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.     

Service users and mental health nursing

A better understanding of the views of service users has become increasingly relevant in providing mental health services and for the role of the mental health nurse in meeting users' needs. The four key issues that this research endeavoured to address were: (1) What are the views and perceived needs of users of mental health services in the context of the role that users see nurses fulfilling? (2) How do student nurses perceive their future role given the changes in nurse preparation? (3) To what extent do the answers to the first two questions converge and/or diverge? (4) Recommend actions on ways in which mental health nurse training could be improved, in light of the findings of this research. Methodologically, both qualitative and quantitative data gathering approaches were used, the former for stage one in setting the agenda and the latter for stage two by means of questionnaires. The findings indicate that the key concerns for users are issues of choice, individuality, information and quality of care in terms of positive interpersonal relationships with those who have responsibilities for helping them and who are sensitive to their real needs. Users are not asking for any costly or extravagant therapies but support that is relevant to their needs and provided in a compassionate manner. The context of their lives and the degree to which users feel integrated into society is a prominent concern. These findings have implications for how mental health nurses are educated and trained and how on qualifying they function in practice. The findings throw into question whether mental health nursing can adapt to the desired changes that are being called for.     

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.     

Role of the mental health nurse towards physical health care in serious mental illness: an integrative review of 10 years of UK literature

People with serious mental illness have significantly poorer physical health compared to the general population. Mental health nurses are in a prime position to help reduce unacceptable death in this population. A literature search was undertaken to identify the role of the mental health nurse in regards to physical health care, intervention, and attaining the necessary knowledge to address the physical health needs of people in the UK with serious mental illness. Of 254 papers identified, nine met the inclusion criteria. An integrative literature review found that mental health nurses are not routinely supported by physical health-care education and training, with many expressing role ambiguity. Inpatient setting correlated to a less positive role attitude; poor primary-secondary care interface communication compounded the problem of this vulnerable population having their physical health needs identified and met.     

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.     

District nurses' involvement and attitudes to mental health problems: a three-area cross-sectional study

Aims and objectives. The main aims of this study were to obtain information on the extent of staff contact and input with mental health problems and to determine their experience, training and attitudes to such problems. Background. Historical changes and policy shifts have resulted in primary care providers playing an increasing role in the care of mental health problems. Such problems are common within community settings and a major cause of suffering and disability. District nurses in particular are likely to encounter a high level of psychological co‐morbidity in their patients. Information is lacking on their involvement, attitudes and specific training for this area of their work. Design and methods. A cross‐sectional study was conducted of the staff of district nursing services in three areas, Jersey (Channel Islands), Lewisham and Hertfordshire, using a postal questionnaire. Results. Questionnaires were sent to 331 staff; 66% responded. Community and district nurses estimated a 16% prevalence of mental health problems among their patients, most commonly dementia, depression and anxiety disorders. Staff noted participation in a wide range of psychological care activities, but identified a lack of training for this aspect of their role (three‐quarter of nurses had received no such training during the past five years). They reported a willingness to develop their understanding and skills by means of educational programmes. Attitude measures revealed generally optimistic views concerning depression treatment, a rejection of deterministic attitudes about this condition and confidence in the role of district nursing staff in managing such problems. Conclusions. The need for primary care mental health training is widely noted and based upon consistent evidence of the limited detection and treatment of these problems. This study has employed quantitative methods to clarify the extent and nature of district nursing staff involvement in this area of practice and indicates that training needs are acknowledged by community nurses from geographically distinct settings. Relevance to clinical practice. Staff are interested in developing knowledge and skills pertinent to the psychological problems of their patients and their views reveal a consensus that the most important areas for learning are recognition of mental disorders, anxiety management, crisis intervention and pharmacological treatments for depression.     

The training needs of primary care nurses in relation to mental health

Nurses working in primary care are in the front line of providing mental health services. The National Service Framework for Mental Health sets out new standards in service provision, yet this key group of staff is, in many cases, not fully equipped with the necessary skills and knowledge to comply. Michael Nash has conducted a training needs analysis of primary care nurses in a London borough. The results highlight areas of concern and indicate a way forward to ensure appropriate mental health care training for these professionals.     

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes,practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post‐registration physical health‐care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post‐registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.     

The educational preparation of nursing staff undertaking pre-assessment of surgical patients--a discussion of the issues

This article discusses the education and training needs of nursing staff undertaking the pre-assessment of surgical patients in the context of role development within health care. The authors undertook this piece of work as part of a project to inform the development of a competency framework for use by registered nurses working in the field of pre-assessment screening and preparation of surgical patients. A selective review of the literature on the education and training needs of pre-assessment nurses, and nurses undertaking expanded roles has been undertaken and some of the emerging issues are debated. The nature of current preparation for these roles and the apparent lack of any consistent approach to education and training for staff adjusting their scope of professional practice is debated. A brief review of the nature of competence and some of the different models including occupational competence models are presented. Finally, the implications of these for the development of a strategy for the acquisition and demonstration of knowledge and skills in pre-assessment nursing staff are presented.     

