The need for psychiatric nursing: towards a multidimensional theory of caring

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. Although research has documented psychiatric nursing activity, little study has been made of the 'need' for psychiatric nursing within a multidisciplinary service. Employing adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals. The study was based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you, knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation distinguished these domains. The emergent theory extends current awareness of the importance of interpersonal relations in nursing. To what extent current health care policy, which emphasizes the promotion of alternative roles for nurses, will challenge this essential focus remains unclear.     

Undergraduate nursing students' attitudes towards mental health nursing: determining the influencing factors

Available evidence clearly demonstrates that undergraduate nursing students typically hold unfavourable attitudes towards psychiatric / mental health nursing as a career. It has been suggested that students' negative attitudes towards mental illness and consumers of mental health services may be responsible for the unpopularity of this specialty area; however, research exploring the relationship between career choices and students' attitudes is lacking. A sub-set of data from a large Victorian study that examined undergraduate nursing students' attitudes towards mental illness, mental health nursing, and mental health clinical placement experiences was used to clarify the nature of this relationship. In total, complete data was available from 605 students undertaking their first mental health placement who provided responses to a 24-item pre-placement survey. This survey assessed the following three areas: 1. preparedness for the mental health field; 2. attitudes towards mental illness; and 3. attitudes towards mental health nursing. The findings demonstrate significant relationships between students' attitudes, beliefs, and characteristics and desire to pursue a career in psychiatric mental health nursing. The identification of these relationships provides a basis from which interventions to influence nursing students' attitudes towards psychiatric/mental health nursing, can be planned.     

Bringing psychiatric nursing into the twenty-first century

Psychiatric nursing stands at a crossroads, in danger of losing both its identity and standing within the larger body of nursing. Enrollment in graduate programs is at an all time low and many traditional employment opportunities for psychiatric nurses are disappearing. Many explanations have been proposed to account for the crisis in psychiatric nursing practice. Although many of the identified external forces have had real impact on psychiatric nursing, these factors have impacted all of nursing. Yet our Nurse Practitioner (NP) peers are thriving, with proliferation of NP programs with unprecedented enrollment for this nationally accepted and understood role. The psychiatric nursing crisis may be most directly related to the reality that we as a professional group have thus far failed to adequately respond to external realities that have dramatically altered the environment in which psychiatric nursing occurs. This article argues for reframing the discipline of psychiatric nursing, accomplished as a national consensus building process, and including 4 critical components: (1) reconceptualization of what constitutes the core of psychiatric nursing content and represents the epistemological heart of the profession; (2) identification of the critical clinical competencies that reflect the core content, represent the role and scope of psychiatric nursing, and that match current and anticipated practice realities; (3) identification and standardization of measurable clinical outcomes, predicated on both content and competencies, which will allow psychiatric nurses to measure, in meaningful ways, the impact of their practice on patients' health; and (4) establishment of a research agenda that will allow psychiatric nursing to expand its unique knowledge base.     

The psychiatric educational experiences of advance beginner RNs

The nursing profession is in an extraordinary position to improve educational experiences of prospective nurses, particularly within psychiatric nursing. To acquire an enhanced understanding of the nurse's instructive learning process and skills regarding psychiatric nursing, this study described and explored the experiences of advance beginner nurses employed in mental health facilities. It also denoted the registered nurses' (RNs) educational preparedness to function in their new professional role. Reflection of the nurse's personal experiences was acquired by using a qualitative study with a phenomenological approach. Colaizzi's Frame work [Colaizzi, P., 1978. Psychological research as the phenomenologist views it. In: Valle, R., King, M. (Eds.), Existential Phenomenological Alternative for Psychology. Oxford University Press, NY, pp. 48-71] guided the mode of data analysis by enlisting 15 advance beginner nurses to participate in in-depth, audio-taped interviews. Results from this study indicated a need for educational improvements to accurately reflect trends of psychiatric patient care in order to emphasize interpersonal relationships as well as multi-diagnosis and co-morbidity. Additionally, increased contact with diverse patient populations and responsibilities congruent with other clinical placements in managing the patient's overall care were noted to be critical. This study suggests that some nursing educational programs can improve their curriculum, methods of teaching and approach used to introduce students to psychiatric mental health nursing.     

Mental health nurses and qualitative research methods: a mutual attraction?

