Enabling professional development in mental health nursing: the role of clinical leadership.

Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing.

Barriers to exercise prescription and participation in people with mental illness: the perspectives of nurses working in mental health.

ACCESSIBLE SUMMARY: Exercise is valuable in the treatment of mental illness, yet personal and organizational barriers limit widespread implementation by nurses in mental health settings. Using a self-report questionnaire, we sought to identify how often nurses prescribe exercise and their level of agreement with previously identified barriers to exercise prescription and participation for mental health consumers. Nurses disagree that many of the previously identified barriers should impede exercise prescription for people with mental illness. Nurses agree that many of the barriers expressed by mental health consumers might prevent exercise participation. Our study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness; however, it is limited to a small sample. Confirmation of these findings in larger, geographically and professionally diverse groups is needed. ABSTRACT: Evidence is mounting for the efficacy of exercise in the treatment of people with mental illness. Nurses working in mental health settings are well placed to provide exercise advice for people with mental illness. However, quantitative examinations of the barriers to exercise prescription experienced by nurses, or their views regarding the barriers to exercise participation experienced by people with mental illness, are lacking. In this study, 34 nurses completed the Exercise in Mental Illness Questionnaire-Health Professionals Version (EMIQ-HP). This survey examined the frequency of exercise prescription and the level of agreement with statements regarding barriers to exercise prescription for, and exercise participation by, people with mental illness. The level of agreement scores for statements for each section was summed, with a higher score indicating a higher level of agreement. Nurses disagree with many of the barriers to exercise prescription presented in the literature. The level of agreement scores did not differ between nurses who prescribe exercise 'Always', 'Most of the time', 'Occasionally' or 'Never'. We found a non-significant negative relationship between frequency of exercise prescription and summed level of agreement scores for barriers to exercise prescription. Consensus regarding barriers to exercise participation by mental health consumers is less clear. This study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness. Confirmation in larger samples is needed before translation of research to practice.

A systematic review of nurse physical healthcare for consumers utilizing mental health services.

People with serious mental illness have higher rates of physical illness and are more likely to experience premature death than the general population. Nurse-led strategies to improve physical healthcare in mental healthcare services could potentially reduce these inequalities. However the extent of nurse involvement in physical healthcare (such as physical risk screening, health education and care co-ordination) in mental health settings is not known. A systematic review was conducted on nurse-led physical healthcare reported for consumers with serious mental illness (SMI) in mental health services, and their benefits. Electronic literature bases (CINAHL, Proquest, PsychINFO and Web of Science) were systematically searched, in conjunction with a manual search of literature reviews on physical healthcare in mental health services. Articles were included if they: (a) were published in the last 10 years; (b) were English language; (c) involved physical healthcare of adult consumers receiving mental healthcare services; and (d) reported nurse involvement in physical healthcare. Forty articles were included in the review. The distribution of types of care were: health education (47%), screening and/or monitoring (33.3%), care co-ordination and management (33.3%), lifestyle programme delivery (30.5%), follow-up actions to screening results (25%) and registers and data administration (5.5%). Overall, the evaluation of nurse-based physical healthcare is in early stages. Thus far, they appear to have positive implications for consumers with SMI.

A practical guide to writing clinical articles for publication.

The sharing of nursing knowledge between clinicians can strengthen the profession. Clinicians often underestimate the relevance and importance of what they may contribute and feel daunted by the idea of writing for publication. This article presents a practical approach to writing clinical articles for publication in professional journals such as Nursing Older People. It considers: what is a clinical article; the structure of a clinical article (Why? Where? How? What? What now?); choosing the journal; and understanding the editorial process.

A role for mental health nursing in the physical health care of consumers with severe mental illness.

There is extensive international evidence that people with severe mental illness have a lower standard of physical health than the general population. This leads to higher morbidity and mortality rates. Many of the causes for this poor physical health are modifiable. Yet the physical needs of this consumer group are neglected by healthcare systems in Australia, and elsewhere. While medical specialists are clearly integral to remedying this, nurses are well placed to play a key role in focused prevention and early intervention in the physical well-being of consumers with mental health problems. This paper outlines the specifics on how mental health nurses can be sensitized, prepared and empowered to help turn this serious health issue around. In particular, mental health nurses could be trained in and then utilize a new physical health check and response system in the UK (called the Health Improvement Profile) if adapted for use within Australia. This profile will be briefly introduced, and then its value to improving health care discussed.

Developing more positive attitudes towards mental health nursing in undergraduate students: part 2--The impact of theory and clinical experience.

Previous research examining the impact of education on nursing students' attitudes towards mental health nursing as a career has highlighted clinical experience as the primary influencing factor and generally has not considered the impact of theory. The current study compared a cohort of second-year and a cohort of third-year nursing students from the same university. Second-year students had received more theory and clinical experience than their counterparts. Questionnaires were distributed to the total population of students before commencement of, and after completion of clinical placement. This paper examines students' perceived preparedness for and satisfaction with clinical experience, attitudes towards people with mental illness, and attitudes towards mental health nursing as a career option following the completion of differing amounts of theory and clinical experience. The results demonstrate some statistically significant differences with increased amounts of theory and clinical experience in the second-year cohort being positively influential. The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing. However, little difference in perceived preparedness for and satisfaction with clinical experience was noted between the two cohorts.

