Title: Community Mental Health Nursing:Jack-of-all-trades and Master of None or a necessarily Versatile Profession Abstract The alma of this study was to explore whether Mental Health Nurses truly understand their role and whether they base their professional Identity on united views about the unique skills, knowledge and expertise brought by them to a multidisciplinary care delivery process. Several studies have attempted to define the role of the Mental Health Nurse (MAN) and concluded that mental health nursing was difficult to comprehend.
Clear role definition is essential for maintaining a sustainable reflections identify and directing the focus of Mental Health Nurses in their clinical practice. 8 Community Mental Health Nurses (COHN) working across two mental health teams were approached to participate using a questionnaire. Transcripts were analyses using a qualitative approach based on grounded theory. A number of key themes were identified, which defined mental health nursing roles.
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First, Chins expected to conduct more psychologically based Interventions than were achievable In practice. Second, emphasis on knowledge of medication and administration was highlighted as paramount. Finally Chins view development of a therapeutic working alliance as essential. In conclusion, there was evidence of an eroding away of the fundamental and essential tasks of Mental Health Nurses and reasons for this were multi-factorial, giving the impetus to broaden the project and capture nursing views . Trust CCNY which employs mental health nurses.
Keywords: across -?? grounded theory, interventions and roles, mental health nursing. Introduction Historically, nursing has been practiced Interdependently with medicine or on occasions Instead of. The founder of the modern nursing profession Florence Nightingale advocated for nursing to have a unique body of knowledge and skills, different from that of the medical profession. More than 100 years ago, the quest for raising the profile of mental health nursing In particular continues to date (Potter and Perry 1995).
The origin of the Mental Health Nurse (MAN) can be traced back to the 18th and 19th centuries when the keeper was responsible for helping to confine people who were deemed to be mad. With the passing of time the title of keeper changed to that of attendant, mental nurse, psychiatric nurse, nurse therapist, and eventually Mental Health Nurse. However, the role of the MAN also has changed over the last 30 years with clinical experience suggesting that contemporary Moons have more autonomy in how they spend their time and the type of care given to patients (Whetting & McLaughlin 2000).
McKenna et al (2006) that the Joint effects of innovations such as newly configured services, the development of new nursing roles and the delegation of nursing work to support workers will Inevitably transform the traditional role of the mental health nurse. There has been concern highlighted that Hess changes represent a wholesale abdication of what once gave nursing its adherence to policies or the pursuit of organizational outcomes (Pearce 2008).
There is need for more critical thinking and direction in which community mental health nursing is heading, taking into account the views and perceptions of nurses on the frontline perceptions and how it is affecting their work. Bristlecone et al 2007 Cautions, Failure not to act could result in derailment of the nursing role, deskilling and the demonstration and De-professionalisms of mental health nursing (Bristlecone et al 2007). Bona and Doyle (2008) remark that the over involvement of nurses in the bureaucratic processes of care provision has the potential to dilute the quality of nursing care.
Who are we, where do we come from and where are we heading? Those are not only the common existential question, which torment most of us at some point in our professional lives but also seem to be in the forefront for a modern profession with ancient roots. The title “Mental Health Nurse” was one of many recommendation following a review of this challenging branch of nursing carried out in 1994 (DOD 1994). Since then there have been enormous changes in our thinking about mental illness followed by exciting developments in treatment and service delivery (Journey 1996).
Within the NICE guidance on Schizophrenia, for instance, there has been an emphasis on expanding the role of the Mental Health Nurse to include providing cognitive-behavioral therapy (CB) for hallucinations and delusions, (National Institute for Clinical Excellence, 2002). It has been well documented, however, that nurses’ expanding practical role has had consequent negative impact on the interpersonal dimension of patient care in recent years (Morehouse and Morehouse, 2004; Hunt and Wandering, 1995; Ball, 1995).
According to Morehouse & Morehouse, (2004) nurses are only too willing to accept changes to their role from outside the profession which ultimately undermines the sense of ownership in relation to their own unique contribution to the care delivery process. Practically, Mental Health Nurses require diverse skills including effective communication skills to promote evidence-based interventions for service users in their Journey to recovery from mental health. During their professional career pathway, Mental Health Nurses acquire and demonstrate skills to show that the care they provide is evidence-based and effective.
