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Leadership and management in mental health nursing
Journal of Nursing Management
Abstract
Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader's influence and regard leadership and management as distinct from the nurses' practical work.
The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing.
A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995-July 2010.
Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships.
Mental health nurses' leadership, management and transformational leadership are positively related in terms of effectiveness and nurses' skills.
It is important to consider mental health nurses' management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization.
... Leaders who approach communication in an open and frank manner are considered more informative by their peers (Dube & Jooste, 2006). Communication from those in leadership roles is regarded as more than an exchange of information and includes an interpersonal process that can have a direct impact on clinical care and a team's performance (Blegen & Severinsson, 2011). The way in which communication takes place influences how teams develop (Clifton, 2006). ...
... As a profession, mental health nursing relies on communication and relationship building as the core of its clinical practice (Burnard, 2003). This suggests communication might have particular relevance for clinical leaders in this specialty, however, studies of clinical leadership in mental health nursing are limited (Blegen & Severinsson, 2011). ...
... Participants identified communication as an essential attribute for effective clinical leadership, and although other studies have produced similar findings (Blegen & Severinsson, 2011;Holm & Severinsson, 2010), data that emerged from this study suggest a combination of attributes and characteristics that enables effective communication for clinical leadership in mental health nursing. The ability to communicate in a way that supports and empowers others has been associated with effective leaders in a number of settings (Abbasi et al., 2011;Holm & Severinsson, 2010). ...
Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.
... In hectic professionally demanding settings, it is not surprising that culture, peers, immediate management, and sources of support and acknowledgment all contribute to constructive work with patients in mental health units (Blegen & Severinsson 2011;Cleary et al. 2010). High-level personal demands are placed on registered nurses (RN) working in these environments, and they require interpersonal support and effective role models to maintain their optimism and effectiveness (Cleary 2003;Cleary et al. 2011a;Hummelvoll & Severinsson 2001a;Perry 2009). ...
... Responses to how acknowledgements should be conveyed fit with notions of good manners and normal professional behaviour in the form of saying thank you, recognizing extra effort, praise for perseverance, 'verbal' and 'supportive feedback', compliments on achievements, and 'positive reinforcement'. In other words, the RN value being treated respectfully and appreciatively (Blegen & Severinsson 2011). In line with these comments, when describing what sort of acknowledgements they sought, positive feedback and interpersonal recognition were each nominated by more than half of the respondents. ...
In acute mental health inpatient units, it is not surprising that culture, peers, immediate management, and sources of support and acknowledgment all contribute to positive nursing outcomes. In this qualitative study, four questions targeting leadership, culture, support, and acknowledgement of work well done were asked of 40 registered nurses (RN) working in acute mental health units. Findings convey a mixed picture indicating variation across units. Three-quarters believe that senior nursing staff actively contribute to a positive working environment. Almost half of the RN nominated peers as the providers of counsel and support when required, and a similar percentage believed that senior nursing staff fulfil these roles. Of interviewees, 33% said their nursing achievements are never, or rarely, acknowledged. For these RN, management, peers, and nurse unit managers are the preferred personnel to provide appropriate positive feedback. Thus, there is a gap between the expectations and hopes that nurses have for senior management approaches and behaviours and the reality of their daily experience. Overall, the responses portray a culture that underpins and enables both subtle interpersonal interactions that might arise out of necessity given the perceived lack of support from non-hands-on RN and administrators.
... Realizing the goal of more mentally healthy work environments requires true leadership, and true leadership requires courage (Brown, 2018). It is the courage of transformational and servant leaders that promotes and facilitates a positive culture where mental health is supported by proactive measures (Blegen and Severinsson, 2011). Enacting this courageous leadership also requires effective and innovative HRM solutions that push past and challenge outdated notions of what it means to have mental health challenges and how to address the topic. ...
... The task of psychological nursing is that medical workers through a series of good psychological nursing measures, to affect the patient's feelings and understanding, change the patient's psychological state and behavior, as far as possible for patients to create the best psychological ring state beneficial to treatment and rehabilitation, so that they can recover as soon as possible [29]. Psychological nursing is vital in clinical nursing, extending its reach across various clinical departments, including internal medicine, surgery, obstetrics and gynecology, pediatrics, and other critical areas [30]. The scope of psychological nursing extends from the patient's mental state and the disease to the patient's family, community, preventive care, and improving the patient's quality of life. ...
... Nursing management influences care outcomes (Aiken et al., 2016;Wong, Cummings, & Ducharme, 2013), but we found only a few studies concerning directly psychiatric nursing managers. Alloubani, Akhu-Zaheaya, Abdelhafiz, and Almatari (2019) examined psychiatric nursing managers' leadership styles, but Blegen and Severinsson (2011) addressed mental health nursing management and leadership more broadly. Because management is a key component of strategies that aim to reduce containment methods, it is important to identify nursing managers' attitudes towards containment methods. ...
Aims:
This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods.
Background:
Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods.
Methods:
This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n=90) completed the Attitude to Containment Methods Questionnaire (ACMQ). The results were described with statistics and the associations between attitudes and background variables were analyzed using parametric tests.
Results:
Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards pro re nata medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees.
Conclusions:
In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed.
Implications for nursing management:
This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff.
... Gerbing's (1988) twostage modeling approach A positive relationship was found among transformational leadership and psychological wellbeing mediated or partially mediated by the meaning found in work. Blegen and Severinsson (2011) To provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. ...