Developing more positive attitudes towards mental health nursing in undergraduate students: part 1--does more theory help?

Negative attitudes towards mental illness and the mental health nursing profession have deterred many undergraduate nursing students from considering this area as an attractive career option. Positive clinical experience has been identified as the most important factor in producing more favourable attitudes. While the quantity of theory is identified as important, its impact on attitudes has not been examined through research. This study compared two groups of students undertaking different numbers of theoretical and clinical hours in mental health nursing to determine if this increase has an impact on nursing students' attitudes. Anonymous questionnaires were distributed to the total population of students following completion of the theoretical component of the programme but prior to clinical experience. The questionnaire was designed to assess: (1) nursing student's preparedness for and attitudes towards the mental health field; (2) consumers of mental health services; and (3) the students' career preferences. This first paper in a two-part series examines the impact of theoretical hours and suggests that while other attitudes are fairly similar between the two groups, the group exposed to more theory exhibited significantly more positive attitudes towards psychiatric nursing as a career.

Reflection without shame--reflection without blame: towards a more collaborative understanding between mental health consumers and nurses.

It is now a clear policy expectation that consumers of mental health services be given the opportunity to be active participants in all aspects of mental health service development and delivery. Psychiatric nurses have an important role to play in ensuring opportunities for genuine participation; however, the literature suggests that this role is not always realized in practice. Negative attitudes of health professionals (including nurses) to consumer has been identified as a significant barrier to the realization of this policy goal, with education and training recognized as an important strategy for developing more positive attitudes. This paper describes the implementation of a mental health consumer academic position, through the personal reflections of a nurse academic and a consumer academic. More specifically, the paper addresses the reactions of some nurses to the work of the consumer academic and the apparent feeling of being attacked as nurses. By recognizing this defensiveness, nurses and other health professionals may more effectively move towards promoting consumer participation in mental health care.

The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction.

There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students.

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses' careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: 'fear of the unknown', 'reconciling difference between general acute health and mental health settings' and 'supporting practice'.

Consumer participation in mental health services: looking from a consumer perspective.

Widespread changes to the structure and delivery of mental health services have effected considerable change in the role of the service user or consumer. The view of consumers of mental health services as passive recipients of care and treatment is gradually undergoing a significant shift, in light of an increasing expectation that consumers be provided with opportunities to become actively involved in all aspects of their care. Consumer participation is now broadly reflected in government policy; however, to date there has been little exploration of the extent to which the policy is being realized in practice. To provide a greater understanding of these experiences and opinions, in-depth interviews were conducted with consumers of mental health services (n = 15). The interview transcripts were analysed through the identification and explication of major themes. The findings reinforce the need to view consumers as heterogeneous and respond to individual needs and interests regarding consumer participation. Despite variations in experience there is a clear need to develop mechanisms to support consumer involvement and to influence the attitudes of health professions to become more valuing of a consumer perspective. Nurses are in an ideal position to lead this process.

The role of a mental health consumer in the education of postgraduate psychiatric nursing students: the students' evaluation.

Recent Australian Government policy reflects the integral nature of active consumer participation to the planning and delivery of mental health services. The effectiveness of consumer participation in improving mental health services has received some attention in the literature. Commonwealth Government funding enabled the development of a partnership between the Centre for Psychiatric Nursing Research and Practice and the Melbourne Consumer Consultants' Group. The successful application enabled the employment of a mental health consumer as an academic staff member of the Centre for Psychiatric Nursing Research and Practice. One important aspect of this role involved the mental health consumer teaching a consumer perspective to postgraduate psychiatric nursing students. The primary aim was to increase the students' awareness of and sensitivity to greater consumer participation within the mental health arena. This paper presents the results of an evaluation of the consumer academic role in teaching within the Postgraduate Diploma in Advanced Clinical Nursing (Psychiatric Nursing). An evaluation form was distributed to students (n = 21) on completion of the semester. The findings suggest the experience was considered beneficial to students and was impacting significantly on their current practice. This project supports the value of consumer participation in the education of mental health professionals.

Patient satisfaction with psychiatric services provided by a Melbourne tertiary hospital emergency department.

The mainstreaming of psychiatric services within the general healthcare system has created fundamental changes to the manner in which patients access acute psychiatric services. This change was intended to reduce the stigma associated with psychiatric diagnosis and therefore contribute to improved treatment outcomes for patients. The aim of this paper is to discuss the results of a study designed to ascertain the level of psychiatric patient satisfaction with the services received in the emergency department of a Melbourne metropolitan hospital. The results indicate a high level of satisfaction, particularly with the availability of staff with psychiatric qualifications and experience to provident treatment, support and care. The major areas of dissatisfaction identified by patients included: lengthy waiting times, lack of privacy in the triage area and negative attitudes of general staff. These findings support the argument from the literature for psychiatric consultancy services to be available in the emergency department, and further identifies the need for triage guidelines to be tailored to the needs of mental health patients and for emergency department triage staff to be appropriately educated to adequately triage these patients.

