The views of mental health nurses on continuing professional development

It's Not Just in the Walls: Patient and Staff Experiences of a New Spatial Design for Psychiatric Inpatient Care

The environment in psychiatric inpatient care is key to patient recovery and staff job satisfaction. In this qualitative study of patient and staff experiences of a new spatial design in psychiatric inpatient care, we analysed data from 11 semi-structured interviews with patients and five focus group discussions with staff using qualitative content analysis. The new design contributed to feelings of safety and recovery, but patients and staff also reported some frustration and added stress. The results lead us to conclude that while the new spatial design improves some conditions for recovery and job satisfaction, the design itself is simply not enough. Changes in care environments require that both patients and staff be informed and involved in the renovation to ensure that patients feel respected and staff feel confident in using the new environment before and during treatment and follow-ups.

Nursing Education to Enhance Culturally and Linguistically Diverse (CALD) Community Access to Mental Health Services: A Scoping Review

Research has found that training health care professionals can enhance the access of the culturally diverse community to appropriate mental health services. Yet, little research has been conducted that explicitly focuses on improving nursing knowledge, skills, attitudes, and behaviours that can enhance the access of the Culturally and Linguistically Diverse (CALD) community. This scoping review aims to locate, summarise, and recap what is known in the academic literature about educational interventions and programs to improve mental health nurses' cultural competence. Examining how educational interventions and programs can improve mental health nurses' knowledge, skills, attitudes, and behaviours to facilitate Culturally and Linguistically Diverse (CALD) community access to mental health services can also identify gaps in knowledge to report future research areas. Fifteen studies included in the review reported a positive effect of cultural competence interventions; however, it was difficult to establish a single effective intervention method due to the significant heterogenicity in cultural competence intervention strategies. Most studies in this scoping review included nurses as participants. However, only one study solely focussed on cultural competence intervention for mental health nurses. Two other studies included mental health nurses as participants, along with other mental health professionals. Henceforth, there is a prerequisite for more research focussing on enhancing mental health nurses' cultural competency. Additional research is required to evaluate educational interventions' impact on improving cultural competence attributes on specific practitioner behaviours and the effects on health care and health care outcomes. This review can form a basis for future research studies that will emphasise the impact of cultural competence interventions for mental health nurses.

Experiences of student nurses on role modelling of a therapeutic approach by registered nurses: Recommendations for improvement

BACKGROUND

A therapeutic approach involves portraying the attributes of being polite towards fellow human beings and patients, respecting them irrespective of their circumstances and having sympathy and compassion for them. Knowledge of therapeutic approach is the initial step towards gaining patients' trust and developing student nurses' communication with patients; however, theoretical knowledge alone may not increase application in practice. Role modelling of a therapeutic approach increases patient care satisfaction and enables student nurses to therapeutically communicate with patients, colleagues and all other staff members. The most appropriate way for student nurses to learn what it means to portray therapeutic approach is seeing registered nurses' role modelling it.

OBJECTIVES

To make recommendations for the enhancement of role modelling of therapeutic approach by registered nurses for student nurses at a regional public hospital.

METHOD

A qualitative, exploratory, descriptive, phenomenological and contextual design was used. Three focus group interviews were conducted. Data were analysed using Giorgi's descriptive phenomenological method. Measures to ensure trustworthiness and ethical principles were applied throughout the research.

RESULTS

One central theme with three main themes and related sub-themes indicated that student nurses had negative experiences on role modelling of therapeutic approach owing to registered nurses' non-therapeutic communication, lack of professionalism and ethical conduct as well as poor quality patient care. However, only the recommendations seeking to address the experiences of non-therapeutic communication which included negative attitudes of registered nurses towards patients, lack of provision of patient information, poor handling of patients' complaints as well as racial discrimination re-handling of patients' complaints will be highlighted.

CONCLUSION

The majority of student nurses had negative experiences on role modelling of therapeutic approach by registered nurses. They needed registered nurses to improve their approach towards patients. It is expected that the implementation of the recommendations will enhance therapeutic approach to patients.

Lifelong learning and nurses' continuing professional development, a metasynthesis of the literature

Background

Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development.

Methods

A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed.

Results

We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards.

