Exploratory study of mental health consultation-liaison nursing in Australia: Part 1. Demographics and role characteristics

Mental health nursing roles in Consultation-Liaison (CL) psychiatry and emergency departments are rapidly developing within Australia since the mainstreaming of mental health services within the general health-care system. Anecdotal evidence suggests that many of these positions have been initiated and developed in relative isolation and with little formalized support. Consequently, a comprehensive understanding of these roles and the nurses who occupy them is limited. A survey was developed and distributed to gather information on CL nurses in Australia. The survey was aimed at CL nurses working in a range of settings and included questions relating to demographics, qualifications, experience, clinical practice, organizational structure, education, clinical supervision, education and training and work satisfaction. This, the first of a two-part paper, will present the key findings relating to demographics and characteristics of the role. Overall, the findings demonstrated that the CL nurses who responded to the survey (n = 56) were experienced psychiatric/mental health nurses working primarily in general hospital wards and/or emergency departments; receive requests for consultation from a range of health professionals but predominantly nurses; provide education to a range of staff groups; and use a range of titles to identify their role.     

Nurse faculty perceptions regarding psychiatric-mental health nursing behavioral interventions: a cross-cultural comparison

Mental disorders are internationally responsible for significant disease burden and disability. However, limited cross-culturally comparisons, related to psychiatric-mental health nurses and the care they deliver, have been conducted. Therefore, the purpose of this article is to present information obtained from nurse faculty from Australia, Hong Kong, Japan, South Korea, Thailand and the USA (State of Hawaii) about: a) titles and educational preparation of the psychiatric-mental health nurses; b) the role and perception of others about the psychiatric-mental health nurses; c) nursing behavioral interventions, including medications; d) length of stay of hospitalized psychiatric patients; e) leading mental health problems; and, f) the profile of the population with a mental illness. The findings reflect diversity in the role and educational preparation of psychiatric-mental health nurses, as well as how psychiatric-mental health patients are treated.     

Role perceptions and reported actual role content of hospital nurses in Mainland China

Aim. The study aimed to explore nurses’ views and experiences regarding their working roles in Mainland China. Background. Ministry of Health guidance relating to the hospital nurse's role has been widely used in Mainland China since 1982 but it does not adequately cover the development of new roles arising from recent health care system reforms. This has led to increasing concerns about the potential of role conflict and role ambiguity for nurses especially where role expectations are not reflected in actual role content leading to job dissatisfaction and higher turnover. Methods. A cross‐sectional survey design using postal questionnaires comprising demographic questions and four scales measuring role perception and actual role content, job satisfaction, occupational stress, role conflict and role ambiguity was used. Five hundred and twelve hospital nurses in Beijing participated representing a response rate of 81%. Results. Most respondents reported that staff nurses should undertake most of the roles described in the domain of patients’ physical care, psychosocial and communication and professional aspects of patient care and patient care management and there was overall consensus regarding the roles of other health care personnel. Further, they reported that nurses always or sometimes carried out these roles. Different role perceptions were reported across educational groups. Additionally, nurses’ ratings of role perception and actual role content were related to their ratings of job satisfaction, occupational stress, role conflict and role ambiguity (p < 0·05). Conclusions. There was relative consensus regarding role perceptions but the role boundary between nursing and non‐nursing work lacked clarity. The importance of role expectations is highlighted regarding job satisfaction and other components of working lives. Relevance to clinical practice. Acknowledgement of a potential gap between expectations and actual role of nurses provides the basis for developing strategies to reduce resulting occupational stress, role conflict and role ambiguity and increase job satisfaction. Additionally the findings provide a basis for international comparison of actual nurse role content and the potential support needs of nurses from Mainland China who move to work in other health care systems.     

Emotional problems in primary care: what is the potential for increasing the role of nurses?

It has been suggested that the role of primary care and community nurses should be expanded in relation to mental health in order to assist in the prevention and management of prevalent emotional disorders such as depression and anxiety. However, relatively little is known about the mental health work presently undertaken by these nurses. Furthermore, nurses'training needs, attitudes and organizational barriers to role expansion in this area have not been systematically explored. This article seeks to review the literature on nurses' potential and current mental health work, current and future training needs, the views of patients and nurses concerning an expanded nursing role, and organizational issues of relevance. Educational interventions which have been systematically evaluated are also reviewed. The results suggest that nurses are already involved in emotional health care with a variety of patient groups, although this is not always acknowledged as mental health work. While clear potential for an expanded role exists, there is little consensus as to what role would be most effective for each nursing group, and few educational interventions have been demonstrated to be of proven effectiveness.     

Toward an integration of competencies for advanced practice mental health nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of boundaries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic programs. The purposes of this article are to discuss the need for a blended clinical specialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners.     

The role of second health professionals under New Zealand mental health legislation

The development of generic statutory roles in mental health care has been the subject of discussion by New Zealand nurses for the past decade. One such role is that of second health professional in judicial reviews of civil commitment. Issues identified by New Zealand nurses have also been raised in England, where it seems that nurses are likely to assume the role of Approved Mental Health Worker under English mental health law. A survey of mental health nurses found that few had received any preparation for the role of second health professional and 45% did not feel adequately prepared for the role. Some of these issues are reflected in a New Zealand inquiry which resulted in the Ministry of Health developing a written report form for second health professionals. However, the form has the potential to reduce the mental health nursing role to a narrow legal role. Statutory roles such as that of second health professional challenge mental health nurses to critically reflect on the conceptual and ethical basis of their practice. While traditional concepts such as therapeutic relationships and advocacy need to be reviewed in light of these changes, nurses need to be vigilant in articulating the moral and clinical basis of their roles. The development of guidelines for he second health professional role is suggested as a way of supporting clinical practice in this area.     

