Catherine Hangan

Mental health nursing standards for Australia: A review of current literature

The expanding role of the mental health nurse brings new challenges and rewards. To support this, nationally adopted, formalized standards of practice are required. Currently, the Standards of Practice for Mental Health Nurses in Australia published by the Australian and New Zealand College of Mental Health Nurses in 1995 provide a guide for mental health nurses working in Australia. While these standards have played a role in supporting mental health nurses, they have not been widely adopted. This report reviews the current literature on standards for practice and describes an evidence-based rationale as to why a review and renewal of these is required and why it is important, not just for mental health nurses but to the field of mental health in general.

The review and revision of ‘Standards of practice for mental health nurses in Australia’

In recent years, there has been growing concern for the wellbeing of people affected by mental illness and the recipients of mental health care in Australia. Despite significant positive change there is always room for improvement and one means of introducing and monitoring improvement is through the use of service provision standards. National and international reviews of mental health care highlight the need for responsive service delivery that meets the needs of all people affected by mental illness regardless of their place in the systems of care. The development of documents such as the National Standards for Mental Health Services by the Commonwealth Department of Health and Ageing (Australian Health Ministers Advisory Council 1996) maintained the impetus towards the development of quality measurement tools for mental health service provision. Given the magnitude of change in the area of mental health care over the past decade and the major role that mental health nurses play in the delivery of mental health care it is considered a priority to ensure that this professional group is supported by relevant and appropriate standards for practice.

Are we there yet? The journey to contemporary standards for mental health nursing

Perspective taking, the main cognitive component of empathy, has a particularly important and complex role to play in the clinician-client relationship, particularly in mental health nursing. However, despite extensive investigation into the outcomes of this construct (e.g. sympathy, altruism), the process by which people take anothers psychological point of view has received comparatively little attention. The purpose of this study was to investigate what the individual does when attempting to take the perspective of another person. The aims were to identify the specific strategies people used to accomplish this task, to consider how and why these strategies were chosen, and the relationship between the strategies and subsequent outcomes. Participants described an example of their own perspective-taking experience. Adopting an interpretive phenomenological approach, analysis resulted in the generation of several themes of direct relevance to both the perspective taking process and the wider empathic experience. Of particular importance were two superordinate themes, use of other-information and use of self-information. One significant subordinate theme (within use of selfinformation) to emerge was that of past experience, where the participant had experienced either (a) a similar role to that which they occupied in the present situation, or (b) a similar situation to that of the target person. Both of these experiences were determinants of how easy participants perceived the task of apprehending the target’s perspective. Within the wider empathic experience, themes included emotional manifestations (e.g. sympathy), as well as judgements of appropriate behaviours. Implications of findings when working in clinical and mental health settings are discussed.There have been a number of studies overseas investigating collaborative inter-professional educational models for preparing mental health professionals who work in integrated or multidisciplinary mental health services. Recent implementations include the Canadian Collaborative Mental Health Initiative Tool kit, and the NHS Quality Improvement Scotland Standards for Integrated Care Pathways for Mental Health. Integrated and multi-disciplinary models of primary health service delivery have been shown to be effective and suitable for delivery of services in regional and remote rural areas and for Indigenous clients in Australia. The key strengths of multidisciplinary mental health service models may be attributed to their client focus and adaptation to complexity. The overarching aim of this Australian Learning and Teaching funded project is to develop effective, collaborative, cross-disciplinary leadership frameworks for university learning and teaching which enhance the professional preparation of the multidisciplinary mental health workforce. We are developing strategies that will prepare students in professional health training programs to be better equipped to work in multidisciplinary settings. This paper presents an overview of the project and the results of the first sets of interdisciplinary workshops.

Are we there yet? The journey to contemporary standards for mental health nursing in Australia

Perspective taking, the main cognitive component of empathy, has a particularly important and complex role to play in the clinician-client relationship, particularly in mental health nursing. However, despite extensive investigation into the outcomes of this construct (e.g. sympathy, altruism), the process by which people take anothers psychological point of view has received comparatively little attention. The purpose of this study was to investigate what the individual does when attempting to take the perspective of another person. The aims were to identify the specific strategies people used to accomplish this task, to consider how and why these strategies were chosen, and the relationship between the strategies and subsequent outcomes. Participants described an example of their own perspective-taking experience. Adopting an interpretive phenomenological approach, analysis resulted in the generation of several themes of direct relevance to both the perspective taking process and the wider empathic experience. Of particular importance were two superordinate themes, use of other-information and use of self-information. One significant subordinate theme (within use of selfinformation) to emerge was that of past experience, where the participant had experienced either (a) a similar role to that which they occupied in the present situation, or (b) a similar situation to that of the target person. Both of these experiences were determinants of how easy participants perceived the task of apprehending the target’s perspective. Within the wider empathic experience, themes included emotional manifestations (e.g. sympathy), as well as judgements of appropriate behaviours. Implications of findings when working in clinical and mental health settings are discussed.There have been a number of studies overseas investigating collaborative inter-professional educational models for preparing mental health professionals who work in integrated or multidisciplinary mental health services. Recent implementations include the Canadian Collaborative Mental Health Initiative Tool kit, and the NHS Quality Improvement Scotland Standards for Integrated Care Pathways for Mental Health. Integrated and multi-disciplinary models of primary health service delivery have been shown to be effective and suitable for delivery of services in regional and remote rural areas and for Indigenous clients in Australia. The key strengths of multidisciplinary mental health service models may be attributed to their client focus and adaptation to complexity. The overarching aim of this Australian Learning and Teaching funded project is to develop effective, collaborative, cross-disciplinary leadership frameworks for university learning and teaching which enhance the professional preparation of the multidisciplinary mental health workforce. We are developing strategies that will prepare students in professional health training programs to be better equipped to work in multidisciplinary settings. This paper presents an overview of the project and the results of the first sets of interdisciplinary workshops.

Raising our standard : The review and renewal of the 'Standards of Practice for Mental Health Nurses' in the 21st century

In this paper, we report on a research project funded by the Australian College of Mental Health Nurses’ and Bristol Myers Squibb Research Grant in 2007. We examined ways in which Mental Health Nurses could correctly identify patients during medication administration that promote medication safety and that are acceptable to both consumers and nurses. Central to the safe practice of medication administration are the “five rights” – giving the right drug, in the right dose, to the right patient, via the right route, at the right time. In non-psychiatric settings, such as medical and surgical inpatient units, the use of identification aids, such as wristbands, are common. In most Victorian psychiatric inpatient units, however, standardised identification aids are not used. Anecdotally, consumers dislike some methods of patient identification, such as wearing wrist bands, and some nurses perceive consumers’ rights are infringed through wearing personal identifiers. In focus groups, mental health consumers and Mental Health Nurses were invited to discuss their experiences of patient identification during routine psychiatric inpatient medication administration. They were also asked their opinions of, and preferences for, different ways of verifying “right patient” during routine medication administration. In our paper, we will present the findings of a qualitative research project in which we explored the experiences, opinions, and preferences of mental health consumers and Mental Health Nurses towards methods of correctly identifying patients during medication administration.