Conclusions

Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

In-Service Education: Evolving Internationally to Meet Nurses' Lifelong Learning Needs

In-service education (ISE) in nursing is teaching that occurs in the workplace. Internationally, ISE activities have been evident in nursing for many years because it has been seen as a convenient and cost-effective way to deliver education to nurses with minimal disruption to staffing levels and the delivery of patient care. ISE-related literature was sought to address the aim of tracing development and focus of nursing ISE in New Zealand. A key finding of this literature review is that ISE has been adapted in New Zealand and internationally to meet the demands of evolving nursing practice, and for this reason it remains relevant and essential to nurses. The embeddedness of ISE within clinical environments also supports its relevance. Future research is called for to establish which aspects of ISE are critical to ensuring its ongoing success. [J Contin Educ Nurs. 2019;50(7):313-318.].

The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study

BACKGROUND

Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments.

OBJECTIVE

We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described.

METHODS

The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course.

RESULTS

Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages.

CONCLUSIONS

Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed.

Rede de atenção psicossocial: adequação dos papéis e funções desempenhados pelos profissionais

Resumo OBJETIVO Verificar a adequação dos papéis e funções desempenhados pelos profissionais de nível superior nos serviços da rede de atenção psicossocial de uma capital do Nordeste brasileiro. MÉTODO Estudo analítico, transversal, de abordagem quantitativa. A amostra foi composta por 65 profissionais de sete serviços da rede de atenção psicossocial de Natal, Rio Grande do Norte, Brasil. Utilizou-se um questionário com perguntas fechadas e semiabertas. Os dados foram analisados através do SPSS versão 20.0, com aplicação dos testes Qui-quadrado e exato de Fisher. Adotou-se nível de significância de 5% (p<0.05). RESULTADOS detectou-se inadequação quanto ao atendimento aos grupos de familiares (52.3%), à formação especializada em saúde mental (69.2%; p=0,02) e às condições de trabalho nos serviços (87.7%). CONCLUSÃO Os papéis e as funções desenvolvidas pelos profissionais nos serviços pesquisados estavam condizentes com a proposta desses serviços, embora convivendo com inúmeras dificuldades.

Communication elements supporting patient safety in psychiatric inpatient care

Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries.

Leading a Recovery-oriented Social Enterprise

Recovery-oriented mental health services promote the principles of recovery, such as hope and optimism, and are characterized by a personalized approach to developing consumer self-determination. Nurse leaders are increasingly developing such services as social enterprises, but there is limited research on the leadership of these programs. Leading a recovery-oriented mental health nurse social enterprise requires visionary leadership, collaboration with consumers and local health providers, financial viability, and commitment to recovery-focused practice. This article describes the framework of an Australian mental health nursing social enterprise, including the service attributes and leadership lessons that have been learned from developing program sustainability.

Two steps forward, one step back: the intricacies of engaging with e-portfolios in nursing undergraduate education

OBJECTIVES

To share the experience of implementing and refining the use of e-portfolios into an undergraduate nursing degree.

DESIGN

This is a reflective piece that explores the hurdles experienced in introducing and maintaining e-portfolio's into higher education, particularly in undergraduate nursing curricula.

DATA SOURCES

Nil

REVIEW METHODS

Review of the literature, and comparing and contrasting this against the experience of the authors.

RESULTS

Hurdles included access to computer and quality internet connections, along with the levels of IT literacy of staff, and the common misconception that all students are IT savvy. What was also evident was how the need for both pedagogical and technical support to both staff and students was paramount in achieving an understanding of the software, and the scope and perspective of e-portfolio pedagogy. With each of these hurdles, staff reluctance to engage in e-portfolio use in the tertiary sector was evident. On reflection of each of these challenges, the authors identified that their experience mirrored other tertiary institutions in that a single hurdle alone is not responsible for fragmented e-portfolio implementation, but a combination of factors. Through exploring recommendations from other tertiary institutions, the authors recognize the limitations within their own working environment that contributed to the pitfalls experienced.

CONCLUSION

Despite e-portfolios being introduced into higher education for over a decade, its successful implementation into undergraduate nursing curricula continues to be fraught with pitfalls, creating the sense of moving backwards more so than forwards. As with any new learning tool, careful consideration needs to be given to comprehensive planning, implementation, review and evaluation to either prevent the hurdles identified, or limit their impact on the quality of the portfolio produced and the learning attained from the process.

The effects of mobile applications in cardiopulmonary assessment education

BACKGROUND

Mobile applications can be used as effective simulations for nursing education. However, little is known regarding the effects of mobile application-mediated training on nursing. The aim of this study was to determine the effectiveness of mobile applications by comparing the effectiveness of a high-fidelity human patient simulator to that of a mobile application on student learning.

