'Partnership': a co-operative inquiry between Community Mental Health Nurses and their clients. 2. The nurse-client relationship.

This paper describes the output of a co-operative enquiry between Community Mental Health Nurses and their clients. Two nurses and two clients volunteered to participate as co-researchers and co-subjects with two facilitators in a co-operative inquiry group. The subject of the inquiry, agreed by the group, was the relationship between the nurse and client. The description of the nurse-client relationship and the influences on it is extremely rich and potentially useful with implications for clinical and managerial practice. Despite the limitations of the study, co-operative inquiry appears to be a useful vehicle for contributing to an increased understanding of the nurse-client relationship with potential for further research and development. Unsurprisingly, when both the relationship characteristics and the health care context are appropriate there seems to be more positive outcomes for both nurse and client. Within the current health policy context there are increased external demands with the potential to disrupt this relationship. Nurses need to be aware of the potential effects of these so that the relationship and the client do not suffer and health service managers need to be aware of the contribution their behaviour may have on the nurse-client relationship.

Barriers to research implementation by community nurses.

This article presents the community findings from a study of nurses in community and acute settings using Funk et al's Barriers to Research Utilization Scale (Barriers) (Funk et al, 1991a), which aimed to identify the main barriers to implementing research in practice. The Barriers questionnaire was sent to all nurses working in three community trusts in Yorkshire (n=2327), and practice nurses in one Yorkshire health authority (n=190). A 51.5% response rate gave a sample of 1297 nurses. The top two barriers were reported to be lack of time and resources. There were significant differences between sub-samples, e.g. older women perceived more barriers than younger colleagues, and practice nurses had particular problems with the cooperation of GPs. Factor analysis generated four new factors different from those found by Funk et al (1991a) (shown in brackets): benefits (nurse characteristics); quality (research characteristics); accessibility (presentation of the research characteristics) and resources (setting characteristics). Recommendations include developing nurses' critical appraisal skills so that, given more time and adequate resources, research findings might be judiciously implemented in practice.

'Partnership': a co-operative inquiry between community mental health nurses and their clients. 1. Research methodology, process and reflections.

The aim of this study was to explore the utility of co-operative enquiry between community mental health nurses and their clients. The research design was a form of co-operative enquiry. Two nurses and two clients volunteered to participate as co-researchers and co-subjects with two facilitators in a co-operative inquiry group. The subject of the inquiry, agreed by the group, was the relationship between the nurse and client. The method for the inquiry was developed by the participants and consisted of dialogue groups. This paper provides a description of the research design and methodology with a first-person account of the research experience and reflections by the two facilitators. The process is considered with particular reference to the influence of the study facilitators. Their position changes from wanting to influence an 'external' relationship to one of being influenced within the research relationship over time through reflection and growing self-awareness. This results in the inquiry ultimately being driven by the agenda of the group rather than the process. The outcomes of the study were both informative and transformative and the content of the inquiry relating to the nurse-client relationship will be presented in a second paper.

Developing user involvement in mental health services.

This paper describes the user consultation component of a corporate approach to the mental health needs assessment of a local population. The context of the paper is established by presenting the views of users and user representatives on current mental health services. This is followed by the development of participants' views of an 'ideal' mental health service within the boundaries of technical feasibility. Three focus groups were held with current service users, and one group with user representatives. The users have extensive experience of a range of mental health services. The findings suggest that user representatives tend to represent their own needs rather than those of users. It would also seem that service users are not a homogeneous group, different groups having different priorities. Overall, users' views of current services generally reflect previous studies, but the 'ideal' approach seems to broaden the discussion and identify an agenda for change. This agenda is framed within categories of service delivery, service providers, labelling, advocacy, future research, leaving services, involvement, co-ordination, information, choice and accessibility. There is no clear role specifically identified for mental health nurses by users, but many opportunities are highlighted. Exploration of the utility of co-operative inquiry between mental health nurses and service users is recommended.

Evaluation of stress prevention and management workshops in the community.

Little emphasis has been placed by clinicians on the need for routine evaluation of outcomes of community mental health nursing interventions. Although numerous descriptive studies exist, there is little systematic evaluation of the work of community mental health nurses, and this problem is particularly acute in the field of preventative work. This paper presents the results of a small initiative to incorporate outcome evaluation into the clinical work of a community mental health team. Ninety-nine participants in a series of stress management workshops completed stress questionnaires before a series of 2-day workshops and were followed up at between 3 and 6 months afterwards. At follow-up, participants reported greater gains in terms of stress management than did no-treatment controls. The study offers tentative evidence for the effectiveness of community mental health nurses in offering effective preventative interventions and also indicates that such interventions are amenable to outcome evaluation within the context of routine clinical practice.

Research design and methodology for a local mental health needs assessment.

The development of a methodology for the assessment of the mental health needs of a local population is described. A framework of corporate consultation was adopted to include methods of accessing the views of key stakeholders. This involved a provider perspective from a survey of clinicians, a user perspective gained through a series of focus groups and a purchaser perspective obtained from semi-structured interview and focus groups. The method adopted for the focus groups was based on an 'ideal research and change practice', which offers potential for development and usage by service planners, including mental health nurses. This article explores issues around qualitative research and the implications for mental health nurses.

Community psychiatric nursing: promoting health in a community setting.

With the development of care in the community, some mental health nurses have adopted approaches focused on health. This article explores one model of this approach which is aimed at secondary and tertiary health promotion in a community setting.

Accountability in mental health nursing.

Accountability for nursing practice is implicit and the clients' interests are paramount. Nurses are in the best position to offer information to the client, therefore their approach will have a significant effect. A research-based nursing approach offers informed choice and empowerment and ethically, this is in the interests of everyone, particularly the client.