Scoping practice issues in the Australian mental health nursing workforce

Issues and challenges in the mental health workforce development

As in many other developed countries, the proportion of the population in Australia that will experience a mental health disorder is increasing. To respond adequately and appropriately to what some might say is an epidemic will require not only an available workforce but also one which is highly skilled. Unfortunately the current protracted shortage of nurses generally, and which is projected to worsen over the next few years, will also have a significant impact on the provision of care for a large and vulnerable portion of the population, those who experience mental illness. This article will provide an overview of the issues and challenges confronting the development of a sustainable mental health nursing workforce.

A major stream in mental health in undergraduate nursing programmes: identifying the benefits and acknowledging the innovation

The literature demonstrates the problems mental health nursing has faced in securing sufficient graduate nurses to meet current and projected workforce needs. Deficiencies in educational preparation have been identified as a significant contributing factor. A major stream in mental health nursing has been introduced into undergraduate Bachelor of Nursing programmes as one strategy to address this problem. To-date, 11 streams have been introduced into Australian universities and no evaluations of the impact of these initiatives have been published as yet. This qualitative research was undertaken to explore the implementation and outcomes of major streams. In-depth telephone interviews were undertaken with participants from 10 universities, to explore their experiences with and opinions of this initiative. This paper specifically addresses the perceived benefits. Qualitative data analysis revealed many benefits to the major in promoting the value of, and encouraging interest in mental health nursing for undergraduate students. Four main themes were identified: (1) benefits to students; (2) benefits to the university; (3) benefits to industry; and (4) innovative approaches to education. The findings suggest the major in mental health nursing can contribute to addressing workforce problems in mental health nursing.

Addressing the mental health nurse shortage: undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.

Impacts of seclusion and the seclusion room: exploring the perceptions of mental health nurses in Australia

The practice of seclusion does not sit comfortably with contemporary Australian mental health policy that emphasizes the provision of mental health services in the least restrictive environment. The negative impact of seclusion on patients and nurses is increasingly being acknowledged. On the other hand, seclusion receives wide support from nurses as a necessary behavior management strategy. The aim of this study was to examine nurses' perceptions of the impact of seclusion and the seclusion room on patients and the changes they would consider to the seclusion room in relation to characteristics of the nurses, including therapeutic optimism, job satisfaction, and burnout. One hundred twenty-three nurses employed in mental health services from Queensland, Australia, participated in this study by completing four self-report scales to measure these attitudes and characteristics. Data were analyzed using descriptive statistics and Pearson's product-moment correlation coefficients. The findings indicate some relationship between the three scales and attitudes to seclusion; however, therapeutic optimism had the strongest link. Participants with higher scores for optimism were more likely to acknowledge the detrimental effects of seclusion and the seclusion room and were more likely to support positive changes to the seclusion room.

Scratching beneath the surface: influencing factors on nurses' attitudes toward the use of seclusion

Reducing the use of seclusion is now widely identified as a quality issue for mental health services and reflects recognition of the detrimental impact of seclusion on consumers of services. Despite this, the research evidence suggests that nurses continue to support the use of seclusion in order to maintain a safe environment. The aim of this study was to consider how factors such as Therapeutic Optimism, Job Satisfaction, and Burnout might relate to nurses' attitudes toward seclusion. The Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory, and Minnesota Satisfaction Questionnaires were completed by 123 nurses employed in one of eight participating mental health services. Data analysis included Spearman's rho and independent-samples t-tests statistics. The findings suggested several significant relationships between attitudes toward seclusion and therapeutic optimism, job satisfaction, and burnout. Participants with higher optimism scores, high intrinsic motivation, low emotional exhaustion, and high personal accomplishment were more likely to respond negatively to the use of seclusion. This research enhances our understanding of attitudes toward seclusion and may assist in the development of interventions to influence more positive attitudes.