METHODS

Following lectures on the lungs and the heart, twenty-two students were separated into two groups to perform a simulation exercise. Then, the students' education effects were evaluated based on their knowledge of lung and heart assessments, their clinical assessment skill, and satisfaction with their education.

RESULTS

After four weeks, the mobile application group maintained their knowledge, whereas the high-fidelity human patient simulator group exhibited significantly decreased knowledge of the lung assessment. Knowledge of the heart assessment was significantly increased in both groups. There was no significant difference in clinical assessment skill or educational satisfaction between the groups.

CONCLUSIONS

We found that mobile applications provide educational tools similarly effective to a high-fidelity human patient simulator to maintain memory and to teach cardiopulmonary assessment skills.

US and international health professions' requirements for continuing professional development

There is not a comprehensive global analysis of continuing professional development (CPD) and continuing education (CE) in the major health professions in published literature. The aim of this article is to summarize findings from the US and international literature on CPD and CE practices in the health professions, comparing the different requirements and frameworks to see what similarities and challenges exist and what the future focus should be for the pharmacy profession. A literature review was conducted on CPD and CE in selected health professions, namely pharmacy, medicine, nursing, ophthalmology, dentistry, public health, and psychology. Over 300 papers from the health professions were retrieved and screened. Relevant articles based on the abstracts and introductions were summarized into tabular form by profession, minimum requirements for licensure, nature of credits, guidelines on how to record CE and CPD activities, and specific CE and CPD definitions. Wide variations exist among the health professions. Lessons learned from this information can be used to further clarify and define the role of CE and CPD and self-directed lifelong learning in pharmacy and the health professions.

Knowledge transfer from an e-learning course to clinical practice

BACKGROUND

Continuing education is essential in improving practical psychiatric nursing skills. However, little is known about how knowledge gained in continuing education is transferred to nurses' daily work.

OBJECTIVES

To describe the transfer of knowledge gained from an e-learning course to daily practice.

DESIGN

Qualitative study design.

SETTINGS

One hospital district in Southern Finland with three specialized psychiatric wards (acute, rehabilitation, geriatric wards).

PARTICIPANTS

Nursing staff (N=53) were recruited and 35 participated voluntarily in the e-learning continuing education course in spring 2009.

METHODS

The data comprised nurses' reflective writing during the e-learning course and course evaluation forms completed after the course. We used qualitative design with inductive content analysis to analyze nurses' writings.

RESULTS

The nurses were willing and able to transfer what they learned to their daily practice including the course themes, communication and co-operation among staff members, understanding of preventive and alternative treatment methods and critical thinking regarding one's own work. After the e-learning course the nurses were able to identify development areas such as issues related to staff members' daily work, the patient's role on the ward, alternative methods to avoid coercion, issues pertaining to the care environment on the ward, psychiatric nurses' education, and making an action plan for aggressive situations. All nurses would recommend the course to other nurses.

CONCLUSIONS

New knowledge is easily adopted and transferred to daily practice.

Advanced psychiatric nurse practitioners’ ideas and needs for supervision in private practice in South Africa

Background: Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field.Objectives: The aim of this study was to explore and describe advanced psychiatric nursepractitioners’ ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa.Method: A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch’s method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature.Results: The data analysis generated the following themes – that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa.Conclusion: This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

Strengthening practical wisdom: mental health workers' learning and development

BACKGROUND

Practical wisdom, understood as knowing how to be or act in any present situation with clients, is believed to be an essential part of the knowledge needed to be a professional mental health worker. Exploring processes of adapting, extending knowledge and refining tacit knowledge grounded in mental health workers' experiences with being in practice may bring awareness of how mental health workers reflect, learn and practice professional 'artistry'.

RESEARCH QUESTION

The aim of the article was to explore mental health workers' processes of development and learning as they appeared in focus groups intended to develop practical wisdom. The main research question was 'How might the processes of development and learning contribute to developing practical wisdom in the individual as well as in the practice culture?'

RESEARCH DESIGN

The design was multi-stage focus groups, and the same participants met four times. A phenomenological hermeneutical method for researching lived experience guided the analysis.

PARTICIPANTS AND CONTEXT

Eight experienced mental health workers representing four Norwegian municipalities participated. The research context was community-based mental health services.

ETHICAL CONSIDERATIONS

The study was reported to Norwegian Social Data Services, and procedures for informed consent were followed.