The education and training needs of qualified mental health nurses working in acute adult mental health services

This paper presents findings from a research study that investigated the education and training needs of qualified mental health nurses who work in acute adult mental health services in the UK. The study aimed to address a key knowledge 'gap' highlighted by recent Department of Health reports () that suggest that little is known regarding the education and training expectations, priorities and needs of mental health nurses who work in acute adult mental health services. This study aimed to identify (i) what type of post-registration education and training mental health nurses working in acute settings need; (ii) how the nurses want education and training to be delivered; and (iii) what qualifications and accreditation the nurses want to receive? The research consisted of two methods: focus groups and a questionnaire survey. This paper reports on the findings from the questionnaire survey. The results of the survey demonstrate that there is a real need for post-registration education and training for this group of nurses; to equip them with the relevant knowledge and skills to nurse people in the acute phase of their mental illness in acute inpatient settings.     

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.     

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.     

Training needs of managers in occupational mental health nursing field

Aim: In recent years, the mental health of workers has become a vital issue and the role of managers in occupational mental health promotion is now viewed as extremely important. In this study the training needs of managers with respect to occupational mental health were identified from the perspective of occupational health nurses, who are required to support managers in dealing with this complex problem. Methods: The subjects of the present study were 748 managers in a large public service enterprise who had taken part in training seminars on occupational mental health conducted from 2000 to 2001. In 2004 data were collected from written reports presented by occupational health nurses, which contained questions asked by the participants in the seminar. The content of 163 questions registered in the reports was coded and repeatedly classified based on the similarities between them, and five categories were eventually extracted. Results: The following categories were extracted: (i) basic knowledge of mental disorders; (ii) care for workers with mental disorders; (iii) workplace environment; (iv) mental health promotion; and (v) development of the workplace mental health management system. Conclusions: The managers targeted in this research showed great interest in promoting mental health in the workplace. It is necessary for occupational health nurses as health‐care professionals to cooperate with managers, comprehend their problems and concerns, and support them.     

Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa

Using programme research, this paper reports on the evaluation of a programme designed to orientate primary health care nurses towards the provision of a comprehensive approach to care. In addition to training in psychiatric care, this was deemed necessary in order to facilitate comprehensive integrated primary mental health care in South Africa. Nurse-patient consultations were evaluated on indicators of comprehensive care before and after the programme. Interviews were also conducted with the participants individually and in a group. The results indicate that there are several factors which mediate the provision of comprehensive care by primary health care nurses. These include individual factors as well as contextual factors, inter alia, the structure and organization of the health care system, which historically has been organized to promote biomedical care. Furthermore, biomedicine has dominated training models in South Africa, instilling in nurses a biomedical approach to patient care.     

Mental health issues in primary healthcare

This article describes a project that was designed to explore mental health issues arising in primary care, as a basis for understanding primary care professionals' mental health training needs. Whilst recent UK government initiatives, such as the National Service Framework for Mental Health, have emphasized the need to enhance mental healthcare in the general population, the capacity to respond effectively is likely to be dependent upon primary care professionals acquiring the relevant skills. To achieve this, a thorough understanding of the issues inherent in dealing with mental health problems in primary care is required. Given that the mental health issues facing primary care professionals may differ from those that confront mainstream mental health professionals, logic dictates that primary care professionals may require a discrete set of skills and a special approach to mental health training. The principal aim of this project was, hence, to identify mental health issues arising in clinical practice, as a first step towards identifying primary care training needs. A series of focus groups and semi-structured interviews was used to gather information about mental health issues arising in primary care, based on the experiences of primary care professionals and users' representatives. The findings suggest that primary care professionals are confronted by a wide range of mental health issues, many of which lie outside of the scope of the current National Service Framework for Mental Health. The article discusses the implications for mental health training in primary care practice and future research.     

Mental health in the community: roles,responsibilities and organisation of primary care and specialist services

UK health policy embodies two opposing trends affecting mental health care in the community: a move towards a primary care-led NHS which inevitably reflects the concern of GPs with 'milder' mental illness, and specific mental health policies intended to refocus the specialist services on people with 'serious' mental illness. A training needs assessment study undertaken with primary care staff and community psychiatric nurses revealed the problems created on the ground by these opposing trends. This paper describes these problems from the perspectives of three groups: primary care nurses, general practitioners (GPs) and community psychiatric nurses (CPNs). The overall impression was of primary care teams encountering high levels of need for which they felt unprepared, and of a CPN service torn in two by the opposing demands of GPs and their employing trust. The discussion section of the paper compares the findings of the study with a model for reorganisation put forward in the literature and highlights the obstacles to be overcome in bridging the policy gap.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Mental health issues within the general health care system: the challenge for nursing education in Australia

The mental health content of undergraduate nursing programs has consistently been identified as inadequate in preparing graduate nurses with the knowledge and skills for, and interest in, a career in mental health nursing. Since the introduction of generic nursing education, undergraduate programs have become primarily focused on the development of generalist skills, with specialisation occurring at postgraduate level. The integration of mental health services within the broader health care system in Australia has led to a significant increase in the prevalence of mental health problems within the general health care setting. The relevant literature suggests that nurses are not well prepared to meet the mental health care needs of this population. The aim of this paper is to briefly outline the incidence of mental health problems within the general health care system, the implications for nursing, and the potential role which nursing could play in recognising, and providing appropriate care for the treatment of mental health problems. The implications for nursing education, and the need for mental health nursing skills to be considered essential for all nurses will be discussed.     

A national survey of practice nurse involvement in mental health interventions

BACKGROUND: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. AIM: This study aimed to quantify practice nurses' involvement in delivering mental health interventions in primary care settings. METHOD: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non-eligible respondents were removed an adjusted response rate of 54% was achieved. RESULTS: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side-effects were infrequently monitored and PNs' understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. CONCLUSIONS: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.