Self-reports of recovery-oriented practices of mental health nurses in state mental health institutes: development of a measure

The focus of this study was to modify a measure of recovery practice for mental health nurses and explore nurses' self reports of recovery practices. Findings support the soundness of the Recovery Self Assessment-Registered Nurse Version (RSA-RN) as a self-assessment instrument designed to evaluate recovery-oriented nursing practice. More favorable perceptions of recovery practices were noted amongst older and more experienced nurses, those who had previous formal training or education in mental health recovery or psychiatric rehabilitation, and those who considered their facilities to be recovery-oriented. The RSA-RN can be use to identify nurses' and nursing departments' strengths in the provision of recovery-oriented interventions and lead to focused performance improvement.     

对在职护理本科生精神科护理临床实习需求的调查

目的了解在职护理本科生对精神科护理临床实习的需求。方法采用自行设计问卷,调查北京2所护理学院的在职护理本科二年级的204名学生对精神科护理临床实习的需求。结果89．7％的护生认为对在职护理本科生有必要开设精神科护理课程;91．2％的护生认为课程设置中应该安排精神科的临床实习,实习时间最好为1—2周。实习过程中希望采用临床观摩、亲自参与患者护理等形式,达到掌握沟通交流的技巧、患者的安全护理、典型症状的识别、精神科药物护理等目的。结论对在职护理本科生教学中有必要安排精神科护理课程,并在课程设置中增设临床实习内容,提高护生的综合能力。     

Exploration of personal recovery-oriented care on an acute mental health unit

BackgroundPersonal recovery should be the cornerstone of mental health nursing practice. Nursing interventions should build on consumers' strengths to provide hope, so consumers are empowered to achieve their own personal goals.AimThe aim of this study was to explore mental health nurses’ lived experience of their practice, understanding and knowledge of personal recovery-oriented care on acute mental health units.MethodVan Manen's methodology was utilised in this study. Data was gathered through semistructured conversational interviews with mental health nurses working on an acute unit.FindingsParticipants found personal recovery was difficult on an acute mental health unit. Factors that participants identified that impeded personal recovery-oriented care on acute mental health units included: the acuity of consumers in a low dependency area, lack of time to engage consumers, and loss of the therapeutic role for mental health nurses on acute units.DiscussionMental health nurses are expected to focus on the personal recovery needs of mental health consumers while managing clinical risks to consumers and others on the acute unit. This has the mental health nurse navigating a course between two worlds, and results in mental health nurses being confused between concepts of personal recovery and clinical recovery.ConclusionIf acute mental health nurses cannot define personal recovery, they will not be able to effectively implement interventions that support consumers in their personal recovery journey on acute units and will be drawn into the clinical recovery paradigm.     

A grounded theory study of the role that nurses play in increasing clients' willingness to access community mental health services

ABSTRACT:  lients and caregivers frequently encounter difficulties in accessing mental health services. Early intervention to care and treatment is essential to recovery as delays can adversely affect the severity and the duration of the illness. This paper reports the factors that encouraged and deterred young adults with schizophrenia and their caregivers when trying to seek early access to community mental health services, and examines how community mental health nurses made themselves accessible to these individuals in order to increase their access to services. The findings showed that several factors simultaneously encouraged and inhibited individuals initiating contact at community mental health centres, and these had serious implications for care and treatment, and recovery. There were two client access pathways to care: a direct access pathway where an individual recognized signs of being unwell and sought help early; and an indirect access pathway where others, such as caregivers, general practitioners, police, and inpatient facilities initiated contact on an individual's behalf. Nurses used three strategies to enhance client and caregiver access to services: 'promoting favourable experiences to enhance approachability', 'using technology to promote access' and 'being available'. The findings have significance for nursing practice because they reinforce the importance of having good relationships with clients and caregivers, and the need to take account of the needs of caregivers. They highlight the benefits and drawbacks of using telecommunications to enhance accessibility, and why it is necessary to analyse nurses' workloads and time management skills.     

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.     

The experience and views of mental health nurses regarding nursing care delivery in an integrated, inpatient setting

Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.     

某地级市社区护士工作现状与居民护理需求的调查

目的调查某地级市社区护士工作现状与居民护理需求。方法采用自行设计的调查问卷对135名社区护士和338户社区居民进行调查。结果社区护士的工作重点在治疗护理方面,而预防、康复、保健、健康宣教和计划生育5项的工作力度明显不够;社区护理工作现状与居民需求存在差异,居民对社区护理服务的需求从疾病治疗向疾病预防和健康促进转变。结论社区护士应转变观念,加强疾病预防和健康促进的理念;社区护理应以居民需求为导向,尽快建立以社区人群健康为中心,融医疗、预防、保健、康复、健康教育、计划生育于一体的综合性社区护理服务模式。     

Nurses decrease barriers to health care by "hyperlinking" multiple-diagnosed women living with HIV/AIDS into care.

The Well-Being Institute (WBI), a community-based nursing organization in Detroit, Michigan, has developed and put into practice innovative intervention and service delivery models to assist HIV-positive women who have a history of substance abuse and mental illness. These multiple-diagnosed women are known to have special problems and barriers to accessing health care. The service delivery model is based on "hyperlinking" women into hard-to-get health care appointment slots through nurses' personal contacts in health care clinics. The intervention model is the personalized nursing LIGHT model. This article describes the service delivery and intervention models and discusses outcomes of the WBI Women's Intervention Program in practice. The program locates HIV-positive, substance-abusing women; enrolls them in primary medical and mental health care; and helps retain them in health care. The results of the model in practice demonstrate its success in hyperlinking hard-to-reach and hard-to-serve HIV-positive women with health care and other needed services and resources. In addition, these multiple-diagnosed women have shown positive effects with respect to improved sense of well-being and decreased psychosocial distress.     

