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The aim of this integrative systematic review was to systematically search, critically appraise, and summarise reported research related to readiness to practice and types of clinical support offered to newly registered nurses and preregistration nurses (such as, mentoring, preceptorship, or clinical facilitation). The review was undertaken in February 2017. The databases of Medline, CINAHL, Academic Search Complete, and Cochrane Library were searched. The search returned 137 articles. The final number of papers (after screening and exclusions) was 15 articles related to the topic. Key findings that influence work readiness for newly registered nurses were - Importance of Preceptors for Facilitating Work Readiness with the sub themes of Positive relationships between the preceptors and the student or newly registered nurse, Preparing and supporting the preceptor for the role and Using a model to guide preceptorship of students, the second theme was related to Clincal Exposure, including a sub theme of Adequate clinical exposure and clinical competence. Work readiness has been attributed to many factors and this review has revealed a number of key factors that contribute to newly registered nurses’ work readiness such as preparation of the preceptor, positive relationships and adequate clinical exposure..

Nurses and subordination: a historical study of mental nurses’ perceptions on administering aversion therapy for ‘sexual deviations’ This study aimed to examine the meanings that nurses attached to the ‘treatments’ administered to cure ‘sexual deviation’ (SD) in the UK, 1935–1974. In the UK, homosexuality was considered a classifiable mental illness that could be ‘cured’ until 1992. Nurses were involved in administering painful and distressing treatments. The study is based on oral history interviews with fifteen nurses who had administered treatments to cure individuals of their SD. The interviews were transcribed for historical interpretation. Some nurses believed that their role was to passively follow any orders they had been given. Other nurses limited their culpability concerning administering these treatments by adopting dehumanising and objectifying language and by focussing on administrative tasks, rather than the human beings in need of their care. Meanwhile, some nurses genuinely believed that they were acting beneficently by administering these distinctly unpleasant treatments. It is envisaged that this study might act to reiterate the need for nurses to ensure their interventions have a sound evidence base and that they constantly reflect on the moral and value base of their practice and the influence that science and societal norms can have on changing views of what is considered ‘acceptable practice’.

Aims and objectives. The study aimed to examine the experiences of patients and meanings attached to ‘treatments’ of sexual deviations, which included homosexuality and transvestism, in the UK (1949–1992), exploring reasons for such treatments, experiences and how individual lives were affected. Background. Male homosexuality remained illegal in England until 1967 and, along with transvestism, was considered an antisocial sexual deviation that could be cured. Homosexuality remained classifiable as a mental illness until 1992. Nurses were involved in administering treatments to cure these individuals; however, there is a paucity of information about this now-discredited mental health nursing practice. Design. A nationwide study based on oral history interviews. Methods. Purposeful and snowball sampling was utilised when selecting participants for the study. Participants were recruited via adverts in gay establishments/media. All participants gave signed informed consent. Face-to-face oral history interviews were conducted and transcribed for historical interpretation. Results. Seven former male patients made contact, aged 65–97 years at interview. All reported that the treatments had been unsuccessful in altering their sexual desires or behaviour. Most sought treatment owing to unsupportive and negative attitudes from friends, family and wider society. Others selected treatments instead of imprisonment. Most eventually found happiness in same-sex relationships. However, all were left feeling emotionally troubled by the treatments they received. Conclusion. Defining homosexuality and transvestism as mental illnesses and implementing what could be argued to be inefficient treatments to eradicate them appears to have had a lasting negative impact on the patients who received them. Relevance to clinical practice. Nurses who care for older gay, lesbian, bisexual and transgender patients need to be mindful of their potential past treatment by healthcare services and ensure that they are non-judgmental and accepting of their sexual orientation and current gender.

Aims. This article is a report of a study that aimed to establish a national picture of the implementation of Review recommendations over time in both Mental Health Trusts and Higher Education Institutions (Universities) in England. Background. The 2006 Review of Mental Health Nursing in England by the Chief Nursing Officer made 17 key recommendations for Mental Health Trusts and Universities to improve mental health nursing. This article outlines key findings from a national survey of National Health Service Trusts and Universities in England with regard to prioritization and progress on implementation of these recommendations. Methods. An e-survey was carried out in 2008-2009 based on the Chief Nursing Officer review recommendations and guidance. Participants included all Trusts which delivered mental health services (n=68) and Universities which delivered pre-registration mental health nursing education (n=50) in England. Results. There appears to be some evidence that the Chief Nursing Officer review of Mental Health Nursing in England continues to be implemented in both Mental Health Trusts and Universities. There is variety in levels of implementation, but Mental Health Trusts and Universities broadly agree on priority areas. Conclusions. The Chief Nursing Officer review has been influential in focusing the care and education of mental health nurses and services in England. There appears to be a range of barriers and facilitators which aid the implementation of healthcare policy. More attention is required from researchers to enhance and evaluate the impact of policy implementation on the quality of care provided. © 2011 Blackwell Publishing Ltd.

