The nurses who received efficient clinical supervision reported more job and personal resources and were more motivated and committed to the organisation than their peers. However, professional inefficacy was the only burnout dimension on which they scored lower than other nurses. Conclusions. Clinical supervision can be conceptualised as an additional job resource associated with other job and personal resources, which mutually reinforce each other, promoting well-being at work. Efficient clinical supervision is probably both an antecedent as well as a consequence of well-being at work. Relevance to clinical practice. The results of this study advocate management planning to provide formal support for health care providers. Medical-surgical nurses are interested in clinical supervision. Reflecting on practice in clinical supervision generates new ideas about how to improve the quality of care and the psychosocial work environment. However, clinical supervision may be viewed as a preventive method rather than a treatment for burnout.     

Emergency mental health nursing for self-harming refugees and asylum seekers

This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.     

Nurse prescribing: a case for clinical supervision

This article will discuss the implications of nurse prescribing in mainstream primary health care and its impact on the fields of mental health and learning disabilities. Complexities and issues which require serious consideration by those nurses wishing to pursue such a specialist and extended role will be discussed in relation to these practice areas. Titchen's (1998) critical companionship model will be illustrated as an example of one framework for clinical supervision. This is to allow the processes, competencies and contextual issues to be explored by both novice and expert prescribers. The article concludes that for safe, effective and competency-based practice, clinical supervision also assists in mediating the professional and political aspirations in support of supplementary nurse prescribing.     

General practitioners' perceptions of community psychiatric nurses in primary care

The management of and responsibility for the care of people with mental health problems in the community is increasingly being assumed by general practitioners (GPs) and primary care personnel. As primary care groups (PCGs) evolve, so must their expertise in managing people with a wide range of mental health problems. It is expected that all mental health professionals will participate in this development, although it is likely that community psychiatric nurses (CPNs) will be the largest professional group involved, with a significant part to play in the shaping, management and delivery of mental health services. To date, there has been little research into how CPNs are perceived by other primary health care professionals. This study seeks to provide an insight into how GPs assess the contribution of CPNs in primary care. Overall, the results of the study suggest that GPs view CPNs favourably and consider that they have an important role to play. Greater involvement in primary care raises issues about the education and preparation of CPNs, their professional development and supervision needs.     

Australian nursing curricula and mental health recruitment

Debate about nursing curricula has been on the forefront of industry and academia in Australia particularly since the shift from the 'apprenticeship style' of training for nurses to a university-based, comprehensive, bachelor's degree. There is the suggestion that university-based courses are rather inflexible and take for granted that the provision of mental health nursing across what is an essentially general course will ultimately attract the numbers of quality staff members required to fill speciality positions in mental health. Recent literature advocates for a direct entry undergraduate mental health programme in Australia, similar to that in the UK. This is suggested as one of many strategies to address the growing disparity between the demand and the supply for effective mental health treatment and care. The support of preceptor staff in the clinical field in terms of workloads, supervision and professional development are also identified as areas for attention. Another strategy that this paper addresses is the increased support of student preceptors in the areas of workload, supervision and professional development, whereas they forge organizational links between the tertiary sector and industry to facilitate enhanced communication channels between the theoretical curriculum (the theory) and the clinical sites (the practice). Additionally, increasing the mental health content in current curricula to a level that reflects hospital-based and community mental health needs is also required.     

CLINICAL SUPERVISION,BURNOUT, AND JOB SATISFACTION AMONG MENTAL HEALTH AND PSYCHIATRIC NURSES IN FINLAND

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

Clinical supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland

This paper presents the findings from a survey of Finnish mental health and psychiatric nurses. The aim of the study was to describe and evaluate the current state of clinical supervision, and ascertain the levels of burnout and job satisfaction experienced by these health care professionals. Clinical supervision was found beneficial for mental health and psychiatric health care professionals in terms of their job satisfaction and levels of stress. The findings seem to demonstrate that efficient clinical supervision is related to lower burnout, and inefficient supervision to increasing job dissatisfaction.     

