Mental health nurses’ contributions to community mental health care: An Australian study

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses’ experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15‐min intervals over a 4‐week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.     

Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.     

Sharing power in criminal justice: The potential of co‐production for offenders experiencing mental health and addictions in New Zealand

Co‐production has begun to make inroads into research, policy, and practice in mental health and addictions. Little is known, however, about the role co‐production has or could have in shaping how the criminal justice system responds to mental health and addictions. Given that a large majority of prisoners in Aotearoa New Zealand have been diagnosed with either a mental health or substance use disorder within their lifetime, it is imperative alternative approaches are considered if we are to reduce the high imprisonment rates and contribute positively to health, safety, and well‐being of all New Zealanders. In this study, we explore how co‐production has been conceptualized and used in criminal justice systems internationally, and offer an experiential account of our first steps into co‐production both in service delivery and research. We conclude by proposing a way forward to expand partnerships between those who have experience‐based expertise and researchers within the criminal justice context, offering a small‐ and large‐scale project as potential examples of what co‐production may look like in this space.     

The role of the community mental health nurse in the administration of depot neuroleptic medication: 'not just the needle nurse!'

An ethnographic study explored the nature of community mental health nurses' involvement with clients during appointments for the administration of depot neuroleptic medication. Little has been written about this aspect of community mental health nursing practice. Findings illustrate how community mental health nurses attempt to engage clients in meaningful interactions when they attend appointments for their injections. Promoting an atmosphere of normalcy and minimising the distress of having neuroleptic medication by injection were key elements in approaches employed by nurses in this study. Results support current discussions in nursing literature concerned with the need for community mental health nurses to have well-developed interpersonal skills to enable them to capitalise therapeutically from the depot injection encounter.     

The mental health nurse practitioner in the emergency department: an Australian experience

This paper describes the establishment of a mental health nurse practitioner (MHNP) position in New South Wales, Australia. The authors report on a MHNP role that functions collaboratively within a large inner city emergency department. Attention is centred on what constitutes advanced mental health nursing practice in the emergency department setting. Three areas associated with the work of MHNPs--therapeutic techniques, prescribing and care coordination and referral--are highlighted to explore the scope of the MHNP role. The authors propose that the success of this position is based on a process of consultation and evaluation, partnership between disciplines and clinical services and the role maintaining a truly nursing focus rather than attempting to replace or replicate psychiatric medicine.     

Community mental health work: Negotiating support of users' recovery

Mental health services have changed over the past decades through an increased emphasis on deinstitutionalization and normalization, and with recovery processes situated in everyday life as a new locus of support. These changes have led to a need for new knowledge and methods concerning the provision of community mental health services. The aim of the present study was to explore how community mental health workers provide support to users, by investigating professionals' own narratives of how they work. Seven community mental health workers participated in narrative interviews, which were subject to a qualitative, interpretive analysis. A primary finding was that community mental health workers provide flexible and individually‐adjusted support through engaging in negotiations with users, management, and others. Our findings show both opportunities and challenges of negotiating support, raising the following question for discussion: How and when are negotiations a valuable way for professionals and users to collaborate?     

An initial exploration of community mental health nurses' attitudes to and experience of sexuality-related issues in their work with people experiencing mental health problems

Human sexuality is a complex dynamic concept that escapes simple definition. Within nursing there seems to be a preference for broad holistic definitions that emphasize sexuality as an aspect of the unique human character. Whilst the nursing literature mostly portrays sexuality as wholesome and good, it also notes that sexuality can be a vehicle for the expression of power, hostility or hatred. In this study, the authors did not prescribe or limit the definition of 'sexuality'. Rather the term 'sexuality' was used in a broad sense in order to embrace the range of variables within the concept and allow respondents to consider the issues according to their own perspective. Despite broad acceptance of sexuality as a legitimate focus of health care, clinicians remain ambivalent about actively broaching sexual issues and there is a potential for clients' needs to go unmet. A number of intertwining variables can influence sexuality-related nursing practice. Nurses' attitudes are regarded as major barriers that prevent open discussion on the topic. This study aims to explore a sample of community mental health nurses' views on the topic of sexuality in relation to their work with clients. The authors adapted a sexual ideology scale previously used for the purposes of teaching students and promoting discussion. The questionnaire was distributed to nurse delegates at an annual CPNA conference. Two of the authors were available throughout the conference to discuss the study. Delegates were asked to recruit CMHN colleagues following the conference in order to increase the sample. The data are described and analysed using SPSS for Windows. Respondent characteristics have been cross-tabulated with item responses and analysed using chi-square and other statistical tests of association. The respondents (n = 122) confirmed sexuality as a relevant clinical issue and there was an overwhelming affirmation of people with mental health problems as sexual beings. Sixty-three per cent (n = 77) of respondents anticipated that people with mental health problems who are in relationships might experience sexual problems, and 52.4% (n = 64) agreed that a sexual history should be routinely included in assessment. Seventeen per cent (n = 21) had encountered clients becoming sexually aroused during the administration of a depot injection in the community. The authors identify this as an area of concern that warrants further investigation. The results indicate that although awareness of sexuality issues may be high there may be less agreement as to how such awareness should translate into CMHN practice.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Oxymoronic or synergistic: Deconstructing the psychiatric and/or mental health nurse

Examination of the names used to signify a nurse who specializes in working with people with mental health problems indicates the absence of a shared nomenclature and the frequent conflation of the terms ‘psychiatric’ and ‘mental health’. Informed by the work of Derrida (1978) and Saussure (1916–1983), the authors encourage the deconstruction of and problematization of these terms, and this shows that what nurses who work with people with so‐called mental illness are called has depended on where they have worked, the vagaries of passing fashion, and public policy. Further, there are irreconcilable philosophical, theoretical, and clinical positions that prevent nurses from practicing simultaneously as ‘psychiatric’ and ‘mental health’ nurses. Related service user literature indicates that it is disingenuous to camouflage ‘psychiatric’ services as ‘mental health’ services, and as signifiers, signified, and signs, psychiatric and mental health nursing are sustained by political agendas, which do not necessarily prioritize the needs of the person with the illness. Clearly demarked and less disingenuous signs for both mental health and psychiatric care would not only be a more honest approach, but would also be in keeping with the service user literature that highlights the expectation that there are two signs (and thus two services): psychiatric and mental health services.     

