A survey of psychiatric nurses' opinions of advanced practice roles in psychiatric nursing

Tasks and activities of Advanced Practice Nurses in the psychiatric and mental health care context: A systematic review and thematic analysis

BACKGROUND

To adequately describe the advanced psychiatric nursing roles and to distinguish them from the other roles of psychiatric and general nursing care, it is necessary to explore the concrete tasks and activities and the scope of practice of Psychiatric Mental Health Advanced Practice Nurses (APN).

OBJECTIVE

to extract, summarize and systematize the tasks and activities of the Psychiatric Mental Health APN from the international scientific literature.

DESIGN

systematic literature review reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement and checklist.

METHODS

The database search was performed using CINAHL, PubMed/Medline, Cochrane Library and Google/Google Scholar databases. Literature sources in English and German, which reported tasks and activities of the Psychiatric Mental Health APNs were included in the analysis. No time restrictions were defined. Roles such as Community Mental Health Nurses and Public Mental Health Nurses were excluded from the analysis. Data were extracted by independent reviewers for qualitative thematic analysis.

RESULTS

An extensive body of international literature on Psychiatric Mental Health APN sub-roles could be identified through a systematic literature search. Through our synthesis the main tasks and activities of Psychiatric Mental Health APNs could be identified and described. Altogether 46 items (practice dimensions) could be identified from the 20 sources and finally systematically summarized into six themes or "practice domains": (1) direct (clinical) nursing and care practice, (2) care coordination and case management, (3) psychosocial health promotion and prevention, (4) consulting, education and coaching, (5) leadership and public relations, and (6) research and practice development.

CONCLUSIONS

The results of this review provide a thorough outline of the tasks and activities of the Psychiatric Mental Health APN. Thus, the results reported here form the basis for a further differentiation of the tasks and activities of the Psychiatric Mental Health APNs from the basic nursing activities as well as tasks and activities of the generalist APNs. In this context, however, an attempt should be made to increase the specificity of the settings by including the tasks and activities of the community and public mental health nurses.

Postgraduate education in psychiatric nursing in Israel: closing the gap

Deinstitutionalization policies are being gradually implemented in Israel. Most recently, an insurance reform has been approved, in which mental health services will be included in the HMO's service package. As most Israeli mental health nurses are currently employed in institutional settings, the Ministry of Health's Nursing Division seeks to estimate their scope of employment in preparation for the anticipated changes. The aim of this study is to describe present-day professional practice characteristics of qualified psychiatric nurses and identify practice areas for which advanced training may be required. The research design is cross-sectional on a national level, including all state psychiatric hospitalization services. A countrywide sample of nurses with post-basic training in state psychiatric hospitals identified areas of practice in which further training may be required: psychotherapy intervention (60% of respondents); consultation for the elderly (60%); care prescriptions (64%); community drug treatment management (69%); and referral to professionals and community resources (56%). Nurses reported gaps in continued care and community rehabilitation activities. These findings have training implications in an era of increased focus on chronic mental illness in the community.

Australian mental health nurses' attitudes to role expansion

PURPOSE

This study examined the attitudes of Australian community mental health nurses toward role expansion.

DESIGN AND METHODS

This study used an exploratory descriptive design. An anonymous questionnaire was completed by 154 community mental health nurses in metropolitan and rural areas to explore their attitudes to expanded practice.

FINDINGS

Nurses demonstrated an overwhelmingly positive attitude toward expanded practice and considered all stakeholders, particularly consumers, would be the beneficiaries if nurses were legally able to undertake tasks such as prescribing medication.

PRACTICE IMPLICATIONS

As a large proportion of the specialist mental health workforce, mental health nurses comprise a largely underutilized resource. With consumers identified as the primary beneficiaries of expanded practice, it is likely that nurses' motivation to pursue expanded practice roles will assist in the provision of improved mental health care.

Examination of the effect of education about electroconvulsive therapy on nursing practice and patient satisfaction

INTRODUCTION

Electroconvulsive therapy (ECT) procedures require the work of a multidisciplinary team that includes an anesthesiologist, a psychiatrist, and a treatment nurse. Electroconvulsive therapy is treated like a minor surgical procedure that requires preoperative preparation and postoperative care.

AIM

This research was conducted as a quasi-experimental study for the purpose of evaluating the effect of education about ECT given to nurses who work on a psychiatric ward.

SAMPLE

The research pretest sample was composed of 52 ECT procedures in which nurses participated in managing that were conducted between April and October 2006 on the psychiatric ward of Dokuz Eylül University Hospital. The posttest sample was composed of 52 ECT procedures in which nurses participated in managing that were conducted between January and March 2007 on the same psychiatric ward. DATA COLLECTION TOOL: The observation form for the determination of nursing care in ECT and satisfaction form, which were developed by the researcher from expert opinion, were used for data collection. Data obtained were analyzed using the test for significance between 2 means.

RESULTS

The nurses included in the research received a total score of 4 for nursing care in ECT procedure before education and X = 11.5 after education. The difference in the mean scores for nursing care in ECT procedure before and after education was found to be statistically significant (P < 0.05). The mean score for patient satisfaction with nursing care in ECT procedure before education was X = 2.5 and that after education was X = 4.1. The difference between the 2 means was found to be statistically significant.

CONCLUSIONS

Education given to nurses about ECT improved nursing practice and increased patient satisfaction. For this reason, it is recommended that nursing care in ECT continuing education be planned and given at regular intervals.

