Iain W Graham

Career in mental health still an unlikely career choice for nursing graduates: A replicated longitudinal study

The lack of qualified mental health nurses is at critical level with the problem likely to worsen as the aging mental health nursing workforce retires. This study investigates the career preferences of undergraduate nursing students by comparing preferences at the start, middle, and end of the Bachelor of Nursing program. The comparison of the cohorts gave an indication of the change in preferences over the intervening years. It replicates research completed in 1992, 1997, and 2001, and develops a profile of nursing career preferences and the rationale underpinning those preferences in a cohort of students (n = 150) who began their Bachelor of Nursing studies in 2007 and completed in 2009. The main findings included that, like the previous studies, mental health nursing is one of the least desirable career choices for most nurses at the start of their course and remains so as they approach graduation. The reasons change but the outcome remains the same. The current system of using the Bachelor of Nursing award to produce mental health nurses in Australia does not encourage nurses to consider a career in mental health nursing. Which begs the question: where will mental health nurses in the future come from?

Reflective Practice: using the action learning group mechanism

Many practising nurses, midwives, health visitors and their educators recognise the phenomena of the theory-practice gap. Due to social, economic and political developments it is now crucial for the gap to be closed. This paper provides a commentary on how one mechanism, called an action learning group (ALG), has been utilised in a post-registration diploma/degree programme in Nursing and Midwifery Studies as a method to secure that closure. Presented within the introduction to the paper is a discussion on reflective learning and its understanding by an academic team. The paper then considers the ALG formula with discussion upon its uses and an example of student experience. The paper concludes by discussing the aspirations of the academic team with regard to ALGs and their role in post-registration nurse, midwife and health visitor education.

Addressing the mental health nurse shortage: undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.

Divergence and convergence in nursing and health care among six countries participating in ICN's 2010 Global Nursing Leadership Institute

ZITTEL B., EZZEDDINE S.H., MAKATJANE M., GRAHAM I., LUANGAMORNLERT S. & PEMO T. (2011) Divergence and convergence in nursing and health care among six countries participating in ICNs 2010 Global Nursing Leadership Institute. International Nursing Review59, 48–54 In 2009 the International Council of Nursing (ICN) launched, with support from Pfizer External Medical Affairs, a Global Nursing Leadership Institute (GNLI) which was again repeated in the fall of 2010. The programme, provided in English, at a location near ICN headquarters in Geneva, Switzerland, provided the opportunity for senior and executive level nursing leaders throughout the world to acquire new knowledge and skills about national and global leadership within a supportive and stimulating learning environment. Once selected for participation, GNLI members are requested to complete a country profile – a two to three page precis providing information regarding health and nursing specific to their respective country encompassing the following: the countrys health system and how it is funded; identification of current or proposed changes in the health system; national demographic data such as population, gross national income, average life expectancy, number of nurses and physicians, and the top three causes of deaths; and key issues facing the health system and nursing in the country. On arrival at the Institute, participants were divided into leadership development teams, small groups of six persons each, which met throughout the week to discuss the ways in which health challenges and nursing in their respective countries both converged and diverged. Shared insights learned are presented from one such 2010 GNLI team representing nursing leaders from the countries of Australia, Bhutan, Lebanon, Lesotho, Thailand and the USA. A comparative analysis of the health profiles of their respective countries is also provided.

Nurse Practitioner preparation: Is it time to move beyond masters level entry in Australia?

Nurse Practitioner education in Australia currently requires a post graduate qualification at masters level for endorsement by national registration bodies and entry into practice. This paper reviews the evidence and debate in America that saw the education of Nurse Practitioners advance to the doctoral level in 2004. Consideration will then be given to the similarities between the American and Australian context, in order to open the debate about whether it is timely for Australian universities to consider the need to advance Australia Nurse Practitioner education to the Doctor of Nursing Practice.

