What Were the Nursing Practices of Mental Health Nurses in Mental Institutions 1800 to 1960: A Scoping Review.

This scoping literature review describes the practices of nurses working in mental asylums between 1800 and 1960 prior to the introduction of psychotropic drugs. Studies published in English from 1976 to 2021 from CINAHL, PubMed, ProQuest, PsyINFO, MEDLINE and Google were searched in August 2021. Twenty-three papers were retrieved with three distinct periods identified that shaped nursing practice. These were custodial care, moral and somatic treatment. Shifts in nursing practice were shaped by the desire of psychiatry to be recognised as a medical speciality, the feminisation of nursing and the formal development of nurse training in general hospitals.

Lunatic Asylums and Indigenous Australians during the Nineteenth Century.

Lunatic asylums formed part of the civic infrastructure that was constructed out of British colonists invading and subsequently colonising unceded, Indigenous Australian lands during the eighteenth and nineteenth century. This historical narrative examined nineteenth century primary and secondary sources including, patient lists, medical files, and government correspondence, to provide insight into the experiences of Indigenous Australians admitted to Australia's earliest lunatic asylums. Awareness that lunatic asylums formed part of the structure imposed during colonisation, provides nurses and other health professionals with greater historical literacy regarding the impact of colonial lunatic asylums on Indigenous Australians. Such impacts continue to be experienced through transgenerational trauma and emphasise the importance of culturally safe mental health services.

Exploring resilience and workplace adversity in registered nurses: A qualitative analysis.

The aim of this study was to explore New Zealand registered nurses' experiences of resilience and workplace adversity. Resilience research in nursing has concentrated on quantitative and individual aspects. Contextual factors have been largely ignored. This study addresses this gap by qualitatively researching and documenting nurses' experiences of resilience and workplace adversity. An online survey of New Zealand registered nurses was conducted in 2018. Qualitative responses were analyzed using Braun and Clarke's thematic analysis method. Three themes emerged: (i) perseverance; (ii) how the past influences my present resilience; and (iii) things I do to stay strong. Nurses rely on personal resilience to overcome workplace adversity. Health service organizations must implement policies and procedures that (i) reduce workplace adversity, and (ii) encourage and develop strategies for nurses to individually and collectively face adversity with resilience. Future research needs to explore how healthcare organizations can modify existing systems and structures to align with nurses' efforts to sustain and develop resilience.

Exploring Online Mentorship as a Potential Strategy to Enhance Postgraduate Mental Health Nursing Education through Online Delivery: A Review of the Literature.

The value of mentorship to professional development in nursing education has been consistently demonstrated in the literature. The benefits for mental health nursing are particularly noted for attracting nursing students and new graduates into this area of practice. The proliferation of online delivery of mental health nursing programs poses particular issues in providing mentorship to students. Despite changes to the mode of educational delivery, the mentorship literature primarily addresses face-to-face processes. The aim of this paper is to present a review of the literature pertaining to online mentorship. A literature search of the CinAHL, Medline, ProQuest and Google Scholar databases was undertaken to identify relevant literature. Hand searches of reference lists were also conducted. The findings demonstrate the paucity of literature addressing this topic. Evaluation of online mentorship programs are particularly scarce, small scale and usually conducted at one site only. Few descriptions of the content and structure are provided meaning that program development cannot benefit from existing knowledge and expertise. There is an urgent need for online mentorship accompanied by rigorous and systematic evaluation frameworks to maximize the benefits of mentorship to an online environment.

Professional relationships between nephrology clinicians and patients: a systematic review.

BACKGROUND: Nephrology nurses and patients expressed that the clinician-patient relationship in a haemodialysis (HD) unit might be best described as being part of an extended family. However, there is a risk that professional boundaries may become blurred due to the perceived closeness of this relationship. OBJECTIVE: This systematic review sought to explore the experiences of nephrology clinicians in establishing and maintaining a professional relationship with people experiencing end-stage kidney disease who are receiving HD treatment. METHOD: A search strategy was created using JBI systematic review guidelines for six databases (PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library and JBI library). Qualitative studies were eligible for inclusion when the participants were nephrology clinicians who provided HD treatment or management of patients in a hospital outpatient HD unit or a community HD centre. RESULTS: Three studies met the inclusion criteria and the findings were synthesised into two themes (1) establishing a professional relationship and (2) coping mechanisms. All three studies focused on nephrology clinicians realising the importance of treating patients as individuals. Nephrology clinicians demonstrated advanced communication skills, empathy and compassion when interacting with patients, which seemed to contribute to patient satisfaction. This systematic review found some qualitative evidence to explain how nephrology clinicians establish and maintain a professional clinician-patient relationship with patients in the HD unit. CONCLUSION: This review highlighted a significant gap in research concerning the trajectory of the clinician-patient relationship across all members of the renal multidisciplinary health care team.

