Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.     

Population health as a framework for forensic nursing curriculum

The American Association for the Colleges of Nursing (AACN) has recommended that master's level graduate programs prepare nurses as generalists. There is, however, a gap in the educational ladder at the master's level when current master's clinical nurse specialist (CNP) and nurse practitioner (NP) programs are reconfigured as doctoral programs. To fill this gap, a curriculum model using population health as a framework is proposed.     

Resistance to group clinical supervision: A semistructured interview study of non‐participating mental health nursing staff members

This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio‐recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: (i) ‘forced non‐participation’, where an informant was in favour of supervision, but presented practical reasons for not participating; and (ii) ‘deliberate rejection’, where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: ‘difficulties related to participating in supervision’ and ‘limited need for and benefits from supervision’. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already‐existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post‐registration clinical education and reflective practice for this group.     

Undergraduate nursing students’ views of mental health nursing in the forensic environment

The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students’ attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students’ understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.     

Professional identity in community mental health nursing: a thematic analysis

AIM: The study aimed to explore how community mental health nurses (CMHNs) UK perceived their working lives. This was subdivided into questions related to: How do nurses perceive their professional status in terms of public image compared with their understanding of their working lives? How does the relationship between professional aspirations and experiences of working life affect their feelings about their work and their self image? BACKGROUND: In a rapidly changing organizational context CMHNs face the challenge of achieving a coherent professional identity. METHOD: An interview study was conducted and analyzed using semi-structured interviews and a thematic analysis to identify categories and themes in 34 CMHN's accounts of their working lives. FINDINGS: The data were classified into four major themes: (i) The client focus: the public service identity of the profession; (ii) Not being a profession: skepticism, doubt and uncertainty; (iii) Growing out of the role: professional development as exit strategy; (iv) Waiting to be discovered: the search for recognition. CONCLUSIONS: The metaphor of nurses searching for recognition has demonstrated its usefulness as a means of illuminating the quest undertaken by CMHNs to establish the legitimacy of their work, and achieve acknowledgment and appreciation. This underlies the search for professional identity in community mental health nursing.     

Changing the mental health nursing culture: the nursing clinical development unit approach

Developments in nursing as a profession have been accompanied by a perceived need to increase the relevance of research to nursing practice. The increased exposure to research in nursing curricula and the development of nursing academia has had little impact on either the conduct of clinical research or its utilization within the work place culture. Nursing Clinical Development Units (NCDU) were established with the view to overcoming some of these barriers through partnerships between academia and the clinical field. The aim of NCDU is to strive for improved patient outcomes. Education and research activities should be directed to achieve this patient-orientated outcome. The aim of this paper is to describe the NCDU program introduced by the Centre for Psychiatric Nursing Research and Practice (CPNRP) in Melbourne, Victoria. The way in which the program is designed to facilitate the relationship between CPNRP and the clinical field with the aim of contributing to improved patient outcomes will be emphasized. An evaluation of the program to date suggests that such links will be strengthened, and that this partnership will contribute to a greater involvement in clinically based research.     

Exploring evidence of the therapeutic relationship in forensic psychiatric nursing

While the body of nursing research in forensic psychiatry is growing rapidly, the therapeutic nurse-patient relationship in secure hospitals needs to be further examined. This paper reports on a research project that found two representations of the nurse-patient relationship in two male acute secure inpatient units. One representation was formed by the data collected from the unit nurses in semistructured interviews. The nurses valued the relationship and described their practice as therapeutic, however, evidence from the interviews would suggest that the nurses operate from a social frame of reference. Examination of the nurses 'entries in patients' case files formed the other representation. Through their documentation practices, nursing was represented as being oriented to custodial care. While neither representation can capture the clinical reality, these findings are relevant to forensic psychiatric nurses as their entries are a historical record through which their practice will become known to others, and in some cases, judged by others.     

Exploration of the graduate nursing program in a forensic mental health setting: A qualitative enquiry

BackgroundForensic mental health nursing is a specialised practice area. Graduate programs are essential for recruitment and retention. There have, however, been very few studies exploring forensic mental health graduate programs.AimThe aim of this study was to explore the experience of graduate nurses who completed a 2-year graduate program in a forensic mental health service in the state of Victoria Australia, and the nurses who support the graduates in the program.MethodsAn exploratory study was conducted gathering data via one-to-one interviews, with purposive sample of 20 forensic mental health nurses.FindingsAnalysis resulted in the interpretation of two themes; essential ingredients and ‘hitting hurdles’.DiscussionGraduate nurses commence with limited knowledge, experience challenges, and organisational pressures.ConclusionTransition to practice was enhanced with consistent support, university education, and program structure.     

A clinical teaching guide for psychiatric mental health nursing: a qualitative outcome analysis project

Limited curriculum enhancement resources are available to psychiatric nurse educators. This article provides a clinical teaching guide for novice instructors teaching an introductory psychiatric nursing course. The investigation is grounded in a constructivist theoretical framework and extends a previous case study project that explored how students learn during a mental health practicum (Melrose 1998, Melrose & Shapiro 1999). The guide was tested and modified by applying a qualitative outcome analysis methodology. Insight into interpreting student behaviour and providing appropriate and stage-specific teaching tools is revealed. Theoretical components, assessment questions for teachers, student behavioural signs and teaching strategies are identified and discussed to describe significant features in creating personally meaningful learning experiences.     

