Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

There were two objectives of this study. The first was to identify the attitudes of home‐visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home‐visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home‐visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.     

Nursing considerations for dual diagnosis in mental health

It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Clients with mental health problems who sexualize the nurse-client encounter: the nursing discourse

Title. Clients with mental health problems who sexualize the nurse‐client encounter: the nursing discourse. Aim. This paper is a report of a study of psychiatric nurses’ responses to clients who were sexualizing the nurse–client encounter. Background. Studies involving general nurses have reported incidents of ‘unwanted sexual attention/behaviour’ from clients. These behaviours have been identified, in the literature, as a form of sexual aggression and sexual harassment. Reported responses have included physically avoiding the person, ignoring verbal comments or adopting a no‐‘nonsense’ professional approach. Methods. A grounded theory study was conducted in 2005–2006 using tape‐recorded unstructured interviews with 27 psychiatric nurses working in an urban mental health service in the Republic of Ireland. Tapes were analyzed, with the assistance of Nud*ist 4, Word documents, mind maps and memoing. Findings. There were unwritten and unspoken professional expectations or norms that clients treated participants and nursing encounters in an asexual way. However, on occasions, clients transgressed these taken‐for‐granted norms and engaged in behaviour labelled ‘sexualizing the nurse–client encounter’. In contrast to previous studies, our interviewees did not use the language of sexual harassment, but used the discourses of ‘mad/bad’ and ‘inappropriate’ to codify the behaviour. The tendency to view behaviour through the psychiatric discourse of badness and boundary violation gave rise to nurses either ignoring the behaviour or responding by using ‘suppressive strategies’. Consequently, other possible lenses of understanding were pushed to the background. Conclusion. Only when educators and clinicians view clients’ sexual behaviours through alternative lenses of understanding will different actions and outcomes become possible and the rights of all, both nurses and clients, be respected.     

Assertive community treatment (ACT) case managers’ professional identities: A focus group study

Assertive community treatment (ACT) case managers provide healthcare services to people with severe and persistent mental illness. These case managers take on generic roles in multidisciplinary teams and provide all‐around services in the clients’ private homes. This focus group study aimed to gain insight into Danish ACT case managers’ professional identity work by examining their discussions of ethical dilemmas and collaboration in their everyday practice. Data were collected during five focus groups at three ACT teams in the North Denmark Region and subjected to discourse analysis emphasizing how identity work was accomplished through talk. The findings indicated that the case managers constructed professional identities by actively positioning themselves and the particular ACT approach in relation to other mental healthcare professionals and clients. They represented themselves as achieving better client‐related outcomes by being more assertive and persistent, and as responsible caregivers who provided the help that their clients needed when other services had failed to do so. They depicted their services as being focused on the clients’ well‐being, and their persistent efforts to establish and sustain interpersonal relationships with clients were an important part of their service. Basic nursing tasks were described as an important part of their everyday work, and even though such tasks were not distinctive for ACT case managers, the representations of their work seemed to give them a sense of worth as professionals and legitimized a unique role in the community mental healthcare services.     

Mental health and debt: challenges for knowledge, practice and identity

People with mental health problems (MHPs) in Britain are nearly three times more likely to report debt compared with individuals without similar conditions. With one-in-four respondents with MHPs reporting personal debt, this may be equivalent to eight or nine clients in the recommended national community mental health nurses' (CMHNs) caseload of 35. Although client debt is not a new problem for CMHNs, it can pose significant difficulties for client well-being and nursing practice. This paper reviews the published literature on debt and mental health, then considers three of the challenges that client debt can present to: (1) nursing knowledge--moving away from understandings of client debt based on crisis, and towards those focused on process and prevention; (2) nursing practice--reworking the collaborative relationship between CMHNs and external debt advice agencies; and (3) nursing identity--managing the role conflicts that engaging with client debt can bring. The paper concludes by contending that nurses should raise and monitor debt issues among clients, but cannot be expected to become proxy 'debt advisors', with CMHNs being encouraged to increasingly collaborate with debt advisors (rather than simply referring on clients).     

Complementary roles of nurse and health-care assistant

Summary

• ? In community hospitals, and units for people with learning disabilities, the theoretical framework of Oxfordshire nursing services was used to examine the complementary roles of nurse and support worker.
• ? This framework proposes that the mix in nursing teams should be determined by the needs of patients/clients.
• ? The sample consisted of directors of nursing services, senior nurses/managers, nurses, support workers and patients/clients. Data were collected by utilizing a multimethod approach.
• ? Findings showed that in the deployment of grade-mix the needs of clients/patients were overlooked.
• ? In the community hospitals the primary nurses were the main caregivers regardless of whether the patients needed the qualified input. Conversely, in the units for people with learning disabilities, the main involvement of direct-care staff disregarded the fact that needs of many clients could only be met with a nurse's input.
• ? In their present supervisory role the primary nurses were posed with the problem of losing client contact.

