1
|
Richards SJ, O'Connell KA, Dickinson JK. A Missed Opportunity to Cultivate Positive Attitudes about Mental Health Recovery among Undergraduate Nursing Students - A Quasi-Experimental Controlled Study. Issues Ment Health Nurs 2024; 45:391-398. [PMID: 38241519 DOI: 10.1080/01612840.2023.2291653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Mental health recovery is a critical concept that needs to be thoroughly understood and supported by nurses. Undergraduate nurse educators have the opportunity to clarify misconceptions and cultivate positive recovery attitudes. AIM To assess the impact of an undergraduate nursing course on attitudes toward mental health recovery and the relationship between recovery attitudes and prejudice toward those who experience a mental illness. METHODS A quasi-experimental pretest-posttest, nonequivalent-control group study was conducted using a sample of undergraduate nursing students in New York City (N = 126). The intervention group was assigned to an undergraduate mental health nursing course and the control group to a pediatric/maternal health nursing course. Attitudes toward mental health recovery and prejudice were measured at the beginning and end of the semester. Two-way mixed analyses of variance were used to determine the differences in students' attitudes. Pearson product-moment correlation analyses were used to assess the relationship between prejudice toward people who experience a mental illness and attitudes toward recovery. RESULTS The mental health nursing course had no measurable impact on students' recovery attitudes. However, there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice toward those who experience a general mental illness (r = -0.54), depression (r = -0.60), or schizophrenia (r = -0.43). CONCLUSIONS Curriculum reform is needed to optimize the impact of undergraduate education on students' attitudes. Possible changes include a more holistic approach to mental health that does not over accentuate the biomedical model, the use of nontraditional clinical sites that provide students an opportunity to interact with those further along in their recovery, and the inclusion of those in recovery in curriculum development. As there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice, educational interventions that positively impact one may also impact the other. Further research is needed to investigate if the relationship is causal.
Collapse
Affiliation(s)
- Stephen J Richards
- Nursing Education, Mount Sinai Phillips School of Nursing, New York City, NY, USA
| | - Kathleen A O'Connell
- Health and Behavior Studies, Teachers College, Columbia University, New York City, NY, USA
| | - Jane K Dickinson
- Health and Behavior Studies, Teachers College, Columbia University, New York City, NY, USA
| |
Collapse
|
2
|
Thomson AE, Mullins S. Environments that promote recovery in acute care mental health: nursing perspectives explored through interpretative description. Contemp Nurse 2024:1-14. [PMID: 38386865 DOI: 10.1080/10376178.2024.2319849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND A significant change in mental health care has involved the need to implement recovery-oriented practices and services. However, recovery-oriented care has been poorly defined within acute care mental health settings. OBJECTIVES The central aims of the study were to increase knowledge about what constitutes a recovery-oriented environment within contemporary acute care units and to inform recovery-oriented nursing practice. METHODS Interpretative description was applied to answer the question: What strategies and resources do nurses identify as being most conducive to fostering a recovery-oriented environment in acute care mental health units? Purposive sampling was used to recruit 11 nurses from 6 acute care units. The inclusion criteria included a minimum of 1-year patients and holding active nursing registration. Nursing experience in community-based or chronic care settings and with children and adolescents were exclusion criteria. Six nurses also participated in a focus group. RESULTS Key aspects of a recovery-oriented acute care environment included understanding the needs of individual patients along with the dynamics of the healthcare team. Nurses had important roles in promoting recovery-oriented environments and reported a need for increased resources to move beyond the bio-medical model and align practice with personal recovery. CONCLUSION A recovery-oriented environment was described as a safe, peaceful and holistic environment with adequate space to balance needs for privacy, interaction and activity. This environment is fostered through respectful communication and healthy relationships among team members, patients, family and formal supports. These nurses had the knowledge, skill and desire to promote recovery-oriented environments, yet resources such as leisure activities and group therapy were required to promote personal recovery.
Collapse
Affiliation(s)
- Andrea E Thomson
- Department of Psychiatric Nursing, Faculty of Health Studies, Brandon University, 270 - 18th Street, Brandon, Manitoba, Canada R7A 6A9
| | - S Mullins
- Department of Psychiatric Nursing, Faculty of Health Studies, Brandon University, 270 - 18th Street, Brandon, Manitoba, Canada R7A 6A9
| |
Collapse
|
3
|
Kuek JHL, Raeburn T, Chow MYZ, Wand T. A Constructivist Grounded Theory Study on Mental Health Recovery from a Lived Experience Perspective in Singapore. Community Ment Health J 2024; 60:394-402. [PMID: 37747635 PMCID: PMC10821989 DOI: 10.1007/s10597-023-01184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
More contemporary personal recovery conceptualisation of mental health recovery emphasize the need to consider the perspectives of people who experience mental ill-health. Most lived experience research has been done in Western cultures with relatively few studies in Asian ones, creating a gap that needs to be addressed due to differences in cultural worldviews. This study explores the notion of recovery from the lens of people experiencing mental health challenges in Singapore. We adopted a constructivist grounded theory perspective to evaluate qualitative data from 21 participants. The core category which best represented what recovery meant was "reconciling and living with experiences of mental ill-health". Our findings suggest that a variety of societal aspects greatly influence perceptions of mental health recovery in Singapore, as participants often shared their desire to live a meaningful life within society but could only do so if they found a way to manage their symptoms more effectively.
Collapse
Affiliation(s)
- Jonathan Han Loong Kuek
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia.
| | - Toby Raeburn
- Faculty of Nursing and Midwifery, Health Sciences & Physiotherapy, The University of Notre Dame, New South Wales, 2010, Australia
| | - Melissa Yan Zhi Chow
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Timothy Wand
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia
| |
Collapse
|
4
|
Pearson M, R Egglestone S, Winship G. The biological paradigm of psychosis in crisis: A Kuhnian analysis. Nurs Philos 2023; 24:e12418. [PMID: 36779230 DOI: 10.1111/nup.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 11/24/2022] [Accepted: 01/14/2023] [Indexed: 02/14/2023]
Abstract
The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing.
Collapse
|
5
|
Shue SA, Traylor M, Kukla M, Salyers MP, Rollins AL, Henry N, Eliacin J, Garabrant J, McGuire AB. Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:283-295. [PMID: 36495371 DOI: 10.1007/s10488-022-01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. METHOD VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. RESULTS The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. CONCLUSION Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.
Collapse
Affiliation(s)
- Sarah A Shue
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA.