Mental health nurses and qualitative research methods: a mutual attraction? In response to issues arising out of curriculum developments, the authors wished to examine more closely the potential reasons why psychiatric/mental health (P/MH) nurses appear to gravitate towards certain research methodologies. This paper therefore briefly examines the essential differences between qualitative and quantitative research paradigms, focusing on philosophical, epistemological and methodological issues. It then proceeds to examine some of the essential characteristics and attributes of P/MH nurses and suggests some differences in emphasis between these and other disciplines of nursing. The authors posit that psychiatric/mental health nurses are drawn to the qualitative paradigm as a result of the potential synchronicity and linkage that appears to exist between the practice of mental health nursing and qualitative research. This apparent synchronicity appears to centre around the three themes of: (a) the purposeful use of self; (b) the creation of an interpersonal relationship; and (c) the ability to accept and embrace ambiguity and uncertainty. Given this alleged synchronicity the authors argue that there are implications for nurse education and nursing research. Further it is possible that each nursing situation where the mental health nurse forms a relationship and attempts to gain an empathic sense of the individual’s world is akin to an informal phenomenological study, the product of which would be a wealth of qualitative data. However, as this would be a subconscious, implicit process, the data would remain predominantly unprocessed. The authors conclude that perhaps these data are the knowledge that expert practitioners draw upon when making intuition‐based clinical judgements.     

Sociology and nursing: Role performance in a psychiatric setting

The role of sociology in nursing continues to cast new light on many aspects of health and illness. Over the last 20 years, nursing practice has seen sociological theory become a valuable clinical tool, both in the diagnosis and prognosis of a wide range of illnesses and long‐term conditions. Nevertheless, of these, the sociological examination of mental health problems and its impact upon nursing practitioners has received little coverage, simply because, as a discipline, mental health nursing has historically been wedded to a biomedical model, one which continues to embrace psychiatry/psychology as the driving force in the diagnosis and treatment of psychopathology. Adopting a sociological approach, this paper brings to light previously unexplored insights into the way nurses interact with patients experiencing mental health problems. Drawing on social interactionist methodology, this paper considers depression and other mental health problems in relation to current psychiatric nursing practice. Specifically, the paper focuses on aspects of role performance and interpersonal care in a psychiatric setting, and the impact the individual role may have on the wider aspects of institutional and official practices. The paper concludes by making a number of recommendations/observations for nursing practice.     

Beginning the recovery journey in acute psychiatric care: using concepts from Orem's Self-Care Deficit Nursing Theory

A national agenda has been established for mental health systems to move toward a recovery model of care. Recovery principles are embedded in the foundations of nursing science and practice. Orem's Self-Care Deficit Nursing Theory (SCDNT) is in alignment with the ideals of recovery and can provide a structure for changing cultures on inpatient psychiatric units. SCDNT can guide research activities that link a patient's self-care abilities to improved recovery model outcomes. This paradigm shift is an opportunity for psychiatric nursing to return to its roots and deliver care that is patient-centered and conducive to recovering from mental illness.     

An exploration of the meanings of space and place in acute psychiatric care

Spatial human experiences such as confinement and freedom are important to acute psychiatric care. The physical space that inpatient psychiatric/mental health nurses and acute psychiatric patients share influences human relationships. The purpose of this paper is to explore the meanings of space and place in acute psychiatric settings, to discuss how these meanings affect human relationships, nurses' work environment and patients' perception of care, and to present how the design and use of nursing stations affects therapeutic relationships. We hope to encourage dialogue and research that will help clarify the meaning of space and place in acute care psychiatric units, and make for healthier work environments for nurses and healing care environments for patients.     

Towards a critical theory of mental health nursing

Towards a critical theory of mental health nursing In this paper, the author argues that, despite the self-image of the mental health nursing profession as innovative, radical and progressive, this is a'false consciousness'. Mental health nursing is deeply immersed in a crisis of legitimacy which dates from, at least, the publication of Russell Barton's Institutional Neurosis in 1959. However, although mental health nurses responded positively to the insights of Russell Barton, they failed to respond directly to the dissenting voices of the anti-psychiatrists or the damning criticisms of various official inquiries into care in various individual psychiatric hospitals during the 1970s. Instead mental health nursing has uncritically embraced humanistic psychology and vaingloriously promoted a false image of mental health nursing which suggests that it has wholeheartedly embraced sensitive user-centred approaches to care. However, the author suggests that, despite superficial similarities between person-centred psychology and the theories of the anti-psychiatrists, mental health nursing can never develop truly liberating approaches to care unless it widens its focus from purely interpersonal relationships and addresses historical, structural and ideological influences on both mental health services and the causation of mental distress.     

