Psychiatric and Mental Health Nursing

The craft of caring

Mary Chambers, Mary Chambers

• Verlag: Routledge
• Jahr: 2017
• ISBN:
  9781482221978
• Auflage: 3
• Thema: Medicine
• Thema: Health Care Delivery

This new edition of a bestselling, evidence-based textbook provides a comprehensive overview of psychiatric and mental health nursing. Keeping service users and their recovery at the centre of care, the holistic approach will help nurses to gain the tools and understanding required to work in this complex area.

Extensively updated for this new edition, the text looks at:

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• Aspects of mental health nursing: covering topics such as ethics, developing therapeutic relationships and supervision.

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• The foundations of mental health nursing: discussing diagnosis, assessment and risk.

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• Caring for those experiencing mental health distress: looking at wide range of troubles including anxiety, bipolar disorder, eating disorders and issues around sexuality and gender.

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• Care planning and approaches to therapeutic practice: exploring ideas, pathways and treatments such as recovery, CBT, psychodynamic therapies and psychopharmacology.

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• Services and support for those with mental health distress: covering topics such as collaborative work, involvement of service users and their families and carers, and a range of different mental healthcare settings.

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• Mental health nursing in the twenty-first century: highlighting emerging and future trends including the political landscape, physical health and health promotion, and technological advances.

This accessible and comprehensive textbook integrates service user perspectives throughout and includes student-friendly features such as learning outcomes, key points summaries, reflection points and further reading sections. It is an essential resource for all mental health nursing students, as well as an invaluable reference for practising nurses.

Section 1

Aspects of mental health nursing

1 The nature of mental health nursing

BEN THOMAS

Introduction

Mental health nursing today

Understanding the nature of mental health nursing

Policy direction and mental health nursing

The wider nursing context

Mental health nurses – competent and capable

The craft of caring

The views of people with lived experience: service users and carers

National reviews of mental health nursing – lessons learnt

The future of mental health nursing

Conclusion

References

Further reading

Relevant web pages

LEARNING OUTCOMES

• To know what values-based practice means and its importance in mental health nursing.

• To be able to describe recent government policies relating to mental health and their implications for mental health nursing.

• To understand the wider context of nursing and the application of the 6 Cs (Compassion in practice) to mental health nursing.

• To be able to identify the difference between competence and capability and their development in mental health nursing.

• To be aware of the national reviews of mental health nursing and the changing nature of the profession.

• To understand some recent developments and future directions for mental health nursing.

SUMMARY OF KEY POINTS

• Mental health nurses have a key role to play in implementing the major developments and changes taking place in mental health services globally.

• The role of the mental health nurse continues to evolve in response to changing societal needs and priorities for health and social care.

• Mental health nurses are key contributors to mental health policy and in defining the vision for the future mental health of the population.

• The role of mental health nurses has to be positioned within the wider context of nursing, particularly the overall vision and strategy, professional standards of practice and behaviour changes in nurse education, and the developing evidence base of nursing.

• People who use mental health services can expect to receive skilled, compassionate care and support from competent and capable mental health nurses.

• There are a number of internal and external influences that will affect the future development of mental health nursing, including social and economic determinants and advances in the evidence base for the care and treatment of people with mental health problems.

INTRODUCTION

This chapter provides a broad overview of mental health nursing as it is currently practised in England. Since nurses are the largest group of professionals providing mental health care in most countries, the chapter will have wider value beyond England. It will also be of relevance to the many countries which have little or no information on their nursing workforce for mental health and limited knowledge of their impact on health outcomes. The chapter highlights some of the major government policies relating to mental health and their impact on mental health nursing. Worldwide many countries require a radical change in the delivery of mental health care, and some are yet to prevent abuses of human rights and discrimination against people with mental health problems. According to the World Health Organization, only 36 per cent of people living in low-income countries are covered by mental health legislation compared with 92 per cent in high-income countries.¹ Nevertheless, in some countries mental health care has undergone major changes and it is clear that governments are committed to improving services. Nurses have a central role to play in implementing these developments and initiatives. Mental health nursing is examined in the context of nursing more widely and the competencies, skills and capabilities required are described. The chapter concludes with a look at future trends and drivers which will affect the profession, including an emphasis on health promotion and the prevention of mental health problems, demographic changes and advances in digital technology.

