Getting psychosocial interventions into mental health nursing practice: a survey of skill use and perceived benefits to service users.

AIM: To investigate the use of psychosocial interventions by mental health nurses following training and perceived benefits to service users. BACKGROUND: Psychosocial interventions are recommended to support the recovery of persons with enduring mental illness. Despite two decades of postgraduate training in psychosocial interventions internationally, implementation challenges still remain. DESIGN: A cross-sectional exploratory, descriptive survey was employed. METHODS: A survey was mailed to the total population of nurses (n = 58) working in some health regions in Ireland who completed training in psychosocial interventions between 2005-2010. Data were collected between November 2011-January 2012, yielding a response rate of 64%. Descriptive and correlational statistics were used to analyse the data. RESULTS: There were statistically significant increases in the use of psychosocial interventions post training. Cognitive behavioural therapy and family interventions were the least used interventions. Assessment and outcome measures, concordance therapy and relapse prevention were preferential interventions. Perceived outcomes for service users were awareness of relapse indicators, enhanced coping skills and fewer admissions. Case load demands, lack of access to supervision and time constraints prevented implementation. Free text comments indicated a dissonance between generic nursing roles and implementation of structured psychosocial interventions in practice. CONCLUSIONS: The findings indicate a requirement for nursing leadership to legitimize psychosocial interventions as core nursing work. For service users to experience this type of nursing, we propose the nomination of dedicated psychosocial intervention nurses to multidisciplinary teams. Support through guidelines, clinical supervision and audit by senior nurse managers is critical to implementation.

Nursing students' views of clinical competence assessment.

This paper reports on some outcomes of a research study evaluating a new assessment framework of clinical competence used in undergraduate nursing programmes in the Mid West Region of Ireland. First, this paper presents both the strengths and weaknesses of the present model, as articulated by student nurses. Second, it generates a broader critical debate around the concept of competency assessment. The model of competence in question was developed by the Irish Nursing Board then elaborated on by the University of Limerick in partnership with local health service providers in 2002. Methodology involved a triangulated approach, comprising a series of focus group interviews with students (n=13) and preceptors (n=16) followed by a survey of students (n=232) and preceptors (n=837). Findings from the student focus groups are reported here. Themes identified using Burnard's (1991) framework for analysis are preparation for competency assessment, competency documentation, supporting assessment in practice, organisational and resource factors and the competency assessment structure and process. Results from this research have implications for refinement and revision of the present competency assessment framework, for student and staff preparation and for collaboration between stakeholders.

Preceptors' views of assessing nursing students using a competency based approach.

The purpose of this study was to evaluate clinical competence assessment in BSc nursing registration education programmes. This research was undertaken in two phases and incorporated both quantitative and qualitative methodologies. In the first phase, two focus groups were conducted with preceptors working in general, mental health and intellectual disability nursing (n=16). In the second phase, a survey was undertaken with preceptors (n=837) in these disciplines. This paper reports on the focus group findings of preceptors' views and experiences of assessing undergraduate nursing degree students using a competency based approach. A semi-structured interview guide was used to focus the discussions. Three higher order categories that emerged included: attitudes to competencies, being a preceptor and competencies in practice. Competing demands in the clinical environment impacted on preceptors' experiences of the assessment process. Difficulties such as the wording of competency documentation and incorporation of skills into the assessment were articulated. The importance of a regional and national review of competency assessment systems to find a common language for student assessment as well as promoting greater student skill development within competency frameworks is recommended. These findings; highlight the importance of making assessments more workable within the current environment and aim to inform future development of competence assessment.

Competency assessment methods - tool and processes: a survey of nurse preceptors in Ireland.

Determining student nurses' clinical competence is underpinned by significant challenges including a lack of reliable assessments methods and multiple factors that impact on the assessment function of preceptors. The purpose of this study was to explore preceptors' views and experiences of a competency assessment tool and process used to assess BSc student nurses' clinical competence. Data were collected using a mixed method descriptive approach that included focus groups (n=16) and a survey of preceptors (n=837) in general, mental health and intellectual disability nursing in Ireland. This paper reports the results of the preceptor survey, which yielded a response rate of 30.4%. Findings revealed that preceptors had difficulty in understanding the language used in the competency assessment document. There was a lack of continuity of the same preceptor to students over the assessment period and over half of the preceptors gave less than 30 min to the formal interview process. Preceptors more often assessed knowledge and attitudes compared to skills. Matching preceptor roster with students, standardisation of the process and a moderator system to support the integrity of competency assessment is recommended.

Training primary care nurses in late-life depression: knowledge, attitude and practice changes.

Aim. This paper reports on the uptake of a two-day late-life depression training programme with primary care nurses and its impact on knowledge, attitudes and the use of a brief screening protocol following training. Background. Late-life depression is a common condition associated with medical illnesses, impaired psychosocial functioning and risk for suicide. Although treatable, it is under recognized in primary care. Nurses have an important contribution to make to its detection, yet few studies have focused on training primary care nurses for this role. Design. An uncontrolled pre- and post-test design was used. Data were collected using the Late-Life Depression Quiz, the Depression Attitude Questionnaire (DAQ) and an Impact on Clinical Practice Questionnaire at 1 and 3 months. Seventy-three nurses commenced training and 66 completed the programme out of a total of 253 invited to participate. Results. Statistically significant differences were found between pre- and post-training for knowledge about late-life depression (P < 0.0005). No significant association was found between age, length of experience, level of contact and pre-training knowledge scores. Attitudes towards depression were more optimistic following training which were significant for nine of the DAQ statements (P < 0.05). However, when the overall level of significance was adjusted for multiple testing of 20 DAQ items, two remained statistically significant (P < 0.0025). Finally, a 77% response rate to the 1-month practice questionnaire and a 52% at 3 months showed that nurses were using the screening measure (mean 5.0, SD 7.71; mean 5.6, SD 7.71 respectively). Conclusion. A short training programme on late-life depression was effective in producing both knowledge and attitude change in primary care nurses. The use of a short two-item depression screening measure prompted nurses to complete more in-depth assessment for depression. Relevance to clinical practice. Training primary care nurses to identify and manage older persons with depression is essential to improve quality of life.