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SKIDMORE D., WARNE T. & STARK S. (2004) Journal of Psychiatric and Mental Health Nursing 11, 348–356 Mental health practice and the rhetoric–reality gap This paper had its genesis in a national project, sponsored by the English National Board for Nursing, Midwifery and Health Visiting, to explore team working within mental health practice. The project extended over a 2-year period and utilized various methods of data collection. However, this paper focused on data, from the national survey and informal interviews (based in eight regions), that addressed specific issues within the practitioner group. Of the 800 questionnaires sent out 26% were returned. Fifty-three percent of the returns were from practitioners, 14% user/carers and 33% educationalists. Our focus was that of the practitioners. This group had a response rate of 50% (i.e. 50% of the surveys sent out to practitioners were returned). A content analysis of 100 interviews was used to triangulate the data. Whilst the original brief was to explore team working the survey also highlighted data that indicated a common understanding of what mental health practitioners do and what they say they do and that, although there was a commonality of vocabulary, different practices existed between and within regions. This is the focus of this paper. We argue, from our findings, that different practice is a result of ‘habitus’. Whilst practitioners reported that they subscribe to a national agreement of meaning, there is a rhetoric–reality gap: that which is said to be done is not what is, in fact, practised. At the local level we argue that working within the habitus (educationally) can address the rhetoric–reality gap. However, we recommend further studies in order to explore how working within the habitus can address this matter across regions. [ABSTRACT FROM AUTHOR]

A nurse prescribing scheme has recently been implemented within the Republic of Ireland. This paper reports on the views of community mental health nurses on nurse prescribing just prior to the implementation of the scheme. Data were gathered through a 13-item questionnaire administered to 103 members of the Association of Community Mental Health Nurses in Ireland. Results indicated a distinct difference of view between male and female community mental health nurses, with female nurses having greater reservations towards the desirability of nurse prescribing in relation to educational preparation and impact on professional relationships. Overall, only 17% of respondents favoured being supervised in their prescribing practice by their consultant psychiatrist. The paper concludes that there is ambivalence towards prescribing in this important group of nurses which may need to be taken into account if nurse prescribing is to be successfully implemented within the Irish mental health service context. [ABSTRACT FROM AUTHOR]

Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a doctoral research project that involved a state-wide investigation into mental health triage nursing in Victoria, Australia. Mental health triage is a specialized domain of nursing practice that has emerged within the context of wider mental health reform in the State. The overall aim of the study was to produce a comprehensive definition and description of psychiatric triage nursing in Victoria. Methodological triangulation was used in the design of the study to enable the use of both survey (n = 139) and semi-structured interview (n = 21) data collection methods. Mental health triage nursing was found to be a complex, stressful role that involves high levels of responsibility, clinical decision making, and multiple role functions, many of which overlap into areas of practice previously the exclusive domain of medicine, such as assessment, diagnosis, and referral. The paper raises discussion on contemporary professional issues of concern to mental health triage nursing, and concludes with recommendations for the future development of the discipline. [ABSTRACT FROM AUTHOR]

This is the first of two papers reporting community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Service user/nurse relationships and risk are addressed in this initial paper. A mixed method/approach was used. A piloted 15-item questionnaire sought quantitative and qualitative data from 122 nurses throughout England and Wales; 57 questionnaires were returned. Limitations applying to gaining qualitative data via written questionnaire are overtly acknowledged. Quantitative data were analysed using the SPSS program. Content analysis and reflexive appraisal of qualitative data led to production of critically appraised conclusions. Findings are illustrative of complexity. Increased understanding of relevant issues, rather than definitive conclusions, is claimed as an outcome. Reductionist approaches are insufficient in illustrating relevant complexities; nurses offer considered, contextualized responses; diametrically opposed opinions exist about the value of interpersonal relationships and balances between care, control and risk assessment. [ABSTRACT FROM AUTHOR]

This is the second of two papers reporting on a descriptive mixed methods study of community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Forensic community mental health nurses (FCMHNs) have a body of experience of working with mentally disordered offenders in the community. A number of these patients will be subject to conditions on discharge. This in effect acts as compulsory community treatment with the sanction of recall to hospital. This paper examines nurses' perceptions of team-working, legal powers and their effects upon compliance. Findings include that FCMHNs express general satisfaction with their input to decision-making but some concerns were raised that challenge the ethic of team-working. Respondents were broadly in favour of increased professional responsibility, although this may be related to a quest for status. A pragmatic if equivocal support for the use of compulsion in community mental healthcare was also expressed. [ABSTRACT FROM AUTHOR]