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | - Marina Kukla
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Nancy Henry
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Johanne Eliacin
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Jennifer Garabrant
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Alan B McGuire
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| |
Collapse
|
6
|
Eliacin J, Carter J, Bass E, Flanagan M, Salyers MP, McGuire A. Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation. BMJ Open 2022; 12:e057300. [PMID: 35636799 PMCID: PMC9152945 DOI: 10.1136/bmjopen-2021-057300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units. DESIGN VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data. SETTING 34 VHA inpatient mental health units located in every geographical region of the USA. PARTICIPANTS 55 treatment team members. RESULTS Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) No power sharing: patients are excluded from treatment decisions; (2) Limited power sharing: patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) Shared-power: patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy. CONCLUSIONS Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
Collapse
Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica Carter
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Emily Bass
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Mindy Flanagan
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Alan McGuire
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| |
Collapse
|
7
|
Hristodoulidis D, Munro I, Brooks C. Exploration of personal recovery-oriented care on an acute mental health unit. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatr Rehabil J 2021; 44:318-326. [PMID: 34323532 PMCID: PMC8664980 DOI: 10.1037/prj0000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
9
|
Sreeram A, Cross W, Townsin L. Effect of recovery-based interventions on recovery knowledge and attitudes of mental health professionals, regarding recovery-oriented practice: A quantitative narrative review. Int J Ment Health Nurs 2021; 30:1057-1069. [PMID: 34109703 DOI: 10.1111/inm.12897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 12/01/2022]
Abstract
Mental health recovery is an enabling process encouraging consumers to live a productive life, notwithstanding the presence of debilitating symptoms of illness. The recovery model has been integrated into all areas of mental health. However, literature shows that mental health professionals are not equipped to provide recovery-oriented care to consumers. Researchers have recommended recovery-based interventions to develop knowledge, attitudes, and skills to promote recovery-oriented practice in mental health, yet there is a paucity of research regarding the effect of recovery-oriented interventions on the knowledge and attitudes of mental health professionals to improve recovery-oriented practice. Therefore, the purpose of the current review is to understand the effectiveness of interventions on recovery knowledge and attitudes of mental health professionals regarding recovery-oriented practice. The papers were identified through the Population Intervention Comparison and Outcome strategy. The heterogeneity of the selected papers led to a narrative review instead of a systematic review with meta-analysis. The analysis suggested that recovery-based interventions are effective in enhancing the recovery knowledge and attitudes of mental health professionals. Recovery-based interventions have the potential to reduce the use of physical restraints and improve work satisfaction among mental health professionals. The limitations of the studies were the heterogeneity of the selected populations and the absence of strong methodologies to assess the effect of the interventions. Therefore, future investigations should be focused on the effect of interventions on a homogeneous group using randomized controlled trials.
Collapse
Affiliation(s)
- Anju Sreeram
- Federation University, Berwick, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University, Berwick, Victoria, Australia
| | - Louise Townsin
- Federation University, Berwick, Victoria, Australia.,Torrens University, Adelaide, South Australia, Australia
| |
Collapse
|
10
|
Solomon B, Sutton D, McKenna B. The experience and meaning of recovery-oriented practice for nurses working in acute mental health services. Int J Ment Health Nurs 2021; 30:963-974. [PMID: 33792150 DOI: 10.1111/inm.12851] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
Since the 1990s, New Zealand mental health policy has shifted from a focus on the management of symptoms and risk to the recovery of psychological, social, cultural, and physical well-being. Despite a vision for recovery-oriented services being integrated within national and regional policies, there is growing concern that barriers to recovery-oriented service provision continue to exist. Such barriers include the attitudes, skills, and knowledge of front-line staff, as well as system issues. This study explored the experience and meaning of recovery-oriented practice for 10 nurses working in an acute inpatient mental health service. A phenomenological and hermeneutic lens was used to explore the nurses' experience of working in a recovery-focused manner alongside service users. Stories of practice were collected from participants through open-ended conversational interviews. Transcribed narratives were analysed to explore taken-for-granted aspects of working in acute mental health care and to uncover the meaning of being recovery-oriented in this setting. Findings revealed that although the experience and meaning of recovery-focused care varied among nurses, there were common elements in the practice accounts. The accounts highlighted the nurses' role in creating different therapeutic spaces to promote safety, relational commitment, and healing for service users. However, the nurses faced challenges to recovery-oriented care within the team hierarchical culture and the broader service systems. The nurses were, at times, fearless in advocating for service users and recognized that this was essential for developing recovery-focused services. The findings have implications for nursing practice, as well as training and service development.
Collapse
Affiliation(s)
| | - Daniel Sutton
- Auckland University of Technology, Auckland, New Zealand
| | - Brian McKenna
- Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand.,The Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Mullen A, Isobel S, Flanagan K, Harman K. Involving Mental Health Consumers in Nursing Handover: A Qualitative Study of Consumer Perspectives. Issues Ment Health Nurs 2021; 42:730-735. [PMID: 33315485 DOI: 10.1080/01612840.2020.1853288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A number of benefits have been identified for including consumers in nursing handover, such as improved safety and information exchange. In mental health settings these benefits may translate to improved nurse-consumer engagement and working towards the provision of recovery orientated practice. The process of including the consumer, whilst considered best practice, is not well established in mental health settings. Therefore further understanding, in regards to the consumer perspectives about this practice, is needed to inform its adoption and implementation.This qualitative descriptive study explores consumers' perspectives of their possible involvement in the nursing handover process within a mental health inpatient setting. The study took place in two mental health inpatient units in regional New South Wales, Australia. Thirteen semi-structured individual interviews were conducted with consumers, and a conventional content analysis method was used to analyse the data. Findings are presented under two categories: understanding the purpose and process of nursing handover and considering consumer involvement in handover.Findings provide insight into the views of consumers about being involved in nursing handover and further strengthen the rationale for establishing the process as part of routine practice within acute inpatient mental health units. The study also highlights the need to ensure that all processes within these settings accommodate consumer perspectives and involvement.
Collapse
Affiliation(s)
- Antony Mullen
- Hunter New England Mental Health, University of Newcastle, Waratah, Australia
| | | | - Karen Flanagan
- Gold Coast Hospital and Health Service, Southport, Australia
| | | |
Collapse
|
12
|
Baek S. Ecological Predictors of Recovery-Oriented Practices Among Psychiatric Nurses in South Korea. J Psychosoc Nurs Ment Health Serv 2021; 58:37-47. [PMID: 33119120 DOI: 10.3928/02793695-20201013-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Using hierarchical multiple regression analysis, the current study aimed to investigate ecological predictors of recovery-oriented practices among 230 psychiatric nurses in South Korea. Intrapersonal predictors associated with recovery-oriented practice were educational level, type of workplace, and attitudes regarding recovery. Extent of nursing practice environment recognized by nurses at the organizational level was also significant. Recovery-oriented practices were associated with intrapersonal and organizational factors. Therefore, it is necessary to provide multi-level considerations to improve recovery-oriented practices among psychiatric nurses. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 37-47.].
Collapse
|
13
|
Molloy L, Guha MD, Scott MP, Beckett P, Merrick TT, Patton D. Mental health nursing practice and Aboriginal and Torres Strait Islander people: an integrative review. Contemp Nurse 2021; 57:140-156. [PMID: 33989117 DOI: 10.1080/10376178.2021.1927773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: For nearly thirty years, significant concerns have been raised about the public-provided mental health services for Aboriginal and Torres Strait Islander peoples. Staff have been identified as having little understanding of Indigenous culture, and this had resulted in inappropriate treatment. In attempting to understand what specialist knowledge exists to guide mental health nursing practice with Aboriginal and Torres Strait Islander peoples, the authors have turned to published peer-reviewed literature.Methods: The approach chosen to explore this area was an integrative review. This provided a method to identify, analyse, and synthesise a wide range of literature.Results: The available evidence points to the need that treatment planning must be focused on the promotion of social and emotional wellbeing and not simply the treatment of symptoms. It also emphasises the importance of cultural safety informed by awareness and understanding of social, cultural and historical factors that can impact the health and treatment of Aboriginal and Torres Strait Islander peoples. Within the literature, staff reported difficulty in understanding how knowledge about social and emotional wellbeing could translate into practice. Nurses working in mental health contexts reported not feeling adequately prepared for, or confident in this area of practice.Conclusions: There is a paucity of current literature on mental health nursing practice for Aboriginal and Torres Strait Islander peoples, with the literature available not providing clear guidance for effective and meaningful practice.