An examination of the scope and purpose of education in mental health nursing

This study examined the education of mental health nurses by surveying all qualified mental health nurses working within one National Health Service region in Scotland. Using an adaptation of a previously used instrument, 488 questionnaires were distributed producing a response rate of 194 (39.75%). The study's themes - initial preparation, professional development and future practice - reveal findings of interest, particularly the axis of RMN (pre-1992 education) and RMN (Project 2000 education). In terms of initial preparation, clear differences between groups were found. Pre-1992 RMNs' report on educational experience majoring on practical skills contrasts sharply with Project 2000 respondents who, in spite of a course philosophy of reflective practice, emphasised an apparent lack of practical skills for practice. For professional development, both groups valued flexible approaches via journal reading, teaching, networking and participating in clinical supervision. In terms of educational provision, short course provision with an emphasis on short, flexible course provision (e.g., in-service study days), practice education and closer (and flexible) links between higher education and the practice area were highlighted as the most important ways to prepare for future practice.

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.

Knowledge and attitudes toward electroconvulsive therapy among health care professionals and students

Widespread variations in electroconvulsive therapy (ECT) prescription between and within countries have led many researchers to study professionals' attitudes to the procedure. A questionnaire looking at knowledge and attitudes was administered to 593 medical and nursing students, psychiatrists and anesthetists, and theater and psychiatric nurses. Respondents were based in 2 Irish cities, Dublin and Cork. Poorer knowledge of ECT was found in the nursing group, and this included psychiatric nurses: a third overestimate ECT mortality, most did not know if it caused permanent brain damage, and only 1 psychiatric nurse (2.9%) expressed positive attitudes to its use. Nursing students had significantly lower knowledge and more negative attitudes than medical students, and exposure to the procedure of ECT failed to improve their attitudes. The strongest predictor of better knowledge and more positive ECT attitudes was membership of the medical group. There were direct associations between better knowledge and more positive attitudes in the medical group but not among the nursing group. Low ECT knowledge among psychiatric nurses has implications in obtaining patients' valid consent. Our failure to link exposure to ECT to better nursing attitudes is discussed along with other educational lessons.

A conversation: challenging the relevance and wisdom of separate mental health legislation

This paper explores the dilemmas encountered by mental health nurses when working with mental health legislation. The concerns and considerations of an expert mental health nurse, complemented by the opinion of an expert in health-care and legal issues are presented. It is argued that there is currently a distorted perception with regard to the function and sentiment of mental health legislation, and this paper aims to restore balance in interpreting and working with such law. Viewing mental health legislation primarily as a mechanism for involuntary hospitalization effectively removes any power or recourse given to mental health consumers by the law. Principles of mental health care and legislation are examined as well as the relationship the law has with dangerousness to self or others and mental ill health. A dialogue is established between the two authors to assist the exploration of these legal and clinical issues. The continued relevance of specific mental health legislation is brought into question. It is proposed that the existence of such legislation constitutes discrimination and contributes to stigma associated with mental illness. An alternative legislation for all circumstances where an individual is deemed incompetent is proposed as the most significant step towards mainstreaming of mental health care and an end to discrimination.

Greek psychiatric care reform: new perspectives and challenges for community mental health nursing

The purpose of this article is twofold: (1) to explore the main issues of psychiatric care reform in Greece and outline the operating way of the new residential structures of psychiatric care and rehabilitation; and (2) to focus on the implementation of mental health nursing roles in the primary care services such as supervisor-therapist, liaison, coordinator-crisis interventionist and counsellor-trainer within the context of a multidisciplinary therapeutic team. Given that multiple professionals are involved in mental health care in primary care, issues of role are likely to be crucial to the effective implementation of new workers. Moreover, there is existing evidence of ambiguity in the roles of different mental health professionals in primary care, relating to the problems they manage and the treatments they provide. The authors believe that more emphasis needs to be given to the mental health nursing specialty in Greece, because the large majority of patients requiring mental health care should have the possibility of taking better quality of care as the psychiatric structures at community are continuously developing.

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.

Mental health nurse practitioner: expanded or advanced?

The role of the nurse practitioner has been described as the apex of nursing practice. Such a statement has significant implications for the professional status of nursing in its own right. The aim of this paper is to discuss the nature of the nurse practitioner role in Australia and the importance of distinguishing between advanced and expanded practice. Evaluations of the nurse practitioner role suggest that specifically nursing contributions lead to a high level of consumer satisfaction. If nursing in general, and mental health nursing in particular, is to maintain and further develop their professional status, debate about the implications of the nurse practitioner role, and the terminology used to describe its scope, is crucial.

Managing adverse drug reactions: an orphan task

BACKGROUND

Nurse prescribing initiatives have potential to impact on medication management for long-term conditions. Over time, the adverse effects of medications become increasingly onerous. This 'side-effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group.

AIM

This paper explores the introduction of nurse-administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management.

METHODS

This was an observation study, with a quasi-experimental comparator group design, undertaken with clients receiving long-term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse-client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently.

FINDINGS

Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health-promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal.

IMPLICATIONS

The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the 'care gaps' in medication management may benefit service users. The 'checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.

Scoping practice issues in the Australian mental health nursing workforce

This is the third of four articles on the scoping study of the Australian mental health nursing workforce conducted on behalf of the Australian and New Zealand College of Mental Health Nurses (ANZCMHN) for the Australian Health Ministers Advisory Council (AHMAC) National Working Group on Mental Health (NWGMH). Its purpose is to focus on factors that significantly affect mental health nursing practice. The issues of advanced practice, regulation of nursing, accreditation, credentialing and demarcation with other disciplines are addressed.