Organizational factors to optimize mental health nurses' wellbeing in the workplace: An integrative literature review

Mental health nursing is a privilege and a rewarding profession. There has been a call for transformational change in mental health services to improve outcomes for the people of New Zealand, with mental health nurses integral to this. However, with predicted nursing shortages, high levels of burnout, and increasing demands in the workplace, an organizational focus on wellbeing for mental health nurses is needed to sustain the workforce, implement change and improve outcomes for people using mental health services. An integrative review of the literature was undertaken to explore how organizations can optimize mental health nurses' wellbeing in the workplace and to identify measures for organizations to support mental health nurses' wellbeing with a focus on New Zealand. Seven articles were included in this review after a search, data extraction and evaluation. Data were synthesized and categorized using thematic analysis. The findings indicate organizations can invest in several initiatives to enhance mental health nurses' wellbeing in the workplace. These include professional development, skills to build resilience, enabling time to reflect on practice, enhancing professional supervision, having the right managerial support and focusing on individual's strengths. Organizations need to prioritize mental health nurses' wellbeing by embedding the practical strategies this review identified and by addressing organizational barriers to wellbeing. Organizations should consider implementing multileveled organizational wellbeing initiatives to nurture and grow the New Zealand mental health nursing workforce which in turn will contribute to quality care and enable mental health nurses to have long meaningful careers. Time, investment and resources are essential for these initiatives to be effective.

Embedding LGBTQI+ competency into nursing education: Formative evaluation of an interdisciplinary project

BACKGROUND

In order to avoid perpetuating inequities faced by lesbian, gay, bisexual, transgender, queer, intersex, and other minority (LGBTQI+) communities, future nurses need to recognize and resist discriminatory, oppressive, heteronormative and cisnormative health and social systems.

OBJECTIVES

To share the development, embedding, and formative evaluation of an interdisciplinary project to improve LGBTQI+ health content across an undergraduate nursing curriculum.

METHODS

This paper describes a collaborative interdisciplinary project to embed LGBTQI+ health content across a 3-year undergraduate nursing degree. An anonymous cross-sectional online survey was sent to 87 student nurses enrolled in the final semester of their undergraduate degree. The survey included six Likert scale-type questions and five open-ended questions. Qualitative data were analyzed by inductive, reflexive thematic analysis.

RESULTS

Most students rated the topic relevant 'extremely' relevant (77 %) to nursing. Students' self-reported comfort discussing LGBTQI+ health in class varied from 'extremely' (42 %) through to 'not at all' (6 %). Thematic analysis of student responses to open-ended questions identified five themes: (1) Becoming aware of LGBTQI+ diversity; (2) Personal values and beliefs; (3) Learning in order to improve clinical encounters; (4) Inconsistency and a lack of incorporation across the curriculum; and (5) (Dis)comfort in the learning environment.

CONCLUSIONS

Opportunities to better embed LGBTQI+ competency included clear acknowledgement of wider systems of power and oppression, integration and consistent modeling by nursing faculty, and linkage of content to other equity issues to address the intersectional nature of inequities.

Self-reported health-related quality of life of mental health service users with serious mental illness in New Zealand

INTRODUCTION

Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored.

AIM

To explore the self-reported HQoL of mental health service users in New Zealand.

METHODS

Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population.

RESULTS

Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation-emotional domain.

DISCUSSION

Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer functioning on multiple HQoL domains. Future studies should seek to understand the factors contributing to perceptions of HQoL of mental health service users in New Zealand.

Self-reported health-related quality of life of mental health service users with serious mental illness in New Zealand

INTRODUCTION: Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored. AIM: To explore the self-reported HQoL of mental health service users in New Zealand. METHODS: Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population. RESULTS: Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation — emotional domain. DISCUSSION: Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer functioning on multiple HQoL domains. Future studies should seek to understand the factors contributing to perceptions of HQoL of mental health service users in New Zealand. KEYWORDS: Mental illness; mental health; New Zealand; quality of life; self report

New Zealand's Mental Health District Inspector in historical context: "the impartial scrutiny of a citizen of standing"

The Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ) legislates for District Inspectors who ensure that mental health consumers held under the Act are aware of their legal rights. The New Zealand District Inspector role first appeared in 19th century legislation. Its historical longevity does not, however, denote that this role has been consistent since its inception. This article looks at the historical development of the District Inspector and its companion role, the Official Visitor, focusing in particular on the period 1969-1992, when the purpose and scope of the roles was part of a Mental Health Act 1969 review. This was a time of fundamental social and professional change, shifting ideas of psychiatric practice, new locations of treatment, and growing emphasis on patient/consumer rights. The sometimes heated debates surrounding the roles reflect these changing ideas. An historical analysis of the District Inspector and Official Visitor roles aids understanding of how the social and political contexts affect mental health issues; this has relevance for current mental health law.

Implementing and maintaining nurse-led healthy living programs in forensic inpatient settings: an illustrative case study

BACKGROUND

Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible.

OBJECTIVE

To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand.

DESIGN

This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded.

RESULTS

Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management.

CONCLUSION

Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.

Gender and class tensions between psychiatric nurses and the general nursing profession in mid-twentieth century New Zealand

Abstract Histories of twentieth century nursing usually present 'general nursing' as the norm and make the assumption that nursing was a female-dominated profession in which men were a marginalised minority. In this article, we argue that in New Zealand, psychiatric nursing had developed a distinct culture from general nursing, was more an occupation than a profession, and was one in which men held a central and powerful position. We explore the tensions that developed between male psychiatric nurses (attendants) and professional nursing leaders when general nursing began to gain authority over mental hospital nursing in the period 1939 to 1959. We argue that rather than being marginalised, the male nurses used their strength as unionised, working-class men to resist the incremental control by general nursing, a profession underpinned by middle-class values. Some battles were lost, but overall the men retained a powerful position in the mental health system during this period.

On the brink of change? Implications of the review of undergraduate education in New Zealand for mental health nursing

A New Zealand Nursing Council review of undergraduate education provides an ideal opportunity to make much needed changes to the system of preparation for mental health nurses. This article critiques comprehensive nursing education through an examination of its history in New Zealand, recent mental health reports and a projected estimate of workforce needs. Historical analysis reveals a process of marginalization and invisibilization of psychiatric/mental health nursing within comprehensive programmes with a consequent reduction of skills and a weakening of the profession. The author concludes that psychiatric/mental health nursing is a distinct scope of practice which requires specialty undergraduate preparation.

Adaptation to the mental health setting: the lived experience of comprehensive nurse graduates

The aim of this qualitative descriptive study was to explore the experience of new comprehensive nurse graduates as they adapted to working in the acute psychiatric setting. Interviews were conducted with four participants, focusing on their current work experiences and how the philosophical beliefs and values derived from their educational preparation fit with those they encountered within the practice setting. The data were analysed by noting common experiences, values and meanings and identifying the themes that emerged. The themes were: transition to practice, conflict, contradiction, structural constraints, and the 'reality' of the psychiatric setting. The results of the study confirm the concern that has been voiced by new graduates about the quality and quantity of current orientation programs. Conflicting values and beliefs concerning the nature of mental health/psychiatric nursing also became evident. It appears that the graduates' Comprehensive nursing preparation may have contributed to their feelings of unease as they attempted to fit their own values and beliefs about nursing with those of the acute psychiatric setting.