Collapse
Affiliation(s)
- Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, Australia.,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Monica D Guha
- Western New South Wales Local Health District, Bloomfield, Orange, NSW, Australia
| | - Matthew P Scott
- Wiradjuri Nation, Clinical Nurse Specialist- Aboriginal Mental Health, Western New South Wales Local Health District, Bloomfield, Orange, NSW, Australia
| | - Paul Beckett
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | | | - Declan Patton
- School of Nursing and Midwifery. Royal College of Surgeons in Ireland, Dublin, Ireland.,Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia.,University of Wollongong, Wollongong NSW, Australia
| |
Collapse
|
14
|
Student mental health nurses' understanding of recovery: A phenomenographic study. Nurse Educ Pract 2021; 53:103082. [PMID: 34023663 DOI: 10.1016/j.nepr.2021.103082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Abstract
AIM To explore the variation in mental health nursing students' understanding of recovery. BACKGROUND In mental health practice clinical understanding of recovery has been challenged with a new understanding based on the individualised experiences of the person, often referred to as personal recovery. Despite international policy endorsement, practice has been slow to embrace the principles of personal recovery and little is known about student nurses' understanding of the concept. DESIGN Qualitative phenomenographic study METHOD: In-depth semi-structured interviews including discussion of a clinical scenario, were conducted with 13 pre-registration student nurses. Data was analysed iteratively using a seven stage phenomenographic framework, identifying categories of description and the outcome space. RESULTS Analysis revealed a branched outcome space with four qualitatively distinct ways of understanding recovery. Branch one can be broadly aligned to clinical recovery and contains one category only, 'Recovery as Clinical Improvement'. It is distinctly different from branch two which contains three categories on a continuum, which represent more and less complete ways of understanding personal recovery: 'Recovery as Making Progress', 'Recovery as Managing to Live Well' and 'Recovery as Learning to Live Differently'. Most participants demonstrated understanding in the less sophisticated categories. CONCLUSION Recovery is central to mental health nursing, yet this study suggests it is a problematic concept for students. Features of personal recovery can be found in the second branch of the outcome space, with the most sophisticated category 'Learning to Live Differently' best representing the principles of recovery espoused in nursing literature and international policy. Phenomenography has allowed a more complex picture to emerge, replacing the dichotomy between clinical and personal recovery and enabling a differentiation between more and less complete ways of understanding personal recovery. This study addresses the lack of attention given to student nurse experiences of recovery. The insights support educators, both in clinical and academic settings, to address personal recovery in more explicit way where partial understanding can be explored.
Collapse
|
15
|
Park S, Park S, Lee YJ, Park CS, Jung YC, Kim S. Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data. J Korean Acad Nurs 2021; 50:333-348. [PMID: 32632069 DOI: 10.4040/jkan.19203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. METHODS The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. RESULTS Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. CONCLUSION Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.
Collapse
Affiliation(s)
- Suin Park
- College of Nursing, Kosin University, Busan, Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Young Joo Lee
- College of Nursing, Daegu Catholic University, Daegu, Korea.,Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
| | - Choon Seon Park
- Department of Quality Assessment Administration, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Young Chul Jung
- Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea.,Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Sunah Kim
- College of Nursing, Yonsei University, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea.
| |
Collapse
|
16
|
Lim E, Wynaden D, Heslop K. Using Q-methodology to explore mental health nurses' knowledge and skills to use recovery-focused care to reduce aggression in acute mental health settings. Int J Ment Health Nurs 2021; 30:413-426. [PMID: 33084220 DOI: 10.1111/inm.12802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
When nurses practise recovery-focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery-focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q-methodology that examined the knowledge and skill components of recovery-focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co-production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery-focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery.
Collapse
Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
17
|
Chang YC, Chang LH, Hsu ST, Huang MW. Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study. BMC Psychiatry 2021; 21:154. [PMID: 33726694 PMCID: PMC7962288 DOI: 10.1186/s12888-021-03152-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals' experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. METHODS Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. RESULTS The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals' self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients' lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. CONCLUSIONS To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.
Collapse
Affiliation(s)
- Yen-Ching Chang
- grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Hui Chang
- grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-Ting Hsu
- grid.414813.b0000 0004 0582 5722Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Meng-Wen Huang
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
| |
Collapse
|
18
|
Mullen A, Harman K, Flanagan K, O'Brien B, Isobel S. Involving mental health consumers in nursing handover: A qualitative study of nursing views of the practice and its implementation. Int J Ment Health Nurs 2020; 29:1157-1167. [PMID: 32677320 DOI: 10.1111/inm.12756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/28/2020] [Accepted: 05/28/2020] [Indexed: 01/05/2023]
Abstract
Nursing handover occurs between shifts and is an important means of communication and information exchange around consumer care. The involvement of consumers in nursing handover, known as 'bedside handover', is well established within general health settings and promotes a patient-centred approach to care. Bedside handover represents an opportunity for mental health settings to consolidate recovery-oriented principles, albeit with some unique challenges in the way that involving consumers in nursing handover is implemented. This qualitative descriptive study explores the views of nursing staff and nursing managers about involving consumers in nursing handover and the process of implementation across five mental health inpatient units in Australia. The study took place in a local health district covering regional and rural areas of New South Wales that had issued a directive to implement bedside handover. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study. Six focus groups were held with nursing staff (n = 22), and eleven individual interviews were undertaken with nursing managers to explore their perceptions of bedside handover and its implications for nursing practice. The data were analysed using thematic analysis. Data from focus groups and interviews were analysed separately and then combined to generate three themes: (i) the mental health context is different; (ii) protecting consumer privacy and confidentiality; and (iii) it might make things worse. The findings provide insights into both the challenges, and the process of involving consumers in nursing handover within mental health settings and provides guidance for future implementation.
