A job description for the effective self-management of a long-term condition: experiences of living with difficult asthma.

This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process.

The reality of teamwork in an acute mental health ward.

PURPOSE: The study aims to explore the activities of mental health nurses in an acute inpatient ward. Teamwork emerged as one of several important matters for analysis. DESIGN AND METHODS: Ethnography and data collection took place through participant observation. This included recording of naturally occurring talk. FINDINGS: Three themes emerged: nurses' continuing attention to teamwork, the handover, and the team meeting. The vast potential of information to be communicated across the nursing team was observed to result in the use of summarizing practices. These appeared to mitigate nurses' ability to give sophisticated accounts of their evident expertise in multidisciplinary meetings. PRACTICE IMPLICATIONS: Nurses should be challenged to articulate their interventions and display their work within the acute mental health setting.

Minding our own bodies: reviewing the literature regarding the perceptions of service users diagnosed with serious mental illness on barriers to accessing physical health care.

International studies consistently demonstrate that individuals diagnosed with severe mental illness (SMI) have an increased risk of co-morbid physical health problems and premature death. During the past decade, government policy in the UK has focused on improving the physical health of those with SMI. Despite this, international research has continued to report barriers to accessing appropriate services. These have been identified as emanating from service users and professionals alike, and also from institutional bureaucracy. Most of this research has reported difficulties from the perspective of various professional groups, with little attention being paid to the service user voice. Studies from the service user perspective undertaken in the past 10 years equate to six qualitative and three quantitative studies, and it appears that poor physical health care remains a problem in the developed world. The quality of this care is compromised by practical problems and interpersonal difficulties between service users and health-care providers and between providers of mental health services and those providing physical health care. This paper presents a review of the nine international studies and discusses the implications for developing policy and practices that could lead to improved physical health-care services for people experiencing SMI.

Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies.

Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.

Leadership and mental health nursing.

This discussion paper argues for the critical importance of successful leadership for effective mental health nursing, observing that nursing leadership has long been regarded problematically by the profession. Using empirical and theoretical evidence we debate what leadership styles and strategies are most likely to result in effective, recovery-orientated mental health nursing. Models of transformational and distributed leadership are found to be highly congruent with mental health nursing values, yet the literature suggests it is a type of leadership more often desired than experienced. We note how the scholarly literature tends to ignore the "elephant in the room" that is organizational power, and we question whether transformational leadership pursued within a specific clinical context can influence beyond those confines. Nevertheless it is within these contexts that consumers experience nursing, effective or otherwise, thus we should advocate what is known about effective leadership wherever it is required.

Ethnographic research into nursing in acute adult mental health units: a review.

Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed.

The real-life practice of acute inpatient mental health nurses: an analysis of 'eight interrelated bundles of activity'.

This study focuses on nursing in an inpatient mental health setting. Its analytic structure follows from a previous review of nursing studies by Allen, which did not include studies of mental health nursing. Allen's review concluded that the nurses' role could be understood as that of healthcare intermediary and that nurses' work could be analysed as eight interrelated bundles of activity. These bundles include such matters as managing the work of others. This study aims to assess the fit of this model to mental health nursing and to add to the body of work concerning the social organisation of nursing. The research materials discussed are derived from an ethnography of a psychiatric unit. The analytic framework employed leads us to conclude that the work of mental health nurses can be understood, too, as that of the healthcare intermediary. However, one bundle is found to fit less well and this is attributed to the fragile uncertainty of knowledge in psychiatry. The use of an additional bundle to describe in-context nursing interventions is suggested. It is argued that getting to grips with the reflexive relationship between individual patient care and the social organisation in which this is practised is essential for any practice development efforts.