Objectives. To establish a national picture of the implementation of these recommendations in both trusts and higher education institutions. Background. The Chief Nursing Officer for England Review of Mental Health Nursing made 17 key recommendations to improve mental health nursing. Subsequent publications aimed to help implement these recommendations. Design. An e-survey. Methods. The survey was based on the Chief Nursing Officer review recommendations and guidance. Participants: all relevant trusts who deliver mental health services (n = 68) and higher education institutions who deliver pre-registration mental health nursing education (n = 50) in England. Results. A total of 42 trusts (63·6%) and 40 higher education institutions (80%) completed the survey. The survey indicates that the Chief Nursing Officer review has stimulated some activity in all organisations who responded. Eleven of the recommendations were ranked similarly by trusts and higher education institutions. There were statistically significant differences between trusts and higher education institution priorities in four areas, inpatient care, evidence-based interventions, multidisciplinary team working and recruitment and retention. Conclusions. The findings of the survey demonstrate that all organisations have made some progress in the implementation of the Chief Nursing Officer recommendations. Trusts and higher education institutions broadly agree on the importance of each of the Chief Nursing Officer recommendations, with the exception of four items. A range of factors was identified by respondents that were perceived as facilitators and barriers to the implementation of the Chief Nursing Officer review. Relevance to clinical practice. This article contains findings that are highly relevant for current and future clinical practice in mental health. Despite some progress, clear differences between higher education institutions and trusts are apparent. It is important that these differing perspectives are acknowledged and resolved to improve healthcare provision. Both trusts and higher education institutions reported difficulty with engaging service users and carers. A range of factors are identified that act as facilitators and barriers to the implementation of healthcare policy.

Objectives To review national (UK) literature in order to (i) examine service user and carer views of UK-registered mental health nurses; (ii) identify the diversity of populations from which these views have been collected; (iii) assess the methodological rigour of the current knowledge base and (iv) evaluate the extent to which service users and carers have been involved in the development and execution of this work. This paper reports only on service users' views. Design Systematic review. Data sources Electronic and evidence-based databases, reference checking and hand searching of key academic journals, national policy and user/carer organisational websites. Review methods Two reviewers independently undertook study eligibility judgements and data extraction. Eligible studies were sub-classified according to service setting (inpatient/residential, community/non-residential or mixed/unspecified). Each study was assessed against key quality criteria. Data were synthesised in a narrative format. Results One hundred and thirty two studies were included in the review. The majority were small-scale academic studies biased towards white, adult service users. Few studies provided evidence of user collaboration. Service users regard mental health nursing as a multi-faceted role delivering practical and social support alongside more formal psychological therapies. Service users report inadequate information provision, poor inter-professional communication and a lack of opportunities for collaborative care. Service users perceive inpatient mental health nurses as particularly inaccessible. Conclusions UK-registered mental health nurses should be equipped with both therapeutic clinical skills and generic skills associated with relationship building, engagement and communication. Future research should be conducted in collaboration with service users and include clear and effective mechanisms for the dissemination and implementation of research findings. In particular, the views of children and adolescents, the elderly and black and minority ethnic groups, currently under-represented in research, should be examined.

Summary Background There is clear evidence for the effectiveness of specific interventions for common mental health problems in primary care. A major challenge is the inflexibility of traditional approaches to respond to the sheer volume of need. Evidence for brief cognitive behavioural therapy (CBT) based guided self-help interventions is emergent and may offer a way forward in responding to the issues of volume and accessibility. We present, an evaluation of a training course designed to equip non CBT trained workers to deliver such interventions. Process Seventeen primary care mental health workers participated in a 10-day training course focussed on CBT based facilitated self-help approaches. Evaluation focussed on knowledge of CBT; acceptability/usefulness of the training; self perceived incorporation into participants’ clinical practice and perceived barriers to the use of the knowledge and skills acquired. Measures were administered pre and post training and 6 months later. Results Positive changes were recorded in knowledge, self rating of use of CBT techniques, usefulness of training which largly maintained 6 months after the course concluded. Perceived barriers to implementation of the intervention were noted particularly in the institutional domain and remained up to 6 months post the course. Discussion In this group of staff the training outlined was able to produce desired changes that were maintained. The degree to which these changes were responsible for improved access or effectiveness is beyond the scope of this paper. Further research is recommended in relation to the optimum level of training required to deliver effective brief interventions as part of a stepped system of mental health care.

The introduction of primary care graduate mental health workers (PCGMHWs) is a central element of a national strategy to support the capacity in primary care to respond effectively and appropriately to people presenting with mental health problems. The commitment in the NHS Plan to recruit 1,000 workers across England by 2004 (Department of Health, 2000) has not been easy to deliver. This paper describes the experience and process of introducing these workers in the North West region of England within the context of the challenges of implementing national policy; it identifies elements of the approach which have facilitated implementation and provides a case study which might have broader relevance.