Psychological resilience in New Zealand registered nurses: The role of workplace characteristics.

AIM: To investigate the impact of workplace factors on psychological resilience in registered nurses. BACKGROUND: Nursing is characterized by persistent workplace adversity. Psychological resilience has been postulated as a means to mitigate the effects of workplace adversity. There is little research that examines the role of workplace factors (i.e., practice environment and bullying) in shaping resilience. METHODS: A cross-sectional survey was conducted among 480 registered New Zealand nurses. Psychological resilience was self-reported using the CD-RISC-10, while practice environment and workplace bullying were self-reported using PES-NWI and NAQ-R, respectively. RESULTS: For every point increase in PES-NWI and NAQ-R, there was an increase of 2.84 points (95%CI = 1.79, 3.89; p-value = <0.001) and a decrease of 0.07 points (95% CI = -0.12, -0.03; p-value = 0.002) in resilience, after controlling for demographic and job-related characteristics. These two factors explained for 12.6% of the variation in resilience. About 25.8% of registered nurses experienced bullying. CONCLUSION: Workplace factors are associated with psychological resilience in registered nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are key to transforming health care work environments to promote positive outcomes for nurses, the organisation and patient outcomes. Future efforts to promote psychological resilience in registered nurses need to enhance the practice environment and reduce workplace bullying.

Leadership and registered nurses (RNs) working after-hours in Residential Aged Care Facilities (RACFs): A structured literature review.

AIMS AND OBJECTIVES: The aim of this literature review is to synthesise and analyse the literature pertinent to the RN's competence and confidence to undertake the leadership role when working in residential aged care facilities after-hours and to determine any association of leadership with quality resident outcomes. BACKGROUND: Registered nurses (RNs) working in Residential Aged Care Facilities are required to undertake complex management tasks including leading nursing care teams, supervising non-nursing staff and allocating workloads according to residents' care needs, staff skills and experience. Registered nurses plan, assess, manage medication, evaluate each resident's care, liaise with doctors and allied health professionals and are responsible for evidence-based practice in accordance with the Nursing Standards for Practice (2016). Researchers have commented that effective nurse leadership can improve quality of care, improved resident outcomes and reduce adverse events. DESIGN: A review of original research papers based on the structured methodology described by Kable, Pich, and Maslin-Prothero (Nurse Education Today, 32, 2012, 878-886). METHODS: The review was conducted according to the 12-step structured framework by Kable et al. (Nurse Education Today, 32, 2012, 878-886). The search included peer-reviewed papers published between 2002-2017 on RN leadership after-hours, factors contributing to or with relationships to nursing leadership. Nineteen papers were found that researched the impact of leadership in aged care settings. RESULTS: The literature review concluded that nursing leadership has been linked to the quality of care and clinical outcomes in the aged care setting. However, RNs in the aged care setting have limited opportunities to develop key leadership competencies and confidence in order to meet the many challenges found in this environment due to lack of access to aged-care-specific leadership education. Minimal publications address the importance of the leadership of after-hours RNs. Results from this literature review will inform future research in this area. CONCLUSION: Nineteen papers identified the leadership required of RNs in aged care settings. However, limited research investigating the association between nursing leadership and clinical outcomes was found. The findings from this literature review suggest that leadership in the aged care setting may be facilitated through specific educational activities such as RN shadowing shifts, continuing professional development, working with peers and by demonstrating and practising leadership competencies. Based on the literature reviewed, a need for more research in this area is required. In a specific manner, research into RN leadership, competence and confidence in aged care facilities after-hours is needed. RELEVANCE TO CLINICAL PRACTICE: Registered nurses working in the aged care setting after-hours need access to leadership education. Better quality of care, improved resident outcomes and reduced adverse events are associated with sound leadership.

Recovery without autonomy: Progress forward or more of the same for mental health service users?