FINDINGS

Two examples of processes of re-evaluation of experience (Association, Integration, Validation, Appropriation and Outcomes and action) were explored. The health workers had developed knowledge in previous encounters with clients. In sharing practice experiences, this knowledge was expressed and developed, and also tested and validated against the aims of practice. Discussions led to adapted and extended knowledge, and as tacit knowledge was expressed it could be used actively.

DISCUSSION

Learning to reflect, being ready to be provoked and learning to endure indecisiveness may be foundational in developing practical wisdom. Openness is demanding, and changing habits of mind is difficult.

CONCLUSION

Reflection on, and confrontation with, set practices are essential to building practice cultures in line with the aims of mental health services.

Mental health nursing in Australia: resilience as a means of sustaining the specialty

As a concept, resilience is continuing to attract considerable attention and its importance across various life domains is increasingly recognised. Few studies, however, have defined or considered the notion of the group or collective resilience of a profession, including the capacity of that profession to withstand adversity and continue to develop positively in the face of change. This article considers the notion of resilience from the perspective of the specialty of mental health nursing, including the ways the specialty has adapted--and continues to develop--to changes experienced since deinstitutionalisation. Insights are drawn from a national Delphi study undertaken in Australia to develop a Scope of Practice for Mental Health Nurses, with responses used as a springboard to consider the impact of the perceived loss of professional identity on the collective resilience of the profession. Recommendations for a way forward for the profession are considered, including the ways in which a collective professional resilience could be developed to sustain and strengthen the professional identity of mental health nursing in Australia and across the globe.

Integrity and mental health nursing: factors to consider

Integrity is interpreted as a holistic phenomenon that incorporates personal characteristics, cognition, interpersonal awareness, and practical enactment-ultimately relating to matters society deems worthwhile. This approach enables integrity to be understood as both a personal morality and a social (group) morality. Mental health nurses embedded in a hierarchical bureaucratic organisation may act according to their personal morality and display moral strength in many situations; however, if the social morality of the group is at variance with their convictions, as individuals their capacity to be courageous and enact integrity will be tested. A likely consequence will be that those with the most cherished positive patient care values, those with a stronger adherence to moral convictions about the public good, and those with a clearly developed understanding of integrity parameters will depart, and possibly leave the profession. In this article, we provide an overview of the structural and contextual realities of nursing work within organisations and discuss how these factors can compromise whole unit integrity and seriously challenge mental health nurses' commitment to enacting integrity. In the final section of this article, broad suggestions for strengthening individual and group integrity are provided.

Recent graduate nurse views of nursing, work and leadership

AIMS AND OBJECTIVES

To assess recent nurse graduates of a large university and seeks their views of university preparation, requisite nursing skills and qualities, workplace transition, supports received, nurse leadership and role models, and career development and retention.

BACKGROUND

Concern about attracting and retaining registered nurses is a continuing workforce issue in parts of Asia and throughout the world.

DESIGN

Qualitative interviews with recent nursing graduates.

METHODS

Seventeen face-to-face interviews took place using a structured schedule of 23 questions. Data were coded and analysed by hand to determine clusters of interest and develop themes.

RESULTS

Four broad topics emerged: (1) skills and qualities graduates consider central to nursing; (2) the support they received during the transition from graduate to novice practitioner and that which continues; (3) elements they value in nursing role models and leaders; and (4) the ward characteristics that will encourage them to remain in nursing and develop a career. Interviewees expressed concerns about retention-related issues, making suggestions for improvements. Unique findings focus on the blaming culture that many respondents consider they are working in, and the system whereby they are not free to access postgraduate studies until a specific time frame has elapsed, and when they do pursue further studies, they are bonded to the auspicing hospital/health service.

CONCLUSIONS

Responses unique to this research are the explicit concerns about a blaming culture, and complaints about rigid rules (bonding system) that virtually prevent an individual from accessing postgraduate studies independent of the hospital system. Interviewees strongly resent the bonding system that indentures them to that place of work.

RELEVANCE TO CLINICAL PRACTICE

Quality health care is dependent on a well-educated, sustainable and skilled nursing workforce. Recognition of the concerns of newly graduated nurses in relation to nursing skill acquisition, workplace support issues and career concerns can assist in ensuring these issues are adequately addressed and in turn contribute to a stronger, more stable and competent nursing workforce.

Mandatory continuing professional development requirements: what does this mean for Australian nurses

Background

This paper presents a discussion related to the recent decision in Australia to introduce mandatory Continuing Professional Development (CPD) for nurses. Historically there has been international debate surrounding mandatory CPD requirements; this debate is ongoing as Australian nurses face a diverse range of CPD offerings from a variety of providers.

