Mental health nurses establishing psychosocial interventions within acute inpatient settings

Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be ‘at high risk’ of harm. Subsequently, recovery‐based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems.     

People with learning disabilities who also have mental health problems: practice issues and directions for learning disability nursing

The plight of people with learning disabilities who have mental health problems has become an issue of contemporary importance in the provision of health services to this section of the population. This paper will argue that learning disability nursing has a central role to play in the promotion of mental health for this client group ( Department of Health 1995a ). However, learning disability nursing presently operates without a clear model of mental health. Therefore, before this potential can be realized there is a need to establish the common ground between the discourses of learning disability nursing and those of psychiatric nursing which might be related to this client group. This paper begins by identifying the background issues relating to the problems of meeting the mental health needs of people with learning disabilities. It then proposes that an applied behavioural approach has the potential to provide a coherent theory that can link the discourses of normalization, developmental psychiatry and mental health nursing, whilst also establishing the applied behavioural approach as a powerful technology upon which meaningful interventions can be designed.     

The realities of mental health nursing in acute inpatient environments

ABSTRACT:  The purpose of this ethnographic study was to understand how nurses construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reform. During a 5-month period, fieldwork observations, interviews and discussion groups occurred in a 22-bed acute inpatient mental health facility in New South Wales, Australia. The findings demonstrate how the current role of acute care has resulted in nurses working in increasingly complex environments characterized by competing priorities and new demands. Nurses struggled to fit the changed service philosophy with traditional models of practice within this fluid and changing environment. The findings are relevant within the context of current debates and can be used to enhance the understanding of contemporary acute mental health nursing practice and inform the continued development of mental health nursing in these settings.     

Mental health inpatient experiences of adults with intellectual disability

This paper presents findings from a study exploring the mental health inpatient care of people with a dual disability of intellectual disability and mental health issues from the perspective of those people with the dual disability. A mixture of semi‐structured interviews and focus group interviews were carried out with nine participants who had been admitted to an inpatient unit for mental health care exploring their experience of care. Interviews were transcribed and analyzed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around ‘Therapeutic and Meaningful Activity’, ‘Emotion Focussed Care’, and ‘Feeling Safe?’ Participants were able to identify the aspects of inpatient care that worked for them in terms of coping with time in hospital. This research suggests that there are several factors that should be considered in providing effective mental health inpatient care for people with dual disability. A number of strategies and recommendations for responding to their needs are identified and discussed.     

Closeness, chaos and crisis: the attractions of working in acute mental health care

This paper makes a case for the attractiveness of acute mental health inpatient nursing (acute nursing) and argues that an altered perception of this work is essential if we are to provide the most acutely mentally ill and vulnerable people with a stable and expert nursing workforce. The discussion draws on an ethnographic study conducted in an inner-city psychiatric unit in England and the advantages of this method for understanding nursing work are described. Within our findings, we set out two overarching themes: the contextual realities of the contemporary acute ward and features of attraction that encourage nurses to work in the acute care setting. The former includes nurses' responsibility for the total ward environment and the latter the 'comfort of closeness' and 'surviving and thriving in chaos and crisis'. In conclusion, we argue that despite the unpopularity of the acute inpatient mental health environment, the highly sophisticated skills employed by acute nurses actually ensure the promotion of health for the majority of service users.     

The challenges of mental health care reform for contemporary mental health nursing practice: relationships,power and control

This ethnographic investigation was concerned with the way mental health nurses' construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reforms of the 1990s. The setting for this study was a 22-bed acute inpatient mental health facility. Over a 5-month period, data were collected through fieldwork observations, focused interviews and discussion groups. In this article, common cultural practices in relation to the imperatives of relationships, power, restrictions and safety are discussed. The findings demonstrate how the client stabilization role of the unit locates these imperatives as central to the delivery of nursing care. The discussion reveals nurses negotiating relationships that are contradictory and challenging in ordinary and everyday ways within the exigencies of daily practice.     