Recovery as a Model of Care? Insights from an Australian Case Study

The terms “model of health care,” “service model.” and “nursing model of practice” are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.     

Maximising psychiatric nurses' contribution to interdisciplinary working

Internationally, the deinstitutionalization of psychiatric care has resulted in expanded roles for mental health nurses within a community interdisciplinary team setting. This presents an opportunity for mental health nurses to improve service delivery. This opportunity also results in a more empowered nursing team. This article identifies change issues within one community psychiatric nursing team and the team's contribution to an improved service delivery where service users can avail of same day assessment for crisis referrals, a reduction in waiting times for assessment and co-ordinated delivery of care with an identified key worker utilizing a recovery model philosophy.     

护士安宁护理自我效能及其影响因素的调查分析

目的探讨护士安宁护理自我效能情况及其影响因素。方法采用方便抽样方法,选择260名护士,采用护士安宁护理自我效能调查问卷进行调查。结果影响护士安宁护理自我效能的主要因素是对死亡态度、过去所在科室、护理终末期病人的经验、自觉重要程度。护士过去经验和对安宁护理的自觉重要程度与自我效能呈正相关（均P〈0.001）。结论增加护士照护经验积累,提高心理与灵性照护能力,重视安宁护理的教育及培训,对提高安宁护理质量具有积极的意义。     

Mental health nurses' work with family caregivers of older people with depression: review of the literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Meeting the continuing education needs of rural nurses in role transition

BACKGROUND: The community health center (CHC) model of care delivery is gaining acceptance throughout Canada's newly created rural health regions. The resulting change in nursing functions presents a challenge to regional health authorities to ensure the attainment and maintenance of practice competencies. METHOD: This qualitative study examined strategies used in selected parts of Canada to prepare and support rural diploma-prepared nurses for role transition from acute care into CHCs. RESULTS: In light of CHC nurses' increased degree of autonomy, skill level, and focus on community wellness, the findings indicate a need for additional educational preparation and supportive strategies for transitioning nurses. CONCLUSION: Regions should educate the public and staff about the principles of primary health care, population health, and factors that determine health to help stakeholders understand their community, the current gaps in service delivery, and the role of CHC nurses. Key players at the provincial level should work together to address competency issues and continuing education needs of nurses in career transition.     

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.     

某医院护士的心理健康水平及其影响因素

目的了解护士的心理健康状况,探讨影响护士身心健康的相关因素。方法采用SCL-90症状自评量表、护士工作压力源量表及自行设计的个人一般情况调查表,对某医院248名护士进行问卷调查。结果护士心理健康水平与中国常模比较,除人际关系外,其余各类因子得分均高于中国常模,有显著性差异(P<0.05)。本次测评检出248名护士中符合筛查阳性标准者58人,占23.4%;不同科室护士SCL-90各类症状因子分比较,各科室间有显著性差异(P<0.01),尤其外科、儿科、ICU监护室心理健康水平偏低;工作压力源与心理健康因子分呈显著正相关,与心理健康水平呈负相关。结论护理工作的性质及特点决定了护士的心理压力,护士的工作压力和心理健康水平显著相关。目前护士的心理健康水平现状不容乐观,呼吁全社会关心和爱护护士,提高她们的社会地位。     

某医院护士的心理健康水平及其影响因素

目的了解护士的心理健康状况,探讨影响护士身心健康的相关因素。方法采用SCL-90症状自评量表、护士工作压力源量表及自行设计的个人一般情况调查表,对某医院248名护士进行问卷调查。结果护士心理健康水平与中国常模比较,除人际关系外,其余各类因子得分均高于中国常模,有显著性差异（P〈0.05）。本次测评检出248名护士中符合筛查阳性标准者58人,占23.4%;不同科室护士SCL-90各类症状因子分比较,各科室间有显著性差异（P〈0.01）,尤其外科、儿科、ICU监护室心理健康水平偏低;工作压力源与心理健康因子分呈显著正相关,与心理健康水平呈负相关。结论护理工作的性质及特点决定了护士的心理压力,护士的工作压力和心理健康水平显著相关。目前护士的心理健康水平现状不容乐观,呼吁全社会关心和爱护护士,提高她们的社会地位。     

Mental health placements in a general health setting: no substitute for the real thing!

Aim. To determine effectiveness of clinical placements in non‐mental health facilities in producing improvement in attitudes toward people with a mental illness and toward mental health nursing in nursing students. Background. Clinical placements in mental health settings have favourably impacted students’ attitudes and confidence in mental health settings. Placement shortages have created discussion about using non‐mental health settings to gain this experience, as mental illness is common in all health settings. To date, no research findings support or refute the efficacy of non‐mental health settings in influencing confidence and attitudes. Design. A within‐subject design was used. Participants provided self‐report data soon after the beginning and at the conclusion of the mental health component. Methods. A questionnaire was administered to a cohort of undergraduate nursing students (n = 66) to measure attitudes, preparedness for practice and interest in mental health nursing as a career, using a pre‐ and post‐test design. Results. Only 25% of participants completed clinical experience in a mental health facility. Minor improvement in attitudes, confidence and appreciating the nursing role in mental health were identified, but the impact on attitudes was considerably less favourable than when clinical experience was undertaken in a mental health facility. Conclusion. Participants who completed clinical experience in a non‐mental health facility did not demonstrate more favourable views about mental health nursing. Relevance to clinical practice. Clinical placements in mental health are essential preparation for undergraduate students to maximise improvement in attitudes to the care of people diagnosed with a mental illness and to mental health nursing.