Some reflections on cultural and social considerations in mental health nursing

This article critiques the contribution of two main theoretical perspectives on mental health care and ethnicity, with particular reference to Asian women. It considers the work of those who highlight the impact of culture on the health and illness experience (Kleinman 1980, Rack 1982, Fernando 1989) and the work of authors who argue that the impact of broader socio-economic structures must be considered (Donovan 1989, Pearson 1989, Ahmad 1993). It is posited that the emphasis on cultural difference results in crude monolithic generalizations about Asian culture and operates as a smokescreen for the impact of poverty and racism. The backdrop to this article is provided by an assessment of the problematic conceptual framework of Western mental health and the role it plays in perpetuating stereotypes. It is concluded that mental health nurses need a thorough understanding of the complexity of the cultural and social factors that influence health and illness; an understanding which falls somewhere between these two theoretical perspectives. Such an approach needs to be grounded in the experience of mental health clients themselves if it is to be appropriate.     

Home care of the elderly with mental health needs

A King's Fund report on mental health in London (1997) highlighted the difficulty of adequately meeting the needs of older people with mental health problems. This article describes the work of the home nursing team, a London project that aims to provide appropriate care for this group of clients during the acute phase of their illness. The six-member mixed-grade nursing team provides care in the client's own home, providing an alternative to hospital admission. The team aims to be sensitive to the needs and wishes of clients and involve them in decisions about their care. Team members work closely with carers and other services, ensuring continuity of care.     

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.     

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.     

COE Final Report: Chiba University

Background: The Center of Excellence (COE) program for the Creation and Dissemination of a New Japanese Nursing Science at the Chiba University School of Nursing aims to develop nursing science that is appropriate for Japanese culture and to internationally disseminate the importance of culturally based care. The object of this culturally appropriate nursing is not only clients/families but also nurses themselves, because although the cultural aspect of a nurse is tacit, it has deep influence on nursing care. Method: We organized our research subprojects from the viewpoint of “Interpersonal Helping,” which is different from the former approach of nursing, and we conducted research study on these subprojects. We conducted our research studies to clarify culturally appropriate nursing by the qualitative meta‐synthesis method. We performed international comparative research study on culturally appropriate nursing and conducted international conferences to elaborate and disseminate our outcomes. Results: Fourteen outcomes of meta‐synthesis studies have already been published until now, and more than 200 primary research studies have been conducted. We developed mainly 2 education programs and adopted them practically. From the inductive analysis of all our primary researches, we derived 4 viewpoints that clarify cultural aspect in nursing. The Cultural Nursing Society was established in 2007. Conclusions: We finally named this culturally appropriate nursing which respected the difference of individual culture “Cultural Nursing”. The importance of Cultural Nursing will further increase in the near future. We plan to establish and systematize this Cultural Nursing Science, which is based on the outcome of our program, and enroll researchers and nurses who have the ability to study and practice Cultural Nursing from both interdisciplinary and international aspects.     

Nursing considerations for dual diagnosis in mental health

It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.     

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.     

Emergency department mental health triage scales improve outcomes

The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients' reactions to the impact of this change to service delivery in future evaluations.     

Acupuncture: an important treatment option

In recent years acupuncture has gained increasing acceptance in this country as a treatment option for certain painful conditions. At the same time, nurse practitioners are seeing greater numbers of Asian immigrants whose beliefs about health and illness are based on the theory of Chinese traditional medicine. This article provides an explanation of Chinese traditional medicine and the use of acupuncture in that context, so that nurse practitioners may take these beliefs into account when planning care for Asian clients. Information on the use of acupuncture from a Western health care perspective is also presented to give nurse practitioners an understanding of this treatment, which will enable them both to explain it to clients and to refer them for acupuncture when appropriate.     

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.     

Community mental health services for the underserved: a culturally specific model

Underutilization of community mental health services by minorities has been an ongoing concern in the field of mental health. Many agencies are mainstream and ethnocentric in their services to culturally diverse clients, resulting in color-blind treatment approaches. During the era of civil rights, the concept of difference was used to exclude groups of individuals, families, and communities from access to resources. However, ethnicity does matter and make a difference. This article will address the need for culturally relevant services for African-American clients with the dual diagnosis of substance abuse and mental illness. The intent is to provide mental health care providers with a culturally specific model that will render culturally relevant and culturally competent services to individuals from diverse cultural backgrounds.     

Integrating health care for women diagnosed with HIV infection, substance abuse, and mental illness in Detroit, Michigan.