AN EXPLORATION OF THE MEANINGS OF SPACE AND PLACE IN ACUTE PSYCHIATRIC CARE

Spatial human experiences such as confinement and freedom are important to acute psychiatric care. The physical space that inpatient psychiatric/mental health nurses and acute psychiatric patients share influences human relationships. The purpose of this paper is to explore the meanings of space and place in acute psychiatric settings, to discuss how these meanings affect human relationships, nurses' work environment and patients' perception of care, and to present how the design and use of nursing stations affects therapeutic relationships. We hope to encourage dialogue and research that will help clarify the meaning of space and place in acute care psychiatric units, and make for healthier work environments for nurses and healing care environments for patients.     

Collaboration in care and research

This article focuses on psychiatric mental health nursing care and research, with particular attention to collaboration with other health professionals in the area of geriatric mental health. Various components of the NIMH Task Force on Nursing report and recommendations are emphasized. These include research focused on: (a) improving the understanding, treatment, and rehabilitation of the mentally ill; (b) preventing mental illness and promoting mental health; (c) continuous care of persons who are acutely or chronically mentally ill or who are at risk for mental illness; (d) therapeutic interventions with ill persons or those at risk; and (e) the design, implementation, and evaluation of new and existing models of care delivery. An illustrative model of research in geriatric mental health nursing is presented. Particular attention is given to collaborative relationships developed by the primary nursing research team and the nursing staff in an acute care setting, colleagues providing nursing home care, and physician colleagues in geriatric mental health, gerontology, and neurology. Strategies to enhance collaboration and develop collegial relationships for better patient care are presented.     

Coping with everyday reality: Mental health professionals’ reflections on the care provided in an acute psychiatric ward

There is little research evidence about how the mental health professionals are coping with the complexity of everyday practice in psychiatric acute care. The aim of this study was to explore mental health professionals’ reflections on their work on an acute psychiatric ward. Data were collected using participant observation and interview methods. Three core themes were identified from a qualitative hermeneutic analysis. The first core theme, coping with uncertainty, uncovered a dialectical pattern of the factors contributing to thriving and strain in the working situation. The second core theme, caring for the patient, included the caring process, patients’ pathway to acute psychiatric care, as well as the patients’ needs and roles on the ward. The third core theme, coping strategies, included five different methods the primary nursing system, concealing versus integrating, milieu therapy, seclusion and the medical orientated model. It was concluded that good mental health care is a result of collaboration between health professionals and the health services. This study highlights the need for support to professionals and for establishing structures that will enable collaboration to take place. Taken together, this may contribute to enhancing the care of the patient and their families.     

Psychiatric/mental health nursing

From a historical perspective, psychiatric/mental health nursing as a specialized area of practice is in its early developmental stages. Within the discipline of nursing and on the interdisciplinary scene, the range and scope of actions of the psychiatric/mental health specialists is still being debated. Professional roles and responsibilities are somewhat blurred. But the role is expanding. Contemporary psychiatric nursing practice has moved to a position of collegial support among the disciplines with shared responsibility. The attitudes of society, of the nursing profession, and of the health care providers will continue to influence the maturation process of the psychiatric/mental health nursing specialty.     

Severe mental illness, statutory supervision and mental health nursing in the United Kingdom: meeting the challenge

Within the United Kingdom a combination of limited resources and public fears about the behaviour of mentally ill people living in the community has led the government to prioritize those with severe mental illness. In support of this legislation has been passed which provides for those mentally ill deemed 'at risk' to be supervized in the community against their will. This supervisory role will be mainly undertaken by mental health nurses. Through examination of relevant British and American literature, this paper argues that mental health nursing at a national level lacks a defined role which the new legislation may provide, thereby enhancing the profession's voice in overall mental health policy formulation. Such a role, however, also poses important questions for mental health nurses' practice, their relationships with users, colleagues and the wider society. Such issues may have unforeseen negative consequences for users. It is argued that the legislation will pose important dilemmas for mental health nurses in these domains. It is argued that a proactive research agenda needs to be established which is relevant and of use to practitioners when confronted with issues in their supervision role. Areas for future research are suggested.     

What is Good Mental Health Nursing? A Survey of Irish Nurses

The practice, theory, and preparation associated with nursing people with mental health issues has changed in profound ways in recent decades. This has in part been reflected by a shift in nurses identifying as being mental health rather than psychiatric nurses. Context, theory, and values shape what it means to be a mental health nurse. Thirty experienced mental health nurses in Ireland completed a survey on what good mental health nursing is and a definition induced from their responses. Mental health nursing is a professional, client-centered, goal-directed activity based on sound evidence, focused on the growth, development, and recovery of people with complex mental health needs. It involves caring, empathic, insightful, and respectful nurses using interpersonal skills to draw upon and develop the personal resources of individuals and to facilitate change in partnership with the individual and in collaboration with friends, family, and the health care team. This appears to encapsulate the best of what it meant to be a psychiatric nurse, but challenges remain regarding how to reconcile or whether to discard coercive practices incompatible with mental health nursing.     

