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McAllister S, Simpson A, Tsianakas V, Robert G. "What matters to me": A multi-method qualitative study exploring service users', carers' and clinicians' needs and experiences of therapeutic engagement on acute mental health wards. Int J Ment Health Nurs 2021; 30:703-714. [PMID: 33459482 DOI: 10.1111/inm.12835] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Nurse-patient therapeutic engagement on acute mental health wards is beneficial to service users' outcomes and nurses' job satisfaction. However, engagement is not always fulfilled in practice and interventions to improve engagement are sparse and ineffective. We explored the experiences of service users, carers, and clinicians drawing from 80 hours of non-participant observations in an acute mental health ward and semi-structured interviews with 14 service users, two carers, and 12 clinicians. Analysis of these data resulted in 28 touchpoints (emotionally significant moments) and eight overarching themes. Service users, carers, and clinicians identified a lack of high-quality, person-centred, collaborative engagement and recognized and supported efforts to improve engagement in practice. Potential solutions to inform future intervention development were identified. Our findings align with previous research highlighting negative experiences and support the need to develop multicomponent interventions through participatory methods.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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White MR, Stein-Parbury J, Orr F, Dawson A. Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia. Int J Ment Health Nurs 2019; 28:605-615. [PMID: 30556954 DOI: 10.1111/inm.12566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/29/2022]
Abstract
Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.
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Affiliation(s)
- Melanie R White
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Orr
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Isobel S. 'In some ways it all helps but in some ways it doesn't': The complexities of service users' experiences of inpatient mental health care in Australia. Int J Ment Health Nurs 2019; 28:105-116. [PMID: 29897669 DOI: 10.1111/inm.12497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/30/2022]
Abstract
Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users.
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Affiliation(s)
- Sophie Isobel
- Mental Health Research, Sydney Local Health District, Concord Centre for Mental Health, Concord, New South Wales, Australia
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Zolezzi M, Alamri M, Shaar S, Rainkie D. Stigma associated with mental illness and its treatment in the Arab culture: A systematic review. Int J Soc Psychiatry 2018; 64:597-609. [PMID: 30019976 DOI: 10.1177/0020764018789200] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mental health has not had the same public profile as physical health. This has contributed to the stigma associated with mental illness and to its treatments. Research investigating how the traditions and values amongst those with an Arab heritage contribute to stigmatizing beliefs, attitudes or actions in the provision of mental healthcare has not been widely reported. AIM To systematically review the literature and summarize the findings of studies reporting stigmatizing beliefs, actions and attitudes toward treatment of people with mental illness in the Arab population. METHODS PubMed, Ovid, Psycharticles and Embase were used to identify original studies of non-institutionalized Arab adults or children reporting findings relevant to stigma toward mental illness. A manual search of the bibliography of all selected original studies was also undertaken. Independent data extraction was performed by two reviewers, who then met to compare data and reach consensus. Findings were classified as stigmatizing beliefs, actions or attitudes toward mental health treatments. RESULTS A total of 33 articles were retrieved for full review. Those utilizing qualitative methodology provided insight into the many ways mental illness is viewed and defined among those with an Arab heritage. Among the studies using quantitative methodology, most compared stigmatizing beliefs, attitudes toward mental health treatments or stigmatizing actions among different Arab populations, some also investigated correlations between characteristics of the Arab population tested with stigmatizing beliefs, actions and attitudes toward mental health treatments. Findings from studies undertaken in Qatar reported greater stigmatizing beliefs, actions or attitudes toward mental health treatments among Qatari versus non-Qatari Arabs. CONCLUSION A large diversity in the stigmatizing beliefs, actions and attitudes toward treatment of mental illness within the Arab population were identified. The influence of cultural variations on stigma should be explored further and used to tailor anti-stigma interventions in this population.
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Affiliation(s)
| | - Maha Alamri
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Shahd Shaar
- College of Pharmacy, Qatar University, Doha, Qatar
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Zarea K, Fereidooni-Moghadam M, Baraz S, Tahery N. Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran. Issues Ment Health Nurs 2018; 39:244-250. [PMID: 29064747 DOI: 10.1080/01612840.2017.1377327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards. DESIGN A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data. RESULTS Four themes were developed based on the analysed data: "experiencing psycho-social challenges," "experiencing psychological challenges," "encountering catalysts causing challenges," and "employing various strategies for coping with challenges." CONCLUSIONS Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.