However, skills as diverse as assessment, effective communication, forming therapeutic interactions, caring for physical and mental health needs as well as leadership and management are only part of the skills profile for an effective Mental Health Nurse. The concept of a degree only nursing profession seems to have been driven by a desire for nursing contribution to be valued at least as much as the contributions of other professions involved in delivering direct patient care (Ford 2009). So far, however, efforts seem to have been focused on modernizing the image of the profession, rather on issues of cake professional identity.
In the current climate of uncertainty and rapid changes within the National Health Service (NASH) more than ever makes sense to be clear about our professional Identity as means to developing strong professional values and evidence-based practice models for nursing. Context The Royal College of Nursing 2011 launched a Campaign for “Defining mental health nursing and modernizing the image of the profession. The campaign was announced and a short video was shown at the 1 lath .. Annual Nursing Conference, which took through the interest of local Mental Health Nurses. It was initiated as a local development following on from the Conference.
The delegate nurses, who attended, shared their experience with the nurses in the local subgroup of the Nursing Forum. A discussion was generated and a brainstorming event was facilitated. It became apparent that the nurses who were present at the meeting had valid but diverse opinions and attitudes about their own role and that Jointly of the nursing team. This ignited the local interest and a decision to pilot this project in order to find out “What is Mental Health Nursing? ” Method &Data Collection A mini pilot study was initiated and questionnaires were distributed among Mental Health Nurses in the two teams.
Qualitative data methods have been selected to best elicit the subjective views of front line nurses. The questionnaire consisted of 5 open- ended questions that captured the participant’s perceptions about the core skills, knowledge and resources that best characterize the main pillars of the contemporary Mental Health Nursing role. Respondents In context with the meeting all nurses were asked to complete a questionnaire to support the mini pilot project. Of the 8 we had 5 completed responses, a return rate of Sixty five percent of the completed questionnaires, 20% male and 80% of respondents’ female.
Data Analysis The respondents defined Mental Health Nursing using the follow category descriptions; 1. Develop a working alliance with a person experiencing mental health problems. 2. Good knowledge and understanding of the different mental disorders and their presentation. 3. Knowledge about medication and their administration. 4. Containing and managing challenging behaviors. When asked about what they would consider to be their unique professional knowledge the irritants were clustered in themes also in 4 categories; 1 . Knowledge about mental disorders and their symptoms 2.
Knowledge about medication management 3. Knowing how to identify and address need/ adopting a holistic approach, as there does not seem to be clear distinction between social, psychological or physical needs 4. Knowledge of psychological therapies Theme one The most common theme was recovery through a range of potential therapies such as CB, 1 to 1 work, counseling family therapy CB and DEBT and medication. Theme two The questionnaire addressed the environmental aspects of Mental Health Nurse and asked in the experience of their role what areas were of importance.
Here respondents talked about the need to have a safe and secure environment to provide 1 to 1 support that is directed around the needs of the clients. Effective Resounding was addressed and there was no common trend which could be elicited. Feedback from one respondent detailed the improvement that the PER had brought to service delivery. Better salaries and training were highlighted as essential resources inclusive of well-equipped library and access to relevant Journals. Effective working conditions such as time and space were presented as a key need.
Theme three Other themes highlighted within the environmental aspect were training and were the need to ensure time off was available from the clinical work-load to facilitate this learning. One response detailed the needs of the nurse to respond to the client network as a whole. The Organizational component of the questionnaire presented the following findings; The common themes were resounding and opportunities for professional growth and development. It was also highlighted that good managerial support was key to effective community mental health nursing and that communication should be a 2 way process.
The expansion of nursing roles was detailed and clinical examples of prescribing and consultation highlighted. Finally, the need to acknowledge effective practice and work and achievements was raised and one respondent directly details this process through “re-imbruement”. Discussion This study addressed the question What is Mental Health Nursing? “. Data from the participants suggests that Mental Health Nurses saw themselves performing a variety of roles: medication management, therapists, advocacy, befriending, and psycho-educator.
Furthermore, about 80% of the participants did not mind changing heir title too more expansive one such as “mental Health practitioner”. On the order hand the respondents did not give much premium to the importance of managing physical health of patients with mental illness by Mental Health Nurses, whereas this is one area traditionally associated with nursing, which have been gradually neglected over the years. The physical health of people with long term mental illnesses is, of course, an important area for attention, particularly as we know that standardized mortality rates in schizophrenia are 2. Times higher than those in general population. It is also well documented that 45% of people with long-term mental illness also have substantial physical illness, particularly those of cardiovascular and respiratory variety (DOD, 1995, Labeled, 1989). Clearly the participants considered the provision of psychologies therapies such as Cognitive Behavior Therapy (CB) and Dialectical Behavior Therapy (DEBT) as all important aspect of their role, but it seems there is limited time in clinical practice to effectively implement them.