Despite the promotion of various leadership styles based on leader-follower relationship, individual competencies, competition and goals, calls have been made for a leadership approach that is embedded in the often implicit notion of responsibility. Responsible Leadership (RL) highlights two fields of study: social responsibility and stakeholder leadership to achieve mutually beneficial business goals. RL presents an attractive and important integration of research on leadership and corporate social responsibility and offers the opportunity to provide significant advances in organisational studies. While much has been studied about social responsibility, less is known about the influence of RL on employee outcomes, such as presenteeism, organisational commitment and turnover intentions. Presenteeism is defined as attending work while being ill and unable to work, at least not at full capacity. Presenteeism costed the Australian economy $A34.1 billion (2.7% of the Gross Domestic Product) for 2009-2010 (Medibank, 2011). It is well recognised in both psychological and occupational-hazard studies but needs further exploration in the context of organisational leadership. Presenteeism indicates a substantial impact on employees’ productivity and imposes a significant economic burden both on businesses and national economies. This thesis proposes a structural model and examines the direct influence of RL on employee outcomes, including presenteeism, organisational commitment and turnover intentions. It also examines the mediating roles of both organisational commitment and employee turnover intentions on the relationship between RL and presenteeism. The proposed model was tested using a heterogeneous sample of employees from various Australian industry sectors. A web-based survey was mailed to 3500 employees and 323 responses were collected to confirm 200 complete responses. A total of 123 responses were incomplete and were therefore excluded from the findings, resulting in an overall response rate of 9.2%. Participants responded to scales measuring responsible leadership, presenteeism, organisational commitment and turnover intentions. Eight hypotheses were developed to examine the thesis aims. Structural equation modelling (SEM) was used to test the proposed hypotheses. The results of SEM provided support for eight hypotheses. The significant findings of the study were threefold. First, RL behaviours were negatively and significantly related to both presenteeism and employee turnover intentions in workplaces among Australian employees. The results suggest that when employees perceive their leaders to be responsible, there is greater likelihood that employees will exhibit lower presenteeism and turnover intentions at work. Second, RL was also positively and significantly related to organisational commitment. This result suggest that RL has a significant and positive influence on employees’ emotional attachments to their organisations (affective commitment) and the individual personal values (normative commitment) than their costs of resigning, such as losing attractive benefits or seniority (continuance commitment). Third, the results support the hypotheses that organisational commitment and employee turnover intentions partially mediate the relationship between RL and presenteeism. The results suggest that both organisational commitment and employees’ turnover intentions reduce the total influence of RL on presenteeism. The findings of this thesis provide valuable insights by corroborating and extending theory and research in several ways. First, the study is one of the first reported studies to test the direct and indirect relationship between RL and presenteeism with an Australian sample. Second, it empirically tests an underexplored assumption of RL theory by examining the influence of RL on employee outcomes including organisational commitment, employee turnover intentions and presenteeism. Third, the proposed model in this thesis is one of the first to examine how and why RL influences presenteeism by integrating two mediators, organisational commitment and employee turnover intentions. Fourth, several implications for practice can be highlighted including designing employee training programs to promote RL skills among managers, recognising presenteeism, incorporating organisational strategies to recover losses from presenteeism, and encouraging managers to enhance organisational commitment and reduce employee turnover intentions in organisations. In conclusion, limitations of the study are presented along with recommendations for future research.
Creation Date
... Although transformational nursing leadership has been investigated in Western countries [63,64], there have been many published studies that develop a hierarchal model using SEM to explore the relationships between transformational leadership, job content, work attitudes and general health status. However, the relationships among them still have not been clear defined. ...
The present thesis report research on the role of leadership style related to the quality of nurses' working lives in Taiwanese hospitals. It begins by focusing on the mental health of nursing work forces and questions the applicability of leadership styles employed in different ownership of health care organisations. There is very little literature on this issue and knowledge of how such hospitals function is not clear. The thesis addresses the influences of nursing leadership style at both the individual and organisational levels examining the perception of nurses and developing a research model using Structural Equation Model (SEM). Both the leader's perspective and subordinate's viewpoint were measured. Two studies were conducted which illustrated the perception of leadership style in Taiwanese healthcare settings. The first study was designed as the qualitative study which used in depth interviews with 21 representatives to explore the current organisation status of hospitals and attitudes towards and interpretation of leadership.
Study Two was a quantitative study which was informed by the results of Study One and 651 employees participated in a questionnaire survey. This thesis proposed a model of the relationships among the key variables. Analysis of the data based on this model revealed that transformational leadership style contributed significantly to supervisor support. Supervisor support was an important mediator variable that explained the relationship between transformational leadership and job satisfaction and organisational commitment. In addition, the effects of transformational leadership style on the general health well-being of nurses were buffered by job satisfaction and organisational commitment. Organisational commitment was the strongest factor related to the general health well-being of Taiwanese nurses than job satisfaction. The study highlighted the influences of certain aspects of leadership such as mental health outcomes. Leadership is a complex process and may diffuse throughout an organisation. This thesis makes a useful contribution to the literature on the mental health well-being of nurses and provides a comprehensive background of a Taiwanese approach to nursing leadership research.
... As a leadership style, it has been shown to be compatible with how nurses function in their various clinical settings. For example, in the area of mental health nursing, transformational leadership processes support the collaborative involvement of consumers in care delivery (Cleary, Horsfall, Deacon, & Jackson, 2011) and the development of essential interpersonal skills of nurses working in mental health settings (Blegen & Severinsson, 2011). Studies in nursing have shown transformational leadership to be a style of leadership to support high job satisfaction among nurses, increased organisational commitment, enhanced role clarity, reduced workplace conflict, and lower levels of stress, anxiety and emotional exhaustion among staff (Cummings et al., 2010). ...
Clinical leadership has been identified as crucial to positive patient/client outcomes, across all clinical settings. In the new millennium, transformational leadership has been the dominant leadership style and in more recent times, congruent leadership theory has emerged to explain clinical leadership in nursing. This article discusses these two leadership models and identifies some of the shortcomings of them as models for clinical leadership in nursing. As a way of overcoming some of these limitations, aesthetic leadership is proposed as a style of leadership that is not antithetical to either model and reflects nursing's recognition of the validity of art and aesthetics to nursing generally. Aesthetic leadership is also proposed as a way to identify an expert clinical leader from a less experienced clinical leader, taking a similar approach to the way Benner (1984) has theorised in her staging of novice to expert clinical nurse.
... Although transformational nursing leadership has been investigated in Western countries [63,64], there have been many published studies that develop a hierarchal model using SEM to explore the relationships between transformational leadership, job content, work attitudes and general health status. However, the relationships among them still have not been clear defined. ...
Background
Taiwan’s NHI system is one of the most successful health care models for countries around the globe. However, little research has demonstrated the mental health issues associated with nursing transformational leadership style under the NHI system, especially in the quality of nurses’ working lives in Taiwan. It is important to know the relationship between transformational leadership style and the mental health of nurses, organisational commitment and job satisfaction. The research aimed to understand the influences of nursing transformational leadership style on the quality of nurses’ working lives in Taiwan. The research hypothesis was that transformational leadership styles would have positive influence on the quality of nurses’ working lives.
Methods
This was a cross-sectional quantitative study. Nurses from each type of hospital ownership (private, public and religious) were recruited. Participation was voluntary and signed informed consent was obtained. The inclusion criteria were nurses with at least one year’s work experience in the hospitals. Self-administrated questionnaires were used. A total of 807 participants were contacted and 651 questionnaires were fully completed (response rate 80.7 %). A theory driven model was used to test the research hypotheses using structural equation modelling performed with AMOS 16.0.
Results
Transformational leadership contributes significantly to supervisor support. Workplace support, particularly from the supervisor, is an important mediator variable that explains the relationship between transformational leadership and job satisfaction. Organisational commitment was the strongest factor relevant to the general health well-being in Taiwanese nurses than job satisfaction. The hypothesized positive relationships between transformational leadership and all variables were supported by the data.