In Western nations, the Recovery approach has become a widely accepted philosophy and treatment concept in mental health. Yet, community understanding of the Recovery approach remains largely unexplored. This study aimed to investigate (i) people's awareness of the principles underpinning the Recovery approach in mental health, and (ii) the treatment approaches people consider most important, and whether these align with the Recovery approach. To achieve these aims, a random sample of 1217 Australian adults participated in the National Social Survey (QSS) via telephone interview. People's experience with mental health services, the importance they place on various treatment approaches, and their awareness of principles underpinning the Recovery approach were assessed. Analyses were conducted using descriptive statistics. Most participants (94%) agreed that 'regardless of the severity of symptoms experienced and/or the mental illness diagnosis, being diagnosed with a mental illness means there is always hope for a meaningful life'. Moreover, most participants considered treatments in line with the Recovery approach as important. However, few participants (35%) agreed with the principle that 'after diagnosis, the person themselves should direct the long-term management of their mental illness, rather than a medical professional'. Australian people were to some extent aware of the principles underpinning the Recovery Approach, particularly with regard to hope, ability to live a meaningful life, and the importance of support from family, friends, and others living with mental illness. Nonetheless, autonomy was not highly prioritized, with the prevailing view that management of mental illness should be directed by the medical profession.

Changing nursing student attitudes to consumer participation in mental health services: a survey study of traditional and lived experience-led education.

Mental health policy emphasises the importance of consumer participation in mental health services. To align education with policy and orient future healthcare services to active consumer involvement, the potential of academics with a lived experience of mental illness to impact on student attitudes towards consumer participation needs to be examined. A cohort comparative study was undertaken comparing attitudinal change between undergraduate nursing students undertaking two different mental health courses, one nurse-led (n  =  61) and one lived experience-led. Attitudes were measured through the Mental Health Consumer Participation Questionnaire. Within-cohort change was assessed via dependent sample t-tests, and degree of change was observed in each cohort, by comparing effect sizes. For the nurse-led course, attitudes on consumer involvement t (60)  =  -1.79, p < 0.005 (95% CI: -2.84, -0.74) and consumer as staff t (60)  =  -4.12, p < 0.005 (95% CI: -3.34, -1.16), positively changed with effect size r of 0.40 and 0.47, respectively. For the lived experience-led course, attitudes on consumer capacity t (109)  =  -3.63, p < 0.005 (95% CI: -0.48, -1.41) and consumer as staff, t (109)  =  -5.63, p < 0.005 (95% CI: -0.97, -0.46), positively changed, effect size r of 0.33 and 0.47, respectively. Mental health nursing education has a positive and selective influence on attitudes to consumer participation. Lived experience-led education was more beneficial in changing attitudes to consumer capacity and both types of education had similar positive effects on attitudes to consumers as staff.

Lived-experience participation in nurse education: reducing stigma and enhancing popularity.

Mental health nursing consistently emerges as less popular than other specialties, and both service users and mental health practitioners are affected by negative attitudes. Education is fundamental to attracting students to the field of mental health nursing. The aim of this study was to determine the impact of undergraduate mental health curricula on student attitudes to people with mental illness, and career interest in mental health nursing. A traditional mental health course was compared to a course delivered by a person with lived experience of mental illness (and mental health service use) for its impact on student attitudes and career intentions in mental health nursing (cohort 1: n = 70, cohort 2: n = 131, respectively). In both cohorts, attitudes were measured via self-report, before and after the course, and changes were investigated through within-subjects t-tests. The lived experience-led course demonstrated statistically-significant positive changes in intentions to pursue mental health nursing and a decrease in negative stereotypes, which were not observed in the traditional course. The valuable contribution of mental health nursing emerged in the traditional, but not lived-experience-led, programmes. These findings support the value of an academic with lived experience of mental health challenges in promoting attraction to mental health nursing as a career option.

It's the anxiety: facilitators and inhibitors to nursing students' career interests in mental health nursing.

Increasing the rate of recruitment of nursing students into mental health nursing (MHN) is vital to long-term sustainability of health care system support for people diagnosed with mental illness. However MHN is not a popular career path; this raises questions about what attitudes and beliefs may divert or attract students to this specialisation. The current research involved a survey of undergraduate nursing students at a regional university in Australia to clarify the nature of relationships between attitudes (e.g., the value of mental health nursing, stereotypes of people with mental illness) and how they may be antecedents to considering MHN as a career path. Through a structural equation model, it was ascertained that anxiety surrounding mental illness leads to less interest in MHN as a future career and suggests that anxiety is (a) partly due to negative stereotypes, and (b) countered by preparedness for a MHN role. Beliefs on how MHN can make a valuable contribution to people's well-being did not affect interest in pursuing MHN. These findings reconfirm the need to reduce anxiety about mental illness by educational approaches that effectively prepare students for MHN, combined with challenging negative stereotypes.