Promoting leadership: the development of a nurse executive team in an acute hospital trust

AIM The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. BACKGROUND This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. METHOD A questionnaire using quantitative and qualitative measures was used to explore the groups leadership style and evaluate the professional development programme. FINDINGS The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. CONCLUSIONS The issues raised, such as team-working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. IMPLICATIONS FOR NURSING MANAGEMENT In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.

Models of case management for working with young children: Implications for mental health nurses

The care of children with behavioural disorders/mental illnesses is an important and emerging role for mental health nurses. Unfortunately, there is little evidence on which to base their practice. Children, because of their rapid emotional, physical, and cognitive development, and their dependence on their families, need special consideration in their mental health care. The limited evidence available indicates that this special consideration should include a focus, not only on the child, but also on the parents and social and school networks of the child. Evidence from the adult literature indicates the most effective case management models are the ones in which the case manager offers as many services as possible, including talking therapies. This also seems to be true when working with children. Mental health nurses, because of their background and commitment to holistic care, are ideally suited to offer this type of service. However, mental health nurses have not been good at articulating what they do. This can limit the recognition of the contribution they make and their opportunities.

Intramuscular hemangioma of the posterior belly of the digastric muscle failing to highlight on magnetic resonance imaging.

Intramuscular hemangiomas of the digastric muscle are rare. We present the fifth case reported and the second to be imaged in vivo with magnetic resonance imaging. Accurate preoperative diagnosis of these lesions is difficult, but may be facilitated by a high degree of clinical suspicion and imaging. Magnetic resonance imaging using T2-weighted sequencing has been reported to effectively highlight these lesions. We present a case in which magnetic resonance imaging failed to highlight an intramuscular hemangioma of the posterior belly of the digastric muscle. Possible reasons for this failure are discussed.

Advanced Practice Nursing: Continuation of the Dialogue

This column continues the dialogue about advanced practice nursing. Professor Iain Graham of Bournemouth University shares his ideas about advanced practice nursing in the United Kingdom and answers questions about the tasks and responsibilities of advanced practice nurses within the National Health Service.

Children with Behavioral/Mental Health Disorders and School Mental Health Nurses in Australia

TOPIC This review of the literature addresses Australian school mental health nursing is an emergent field of practice. PURPOSE Children with behavioral/mental health disorders present challenges to schools, teachers, and their families. They can be disruptive in class, inappropriate with their peers, and perform poorly academically. Often this group of children do not respond to the schools usual strategies to support appropriate behavior. When children with behavioral/mental health disorders do not receive specialized support based on their problems and needs, their problems can escalate over time and in adolescence their behavior may become more challenging, with increased aggression, substance use, contact with the criminal justice system, and school failure with or without dropout. CONCLUSION Mental health nurses, working as case managers, could be effective in the support of children with behavioral/mental health disorders in schools. Mental health nurses, because of their professional education and clinical practice, work not only with the individual child but also with family members. They are well prepared to case manage in schools and support individual teachers and health and welfare services in their management of their clients with behavioral/mental health disorders.TOPIC:  This review of the literature addresses Australian school mental health nursing is an emergent field of practice. PURPOSE:  Children with behavioral/mental health disorders present challenges to schools, teachers, and their families. They can be disruptive in class, inappropriate with their peers, and perform poorly academically. Often this group of children do not respond to the schools usual strategies to support appropriate behavior. When children with behavioral/mental health disorders do not receive specialized support based on their problems and needs, their problems can escalate over time and in adolescence their behavior may become more challenging, with increased aggression, substance use, contact with the criminal justice system, and school failure with or without dropout. CONCLUSION:  Mental health nurses, working as case managers, could be effective in the support of children with behavioral/mental health disorders in schools. Mental health nurses, because of their professional education and clinical practice, work not only with the individual child but also with family members. They are well prepared to case manage in schools and support individual teachers and health and welfare services in their management of their clients with behavioral/mental health disorders.