Conclusions
Our findings have important consequences for organisational health. Our model demonstrates a complete picture of the work relationships on the quality of nurses’ working lives. The results provided information about the subordinates’ perceptions of transformational nursing leadership styles and mental health outcomes in different hospital settings, as well as identified organisational factors that could improve the quality of nurses’ working lives.
... A literature review on leadership and management in mental health nursing confirms that ethical concerns must be constantly prioritized throughout every level of the organization. 14 Another review on clinical supervision in Finland indicates that supervision for nurses in administrative and leadership positions might help clarify ethical issues, 15 but more research is required to investigate the ethical decision-making process in nursing management. 16 Clearly, there is a need for leadership education and training to support nurse managers in their tasks of enhancing ethical competence, creating an ethical work climate and/or improving ethical practice. ...
Ethical leadership is important for developing ethical healthcare practice. However, there is little research-based knowledge on how to stimulate and educate for ethical leadership.
The aim was to develop and investigate the feasibility of a 6-week web-based, ethical leadership educational programme and learn from participants' experience.
A training programme was developed consisting of (1) a practice part, where the participating middle managers developed and ran an ethics project in their own departments aiming at enhancing the ethical mindfulness of the organizational culture, and (2) a web-based reflection part, including online reflections and coaching while executing the ethics project. Focus group interviews were used to explore the participants' experiences with and the feasibility of the training.
Nine middle managers were recruited from a part-time master's programme in leadership in Oslo, Norway. The research context was the participating leaders' work situation during the 6 weeks of training.
Participation was voluntary, data anonymized and the confidentiality of the participating leaders/students and their institutions maintained. No patient or medical information was involved.
Eight of the nine recruited leaders completed the programme. They evaluated the training programme as efficient and supportive, with the written, situational feedback/coaching as the most important element, enhancing reflection and motivation, counteracting a feeling of loneliness and promoting the execution of change.
The findings seem consistent with the basic assumptions behind the educational design, based partly on e-health research, feedback studies and organizational ethics methodology, partly on theories on workplace learning, reflection, recognition and motivation.
The training programme seems feasible. It should be adjusted according to participants' proposals and tested further in a large-scale study.
© The Author(s) 2015.
... By way of application, Blegen and Severinsson (2011) suggest that the principles and practices recommended for mental health nursing leaders are best framed by transformational models, which emphasise the importance of relationship -implying that leadership is not about the leader alone, but also about the people with whom the leader interacts. Cleary, Horsfall, Deacon and Jackson (2011) similarly advocate for transformational approaches to leadership in the mental health nursing context -but they go further, suggesting this approach is more of an ideal than a reality in settings that are constrained by organisational priorities (see also Box 2). ...
Indigenous Australians have higher levels of mental illness, self-harm, suicide and substance abuse than non-Indigenous Australians, as well as more frequent contact with the criminal justice system. These indices point to the need for strong leadership to support Close the Gap programmes that have now been implemented across Australia. This article considers leadership as a journey of learning for Australian Indigenous leaders. Through the use of story, it is suggested that a situational leadership approach, incorporating the principles of mindfulness, provides the most appropriate framework for Indigenous leaders who work with Indigenous communities. Flexible approaches are needed to meet the needs of diverse Indigenous populations, and address the complex challenges involved, including lateral violence. Such flexibility will enable Indigenous leaders and communities to work together to achieve improvements in the health outcomes, not only for Indigenous Australians, but also for Indigenous populations worldwide.
... The need for strong leadership in complex and challenging health settings is discussed at length in the literature (Blegen & Severinsson, 2011;Cleary, Horsfall, Deacon, & Jackson, 2011). For example, some commentators argue that responsible and ethical leadership in nursing enables the more effective delivery of health care (Wong & Giallonardo, 2013). ...
... The nurse leader must have the capacity to lead diverse groups, obtain multiple points of view, and stimulate creative and shared problem solving. The nurse leader must also collaborate and partner with other community leaders and members of other disciplines and agencies in the service of meeting actual or anticipated health needs (Blegen & Severinsson, 2011;Cummings et al., 2010;Pieterse, van Knippenberg, Schippers, & Stam, 2010;Smith & Manfredo, 2011). ...
Rural health disparities are due in part to access barriers to health care providers. Nursing education has been extended into rural areas, yet a limited rural research and practice literature informs the content and delivery of these educational programs. The University Of Virginia School of Nursing through a grant from the Health Resources and Services Administration developed the Nursing Leadership in Rural Health Care (NLRHC) Program. The transformational nursing leadership in rural health care (TNLRHC) model guided the development of NLRHC program content and teaching methods. This article describes the TNLRHC model and how it has steered the integration of rural content into advanced practice nursing (APN) education. The capacity of the TNLRHC model for promoting innovation in APN education is described. Recommendations regarding the future development of APN education are presented.
Copyright © 2014 Elsevier Inc. All rights reserved.
... The nurse leader must have the capacity to lead diverse groups, obtain multiple points of view, and stimulate creative and shared problem solving. The nurse leader must also collaborate and partner with other community leaders and members of other disciplines and agencies in the service of meeting actual or anticipated health needs (Blegen & Severinsson, 2011;Cummings et al., 2010;Pieterse, van Knippenberg, Schippers, & Stam, 2010;Smith & Manfredo, 2011). ...
Background: The need for nursing leaders in rural health care is critical as the nursing workforce adjusts to: severe shortages, growing health disparities, increasing globalization, widespread need for disaster preparedness, and continued shrinking of the healthcare budget. This presentation reports on an advanced nursing education grant preparing leaders in public health nursing, health systems management, and psychiatric mental health nursing with expertise in rural health care to address preventable health problems, improve functioning for those with chronic illness, and to meet the needs of disadvantaged rural populations. Description: Transformational leaders have a clear vision and exert influence as role models who are willing to take risks and are responsive to the needs of the community. Our model for transformational leadership was expanded to address rural healthcare systems in the context of rural population and community characteristics. By recruiting students who are practicing in rural areas and by delivering essential curriculum components electronically, the program promotes education and retention of healthcare resources in rural places. Lessons Learned: It is important to infuse MSN and DNP curriculum with transformational leadership principles, strengthen existing distance-based education modalities, and emphasize rural healthcare concepts. MSN and DNP graduates empowered with transformational skills are prepared to assume leadership in rural communities and to become change agents, influencing the nursing workforce, other disciplines, and communities. Recommendations: Our goal is consistent with the recent report on the future of nursing, which addresses the compelling need for well-trained nursing leaders who practice at the highest level of their education.
... The nurse leader must have the capacity to lead diverse groups, obtain multiple points of view, and stimulate creative and shared problem solving. The nurse leader must also collaborate and partner with other community leaders and members of other disciplines and agencies in the service of meeting actual or anticipated health needs (Blegen & Severinsson, 2011;Cummings et al., 2010;Pieterse, van Knippenberg, Schippers, & Stam, 2010;Smith & Manfredo, 2011). ...