MENTAL HEALTH NURSING TODAY

The role of the mental health nurse continues to evolve in response to changing societal needs and priorities for health and social care. Mental health nurses play a key role in delivering mental health services in many countries around the world. They work with people with mental health problems, their families and carers, across the life course. They work in a diverse range of settings, including acute admission wards, community teams, emergency departments, the independent and voluntary sectors, the criminal justice system and education. Globally, nurses represent the most prevalent professional group working in mental health services. The median rate of nurses in this sector (5.8 per 100,000 population) is greater than the rate of all other human resources groups combined. Being the largest professional group working in mental health services, mental health nurses have huge potential and opportunities to influence health and social care, and people’s health outcomes. There are 95,913 nurses registered with the Nursing and Midwifery Council (NMC) with a mental health qualification in the UK. Out of these, 37,930 mental health nurses work in the NHS. The number of mental health nurses working in social care and in the voluntary and independent sectors is not known but is estimated at several thousand.

Worldwide there is a substantial gap between the burden caused by mental health problems and the resources available to prevent and treat them. It is estimated that 4 out of 5 people with serious mental disorders living in low- and middle-income countries do not receive the mental health services that they need. Depression alone accounts for 4.3 per cent of the global burden of disease and is among the greatest single causes of disability worldwide. It is estimated that the cumulative global impact of mental health problems in terms of lost economic output will amount to US$16.3 trillion between 2011 and 2030.¹

Mental health problems are responsible for the largest burden of disease in England, 23 per cent of the total burden compared to 16 per cent for cancer and 16 per cent for heart disease. Mental disorder affects more than 1 in 4 of the population at any one time and costs the English economy £105 billion a year.² With increasing needs and expanding services, there is a pressure on workforce supply. It is vital that we invest in the current and future nursing workforce to have the capacity and capability to deliver services that provide a good experience and improved health outcomes for people with mental health problems. Health Education England (HEE) is responsible for overseeing and where necessary building the workforce. In 2015/16 HEE increased the number of mental health student nurse commissions by 3.2 per cent, which equals 3,243 student mental health nursing places altogether for England.

Following a number of high-profile national reports, such as the report of the Mid Staffordshire inquiry,³ HEE invited Lord Willis to be the independent chair of the ‘Shape of Caring’ review to determine the future education and training of registered nurses and care assistants. The report published in March 2015 includes 34 recommendations under 8 broad themes. The recommendations and the implications for mental health nursing are discussed in more detail in chapter 73.

Developments in mental health services over the last decade have provided many opportunities for mental health nurses to expand their role, develop new skills and acquire more autonomy and responsibility. Many mental health nurses are specialists who prescribe medications and treatments and make referrals to other services. Some mental health nurses lead their own services and run their own clinics, assessing and caring for people who self-refer or are directly referred from others. Working in partnership with service users and carers, many have developed new services and models of care: for example, providing 24-hour crisis care; street triage – working with police officers as a first-line response for people with mental health problems; providing school-based early interventions and targeted mental health support for vulnerable children and their families; and assessing and supporting refugees and asylum seekers. The many varied new roles taken on by mental health nurses include nurse consultants, modern matrons and advanced nurse practitioners. It is clear from all these developments that mental health nursing is increasing in complexity and diversity. Mental health nurses seldom work on their own. Generally, mental health nurses work as part of a multidisciplinary team with psychiatrists, general practitioners, psychologists and social workers. The complexities of multidisciplinary team working are increasing as nurses take on new roles in integrated services such as the criminal justice system. Changes in mental health law have also enabled mental health nurses to take on roles previously held by other professionals, such as the ‘approved’ mental health practitioner. The development of these new roles is seen as important in strengthening the capacity of the profession, improving its image and making mental health nursing an attractive career option, enhancing clinical career structures and providing fulfilling jobs and opportunities.

UNDERSTANDING THE NATURE OF MENTAL HEALTH NURSING

The primary purpose of mental health nursing is to promote mental health and quality of life, and to deliver compassionate care and support to people with mental health problems, their families and carers. As with all professional groups, mental health nurses are encouraged to continuously reflect upon their role and on how they deliver care, and seek to improve the way they function and develop in response to changing needs and a rapidly transforming health and social environment. Through reflection and supervision it is important that mental health nurses e...