本科护生社会支持、自尊、应对方式与心理健康的相关研究

目的探讨实习阶段本科护生社会支持、自尊、应对方式与心理健康的关系。方法采用问卷调查法对89名5年制本科实习护生进行调查,分别在实习前1个月、实习1个月末、实习4个月末和实习7个月末收集资料。结果本科护生实习期间,心理健康平均水平较我国18~29岁青年组常模高,不同实习时期均有10.00%左右的护生心理处于亚健康和不健康状态;消极应对均分和心理健康总均分呈正相关;自尊均分、社会支持均分、积极应对均分与心理健康总均分呈负相关。结论本科护生实习期间心理健康总体水平较好,社会支持、自尊、应对方式均不同程度地影响本科护生的心理健康。     

Development and validation of clinical indicators for mental health nursing practice

A national study was undertaken in Australia to develop and validate a set of clinical indicators for mental health nursing. Using survey and action research procedures, the indicators were developed in two stages. During stage one, focus group interviews involving 39 nurses were conducted at national conferences in Australia and New Zealand in order to provide a pool of indicator statements. A Delphi survey of an Australian sample of mental health nurses (n = 33) was then conducted to refine the indicators. In stage two, the refined indicators were tested and validated in selected clinical settings. A total of 1751 mental health nurses employed at 14 sites were involved in the second stage of the study. The resulting data were used to establish the set of national indicators that the Australian and New Zealand College of Mental Health Nurses will use in practice accreditation and benchmarking.     

Evaluating the impact of a preceptorship course on mental health nursing practice

The crisis in the recruitment of nursing graduates into the mental health nursing field dictates the need for assertive and innovative strategies to promote the positive aspects of this field of nursing. A positive clinical experience has been identified as one of the most important determinants of nursing students' attitudes towards mental health nursing. The Centre for Psychiatric Nursing Research and Practice implemented the course "Preceptorship in Psychiatric Nursing" as a means to increase the skill level within and interest towards the preceptorship role in clinical practice. This paper presents an evaluation of courses conducted between 2000 and 2002. The findings suggest that participants (n = 150) were highly satisfied with the content and delivery of the course, and that it is likely to affect their attitude towards and fulfillment of the preceptorship role.     

对朝鲜族和汉族护生临床实习前后心理健康状况的研究

[目的]探讨朝鲜族与汉族护生临床实习前后心理健康状况。[方法]应用艾森克个性问卷及症状自评量表(SCL-90),对延边地区朝鲜族、汉族护生实习前后的心理健康状况进行评定。[结果]朝鲜族、汉族护生间的个性差异无统计学意义(P>0.05)。实习前护生SCL-90总均分、阳性项目数和各因子分均高于国内女性常模,差异有统计学意义(P<0.01或P<0.05);朝鲜族与汉族护生心理健康状况差异无统计学意义(P>0.05)。实习后护生躯体化、强迫症状、焦虑、精神病性、阳性项目数与国内女性常模比较差异有统计学意义(P<0.01或P<0.05),实习前后朝鲜族护生强迫症状、人际关系、焦虑、恐怖、偏执、精神病性、总均分、阳性项目数差异有统计学意义(P<0.01或P<0.05),而汉族护生实习前后各项差异均无统计学意义(P>0.05)。[结论]朝鲜族与汉族护生实习前后心理健康状况均较差,学校、实习医院护理管理者应给予重视。     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

HIV prevention for people with serious mental illness: a survey of mental health workers’ attitudes,knowledge and practice