Collapse
Affiliation(s)
- Antony Mullen
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Katryna Harman
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Flanagan
- Gold Coast Hospital and Health Service, SouthPort, Queensland, Australia
| | - Beth O'Brien
- Hunter New England Mental Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Isobel
- Faculty of Medicine and Health, School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
19
|
Lorien L, Blunden S, Madsen W. Implementation of recovery-oriented practice in hospital-based mental health services: A systematic review. Int J Ment Health Nurs 2020; 29:1035-1048. [PMID: 33063396 DOI: 10.1111/inm.12794] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023]
Abstract
Recovery-oriented practice has become the dominant paradigm of practice in mental health services internationally. The exception is hospital-based mental health services where the biomedical model continues to prevail, in this context defined by high acuity and safety concerns. This review aims to identify the approaches to, and feasibility of, implementing recovery-oriented practice in hospital-based mental health services. A systematic review of the literature (2010-2019) identified seventeen studies of recovery-oriented practice implementation in hospital-based mental health services. One study was excluded based on quality assessment. Of the remaining studies, seven reported on staff training initiatives, four reported service user programmes facilitated by staff, and five were implementations of models of care. The findings indicate that it is feasible, albeit challenging, to implement recovery-oriented practice in hospital-based mental health services. More successful approaches are multimodal, applied over several years and have organizational support. The main barriers to implementation include resistance to change from the embedded, biomedical model, staff attitudes towards recovery, and an absence of consumer involvement in the implementation of recovery-oriented practice.
Collapse
Affiliation(s)
- Leonie Lorien
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Sarah Blunden
- School of Health, Medical and Applied Sciences, CQUniversity, Sydney, New South Wales, Australia
| | - Wendy Madsen
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
| |
Collapse
|
20
|
Stanton J, Thomas DR, Jarbin M, MacKay P. Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study. PLoS One 2020; 15:e0239815. [PMID: 33064721 PMCID: PMC7567378 DOI: 10.1371/journal.pone.0239815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction There is a dearth of research to guide acute adolescent mental health inpatient care. Self-determination Theory provides evidence that meeting needs for relatedness, autonomy and competence is likely to increase wellbeing and intrinsic motivation. These needs may be able to be met in the inpatient environment. Method This qualitative study aimed to explore young people’s experience of acute mental health inpatient care with particular attention to meeting of these three needs. Fifteen young people were interviewed. The importance of relatedness with staff, other young people and families was identified. Results Relatedness with staff and peers were valued parts of admission. Some young people describe enhanced relatedness with family. They described loss of autonomy as a negative experience but appreciated opportunities to be involved in choices around their care and having more freedom. Coming into hospital was associated with loss of competence but they described building competence during the admission. Engaging in activities was experienced positively and appeared to enhance meeting of all three needs. Meeting of the three needs was associated with an experience of increased safety. Conclusions Engaging young people in activities with a focus on relatedness, autonomy and competence may have specific therapeutic potential. Autonomy, experience of competence and connection with staff may enhance safety more effectively than physical containment. Peer contact may have untapped therapeutic value we understand little of. This study supports the value of Self-determination Theory as a guide day to day inpatient care to meet the needs of adolescents for relatedness, autonomy and competence.
Collapse
Affiliation(s)
- Josephine Stanton
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
| | - David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Maarten Jarbin
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Pauline MacKay
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
21
|
Mullen A, Isobel S, Flanagan K, Key K, Dunbar A, Bell A, Lewin TJ. Motivational Interviewing: Reconciling Recovery-Focused Care and Mental Health Nursing Practice. Issues Ment Health Nurs 2020; 41:807-814. [PMID: 32420769 DOI: 10.1080/01612840.2020.1731891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Motivational interviewing (MI) is a long-established evidenced-based intervention aimed at guiding people to implement change. Originally developed by William Miller from the United States and Stephen Rollnick from the United Kingdom, a strong emphasis for MI is the underlying 'spirit', rather than merely the specific techniques within the model. The 'spirit' of MI consists of four key components: acceptance, partnership, evocation and compassion. These have direct overlap with concepts within the personal recovery model recognised as a critical framework in delivery of contemporary mental health services for consumers. Despite this recognition, recovery concepts have struggled to gain consistent traction, particularly within inpatient mental health units. This paper proposes that MI presents one strategy for integrating recovery-focused principles within routine mental health nursing (MHN) practice. An overview of MI and its relationship with recovery principles is discussed in the context of contemporary MHN practice. Evaluation results of a locally developed MI workshop for MHNs within a regional area of New South Wales (NSW) in Australia are presented to highlight the emerging evidence for this potential. Following the workshop, MHN participants showed key improvements in knowledge and confidence scores, as well as in understanding of key MI processes and strategies. The consolidation of these skills through training and a supervision framework is outlined.
Collapse
Affiliation(s)
- Antony Mullen
- Hunter New England Mental Health, Newcastle, Australia.,University of Newcastle, Newcastle, Australia
| | | | - Karen Flanagan
- Gold Coast Hospital and Health Service, Mental Health, Southport, Australia
| | - Kylie Key
- Hunter New England Mental Health, Newcastle, Australia
| | - Anna Dunbar
- Southern Nsw Local Health District, Queanbeyan, Australia
| | - Alison Bell
- Bell MHT Training Consultancy, Gosford, Australia
| | - Terry J Lewin
- Hunter New England Mater Mental Health Service, Waratah, Australia
| |
Collapse
|
22
|
Gyamfi N, Bhullar N, Islam MS, Usher K. Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review. Int J Ment Health Nurs 2020; 29:322-347. [PMID: 32162835 DOI: 10.1111/inm.12712] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 02/06/2023]
Abstract
This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).
Collapse
Affiliation(s)
- Naomi Gyamfi
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Kim Usher
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| |
Collapse
|
23
|
van Daalen-Smith C, Adam S, Hassim F, Santerre F. A World of Indifference/Un Monde D'Indifférence: Canadian Women's Experiences of Psychiatric Hospitalization/Expériences Canadiennes d'hospitalization psychiatrique au Canada. Issues Ment Health Nurs 2020; 41:315-327. [PMID: 31770058 DOI: 10.1080/01612840.2019.1661047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article presents findings and analysis stemming from a two-year qualitative study that explored, in their own voices, women's lived experience of psychiatric hospitalization. Feminist Standpoint Theory and Foucauldian analysis frame and provide the moorings for validity, methodology, and analysis of this woman-centred inquiry. The verbatim representation of lived experience, coupled with the coauthoring of this article with two of the study's participants provides an authentic articulation of participant standpoint. Furthermore, this approach creates a space in nursing scholarship in which the co-development of knowledge is also made possible. Overarching themes of docility-making, harm, betrayal, indifference, and resistance are presented and situated in a broader analysis of the hegemony of bio-psychiatric discourse and its colonization of nursing practice. In order to disrupt systems that fail to meet patient needs and fail to represent nursing's values and ethos, we shed light on the possible systemic factors behind the experience of "indifference".
Collapse
Affiliation(s)
| | - Simon Adam
- School of Nursing, York University, Toronto, Toronto, Ontario, Canada
| | - Fatima Hassim
- Sheridan College Institute of Technology and Advanced Learning, Oakville, Ontario, Canada
| | | |
Collapse
|
24
|
Dawson L, River J, McCloughen A, Buus N. 'Every single minute and hour is scrutinised': neoliberalism and Australian private mental health care. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:277-292. [PMID: 31677191 DOI: 10.1111/1467-9566.13009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is little understanding of how recovery-oriented approaches fit within contemporary mental healthcare systems, which emphasise biomedical approaches to care, increased efficiency and cost-cutting. This article examines the established models of service delivery in a private, youth, mental health service and the impacts of the current system on staff. It explores whether the service is prepared or capable of adopting recovery-oriented approaches to care. Qualitative interviews were undertaken with staff and thematically analysed to understand the everyday practices on the unit. Data suggest that economic efficiencies and biomedical dominance largely shaped how health care was organised and delivered, which was perceived by staff as inflexible to change. Additionally, findings suggest that market-oriented principles associated with neoliberalism restricted the capacity of individuals to transform services in line with alternative models of care and lowered staff morale. These finding suggest that, while neoliberal ideologies and biomedical approaches remain dominant in organisations, there will be challenges to adopting alternative recovery-oriented models of care and promoting healthcare systems that understand mental health issues in broader socio-political contexts and can flexibly respond to the needs of service users.