This article describes the evolution of Personalized Nursing, a comprehensive nursing practice model of care. Findings from several nursing research studies contributed to the development of Personalized Nursing. The model includes a practice model of the art of nursing care based on nursing theory and a specific nursing process that directs nursing care delivery. The process of care delivery includes location of hard-to-reach clients; linkage to health care providers; integration of care among providers for clients diagnosed with HIV, mental illness, and substance abuse; and strategies to promote retention in health care. Use of Personalized Nursing is designed to assist clients to improve their well-being and increase positive health-related behaviors. Personalized Nursing has been used in urban landscapes to serve multiply diagnosed clients at risk for HIV infection. The model is currently being used in a study targeting multiply diagnosed women who are lost to follow-up from medical care.     

Adult learning center: a unique adventure for a school nurse.

The school nurse's role in an Adult Learning Center presents a unique challenge. The learning center serves clients who range in age from infancy to elderly adults. The population includes low-income children in day care to alternative high school or adult education classes. Many participants have no health insurance or source of primary health care. The school nurse provides care to meet individual health needs, needs that may be illness related or involve health promotion or primary prevention. The nurse's involvement includes health assessment and appropriate nursing care. This learning environment, although non-traditional for a school nurse, offers health services to those who are at risk due to lack of health education, poor health habits, or lack of access to health care. The school nurse is an essential bridge to people who need care and who may have no other source of health information or care in the community.     

Mental health nursing: Daring to be different,special and leading recovery‐focused care?

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.     

Reconstructing mental health nursing in home care

BACKGROUND: Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings. AIM: The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems. METHOD: We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis. FINDINGS: The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely. CONCLUSIONS: Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.     

Mental health nursing and cultural diversity

The focus of this article is on ethnic cultural difference. The establishment of a bi-cultural model of health care delivery has been a recent priority in New Zealand. Bi-culturalism has become an important concept for Maori and Pakeha (Europeans), working in partnership in the planning and implementation of mental health services in New Zealand. Adoption of the principles of respect and recognition of the uniqueness of different cultural identities, by nurses, has meant that clients who use mental health services in New Zealand are beginning to benefit from nursing care that is culturally competent.     

The impact of volunteering in mental health settings on nursing students' attitudes

Nursing faculties are working to improve students’ attitudes towards mental illness and people with severe mental illness, given the repercussions a lack of knowledge and negative attitudes may have on the quality of care. Complementing undergraduate programmes with volunteering activities affords students the opportunity to interact with people with a severe mental illness, and allow them to develop positive attitudes and overcome prejudice. Aim: to explore and deepen in nursing students attitudes prior to and following volunteering on an Acute Mental Health Inpatient Unit. By means of mixed methods approach, students were assessed at two time points by questionnaires including “Community Attitudes to Mental Illness” and “Semantic Differential”, and by testimonies gathered from interviews. Positives changes in attitudes were identified and monitored over time capturing a destigmatizing tendency. The participation in educational strategies such as volunteering in Acute Mental Health Inpatient Unit, complementary to undergraduate programmes and clinical placements in mental health, allows nursing students to develop more diversified and positive attitudes towards mental illness and people with severe mental illness. The impact of an interventional education strategy is not as powerful in nursing students as it might be in students of other non-healthcare oriented university degrees due to their baseline attitudes.     

Recovery as a Model of Care? Insights from an Australian Case Study

The terms “model of health care,” “service model.” and “nursing model of practice” are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.     

Coronary heart disease in Asian Indians: perspectives of family members

Despite the high prevalence rate and significant mortality and morbidity from coronary heart disease in Asian Indians (irrespective of their religious background), very few studies have reported on family members' experiences of caring for a person with coronary heart disease. This paper reports on family members' experiences of coronary heart disease in Asian Indians residing in Australia, and is part of a larger study that explored the experiences and/or understanding of coronary heart disease in Asian Indians from the perspective of patients, family members and 'healthy' participants. Using a constructivist approach semi-structured in-depth interviews were conducted with five family members. Findings are represented under the following main categories: 1. A period of complexity for family members; 2. Indian Culture: Its influence on health/health behaviour & illness experience; 3. Impact of migration and societal discrimination; 4. Disappointment with health care services and the health system; and 5. Strategies to prevent cardiac illness and attain optimal health. Cultural factors had both positive and negative influences not only on the illness experience but also on health behaviour and attitude. The impact of Indian culture in relation to coronary heart disease needs to be understood not only at the cultural level by providing culturally sensitive health care, but also by educating Asian Indians to change their health attitude and behaviour and improve their lifestyle. Asian Indians need education and advice to become more resilient and adaptable to a Western society and also to become aware of the acculturative effects of a Western lifestyle.