Mental health work observed: a comparison of the perceptions of psychiatrists and mental health nurses

This study explores mental health nurses' and psychiatrists' perceptions of their work. It was carried out in five mental health Trusts in the West Midlands, UK. Three groups were surveyed: psychiatrists, hospital-based nurses and community mental health nurses (CMHNs). Results showed that CMHNs' sources of job satisfaction and dissatisfaction were more similar to those of psychiatrists than to those of their hospital-based counterparts. All three groups cited the intrinsic worthwhileness of their work, autonomy, the scope for creativity, the variety their job offered and their contact with clients as contributing to their overall job satisfaction. Hospital-based nurses listed the support they received from colleagues as their second source of job satisfaction, whereas CMHNs and psychiatrists cited the provision of care to patients. Excessive administrative duties and the absence of or poor quality of management were perceived by all three groups as sources for dissatisfaction with their work. Hospital nurses cited job insecurity as a principal concern more frequently than CMHNs and psychiatrists. The paper concludes by discussing recommendations for changes to improve the nature of the work in mental health services and in the work environment. Changes must reflect the concerns of the different groups of mental health professionals.     

Mental health nurse supplementary prescribing: experiences of mental health nurses, psychiatrists and patients

AIM: This paper is a report of a study to explore the views of patients, mental health nurses and psychiatrists involved in mental health nurse supplementary prescribing. BACKGROUND: Medication prescribing by mental health nurses in the United Kingdom is controversial. However, the experience of mental health patients suggests that increasing prescribing capacity could be one strategy to provide a person-centred prescribing approach. METHOD: A qualitative study was carried out in 2005. Semi-structured interviews were conducted with 12 psychiatrists, 11 mental health nurses with prescribing authority, and 12 patients who had been prescribed psychiatric medication by a mental health nurse. Participants were interviewed about positive aspects of supplementary prescribing including the extent of it being evidence-based, person-centred and clinically focussed. FINDINGS: Participants from all three groups had a positive reaction to nurse supplementary prescribing. Mental health nurse prescribing was viewed as evidence-based, person-centred and with an additional focus on physical health. Mental health nurses worked within their levels of competency. Barriers to the implementation of mental health nurse prescribing were nurses' lack of prescribing experience, shortfalls in supervision, insufficient focus on redesigning the service to support the role of the mental health nurse, and preparation for the role. CONCLUSION: Mental health nurse prescribing seems potentially beneficial. However, more rigorous audit and evaluation are needed to confirm its safety, patient satisfaction and health outcomes. Mental health nurse prescribing will require service redesign to ensure that is becomes embedded in the service organizational culture.     

The work and values of mental health nurses observed

While there is agreement among stakeholders that change is required in mental healthcare, yet the precise nature of this change and how it should be brought about are relatively under-explored. Research has looked at developments taking place in primary mental health services, but relatively little has examined the work of community mental health nurses (CMHNs), especially those working at the interface between primary and secondary care. This study used a 39-item questionnaire to explore how CMHNs perceive their role and the degree to which they are able to carry it out. The findings suggests that while CMHNs are enthusiastic about their work and are keen to see mental health services develop in primary care, many are concerned about how they are perceived by other health personnel, deficiencies in their therapeutic skills and the level of support they currently receive. The study concludes by suggesting areas that managers, commissioners and educators should target to enable CMHNs to continue to play their part in a service that relies heavily upon them.     

急诊护士遭受工作场所暴力后心理状况调查分析

目的探讨急诊护士遭受工作场所暴力后的心理健康状况。方法应用症状自评量表（symptom checklist-90,SCL-90）对3所综合医院60名遭受过工作场所暴力后的急诊护士进行问卷调查,并将SCL-90各因子得分与国内常模进行比较。结果遭受工作场所暴力后,急诊护士在躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、精神病性等方面的因子分及总分、总均分均高于常模,均P〈O．01或P〈0．0．5,差异具有统计学意义。结论遭受工作场所暴力后,急诊护士心理健康状况明显差于一般人群,应给予受暴者人文关怀,并采取措施预防和干预工作场所暴力和心理伤害的发生。     

Assault experiences: Lessons learned from mental health nurses in Taiwan

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in‐service, violence‐prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in‐service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in‐service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.     

Violence in mental health settings: A systematic review

The introduction of smoke‐free policies is increasingly common in mental health settings, to improve health. However, a barrier to implementing smoke‐free polices is staff concern that violence will increase. We conducted a systematic review comparing the rates of violence before and after the introduction of smoke‐free policies in mental health settings. Two authors searched major electronic databases. We included studies reporting the prevalence of violence (verbal and/or physical or combined) before and after the introduction of a smoke‐free policy in a mental health, forensic, or addiction setting. We included 11 studies in the review. A narrative synthesis was used to describe the key results of each study. Six studies measured physical violence specifically; four reported a decrease or no change and two reported a short‐term increase. Five of these six studies also measured verbal violence; two found an increase, with one of the studies reporting that this increase was temporary. Three reported a decrease in verbal violence. A further five studies evaluated the rate of combined verbal and physical violence; four reported a decrease or no change and the other an increase. We conclude that the introduction of smoke‐free policies generally does not lead to an increase in violence. There is a need for more robust studies to support this finding. However, the conclusions from this review may be a step in reducing staff concerns.     