Collapse
Affiliation(s)
- Lisa Dawson
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, NSW, Australia
| | - Jo River
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrea McCloughen
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
| | - Niels Buus
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
25
|
Tanaka K. Experiences of community mental health nurses in Japan as the basis of their nursing philosophies. Perspect Psychiatr Care 2019; 55:636-643. [PMID: 31004364 DOI: 10.1111/ppc.12386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the experiences of Japanese community mental health nurses (CMHNs) that help form the basis of their nursing philosophies. DESIGN AND METHODS This study uses the narrative research method. I conducted participant observation and narrative interviews with nine CMHNs in Japan. FINDINGS Four themes emerged: (1) experiences as consumers' peers; (2) nurses' own recovery; (3) high levels of spirituality; and (4) a free spirit. PRACTICE IMPLICATIONS Recognizing these nurses' intrinsic experiences could help to shift mental health nursing paradigms from those based on biomedical models to newer perspectives found in recovery models.
Collapse
Affiliation(s)
- Koji Tanaka
- Department of Nursing, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| |
Collapse
|
26
|
Lim E, Wynaden D, Heslop K. Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study. Int J Ment Health Nurs 2019; 28:237-246. [PMID: 30027634 DOI: 10.1111/inm.12524] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Abstract
Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.
Collapse
Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
27
|
Waldemar AK, Esbensen BA, Korsbek L, Petersen L, Arnfred S. Recovery-oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings. Int J Ment Health Nurs 2019; 28:318-329. [PMID: 30151987 DOI: 10.1111/inm.12537] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/30/2022]
Abstract
Despite an increasing attention towards recovery orientation in the mental health services, the provision of recovery-oriented practice is challenged in the inpatient wards. Moreover, the existing research within this area is modest and we currently have limited knowledge of how recovery-oriented practice is integrated into inpatient settings. A cornerstone of recovery-oriented practice is the collaboration, patient involvement, and choices, particularly when deciding and planning treatment options. Thus, this ethnographic study aimed to explore how recovery-oriented practice is reflected in the interactions between patients and health professionals around treatment in two mental health inpatient wards in Denmark. Participant observations were conducted in two mental health inpatient wards from November 2014 to January 2015. The Recovery Self-Assessment scale inspired the observation guide and the initial data analysis. Field notes were analysed deductively and inductively using qualitative content analysis. One theme with four subthemes emerged showing that interactions were characterized by an 'as-if collaboration' where 'negotiating on limited grounds' was an important feature of interactions, in which health professionals seemed to have superiority, acting on behalf of 'competing demands'. Patients had to navigate in a field of 'inconsistent guidance and postponed decisions' and faced tendencies of 'control and condescending communication'. The results suggest that recovery oriented values such as equal collaboration, choice and patients' personal preferences are reflected rhetorically in the interactions between patients and health professionals. However, they are negotiated within organizational logics and often overruled by competing demands.
Collapse
Affiliation(s)
- Anna Kristine Waldemar
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases VRR, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lisa Korsbek
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Lone Petersen
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatry West, Psychiatric Hospital Slagelse, Region Zealand Mental Health Services, Slagelse, Denmark
| |
Collapse
|
28
|
Hornik-Lurie T, Shalev A, Haknazar L, Garber Epstein P, Ziedenberg-Rehav L, Moran GS. Implementing recovery-oriented interventions with staff in a psychiatric hospital: A mixed-methods study. J Psychiatr Ment Health Nurs 2018; 25:569-581. [PMID: 30411432 DOI: 10.1111/jpm.12502] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study examines the influence of three different recovery-oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed-methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery-oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced. Mainly, the illness management and recovery training created a positive change in the work attitude and some work-related practices of mental health staff and the increased presence of a person-centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services. Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients. Psychiatric advance directives were reported as more challenging to implement and with limited impact. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Recovery-oriented trainings can be internalized and implemented by staff in medical model psychiatric settings. Despite recovery-oriented training, challenges do occur-notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses. Using multiple recovery-oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice. Ongoing comprehensive mental health staff training on recovery-oriented care programmes is essential in order to sustain change over time. Training is not enough in itself-hospital administrations need to be actively involved in promoting recovery-oriented policies. ABSTRACT: Introduction Developing person-centred recovery-oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim To assess the knowledge, attitudes and practices developed following recovery-oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery-oriented intervention in psychiatric wards. Method A mixed-methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery-oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person-centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice Our findings support the need for broader staff training in recovery-oriented interventions. Recruiting the support of the hospital administration for recovery-oriented intervention programmes is key, both ethically and structurally.
Collapse
Affiliation(s)
- Tzipi Hornik-Lurie
- The Falk Institute for Mental Health Studies, Kfar Shaul Hospital, Jerusalem, Israel
| | - Anat Shalev
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Beer-Sheva Mental Health Center, Beer Sheva, Israel
| | - Lior Haknazar
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | - Galia S Moran
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
29
|
Vahidi M, Ebrahimi H, Areshtanab HN, Jafarabadi MA, Lees D, Foong A, Cleary M. Therapeutic Relationships and Safety of Care in Iranian Psychiatric Inpatient Units. Issues Ment Health Nurs 2018; 39:967-976. [PMID: 30204047 DOI: 10.1080/01612840.2018.1485795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Enhancing therapeutic relationships between patients and staff is of central importance to improve the quality and safety of care in psychiatric inpatient units. However, there is limited evidence as to how therapeutic relationships may be enabled in this specific context. This paper presents findings of a study that explored the link between therapeutic relationships and safety in Iranian psychiatric inpatient units. In this exploratory, descriptive study, seven patients at the point of discharge and 19 staff in psychiatric inpatient units in Iran were interviewed regarding their experiences of care. The quality of staff-patient relationship in providing a safe environment was categorized into two groups of "facilitators" and "inhibitors". Facilitators of a safe environment included "supportive relationship with patients" and "improving patient capacity for self-efficacy/self-control". Inhibitors, on the other hand, included "detachment from patients" and "domination over patients", which ultimately limited safety on the ward. Findings indicate interrelated environmental, patient and staff factors mediating the potential for therapeutic relationships and quality and safety of care. Findings suggest the need for more effective preparation and support for staff working within psychiatric inpatient settings. In addition, environments more conducive to collaborative recovery-oriented practice are required to enhance therapeutic relationships and improve quality and safety of care. Both individual staff responsibility and effective leadership are required to realize change.
