Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.     

Rebuilding the foundations: Major renovations to the mental health component of an undergraduate nursing curriculum

Concerns relating to the adequacy of nurses' preparation for the care of people with mental illness prompted significant revision of the mental health component in a Bachelor of Health Science nursing programme in New Zealand that prepares approximately 200 students per year. Working collaboratively with clinical providers, university staff developed and introduced three courses (equivalent to 450 hours of learning) specifically focused on mental health science, inpatient practice, and primary community mental health practice. This paper provides an overview of the new courses and reports the findings of an appreciative inquiry evaluation of this curriculum innovation.     

Rethinking mental health nursing education in Australia: a case for direct entry

Desperate times call for creative solutions. The mental health workforce shortage has created an opportunity to rethink current and future education and training needs in order to prepare competent and compassionate practitioners to meet the changing demands of consumers and their carers requiring mental heath treatment and support. This article urges consideration of an undergraduate direct entry mental health programme similar to that of midwifery or the nursing foundation/mental health branch programmes of the UK.     

Exploring pedagogies used in undergraduate mental health nursing curriculum: An Integrative Literature Review

The growing demand of mental health services among the population and the stigma associated with mental health conditions have resulted in a shortage of skilled nurses competent in delivering quality care to persons experiencing mental health conditions. This suggests the need to develop a systematic and comprehensive curriculum to prepare nursing students for a career in mental health nursing. An integrative review on empirical studies was conducted based on Cooper’s five‐stage integrative review framework to investigate the different pedagogies and to highlight the elements of an effective curriculum for teaching mental health nursing. All quantitative, qualitative, and mixed‐method studies published between 2009 and 2019 that examined pedagogies in mental health nursing for nursing undergraduates were included in this review. Databases of interest included PubMed, Cochrane, PsycINFO, Embase, Scopus, Web of Science, and ProQuest Dissertations and Theses. To ensure methodological rigour and validity, the 23 included studies were independently evaluated by two authors through critical appraisal tools developed by Joanna Briggs Institute for quantitative and qualitative studies. Results from this review were categorized into three themes: (i) the deployment of simulation; (ii) pedagogies in enhancing critical thinking; and (iii) importance of consumer‐oriented educational experiences. These results suggested that students would benefit substantially from in‐depth discussions, critical reflections, and real‐life experiences. Mental health nursing curricula should incorporate simulations, pedagogies for critical thinking, and consumers’ lived experience to supplement the clinical rotations.     

Addressing the mental health nurse shortage: Undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.     

Towards a Foucauldian reading of the Australian mental health nursing workforce

This article reflects on the findings of the recently published Scoping Study of the Australian Mental Health Nursing Workforce from the perspective of Foucault's work on 'governmentality'. First, the policy background to the scoping study is described. This is followed by a discussion of Foucauldian concepts and method that will be used to explore selected aspects of the scoping study. The related concepts of 'governmentality' and 'technologies of the self' are used to begin a theoretically grounded analysis of mental health nursing education and practice, with particular attention to discourses of 'change' and 'survival'. The examples chosen are used to support the argument that competing discourses order multiple 'readings' of Australian mental health nursing, including whether or not it is thriving or surviving. The article ends with comments on whether a Foucauldian analysis adds anything to what has been reported in the scoping study.     

Working together: a joint initiative between academics and clinicians to prepare undergraduate nursing students to work in mental health settings

There is ongoing concern among mental health professionals regarding the recruitment of newly graduated nurses to this specialist nursing area. Many reasons for the problem have been identified, including the perceived inadequate preparation by the tertiary sector, students' prejudices and anxieties about mental illness, a perceived lack of support while undertaking clinical placement, and the quality of the clinical placement itself. This paper describes a collaborative response to these issues undertaken in the Illawarra region of New South Wales, Australia. The implementation of preclinical undergraduate workshops using problem-based learning and role plays were undertaken. Mental health nursing scenarios were developed in association with experienced clinicians to introduce core concepts in a supportive learning environment. Quantitative and qualitative evaluation data were collected immediately following the workshop and again after the students returned to the university following a mental health clinical placement. A further survey of one cohort was undertaken 12 months after initial state registration and the beginning of a career in mental health nursing. Results showed that both students' and clinicians' attitudes to the workshops were consistently positive and indicated that the workshops were beneficial in preparing students for their clinical placement. Importantly, since the implementation of the workshops and other collaborative initiatives, an increasing number of newly graduated nurses from the region are choosing to work in mental health.     