This paper aims at acquiring knowledge about the quality of sleep of adult and elderly psychiatric patients who receive clinical or outpatient nursing care, and identifying key factors in perceiving a sleep problem. To do so, a sample of 1699 psychiatric patients were asked whether they perceived a sleep problem and were invited to fill in the Pittsburgh Sleep Quality Index (PSQI) and additional questions. Five hundred and sixty (33%) questionnaires were returned. As a result, we find that 36% of the patients perceived a sleep problem, while the PSQI assessed 66% of the sample as being 'bad sleepers'. Forty-nine per cent of the respondents used sleep medication one or more times a week. Five items of the PSQI were shown to be predictors of a perceived sleep problem. Four of these are insomnia symptoms, while the fifth is the use of sleep medication. Moreover, the patients who used sleep medication most scored significantly worse on all PSQI components than patients who used sleep medication less than once a week. In conclusion, many psychiatric patients perceive a sleep problem and all nurses could be confronted not only with the night-time consequences of this, but also with daytime consequences. Therefore, sleep problems must not be viewed as an isolated problem but must be seen in relation with social functioning. [ABSTRACT FROM AUTHOR]

The UK parliament approved legislation expanding prescribing rights for all registered nurses in 2006. Mental health nurses do not appear to be embracing prescribing to the same degree as their colleagues. For example, mental health nurses represent 14% of the UK nursing population, but only 3% nurse prescribing population. In order to explore this disparity, the paper discusses quantitative analysis of the following objectives: (1) describe the impact of nurse prescribing on nurse prescribers in NHS Greater Glasgow and Clyde; and (2) identify differences between mental health nurse prescribers and other nurse prescribers in NHS Greater Glasgow and Clyde. Following online pilot study, a 26-item questionnaire was posted to 668 nurse prescribers in NHS Greater Glasgow and Clyde. A total of 365 questionnaires were returned (55.4%). Significant differences were found between mental health nurse prescribers and others in terms of age, gender, prescribing practice, academic achievement, method of prescribing, workplace, experience and attitude to prescribing. Possible reasons for these differences are suggested and form the basis of further planned research. [ABSTRACT FROM AUTHOR]

Mental health nurses have traditionally been discouraged from engaging with service users' experiences of hearing voices and to reinforce reality. However, this may not be a helpful way of intervening in what can be a very distressing symptom. There is little evidence of service users' experiences of community mental health nurses' (CMHNs) responses to their voices. This paper presents the findings of an exploratory interview study of a sample (n = 20) of service users to ascertain their perception of CMHN responses to their experience of hearing voices. Data are both quantitative and qualitative in nature. Content analysis of the qualitative elements of the study suggests responses can be conceptualized as facilitators, barriers and attributions. CMHNs are considered to be allies and the quality of the relationship is deemed important. The therapeutic repertoire of CMHNs, however, is seen as limited and rarely extends beyond facilitating access to the psychiatrist for review of medication. [ABSTRACT FROM AUTHOR]

There is evidence to suggest that community mental health nurses experience stress and burnout related to their work. Previous research has been limited by a number of methodological problems. One of the problems is that studies have tended to have small or unrepresentative samples, and many researchers have only examined mental health nurses as a subset within their research, which limits the generalizability of the findings. The All-Wales Community Mental Health Nurse (CMHN) Stress Study was set up in order to address this issue. The total population of CMHNs in Wales was surveyed (N = 614) and 301 (49%) responded. The questionnaire booklet contained a number of validated instruments to measure stress, burnout, and coping, together with a demographic questionnaire. The demographic questionnaire included three open ended-questions. These questions were asked in order in determine the CMHNs' own views of the sources of stress in the workplace, and to investigate which methods they use to cope. This paper reports the findings from the content analysis of the three questions. The results from the other measures are reported in the companion paper (Edwards et al. 2000). The most frequently cited stressors included perceived workload, excessive paperwork and administration, and a broad spectrum of client-related issues. Coping strategies that CMHNs reported using included peer support, a range of personal strategies such as relaxation, and belief in self and supervision. It appears from the findings that a range of factors such as organizational pressures and factors related to working with patients are important in determining stress levels, and that informal rather than formal support networks are the preferred methods of coping. [ABSTRACT FROM AUTHOR]