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Affiliation(s)
- Koroush Zarea
- a Nursing Care Research Center in Chronic Diseases , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Malek Fereidooni-Moghadam
- b Nursing and Midwifery Care Research Center, School of Nursing and Midwifery , Isfahan University of Medical Sciences , Isfahan , Iran
| | - Shahram Baraz
- a Nursing Care Research Center in Chronic Diseases , Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
| | - Noorollah Tahery
- c Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran
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Affiliation(s)
- Thomas John
- Inpatient Quality & Development Lead, Kent and Medway NHS and Social Care Partnership Trust
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Patterson C, Procter N, Toffoli L. Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient. J Adv Nurs 2016; 72:2042-53. [DOI: 10.1111/jan.13024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Nicholas Procter
- University of South Australia; Adelaide South Australia Australia
| | - Luisa Toffoli
- University of South Australia; Adelaide South Australia Australia
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Thibeault C. An Interpretation of Nurse-Patient Relationships in Inpatient Psychiatry: Understanding the Mindful Approach. Glob Qual Nurs Res 2016; 3:2333393616630465. [PMID: 28462325 PMCID: PMC5342637 DOI: 10.1177/2333393616630465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/27/2015] [Accepted: 12/29/2015] [Indexed: 02/03/2023] Open
Abstract
Nurses who work in acute inpatient psychiatry, where lengths of stay are increasingly shortened, struggle to establish therapeutic nurse–patient relationships. The purpose of this inquiry was to illuminate the nature of relationships between inpatient psychiatric mental health (PMH) nurses and their patients. The author used semistructured interviews and nonparticipant observation in an interpretive phenomenological inquiry. The data consisted of texts that were transcribed from narratives and observations. The meanings that were generated led to the uncovering of patterns of commonality, or themes. Of the themes uncovered, the theme of mindful approach highlighted PMH nurses as engaging with patients in distress, strategically creating encounters to establish a basis for ongoing therapeutic work. The PMH nurse–patient relationship in acute inpatient psychiatry continues to be under pressure, but nurses still carefully construct relational approaches in response to patient distress, and patients in these settings experience these approaches as meaningful to their recovery.
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Chambers M, Kantaris X, Guise V, Välimäki M. Managing and caring for distressed and disturbed service users: the thoughts and feelings experienced by a sample of English mental health nurses. J Psychiatr Ment Health Nurs 2015; 22:289-97. [PMID: 25944483 DOI: 10.1111/jpm.12199] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 12/01/2022]
Abstract
This paper reports the thoughts and feelings experienced by registered mental health nurses caring for distressed and/or disturbed service users in acute inpatient psychiatric settings in England. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; prevailing feelings experienced by nurses were fear, anxiety and vulnerability. To enhance care quality, nurses expressed the need for better communication with service users, and preventing the use of coercive measures and promotion of alternative methods of care and management. The nurses considered that debriefing dialogues following untoward incidents, practice development initiatives, education and training together with clinical supervision could be the way forward. The paper builds on the existing literature in offering clear explanations of nurses' thoughts and feelings when caring for distressed and/or disturbed service users in an English acute, inpatient psychiatric setting. Despite the small sample size and the limitations that it generates, the study findings will be of interest to the wider mental health nursing community. The findings will link to other national and international studies and therefore be valuable for future research studies of this kind. Collectively, they are building up a general picture of the distress, cognitive and emotional dissonance experienced by mental health nurses when using coercive interventions. The findings will help to develop mental health nurse education and enhance practice. High levels of distress and disturbance among service users experiencing acute mental illness is a major problem for mental health nurses (MHNs). The thoughts and feelings experienced by these nurses when caring for service users are of paramount importance as they influence clinical practice and caregiving. Similarly to research by other countries, this paper reports national, qualitative data regarding the thoughts and feelings of English MHNs who care for these service users within acute inpatient psychiatric settings. Data were collected from focus groups in which MHNs working in acute inpatient settings in England participated and analysed using inductive content analysis. Findings highlighted three broad themes: (1) emotional and cognitive dissonance; (2) therapeutic engagement; and (3) organizational management and support. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; the prevailing feelings experienced by nurses were fear, anxiety and vulnerability. Nurses would like better communication with service users, prevention of coercive measures and the use of alternative methods of care and/or management to ensure enhanced care. Participants considered practice development initiatives, education, training, staff and managerial support including debriefing and clinical supervision as the way forward. Despite the small sample size and its limitations, these national data add to the existing literature, and the study findings link to those of other studies both nationally and internationally. Collectively, these studies are building up a general picture of the distress, cognitive and emotional dissonance experienced by MHNs when using coercive interventions. The findings will help to develop MHN education and enhance practice.