Rural health disparities are due in part to access barriers to healthcare providers. Nursing education has been extended into rural areas, yet a limited rural research and practice literature informs the content and delivery of these educational programs. The University Of Virginia School of Nursing (UVASON) through a grant from the Health Resources and Services Administration developed the Nursing Leadership in Rural Health Care Program (NLRHC). The Transformational Nursing Leadership in Rural Health Care (TNLRHC) model guided the development of NLRHC program content and teaching methods. This paper describes the TNLRHC model and how it has steered the integration of rural content into advanced practice nursing (APN) education. The capacity of the TNLRHC model for promoting innovation in APN education is described. Recommendations regarding the future development of APN education are presented.
... Leadership and management are usually subjected to discrete treatment in policy and in the literature, with leaders defined as having strategic 'visionary' roles and managers as having operational responsibilities (Hancock et al. 2005, Cummings et al. 2010, Blegen & Severinsson 2011. The clinical leadership role of SCNs in Scotland is distinct from that of managers operationally and strategically (Scottish Executive Health Department 2006, Scottish Government Health Department 2008b. ...
Person-centred, safe and effective care is at the heart of delivering the fundamentals of care. Patients, the public and the nursing profession want high quality of care to be assured. Today there are many challenges to achieving this ambition reliably and consistently. This article reports a nursing team’s experience of implementing ‘care and comfort’ rounds over time. The means of implementation is detailed plus the evidence to support the quality improvement achieved. The evidence includes measures of incidence of slips trip and falls, call buzzer use and patient experience data. The results show that the implementation of care and comfort rounds led to proactive rather than reactive nursing care being delivered; the number of patient falls was reduced; the use of call buzzers was reduced; patient experience was enhanced; a more controlled environment was provided for patients and staff satisfaction in care delivery was increased.
... In the context of challenging situations, our results suggest that knowledge about patients, not professional knowledge, is what counts. Psychiatric nurses would be expected to take on the role of nursing leadership in psychiatric care (14,15), but our results suggests this was not the case. Psychiatric nurses were to some extent acknowledged as having positional power as the ones responsible for structuring care, and they might possess some referential power as role models, but, in relation to nursing assistants, they thoroughly miss out on acquiring and exercising power of expertise through the utilisation and sharing of nursing knowledge. ...
Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession-specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision-making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first-hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person-centred care.
... Leadership and management are usually subjected to discrete treatment in policy and in the literature, with leaders defined as having strategic 'visionary' roles and managers as having operational responsibilities (Hancock et al. 2005, Cummings et al. 2010, Blegen & Severinsson 2011. The clinical leadership role of SCNs in Scotland is distinct from that of managers operationally and strategically (Scottish Executive Health Department 2006, Scottish Government Health Department 2008b. ...
... Leadership and management are usually subjected to discrete treatment in policy and in the literature, with leaders defined as having strategic 'visionary' roles and managers as having operational responsibilities (Hancock et al. 2005, Cummings et al. 2010, Blegen & Severinsson 2011. The clinical leadership role of SCNs in Scotland is distinct from that of managers operationally and strategically (Scottish Executive Health Department 2006, Scottish Government Health Department 2008b. ...
Aims: To investigate the experience and views of Senior Charge Nurses (SCN) in relation to the implementation of a national clinical leadership policy
Background: The role of the Senior Charge Nurse (SCN) in providing clinical leadership is evolving. However, recent evidence suggests that research is needed to inform the development of leadership and quality improvement and to connect them.
Methods: Data were collected using an electronic survey to all SCN in one locality and semi-structured interviews with a sub-sample of respondents. Fifty (54%) SCNs responded to the survey and, nine SCNs were interviewed.
Results: SCN reported mainly positive perceptions of clinical leadership, clinical team performance and improvement of care delivery for patients following the leadership programme implementation. Themes related to confidence, quality improvement and team performance were generated.
Conclusion: Leading Better Care was reported to enhance SCN clinical leadership with some development needed to link the detail of change management with the wider strategic direction.
Implications for nursing management: Role clarity is important for SCNs as it guided and informed SCN activity and, what they expected of others. Quality improvement could be challenging and may need further support if it is to form the cornerstone of enhancing the patient experience.
... Despite the absence of any discrete pathological process, many psychiatric practitioners describe psychiatric drugs as 'medicine', 27 stretching the accepted dictionary definition of 'a drug or other preparation used for the treatment or prevention of disease (per se)'. Psychiatric traditionalists may express displeasure, but the scientific facts are clear: there is no 'disease' (i.e. ...
The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of 'mental illness' or 'mental disease', which can only be addressed by 'treatment' with psychiatric drugs. Psychiatric drugs are used only to control 'patient' behaviour and do not 'treat' any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with 'serious' forms of 'mental illness' can 'recover', without psychiatric drugs, has been marginalized by drug-focused research, much of this funded by the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary 'mental health' policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the 'mental health' of the people in their care.
Purpose
Developing nursing leadership has become a key policy priority to achieve universal health coverage. This study aims to explore the current status, developing trends and research frontiers in the field of nursing leadership.
Design/methodology/approach
In total, 1,137 articles and reviews on nursing leadership from 1985 to 2022 were retrieved from the Web of Science Core Collection database. Trends of publications, journals, countries/regions, institutions, documents and keywords were visualized and analyzed using Microsoft Excel and CiteSpace software.
Findings
Nursing leadership research showed an overall increase in number despite slight fluctuations in annual publications. The USA was the leading country in nursing leadership research, and the University of Alberta was the most productive institution. The Journal of Nursing Management was the most widely published journal that focused on nursing leadership, followed by the Journal of Nursing Administration . Keyword analysis showed that the main research hotspots of nursing leadership are improvement, practice and impact of nursing leadership.
Originality/value
This article summarizes the current state and frontiers of nursing leadership for researchers, managers and policy makers, as well as follow-up, development and implementation of nursing leadership. More research is needed that focuses on the improvement, practice and impact of nursing leadership, which are cyclical, complementary and mutually reinforcing. Longitudinal and intervention studies of nursing leadership, especially on patient prognosis, are also particularly needed.
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.
