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.     

Perceptions on individualized approaches to mental health care

Ways of working on acute psychiatric units have come under intense scrutiny in order for service users to receive modern care and treatment. This has led to various ways not only to improve the therapeutic milieu on psychiatric wards, but also to develop standardized approaches to care. This paper reports on a study on the development of a care pathway for people diagnosed with schizophrenia, with the aim of standardizing the care process. Action research was used to develop the care pathway and views were collected, and observations made from a range of mental health professionals. Not all respondents were in agreement with a care pathway and this led to clinicians defending the individualized nature of psychiatric care. Implementation of a care pathway may help not only to rekindle the therapeutic purpose of psychiatric care, but also to build in the individualized approach to carrying out hospital care. Limitations of the study have also been briefly reported.     

Primary health care practitioners' tools for mental health care

The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.     

Towards a rhetoric of spirituality in mental health care

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.     

A role for mental health nursing in the physical health care of consumers with severe mental illness

There is extensive international evidence that people with severe mental illness have a lower standard of physical health than the general population. This leads to higher morbidity and mortality rates. Many of the causes for this poor physical health are modifiable. Yet the physical needs of this consumer group are neglected by healthcare systems in Australia, and elsewhere. While medical specialists are clearly integral to remedying this, nurses are well placed to play a key role in focused prevention and early intervention in the physical well-being of consumers with mental health problems. This paper outlines the specifics on how mental health nurses can be sensitized, prepared and empowered to help turn this serious health issue around. In particular, mental health nurses could be trained in and then utilize a new physical health check and response system in the UK (called the Health Improvement Profile) if adapted for use within Australia. This profile will be briefly introduced, and then its value to improving health care discussed.     

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.     

The association between schizophrenia and cigarette smoking: a review of the literature and implications for mental health nursing practice

Despite a fall in smoking activity among the general population, individuals with schizophrenia continue to smoke at alarming rates and suffer poor health as a consequence. It would appear that limited and conflicting knowledge, outdated perceptions, and ineffective interventions have hindered efforts to promote healthy behaviours among this group. This paper reviews the literature on the association between nicotine dependence and schizophrenia and explores explanations for the phenomenon. Complex psychopathological, biochemical, and neuropharmacological interactions between smoking and schizophrenia are revealed. The interface of schizophrenia and smoking behaviour, particularly among those hospitalized in mental health facilities, and rationales for the management of this manifestation are examined. In addition, inferences regarding the role of mental health nurses in the care of this population are reached, and implications for nursing practice are discussed.     

Developing and testing instruments for improving cooperation and patient's participation in mental health care

The main purpose of the project was to develop computerized instruments that could be used by nurses and patients to assess their cooperation and mutual contributions to care. This paper presents a part of the project: the reliability and validity testing phase of a process of instrument development. To test the validity and reliability of the instruments, data were collected with questionnaires from nurses (n = 146) and patients (n = 286). The validity evaluated as construct validity and the reliability evaluated as internal consistency of the instruments were quite good. Construct validity was tested by factor analysis, and internal consistency was tested by Cronbach's alpha coefficient, which varied from 0.69 to 0.79. The instruments, which consisted of a software application that can be operated in a www environment, were meant to be used as tools in the psychiatric nursing context for assessing the cooperation between the nurses and patients and the patient's participation in his/her care. Furthermore, the computer programme can be used as a tool for developing and assessing the patient orientation in nursing.     

GP group profiles and involvement in mental health care

Rationale and objectives Mental health is one of the leading causes of morbidity worldwide. Its impact in terms of cost and loss of productivity is considerable. Improving the efficiency of mental health care system has thus been a high priority for decision makers. In the context of current reforms that privilege the reinforcement of primary mental health care and integration of services, this article brings new lights on the role of general practitioners (GPs) in managing mental health, and shared‐care initiatives developed to deal with more complex cases. The study presents a typology of GPs providing mental health care, by identifying clusters of GP profiles associated with the management of patients with common or serious mental disorders (CMD or SMD). Methods GPs in Quebec (n = 398) were surveyed on their practice, and socio‐demographic data were collected. Results Cluster analysis generated five GP profiles, including three that were closely tied to mental health care (labelled, respectively: group practice GPs, traditional pro‐active GPs and collaborative‐minded GPs), and two not very implicated in mental health (named: diversified and low‐implicated GPs, and money‐making GPs). Conclusion The study confirmed the central role played by GPs in the treatment of patients with CMD and their relative lack of involvement in the care of patients with SMD. Study results support current efforts to strengthen collaboration among primary care providers and mental health specialists, reinforce GP training, and favour multi‐modal clinical and collaborative strategies in mental health care.     

Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.     

Service user involvement in care planning: the mental health nurse's perspective

A dissonance between espoused values of consumerism within mental health care and the 'reality' of clinical practice has been firmly established in the literature, not least in terms of service user involvement in care planning. In order to begin to minimize such dissonance, it is vital that mental health nurse perceptions of service user involvement in the core activity of care planning are better understood. The main findings of this qualitative study, which uses semistructured interviews, suggest that mental health nurses value the concept of user involvement but consider it to be problematic in certain circumstances. The study reveals that nurses hold similar views about the 'meaning' of patient involvement in care planning but limited resources, individual patients characteristics and limitations in nursing care are the main inhibiting factors. Factors perceived as promoting and increasing user involvement included: provision of accurate information, 'user-friendly' documentation, mechanisms for gaining service user feedback, and high staff morale.     

Greek psychiatric care reform: new perspectives and challenges for community mental health nursing

The purpose of this article is twofold: (1) to explore the main issues of psychiatric care reform in Greece and outline the operating way of the new residential structures of psychiatric care and rehabilitation; and (2) to focus on the implementation of mental health nursing roles in the primary care services such as supervisor-therapist, liaison, coordinator-crisis interventionist and counsellor-trainer within the context of a multidisciplinary therapeutic team. Given that multiple professionals are involved in mental health care in primary care, issues of role are likely to be crucial to the effective implementation of new workers. Moreover, there is existing evidence of ambiguity in the roles of different mental health professionals in primary care, relating to the problems they manage and the treatments they provide. The authors believe that more emphasis needs to be given to the mental health nursing specialty in Greece, because the large majority of patients requiring mental health care should have the possibility of taking better quality of care as the psychiatric structures at community are continuously developing.