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Affiliation(s)
- M Chambers
- Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK
| | - X Kantaris
- Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK
| | - V Guise
- Department of Health Studies, Faculty of Social Science, University of Stavanger, Stavanger, Norway
| | - M Välimäki
- Department of Nursing Science, Turku University Hospital, Turku, Finland
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Henderson J, Willis E, Walter B, Toffoli L. Measuring the workload of community mental health nurses: A review of the literature. Contemp Nurse 2014; 29:32-42. [DOI: 10.5172/conu.673.29.1.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hung BJ, Huang XY, Cheng JF, Wei SJ, Lin MJ. The working experiences of novice psychiatric nurses in Taiwanese culture: a phenomenological study. J Psychiatr Ment Health Nurs 2014; 21:536-43. [PMID: 24612192 DOI: 10.1111/jpm.12121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/30/2022]
Abstract
Novice psychiatric nurses experience heavy workloads, insufficient training and support in Taiwan. The aim of this study was to understand the working experiences of novice psychiatric nurses during their first year in a clinical setting. A qualitative phenomenological approach, using semi-structured face-to-face interviews was used. Narratives were analyzed using Colaizzi's seven-step method. Data saturation was reached after interviews were conducted with 15 nurses based on the purposive sampling. Four themes and eight sub-themes were identified: struggling (lacking a sense of security and competency), emulating (learning the process of interaction with clients and families, learning an appropriate role from nursing staff), prevailing (developing core competency, creating a therapeutic environment) and belonging (coping with the job, becoming a part of the psychiatric nursing staff). The findings from this study demonstrate that nurses are often inadequately prepared for psychiatric nursing. They have little understanding of mental illness, are unable to communicate appropriately with clients and struggle to cope with the conditions. Our study supports the importance for helping nurses to improve their essential knowledge and skills for coping with the job and providing good quality care, particularly in the first year.
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Affiliation(s)
- B J Hung
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Cleary M, Horsfall J, Escott P. The recovery continuum: how do meaningful activities for consumers fit? Issues Ment Health Nurs 2013; 34:911-3. [PMID: 24274248 DOI: 10.3109/01612840.2013.854537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Michelle Cleary
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
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Johansson IM, Skärsäter I, Danielson E. The experience of working on a locked acute psychiatric ward. J Psychiatr Ment Health Nurs 2013; 20:321-9. [PMID: 22845661 DOI: 10.1111/j.1365-2850.2012.01919.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health-care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context.
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Affiliation(s)
- I M Johansson
- School of Health Sciences Jönköping University Box 1026 SE-551 11, Jönköping, Sweden.
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Koivunen M, Kontio R, Pitkänen A, Katajisto J, Välimäki M. Occupational stress and implementation of information technology among nurses working on acute psychiatric wards. Perspect Psychiatr Care 2013; 49:41-9. [PMID: 23293996 DOI: 10.1111/j.1744-6163.2012.00339.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The study describes nurses' occupational stress and implementation of information technology on acute psychiatric wards. DESIGN AND METHODS The sample consisted of 146 Finnish nurses. The data were collected using a structured questionnaire in 2006. FINDINGS Eleven percent of the nurses felt that work was very mentally strenuous and 45% felt that it was rather mentally strenuous. Male nurses reported more stress and dissatisfaction than female nurses. Nurses with very positive attitudes towards Internet use reported less stress and more job satisfaction than nurses with neutral attitudes towards Internet use. PRACTICE IMPLICATIONS By supporting positive attitudes to information technology in nurses' daily work, we may increase their job satisfaction and thereby reduce their stress experiences.