Collapse
Affiliation(s)
- Maryam Vahidi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Ebrahimi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Namdar Areshtanab
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Asghari Jafarabadi
- b Department of Statistics and Epidemiology, Faculty of Health sciences , Tabriz University of Medical Sciences , Tabriz , Iran
| | - David Lees
- c School of Health Sciences , University of Tasmania , Launceston , Tasmania , Australia
| | - Andrew Foong
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
| | - Michelle Cleary
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
| |
Collapse
|
30
|
Cleary M, Raeburn T, West S, Escott P, Lopez V. Two approaches, one goal: How mental health registered nurses' perceive their role and the role of peer support workers in facilitating consumer decision-making. Int J Ment Health Nurs 2018; 27:1212-1218. [PMID: 29770544 DOI: 10.1111/inm.12473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/16/2023]
Abstract
Recovery-oriented principles underpin modern-day mental health care and are enhanced by consumer participation in decision-making. Understanding how consumer participation can be maximized is central to promoting recovery-oriented care. This study explored the key strategies used by mental health registered nurses and perceived by nurses to be used by peer support workers in facilitating consumer decision-making to determine similarities, differences, and possible tensions. A qualitative descriptive approach using semi-structured interviews was conducted with nine nurses employed in mental health care. Thematic analysis was conducted using open coding. Frequency of views expressed and prevalence of these amongst participants were noted to determine the most common strategies and challenges. Registered nurses use strategies aimed at empowerment, self-management, and managing expectations to facilitate decision-making but are challenged by entrenched coercion within the system. These same nurses view peer support workers as using their lived experience to build rapport, role model, and advocate for consumers. Tensions arise in how the peer support workers' lived experience should be used and how this impacts on professional and therapeutic boundaries. Nurses expressed support for the role of peer support workers and viewed their inclusion in facilitating consumer decision-making positively. Their own role is perceived as being caught between modern-day service principles of empowerment and long-standing practices based on coercion.
Collapse
Affiliation(s)
- Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Toby Raeburn
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sancia West
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Phil Escott
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia.,Sydney Local Health District Mental Health Service, Sydney, New South Wales, Australia
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
31
|
Waldemar AK, Esbensen BA, Korsbek L, Petersen L, Arnfred S. Recovery orientation in mental health inpatient settings: Inpatient experiences? Int J Ment Health Nurs 2018; 27:1177-1187. [PMID: 29359397 DOI: 10.1111/inm.12434] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/01/2022]
Abstract
Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept in and the organization of these settings. In Denmark, educational and organizational efforts have been made to organize inpatient services with a recovery-oriented approach. Hence, we aimed to explore whether and how these efforts are reflected in the inpatients' experiences of their care and treatment. Semi-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants' experiences were identified. The participants felt accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist predominantly of medication. Furthermore, they described feeling continuously observed and assessed from a distance by health professionals. Like the sparse previous research among inpatients, the results highlight ambivalent experiences of health professionals' support and ward structure as well as the medical treatment hegemony. As such, the educational and organizational efforts of introducing recovery-oriented practices in the wards seemed not very well reflected in the participants' experiences of their stay.
Collapse
Affiliation(s)
- Anna Kristine Waldemar
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, the Capital Region, Denmark, Ballerup, Denmark
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Center, Rigshospitalet - Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Korsbek
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, the Capital Region, Denmark, Ballerup, Denmark
| | - Lone Petersen
- Competence Centre for Rehabilitation and Recovery, Mental Health Centre Ballerup, the Capital Region, Denmark, Ballerup, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatry Vest, Mental Health Centre Slagelse, the Zealand Region, Slagelse, Denmark
| |
Collapse
|
32
|
Tanaka K, Hasegawa M, Nagayama Y, Oe M. Nursing Philosophy of community mental health nurses in Japan: A qualitative, descriptive study. Int J Ment Health Nurs 2018. [PMID: 28646495 DOI: 10.1111/inm.12363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study reports the findings of a qualitative, descriptive study that sought to clarify nursing philosophy for community mental health nurses (CMHN) working at independent psychiatric home-visit nursing agencies in Japan. We carried out participant observation and semistructured interviews with 13 CMHN in rural and urban areas. We identified eight subthemes and three higher-order themes based on these subthemes. CMHN embraced a nursing philosophy in which they: (i) have respect for consumers' ways of life and their self-realization; (ii) find harmony between view of life and work; and (iii) build communities where residents support each other beyond their roles. Together, these themes constitute a valuable nursing philosophy that supports the recovery of people with mental illness. The themes could also help educate professionals about principles and meanings relevant to recovery, which are regarded as key to changing the professional's care paradigm from a biomedical model to a recovery model.
Collapse
Affiliation(s)
- Koji Tanaka
- Department of Nursing, Kanazawa Medical University, Uchinada, Japan
| | - Masami Hasegawa
- Department of Nursing, Niigata College of Nursing, Joetsu, Japan
| | - Yutaka Nagayama
- Department of Nursing, Kanazawa Medical University, Uchinada, Japan
| | - Masato Oe
- Department of Nursing, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| |
Collapse
|
33
|
Olasoji M, Plummer V, Reed F, Jacob S, Shaw L, Shanti M, Cross W. Views of mental health consumers about being involved in nursing handover on acute inpatient units. Int J Ment Health Nurs 2018. [PMID: 28646504 DOI: 10.1111/inm.12361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The involvement of consumers in handover with nurses has been identified as reducing miscommunication and a reduction in adverse events in generalist nursing settings. Mental health (MH) care is complex, and handover practices need to fit with the philosophy of recovery-focussed practice. Recovery-focussed practice recognizes the person at the centre of care as an expert in their own treatment and decision-making. The aim of the present study was to explore the views of consumers with a mental illness, without prior involvement in nursing handover, about their need to be involved in nursing handover on an acute mental health inpatient unit. Using an exploratory descriptive, qualitative design (n = 11), participants who were receiving care in an acute inpatient unit were recruited using purposive convenience sampling. Data were collected using semistructured interviews and analysed using thematic analysis. Participants' diagnoses were schizophrenia (n = 6), bipolar affective disorder (n = 4), and depression (n = 1). Two themes emerged from the interviews: (i) behind closed doors; and (ii) being involved. Several subthemes were also identified. The first theme, behind closed doors, had two subthemes: (i) it is about us; and (ii) knowing their thoughts. The second theme had three subthemes: (i) clarifying issues; (ii) setting expectations; and (iii) when and how. Nursing handover on the acute inpatient unit offers a good opportunity for consumers to take an active role in the delivery of nursing care. There is a need to rethink the way nursing handover occurs to include consumers.
Collapse
Affiliation(s)
- Michael Olasoji
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.,Peninsula Health, Melbourne, Victoria, Australia
| | - Fiona Reed
- Peninsula Health, Melbourne, Victoria, Australia
| | - Sini Jacob
- Peninsula Health, Melbourne, Victoria, Australia
| | - Liam Shaw
- Peninsula Health, Melbourne, Victoria, Australia
| | | | - Wendy Cross
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
34
|
Affiliation(s)
- Michelle Cleary
- a School of Health Sciences , University of Tasmania , Australia
| | - David Lees
- a School of Health Sciences , University of Tasmania , Australia
| | - Jan Sayers
- a School of Health Sciences , University of Tasmania , Australia
| |
Collapse
|
35
|
Myors KA, Cleary M, Johnson M, Schmied V. 'Modelling a Secure-Base' for Women with Complex Needs: Attachment-Based Interventions Used by Perinatal and Infant Mental Health Clinicians. Issues Ment Health Nurs 2018; 39:226-232. [PMID: 29172815 DOI: 10.1080/01612840.2017.1378784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants.