非现役文职护士岗前培训期间心理健康状况与应对方式的研究

目的调查非现役文职护士岗前培训期间心理健康状况与应对方式,并分析二者的相关性。方法采用一般资料调查表、症状自评量表、应对方式问卷对175名岗前培训的非现役文职护士进行调查。结果除精神病性与中国常模差异无统计学意义外(P0.05),非现役文职护士心理健康状况总分和各因子得分均低于中国常模与军人常模(P0.01)。应对方式各因子得分分别为解决问题(0.76±0.19)分、求助(0.62±0.24)分、退避(0.46±0.25)分、合理化(0.39±0.19)分、幻想(0.38±0.23)分、自责(0.23±0.21)分。SCL-90总分分别与成熟型应对方式解决问题、求助呈负相关(P0.01或P0.05),与不成熟型应对方式自责、幻想、退避呈正相关(P0.01),与混合型应对方式合理化呈正相关(P0.01)。结论非现役文职护士心理健康状况与其应对方式有显著相关性,岗前培训期间应关注非现役文职护士心理健康状况,帮助其采取积极的应对方式。     

Common experiences of mental health nurses and consumers: Ingredients of a symbiotic relationship?

Examination of the history of consumers and mental health nurses reveals that both consumers and mental health nurses have much in common in terms of their powerlessness and their sense of being undervalued. This paper argues that their common problems have a shared solution. It is in the interest of both groups to develop a symbiotic relationship, with each other benefiting by achieving greater influence over the delivery of care. The development of a close alliance requires a change in perception and behaviour towards each other. This paper identifies some of the factors militating against developing a symbiotic relationship and suggests possible ways of addressing them.     

Smoking and mental health nurses: a survey of clinical staff in a psychiatric hospital

There is a lack of evidence on the prevalence of smoking among mental health nurses, and the beliefs and attitudes they hold about smoking at work. This paper describes results from a cross-sectional survey of clinical staff working in a UK specialist charitable-status psychiatric hospital and focuses on the responses of registered mental health nurses. Questionnaires specifically developed for this study were sent to all 1371 clinical employees. Completed questionnaires were returned by 167 of 429 (38.9%) registered nurses (RNs), 300 of 842 (35.6%) nursing assistants (NAs), and 123 of 200 (61.5%) other health professionals (OHPs). Twenty-nine (17.4%) RNs, 93 (31%) NAs and eight (6.5%) OHPs reported themselves as current smokers. Differences in response to attitudinal questions between groups could not be attributed to age. RN smokers were significantly more likely than RN non-smokers to state that staff should be allowed to smoke with patients, and to report therapeutic value for patients in this activity. RN smokers were less likely than RN non-smokers to report that patients should be encouraged to stop smoking. RNs were significantly more likely than OHPs to report therapeutic value for patients in smoking with staff, even after controlling for the possible confounding effect of smoking status. Implications of the survey are discussed in the context of the international literature, including the disproportionately high smoking prevalence among patients living in psychiatric institutions and current guidelines to move towards no 'smoking allowed' areas for staff working in them.     

护士职业应激与精神卫生状况分析

[目的 ]了解护士职业应激与精神卫生状况及其相关性。 [方法 ]应用抑郁自评量表(SDS)和焦虑自评量表 (SAS)及护士职业压力源量表对 779名在岗护士进行调查。 [结果 ]护士抑郁和焦虑发生率分别为3 6.3 %和 14 .2 % ,两者并存者占 11.6% ,SDS和SAS标准分均值与国内常模比较有统计学意义 (P <0 .0 1) ;护士职业应激总分 1.97分± 0 .460分 ;精神卫生与职业应激呈高度正相关 (P <0 .0 0 1)。 [结论 ]护士群体精神卫生状况低下 ,与其职业应激密切相关。管理者应在引导护士正确认识和舒缓职业应激的同时 ,考虑到女性的社会脆弱因素及其独特的生理特征     

The role of the nurse prescriber: the views of mental health and non-mental health nurses

Even though the introduction of the role of the nurse prescriber promises improved access to medicines and increased flexibility in the workforce, the take-up of this role to date has been variable across the UK. This questionnaire-based study sought to compare the expectations of two distinct groups of nurses, one from a mental health and the other from a non-mental health background prior to becoming prescribers. Non-mental health nurses were of the opinion that being able to prescribe would increase efficiency and maximize resources, while mental health nurses saw prescribing primarily in terms of the benefits to clients--increased choice, improved access to care, better information about treatments and better quality of care.