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Camuccio CA, Chambers M, Välimäki M, Farro D, Zanotti R. Managing distressed and disturbed patients: the thoughts and feelings experienced by Italian nurses. J Psychiatr Ment Health Nurs 2012; 19:807-15. [PMID: 22296342 DOI: 10.1111/j.1365-2850.2011.01857.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper reports on a qualitative study to identify Italian nurses' feelings and emotions towards the management of distressed and disturbed psychiatric patients in acute inpatient settings. Four focus groups were carried out involving 33 nurses from seven acute psychiatric services in a region of Italy. Data were analysed using content analysis. Findings highlight that fear is the prevailing feeling experienced by nurses in the management of distressed patients. This includes both fear of being physically harmed and concerns about doing harm or damage to patients. The unpredictability of aggressive behaviour from unknown patients was described as especially frightening. Known patients, namely those previously admitted to the unit, induced less fear, as their behaviour was considered more predictable. Patients with dual diagnosis were also a worry for many nurses, who considered themselves lacking in the personal relational skills needed to manage an individual in crisis. Nurses reported that they try to understand the reasons for a patient's aggressive behaviour and are empathetic to his or her suffering. When such empathy is lacking, nurses experience conflicting feelings of counter-aggressiveness. The paper concludes by emphasizing the need to increase availability of education related to patient management, in particular team working and its internal relationships.
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Pires DEPD, Bertoncini JH, Trindade LDL, Matos E, Azambuja E, Borges AMF. Inovação tecnológica e cargas de trabalho dos profissionais de saúde: uma relação ambígua. Rev Gaucha Enferm 2012; 33:157-68. [DOI: 10.1590/s1983-14472012000100021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trata-se de uma revisão integrativa com objetivo de rastrear a produção científica acerca da influência da inovação tecnológica nas cargas de trabalho dos profissionais de saúde. Selecionou-se 57 publicações nas bases de interesse de 2004 a 2009. Predominaram as pesquisas de campo com abordagem qualitativa, realizadas em hospitais. Nenhum estudo teve por objetivo relacionar inovação tecnológica e cargas de trabalho. Nos estudos sobre inovação tecnológica destacaram-se publicações sobre tecnologias de informação e comunicação e novas formas de organização do trabalho; no tema cargas de trabalho predominaram estudos sobre condições promotoras de estresse e Burnout. Os achados mostraram que as inovações influenciam as cargas de trabalho de modo ambíguo, podendo aumentá-las ou diminuí-las.
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Affiliation(s)
| | | | | | | | - Eliana Azambuja
- Instituto Federal do Rio Grande do Sul; Universidade Federal do Rio Grande, Brasil
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Willis E, Henderson J, Toffoli L, Walter B. Calculating nurse staffing in community mental health and community health settings in South Australia. Nurs Forum 2012; 47:52-64. [PMID: 22309382 DOI: 10.1111/j.1744-6198.2011.00251.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams. BACKGROUND Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings. METHOD A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data. RESULTS The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool. CONCLUSIONS The tool needs further evaluation to determine its applicability to a range of clinical settings.
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Affiliation(s)
- Eileen Willis
- School of Medicine, Faculty of Health Sciences, Flinders University, Adelaide, South Australia
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Coombs T, Curtis J, Crookes P. What is a comprehensive mental health nursing assessment? A review of the literature. Int J Ment Health Nurs 2011; 20:364-70. [PMID: 21481124 DOI: 10.1111/j.1447-0349.2011.00742.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Assessment is the foundation on which nursing care is delivered. The aim of this paper is to better understand the content (what information nurses seek about consumers) and the process (how they go about gathering that information) of a comprehensive mental health nursing assessment in practice. Using terms, such as 'nursing', 'mental health', and 'assessment', the CINAHL, Medline, and PsycINFO databases were searched for studies that describe the content and process of a comprehensive mental health nursing assessment. Although studies of aspects of mental health nursing assessment, such as the assessment of risk or carer burden, were found, no single study described both the content and process of a comprehensive mental health nursing assessment in practice. In Australia, a comprehensive assessment is codified as a competency to practice nursing; however, the standards of practice set for mental health nurses are less clear on what constitutes a comprehensive assessment or how this should be undertaken. The peer-reviewed literature describes assessment as both an independent and interdependent activity. It is described as informal, and there is evidence that comprehensive mental health nursing assessments are not well documented. The credibility of training and research into mental health nursing requires that the content and the process of a comprehensive mental health nursing assessment needs to be clearly defined.