Aim. The aim of this survey was to investigate the attitudes, knowledge and reported practice (capabilities) of mental health workers concerning humanimmunodeficiency virus (HIV) and other sexually transmitted diseases in people with serious mental illness. Background. People with serious mental illness are at increased risk of HIV and other sexually transmitted infections. Mental health workers have a key role to play in promoting sexual health in this population, but it is unclear how they perceive their role in this work and whether they have the capabilities to deliver sexual health promotion. Design. Cross sectional survey. Methods. A questionnaire was devised and distributed to 650 mental health workers working in a London (UK) NHS mental health service. Results. A response rate of 44% was achieved. Overall, workers reported positive attitudes to sexual health promotion and were knowledgeable about risk behaviours and risk factors for HIV infection. Adherence to glove wearing was good. However, participants’ knowledge about HIV/AIDS in people with schizophrenia was poor and most reported they were not engaged in sexual health promotion activities with people with serious mental illness. Glove wearing was predicted by those who had drug and alcohol training and clinical experience and knowledge of risk factors was predicted by previous health promotion training. No other demographic factors predicted any of the other subscales. Conclusion. Mental health workers require training to provide skills for health promotion regarding sexual health and HIV in people with serious mental health problems. In addition, there needs to be more research on risk behaviours. Relevance to clinical practice. The development of effective interventions to reduce this behaviour.     

The clinical activity of mental health nurse lecturers

Concerns have been expressed about the ability of mental health lecturers to prepare practitioners with the skills, knowledge and attitudes needed to implement the National Service Framework for mental health. Specifically mental health nurse lecturers have been criticized for lacking clinical competence and credibility, and for being out of touch with developments in service delivery. This paper presents a selection of findings from a recent review into the clinical activity of mental health lecturers in higher education institutions in England. The issues discussed include roles in practice, questioning the value of face-to-face clinical work, the benefits of being clinically active, the difficulties of clinical academic roles, barriers to maintaining clinical activity, questioning the quality of the clinical workforce, and finally strategies to facilitate clinical activity. Whilst there is support among mental health nurse lecturers for the need to engage with practice at some level, there are inconsistencies in the ways that this is being achieved. Lecturers are, however, getting together to debate how best to keep up with changes in mental health practice and delivery.     

An initial exploration of community mental health nurses' attitudes to and experience of sexuality-related issues in their work with people experiencing mental health problems

Human sexuality is a complex dynamic concept that escapes simple definition. Within nursing there seems to be a preference for broad holistic definitions that emphasize sexuality as an aspect of the unique human character. Whilst the nursing literature mostly portrays sexuality as wholesome and good, it also notes that sexuality can be a vehicle for the expression of power, hostility or hatred. In this study, the authors did not prescribe or limit the definition of 'sexuality'. Rather the term 'sexuality' was used in a broad sense in order to embrace the range of variables within the concept and allow respondents to consider the issues according to their own perspective. Despite broad acceptance of sexuality as a legitimate focus of health care, clinicians remain ambivalent about actively broaching sexual issues and there is a potential for clients' needs to go unmet. A number of intertwining variables can influence sexuality-related nursing practice. Nurses' attitudes are regarded as major barriers that prevent open discussion on the topic. This study aims to explore a sample of community mental health nurses' views on the topic of sexuality in relation to their work with clients. The authors adapted a sexual ideology scale previously used for the purposes of teaching students and promoting discussion. The questionnaire was distributed to nurse delegates at an annual CPNA conference. Two of the authors were available throughout the conference to discuss the study. Delegates were asked to recruit CMHN colleagues following the conference in order to increase the sample. The data are described and analysed using SPSS for Windows. Respondent characteristics have been cross-tabulated with item responses and analysed using chi-square and other statistical tests of association. The respondents (n = 122) confirmed sexuality as a relevant clinical issue and there was an overwhelming affirmation of people with mental health problems as sexual beings. Sixty-three per cent (n = 77) of respondents anticipated that people with mental health problems who are in relationships might experience sexual problems, and 52.4% (n = 64) agreed that a sexual history should be routinely included in assessment. Seventeen per cent (n = 21) had encountered clients becoming sexually aroused during the administration of a depot injection in the community. The authors identify this as an area of concern that warrants further investigation. The results indicate that although awareness of sexuality issues may be high there may be less agreement as to how such awareness should translate into CMHN practice.     

