Introducing change in nursing: the case of research

This paper examines the issue of encouraging change in nursing and focuses on how to move from task-orientated to science-based practice. Therefore, it considers the current theory on the process of change and using two clinical vignettes (one from psychiatric and one from general nursing practice) illustrates how science based practice was introduced. From these vignettes it draws four conclusion: (1) small-scale cultural change is possible even within large bureaucracies; (2) the nature and identity of change agents is not always immediately obvious; (3) there is arguably no one singular best way of bringing about change and; (4) change activists need to have an understanding of several models of change. It then makes managerial, educational and structural recommendations based on these conclusions.     

Education for community psychiatric nurses: content, structure and trends in recruitment

Under the auspices of the Standing Advisory Group for Community Psychiatric Nursing Education, annual surveys of the leaders of the UK's post-registration courses for community psychiatric nurses (CPNs) have taken place since the 1987-88 academic year. In this paper, findings are reported from the 1997-98 survey. Thirty-two of the 39 course leaders running post-qualifying programmes for CPNs (English National Board course 812 or equivalent, and Specialist Practitioner courses) in the 1997-98 academic year responded to a nine-page postal questionnaire. Responses suggested that the majority of courses for CPNs are now offered at first degree level, with most students completing their programmes of study and clinical practice in one full-time academic year. Most courses appeared to include education in key areas of specialist content pertinent to contemporary CPN practice. Examples included: evidence-based psychosocial interventions; collaborative working with users of mental health services; inter-professional issues; cognitive-behavioural interventions; reflective practice and clinical supervision; and medication-related issues. Overall, however, courses for CPNs appeared to be characterized by considerable variations in specialist content. Possible explanations for this are offered, along with suggestions for future research.     

Advocacy in mental health nursing: an integrative review of the literature

The term 'advocacy' has taken on a meaning beyond its legal origins and is now of importance as a concept in health and social care. Within nursing, the role of advocate has been accepted as an important one, although there are arguments against nurses taking on such a role. The majority of papers on this topic relate to nursing generically rather than being specifically mental health oriented. Nurses need to be made aware of the legal framework within which they practice, in terms of duty of care within their role of nurse advocate, maintaining standards of advocacy acceptable to their professional body, accountability relating to action and omission of actions, guidance on guarding against stepping beyond the boundaries of their professional practice of advocacy, and to have adequate knowledge of the law. This paper offers a critique of nursing advocacy models, raising a number of mental health nursing issues and identifying some areas for further research.     

Survey of psychiatrists' views of nurse prescribing

For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists ( n  = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.     

Pragmatism and change: some implications for nurses,

'Change' is a concept currently enjoying much debate and analysis within nursing. Most of this debate and analysis has occurred on a purely academic level: academic examinations of change, however, do not necessarily help nurses understand the mechanisms behind change nor, more importantly, do they necessarily help nurses manage change any better. There is, as such, an argument for the adoption of a more pragmatic approach to change. This paper takes such an approach. The author argues that a greater understanding of change can be gained by examining some of the more fundamental characteristics of change, by comparing and contrasting successful and unsuccessful examples of change and by viewing change as a fluid rather than static entity. A pragmatic approach also reveals the potential of action research as an aid to the understanding of change and as a tool for implementing change in the three distinct spheres of nursing considered: the cognitive-behavioural (personal) sphere, the discipline-wide (professional) sphere and the organizational (managerial) sphere.