Clarity, confidence and complexity: Learning from mental health nurses' experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings

Abstract

Aims and objective To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance.

Longitudinal evaluation of a programme for safety culture change in a mental health service

“…Also relevant are the results of a linked study conducted in the same service prior to the second iteration of data collection for the current study. Focus group interviews were used to explore mental health nurses' experiences and perceptions of providing care for severely deteriorating patients in mental health settings (Brunero et al., 2019). Analysis revealed themes linked to procedures and leadership accountability, confidence in the workforce and complexity of care and the environment.…”

Is vital signs assessment important in the acute mental health setting? A review of fundamental nursing textbooks

“…The recognition of acute physiological deterioration in consumers with serious mental health issues has been identified as a challenge for clinicians (Brunero et al., 2020). These consumers are typically at risk of acute deterioration and premature death due to the presence of comorbid conditions such as heart disease and diabetes (Singleton, 2015; World Health Organisation, 2018).…”

“…There was a perceived need for additional training regardless of the nurses' nationality (Bressington et al., 2018). Similarly a recent Australian study explored 64 mental health nurses' experiences of the acute physiologically deteriorating consumer (Brunero et al., 2020). Key themes included nurses' uncertainty of their ability to accurately assess event urgency including whom to, how to and when to escalate.…”

“…In an Australian study of 70 mental health nurses, reasons for missed nursing care also included inadequate staffing and the increased physical needs and acuity of consumers (Joseph et al., 2022). Traditionally, the focus of care in mental health settings is on consumers' mental health given the acuity of their presentation (Brunero et al., 2020). For example, a study involving 434 nurse and midwives in a 929‐bed hospital in Australia found that mental health nurses utilise significantly fewer core physical assessment skills compared with medical surgical nurses (Osborn et al., 2015).…”