Teaching nursing's history: a national survey of Australian Schools of Nursing, 2007-2008

This paper reports on a survey of Australian Schools of Nursing that took place over an 8months period between 2007 and 2008. This study was implemented to extend understanding of effective teaching of nursing history, an area not previously researched in Australia. A critical interpretive method enabled us to problematise the issue, to highlight what was said about the importance of history teaching as well as ad hoc practices and barriers. The study found that participants value history of nursing teaching, but the crowded curriculum is erasing history's place and potential. It revealed ideological tensions shaping and constraining history of nursing teaching. In Australia, the way nursing's history is taught varies and teaching content, strategies and resources utilised are not evenly available. Pedagogical innovations are not effectively disseminated. Our recommendations for Australian Schools of Nursing that have more general applicability are: (1) Nursing curriculum needs to be developed from a set of principles and standards that define the attributes of the professional nurse, not in response to interest groups and (2) History of nursing pedagogy should be systematically developed and disseminated through a national virtual centre, linked to international centres, to enhance teachers' understanding of the discipline area and to support their teaching practice.

Turning the coin--emphasizing the opportunities in mental health nursing

It is widely acknowledged that mental health nursing has undergone considerable change in Australia during recent decades, including the mainstreaming of mental health services into the general health care system. Recruitment problems and high levels of stress and burnout associated with the profession are seen to be indicative of a degree of demise in the status and desirability of this field of practice. However, new nursing roles have developed in response to these changes. The aim of this paper is to focus on three specific roles: mental health consultation-liaison nursing; mental health nurse practitioner; and the mental health nurse incentive program. These new roles present exciting and rewarding career opportunities for mental health nurses and may increase the attractiveness of mental health nursing for new graduates.

The importance of teaching and learning resilience in the health disciplines: a critical review of the literature

This paper, based on a review of the literature, discusses resilience and the application of resilience research to nursing education. The paper advances the educational discourse on professional preparation, arguing that resilience theory should be part of the educational content and taught in a way that promotes reflection and application in order to give students strength, focus and endurance in the workplace. In addition, we argue that resilience and similar qualities ought to be emphasised in clinical experience courses, internships, work integrated learning and other work experience courses. Recommendations for building resilience in health professionals through education, training and modifications in workplace culture, as well as suggestions for priorities in research are presented.

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.

What are scoping studies? A review of the nursing literature

BACKGROUND

Scoping studies are increasingly undertaken as distinct activities. The interpretation, methodology and expectations of scoping are highly variable. This suggests that conceptually, scoping is a poorly defined ambiguous term. The distinction between scoping as an integral preliminary process in the development of a research proposal or a formative, methodologically rigorous activity in its own right has not been extensively examined.

AIMS

The aim of this review is to explore the nature and status of scoping studies within the nursing literature and develop a working definition to ensure consistency in the future use of scoping as a research related activity.

DESIGN

This paper follows an interpretative scoping review methodology.

DATA SOURCES

An explicit systematic search strategy included literary and web-based key word searches and advice from key researchers. Electronic sources included bibliographic and national research register databases and a general browser.

RESULTS

The scoping studies varied widely in terms of intent, procedural and methodological rigor. An atheoretical stance was common although explicit conceptual clarification and development of a topic was limited. Four different levels of inquiry ranging from preliminary descriptive surveys to more substantive conceptual approaches were conceptualised. These levels reflected differing dimensional distinctions in which some activities constitute research whereas in others the scoping activities appear to fall outside the remit of research. Reconnaissance emerges as a common synthesising construct to explain the purpose of scoping.

CONCLUSIONS

Scoping studies in relation to nursing are embryonic and continue to evolve. Its main strengths lie in its ability to extract the essence of a diverse body of evidence giving it meaning and significance that is both developmental and intellectually creative. As with other approaches to research and evidence synthesis a more standardized approach is required.

Nurse practitioners and medical practice: opposing forces or complementary contributions?

PURPOSE

The medical profession in Australia has expressed concern about the expansion of nursing practice into areas that are traditionally the domain of medicine. Particular apprehension is raised in relation to the prescription of medications. This paper will consider and critique the argument that the standard of care provided by a nurse practitioner would be of lesser quality than that provided by a medical practitioner.

CONCLUSIONS

Despite the medical profession's opposition for nurse practitioner roles, there is little evidence suggesting that the quality of services offered by a nurse practitioner would be inferior.

PRACTICE IMPLICATIONS

Available evidence suggests that care and treatment from nurse practitioners in primary health care is equal to that provided by medical practitioners.

Informal role expansion in Australian mental health nursing

PURPOSE

This study aims to determine the extent to which community mental health nurses are currently practicing beyond the traditional scope of nursing practice.