Modelos de gestão da Enfermagem em Saúde. Método: uma Revisão de Escopo realizada no MEDLINEe CINHAL via PubMed e EBSCO, respectivamente, nas Teses e DissertaçõesCatálogo da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordenação deAperfeiçoamento de Pessoal de Nível Superior, CAPES), na Biblioteca Digital Brasileira de Tesese Dissertações (Biblioteca Digital Brasileira de Teses e Dissertações, BDTD) e no VirtualBiblioteca em Saúde (Biblioteca Virtual em Saúde, BVS). Resultados: a amostra final foi composta poroito estudos e, com base na análise, elaborou-se uma síntese qualitativa, dando origem aduas categorias: modelos de gestão que abordam o tradicional, o normativo e o prescritivo.teorias administrativas; e modelos de gestão que abordam inovação, participação eestilos de gestão centrados nas pessoas. Conclusão: os modelos identificados foram abordadosde uma gestão voltada para as teorias administrativas tradicionais e autocráticas, que privilegiamatividades administrativas e burocráticas, bem como uma liderança autoritária. no entantoconstatou-se que as transformações impulsionadas pela Reforma Psiquiátrica no Brasil e no mundoe o redirecionamento da atenção à saúde mental, com políticas de humanização e valorização do usuário,acelerou a transição desses modelos para uma gestão mais participativa, com foco no cuidado.Palavras-chave: Saúde mental; Gestão de saúde; Enfermagem; Enfermagem Psiquiá
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This article discusses the important concept of justice, one of the four ethical principles developed by Beauchamp and Childress (2019) . Gillon (1994) divided justice into three categories: distributive justice, rights-based justice and legal justice. Justice also forms an important part of British values regarding democracy, the rule of law, individual liberty, mutual respect and tolerance of those of different faiths and beliefs. Following an introduction defining what is meant by the term ‘justice’, the relevant parts of the Nursing Midwifery Council code ( NMC, 2018a ) will be identified and presented. There will then follow a discussion on the three categories of justice as laid out by Gillon (1994) and how justice fits in with British values. Finally, this discussion will point towards how justice can be achieved for the patients in your care and the colleagues you work alongside.
Objective: the objective of this study was to map the scientific evidence available about Mental
Health Nursing management models. Method: a Scoping Review conducted in the MEDLINE and
CINHAL databases via PubMed and EBSCO, respectively, in the Theses and Dissertations Catalog of
the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento
de Pessoal de Nível Superior, CAPES), in the Brazilian Digital Library of Theses and Dissertations
(Biblioteca Digital Brasileira de Teses e Dissertações, BDTD) and in the Virtual Library in
Health (Biblioteca Virtual em Saúde, BVS). Results: the final sample consisted of eight studies
and, based on the analysis, a qualitative synthesis was prepared, giving rise to two categories:
management models approaching traditional, normative and prescriptive administrative
theories; and management models approaching innovative, participatory and people-centered
management styles. Conclusion: the models identified were approached from a management
aimed at traditional and autocratic administrative theories, which privilege administrative and
bureaucratic activities, as well as an authoritarian leadership. However, it was found that the
transformations driven by the Psychiatric Reform in Brazil and in the world and the retargeting of
mental health care, with humanization and user appreciation policies, accelerated the transition
of these models to a more participatory management, with a focus on care.
Keywords: Mental Health; Health Management; Nursing; Psychiatric Nursing
Objective
To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile.
Method
Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterisation variables.
Results
A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health.
Conclusions
Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.
Objective:
To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile.
Method:
Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables.
Results:
A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health.
Conclusions:
Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.
This article critically compares transformational leadership and ethical leadership. It discusses the differences, similarities, weaknesses and strengths of the two styles. The importance of strong leadership in meeting an array of challenges and changes occurring in the NHS is highlighted. The article explores the influence of transformational and ethical leadership styles on the role of nurse leaders, particularly those in mental health, and also the influence of emotional intelligence in leadership. Over the last five decades, there has been a transformation in mental health, but more needs to be done to ensure everyone can access high-quality care when they need it. Transformational leadership remains important in such an ever-changing healthcare environment, but ethical behaviour should be its base.
Context:
In Adult Mental Health Inpatient Units, it is not unexpected that leadership of Associate Nurse Unit Managers contributes to successful implementation of smoke-free policies.
Aim:
In light of challenges facing mental health nursing, and limited research describing their leadership and the role it plays in addressing smoke-free policy implementation, the aim of this study is to explore Associate Nurse Unit Managers perspectives' regarding the implementation of smoke-free policies, which were introduced on 1 July, 2015.
Design, setting, participants:
Individual in-depth semi-structured interviews were undertaken six months post the implementation of smoke-free policies. In this qualitative descriptive study, six Associate Nurse Unit Managers working in a Victorian public Adult Mental Health Inpatient Unit, were asked eight questions which targeted leadership and the implementation and enforcement of smoke-free policies. Associate Nurse Unit Managers provide leadership and role modeling for staff and they are responsible for setting the standards that govern the behavior of nurses within their team. All participants interviewed believed that they were leaders in the workplace.
Main outcomes:
Education and consistency were identified as crucial for smoke-free policies to be successful. Participants acknowledged that the availability of therapeutic interventions, staff resources and the accessibility of nicotine replacement therapy were crucial to assist consumers to remain smoke-free while on the unit.
Conclusion:
The findings from this research may help to improve the understanding of the practical challenges that Associate Nurse Unit Manager's face in the implementation of smoke-free policies with implications for policies, nursing practice, education and research.
Patients in psychiatric care experience a need for and expect to develop interpersonal relationships with professional caregivers and to be respected and listened to. Despite demands for care to be person-centred and recovery-oriented, patients experience that psychiatric inpatient care fails to meet their expectations. Nursing research suggest that nurses aspire to engage with and meet the needs of patients, but that the strenuous reality of inpatient care prevents them from doing so. Exploring the content and context of psychiatric inpatient care from the perspective of professional caregivers might provide valuable insights regarding what caregivers do, and more importantly it can aid in understanding why they do what they do.
This thesis aimed to explore the content and context of adult psychiatric inpatient care from the perspective of professional caregivers. This was achieved by clarifying the concept of person-centred care in the context of inpatient psychiatry, describing staff members’ reasoning on their choice of action and perceptions of interprofessional collaboration in challenging situations in inpatient psychiatric care settings, and exploring nurses’ experiences of good nursing practice in the specific context of inpatient psychiatry. A systematic review of the literature identified 34 scholarly papers that were analysed using evolutionary concept analysis. Focus group interviews were conducted with 26 professional caregivers and analysed using qualitative content analysis. Individual qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and analysed using an interpretive descriptive approach to qualitative analysis.
Reviewing the literature on person-centred care in inpatient psychiatry clarified how person-centred care is expected to result in quality care when interpersonal relationships are used to promote recovery. Professional caregivers’ reasoning on choice of action described different concerns in caregiver-patient interaction resulting in a focus on either meeting patients’ individual needs or solving staff members’ own problems. Describing professional caregivers’ perceptions of interprofessional collaboration suggested that they are being constrained by difficulties in collaborating with each other and a lack of interaction with patients. Exploring nurses’ experiences of good nursing practice revealed how circumstances in the clinical setting affect nurses’ ability to work through relationships.
It is argued that these findings describe the workings of two opposing forces in psychiatric inpatient care. The concept of caring as a process forms the basis for discussing the content of care as a moral endeavour in which nurses strive to do good. The concept of demoralizing organizational processes is used to discuss the context of care as demoralizing and allowing for immoral actions.