     

The Roper, Logan and Tierney (1996) model: perceptions and operationalization of the model in psychiatric nursing within a health board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model's usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its 'fit' with the needs of the client group and the ward team philosophy.     

Using motivational theory with the long-term psychiatric client

This article discusses how psychiatric nurses or nursing students can use motivational theory to work with the long-term client. It is primarily nurses who work most continually with all phases of the long-term client's responses to his or her illness and deal most directly with his or her frustration and despair. This article describes the practical application of motivational theory with a group of clients who demonstrate typical variability in their illness responses. A combination of paper-and-pencil exercises, the Goal Attainment Scaling form (Garwick & Brintelli, 1977) and Checklist for In-Session Achievement, can be used with role play to assist clients to achieve their goals. Nurses and clients are both more likely to experience success when reasonable goals are set, and the focus for treatment is on ability rather than disability.     

Changes in community nursing in Australia: 1995-2000

AIM: This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work. BACKGROUND: There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care. METHODS: Four sources of data were used: community health client administrative data 1995-2000; occasions of service data 1995-2000; staffing numbers 1998-2001; and interviews with 14 community nurses in late 2001. RESULTS: Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes. CONCLUSION: Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.     

Clients' reflections on relationships with nurses: comparisons from Canada and Scotland

It has been suggested that the crucial elements in nursing situations are the nurse, the client, and what goes on between them. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients. Data are presented from studies conducted in Canada and Scotland. It is shown that what clients want, or do not want, during relationships with their nurses, is similar on both sides of the Atlantic. The findings reported in this paper are relevant to transcultural nursing, ethical care, the growth in consumerism, and client advocacy. The findings suggest also that there is a need for nursing research to focus on clinical outcomes in order to establish whether clients' perceptions of helping relationships have any relevance to favourable health outcomes, and the evidence base for clinical nursing.     

对高危人群进行脑卒中社区预防干预的效果评价

目的通过对社区脑卒中高危人群的脑卒中预防干预,探索社区脑卒中综合防治的途径。方法在我院所辖社区居民中,选取符合脑卒中高危人群条件的674例社区居民,经由培训的护士对脑卒中高危人群进行问卷调查及医学体验,实施以健康教育和健康促进为主导的预防脑卒中综合干预。结果干预后高危人群的体质指数、血压、体重、血糖、血脂水平较干预前下降,差异有统计学意义（P〈0.05）：吸烟、饮酒、高脂饮食等不良生活习惯明显改善。结论在社区建立实施健康教育长效机制,全面开展社区预防,对于脑卒中的预防与控制具有极其重要的意义。     

Reminiscence as an Intervention: Rediscovering the Essence of Nursing

The authors initiated an educational program to teach homecare nurses and aides how to implement and evaluate one creative nursing intervention–reminiscence with clients. Client outcomes resulting from the implementation of reminiscence included increased opportunities for self-expression, enhanced coping abilities, the discovery of significance and continuity of life, and enjoyment. Positive staff outcomes also were achieved. The authors conclude that the implementation of creative nursing interventions can assist nurses to rediscover the art and enjoyment inherent in nursing practice and produce positive client outcomes in the current changing healthcare environment.     

Consumer feedback on nursing care and discharge planning

BACKGROUND: Gaining consumer feedback about nursing care and discharge planning is especially important given the changes that have occurred in acute inpatient mental health facilities. Consumers can best define the quality of the service they receive and surveys are considered to be good sources of information about nursing care and discharge planning. AIM: The aims of this study were to clarify consumer discharge needs, ascertain consumer perceptions of helpful practice, identify areas that require improvement, identify resources consumers deem important, ascertain satisfaction with specific aspects of services, and obtain baseline data to improve future discharge planning. METHOD: Satisfaction-with-services and discharge questionnaires were completed by clients (39 and 45, respectively) prior to discharge from three acute inpatient mental health units over a 2-month period. FINDINGS: Findings indicated that clients were most satisfied with the respect they received from staff, attention staff gave to concerns and worries, quality of service provided by nurses, way treatment met client needs and overall stay in hospital. The majority of respondents (95%) indicated that their discharge arrangements were explained to them and 90% were satisfied with these. Whilst over two-thirds indicated that the information provided in hospital to assist with discharge had been helpful, they highlighted some areas for service improvement. Resources to prepare them better for discharge included increased contact with consumer consultants and more information about mental health problems, medication and relapse prevention. CONCLUSION: This study constitutes another small step towards decreasing the gap between consumer expectations and actual treatment by asking consumers about their perceptions of discharge planning. The findings provide the basis for the development of more appropriate strategies to improve the continuity of services between hospital and community mental health settings.     

The scope of private practice nursing in an Australian sample

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.