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Affiliation(s)
- Tim Coombs
- Training and Service Development, Australian Mental Health Outcomes and Classification Network, New South Wales Institute of Psychiatry, Sydney.
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Abstract
The recruitment and retention of mental health nurses within acute inpatient mental health facilities continues to be an ongoing issue. Literature and current research highlight an environment fraught with pressure and stress, identifying several key factors contributing to job dissatisfaction. These factors include greater patient acuity, unpredictable and challenging workspaces, violence, increased paperwork, and reduced managerial support. This qualitative, critical, feminist exploration investigated the lived experiences of 13 female mental health nurses working in inpatient services. They were asked about their practice and perceptions of workplace culture, and they shared their thoughts on stress management and professional well-being. Positive workplace practice was highlighted, and the participants revealed an environment they were proud to be a part of. Individual interviews, focus groups, and reflective practice were all used to collect data. The findings from the investigation unanimously support current literature that clearly confirms mental health nursing to be stressful. Interestingly, however, the findings also clearly identified that the way in which the nurse participants managed their stress was intrinsically linked to their job satisfaction. The major theme identified throughout the present study revealed that the female participants' ability to manage an at times complex workspace through the notions of teamwork, diversity, and creativity. All of the participants considered these elements as significant to providing a high standard in patient care. This research might provide an opportunity for others to view mental health nursing from a different perspective, and through the lived experiences of the participants, embrace the positive and rewarding aspects of the role.
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Affiliation(s)
- Louise Ward
- Griffith University School of Nursing and Midwifery, Griffith Health, Gold Coast, Queensland, Australia.
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Hamdan-Mansour AM, Al-Gamal E, Puskar K, Yacoub M, Marini A. Mental health nursing in Jordan: an investigation into experience, work stress and organizational support. Int J Ment Health Nurs 2011; 20:86-94. [PMID: 21371223 DOI: 10.1111/j.1447-0349.2010.00716.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Changes in mental health services have an impact on the role and practice of mental health nurses. The purpose of this study was to examine Jordanian mental health nurses' experiences of providing mental health care, their work-related stress, and organizational support received. A descriptive correlation design was used. Data were collected using self-report questionnaires from 92 mental health nurses in Jordan. The result of this study revealed that mental health nurses shared a high level of agreement on the importance of most nursing tasks. Mental health nurses reported a moderate level of stress, with a lack of resources and relationship and conflict with other professionals being the most frequent stressors. Nurses perceived a low level of support for their work from their supervisors. Work stress and conflict with other professionals had a significant, negative correlation with the perception the nurses had of their immediate supervisors (r = -0.29, P < 0.001; r = -0.31, P < 0.001). There was no significant correlation between work stress, organizational support, and the nurses' age, sex, or level of education. This study has clinical implications in terms of developing strategies for reducing stress and improving organizational support among mental health nurses, and it should help in future research.
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Moxham L, Dwyer T, Happell B, Reid-Searl K, Kahl J, Morris J, Wheatland N. Recognising our role: improved confidence of general nurses providing care to young people with a mental illness in a rural paediatric unit. J Clin Nurs 2010; 19:1434-42. [DOI: 10.1111/j.1365-2702.2009.02993.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Humble F, Cross W. Being different: a phenomenological exploration of a group of veteran psychiatric nurses. Int J Ment Health Nurs 2010; 19:128-36. [PMID: 20367650 DOI: 10.1111/j.1447-0349.2009.00651.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Concern regarding the low numbers of graduate nurses expressing interest in entering the psychiatric field leads to the question: who would be a psychiatric nurse? In this interpretative, phenomenological study, the lived experiences of seven veteran psychiatric nurses were examined in order to gain understanding of the reasons why they had remained in the field of psychiatric nursing. Each of these participants had more than 10 years' clinical practice in psychiatric nursing and shared a wide range of thoughts, memories, and experiences. The major emergent theme, 'being different', revealed what it is like for the participants being psychiatric nurses. These participants felt and saw themselves as different in many ways from other nurses and from society in general. Related to and an aspect of that difference was the high level of satisfaction they achieved from their role and the striving to achieve harmony.