Authenticity, creativity and a love of the job: experiences of grassroots leaders of mental health nursing in queensland.

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.

"Time enough! Or not enough time!" An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000.

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

Making us what we are: noteworthy people and achievements in Queensland mental health nursing.

Understanding mental health nursing's past is an important way to preserve our cultural heritage. By exploring and then disseminating the insights gained through examination of the past, students and practicing mental health nurses may become more aware of the social and intellectual origins of the profession. They may also have their professional connections and commitment to mental health nursing clarified and reconfirmed. This paper presents the results of a survey conducted in Queensland in 2009. Members of the Australian College of Mental Health Nurses were invited to identify mental health nurses who they perceived had made a noteworthy contribution to the profession. Twenty mental health nurses were identified from the 38 surveys received. The reasons underlying the nominations revealed two main themes: achievements and qualities. Achievements included the subthemes: practice pioneer; career longevity; and far reach of influence. Qualities included: inspirational role model; and passion, dedication and/or commitment. The study provides a beginning conversation on the preservation of heritage and recommends deeper exploration of the history of mental health nursing within Australia, and specifically Queensland.

Comparison of mental health nurses' attitudes towards smoking and smoking behaviour.

Smoking is widely recognized as an important public health issue for the general population and in the mental health field where the rates are particularly high. Mental health nurses are well positioned to take an active role in encouraging and supporting people diagnosed with mental illness to cease smoking. Information about smoking behaviour and the attitudes of mental health nurses is necessary to develop strategies to prepare nurses for this important role. A cross-sectional study was conducted to examine the smoking behaviour and attitudes of mental health nurses in Queensland, Australia, through a random selection of mental health nurses (n = 289). Smoking rates (16%) in this study were lower than those for the Australian population. Smokers were significantly (P < 0.001) less likely to agree that health-care facilities should promote a healthy environment. All participants, but predominantly those who smoked (P < 0.001), supported the individual's right to smoke. Participants believed they possessed appropriate skills to deliver the antismoking message effectively, although stronger beliefs were characteristic of non-smokers. Participants who smoked perceived that their smoking status assisted in facilitating interactions with consumers (P < 0.001). The findings have implications for the health promotion activities of mental health nurses.

Public support for anti-smoking legislation varies with smoking status.

OBJECTIVE: Rural Australians have higher rates of smoking than their urban counterparts, contributing to poorer health outcomes. In 2004, the Queensland Government introduced legislation to reduce the impact of environmental tobacco smoke on the community. The aims of the study were to describe smoking behaviours and associations between smoking behaviour and agreement with current anti-smoking laws. PARTICIPANTS: A total of 1208 people over the age of 18 years and living in rural, remote and very remote central Queensland participated in this telephone survey. RESULTS: About 22% (n = 130) of female and 21% of male (n = 125) participants identified themselves as smokers. No difference existed between the mean age of smokers (47.3 years) and non-smokers (47.1 years). While there is high level of support for smoking restrictions in public places (75%), attitudes vary with smoking status. Smokers were less likely than smokers to agree that the legislation would create a healthier environment, reduce exposure to passive smoking or agree that 'it is right to ban smoking in public places'. Smokers were significantly more likely to agree that the legislation had gone too far. CONCLUSION: The gradual implementation of the anti-smoking legislation is changing social beliefs on what are acceptable smoking practices. It is likely that the legislation within Queensland and the subsequent forced changes in social conditions for smokers will continue to reduce the number of people smoking and reduce exposure to environmental tobacco smoke.

Boundaries and barriers: a history of district nursing management in regional Queensland.

AIM: To explore administrative constraints of district nursing during the latter part of the 20th century in regional Queensland, Australia. BACKGROUND: A greater understanding of the evolution of district nursing can illuminate why present conditions and circumstances exist. METHOD: Thirteen interviews undertaken and analysed historically in association with other documentary evidence from the time period 1960-90. FINDINGS: District nursing services of regional Queensland were initially established by voluntary organizations that had very lean budgets. Throughout the study period, government funding became increasingly available, but this coincided with increased regulation of the services. CONCLUSIONS: District nurses have worked within considerable boundaries and barriers associated with either a lack of funds or imposed regulations. While greater government funding solved some working conditions, it did so by imposing greater administrative responsibilities on the nurses and services that were not always seen as advantageous for clients or as professionally satisfying for the nurses.