Time-limited psychotherapy in the community mental health team

A community mental health team is offering clients short-term focal psychotherapy in the local area. Many clients find the team's base easier to attend than a central unit, and, with good communication and co-operation from other health-care professionals, the relevant clinical nurse specialist is able to make good progress, as indicated by the case study described here.     

An analysis of the concept 'patient satisfaction' as it relates to contemporary nursing care

Patient satisfaction has become an established indicator of the quality of health care yet, despite the abundance of measurement surveys reported in the literature, there are few theoretical underpinnings for this important concept An analysis of the concept of patient satisfaction, specifically as it relates to contemporary nursing care, provides an excellent vantage point to more closely examine this key measure of health care quality A review of pertinent literature is presented, followed by examination of the uses of the concept in professional literature as well as more general sources Denning attributes cited throughout the literature are identified along with the concept's antecedents and consequences Empirical referents, definitions, and measurements are also presented The analysis concludes with re-examination of some of the assumptions underlying patient satisfaction literature in general, and thoughts regarding the significance of patient satisfaction with nursing care in particular Suggestions for future inquiry are offered     

Increasing the vocational focus of the community mental health team

Despite increasing interest in the UK in enabling community mental health teams to support clients' vocational aspirations, surveys suggest that progress to date has been slow. This study aimed to identify factors that facilitate or create barriers to teams engaging in vocational work by exploring experiences and perceptions at three sites where progress had been made. Semi-structured interviews were carried out with on-site and off-site vocational specialists, care coordinators and other professionals identified locally as supportive of vocational work. Participants' accounts were compared with a framework derived from previous research into effective vocational services. The framework encompassed partnership working, attention to clients' needs, choices and mental health, and enabling clients to access and retain employment. Interprofessional partnership working emerged as particularly strong at one site and in turn was key to facilitating attention to the other elements of the framework. Conversely, at the other two sites less well-developed partnership working could create barriers to addressing these elements. Across all three sites access to expert welfare benefits advice was problematic, with evidence of widespread ignorance about the crucial issues involved.     

Increasing the vocational focus of the community mental health team

Despite increasing interest in the UK in enabling community mental health teams to support clients' vocational aspirations, surveys suggest that progress to date has been slow. This study aimed to identify factors that facilitate or create barriers to teams engaging in vocational work by exploring experiences and perceptions at three sites where progress had been made. Semi-structured interviews were carried out with on-site and off-site vocational specialists, care coordinators and other professionals identified locally as supportive of vocational work. Participants' accounts were compared with a framework derived from previous research into effective vocational services. The framework encompassed partnership working, attention to clients' needs, choices and mental health, and enabling clients to access and retain employment. Interprofessional partnership working emerged as particularly strong at one site and in turn was key to facilitating attention to the other elements of the framework. Conversely, at the other two sites less well-developed partnership working could create barriers to addressing these elements. Across all three sites access to expert welfare benefits advice was problematic, with evidence of widespread ignorance about the crucial issues involved.     

LDL apheresis as it relates to nursing practice

Nurses are an essential partner in the treatment of complex diseases and they have extensive influence on patient outcomes. Connecting a patient to a machine takes courage, skill, and a whole lot of trust. Anyone who has earned the title of “nurse” has shown courage. Skill comes with hours and hours of practice. Trust is earned and ongoing. Combine these three attributes and you get the “care” that goes into nursing care. Low-density lipoprotein (LDL) apheresis is a well-established therapy for hypercholesterolemia. This article will focused on the Liposorber^® MA-03 system in a brief conversation of LDL apheresis as it relates to nursing practice.     

A qualitative exploration of communication within the community mental health team

ABSTRACT: This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in‐depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines.     

The mental health nurse: a valuable addition to the consultation-liaison team

Nurses, particularly those working in non-psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation-liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff. The impact of the introduction of a nursing position into an established consultation-liaison psychiatry service was evaluated using an activity audit, a staff attitude survey, and staff focus groups. The findings demonstrated that the addition of the nursing role to the consultation-liaison psychiatry service improved access of general hospital patients to specialist mental health care. It also provided valued expert assistance to staff in the provision of care to this patient group, particularly those with complex problems and significant psychiatric comorbidity. The study found that the nursing consultation was particularly helpful because of its focus on practical and care-orientated interventions. The model of practice that evolved out of this project is described and the findings support the use of both direct and indirect patient interventions as important psychiatric consultation-liaison nurse activities.     

Recovery as a threshold concept in mental health nurse education

This theoretical review discusses the complexities of understanding and applying the concept of recovery for pre-registration mental health nursing. It is suggested that reframing recovering as a threshold concept in mental health nurse education will illuminate the issues and challenges that students and educators appear to encounter. This is attributed to the transformative nature of learning in this area which requires the student to reassess beliefs and prejudices and enter into an uncertain territory where knowledge and values are questioned. Educational approaches are proposed which aim to facilitate the depth of learning required to engage with the concept of recovery at this level whilst responding sensitively to the students' potential reluctance, discomfort and in some cases resistance. Teaching recovery in mental health nursing therefore challenges educators to use any and every approach that stimulates emotional and transformational learning. As such, recovery in mental health is a threshold concept, that once learned, may transform not only the learner in the classroom but their practice in the future.     

Development of a group model of clinical supervision to meet the needs of a community mental health nursing team

Clinical supervision is an important tool in the development of quality nursing care. It involves a process of reflection upon practice, the aim of which is to improve clinical practices and hence improve patient outcomes. The term 'clinical supervision' is itself problematic in that it implies an hierarchical, rather than a nurse-centred and reflective, process. In addition there are a variety of models of supervision which range from the purely managerial to the clinical. This gives rise to confusion and in some cases suspicion, in clinicians. This paper reports on the development, implementation and evaluation of a group model of clinical supervision developed by a small team of mental health nurses in a community mental health setting. This team recognised the need for a formal clinical supervision model but was unsure as to the model which best suited their practice situation and needs. Through collaboration with a university department of nursing, this group developed its own model of group clinical supervision. This paper reports on the development of the model and its evaluation. The model was developed with a small team of community nurses and hence may not be applicable to other teams and other settings. However, the methods described may be useful as a guide to other nurses who wish to plan, implement and evaluate a model of clinical supervision in their workplace.     

Expansion of a medical emergency team system to a mental health facility

Background

Clinical emergency response systems such as medical emergency teams (MET) are used in many hospitals worldwide, but the effect that these systems have in mental health facilities is unknown. This study examined the rate and nature of MET calls to a mental health facility that had relocated to the campus of a tertiary referral hospital.

Methods

This study was a prospective, observational study of MET calls to a newly constructed 170 bed mental health facility. Data were collected on the number and nature of MET calls to the facility.

Results

Over 24 months, there were 66 MET calls to the mental health facility, and 1217 MET calls at the main hospital. The mean MET call rate was 14.2 calls per 1000 admissions (95% confidence interval (CI) 10.8–17.7) at the mental health facility, and 14.7 calls per 1000 admissions (95% CI 13.9–15.5) at the main hospital. Neurological and cardiovascular problems were present in 61% and 41% of MET calls.

Conclusion

The rate of MET calls to a new mental health facility can be similar to that of a tertiary hospital. Staff attending MET calls need to be prepared to manage predominantly neurological and cardiovascular problems.