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Affiliation(s)
- Felicity Humble
- School of Nursing and Midwifery, Monash University, Melbourne, Vic. 3800, Australia
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23
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Roche MA, Duffield CM. A Comparison of the Nursing Practice Environment in Mental Health and Medical-Surgical Settings. J Nurs Scholarsh 2010; 42:195-206. [DOI: 10.1111/j.1547-5069.2010.01348.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Taua C, Farrow T. Negotiating complexities: An ethnographic study of intellectual disability and mental health nursing in New Zealand. Int J Ment Health Nurs 2009; 18:274-84. [PMID: 19594647 DOI: 10.1111/j.1447-0349.2009.00610.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper presents the findings from a study undertaken to describe nursing practice in one dual diagnosis (DD; coexisting mental illness and intellectual disability) inpatient unit in New Zealand. A focused ethnographic approach (using fieldwork observations, a review of documents, and five semistructured interviews) was used to gather data. A model of culture was used to analyze data to allow a description of DD nursing practice. Additionally, this framework allowed for an exploration of the artefacts, values, and assumptions that underpin these practices. Three key themes emerged from the data: keeping everyone safe, managing the complexities in assessment, and narrating their work. Together, these themes indicate that in the absence of a defined model of DD nursing, practice is based on an institutional psychiatric model. We argue that DD nursing models need to be made explicit in order to advance nursing in this area.
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Affiliation(s)
- Chris Taua
- School of Nursing, Christchurch Polytechnic Institute of Technology, Christchurch, New Zealand.
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25
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Cleary M, Matheson S, Happell B. Evaluation of a transition to practice programme for mental health nursing. J Adv Nurs 2009; 65:844-50. [DOI: 10.1111/j.1365-2648.2008.04943.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Mullen A. Mental health nurses establishing psychosocial interventions within acute inpatient settings. Int J Ment Health Nurs 2009; 18:83-90. [PMID: 19290971 DOI: 10.1111/j.1447-0349.2008.00578.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be 'at high risk' of harm. Subsequently, recovery-based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems.
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Affiliation(s)
- Antony Mullen
- Lake Macquarie Mental Health Service, Hunter New England Area Health Service, University of Newcastle, Newcastle, New South Wales, Australia.
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27
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Patterson C, Curtis J, Reid A. Skills, knowledge, and attitudes expected of a newly-graduated mental health nurse in an inpatient setting. Int J Ment Health Nurs 2008; 17:410-8. [PMID: 19128288 DOI: 10.1111/j.1447-0349.2008.00572.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Christopher Patterson
- School of Nursing, Midwifery and Indigenous Health, University of Wollongong, Wollongong, New South Wales, Australia
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28
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Henderson J, Willis E, Walter B, Toffoli L. Community mental health nursing: keeping pace with care delivery? Int J Ment Health Nurs 2008; 17:162-70. [PMID: 18460077 DOI: 10.1111/j.1447-0349.2008.00528.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.
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Affiliation(s)
- Julie Henderson
- School of Nursing and Midwifery, Faculty of Health Science, Flinders University, Adelaide, South Australia, Australia.
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29
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Goodwin V, Happell B. Consumer and carer participation in mental health care: the carer's perspective: part 2 - barriers to effective and genuine participation. Issues Ment Health Nurs 2007; 28:625-38. [PMID: 17613160 DOI: 10.1080/01612840701354612] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Family members and significant others provide significant proportions of unpaid care for people experiencing a mental illness. Although the carer role is pivotal to contemporary mental health service delivery, the role of carers and the issues they face have received only scant attention in the literature. This paper presents the second part of the findings of an exploratory, qualitative inquiry, which sought greater understanding of carers' experiences of, and attitudes to opportunities for participation in care and treatment at an individual or systemic level, with particular emphasis on the role of psychiatric nurses in encouraging or discouraging participation. This paper explores the theme of systemic barriers to participation. These findings demonstrate the variable experiences of carers in their opportunities to participate and the important role nurses can assume in supporting carers' increased participation in the mental health care for their relative or significant other.
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Affiliation(s)
- Val Goodwin
- School of Nursing, The University of Melbourne, Wangaratta, Australia
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