Beginning the Recovery Journey in Acute Psychiatric Care: Using Concepts from Orem's Self-Care Deficit Nursing Theory

A national agenda has been established for mental health systems to move toward a recovery model of care. Recovery principles are embedded in the foundations of nursing science and practice. Orem's Self-Care Deficit Nursing Theory (SCDNT) is in alignment with the ideals of recovery and can provide a structure for changing cultures on inpatient psychiatric units. SCDNT can guide research activities that link a patient's self-care abilities to improved recovery model outcomes. This paradigm shift is an opportunity for psychiatric nursing to return to its roots and deliver care that is patient-centered and conducive to recovering from mental illness.     

Barriers to practice and impact on care: an analysis of the psychiatric mental health nurse practitioner role

This paper is a retrospective review of the literature analyzing the role of the psychiatric mental health nurse practitioner in the community. Presented here is an appraisal of national and state mental health initiatives. Professional nursing regulations are reviewed, focusing on New York State advanced practice nursing. Barriers to practice are assessed with discussion on how barriers, such as statutory collaboration, impede access to treatment in the community for mentally ill psychiatric patients. The current New York State legislative agenda is featured. Clinical vignettes from a nurse practitioner's private community practice are presented to introduce and conclude how clinical practice barriers impede autonomous practice.     

Evidence for psychiatric nursing practice: an analysis of three years of published research

Psychiatric and mental health nursing practice continues to be strongly influenced by tradition, unsystematic trial and error, and authority. Yet the need for quality care that is based on the best and most current empirical research is well documented. Achieving evidence-based practice in the psychiatric nursing specialty will require that qualified nurse researchers conduct research relevant for practice and appropriately disseminate that research to those who can best use it, practicing nurses. This State of the Evidence Review analyzed the 227 data-based studies published in the five most commonly read American psychiatric nursing journals from January 2000 through December 2002. Five major research foci were found: global perspectives, psychiatric nurses as subjects, studies of family caregivers, research with clients across the life span, and testing of nursing interventions. About 88% of the studies were conducted in the United States; 63% involved recipients of mental health care services; but only 11% tested psychiatric nursing interventions. Promoting evidence-based practice in psychiatric nursing will require increasing the numbers of psychiatric nurse researchers, enriching the research process (i.e., increasing relevance and appropriate dissemination), and implementing changes in practice that are based on the best and most currently available evidence, rather than on the equivalents of "Old Wives' Tales."     

Moral sensing and ideological conflict. Aspects of the therapeutic relationship in psychiatric nursing

A qualitative research study was conducted for the purpose of gaining knowledge of the therapeutic relationship as experienced by the psychiatric nurse. Deinstitutionalisation of the mentally ill, one of the goals of the mental health policy in Sweden, has broadened the field for psychiatric nurses. Nursing education on an academic level has prepared the nurse theoretically for increased responsibility in a variety of psychiatric settings. A general psychiatric ward in a large mental institution was chosen for the field work in this study. A phenomenological perspective and aspects of Grounded Theory were combined in the research strategy of participant observation. Data were collected and analysed simultaneously. The emerging conceptual categories were abstracted to two core concepts, moral sensing and ideological conflict. These were seen as central themes of the nurse-patient relationship as experienced by the psychiatric nurse. The nurse experienced that the dominant psychiatric ideology contradicted her own ideology. In order to reduce tension caused by this conflict, the nurse sought emotional support and encouragement from her co-workers. Alliance with the group could be seen as one strategy to reduce tensions but not necessarily to solve moral issues. The implication of this study is that although there may be a change in attitudes and approaches to mental illness and health, there are areas in psychiatric nursing which have not been fully explored. The nurse experiences many conflicts which can be described as ideological. This indicates the need to examine further the value and belief system upon which ethical decision-making is based and its effect on the nurse-patient relationship in psychiatric nursing.     

Mental health nursing roles and functions in acute inpatient units: caring for people with intellectual disability and mental health problems--a literature review

The purpose of this paper is to review current national and international perspectives on the role and function of mental health nursing in dual disability within acute mental health inpatient settings. A universally accepted definition of the role and function of psychiatric nursing has been elusive. The role and function may be presumed to have core attributes that differ according to local conditions. The articulation of the role and function will contribute to the body of knowledge of psychiatric nursing and to improving the understanding of the nurse-patient relationship for those caring for people with dual disability in acute mental health inpatient facilities. The two identified key roles and functions of mental health nursing practice for people with intellectually disabilities within acute inpatient mental health facilities in Victoria will be discussed.