Good characteristics of a clinical supervisor: a community mental health nurse perspective

A qualitative methodology was adopted using a questionnaire and focus group to identify characteristics of a good supervisor from a supervisee perspective (staff nurses working in a mental health setting). Findings from the questionnaire and focus group were used as a basis for the nominal group technique to establish a prioritization of those characteristics identified. Thematic content analysis of the focus group generated five major categories: who provides clinical supervision; what happens during supervision; factors affecting the choice of supervisor; characteristics of a good clinical supervisor; and limitations caused as a result of how supervision is conducted. The ability to form supportive relationships, having relevant knowledge/clinical skills, expressing a commitment to providing supervision, and having good listening skills were perceived by the staff nurses as important characteristics of their supervisor. Supervisees viewed their supervisor as a role model, someone who they felt inspired them, whom they looked up to and had a high regard for their clinical practice and knowledge base. Nonetheless, limitations to the supervisory process were identified. Having their clinical supervisor allocated to them, their supervisor also being their manager, and having supervision sessions documented and stored by this manager threatened the full utility of the clinical supervision. In this paper three categories will be discussed: what happens during clinical supervision; good qualities of a clinical supervisor; and limitations caused as a result of how clinical supervision is conducted. In light of the study's findings, recommendations are offered to develop the provision of clinical supervision.     

Burnout and job satisfaction: a comparative study of psychiatric nurses from forensic and a mainstream mental health service

Within the nursing profession stress and burnout are considered to be widely present and problematic. These factors tend to impact negatively on job satisfaction and ultimately affect the retention of nurses. Psychiatric/mental health nursing as a specialty is considered to be a highly stressful environment; however, there is a paucity of research in this area. The current study adopted a survey design to compare forensic psychiatric nurses ( n = 51) with psychiatric nurses from a mainstreamed mental health service ( n = 78) in relation to burnout and job satisfaction. Forensic nurses displayed lower burnout and higher job satisfaction than their counterparts from the mainstreamed services. These findings are surprising in light of the image of forensic psychiatric nursing as dangerous and unpredictable.     

Illuminating the gendered nature of health‐promoting activities among nursing staff in forensic psychiatric care

When people in Sweden are sentenced and handed over to forensic psychiatric care (FPC), the authorities have overall responsibility for their health recovery. How nursing staff construct gender through their relations in this context affects their understanding of health promotion activities. The aim of this study was to illuminate, using a gender perspective, the understanding of nursing staff with respect to health promotion activities for patients. Four focus group interviews were conducted with nursing staff in two FPC clinics in Sweden. The study has a qualitative inductive design with an ethnographic approach. This study sheds new light on FPC in which its dual goals of protecting society and providing care are viewed from a gender perspective. When relationships within the nursing staff group and the nurse–patient relationship are justified by the goal of protecting society, gender becomes invisible. This might cause patients' individual conditions and needs for certain types of activities to go unnoticed. One of the implications of ignoring gender relations in nursing staff health promotion activities is that it risks contributing to gender stereotypes which impact on the nurse–patient relationship and the quality of care.     

The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction

There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.     

Interventions in the nurse-patient relationship in forensic psychiatric nursing care: a Swedish survey

Nurses (Registered nurses, RN, and Licensed Mental Nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data concerning the extent to which treatment interventions included verbal elements, and the focus of these nurse--patient verbal interactions, were analysed. The most commonly used interventions were 'social interaction', 'regular communication' and 'social skills training'. The most common focus in verbal nurse--patient interaction were 'explaining consequences, confronting and encouraging the patient to talk about his/her crime/behaviour', 'interpretative communications with the patient', and 'communication about functions in daily life'. The salient findings were: (1) seven of the fifteen interventions used by the nurses included verbal elements to a great extent; (2) nurses often used confronting interventions, despite the fact that the large EE (expressed emotion) literature suggest that hostility and critical remarks may provoke a worsening of symptoms among psychotic patients; (3) there was only little correspondence between actual practice and theoretical models; and (4) there were unexpectedly small differences between the two professional groups (RN and LMN), suggesting that the roles are not distinct.     

The role of a mental health consumer in the education of postgraduate psychiatric nursing students: the students' evaluation

Recent Australian Government policy reflects the integral nature of active consumer participation to the planning and delivery of mental health services. The effectiveness of consumer participation in improving mental health services has received some attention in the literature. Commonwealth Government funding enabled the development of a partnership between the Centre for Psychiatric Nursing Research and Practice and the Melbourne Consumer Consultants' Group. The successful application enabled the employment of a mental health consumer as an academic staff member of the Centre for Psychiatric Nursing Research and Practice. One important aspect of this role involved the mental health consumer teaching a consumer perspective to postgraduate psychiatric nursing students. The primary aim was to increase the students' awareness of and sensitivity to greater consumer participation within the mental health arena. This paper presents the results of an evaluation of the consumer academic role in teaching within the Postgraduate Diploma in Advanced Clinical Nursing (Psychiatric Nursing). An evaluation form was distributed to students (n = 21) on completion of the semester. The findings suggest the experience was considered beneficial to students and was impacting significantly on their current practice. This project supports the value of consumer participation in the education of mental health professionals.     

Evaluating the impact of a preceptorship course on mental health nursing practice

The crisis in the recruitment of nursing graduates into the mental health nursing field dictates the need for assertive and innovative strategies to promote the positive aspects of this field of nursing. A positive clinical experience has been identified as one of the most important determinants of nursing students' attitudes towards mental health nursing. The Centre for Psychiatric Nursing Research and Practice implemented the course "Preceptorship in Psychiatric Nursing" as a means to increase the skill level within and interest towards the preceptorship role in clinical practice. This paper presents an evaluation of courses conducted between 2000 and 2002. The findings suggest that participants (n = 150) were highly satisfied with the content and delivery of the course, and that it is likely to affect their attitude towards and fulfillment of the preceptorship role.