There is now a body of research that has shown that the attitudes of nurses towards substance misuse in the mentally ill are generally suboptimal and this has an impact on the quality of nursing care provided. Despite this, to date there have been no published studies that have examined the attitudes of forensic nurses towards substance misusing forensic service users. Sixty-three multiethnic registered forensic psychiatric nurses based on an inpatient unit in outer London were surveyed using the Substance Abuse Attitude Survey (SAAS). This has five subscores: Treatment Intervention, Treatment Optimism, Permissiveness, Non-Moralism and Non-Stereotypes. Only Permissiveness scores were at an optimum level and equivalent to other community mental health workers. The Treatment Intervention and Treatment Optimism subscores were well below those of a multidisciplinary group of community mental health workers. Three other findings were of note. Firstly, women had higher Non-Moralism scores than men. Secondly, staff nurses had higher Non-Stereotypes scores than other grades. Finally, Black nurses had higher Treatment Optimism scores than non-Black colleagues. In conclusion, the attitudes of forensic nurses towards substance misuse in forensic clients are more suboptimal than other groups of community mental health workers. Our findings also indicate that gender, staff grading and ethnicity are associated with suboptimal scores. [ABSTRACT FROM AUTHOR]

Patient allocation is common practice in psychiatric nursing. This study investigates nurse aptitude, a sub-concept of competence, to validate and refine patient allocation. The focus is on operationalizing aptitude for daily management purposes. Aptitude varies in function of the tasks to be performed and the therapeutic relationship of each psychiatric nurse with her individual patients. Time, job context, socio-cultural context and semantic frame of reference have also to be taken into account when operationalizing aptitude. Self and peer opinions are a basis for aptitude measurement as patient care and its management are shared among a small team of nurses. A meticulous idio-graphic analysis is necessary. These constraints generate several measurement difficulties that are to be dealt with without too many unrealistic assumptions. The research design enabled reliable aggregation of peer 'on' and 'from' opinions. These allowed confrontation of opinions and identification of bias in these. Stepwise explorative experimentation led to gauging and calibrating a specific aptitude questionnaire to the context of psychiatric nursing. The final version is now being applied in practice in 14 wards of 11 hospitals in Flanders. [ABSTRACT FROM AUTHOR]

With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles. [ABSTRACT FROM AUTHOR]

Part of the community mental health nurse's (CMHN) role is the assessment of violence posed by clients. It explores factors such as the reduction of inpatient beds and the predictability of violent acts towards nursing staff. This study outlines how the risk of violence is assessed by generic CMHNs, by examining their awareness, understanding and perceptions of violence posed by their clients. The data were collected in one Trust, using questionnaire and focus groups. The findings emphasize the importance of historical evidence but also raise the issue of gut feelings of the nurse. They further identify that clinical judgement can be accurate in assessing for violence, and CMHNs relied upon experience and personal impressions of the presenting evidence, rather than through the use of a standardized instrument. [ABSTRACT FROM AUTHOR]

Recent research has highlighted the role of expressed emotion by ward staff in determining the well-being of psychiatric inpatients. Existing methods of assessing staff expressed emotion involve standardized interviews and are expensive and time-consuming. We report the development of a questionnaire measure of expressed emotion in staff as perceived by patients. In study 1, factor analysis of items administered to patients in a variety of settings led to the development of a questionnaire with three subscales: supportiveness, criticism and intrusiveness. In study 2, the test-retest reliability of the questionnaire was found to be adequate, and some evidence of concurrent validity for the scale was obtained against expressed emotion rated from staff speech samples. In study 3, the scale was shown to have good concurrent validity against the ward atmosphere scale, and scores were found to be independent of insight or experience of admission to hospital. The perceived expressed emotion in staff scale is a convenient measure, which may have utility for both research and clinical purposes. [ABSTRACT FROM AUTHOR]