The triage of psychiatric patients in the hospital emergency department: a comparison between emergency department nurses and psychiatric nurse consultants.

The triage of patients in the hospital emergency department (ED) has developed as an efficient method to determine the level of urgency and provide appropriate care and treatment. The triage process has been found to be less effective for patients presenting with mental health related problems. Triage guidelines specifically tailored for mental health needs have been introduced in the attempt to overcome existing problems, however, the effectiveness of these guidelines has not been extensively tested. This paper presents the findings of a study conducted in a large metropolitan hospital in Melbourne, Australia. All presentations to the ED for psychiatric problems (n = 137) were triaged using the mental health guidelines over a 3-month period. The same presentations were triaged by psychiatric nurse consultants employed in the ED and the results compared. The results indicate a high level of difference in the triage ranking by the two groups of nurses, with emergency nurses tending to classify presentations as more urgent than their psychiatric nurse colleagues. These findings suggest that mental health education for emergency nurses is necessary if the guidelines are to be used effectively and improve outcomes for patients presenting with psychiatric problems.

Negative attitudes towards clients with drug and alcohol related problems: finding the elusive solution.

The difficulties experienced by nurses in providing care to clients with drug and alcohol related problems within general hospital settings have been clearly identified in the literature. Despite this, the problem continues with little or no evidence of improvement. This paper reports the results of a research project undertaken in a large private hospital in metropolitan Melbourne, Victoria, Australia. The study sought to ascertain whether a difference in attitudes, confidence and perceived knowledge related to the care of clients with drug and alcohol problems would be evident between those nurses who used consultation and liaison services from a specialist drug and alcohol unit and those who did not. A questionnaire was administered to 200 nurses, with a 53% completion rate (n = 106). The results showed very little difference between the groups with the exception of the perceived knowledge category which indicated a statistically significant difference.

Undergraduate nursing students' views of mental health nursing in the forensic environment.

The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students' attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students' understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.

The role of the psychiatric consultation-liaison nurse in the improved care of patients experiencing mental health problems receiving care within a general hospital environment.

The Psychiatric Consultation-Liaison Nurse (PCLN) has an imporrtant role in supporting nurses and other health care professionals in caring for patients experiencing mental health problems in a non-psychiatric environment. The limited available research findings suggest the PCLN role to be effective in terms of staff satisfaction, and some suggestion of cost savings is apparent. This paper refers to a survey of the attitudes of health professionals (n-113) too the services provided by the PCLN in a large metropolitan hospital in Melbournre, Australia. The results indicate a high level of satisfaction with the services of the PCLN. Enhancement of the participants' professional role, the professional role of nursing and improving health outcomes was amongst the perceived benefits of the PCLN role.

Who will look after my grandmother? Attitudes of student nurses toward the care of older adults.

A review of the literature illustrates the unpopularity of nursing in the elderly population related to other areas of nursing practice. The aim of this article is to present the findings of a research project conducted in Victoria, Australia, investigating the career preferences of undergraduate nursing students. The results indicate caring for older adults is considered the least popular area of practice for Year 1 nursing students. The reason given by students for their choices demonstrates a negative view of this type of work, largely based on inaccuracies and misconceptions. The implications of these findings for the future care of elderly individuals are discussed.

The mental health nurse: contributing to improved outcomes for patients in the emergency department.

Fundamental changes to health-care policy in Australia have led to an increase in the extent to which emergency department staff come into contact with patients experiencing mental health problems. This has been problematic for nurses, many of whom perceive themselves as lacking the skills and expertise to provide appropriate care and treatment to this client group. Psychiatric/mental health consultation-liaison nursing within the emergency department is becoming established as a means to overcome some of the problems identified. Despite this growth there is a paucity of literature evaluating the effectiveness of this position. This paper presents the results of an evaluation of the mental-health consultation-liaison nurse role in an inner city teaching hospital in Sydney Australia. The survey involved a three stage approach to data collection. The data collected at the commencement of the position included focus groups to ascertain the needs of emergency department nurses and a questionnaire designed to measure the skills, confidence and perceived knowledge of emergency department nursing and medical staff. An evaluation of the satisfaction of nurses and doctors was conducted towards the end of the three month pilot programme. The results confirmed the need for positions of this type and suggested a high level of satisfaction with the service provided.

An overview of the role and functions of a psychiatric consultation liaison nurse: an Australian perspective.

The role of the psychiatric consultation liaison nurse (PCLN) has increased substantially in popularity over the last few years. Despite the growth of this position, a paucity of literature regarding the role, functions and effectiveness of psychiatric consultation liaison nursing continues to exist. The current study was undertaken as part of the Victorian Nurse Practitioner Project. A significant aspect of this study concerned collection of data on the activities of the PCLN. This approach enabled an extensive and detailed profile of the PCLN to be formulated. The findings indicate that the PCLN provided a service to nursing, medicine and allied health in relation to patients experiencing mental health problems in the general hospital setting. Patients referred to the PCLN presented varied clinical features in terms of medical, surgical and mental health disorders. The PCLN performed a range of interventions. The results of this study make a significant contribution to address the current paucity of literature.