Student contributions to clinical agencies: a comparison of adult health and psychiatric staff nurses' perceptions

Clinical rotations in acute medical and psychiatric inpatient facilities are an essential component of the education for undergraduate nursing students. The benefits students receive from these clinical experiences have been documented, but no data have been reported regarding the advantages that students may bring to agencies. This exploratory study, which used a mail-back survey, asked adult health/medical-surgical nurses and mental health/psychiatric nurses in acute care units about the effects undergraduate nursing students had on staff time, staff development, quality of care, staff's personal satisfaction, and unit standards and practices during their clinical rotations. Results indicated that students contribute to the personal and professional satisfaction of the staff by offering opportunities for mentoring and reciprocal learning and allowing nurses to participate in students' professional development. Students also contribute to patient care.     

Home health care's unique role in serving the elderly mentally ill

Psychiatric home health services are a viable option for providing essential treatment to elderly clients having major mental disorders or acute psychiatric problems secondary to a medical illness. This valuable adjunct to in-home treatment can be provided by psychiatric mental health nurse specialists who work collaboratively with other mental health disciplines. If a home health agency does not have a psychiatric treatment component, it can expand its services by hiring a qualified psychiatric nurse and educating its interdisciplinary staff in the appropriate care of mentally ill clients. Referrals can be obtained from facilities for acute psychiatric disorders, psychiatrists, general hospitals, outpatient clinics, and patients themselves or their families. This important service can benefit acutely ill psychiatric patients by enabling them to be discharged from inpatient settings sooner and treated comfortably in the less restrictive environment of their home while receiving appropriate and adequate follow-up and referral. As such, it is cost-efficient to the client and society and represents the community-based care of the future for the mentally ill.     

Specialist educational intervention for mental health nursing staff: delivery, content and personal impact

AIM: This paper reports a study to ascertain the views of acute ward-based mental health nursing staff on the delivery, content and personal impact of an innovative 18-day, whole team educational intervention in acute mental health care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. Educational courses are needed to improve these services. However, existing schemes are often selective, hard to access and limited to developing highly specialist skills for senior nurses. They have also been criticized for making no difference to clinical practice. There is little evidence to guide the development of these or alternative team-based courses. METHOD: Qualitative data were collected over a 6-week period using 12 focus group interviews and individual questionnaires. RESULTS: Four themes were identified. The joint education of nursing staff from different organizations was welcomed and reduced feelings of ward isolation. Mixing qualified and unqualified staff was not regarded positively. In terms of course content and learning themes, unqualified staff were more likely to report positive learning outcomes for knowledge, skills, attitude, morale and personal development; qualified nurses were more likely to indicate positive outcomes in anonymized data from questionnaires than from focus groups. Both groups reported little chance of knowledge implementation without changes in the organization of care. CONCLUSION: Whilst it may be desirable to educate whole nursing teams, more benefit might be gained from shared education between several organizations and separating the education of qualified and unqualified staff before combining these groups in team education. Participants remained pessimistic about their chances of implementing new knowledge and skills in current acute inpatient mental health environments.     

Impact of the role of senior dual disability coordinator on the perceived self-efficacy and job satisfaction of mental health clinicians

Abstract

Purpose: This study aimed to evaluate a new service role in mental health services, namely, the senior dual disability coordinator role (SDDC) for its impact on the perceived self-efficacy of mental health clinicians in managing clients with dual disability (mental illness and acquired brain injury and/or intellectual disability) and their job satisfaction. Method: Mental health clinicians from a health service district in Queensland, Australia who contacted the SDDC for clinical consultation and liaison between July 2011 and July 2013 were asked to complete a questionnaire assessing perceived self-efficacy in working with clients with dual disability as well as their job satisfaction, prior to (T1) and following (T2) their contact with the SDDC. Results: Twenty-five clinicians completed and returned pre- and post-measure questionnaires. Self-reported knowledge of dual disability, clinical skills in dual disability, service knowledge in dual disability as well as perceived self-efficacy, and job satisfaction increased significantly from T1 to T2. There were no significant differences across professional discipline or years of service. Conclusions: The delivery of a clinical consultation liaison service as part of the role of SDDC may assist mental health clinicians with self-efficacy and job satisfaction, regardless of the number of years they have worked in the service or their professional discipline. Mental health clinicians with improved self-efficacy for working with clients with dual disability may be more likely to consider the client suitable for services through mental health and follow-up with treatment and linking the client with other identified suitable services.

