Introduction of a child and adolescent mental health link worker: education and health staff focus group findings.

Policy guidance suggests that outcomes for adolescents with mental health problems can be improved by secondary education services (SES) and child and adolescent mental health services (CAMHS) working more closely. This study reports on staff experiences of the introduction of a mental health link worker (MHLW). The findings of two focus groups are presented, conducted with staff from CAMHS and SES. These focus groups formed part of the overall wider evaluation of the MHLW role. The groups explored staff perceptions and experiences following the introduction of the MHLW, and elicited their views on the effectiveness of this innovative role. Qualitative methods were employed, and analysis was conducted using the principles of grounded theory and the constant comparative method. The findings revealed that the MHLW was well received by both groups, despite the identification of potential barriers. A number of key themes emerged, which included the ability of the link worker to improve communication and to encourage mutual understanding between services. The issues raised by these themes are discussed and recommendations are made for future practice and research.

Multiprofessional clinical supervision: challenges for mental health nurses.

Recent reform and developments in mental health care provision have increasingly espoused the value of multiprofessional teamwork in order to ensure that clients are offered co-ordinated packages of care that draw on the full range of appropriate services available (DoH 1999a; DoH 2000). Supervision in some form is seen as a key part of all professional practice to provide support to practitioners, enhance ongoing learning, and, to a greater or lesser degree, offer some protection to the public (Brown & Bourne 1996, UKCC 1996). Clinical supervision has gained increasing momentum within the nursing profession, but to a large extent this has been within a uni-professional framework -- nurses supervising other nurses. This paper seeks to explore the ways in which multiprofessional working and clinical supervision interlink, and whether supervision across professional boundaries might be desirable, possible, and/or justifiable. Whilst our own view is that multiprofessional supervision is both possible and desirable, we seek to open up a debate, from our perspective as mental health nurses, about some of the issues related to the concept. Our motivation to explore this topic area emanates from our experiences as supervisors to colleagues within multiprofessional teams, as well as the experiences of those attending supervisor training courses. Following a brief overview of the development of clinical supervision in mental health care and recent policy guidelines, some models of clinical supervision are reviewed in terms of their suitability and applicability for multiprofessional working.

Concepts of compliance: understandings and approaches.

This paper will take a critical look at the concepts of compliance and non-compliance, both generally and in the specific context of contraceptive use.

The utilization of the healthcare assistant role in intensive care.

The increasing role of healthcare assistants (HCAs) in intensive care in relation to patient monitoring has raised concerns among some clinical managers, particularly where such roles are not underpinned by a sound knowledge base and critical reasoning ability. This article describes a study which was undertaken in an attempt to identify how HCAs are currently utilized within the general intensive care environment. The results show a wide variation between units in relation to the activities undertaken by HCAs, their training and the levels of remuneration. This article seeks to open up the debate as to whether or not nurses should be challenging the nursing care that is now delivered by non-nurses and makes recommendations for the way forward in this area.

Non-compliance and professional power.

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the 'proper' roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to 'blame' the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.

Parallel process in clinical supervision: enhancing learning and providing support.

The introduction of clinical supervision in nursing is gaining momentum and is proposed as having numerous benefits for nurses, organizations, and ultimately patient care. The necessity for such supervision has arisen partly from a fundamental shift in the nature and definition of nursing work. The emphasis on individualized, holistic care has led to a change in role from one characterized by professional distance to one in which interpersonal involvement is seen as central. Such a shift, though seen as positive, may lead to increased vulnerability as nurses negotiate the blurred boundaries between the personal and the professional in their relationships with patients. Such boundary negotiation is a legitimate focus for learning and support in clinical supervision. However, as with many aspects of nursing, the subtle processes involved in relationship development are often hidden from consciousness, thus missing potential learning opportunities. One way that such hidden aspects of practice may be explored in clinical supervision is through attendance to the way that such processes are parallelled in the supervisory relationship. Drawing on theory and practice from the fields of counselling and mental health nursing, this paper explores the nature of 'parallelling' in clinical supervision. The implications for clinical supervision in nursing more generally are examined in relation to enhancing learning and providing support for supervisees and supervisors.

Quality in nurse education: an exploration of the concept of students as customers.

The issues of Quality and Quality Assurance in nurse education, have become prominent in the design, management and marketing of courses. However, quality is a concept which has many meanings. One of the central ideas which has emerged from the current discourses on quality, is that of the 'customer'. In the new business jargon of the 1990s, with its emphasis on the market and competition, the importance of 'satisfying the needs of the customer/consumer' has been a dominant theme. One of the customers of nurse education is seen as the student. The reconceptualization of the student as customer may carry with it, connotations which do not readily fit into the context of education and learning as a jointly negotiated process. A collaborative, rather than consumerist model is proposed as a preferable basis for the ensuring of quality, and the involvement of students in that process. Such a model, would be in line with a truly student-centred approach to nurse education, where power is shared between those involved in the process. The importance of the current inequality of power in student-teacher relationships is a barrier to such an approach and true student participation, rather than tokenism is called for.

Humanism and positivism in nursing: contradictions and conflicts.

Nursing and nurse education have been influenced by a shift towards a broadly humanistic philosophy as a basis for practice. At the same time, in attempts to develop a knowledge base and credibility as a profession, the vital importance of research has been acknowledge. Both these aspects of nursing are increasingly forming the basis for all nursing courses. However, in this paper, it is argued that the implicit adoption of notions of science based in a positivistic paradigm gives rise to conflicts with a humanistic philosophy. It is contended that nursing has inherited a 'legacy of positivism', which promotes objectivity and reductionism and which excludes subjective meaning and the personal from the research process. In part this has been due to the powerful influence of medical hegemony, which has defined the nature of legitimate knowledge and controlled nursing research through the gatekeeping function of doctors. If nursing is to make progress in the development of a knowledge base, the contradictions between humanism and positivism must be acknowledged as a barrier to an integration of the art and science of nursing. This paper suggests that what is required is a paradigm shift, a redefinition of nursing science, which not only rehumanizes the nature of research, but also refutes and challenges the notion of objectivity and the objective attitude.