The growing number of people worldwide with mental health problems is increasing and making intensive demands on existing services. Recent reorganizations of healthcare provision in the UK have focused predominantly on administrative efficiency, standardization and cost-effectiveness. Although little evidence exists that reorganizations, per se, directly result in improved health nationally, nevertheless, organizational change coupled with improved care provision can have a considerable impact on the mental health of people. It is known that service users want person-centred help with improving their confidence, autonomy and cognitive and social skills so as to be able to manage their lives within the social context in which they live. In this study, semi-structured interviews were used to explore service users' expectations and experiences of acute inpatient care and the early post-discharge period. While the social environment of the wards was seen by many as conducive to promoting safety and interpersonal relationships, others found the experience lacking in assisting them to resume their lives post discharge. If acute care is to become more than a mechanism for addressing and containing risk, better targeted interventions are required to help individuals find strategies that are transferable to the context of their 'real' lives. A number of factors that were identified by respondents in this study are identified and discussed.
Aims and MethodA postal questionnaire survey was conducted of the directors of nursing of all mental health NHS trusts in England, in order to examine current activities and attitudes regarding nurse supplementary prescribing (NSP) in psychiatric settings.ResultsFifty-four per cent of nurse directors returned the questionnaire. They perceived that NSP was an important means for improving patient care and treatment, particularly in community settings. In their opinion, psychiatrists were generally not opposed to its introduction. To date, relatively few mental health nurses have received training in NSP.Clinical ImplicationsDirectors of nursing have positive views and experiences of NSP. Widespread implementation of NSP is likely to occur over the next few years and psychiatrists will need to consider how this will impact on their role.
Violence in psychiatric inpatient units is a major and growing problem. Research interest has primarily focussed on patient characteristics. The role of staff factors and the antecedents of violent incidents has been neglected, despite the fact that staff factors and behaviour may be more readily amenable to change than patient characteristics. The HOVIS study sought to obtain the views of a sample of mental health nurses in current clinical practice about staff-related factors, which they perceive to contribute to, or protect against, the occurrence of violent incidents. A total of 108 nurses working in psychiatric acute admission, intensive care and low secure units, in two NHS Trusts were interviewed using a specially designed semistructured interview schedule. These nurses identified a variety of behaviours, clinical skills, personal characteristics and interpersonal skills that they believe impact on the occurrence of violent incidents. These findings are discussed in relation to their possible training and managerial implications.
How mental health nursing can best improve service users' experiences and outcomes in inpatient settings: responses to a national consultationDespite a number of national developments in the past few years, concerns remain about the experience and outcomes for service users in inpatient care settings. As part of a national review of mental health nursing in England, a consultation exercise was carried out to ascertain the opinions of a wide range of stakeholders in order to inform subsequent recommendations. The consultation question specifically related to inpatient care was 'How can mental health nurses best improve service users' experiences, and outcomes, in inpatient care settings?' The consultation generated a total of 326 written responses, mostly from groups and organizations. Responses were subject to content analysis and the three largest categories were 'Service users influencing services' (n = 80, 31%), 'Service users involved in own care' (n = 74, 29%) and 'Direct clinical time' (n = 68, 26%), including respondents citing the need for protected therapeutic engagement time. Many of the themes raised in the consultation were subsequently reflected in the recommendations made in 'From values to action; the Chief Nursing Officer's review of mental health nursing'.
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