A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision

Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n = 601) and Area Health Services (n = 17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle-aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.     

Developments in mental health nursing: a critical voice

This paper examines stances that are being adopted in relation to the current and future direction of mental health nursing practice. The argument is made that mental health nursing is being pushed into a direction that is essentially positivistic and narrow in its focus, stating that the current hegemony of thinking which dictates that our primary focus of concern should be with individuals suffering from severe or recurring mental illness, allied with the drive towards 'evidence based practice' is symptomatic of wider issues that should be of concern to all parties interested in the issue of mental health care. The authors examine the context and rationale for these developments from socio-political, philosophical and ethical viewpoints, highlighting that their logical outcome is the exclusion of individuals from the right to health care and question the motives underpinning what could be considered a fundamental shift in the provision of mental health services. The argument is then advanced that caution should be adopted by mental health nursing services before abandoning what Gournay (1994) described as 'redundant ideologies' and that a broader view of mental health nursing action should be accommodated. The validity of trying to account for mental nursing action in quantifiable and biomechanistic terms is questioned and an alternative paradigm of accounting for such action is suggested.     

The Mental health Master Class: An innovative approach to improving student learning in mental health nursing

The Master Class was developed as an additional educational innovation designed to promote learning about mental health and illness and mental health nursing as a career option to 2nd‐year undergraduate nursing students. A number of students had approached the mental health nursing academics expressing two polar views on mental health. They either expressed extreme interest in mental health nursing or significant distress and concern related to studying the core 2nd‐year subject. It was considered that the Master Class could potentially provide students with additional support. It was thought the Master Class may either consolidate their interest in mental health or relieve their stress. This article presents the findings of a pre‐ and postevaluation which was employed to explore the effectiveness of the 5‐day intensive mental health Master Class programme on student's mental health learning and their understanding of the role of a mental health nurse. The findings highlighted that prior to participating in the Master Class, there was a significant sense of uncertainty associated with perceived levels of competence required within the profession of mental health nursing. This was coupled with students expressing they wanted to disengage with the profession even before they had commenced any theory or clinical experience. The post‐Master Class findings illustrated a significant improvement in students desire to consider mental health nursing,     

Views and experiences of mental health nurses working with undergraduate assistants in nursing in an acute mental health setting

Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.     

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.     

Preparing mental health nurses for the future workforce: An exploration of postgraduate education in Victoria,Australia

ABSTRACT: Problems with recruitment and retention in the mental health nursing workforce have been consistently acknowledged in the Australian literature. An Australian workforce scoping study conducted in 1999 revealed a significant shortfall between the number of nurses completing postgraduate mental health nursing programmes and both current and future workforce demands. Despite this, there has been no systematic analysis of these programmes to explain why they are not meeting workforce expectations. The primary aim of the current study was to elicit information about the number of applicants, enrolments, and completions during the 5‐year period, 2000–2004. This information was obtained through structured interviews with representatives from Victorian universities (n = 6) who offered postgraduate mental health nursing programmes. Supplementary information, such as approaches to course advertising and student demographics, was also collected. The findings showed an overall increase in the number of students applying to and completing these degrees, although changes in the level of programmes students undertook were evident during this period. Despite revealing important insights regarding postgraduate mental health nursing courses within Victorian universities, the lack of systematic and comprehensive data collection was identified as a problem that limits the extent to which university data can inform recruitment strategies.     

Assistants' in nursing perceptions of their social place within mental health‐care settings

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost‐effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource.     

Undergraduate nursing students’ views of mental health nursing in the forensic environment

The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students’ attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students’ understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.