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings

Pedagogy, power and practice ethics: clinical teaching in psychiatric/mental health settings Often, baccalaureate nursing students initially approach a psychiatric mental health practicum with uncertainty, and even fear. They may feel unprepared for the myriad complex practice situations encountered. In addition, memories of personal painful life events may be vicariously evoked through learning about and listening to the experiences of those diagnosed with mental disorders. When faced with such challenging situations, nursing students often seek counsel from the clinical and/or classroom faculty. Pedagogic boundaries may begin to blur in the face of student distress. For the nurse educator, several questions arise: Should a nurse educator provide counseling to students? How does one best negotiate the boundaries between ‘counselor’, and ‘caring educator’? What are the limits of a caring and professional pedagogic relation? What different knowledges provide guidance and to what differential consequences for ethical pedagogic relationships? This paper offers a comparative analysis of three philosophical stances to examine differences in key assumptions, pedagogic positioning, relationships of power/knowledge, and consequences for professional ethical pedagogic practices. While definitive answers are difficult, the authors pose several questions for consideration in discerning how best to proceed and under what particular conditions.     

Prevalence of co‐occurring alcohol and other drug use in an Australian older adult mental health service

Co‐occurring mental illness and substance use disorder, known as dual diagnosis, is a significant challenge to mental health services. Few older adult specific alcohol and other drug treatment services exist, meaning older adult mental health services may become the default treatment option for many. Evidence suggests that dual diagnosis leads to substandard treatment outcomes, including higher rates of psychiatric relapse, higher costs of care and poorer treatment engagement. This paper explores the prevalence of co‐occurring alcohol and other drug (AOD) use in an older adult community mental health service in inner Melbourne, Australia. This aim was accomplished by using a retrospective file audit of clinical intake assessments (n = 593) performed on consumers presenting to the service over a two‐year period, June 2012–2014. Of consumers presenting to the service, 15.5% (n = 92) were assessed by clinicians as having co‐occurring AOD use. Depression predominated in the dual diagnosis group as the primary mental health disorder. Dual diagnosis consumers in this sample were statistically more likely to be male and younger than their non‐dual diagnosis counterparts. A limitation of this audit was the lack of implementation of screening tools, leaving assessment to clinical judgement or the interest of the clinician. This may also explain the discrepancy between the results of this study and previous work. Although appearing to be a relatively small percentage of assessments, the results accounted for 92 individuals with complex mental health, AOD and medical issues. Poor screening procedures in a population that is traditionally difficult to assess need to be rectified to meet the future challenges inherent in the ageing baby boomer generation, changing drug use trends and extended lifespans through harm reduction initiatives and medical advancements.     

New directions in mental health practice with older people: Canadian strategies for mental health reform

Aim and objective.  The purpose of this article is to draw attention to problems in the Canadian health system that must be overcome if Canada is to ensure that older people can access the services they need.
Background.  Projections suggest that 20% of Canadians will be aged 65+ by 2021. If current prevalence rates for mental illness continue, this will result in a significant increase in the number of older Canadians with or at risk for mental illness and mental health problems.
Design.  Findings of the final report of the Standing Committee on Social Affairs, Science and Technology are summarized and related to the intended role and primary strategy of the proposed Canadian Mental Health Commission.
Methods.  The relevance of the Interprofessional Education for Collaborative Patient-Centred Practice initiative launched by Health Canada is then considered in light of the intention that the Commission adopt collaboration with relevant stakeholders as its primary strategy for achieving mental health reform.
Conclusions.  Fragmentation in service delivery must be overcome if older Canadians are to receive age appropriate mental health services when and where they need them. Yet there is little evidence that the degree of interprofessional collaboration required can be achieved.
Relevance to clinical practice The reforms advocated by the Senate Committee are widely embraced but evidence is needed on how mental health and other professionals can best learn to work together in the interests of older people and other mental health consumers.     

