A comparison of the work and values of community mental health nurses in two mental health NHS Trusts

Nursing Philosophy of community mental health nurses in Japan: A qualitative, descriptive study

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.

A Conceptual Model for Nurses' Decision-making with the Aggressive Psychiatric Patient

Violence in the acute care psychiatric setting is an ongoing serious problem. Maintenance of a safe therapeutic environment is a paramount responsibility of nurses practicing in this area. Ethical and legal standards demand that the nurse intervenes in aggressive situations in a manner that employs the least intrusive and restrictive measures necessary to provide safety. Therefore, accurate and effective decision-making in aggressive situations, which can escalate rapidly, is of great importance. This paper discusses a theoretical model for decision-making in selecting interventions with aggressive psychiatric patients. This model may provide a basis for the development of training and education programs for effective decision-making in this area.

Barriers to collaboration in mental health services for older people: external agency views

The need for mental health services for older people living in rural areas is increasing in South Australia. Providing such care requires coordination between several types of services across government, hospital and non-government sectors. The purpose of this study was to identify barriers to collaboration from the perspective of external aged care agencies. A total of 42 responses from an online survey were qualitatively analysed. Four categories emerged, within which participants had identified barriers to collaboration: (1) awareness of services and certainty about responsibilities, in particular, a lack of awareness of which services are available; (2) referral criteria and processes, including the specific criteria needed to be eligible for these services; (3) opportunities to collaborate, with a perceived lack of formal opportunities for collaboration between individuals working across agencies; and (4) education of staff, with more joint education between agencies being recognised as having the potential to increase local knowledge and provide an opportunity for networking and relationship building, with greatest barriers experienced between mental health and social care services.

Intervening conditions of hospital-based home care for people with severe mental illness

OBJECTIVE

This study discusses the intervening conditions of hospital-based home care (HBHC) for people with severe mental illness in Taiwan.

DESIGN AND SAMPLE

Grounded theory of the Strauss and Corbin approach was used. Participants were selected from six hospitals in Central Taiwan, including 21 clients, 19 caregivers, and 25 professionals.

MEASURES

Semi-structured one-on-one interviews were used to collect data. Data analysis consisted of three stages: open, axial, and selective coding. Data analysis, data collection, and sampling were conducted through the constant comparative analysis process.

RESULTS

Two categories were generated as positive and negative intervening conditions of HBHC services. Eight positive effects and nine negative effects were generated from the data.

CONCLUSIONS

Several positive and negative intervening conditions were found in this study to affect the delivery of HBHC. Government support and several limitations regarding HBHC services quality should be noticed and improved.

Maximising psychiatric nurses' contribution to interdisciplinary working

Internationally, the deinstitutionalization of psychiatric care has resulted in expanded roles for mental health nurses within a community interdisciplinary team setting. This presents an opportunity for mental health nurses to improve service delivery. This opportunity also results in a more empowered nursing team. This article identifies change issues within one community psychiatric nursing team and the team's contribution to an improved service delivery where service users can avail of same day assessment for crisis referrals, a reduction in waiting times for assessment and co-ordinated delivery of care with an identified key worker utilizing a recovery model philosophy.

Calculating nurse staffing in community mental health and community health settings in South Australia

AIM

The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams.

BACKGROUND

Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings.

METHOD

A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data.

RESULTS

The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool.

CONCLUSIONS

The tool needs further evaluation to determine its applicability to a range of clinical settings.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study

AIM

This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression.

BACKGROUND

Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice.

METHOD

In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67).

FINDINGS

Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes.

CONCLUSION

Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

A qualitative study of mental health nurse identities: many roles, one profession

The aim of the study was to clarify and build upon current understandings of mental health nurse (MHN) identity. The study adopted a framework of social constructionism and qualitative methodology. Semistructured interviews were conducted, which were thematically analyzed using Nvivo software. Twenty-five MHN were recruited across three geographical sites in the UK. Participants constructed a cluster of seven MHN identity characteristics that constituted a unique contribution to talk-based therapies. These themes of characteristics are: (i) the MHN as generic specialist; (ii) the MHN as adopting a service-user focus; (iii) the MHN as positioning and utilizing the personal self; (iv) the MHN as spending time with the service user; (v) the MHN as delivering talk-based therapies in versatile ways; (vi) the MHN as having an everyday attitude; and (vii) the MHN as having transferable skills. The distinctiveness, and thus, professional identity of mental health nursing, must be understood as a cluster of capabilities rather than a search for a singular point of difference. The breadth of capabilities employed by MHN highlights the value and worth of their contribution to service-user care.

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers

OBJECTIVE

In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services.

METHOD

A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy.

RESULTS

The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring.

CONCLUSION

Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Maintaining equilibrium: a theory of job satisfaction for community mental health nurses

This study aimed to explore what was satisfying in the role of community mental health nurse (CMHN). Previous studies have emphasized sources of dissatisfaction but the emphasis on satisfaction allowed the researchers to explore positive aspects of the role which have been largely neglected in previous studies and to explore how these nurses managed to sustain satisfaction. This study used a grounded theory, and the primary source of data was in-depth interviews collected over a 1-year period with 12 CMHNs. Data were analysed using the constant comparative method and theoretical sampling. The therapeutic relationship (being therapeutic, knowing oneself, knowing how) was identified as the most significant source of satisfaction for the CMHNs, but this was mediated by three properties associated with role performance - working for the organization, belonging to a team and maintaining a personal life. The properties associated with role performance affected the participants' experience of the therapeutic relationship which determined whether the CMHNs found their job satisfying. This process of balance and counter-balance is best explained by the core category maintaining equilibrium which accounts for the dynamic interaction that occurs between the therapeutic relationship properties and the role performance properties. As a core category maintaining equilibrium describes the process in which the participants were impelled towards satisfaction.

Valuing autonomy, struggling for an identity and a collective voice, and seeking role recognition: community mental health nurses' perceptions of their roles

Leaders in this community mental health system approached the problem of job frustration, morale issues, and turnover concerns of their Community Mental Health Nurses (CMHNs) by designing a qualitative study using Participant Action Research (PAR) methodology based on the philosophy of Habermas. Six focus groups were conducted to address the nurses' concerns. The themes of Valuing Autonomy, Struggling for an Identity and Collective Voice, and Seeking Role Recognition best explained the participants' concerns. The study concluded with an action plan, the implementation of the plan, and a discussion of the plan's final outcomes.

Community mental health nursing: keeping pace with care delivery?

The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.

Workplace satisfaction in a mental health service for older adults: an analysis of the effects of setting and professional status

Research in mental health services for working-age adults has repeatedly shown that work is found more satisfying, if more stressful, by community practitioners than by hospital-based staff. This study examined whether similar differences exist in services for older adults and how this might be influenced by the high proportion of nonprofessionally qualified workers in inpatient settings for mentally infirm older people. The Work Environment Scale was given to all practitioners in a mental health service for older adults in a single London borough. Adjusting for the effect of professional status, community practitioners rated involvement, task orientation, and supervision more positively than institutional staff, but gave less favorable ratings for work pressure and physical comfort. Nurses rated peer cohesion, supervision, autonomy, and innovation more positively than nursing assistants, after controlling for type of setting. Multivariate modeling confirmed that type of setting and professional group were both associated with workplace satisfaction, accounting for 24% and 13% of the variance, respectively. The study highlights aspects of the work environment of mental health staff working with older adults that might benefit from attention.