Master's level mental health nursing competencies, a prerequisite for equal health among service users in mental health care.

PURPOSE: This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging. METHODS: Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services. RESULTS: The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care. CONCLUSION: This discussion paper shapes implications for developments in master's level mental health nursing education curricula.

Effects of Connective Tissue Massage on Pain in Primiparous Women After Cesarean Birth.

OBJECTIVE: To evaluate the efficacy of connective tissue massage to reduce postoperative pain in primiparous women on Postoperative Day 1 after unplanned cesarean birth. DESIGN: A randomized controlled trial with three groups: intervention (Group 1), control or standard care (Group 2), and individualized attention (Group 3). SETTING: Family/newborn units of a large teaching hospital in the Northeastern United States. PARTICIPANTS: A total of 165 women who experienced unplanned cesarean births of singleton newborns at term gestation. METHODS: Participants were randomized to three groups: those in Group 1 received a 20-minute massage, those in Group 2 received the usual standard of care, and those in Group 3 received 20 minutes of individualized attention. On Postoperative Day 1, participants completed questionnaires to measure overall pain, stress, and relaxation at Time 1 and again 60 minutes later. Daily numeric pain ratings and medication consumption data were retrieved from the electronic health care records. Latent growth modeling and analysis of variance were used to analyze data, as appropriate. RESULTS: Participants in Group 1 had increased relaxation (p < .001), decreased pain (p < .001), decreased stress (p < .001), and decreased opioid use on Day 1 (p = .031) and Day 2 (p = .006) of the hospital stay after the intervention compared with the other groups. Additionally, opioid use in Group 1 decreased linearly, whereas the control groups had a nonlinear pattern of change. CONCLUSION: Using massage therapy during postoperative hospitalization improved relaxation and decreased pain, stress, and opioid use in this sample of women after unplanned cesarean births.

Preparing master-level mental health nurses to work within a wellness paradigm: Findings from the eMenthe project.

Mental health promotion remains an important component of mental health nursing practice. Supporting wellness at both the individual and societal levels has been identified as one of the key tenets of mental health promotion. However, the prevailing biomedical paradigm of mental health education and practice has meant that many nurses have not been equipped to incorporate a wellness perspective into their mental health practice. In the present study, we report on an exploratory study which details the knowledge, skills, and attitudes required by master-level mental health nurses to practice within a wellness paradigm from the perspective of three groups of key stakeholders: (i) service users and family members (n = 23); (ii) experienced mental health nurses (n = 49); and (iii) master-level mental health nursing students (n = 37). The findings, which were reported from individual and focus group interviews across five European countries, suggested a need to reorientate mental health nursing education to include a focus on wellness and resilience to equip mental health nurses with the skills to work within a strengths-based, rather than a deficits-based, model of mental health practice. Key challenges to working within a wellness paradigm were identified as the prevailing dominance of the biomedical model of cause and treatment of mental health problems, which focusses on symptoms, rather than the holistic functioning of the individual, and positions the person as passive in the nurse-service user relationship.

Mentoring, coaching and action learning: interventions in a national clinical leadership development programme.

AIMS AND OBJECTIVES: To evaluate mentoring, coaching and action learning interventions used to develop nurses' and midwives' clinical leadership competencies and to describe the programme participants' experiences of the interventions. BACKGROUND: Mentoring, coaching and action learning are effective interventions in clinical leadership development and were used in a new national clinical leadership development programme, introduced in Ireland in 2011. An evaluation of the programme focused on how participants experienced the interventions. DESIGN: A qualitative design, using multiple data sources and multiple data collection methods. METHODS: Methods used to generate data on participant experiences of individual interventions included focus groups, individual interviews and nonparticipant observation. Seventy participants, including 50 programme participants and those providing the interventions, contributed to the data collection. RESULTS: Mentoring, coaching and action learning were positively experienced by participants and contributed to the development of clinical leadership competencies, as attested to by the programme participants and intervention facilitators. CONCLUSIONS: The use of interventions that are action-oriented and focused on service development, such as mentoring, coaching and action learning, should be supported in clinical leadership development programmes. Being quite different to short attendance courses, these interventions require longer-term commitment on the part of both individuals and their organisations. RELEVANCE TO CLINICAL PRACTICE: In using mentoring, coaching and action learning interventions, the focus should be on each participant's current role and everyday practice and on helping the participant to develop and demonstrate clinical leadership skills in these contexts.

Modulation of beta oscillations in the subthalamic area during motor imagery in Parkinson's disease.

Activation of the basal ganglia has been shown during the preparation and execution of movement. However, the extent to which the activation during movement is related to efferent processes or feedback-related motor control remains unclear. We used motor imagery (MI), which eliminates peripheral feedback, to further investigate the role of the subthalamic area in the feedforward organization of movement. We recorded local field potential (LPF) activity from the region of the subthalamic nucleus (STN) in eight patients with Parkinson's disease off dopaminergic medication during performance of a warned reaction time task. Patients were instructed to either extend the wrist [motor execution (ME)], to imagine performing the same task without any overt movement (MI), or, in a subgroup, to perform a non-motor visual imagery (VI) task. MI led to event-related desynchronization (ERD) of oscillatory beta activity in the region of the STN in all patients that was similar in frequency, time course and degree to the ERD occurring during ME. The degree of ERD during MI correlated with the ERD in trials of ME and, like ME, was accompanied by a decrease in cortico-STN coherence, so that STN LFP activity during MI was similar to that in ME. The ERD in ME and MI were both significantly larger than the ERD in VI. In contrast, event-related synchronization (ERS) was significantly smaller in trials of MI, and even smaller in trials of VI, than during ME. The data suggest that the activity in the region of the human STN indexed by the ERD during movement is related to the feedforward organization of movement and is relatively independent of peripheral feedback. In contrast, sensorimotor feedback is an important factor in the ERS occurring in the STN area after completion of movement, consistent with a role for this region in trial-to-trial motor learning or the re-establishment of postural set following movements.