• Implications for Rehabilitation

• Dual disability (mental illness and acquired brain injury and/or intellectual disability) presents specific challenges for mental health services Specific strategies are needed to build capacity among mental health practitioners in order to meet the needs of people with dual disability and provide appropriate services.

• Introducing dual disability coordinators as a specific position within a health service district may assist to improve self-efficacy and job satisfaction of mental health practitioners assisting people with dual disability.

     

Mental health nursing and stress: maintaining balance

The recruitment and retention of mental health nurses within acute inpatient mental health facilities continues to be an ongoing issue. Literature and current research highlight an environment fraught with pressure and stress, identifying several key factors contributing to job dissatisfaction. These factors include greater patient acuity, unpredictable and challenging workspaces, violence, increased paperwork, and reduced managerial support. This qualitative, critical, feminist exploration investigated the lived experiences of 13 female mental health nurses working in inpatient services. They were asked about their practice and perceptions of workplace culture, and they shared their thoughts on stress management and professional well-being. Positive workplace practice was highlighted, and the participants revealed an environment they were proud to be a part of. Individual interviews, focus groups, and reflective practice were all used to collect data. The findings from the investigation unanimously support current literature that clearly confirms mental health nursing to be stressful. Interestingly, however, the findings also clearly identified that the way in which the nurse participants managed their stress was intrinsically linked to their job satisfaction. The major theme identified throughout the present study revealed that the female participants' ability to manage an at times complex workspace through the notions of teamwork, diversity, and creativity. All of the participants considered these elements as significant to providing a high standard in patient care. This research might provide an opportunity for others to view mental health nursing from a different perspective, and through the lived experiences of the participants, embrace the positive and rewarding aspects of the role.     

Ogres and Angels in the madhouse. Mental health nursing identities in film

This project applied ethnographic content analysis to examine 19 American films made during the period 1942-2005. The purpose of this examination is to consider how the medium of American film portrays psychiatric mental health nursing and its world within the hospital. It critiques the way film frames mental health nursing and the profession's interactions with other disciplines, such as psychiatry, that might reveal a disposition that is peculiar to this group. It concludes that Hollywood film genre continues to perpetuate the notion that mental health nursing occupies an aberrant, secret, and dangerous world and that its role remains one of custodial companionship. If Chiari, Pinel, and Tuke, the founders of moral therapy during the Age of Reason observed these films, they could be forgiven if they wondered whether psychiatric mental nursing remained trapped in the Middle Ages While some of the films reviewed may be considered vacuous nonsense, its discourses reflect how society views people with serious mental illness and those who nurse them. This critique is a challenge for the profession to educate society regarding the profession's true work, reclaiming its commitment to affirming the dignity and human rights of those with mental illness by instigating political strategies that will destabilize the subversive and dividing practices that film merely manipulates.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Specialist educational intervention for acute inpatient mental health nursing staff: service user views and effects on nursing quality