DESIGN AND METHODS

A self-administered questionnaire was distributed to community mental health nurses in Victoria, Australia.

FINDINGS

The majority of participants reported routine involvement in practices that would normally be considered beyond the scope of nursing practice, such as prescribing, ordering diagnostic tests, and referral to specialists.

PRACTICE IMPLICATIONS

The extent to which the current mental health service system is dependent upon nurses transgressing professional and legal boundaries warrants further study. Psychiatrists and community mental health nurses need to work collaboratively to understand their respective knowledge and skills and to be clear about how they take responsibility for client care.

Skills, knowledge, and attitudes expected of a newly-graduated mental health nurse in an inpatient setting

Mental health nurses (MHN) are at the forefront of care and treatment within acute inpatient settings. Research suggests that newly-graduated MHN are unsure about the skills and knowledge that they are expected to possess, and are expected to practice at a level that they are not prepared for in their undergraduate courses; however, research focusing on competencies for newly-graduated MHN is scarce. This study aimed to identify competencies expected of newly-graduated MHN working in a regional mental health facility in New South Wales, Australia. Eight registered nurses (with varying levels of experience) participated in individual semistructured interviews. Four themes were identified, and termed: communication, safety, self-awareness, and treatment. Within these four themes, 14 competencies were described that detail clear aims for new graduates, provide a better understanding of mental health nursing, and promote specialized and competent practice in mental health.

The slow death of psychiatric nursing: what next?

Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.

Mental health nurse practitioners in Australia: improving access to quality mental health care

Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority 'area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners.

Identifying sources and effects of carer fatigue and burnout for mental health nurses: a qualitative approach

This project aimed to: identify work-related problems to assist mental health nurses to locate the sources and effects of carer fatigue and burnout, set up a dialogue between the participants and the identified sources of stress in the workplace to address the identified problems, and make recommendations to a local Area Health Service to prevent and manage stressors in the practice of mental health nursing. In total, 20 experienced registered nurses working as mental health nurses were enlisted through a snowballing method of recruitment, and convenience sampling was used to intentionally target those research participants who were interested in identifying sources of carer fatigue and burnout in their work. Data collection was via semistructured interviews which used questions reflecting the first stage of White and Epston's (1990) method of narrative therapy, in which relative influence questioning is used to externalize the problem. The research questions related to the effect of burnout in mental health nursing across various interfaces, through the dominant story of emotional stress and fatigue. The sources of work-related problems for mental health nurses that contribute towards their experiences of carer fatigue and burnout were: employment insecurity and casualization of the work-force; issues with management and the system; difficulties with the nature of the work, inadequate resources and services, problems with doctors, aggressive and criminal consumers, undervaluing consumers and nurses, physical and emotional constraints of the work setting, and nurse-nurse relationships and horizontal violence. The effects of stress were shown in dealing with and reacting to work place stressors.

Towards a Foucauldian reading of the Australian mental health nursing workforce

This article reflects on the findings of the recently published Scoping Study of the Australian Mental Health Nursing Workforce from the perspective of Foucault's work on 'governmentality'. First, the policy background to the scoping study is described. This is followed by a discussion of Foucauldian concepts and method that will be used to explore selected aspects of the scoping study. The related concepts of 'governmentality' and 'technologies of the self' are used to begin a theoretically grounded analysis of mental health nursing education and practice, with particular attention to discourses of 'change' and 'survival'. The examples chosen are used to support the argument that competing discourses order multiple 'readings' of Australian mental health nursing, including whether or not it is thriving or surviving. The article ends with comments on whether a Foucauldian analysis adds anything to what has been reported in the scoping study.

Postdisciplinarity in mental health-care: an Australian viewpoint

This paper outlines some of the powerful forces progressively undermining the conceptual and practical foundations upon which the major disciplines have been established, and dissolving the boundaries which have traditionally distinguished them from each other, particularly those disciplines involved in the healthcare enterprise. It discusses some of the implications of these processes for mental health nursing, and champions a new cadre of 'postdisciplinary' staff, comprising a graduate generic mental healthcare worker and a postgraduate clinical specialist. It is argued that such a specialist --- a 'Generic Mental Health Worker' --- should be welcomed by all those who want to see improved quality of care in mental health services rather than defend a failing system.

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.