Luke J Molloy

Practice what you preach: developing person-centred culture in inpatient mental health settings through strengths-based, transformational leadership

The experience of nursing staff and consumers in inpatient mental health wards is often reported as being negative. Efforts to improve culture and practice have had limited success, with ineffective leadership, staff resistance, and unresponsive organisational culture identified as common barriers to change. Practice development has been promoted as an approach to developing person-centred culture that enables professional development through participation, learning and empowerment. For person-centred practice to flourish, organisational leadership at all levels must reflect the same principles. In preparation for the opening of a new integrated mental health service, an inpatient mental health team participated in a practice development project. An action research approach was used to facilitate a series of “away days,” initially with the nursing team and then other members of the multidisciplinary team (MDT). Transformational leadership principles were adopted in the facilitation of team activities underpinned by strengths and solution-focused practices. Evaluation of the project by staff members was very positive and there was a high level of participation in practice development activities. The project resulted in the creation of a development plan for the ward, which prioritised five key themes: person-centred care, personal recovery, strengths-based principles, and evidence-based and values-based care. The project outcomes highlight the importance of leadership, which parallels the ideals promoted for clinical practice.

The ideas of Frantz Fanon and culturally safe practices for Aboriginal and Torres Strait Islander people in Australia

Mainstream mental health services in Australia have failed to provide culturally appropriate care for Aboriginal and Torres Strait Islander people despite several national reports and policies that have attempted to promote positive service development in response to the calls for change from the Aboriginal and Torres Strait Islander communities. In light of this situation, this article considers the ideas of Frantz Fanon and their potential for promoting cultural safety (Ramsden, 2002) in mainstream mental health services. This article argues that Fanons ideas provide a conceptual strategy for nurses that prompts reflection and establishes a critical theoretical perspective linking power imbalance and inequitable social relationships in health care, thus complementing the aims of cultural safety. The purpose of this critical reflection is to guide nurses’ understanding of the relationship between colonization and health status in order to change their attitudes from those that continue to support current hegemonic practices and systems of health care to those that support the health of Aboriginal and Torres Strait Islander people.

Shared worlds: multi-sited ethnography and nursing research

Background Ethnography, originally developed for the study of supposedly small-scale societies, is now faced with an increasingly mobile, changing and globalised world. Cultural identities can exist without reference to a specific location and extend beyond regional and national boundaries. It is therefore no longer imperative that the sole object of the ethnographers practice should be a geographically bounded site. Aim To present a critical methodological review of multi-sited ethnography. Discussion Understanding that it can no longer be taken with any certainty that location alone determines culture, multi-sited ethnography provides a method of contextualising multi-sited social phenomena. The method enables researchers to examine social phenomena that are simultaneously produced in different locations. It has been used to undertake cultural analysis of diverse areas such as organ trafficking, global organisations, technologies and anorexia. Conclusion The authors contend that multi-sited ethnography is particularly suited to nursing research as it provides researchers with an ethnographic method that is more relevant to the interconnected world of health and healthcare services. Implications for practice Multi-sited ethnography provides nurse researchers with an approach to cultural analysis in areas such as the social determinants of health, healthcare services and the effects of health policies across multiple locations.

Recovery-oriented Care and Leadership in Mental Health Nursing

A recovery-oriented mental health service actively involves consumers as fully as possible in all aspects of their care, empowering them to establish and strive for individual goals and to develop ...

More Satisfying Than Factory Work: An Analysis of Mental Health Nursing Using a Print Media Archive

The move towards comprehensive nurse training in Australia thirty years ago continues to trouble many of its mental health nurses. It has been viewed as a failure by many and the profession has been judged by some commentators to have lost its preparedness for specialist care. Discourse put forward to support this negative evaluation usually centres on the recruitment of mental health nurses and a limited interest among student nurses to undertake mental health nursing because of their negative opinions towards it. Emerging from a larger ethnographic research project focused on mental health nursing practice in Australia, this article presents an analysis of the professions current circumstances using historical print media. As we move further from the era of direct entry, specialist training, the article notes the development of assumptions within the profession. These include the idea that mental health nurses received better training in direct entry, specialist programs, and therefore were better prepared for their specialist roles. The article puts forward a critique that challenges this. The article argues the most profound change faced by the profession is the erosion of the mental health nursing identity in Australia. The loss of the stand-alone hospital system, direct entry specialist training, and specialist professional registration have left mental health nursing with a growing uncertainty about itself as the profession evolves into its (mostly) post-mental institution world. At a time when the specialty of mental health nursing is experiencing serious staff shortages throughout the developed world, the article points to the importance of using historical sources to contextualize our present circumstances.

