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Davidson AR, Reidlinger DP. A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce. Nutr Diet 2022; 79:497-548. [PMID: 35989542 PMCID: PMC9545586 DOI: 10.1111/1747-0080.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 11/28/2022]
Abstract
Aim The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care. Methods A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce. Results A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs. Conclusions The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Lakeman R, Cashin A, Hurley J, Ryan T. The psychotherapeutic practice and potential of mental health nurses: an Australian survey. AUST HEALTH REV 2020; 44:916-923. [PMID: 33121591 DOI: 10.1071/ah19208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/25/2020] [Indexed: 11/23/2022]
Abstract
Objective Mental health nurses (MHNs) have a long, under-recognised, history of engaging in psychotherapeutic practice across the spectrum of mental illness and mental health problems. There is a need for a psychotherapeutic response for people with complex or serious mental health problems within the stepped care model and in response to increased need for psychotherapeutic responses to COVID-19 and natural disasters. This project sought to identify the educational preparation and self-reported competency of MHNs to clinically undertake psychotherapy across the continuum of care. Methods Situated within a larger mixed-methods study exploring how MHNs practice psychotherapy, adapt it to routine care and envisage the future, this paper reports the findings from a survey of MHNs regarding their educational preparation, experience and competence in modalities of psychotherapy and the application of psychotherapy with specific clinical groups. Results In all, 153 MHNs responded to a request to participate in the study. In this cohort, 86% of nurses had postgraduate qualifications specific to psychotherapy and 95% had worked for over 10 years in the mental health field and had hundreds of hours of training in psychotherapy. There was a high level of self-reported competence in working with people with serious mental health problems and at-risk or vulnerable groups. Conclusions Currently, MHNs are not recognised in federal funding arrangements to procure psychotherapeutic intervention for members of the Australian population who require it. MHNs ought to be recognised as independent providers based on both the psychotherapeutic skills they possess and their specialist clinical skills of working with people across the spectrum of mental health problems. Appropriately qualified MHNs need to be funded to use their skills in psychotherapy via access to appropriate funding arrangements, such as Better Access and the National Disability Insurance Scheme. What is known about the topic? MHNs do not appear to be recognised as having postgraduate knowledge and skills in psychotherapy and other psychotherapeutic interventions. This lack of recognition has resulted in the Australian public being unable to access subsidised specialist psychotherapeutic services by this highly experienced group. Most published commentary has been around the Mental Health Nurse Incentive Program, but, to date, scholarly work related to this program has not influenced public views and policy formation despite multiple favourable evaluations. What does this paper add? This study highlights that MHNs possess a largely unrecognised and valuable skill set in psychotherapy practice that they can adapt to work with people with complex needs. What are the implications to practitioners? MHNs possess skills and experience that, if recognised and funded, could be rapidly mobilised to improve consumer outcomes across the continuum of stepped care and in response to increased need during COVID-19.
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Affiliation(s)
- Richard Lakeman
- School of Health and Human Sciences, Southern Cross University, Gold Coast Campus, Southern Cross Drive, Bilinga, Qld 4225, Australia; and Corresponding author.
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia.
| | - Tom Ryan
- Mental Health Service Group, Townsville Hospital and Health Service, Qld 4814, Australia.
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Hurley J, Lakeman R, Cashin A, Ryan T. Mental health nurse psychotherapists are well situated to improve service shortfalls in Australia: findings from a qualitative study. Australas Psychiatry 2020; 28:423-425. [PMID: 32510981 DOI: 10.1177/1039856220924326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper reports the capabilities of mental health nurse (MHN) psychotherapists in Australia and their perceptions on how to best utilize their skills. METHOD An MHN is a registered nurse with recognized specialist qualifications in mental health nursing. One hundred and fifty three MHNs completed an online survey; 12 were interviewed. RESULTS Three themes were derived from a qualitative analysis of the aggregated data: psychotherapy skills of MHN psychotherapists are under-utilized; these nurses bridge gaps between biomedical and psychosocial service provision; and equitable access to rebates in the primary care sector is an obstacle to enabling access to services. CONCLUSIONS MHN psychotherapists are a potentially valuable resource to patients in tertiary and primary health care. They offer capacity to increase access to specialist psychotherapy services for complex and high risk groups, while being additionally capable of meeting patients' physical and social needs. Equitable access to current funding streams including Medicare rebates can enable these outcomes.