Institutionalized nursing staff: planning and developing a specialized educational framework that enhances psychiatric nurses' roles and promotes de-institutionalization

For centuries psychiatric services were provided by mental health hospitals, which were operating upon bureaucratic principles: strict hierarchies, slow processes and segmentation of duties. Research has shown that psychiatric nursing, as exercised in these traditional settings, has dealt with several problems in relation to: the amount and quality of time spent with patients, the type of duties performed, the lack of autonomy etc. The closure of many psychiatric institutions and their substitution with community-based settings, signified that health professionals should perform a variety of new duties, exhibit new skills and develop new perceptions about their work and the patients. In order for such alterations to occur, education can play a vital role in the re-conceptualization of psychiatric nursing and in the practical preparation of students for their future work. The present paper focuses on the contradiction between nursing as practised in Greek mental health hospitals and the current trends and demands placed upon nurses, to exhibit a new 'face'. The purposes of this paper are: first, to review the research on psychiatric nurses' behaviours in mental health hospitals. Second, to present the outcomes of bureaucracy on employees and finally, to propose an educational scheme that could reinforce the shift from institutionalized work to de-institutionalized.     

A broken promise? Exploring the lack of evidence for the benefits of comprehensive nursing education

Over the past approximately 25 years, Australia has undergone significant changes in the educational preparation of nurses. Australia has moved away from specialization in areas, such as mental health nursing at undergraduate level, in favour of a comprehensive model, an approach that remains controversial. The aim of this paper is to identify and critique the three main arguments advanced in support of comprehensive nursing education, which we argue are not supported by existing evidence. The purported wide skill and knowledge base does not appear to have brought about identifiable improvements in consumer outcomes. The evidence regarding stigma suggests comprehensive nursing education has not impacted favourably on nurses' attitudes towards working with people with mental health problems. There is no evidence to support the notion that graduates will be able to better deal with and meet the physiological needs of those people diagnosed with mental illness. From the arguments articulated in this paper, we conclude that comprehensive nursing education has not met its promises or expectations, and as a result, specialist entry-level preparation for nurses ought to be reintroduced as a matter of urgency in Australia.     

The biological sciences in mental health nursing: stakeholders' perspectives

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers' solution to the 'bioscience problem' was to curtail the input. In contrast, service users described serious shortfalls in professionals' abilities to inform them of common side-effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users' views of their needs.     

Advanced practice nursing roles: development, implementation and evaluation

AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals.     

Triumph and adversity: Exploring the complexities of consumer storytelling in mental health nursing education

Consumer participation in the education of health professionals is increasing, particularly in mental health nursing education and storytelling remains the most frequent approach to consumer involvement. The use of story has tended to be accepted as a legitimate educational tool with limited critique or consideration of its potential consequences presented within the academic literature. A qualitative exploratory research study was undertaken with mental health nurse academics (n = 34) and consumer educators and academics (n = 12), to investigate the perceptions and experiences of mental health nurses and consumers regarding the involvement of consumers in mental health nursing education. Data were analysed thematically. Story was a major theme to emerge from consumer participants and received some attention from nurse academics. Consumers and nurses both referred to the power of story to convey the human experience of mental illness diagnosis and service use; and the vulnerability that can result from storytelling. Consumers also described: story as expectation; preparation and support; and the politics of story. All participants supported the value of storytelling in mental health nursing education. Consumers had considered the complexities in far greater detail. The ongoing value of story as an educational technique requires further research. Equally important is considering a broader range of educational roles for mental health consumers.     

Mental health training needs of primary health care nurses

The primary health care team (PHCT) has a critical role to play in the care of people with mental health problems. However, little attention has been paid to the mental health training and preparation required by primary health care nurses. This paper reports on a training needs assessment undertaken in one London health authority area. The findings indicate that primary health care nurses are undertaking a wide range and increasing volume of mental health work with little preparation and training. Specific training needs include time and space to identify training gaps; basic training in mental health, safe working practices and management of role boundaries; and multidisciplinary training. In addition, NHS trusts, primary care groups and health authorities need to clarify which aspects of nurses' mental health workloads are appropriate to their role and develop policies, procedures and training to support them in undertaking that role.     

Preparing nurses to work effectively in the prison environment

Nurses who go to work in prisons begin their new career without having had any specific preparation for this unique and diverse role. The demands placed upon nurses are unlike any they will have experienced in their previous clinical posts. The work of a nurse in prison contains elements of both mental health nursing and practice nursing. The context in which this nursing occurs means that the nurse is presented with complex clinical and professional dilemmas. Consequently, few nurses start to work within this specialty with all of the core competencies required to be clinically effective and confident in their role. This article describes how this unmet educational need was addressed by the development of a diploma level module.     

Turning the Coin—Emphasizing the Opportunities in Mental Health Nursing

It is widely acknowledged that mental health nursing has undergone considerable change in Australia during recent decades, including the mainstreaming of mental health services into the general health care system. Recruitment problems and high levels of stress and burnout associated with the profession are seen to be indicative of a degree of demise in the status and desirability of this field of practice. However, new nursing roles have developed in response to these changes. The aim of this paper is to focus on three specific roles: mental health consultation-liaison nursing; mental health nurse practitioner; and the mental health nurse incentive program. These new roles present exciting and rewarding career opportunities for mental health nurses and may increase the attractiveness of mental health nursing for new graduates.     

Specialist practice in community mental health nursing

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.