AIM: This paper reports a study to evaluate the impact of an innovative 18-day educational intervention for acute ward-based mental healthcare nursing staff on documented quality of nursing care and on service user views of that care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. It is claimed that specialist educational courses are needed to improve these services. However, whilst such courses may lead to positive learning outcomes for participants, the impact on the actual care of service users is unknown. METHOD: An uncontrolled before-and-after evaluation of three acute mental health wards from different United Kingdom National Health Service trusts was carried out. Quality of nursing care was evaluated by extracting documentary evidence from service user records, assessed by two independent researchers according to predefined quality criteria. The views of a purposive sample of mental health service users, currently receiving services from the three designated wards, were ascertained by semi-structured interview. RESULTS: Both documentary evidence and service user views revealed some important baseline deficiencies in the quality of care offered at the study sites. Following the educational intervention, statistically significant improvements were observed in the quality of care planning, initial assessments and the provision of therapeutic care. No statistically significant changes were observed in the quality of risk assessments, medication management or external agency involvement. CONCLUSIONS: Education can have an impact on nursing care but may not be sufficient alone to change mental healthcare practices on acute inpatient wards in the radical manner demanded by policymakers and service user lobby groups. Educational interventions need to be implemented in conjunction with organizational changes that are specifically designed to maximize the opportunities presented by a newly skilled and positive workforce.     

Psychiatric nurses and undergraduate nursing students' perceptions of preceptorship in the mental health setting

The importance of clinical education for nursing is widely acknowledged and considerable effort has been invested into identifying the most effective models. Psychiatric nursing has the additional imperative of increasing recruitment into the field. While clinical experience has been found to influence nursing students' attitudes towards psychiatric nursing and people experiencing a mental illness, little attention has been paid towards the factors that influence these outcomes. This study addresses the question, what is the experience of preceptorship for mental health nurses and undergraduate nursing students' in the mental health setting? An examination of the interactions within this model and the development of a substantive theory are facilitated by utilising the qualitative methodological approach, grounded theory. Findings indicate that psychiatric nurse preceptors seek to accomplish connectedness in the preceptorship relationship, through overcoming fear and other misconceptions. In addition, a number of factors emerged where commonality exists between the experiences of mental health nurse preceptors andthe nursing students. These included the need to manage the reconciling of difference between general acute health and mental health settings, the challenge for both groups to address student fear and preconceived ideas of mental illness and the need of preceptors to 'protect' the students.     

Psychiatric nursing and mental health funding: the double dilemma

The impact of mental illness on disease and disability burden is receiving more recognition than has previously been the case. It is now commonly understood that approximately 20% of the Australian population will experience a mental illness at some stage during their lives. Unfortunately this recognition is not reflected in the funding of mental health services, or in strategies to identify and rectify shortfalls in the nursing workforce. This paper provides an exploration of two areas. Firstly an overview of the current funding devoted to mental health and secondly an examination of workforce data with a view to recognising likely future trends for psychiatric nursing. The data demonstrates the existence of a double dilemma, firstly that the need for psychiatric nurses is likely to increase, and secondly that the looming workforce crisis may be more severe than has been anticipated.     

Addressing the mental health needs of people with learning disabilities

It is now common policy in providing care for people with learning disabilities to ensure improved access to mainstream health services. Consequently, all nursing disciplines are required to have improved understanding about the physical and mental health needs of this client group. This article focuses on their mental health needs. It is predominantly targeted at mental health and learning disability nurses, but will be of interest to all nurses who increasingly come into contact with people with a learning disability and require insight into all aspects of their health.     

Nurses' perceptions of mental health assessment in an acute inpatient setting in New Zealand: a qualitative study

This qualitative study explores the perceptions of mental health nurses regarding assessment in an acute adult inpatient setting in Central Auckland. Fourteen mental health nurses took part in semistructured interviews answering five open-ended questions. The analysis of data involved a general inductive approach, with key themes drawn out and grouped into four categories (roles, attitudes, skills and knowledge) in order to explore the meaning of information gathered. The outcome of the study acknowledged the importance of contextual factors such as the physical environment and bureaucratic systems, as well as values and beliefs present within the unit. The participants expressed concern that their input to assessment processes was limited, despite belief that 24-hour care and the nature of mental health nursing generally suggested that a crucial role should exist for nurses. In order for nurses to be established as central in the assessment process on the unit the study concludes that a nursing theoretical framework appropriate for this acute inpatient setting needs to be developed.     

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.