Recent reform and developments in mental health care provision have increasingly espoused the value of multiprofessional teamwork in order to ensure that clients are offered co-ordinated packages of care that draw on the full range of appropriate services available (DoH 1999a; DoH 2000). Supervision in some form is seen as a key part of all professional practice to provide support to practitioners, enhance ongoing learning, and, to a greater or lesser degree, offer some protection to the public (Brown & Bourne 1996, UKCC 1996). Clinical supervision has gained increasing momentum within the nursing profession, but to a large extent this has been within a uni-professional framework – nurses supervising other nurses. This paper seeks to explore the ways in which multiprofessional working and clinical supervision interlink, and whether supervision across professional boundaries might be desirable, possible, and/or justifiable. Whilst our own view is that multiprofessional supervision is both possible and desirable, we seek to open up a debate, from our perspective as mental health nurses, about some of the issues related to the concept. Our motivation to explore this topic area emanates from our experiences as supervisors to colleagues within multiprofessional teams, as well as the experiences of those attending supervisor training courses. Following a brief overview of the development of clinical supervision in mental health care and recent policy guidelines, some models of clinical supervision are reviewed in terms of their suitability and applicability for multiprofessional working.

The introduction of clinical supervision in nursing is gaining momentum and is proposed as having numerous benefits for nurses, organizations, and ultimately patient care. The necessity for such supervision has arisen partly from a fundamental shift in the nature and definition of nursing work. The emphasis on individualized, holistic care has led to a change in role from one characterized by professional distance to one in which interpersonal involvement is seen as central. Such a shift, though seen as positive, may lead to increased vulnerability as nurses negotiate the blurred boundaries between the personal and the professional in their relationships with patients. Such boundary negotiation is a legitimate focus for learning and support in clinical supervision. However, as with many aspects of nursing, the subtle processes involved in relationship development are often hidden from consciousness, thus missing potential learning opportunities. One way that such hidden aspects of practice may be explored in clinical supervision is through attendance to the way that such processes are parallelled in the supervisory relationship. Drawing on theory and practice from the fields of counselling and mental health nursing, this paper explores the nature of 'parallelling' in clinical supervision. The implications for clinical supervision in nursing more generally are examined in relation to enhancing learning and providing support for supervisees and supervisors.

Policy guidance suggests that outcomes for adolescents with mental health problems can be improved by secondary education services (SES) and child and adolescent mental health services (CAMHS) working more closely. This study reports on staff experiences of the introduction of a mental health link worker (MHLW). The findings of two focus groups are presented, conducted with staff from CAMHS and SES. These focus groups formed part of the overall wider evaluation of the MHLW role. The groups explored staff perceptions and experiences following the introduction of the MHLW, and elicited their views on the effectiveness of this innovative role. Qualitative methods were employed, and analysis was conducted using the principles of grounded theory and the constant comparative method. The findings revealed that the MHLW was well received by both groups, despite the identification of potential barriers. A number of key themes emerged, which included the ability of the link worker to improve communication and to encourage mutual understanding between services. The issues raised by these themes are discussed and recommendations are made for future practice and research.

This paper examines the evidence for the use of cognitive behavioural therapy (CBT) within acute mental health-care settings. Through the provision of a literature review the authors critique the research into the effectiveness of CBT when delivered within acute mental health-care settings, to clients who are acutely psychotic. The review concludes with recommendations for future research to expand the current evidence base.

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.

The increasing role of healthcare assistants (HCAs) in intensive care in relation to patient monitoring has raised concerns among some clinical managers, particularly where such roles are not underpinned by a sound knowledge base and critical reasoning ability. This article describes a study which was undertaken in an attempt to identify how HCAs are currently utilized within the general intensive care environment. The results show a wide variation between units in relation to the activities undertaken by HCAs, their training and the levels of remuneration. This article seeks to open up the debate as to whether or not nurses should be challenging the nursing care that is now delivered by non-nurses and makes recommendations for the way forward in this area.

The issues of Quality and Quality Assurance in nurse education, have become prominent in the design, management and marketing of courses. However, quality is a concept which has many meanings. One of the central ideas which has emerged from the current discourses on quality, is that of the 'customer'. In the new business jargon of the 1990s, with its emphasis on the market and competition, the importance of 'satisfying the needs of the customer/consumer' has been a dominant theme. One of the customers of nurse education is seen as the student. The reconceptualization of the student as customer may carry with it, connotations which do not readily fit into the context of education and learning as a jointly negotiated process. A collaborative, rather than consumerist model is proposed as a preferable basis for the ensuring of quality, and the involvement of students in that process. Such a model, would be in line with a truly student-centred approach to nurse education, where power is shared between those involved in the process. The importance of the current inequality of power in student-teacher relationships is a barrier to such an approach and true student participation, rather than tokenism is called for.

This paper will take a critical look at the concepts of compliance and non-compliance, both generally and in the specific context of contraceptive use.