The main conclusions to be drawn are that, from a nursing perspective, nurses in psychiatric inpatient care need to focus on patients’ experiences and needs. For this they need sufficient resources and time to be present and develop relationships with patients.
Nurses in psychiatric inpatient care also need to take personal responsibility for their professional practice. Attempts to transform psychiatric care in a person-centred direction must consider all of these aspects and their interrelatedness. Further research on psychiatric inpatient care is needed to understand more about how the content of care relates to the context of care.
Accessible summary
Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view.
Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly.
Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care.
In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries.
Abstract
The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi‐structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries.
The strength of mental health nursing and its potential contribution to improved consumer outcomes depends upon strong and clearly articulated leadership. However, studies of leadership have tended to focus on nurses holding senior positions rather than exploring the leadership embedded in clinical work. A qualitative exploratory study was undertaken with identified mental health nurse leaders in one Australian state, in order to explore their experiences and what they found to be most meaningful in their work. This article reports the findings from this study. The data was analysed thematically to yield insights significant to mental health nursing and identity. The findings suggest these leaders find intrinsic rewards in the role; aspire to making authentic connections with consumers; appreciate the position of trust that they hold in bearing witness to individuals' distress; and use creative means to solve problems and achieve therapeutic outcomes. Sharing these themes builds knowledge on values that are embedded in mental health nursing practice and offers scope for integrating leadership attributes into the education, supervision and development of all mental health nurses. These findings also reveal the complexity of mental health nursing as a profession and the difficulties that might be encountered in attempts to define it in terms of its component tasks and functions.
Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.
The aim of the present study was to illuminate what the mental health nursing (MHN) leader needs in order to develop her/his leadership role.
MHN leadership has tended to focus on the nature of the care provided rather than the development of the role.
This literature review (1998-2008) examines papers from the past decade by means of a synthesis of empirical studies.
Three themes emerged: * clarifying role expectations and areas for development at the same time as increasing the influence on patients with mental health problems; * using evidence-based practice to implement improvements and organizational change in mental health; and * employing communication skills as well as supporting, nurturing and empowering others.
This review provided evidence that the MHN leader needs various skills in order to make enlightened changes that can meet the needs of both patients and staff.
The MHN leader needs to explore the range of tasks involved in leadership in order to define role expectations and areas for development. These areas include enhancing patient care; reliance on team work; and attending to the personal life of the staff; increasing collaboration within the organization as well as with the community; utilizing the best available evidence; and communicating in order to improve the organization.
The Australian Federal Government health agenda is advocating an extension of public health principles across all levels of the health sector. Since mental health nurses have long been proponents of public health and health promoting behaviours, an opportunity exists for this specialty of nursing to extend their influence and contribution within health. Solution focused nursing (SFN), a model that emerged from mental health practice, offers a framework to assist mental health nurses and leaders to more clearly practise public health principles within nursing and articulate that practice - for it is in the articulation of practice that nurses and nursing is made visible and valued. This paper aims to expand on and reiterate the SFN model, showing how it connects to public health principles and develops the mental health nurse's role - particularly in those clinical areas that require more than medical management and illness stabilization.
The purpose of this study was to determine the association between leadership styles of leaders of mental health treatment teams and consumers' ratings of satisfaction with the program and their quality of life.
A multifactor model has distinguished three factors relevant to leadership of mental health teams: transformational leadership, in which a leader's primary goal is to lead the team to evolving better programs; transactional leadership, in which the leader strives to maintain effective programs through feedback and reinforcement; and laissez-faire leadership, an ineffective, hands-off leadership style. Research has shown transformational leadership to be positively associated with measures of the team's functioning, but the effects of leadership style on consumers is not well known. A total of 143 leaders and 473 subordinates from 31 clinical teams rated the leadership style of the team leader. In addition, 184 consumers served by these teams rated their satisfaction with the treatment program and their quality of life.
Consumers' satisfaction and quality of life were inversely associated with laissez-faire approaches to leadership and positively associated with both transformational and transactional leadership. Moreover, leaders' and subordinates' ratings of team leadership accounted for independent variance in satisfaction ratings-up to 40 percent of the total variance.
Leadership seems to be an important variable for understanding a team's impact on its consumers.
The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.
Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.
A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.
An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.
Leadership in organizations is important in shaping workers' perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices. Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. Studies have shown that in youth and family service organizations, mental health providers' attitudes toward adopting an evidence-based practice are associated with organizational context and individual provider differences. The purpose of this study was to expand these findings by examining the association between leadership and mental health providers' attitudes toward adopting evidence-based practice.
Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers' characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors' leadership behaviors. Zero-order correlations and multilevel regression analyses were conducted that controlled for effects of service providers' characteristics.
Both transformational and transactional leadership were positively associated with providers' having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers' perception of difference between the providers' current practice and evidence-based practice.
Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices.
Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with 'serious and enduring mental illness'. At the same time research in the LISA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses ave being encouraged to consider the value Of biomedical explanations of serious illness, such as schizophrenia, ann to accommodate these theories and models in the practice of nursing. This paper will examine the challenge of biomedical approach for the continued development of psychiatric nursing needs to develop further its own 'proper focus', if it is to survive as a key player in the health care field of the 21st century.
Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with ‘serious and enduring mental illness’. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accommodate these theories and models in the practice of nursing. This paper will examine the challenge of biomedical approach for the continued development of psychiatric nursing needs to develop further its own ‘proper focus’, if it is to survive as a key player in the health care field of the 21st century.
Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with ‘serious and enduring mental illness’. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accomodate these theories and models in the practice of nursing. This paper will examine the challenge of the biomedical approach for the continued development of psychiatric nursing theory and practice. It is proposed that psychiatric nursing needs to develop further its own ‘proper focus’, if it is to survive as a key player in the health care field of the 21st century.
The literature identifies that mental health services and those individuals working within them have the potential to facilitate inclusion for their client group, because of their power to initiate potential inclusive opportunities. However, evidence suggests that service users themselves perceive many aspects of mental health services as contributing to the problem of exclusion. This has been attributed to an accumulation of messages, attitudes and disempowering practices that have emanated from mental health care providers over a long period. This study employs focus group methodology in a residential rehabilitation unit in an industrial city in the UK. Discussion of the findings highlight how, in spite of alleged inclusive practices, the attitudes held by members of the unit team could impede the clients’ opportunities to become socially included, as a result of defensive practice, paternalistic attitudes, expectations of the local community upon the team and the stagnant views that are embedded in the culture of mental health services. While mental health nurses may see themselves as promoting inclusion, the reality may be quite different.