Lip service: Public mental health services and the care of Aboriginal and Torres Strait Islander peoples

The failure of public mental services in Australia to provide care deemed culturally safe for Aboriginal and Torres Strait Islander people has persisted despite several national reports and policies that have attempted to promote positive service change. Nurses represent the largest professional group practising within these services. This article reports on a multisited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about public mental health services and the services they provided to Aboriginal and Torres Strait Islander people. During the fieldwork, mental health nurses described the constricting effect of the biomedical paradigm of mental illness on their abilities to provide authentic holistic care focused on social and emotional well-being. Despite being the most numerous professional group in mental health services, the speciality of mental health nursing appears unable to change this situation and in many cases maintain this status quo to the potential detriment of their Aboriginal and Torres Strait Islander service users.

Near-hanging and its management in the acute inpatient mental health setting

Being admitted to an inpatient mental health unit does not necessarily protect a patient against suicidal behavior. Given their purpose and design, these clinical areas can provide a safe environment for reducing hanging deaths. Strategies for reducing suicide by hanging in acute inpatient units should include ongoing review of the safety of the environment and the emergency management of near-hanging. After receiving a request from inpatient nursing staff to develop an education program focused on the emergency management of near-hanging, the authors undertook a review of the literature to (a) identify the evidence base within this area and (b) establish an effective means to promote safe practice with the staff. This article provides a synthesis of the literature review and its implications for nursing practice. [Journal of Psychosocial Nursing and Mental Health Services, 52(5), 41-45.].

Mental health nursing practice and Indigenous Australians : a multi-sited ethnography

Abstract Criticism of public mental services provided to Indigenous Australians have persisted over the last two decades, despite several national reports and policies that have attempted to promote positive service change. Mental health nurses represent the largest professional group practising within these services. This paper reports on a multi-sited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about specialist mental health nursing practice and Indigenous Australians. The study found a disunited approach to practice during the fieldwork. Practice was expressed as a series of individual constructions built upon the nurses’ beliefs about Indigenous Australians and their experiences in practice with these peoples. The criticism of mental health services from Indigenous communities was understandable to the mental health nurses, but how they could address this through their individual practices was not always clear to them. The actions by public mental health services to improve cultural safety through generic training related to the broad area of Indigenous health and health service needs, does not appear to evolve into informed specialist mental health nursing practice for Indigenous Australian service users.

Rise of the zombie institution, the failure of mental health nursing leadership, and mental health nursing as a zombie category

In this paper, we propose that mental health nursing has become a zombie category, at least in the Australian context. Mental health nursing is a concept that has lost any real explanatory or conceptual power, yet nevertheless persists in public discourse and the collective imagination. In recent decades, powerful forces have contributed to the zombification of the mental health nursing workforce and the academy. An increase in medical hegemony, the ascendancy of allied health in mental health service provision, the need for uncritical and servile workers, protocol-driven work practices, and a failure of leadership to mobilize any substantial resistance to these trends have enabled the infection to spread. The recognition of zombification, active resistance against the forces that conspire to cause it, and the cultivation of genuine conscientious critical thought and debate offer the only hope of survival of mental health nursing as a thriving specialty.

Prevalence of Trauma in an Australian Inner City Mental Health Service Consumer Population

This study examined the rates and types of trauma reported by consumers utilising an inner city mental health service in Sydney, Australia. The study also explored whether consumers felt that it had been helpful to be asked about their experience of trauma, whether they thought that these questions should be asked routinely and if they wanted to talk about these experiences. Ninety-one consumers from an inner city mental health service were assessed. Eighty-eight percent of the consumers assessed reported that they had experienced at least one traumatic event, while 79% reported having experienced two or more events. A majority of consumers identified that they thought it was helpful to be asked about trauma and that it should be part of an assessment. However, less than one-third of these consumers surveyed wanted to talk about the trauma at the time of assessment. Concerns that clinicians may have in regards to addressing trauma in mental health assessment are not matched by consumers’ expressed beliefs on the issue.