Collapse
Affiliation(s)
- Karen A Myors
- a School of Nursing and Midwifery , Western Sydney University , Sydney , NSW , Australia
| | - Michelle Cleary
- b School of Health Sciences , University of Tasmania , Sydney , NSW , Australia
| | - Maree Johnson
- c Faculty of Health Sciences , Australian Catholic University , Sydney , NSW , Australia
| | - Virginia Schmied
- a School of Nursing and Midwifery , Western Sydney University , Sydney , NSW , Australia
| |
Collapse
|
36
|
Santangelo P, Procter N, Fassett D. Mental health nursing: Daring to be different, special and leading recovery-focused care? Int J Ment Health Nurs 2018; 27:258-266. [PMID: 29318772 DOI: 10.1111/inm.12316] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
Abstract
How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi-disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, "What's special about mental health nursing?" Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the 'Ten P's of the professional profile that is mental health nursing', which are 'present', 'personal', 'participant partnering', 'professional', 'phenomenological', 'pragmatic', 'power-sharing', 'psycho-therapeutic', 'proud' and 'profound'. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.
Collapse
Affiliation(s)
- Peter Santangelo
- Faculty of Health, School of Health Sciences, Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Procter
- Mental Health Nursing University of South Australia, Adelaide, South Australia, Australia
| | - Denise Fassett
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
37
|
Wyder M, Ehrlich C, Crompton D, McArthur L, Delaforce C, Dziopa F, Ramon S, Powell E. Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature. Int J Ment Health Nurs 2017; 26:527-540. [PMID: 28295948 DOI: 10.1111/inm.12315] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Abstract
Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self-care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person-centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe.
Collapse
Affiliation(s)
| | - Carolyn Ehrlich
- Addiction and Mental Health Services, Metro South HHS, Brisbane, Queensland, Australia
| | | | | | | | - Fiona Dziopa
- Griffith University, Nathan, Queensland, Australia
| | | | | |
Collapse
|
38
|
Lim E, Wynaden D, Heslop K. Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. Int J Ment Health Nurs 2017; 26:445-460. [PMID: 28960737 DOI: 10.1111/inm.12378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/19/2022]
Abstract
Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.
Collapse
Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
39
|
Wilson A, Hutchinson M, Hurley J. Literature review of trauma-informed care: Implications for mental health nurses working in acute inpatient settings in Australia. Int J Ment Health Nurs 2017; 26:326-343. [PMID: 28480568 DOI: 10.1111/inm.12344] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Abstract
Trauma-informed care (TIC) is increasingly recognized as an approach to improving consumers' experience of, and outcomes from, mental health services. Deriving consensus on the definition, successful approaches, and consumer experiences of TIC is yet to be attained. In the present study, we sought to clarify the challenges experienced by mental health nurses in embedding TIC into acute inpatient settings within Australia. A systematic search of electronic databases was undertaken to identify primary research conducted on the topic of TIC. A narrative review and synthesis of the 11 manuscripts retained from the search was performed. The main findings from the review indicate that there are very few studies focussing on TIC in the Australian context of acute mental health care. The review demonstrates that TIC can support a positive organizational culture and improve consumer experiences of care. The present review highlights that there is an urgency for mental health nurses to identify their role in delivering and evaluating TIC, inclusive of undertaking training and clinical supervision, and to engage in systemic efforts to change service cultures.
Collapse
Affiliation(s)
- Allyson Wilson
- Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
| | - Marie Hutchinson
- Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - John Hurley
- Southern Cross University, Coffs Harbour, New South Wales, Australia
| |
Collapse
|
40
|
Sayers JM, Cleary M, Hunt GE, Burmeister OK. Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers. Int J Ment Health Nurs 2017; 26:142-150. [PMID: 28026104 DOI: 10.1111/inm.12287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well-being throughout their lives, compared to non-Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme 'supports along the road to recovery'. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients' mental health needs. These insights may inform service review, workforce development, and further research.
Collapse
Affiliation(s)
- Jan M Sayers
- School of Health Sciences, University of Tasmania, Sydney
| | | | - Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| | - Oliver K Burmeister
- School of Computing and Mathematics, Charles Sturt University, Bathurst, NSW, Australia
| |
Collapse
|
41
|
|
42
|
Abstract
Use of illicit substances and nonmedical use of prescription medication worldwide has increased dramatically in the past several years. Approximately 10% of people who use illicit substances will develop a substance use disorder (SUD). Similar to other chronic health disorders, periods of remission and exacerbation commonly occur in SUDs. Due to stigma and difficulty with definition, terminology related to SUDs has changed and evolved. Terms referring to nonuse of substances such as sobriety and abstinence are likely best replaced with the term remission. Similarly, the use of the term relapse, in reference to a return to use after remission should be replaced with the term exacerbation. Research and professional organization consensus indicate that after a period of five years of remission or recovery, the risk of exacerbation is low in SUDs. Recovery is a term used to describe overall improvements in quality of life during remission. Recovery has been defined by organizations and studied in research. Factors that have been shown to improve the success of recovery are increased quality of life, improved self-efficacy, employment, and spirituality. It is important for nurses to improve their understanding of the terminology related to SUDs and to communicate with others using the terms that are the least stigmatizing. Nurses are in a prime position to assess recovery and to help patients and their families implement changes in order to improve the success of their recovery.
Collapse
Affiliation(s)
- Julie Worley
- a Community Mental Health Systems, Rush University College of Nursing , Chicago , Illinois , USA
| |
Collapse
|
43
|
Sayers JM, Hunt GE, Cleary M, Burmeister OK. Brokering Community Engagement: Proactive Strategies for Supporting Indigenous Australians with Mental Health Problems. Issues Ment Health Nurs 2016; 37:912-917. [PMID: 27682060 DOI: 10.1080/01612840.2016.1224284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This qualitative study explored the experiences of mental health employees working with Indigenous clients living with mental illness. Interviews were conducted with 20 mental health workers to identify strategies they adopt to facilitate community engagement with Indigenous clients. Using a thematic analysis approach, 'Brokering community engagement' was the umbrella theme from which two subthemes related to community engagement for the service and clients emerged (1) enabling connections -community and family; and (2) recovery and reconnecting with community. Participant insights enabled a deeper understanding of the role of community in the recovery process for Indigenous clients and highlight the importance of community engagement as a primary, yet multifaceted strategy used by mental health workers in the communities they serve.