The national movement to transform the health care delivery systems must include a focus on mental health treatment. To address similar deficits across other practice domains, the Clinical Nurse Leader (CNL) role has been created. The CNL is a master's degree that prepares a nurse to use a systems perspective to improve outcomes for a cohort of patient, deliver care based on best practices, and coordinate care in a multidisciplinary team. Applying the CNL role to mental health care could help psychiatric mental health nursing be at the forefront in the transformation of mental health care delivery.
The aim of this paper is to critically review the different approaches used to manage mental health care. Underpinning this aim is a literature review carried out using systematic approaches that clarifies how various frameworks are used and experienced. Responding consciously to policy, politics, and economic change there are a number of approaches that coexist without an explicit view as to whether they are useful tools kit or a phenomena that are, in-fact, less positive. Nevertheless experience to date suggests that clear lessons can be learned before practices become more widely adopted across health communities.
One of the most important evolutionary forces in transforming health care is the shift from management to leadership in nursing. The transformational leader will be the catalyst for expanding a holistic perspective, empowering nursing personnel at all levels and maximizing use of technology in the movement beyond even patient-centered health care to patient-directed health outcomes.
Current mental health practice and legislation is influenced significantly by the ill-defined concept of serious mental illness (SMI). Although the concept of SMI originally appeared to include a consideration of a range of forms of mental illness, including dementias, by custom and practice the term has come to mean, often, only people with a psychotic diagnosis. This paper reviews the influence of the term SMI, considering the way older people, younger people and other subgroups within the 'adult' population have been marginalized by the narrow definition of the concept. The paper concludes with a consideration of some of the ethical implications of mental health nurses focusing on an ill-defined 'illness' grouping, and the impact that such a narrow focus might have on the ambition to establish 'health for all by the year 2000'.
Transformational values and competencies will become critically important by the year 2001 if we are to achieve a health system that fosters community well-being and basic care for all, financed through a combined public-private partnership that is cost effective and uses treatments that unite body, mind and spirit. This article will focus on the use of transformational leadership as a strategy to move health-care organizations beyond traditional values and approaches by building upon the core values of total quality management (TQM). Learning organizations will emerge and finally world-class organizations will evolve, combining the characteristics of total quality and learning organizations, and more. A world-class organization can be described as being the best in its class or better than its competitors in the community, state, nation or world.
The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena.
In developing the quality of health care attention has recently focused on the professional progress of nurses. Simultaneously, empowerment ideology has been increasingly adopted as the conceptual framework for the development of nursing. The empowerment process has usually been described from an organizational starting point. In the present study empowerment is approached starting from the individual nurse's point of view.
This study aims to explore (a) what an empowered nurse is like, (b) how he/she performs his/her functions, (c) what promotes empowerment, and (d) what prevents empowerment.
The material was collected by interviewing 30 nurses who had participated in a career advancement project at a university hospital in Finland. The data were analysed by qualitative content analysis.
Five categories were discerned: moral principles, personal integrity, expertise, future orientation and sociability. These represented the performance and the qualities of an empowered nurse, as well as the promoting and preventing factors.
Empowerment is a process steered by personal values and endeavours as well as by environmental factors. An empowered nurse possesses those qualities which make possible high self-esteem and successful professional performance and progress.
The therapeutic relationship is a concept held by many to be fundamental to the identity of mental health nurses. While the therapeutic relationship was given formal expression in nursing theory in the middle of the last century, its origins can be traced to attendants' interpersonal practices in the asylum era. The dominance of medical understandings of mental distress, and the working-class status of asylum attendants, prevented the development of an account of mental health nursing based on attendants' relationships with asylum inmates. It was left to Peplau and other nursing theorists to describe mental health nursing as a therapeutic relationship in the 1940s and later. Some distinctive features of colonial life in New Zealand suggest that the ideal of the attendant as the embodiment of bourgeoisie values seems particularly unlikely to have been realized in the New Zealand context. However, New Zealand literature from the 20th century shows that the therapeutic relationship, as part of a general development of a therapeutic discourse, came to assume a central place in conceptualizations of mental health nursing. While the therapeutic relationship is not by itself a sufficient basis for professional continuity, it continues to play a fundamental role in mental health nurses' professional identity. The way in which the therapeutic relationship is articulated in the future will determine the meaning of the therapeutic relationship for future generations of mental health nurses.
To identify the attributes of effective clinical nurse leaders.
A grounded theory research approach was adopted, using two research techniques: observation and interview.
The literature review revealed that the role of the clinical nurse leader was ill-defined and addressed only in sparse, opinion-based literature. Novel outcomes of the research included: Identifying five attributes of effective clinical nurse leaders--highlighting, respecting, influencing, creativity and supporting. Distinguishing five typologies of effective clinical nurse leaders--discoverer, valuer, enabler, shaper and modifier. Elucidating factors that constrain and facilitate the development of effective clinical nurse leadership.
The results imply that to enhance clinical nursing, leadership factors that enable and constrain clinical nursing leadership have to be identified and acted upon by individuals and those who they report to professionally.
The nurse-patient relationship has traditionally been viewed as the essence of nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in nursing practice. Findings from a phenomenological study of individuals hospitalized with a depressive illness found that a therapeutic relationship did not come instinctively to the mental health nurses, and that there was a dichotomy between the close relationship expected by patients and the distant relationship provided by nurses. It is unclear whether nurses' distancing behaviour was as a result of the participant's depressive illness, a normal part of nursing practice, or whether other features such as nurses' workloads were an influencing factor. Further research is required to explore this issue.
Historical influences still permeate contemporary nursing practise. These are mirrored in organizational philosophies, transactional and autocratic leadership styles and disempowered staff. Whilst there is disparity amongst the theorists' definitions of leadership, there is consensus pertaining to the attributes necessary to realize effective leadership. Transformational leadership is heralded as new criterion for nurse managers, and can be achieved through training, education and professional development in key leadership competencies. To achieve a chain reaction, charismatic transformational leaders espouse intellectual stimulation and individual consideration to empower staff and enhance patient care. Nurse managers that develop and foster transformational leadership can surmount oppressive traditions and confidently navigate a complex and rapidly changing health care environment.
To investigate the relationship between nurse executive leadership and organizational commitment among nurses in acute care hospitals.
A key challenge for organizations is to maximize the contributions of all workers by cultivating their commitment. Nurse leaders are in a position to influence organizational commitment among nurses.
The theoretical constructs underlying this study are the transformational leadership theory and the Etzioni's organizational theory. A cross-sectional, field survey of nurse executives, nurse managers, and staff nurses was conducted to assess nurse executive transformational and transactional leadership and their relationship to organizational commitment. Hypotheses were tested using correlational analysis, and univariate statistics were used to describe the sample.
An inverse relationship between nurse executive transformational and transactional leadership and alienative (highly negative) organizational commitment was statistically significant. A positive association was demonstrated between nurse executive leadership and nurse manager leadership.