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Affiliation(s)
- John Hurley
- School of Health and Human Sciences, Southern Cross University, Australia
| | - Richard Lakeman
- School of Health and Human Sciences, Southern Cross University, Australia
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, Australia
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Hurley J, Lakeman R, Cashin A, Ryan T. The remarkable (Disappearing Act of the) mental health nurse psychotherapist. Int J Ment Health Nurs 2020; 29:652-660. [PMID: 32011061 DOI: 10.1111/inm.12698] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
The aim of this Australian based qualitative study was to better understand key drivers for mental health nurses to undertake training in psychotherapy, and how these capabilities are integrated into their clinical practice. Open ended reposes from a national survey of 153 mental health nurses were supplemented with data from 12 semi-structured interviews of nurses with rich experience of integrating psychotherapy and mental health nursing capabilities. Key findings emerging from the thematic analysis were that mental health nurses are providing uniquely holistic psychotherapeutic services to consumers with often complex conditions, despite overtly hostile clinical and policy contexts. These often very well qualified mental health nurse psychotherapists are different to the traditional identity of either a nurse or psychotherapist. Recommendations from the findings of this study are that where appropriately qualified, mental health nurses be granted eligible provider status for existing Medicare funding items. Finally, training and building foundational capabilities in psychotherapy is highly recommended for all mental health nurses.
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Affiliation(s)
- John Hurley
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Richard Lakeman
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Tom Ryan
- Psychotherapy Specialist Clinic, Mental Health Service Group, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Leach MJ, Jones M, Bressington D, Jones A, Nolan F, Muyambi K, Gillam M, Gray R. The association between community mental health nursing and hospital admissions for people with serious mental illness: a systematic review. Syst Rev 2020; 9:35. [PMID: 32066507 PMCID: PMC7027066 DOI: 10.1186/s13643-020-01292-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Relapse prevention is an important objective in the management of serious mental illness (SMI). While community mental health nurses (CMHN) might be well-placed to support people with SMI in averting relapse, no systematic reviews have examined this association. AIM To review the evidence from studies reporting an association between CMHN exposure and hospitalisation of persons living with SMI (a proxy for relapse). METHODS Searches were undertaken in ten bibliographic databases and two clinical trial registries. We included studies of patients with SMI, where CMHN was the exposure, and the outcome was relapse (i.e. readmission to a psychiatric inpatient facility). Quality assessment of included studies was completed using two risk-of-bias measures. RESULTS Two studies met the inclusion criteria. Studies were rated as being of low-moderate methodological quality. There was insufficient evidence to conclude that community mental health nursing reduced the risk of admission to psychiatric inpatient facilities. CONCLUSIONS The review found no evidence that CMHN was associated with higher or lower odds of admission to psychiatric inpatient facilities among patients with SMI. The findings of the review point to a need for further research to investigate the impact of CMHN exposure and relapse in people with SMI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058694.
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Affiliation(s)
- Matthew J. Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia 5000 Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia 5608 Australia
| | - Dan Bressington
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR China
| | - Adrian Jones
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham, Wales, LL167TD UK
| | - Fiona Nolan
- Florence Nightingale Foundation, School of Health and Human Science, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ UK
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia 5608 Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia 5000 Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
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Henderson J, Javanparast S, Baum F, Freeman T, Fuller J, Ziersch A, Mackean T. Interagency collaboration in primary mental health care: lessons from the Partners in Recovery program. Int J Ment Health Syst 2019; 13:37. [PMID: 31164917 PMCID: PMC6543583 DOI: 10.1186/s13033-019-0297-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/03/2022] Open
Abstract
Background Collaborative care is a means of improving outcomes particularly for people with complex needs. The Partners in Recovery (PIR) program, established in Australia in 2012, provides care coordination to facilitate access to health and social support services for people with severe and persistent mental illness. Of the 48 PIR programs across Australia, 35 were led by Medicare Locals, the previous Australian regional primary health care organisation and nine involved Medicare Locals as partner organisations. Aims To identify features which enabled and hindered collaboration in PIR programs involving Medicare Locals and determine what can be learnt about delivering care to this population. Methods Data were collected from 50 interviews with senior staff at Medicare Locals and from eight focus groups with 51 mental health stakeholders in different Australian jurisdictions. Results Successful PIR programs were based upon effective collaboration. Collaboration was facilitated by dedicated funding, a shared understanding of PIR aims, joint planning, effective network management, mutual respect and effective communication. Collaboration was also enhanced by the local knowledge and population health planning functions of Medicare Locals. Jurisdictional boundaries and funding discontinuity were the primary barriers to collaboration.
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Affiliation(s)
- Julie Henderson
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
| | - Sara Javanparast
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
| | - Fran Baum
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
| | - Toby Freeman
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
| | - Jeffery Fuller
- 2College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Anna Ziersch
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
| | - Tamara Mackean
- 1Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, 5001 Australia
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