THE CULTURAL REALITIES OF CLINICAL SUPERVISION IN AN ACUTE INPATIENT MENTAL HEALTH SETTING

In this paper, the cultural realities of clinical supervision (CS) in acute inpatient mental health settings are explored using an ethnographic approach. Findings suggest that there is a verbal acceptance of CS by mental health nurses but a cultural belief that it has limited experiential value and, thus, a cautious attitude towards its adoption is in practice. This may, in part, be attributable to many nurses believing that they are already undertaking CS, although the informal supervision described does not fit with established definitions of formal supervision. The language used by nurses demonstrates an understanding and appreciation of the benefits of clinical supervision. However, the belief that existing structures inherent to nursing practice already convey these benefits may contribute to the culture of passive resistance to clinical supervision revealed by the findings. This study contributes to current discussions regarding the purpose of CS, the realities of its implementation, and its role relative to existing professional support opportunities.     

The cultural realities of clinical supervision in an acute inpatient mental health setting

In this paper, the cultural realities of clinical supervision (CS) in acute inpatient mental health settings are explored using an ethnographic approach. Findings suggest that there is a verbal acceptance of CS by mental health nurses but a cultural belief that it has limited experiential value and, thus, a cautious attitude towards its adoption is in practice. This may, in part, be attributable to many nurses believing that they are already undertaking CS, although the informal supervision described does not fit with established definitions of formal supervision. The language used by nurses demonstrates an understanding and appreciation of the benefits of clinical supervision. However, the belief that existing structures inherent to nursing practice already convey these benefits may contribute to the culture of passive resistance to clinical supervision revealed by the findings. This study contributes to current discussions regarding the purpose of CS, the realities of its implementation, and its role relative to existing professional support opportunities.     

Do nurses working in adult psychiatry take into consideration the support network of families affected by parental mental disorder?

The aim of this study was to gain information about registered and practical mental health nurses' activities concerning support network of families affected by parental mental illness. Data were collected using a structured questionnaire distributed to all 608 practical and registered mental health nurses working in adult psychiatric units in five Finnish university hospitals. A total of 311 nurses returned completed questionnaires (response rate 51%). Sixty per cent (n = 222) of registered nurses and 36% (n = 88) of practical mental health nurses responded. Information about family relationships and socio-economic situation was gathered regularly by all nurses. The nurses' individual characteristics, such as being a parent, further family education and use of family-centred care, were significantly related to their activeness in discussing the family's support network with the parents. Discussing family relationships and families support networks forms part of patient care in adult psychiatric nursing with families with dependent children (under 18 years of age). Nurses can work directly with the parents to aid them to strengthen their support network for themselves and their children.     

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.     

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.     

Swedish mental health nurses' responsibility in supervised community care of persons with long-term mental illness

The aim of the present study was to describe psychiatric nurses' experience of how the changing focus of mental health care in Sweden, from in-patient treatment to community-based care, has influenced their professional autonomy. Eleven psychiatric nurses were interviewed and a qualitative content analysis was used to identify major themes in the data. Three main themes were found: pattern of responsibility, pattern of clinical judgement, and pattern of control through support and supervision. All themes were related to the nurse's identity, moral responsibility and the feelings of loneliness and independence in his/her daily work. Together, the three themes were found to constitute a process. This study shows the complexity involved in nursing care provided in the patient's home. Achieving control over the patient's everyday life through support and supervision does not imply taking over the patient's autonomy, but rather reducing the stigma attached to mental illness and facilitating the process of rehabilitation.     

Establishing Clinical Supervision in Acute Mental Health Inpatient Units: Acknowledging the Challenges

After decades of discussion about clinical supervision and mental health nursing, the reality is that many acute mental health inpatient settings continue to struggle with the notion of clinical supervision and the implementation process. In this article we delineate the key elements of clinical supervision, explore practical and dynamic difficulties associated with clinical supervision and question whether too much is being asked of this one process, especially in acute inpatient settings. For many mental health nurses, existing practices offer many of the purported benefits of clinical supervision. Ultimately, unless clinical supervision is better understood and implemented effectively, it is unlikely to meet expectations. Clinical supervision should ultimately be defined by the nurses participating in it. This article contributes to current discussions regarding the purpose of clinical supervision, the realities of its implementation, and in particular considers the role of clinical supervision relative to existing professional support opportunities.