Exploring the potential for joint training between legal professionals in the criminal justice system and health and social care professionals in the mental-health services

Effective screening of mentally-ill defendants in the criminal court system requires cooperation between legal professionals in the criminal justice system (CJS), and health and social care workers in the mental-health service (MHS). This interagency working, though, can be problematic, as recognized in the Bradley inquiry that recommended joint training for MHS and CJS professionals. The aim of this study was to examine the experiences and attitudes of workers in the CJS and MHS to inform the development of relevant training. The method was a survey of mental-health workers and legal professionals in the court. The results showed that both agencies were uncertain of their ability to work with the other and there is little training that supports them in this. Both recognized the importance of mentally-ill defendants being dealt with appropriately in court proceedings but acknowledged this is not achieved. There is a shared willingness to sympathize with defendants and a common lack of willingness to give a definite, unqualified response on the relationship between culpability, mental-illness and punishment. Views differ around defendants' threat to security.Findings suggest there is scope to develop interprofessional training programs between the CJS and MHS to improve interagency working and eventually impact on the quality of defendants' lives. Recommendations are made on the type of joint training that could be provided.     

A phenomenological exploration of the lived experience of mental health nurses who care for clients with enduring mental health problems who are parents

This paper is a report of a study to explore mental health nurses' lived experience of caring for adults with enduring mental health problems who are parents. With the advent of community care, more people with enduring mental health problems have contact with their families and are parents. Ultimately, rehabilitative strategies for parents with mental health problems are focused towards functioning effectively within their own family unit and hopefully enabling them to fulfil their parental role. Mental health nurses working with this client group have competing demands to reconcile. For example, advocating for client rights versus protecting the child and supporting the family. This phenomenological study took place within adult mental health services in the UK. Semi-structured interviews were conducted with six nurses. A thematic analysis was conducted on the data. Five themes were identified from the data: support, remaining impartial, addressing the specific needs of a client who is a parent, models of care and interagency communication. The findings suggest that neither a family-centred nor a person-centred approach to care completely meets the needs of this client group. An integrated model of care is proposed that applies person-centred and family-centred approaches in tandem.     

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.     

The lifeworld characteristics of mental health nurses engaging in talk-based therapies: a qualitative study from Scotland and England

Twenty-four mental health nurses were interviewed to gain a greater understanding of their experiences of working within roles delivering talk-based therapies. The study participants, while echoing the broad direction and purpose of policy that supports mental health nurses expanding talk-based therapy roles, also offered insights into the challenges associated with embedding these roles into mental health settings. One area of findings analysed using Nvivo 8 software related to the characteristics of the environments in which these roles are, or will be enacted. Three key characteristics of these environments were: (1) low power and worth; (2) obstacles to success; and (3) uncertainty. Responses to the challenges found within this study are required from individual nurses, local organizations and strategic levels of nursing to ensure the successful implementation and uptake of talk-based therapy roles into the mental health nursing profession.     

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.     

护士组织公平感现状及其与情绪耗竭和心理健康的关系

目的：了解护士组织公平感现状及其与情绪耗竭和心理健康的关系。方法：分层方便抽取辽宁省4所三级医院、7所二级医院共813名护士进行问卷调查,采用LISREL8．7软件进行路径分析,探讨护士组织公平感现状及其与情绪耗竭和心理健康的关系。结果：护士的分配公平感较差;组织不公平感对护士情绪耗竭产生直接影响,对心理健康通过情绪耗竭的中介作用产生间接影响;领导不公平感对护士心理健康产生直接和间接影响。结论：组织不公平感对护士的情绪耗竭和心理健康均有负性影响,通过调整结果分配和提高领导公平感可以降低护士的情绪耗竭,提高其心理健康水平。     

Problem based learning in mental health nursing: the students' experience

Problem based learning (PBL) is well established within the field of health-care education for professionals worldwide, although little has been done to explore the experiences of students undertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL, educationalists in mental health might be reluctant to view it as an option in curricula design. This U.K. study examined the experiences of pre-registration post-graduate mental health student nurses undertaking a 2-year educational course in which all teaching and assessment followed a PBL philosophy. Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed by applying a constant comparative method. The analysis of the data uncovered the following broad themes: 'moves to autonomy, 'surviving the groups' and 'the impact of PBL'. The findings show that participants had mainly positive experiences and gained a range of study and interpersonal skills central to mental health nursing. Participants described initial anxieties resulting from engagement in PBL. However, they increasingly gained confidence in this approach, exercising increasing control over the PBL process. Despite this increased autonomy, participants continued to value the input of skilled facilitators. A recurring issue centred on the potential for interpersonal conflict within the student group and its impact on their learning. It is suggested that more research is needed examining the use of PBL in mental health nursing.