Collapse
Affiliation(s)
- Jan Maree Sayers
- a School of Health Sciences , University of Tasmania , Sydney , NSW , Australia
| | - Glenn E Hunt
- b Discipline of Psychiatry , University of Sydney , NSW , Australia
| | - Michelle Cleary
- a School of Health Sciences , University of Tasmania , Sydney , NSW , Australia
| | - Oliver K Burmeister
- c School of Computing and Mathematics , Charles Sturt University , Bathurst, Sydney , NSW , Australia
| |
Collapse
|
44
|
Björkdahl A, Perseius KI, Samuelsson M, Lindberg MH. Sensory rooms in psychiatric inpatient care: Staff experiences. Int J Ment Health Nurs 2016; 25:472-9. [PMID: 26875931 DOI: 10.1111/inm.12205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
There is an increased interest in exploring the use of sensory rooms in psychiatric inpatient care. Sensory rooms can provide stimulation via sight, smell, hearing, touch and taste in a demand-free environment that is controlled by the patient. The rooms may reduce patients' distress and agitation, as well as rates of seclusion and restraint. Successful implementation of sensory rooms is influenced by the attitudes and approach of staff. This paper presents a study of the experiences of 126 staff members who worked with sensory rooms in a Swedish inpatient psychiatry setting. A cross-sectional descriptive survey design was used. Data were collected by a web based self-report 12-item questionnaire that included both open- and closed-ended questions. Our findings strengthen the results of previous research in this area in many ways. Content analyses revealed three main categories: hopes and concerns, focusing on patients' self-care, and the room as a sanctuary. Although staff initially described both negative and positive expectations of sensory rooms, after working with the rooms, there was a strong emphasis on more positive experiences, such as letting go of control and observing an increase in patients' self-confidence, emotional self-care and well-being. Our findings support the important principals of person-centred nursing and recovery-oriented mental health and the ability of staff to implement these principles by working with sensory rooms.
Collapse
Affiliation(s)
- Anna Björkdahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | | | - Mats Samuelsson
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Mathilde Hedlund Lindberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
45
|
Chester P, Ehrlich C, Warburton L, Baker D, Kendall E, Crompton D. "What is the work of Recovery Oriented Practice? A systematic literature review". Int J Ment Health Nurs 2016; 25:270-85. [PMID: 27381002 DOI: 10.1111/inm.12241] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
Concepts of personal and social recovery in mental illness are constantly evolving because the journey is fluid and subject to change over time. Dynamic interactions between the complexities of human nature and mental illness create ever-altering landscapes of perplexity. The acknowledged ebb and flow of recovery in the presence of chronic and serious mental illness requires health professionals to provide a flexible suite of care, delivered through skills and methods that are responsive and meaningful to the recipient. We conducted a systematic search for qualitative literature that articulated the work of personally-supportive recovery-oriented practice (ROP) to determine the specific components of recovery-supportive work. Twenty-one articles were identified as meeting the inclusion criteria and were synthesized using a coding framework derived from Normalization Process Theory. We identified three kinds of recovery-supportive work required from health professionals: alleviating stigma, delivering effective recovery-supportive responses in the presence of complex health and social situations and managing challenges associated with the work of ROP. We discuss the resources needed for ROP and the barriers that inhibit health professionals' engagement in this work. By elucidating the work of ROP, we highlighted a disparity between health professionals' aspirations and achievements. These revelations could inform service delivery in order to better support consumer recovery in serious mental illness.
Collapse
Affiliation(s)
- Polly Chester
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia
| | - Carolyn Ehrlich
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia
| | - Loretta Warburton
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia.,Metro South Mental health and Addiction Service, Logan Hospital, Cnr. Armstrong and Loganlea Road, Meadowbrook, Queensland, Australia
| | - David Baker
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia.,Metro South Mental health and Addiction Service, Logan Hospital, Cnr. Armstrong and Loganlea Road, Meadowbrook, Queensland, Australia
| | - Elizabeth Kendall
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia
| | - David Crompton
- Centre of National Research of Disability & Rehabilitation Medicine (CONROD), School of Human Services and Social Work, Griffith University, University Drive, Meadowbrook, Queensland, Australia.,Metro South Mental health and Addiction Service, Logan Hospital, Cnr. Armstrong and Loganlea Road, Meadowbrook, Queensland, Australia
| |
Collapse
|
46
|
Cleary M, Lees D, Escott P, Molloy L. Leadership and mental health recovery: Rhetoric or reality. Int J Ment Health Nurs 2016; 25:267-9. [PMID: 27534386 DOI: 10.1111/inm.12250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - David Lees
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Phil Escott
- Sydney Local Health District Mental Health Service, Sydney, New South Wales, Australia
| | - Luke Molloy
- School of Health Sciences, University of Tasmania, Sydney
| |
Collapse
|
47
|
Le Boutillier C, Chevalier A, Lawrence V, Leamy M, Bird VJ, Macpherson R, Williams J, Slade M. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implement Sci 2015; 10:87. [PMID: 26059397 PMCID: PMC4464128 DOI: 10.1186/s13012-015-0275-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. METHODS A systematic review of empirical primary research was conducted. Data sources were online databases (n = 8), journal table of contents (n = 5), internet, expert consultation (n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. RESULTS A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. CONCLUSIONS Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. TRIAL REGISTRATION The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942 ).
Collapse
Affiliation(s)
- Clair Le Boutillier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Agnes Chevalier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Vanessa Lawrence
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mary Leamy
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Victoria J Bird
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Julie Williams
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
48
|
Jacob S, Munro I, Taylor BJ. Mental health recovery: lived experience of consumers, carers and nurses. Contemp Nurse 2015; 50:1-13. [DOI: 10.1080/10376178.2015.1012040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
49
|
Raeburn T, Hungerford C, Sayers J, Escott P, Lopez V, Cleary M. Leading a Recovery-oriented Social Enterprise. Issues Ment Health Nurs 2015; 36:362-9. [PMID: 26090553 DOI: 10.3109/01612840.2015.1011760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Toby Raeburn
- University of Sydney, Sydney Nursing School, Camperdown , Sydney, New South Wales , Australia
| | | | | | | | | | | |
Collapse
|
50
|
Wyder M, Bland R, Blythe A, Matarasso B, Crompton D. Therapeutic relationships and involuntary treatment orders: service users' interactions with health-care professionals on the ward. Int J Ment Health Nurs 2015; 24:181-9. [PMID: 25628260 DOI: 10.1111/inm.12121] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is increasing evidence that an involuntary hospital admission and treatment can undermine the therapeutic relationship. While good relationships with staff are important factors influencing long-term recovery, there is little information on how people experience their relationships with staff while under an involuntary treatment order (ITO). Twenty-five involuntary inpatients were interviewed about their experiences of an ITO. The interviews were analysed by a general inductive approach. Participants described the following themes: (i) the ITO admission was a daunting and frightening experience; (ii) staff behaviours and attitudes shaped their experiences in hospital; (iii) importance of staff listening to their concerns; (iv) importance of having a space to make sense of their experiences; (v) importance of staff ability to look beyond their illness and diagnosis; and (vi) importance of staff working in partnership. These findings highlight that when using recovery principles, such as an empathic engagement with the patients' lived experience, forging partnerships with patients in treatment decision-making to enhance agency, an involuntary treatment order does not have to limit the ability to establish positive relationships.
Collapse
Affiliation(s)
- Marianne Wyder
- School of Social Work and Human Services, University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | | |
Collapse
|