Rural community mental health nursing: a grounded theory account of sole practice

ABSTRACT:  This paper examines community mental health in rural and remote settings, characterized as sole practice. Using a grounded theory approach, the research reported here explored how meanings of health and health care are advanced within the context of rural mental health care, dominated and in the main led by nurses. Five different practice sites in rural New South Wales were involved. The study articulated a model of therapeutics that foregrounds a relationship of intense professional intimacy and trust against a context of geographical disadvantage and professional isolation. The meanings of the relationship are elaborated in terms of unusually high levels of responsibility, professional ingenuity, powerlessness and the independent and risky character of life in the bush.     

An evaluation of a combined education and multi-project practice development programme in mental health

This paper describes a unique mental health practice development programme, which aims to integrate education, research, clinical practice and culture change, and promote collaboration between academics, researchers and healthcare practitioners to meet current government policy needs. The programme combines academic qualifications within the context of practice development and aims to produce practitioners who are dynamic leaders, capable of critical thinking, influencing culture change and challenging the nature of conventional practice. The aim of the evaluation was to give insight into participants' experience of the programme using a qualitative approach. Open-ended questionnaires obtained participant's views on facilitation and module content. Focus groups discovered the views and experiences of participants of the programme. The findings showed that the programme was well-received and impacted positively on both patient care and the personal and professional development of participants. The findings were used to modify the programme for the next intake of participants. The research complements the existing body of knowledge on practice development and highlights the benefits for staff, nurses and service users, and the challenges of implementation. The framework and design has the potential to be applied to other areas of practice beyond mental health.     

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.     

The reality of practice development for nurses working in an inpatient service for people with severe and enduring mental health problems

Nursing practice development is a growing priority for the British National Health Service. However, the nature of practice development remains poorly articulated. Despite the growing number of papers on practice development in nursing, there is insufficient guidance in the literature for the practical day-to-day management of the role, particularly in the inpatient environment. This paper explores the tensions experienced by practitioners engaged in practice development within a service for people mainly with a diagnosis of psychosis. The entrenched culture of the environment is described, which was resistant to change therefore did not easily embrace practice development. Within such a culture it is important to balance effective management with team development and support. Although this balance is essential for positive change, it is the maintenance of the balance that often leads to the tensions experienced by practice development practitioners. The paper describes numerous tensions including the competing agendas, influencing 'hearts and minds' rather than forcing change and working where people are at. Each tension is explored alongside possible survival strategies. The material presented aims to be realistic and although it may not be generalizable to other settings and staff groups, the authors hope to stimulate debate about similar or contrasting experiences of practice development.     

护理实习大专生心理健康水平与应对方式相关性研究

目的调查护理实习大专生心理健康水平及其与应对方式的相关性。方法采用症状自评量表和简易应对方式问卷对188名护理实习大专生进行调查。结果护理实习大专生躯体化、强迫、抑郁、焦虑和恐怖因子得分高于国内常模(P<0.01);积极应对得分与消极应对得分均低于常模(P<0.01或P<0.05);消极应对得分与症状自评量表各因子分呈正相关(P<0.01)。结论护理实习大专生消极的应对方式与心理健康水平密切相关,护理教育者应对护理实习大专生进行有针对性的心理干预。     

Implementing research findings into mental health nursing practice: exploring the clinical research fellowship approach

ABSTRACT:  The lack of research utilization within nursing practice has been extensively discussed in the literature. The Clinical Research Fellowship (CRF) program was developed to assist nurses to change practice on the basis of high-quality research evidence. This paper presents the results of a qualitative study examining the experiences of four CRF participants and three of their unit managers in completing the program and implementing changes within the clinical setting. The major themes to emerge from the data were: experience of the program, outcomes, implementation, assistance from the Centre for Psychiatric Nursing Research and Practice, Victoria, Australia, benefits and drawbacks to the program and whether it would be recommended to others. The findings indicate a positive view of the program itself although problems with the implementation stage were clearly evident. Further support following completion of the program is required to achieve maximum benefit from the program.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.