Discussion

The purpose of this paper is to examine how mandatory CPD requirements for national nursing registration in Australia have evolved and to present an analysis of what this will mean for Australian nurses. What is yet to be determined is how to measure professional development and the effectiveness of professional development education. This is important to the international community with consensus in the literature that professional development is linked to ongoing education. Contradicting arguments are presented about whether this professional development should be mandatory.

Summary

Presenting a contemporary discussion about the current and potential impact of mandatory CPD requirements for nurses, this discussion paper utilises the case of Australia’s current national policy and CPD operation to examine the choices that nurses make in order to fulfil their legislative requirements. Additional arguments are presented about the barriers nurses face in undertaking CPD. The quest for effective CPD is complex and should incorporate different situations for nurses and individual learning styles.

Career development: graduate nurse views

AIMS AND OBJECTIVES

To explore recent Singapore nursing graduates' experience of and views about their career development and progress.

BACKGROUND

The recruitment and retention of an adequate number of registered nurses is a continuing workforce issue in Singapore and other major cities.

DESIGN

Survey of recent nursing graduates.

METHODS

Recent nursing graduates from the Bachelor programme (n = 147) were sent an individual survey; a response rate of 54% was achieved.

RESULTS

Findings show that nurses rated their self-concept in a positive manner and were most satisfied (moderately to very) with helping patients and providing effective care, and the level of patient involvement. They were least satisfied (moderately to only a little) with prestige among the general medical community and the general public, hours of work, lifestyle factors and research opportunities. The following four factors were identified as significant impediments to career development; lack of support in the work place; perceived insufficient clinical career development opportunities; excessive work hours; and limited access to merit-based places in further education.

CONCLUSIONS

Suggestions made to overcome perceived career development barriers are as follows: broad multifactorial healthcare system changes; decreased and more flexible working hours; and fairer access to further clinical and higher education.

RELEVANCE TO CLINICAL PRACTICE

Results highlight the value clinical nurses place on having access to career development opportunities, merit-based further education and work place supports. These factors also have the potential to influence patient care and impact on the retention of nurses in their present job and satisfaction with their nursing career.

Leadership, support and acknowledgement of registered nurses work in acute mental health units

In acute mental health inpatient units, it is not surprising that culture, peers, immediate management, and sources of support and acknowledgment all contribute to positive nursing outcomes. In this qualitative study, four questions targeting leadership, culture, support, and acknowledgement of work well done were asked of 40 registered nurses (RN) working in acute mental health units. Findings convey a mixed picture indicating variation across units. Three-quarters believe that senior nursing staff actively contribute to a positive working environment. Almost half of the RN nominated peers as the providers of counsel and support when required, and a similar percentage believed that senior nursing staff fulfil these roles. Of interviewees, 33% said their nursing achievements are never, or rarely, acknowledged. For these RN, management, peers, and nurse unit managers are the preferred personnel to provide appropriate positive feedback. Thus, there is a gap between the expectations and hopes that nurses have for senior management approaches and behaviours and the reality of their daily experience. Overall, the responses portray a culture that underpins and enables both subtle interpersonal interactions that might arise out of necessity given the perceived lack of support from non-hands-on RN and administrators.

Transportability of tertiary qualifications and CPD: a continuing challenge for the global health workforce

BACKGROUND

In workforces that are traditionally mobile and have long lead times for new supply, such as health, effective global indicators of tertiary education are increasingly essential. Difficulties with transportability of qualifications and cross-accreditation are now recognised as key barriers to meeting the rapidly shifting international demands for health care providers. The plethora of mixed education and service arrangements poses challenges for employers and regulators, let alone patients; in determining equivalence of training and competency between individuals, institutions and geographical locations.

DISCUSSION

This paper outlines the shortfall of the current indicators in assisting the process of global certification and competency recognition in the health care workforce. Using Organisation for Economic Cooperation and Development (OECD) data we highlight how International standardisation in the tertiary education sector is problematic for the global health workforce. Through a series of case studies, we then describe a model which enables institutions to compare themselves internally and with others internationally using bespoke or prioritised parameters rather than standards.

SUMMARY

The mobility of the global health workforce means that transportability of qualifications is an increasing area of concern. Valid qualifications based on workplace learning and assessment requires at least some variables to be benchmarked in order to judge performance.

Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.