Acute and inpatient mental health care largely receives a negative press. These environments are prominently staffed by mental health/psychiatric nurses. The debate about what mental health nurses are, and do, has been around since their inception. Indeed, the service user literature often questions what nurses do, particularly in inpatient settings.

This recent review by Delaney and Johnson aimed to synthesise nurses view of their own work.

Methods

A meta-synthesis (using Cooper’s five stages) of qualitative papers published between 2000 and 2011 was undertaken.

Although the description of their methods was a little dubious, particularly the keywords they used for their search, 800 relevant papers were found and reduced down to the 16 included studies.

Results

No quality assessment was undertaken of the 16 qualitative studies included in the review.

3 themes were identified:

1. Nurse’s work seemed to focus on engagement, maintaining safety and educational interventions leading to empowerment of service users
2. Conditions needed for nurses to work effectively included a cohesive team and self-direction in their role
3. Difficulties encounter by nurses included multiple responsibilities, milieu management, low visibility work and scarce support

Conclusions

The authors concluded:

Inpatient psychiatric nursing is in one stroke theoretically messy, highly practical, and clinically sophisticated. As the majority of nurses in the original studies recounted, they were artfully consumed with maintaining safety and deeply involved with engaging patients. Unfortunately it is a craft that remains relatively indiscernible to the world outside of psychiatric inpatient nurses…

…An important theme that emerged from the investigations was the need for staff to maintain split levels of concern with one eye on the individual and one eye on the milieu. Several dichotomies arose from this dual focus and issues of empowerment often became threaded with issues of control…

…Finally, a tight focus on issues of coercion distracts from what should be the inpatient nursing agenda to improve care, such as greater family involvement; creating patient-centred, recovery-oriented environments; implementing meaningful programming; and involvement in the larger community to create effective care coordination.

Discussion

It’s interesting to understand nursing from the point of view of nurses, however, it is more important to challenge the rhetoric. The findings of this review are based on self-report established during interviews rather than observing what the nurses do, and not all staff on wards are qualified nurses.

Nurses often describe their powers of intuition, accessibility, and positive attitudes, which contrasts sharply with the service user literature which emphasizes the lack of engagement and quality time with nursing staff (Sharac et al, 2010), and the lack of safety in acute inpatient environments.

There is a wealth of literature about nurses on acute mental health wards, including reviews from those experiencing services about what mental health nurses should offer (Bee et al, 2008).

Links

Delaney KR, Johnson ME. (2014) Metasynthesis of research on the role of psychiatric inpatient nurses: what is important to staff? J Am Psychiatr Nurses Assoc. 2014 Mar-Apr;20(2):125-37. doi: 10.1177/1078390314527551.

Sharac J, McCrone P, Sabes-Figuera R, Csipke E, Wood A, Wykes T. (2010) Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review. International journal of nursing studies 2010;47(7):909-917. doi:10.1016/j.ijnurstu.2010.03.012.

Bee P, Playle J, Lovell K, Barnes P, Gray R, Keeley P. (2008) Service user views and expectations of UK-registered mental health nurses: a systematic review of empirical research. Int J Nurs Stud. 2008 Mar;45(3):442-57. Epub 2007 Apr 5. [PubMed abstract]