It is argued the amount of paperwork detracts from the time nurses have to actually deliver direct patient care but is now the norm. Arguably, too much time is spent on filling in data when it is unclear that anyone really looks at the information (Good and Nolan, 2008). Nevertheless, if you’re a mental health nurse, paperwork is a daily expectation. In conjunction with paperwork runs the Care Programmer Approach (CPA) framework. The CPA requires the skill to work with the service user, family and careers where appropriate, equally within a multidisciplinary team.
If used well, it can promote recovery and independence. Care plans, patient care reviews, involvement of careers and promotion of independence are all parts of the CPA. It seems that healthcare workers as a whole are yet to fully embrace this concept as it involves positive risk taking and allowing the individual to have choices we don’t agree with. Furthermore, there seems to be limited access to psychological training for nurses at undergraduate level the only recognized training for nurses is at post graduate level is THORN Programmer.
There is a need to evaluate the work of Thorn nurses in some detail, particularly as case management outcome is still far from clear (Journey using relatively brief programmer, to become effective deliverers of family interventions. Good clinical supervision is essential to effectively implement psychological therapies but it seems these were not available for nurses. As the nurses roles in contemporary NASH services are expanding changes in approach. For example, the dual diagnosis of substance misuse and serious mental illness is now a growing and substantial problem.
Nurses need to be equipped with essential skills such as motivational Interviewing technique, skills in psychosocial interventions in order to adequately promote recovery in these patients population. It has been well documented however that nurses’ expanding practical role has had unsent negative impact on the interpersonal dimension of patient care in recent years (Morehouse and Morehouse, 2004; Hunt and Wandering, 1995; Ball, 1995; Sinclair and Facet, 1991; Cox, 1983; Gillis, 1980).
These authors said that nurses are only too willing to accept changes to their role from outside the profession which, it can be argued, undermines the sense of ownership they have in relation to their own unique interpersonal patient contact. Notwithstanding, nurses are resourceful in that they can draw on a variety of physical and psychological skills and interventions to facilitate the care and reattempt of individual patients and their families, in hospital and community settings. They are nomadic in that they are able to move from ward to ward, sector to sector, community to hospital and vice versa.
They are suitably equipped with a generically transferable set of medical and interpersonal skills designed to meet the needs of a variety of patients, with a range of physical and psychological problems. Study Limitations In this study the authors used questionnaires to collect data from participants, whereas questionnaires are not among the most prominent methods in qualitative search, because they commonly require subjects to respond to a stimulus, and thus they are not acting naturally.
However, they have their uses, especially as a means of collecting information from a wider sample than can be reached by personal interview. Though the information is necessarily more limited, it can still be very useful. For example, the authors are concerned with seeking a quality that points more to identifying critical elements and wringing plausible interpretations from them, something one can pursue without becoming obsessed with finding the eight or ultimate answer, the correct version, the Truth.
To some, there are many overlapping truths operating at different levels and constantly subject to change. A questionnaire can serve as an inductive method with the aim to formulate new theory, where open-ended questions are used to ‘explore a substantive area’ (Gill & Johnson 2001). Notwithstanding, participants were told why the information is being collected and how the results will be beneficial. They were also encouraged to reply honestly and told that if their response is negative this is Just as useful as a more positive opinion. The questionnaire was anonymous.
Conclusion Unfortunately this paper once more shows the confusion among the participants as far as defining the role of the Mental Health Nurse is concerned. This, however, is understandable, taking into account that the work of the Mental Health Nurse is often underpinned by a way of being rather than a way of doing and using service users, is difficult to evaluate (RCA 2011). Furthermore, without being able to put value on performance in an environment driven by insurability of interventions, the temptation of assuming a different professional identity is only a tepee away.
As the nurses roles in contemporary NASH services are expanding due to working with new populations, patients and careers expectations and government policies demanding changes in approach. This is an important time to represent and reassess the role of the Mental Health Nurse. This pilot study builds mini pathway of ideas generated by a committed set of nurses who provide mental health nursing to service users on a daily basis.
There was evidence of an eroding away of the core and essential tasks and reasons for this were multi-factorial and could conclude that rather studies investigating these aspects could be beneficial Recommendations This has touched upon local views and nurses experience; there would be huge value in expanding this work wider in -?? Scoping the views of service users to enable cross referencing of full care dimension of expectations would be beneficial and enlightening.