This study supports the effect of nurse executive leadership on nurse manager leadership and on organizational commitment among nurses despite role distance. To the extent that transformational leadership is present, alienative organizational commitment is reduced. This relationship shows the importance of nurse executive leadership in organizational involvement among nurses in the dynamic context of contemporary hospital settings.
Knowledge about the practice and roles of mental health nurses in New Zealand is currently limited. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for research that reflects the perspective of users. In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses.
The assessment and management of 'risk' has become a focal aspect of contemporary mental health practice. Given their proximal relationship with service users, nurses most often represent the 'front line' of risk management, typically expressed in hospital settings through the bureaucratic process of 'observation'. Much of the available 'evidence' is highly critical of this practice and service user researchers, in particular, have repeatedly called for alternatives. This paper reviews the historical and inter-professional dimensions of the practice of observation, contrasting this with mental health nursing's search over the past two decades, at least within the UK, for professional autonomy. Contemporary mental health nursing is trapped in an anachronistic relationship with psychiatric medicine. If nursing is to prosper, nurses must address the complex issues underlying this inter-professional relationship. The authors describe the development of 'bridging'--a radical alternative to observation practice, which represents a means of managing 'risk' and a way that nurses might develop their interpersonal relationships with people deemed to be at risk, thereby asserting the power of 'caring'.
It is perhaps conventional wisdom that the therapeutic relationship is a cornerstone of psychiatric nursing. It is almost a sine qua non. However, while its importance may be widely recognized, it is notoriously undefined and even those who profess to practise or utilize it, or those who advocate it most strongly, have difficulty in saying exactly what it is. This report details a study carried out with six experienced psychiatric nurses to explore and describe perceptions and understandings of pivotal moments within therapeutic relationships. The nurses were asked, in a series of one-to-one interviews, to consider relationships with clients that they would themselves describe as therapeutic and meditate on those moments at which everything seemed to change and the relationship became qualitatively different. Among the factors the nurses reported as being significant were empathy, uniqueness, meaning and purpose, and appropriate self-disclosure (although many of those terms may require clarification). This paper will consider the implications of these and others for nursing practice and the identity of psychiatric nursing practice.
A structured clinical leadership program was developed to assist nurses working in a metropolitan mental health service to develop and consolidate clinical leadership skills. The Nurses' Self-Concept Questionnaire (NSCO) was used to elicit responses from participants prior to commencement of the leadership program and again at completion. Findings indicate that the program was considered useful and its benefits were carried over into the workplace via the sharing of information. The self-directed nature of this program was found to be an effective way for clinical nurses to undertake continued professional development within the exigencies of clinical practice.
This paper reports a study illuminating the factors that either facilitate or constrain the ability of community psychiatric nurses, in their role as care co-ordinators, to meet service users' and carers' needs.
The Care Programme Approach is the key policy underpinning community-focused mental health services in England, but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the Care Programme Approach and is most often held by community psychiatric nurses, but there has been little research into how this role is performed or how it affects the work of community psychiatric nurses and their ability to meet the needs of service users.
A multiple case study of seven sectorised community mental health teams was employed over 2 years using predominantly qualitative methods including participant observation, semi-structured interviews and document review. The data were collected in one National Health Service trust in south England between 1999 and 2001.
Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, produced 'limited nursing', whereby community psychiatric nurses were unable to provide evidence-based psychosocial interventions that are recognized to reduce relapse amongst people with severe mental illness.
The role of the Care Programme Approach care co-ordinator was not designed to support the provision of psychosocial interventions. Consequently, community psychiatric nurses in the co-ordinator role are faced with competing demands and are unable to provide the range of structured, evidence-based interventions required. This may partially account for the increased inpatient bed use associated with the Care Programme Approach.
The aim was to explore nursing leadership regarding what nurse managers and subordinates see as important and to explore subordinates' opinions of their nurse manager's performance in reality. Background The manager's style can be fundamental for subordinates' acceptance of change and in motivating them to achieve stated visions and goals and high quality of care.
Nurse managers (n=77) and 10 of each included nurse manager's subordinates received a questionnaire to assess 'preferred' leadership behaviour in three dimensions: change, production and employee/relation orientations. The same questionnaire was used to assess subordinates' opinions of their manager's leadership behaviour.
There are statistically significant differences in opinions of preferred leadership between managers and subordinates, especially related to production and relation orientation. The subordinates' perception of real leadership behaviour has lower mean values than their preferred leadership behaviour in all three dimensions.
Subordinates prefer managers with more clearly expressed leadership behaviour than managers themselves prefer and demonstrate.
The purpose of this review was to describe findings of a systematic review of studies that examine the relationship between nursing leadership and patient outcomes.
With recent attention directed to the creation of safer practice environments for patients, nursing leadership is called on to advance this agenda within organizations. However, surprisingly little is known about the actual association between nursing leadership and patient outcomes.
Published English-only research articles that examined formal nursing leadership and patient outcomes were selected from computerized databases and manual searches. Data extraction and methodological quality assessment were completed for the final seven quantitative research articles.
Evidence of significant associations between positive leadership behaviours, styles or practices and increased patient satisfaction and reduced adverse events were found. Findings relating leadership to patient mortality rates were inconclusive.
The findings of this review suggest that an emphasis on developing transformational nursing leadership is an important organizational strategy to improve patient outcomes.
Consumer and carer participation in mental health delivery is now enshrined in Australian Government policy. However, strategies assisting in implementing this vision have not been explored. Nurses are crucial to the mental health workforce, both in numbers and by virtue of the therapeutic relationship. The willingness of nurses to encourage consumer and carer participation is therefore essential for implementation of this policy. This article presents part 1 of the findings of a qualitative study exploring nurses' opinions regarding consumer and carer participation. Data were analyzed using a content-analysis approach, assisted by the software package NVivo. The themes explicated were as follows: Consumer and carer participation-a help or a hindrance? Encouragement-an important role for nurses; and communication-a gift of nursing. These findings highlight the unique and important role nurses can play in encouraging participation and explore some of the issues involved if that role is to become a reality.
Emotional intelligence (EI) has enjoyed growing attention from researchers, educationalists and the public. Arguably, disagreement over the exact nature of EI fuelled by a low level of widely accepted empirical data has stalled its wider application into some areas of professional training. While enjoying significant popularity in areas such as business and leadership, EI remains largely absent from the curriculum of nursing. This paper argues that EI forms the very cornerstone upon which sits desirable mental health nursing abilities as identified by users and recent professional reviews. While distance education and e-learning play an increasingly significant role in nurse education, the enhancement of EI occurs primarily through a socialization process necessitating a 'repackaging' of the nursing curriculum. This paper also proposes that through using service user needs and recent professional reviews as a source for learning outcomes an outline of this 'repacking' can be achieved.
The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.
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