Psychiatric nurse practitioners’ experiences of working with mental health care users presenting with acute symptoms

Abstract

Psychiatric nurse practitioners (PNPs) working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse. The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs) presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education. A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the purpose of data triangulation. Data were analysed in accordance with Tesch's method of open coding. The three themes that emerged were: PNPs experienced working with these MHCUs as entering an unsafe world where care became a burden; they experienced negative emotional reactions and attitudes towards these MHCUs that compromised quality nursing care; and they made a plea for a nurturing environment that would enhance quality nursing care. The PNPs suggest skills and competency development, organisational support, and a need for external resources. Creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacles are essential in the promotion of the overall wellbeing and mental health of PNPs.

Clinical Leadership in Mental Health Nursing: The Importance of a Calm and Confident Approach

“…The importance of confidence in clinical decision-making and remaining calm in a crisis or other unplanned events has been identified across a range of healthcare settings (Cleary et al, 2012;Yang, Williams, & Fang, 2011;Yang et al, 2012). Research has clearly identified that this skill is important for mental health nurses (Cleary et al, 2011(Cleary et al, , 2012Dickinson et al, 2009;Edward, 2005;Ngako et al, 2012), although not described specifically in relation to the qualities of clinical leadership.…”

“…Nursing environments that are unpredictable, such as emergency departments, intensive care units, and acute mental health settings (Cleary et al, 2011(Cleary et al, , 2012Currid, 2008;Gillespie, Gates, & Berry, 2013;Ngako, van Rensburg, & Mataboge, 2012;Nooryan, Gaspryan, Sharif, & Zoladl, 2011;Ward, 2011), require nurses to have specialist skills in their specialized area of nursing and to be confident in decisionmaking (Fry et al, 2013;Yang, Thompson, & Bland, 2012). In a medical intensive care unit, for example, nurses will need to have expertise in a number of clinical procedures that are more common in that setting, such as assessing levels of con-sciousness (Chan & Matter, 2013) or delirium monitoring (Balas et al, 2012).…”

“…In mental health environments, the issues that most often challenge nursing staff include acute psychotic symptoms, self-harm, and behavioral disturbances that can potentially lead to aggression (Cleary et al, 2011;Currid, 2008;Deacon et al, 2006;Edward, 2005;Ngako et al, 2012;Ward, 2011). Clients in acute mental health settings are often in crisis during the initial stages of contact with a service provider (Cleary et al, 2011;Ngako et al, 2012).…”

“…In mental health environments, the issues that most often challenge nursing staff include acute psychotic symptoms, self-harm, and behavioral disturbances that can potentially lead to aggression (Cleary et al, 2011;Currid, 2008;Deacon et al, 2006;Edward, 2005;Ngako et al, 2012;Ward, 2011). Clients in acute mental health settings are often in crisis during the initial stages of contact with a service provider (Cleary et al, 2011;Ngako et al, 2012). The ability to help clients develop strategies to safely navigate in times of crisis is regarded as a core goal of mental health nursing and requires a specialized set of skills (Cleary et al, 2012;Currid, 2008;Deacon et al, 2006;Ward, 2011).…”

Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital

“…In the UK and other Western countries, adolescent inpatient care is becoming increasingly specialized as adolescents form a heterogeneous patient group with mixed disorders and multiple diagnoses (Ellil€ a et al 2007). However, often consumers of inpatient services display acute symptoms such as suicidal intentions, hallucinations, delusions and a risk of harm to themselves and others (Ngako et al 2012), generally resulting from experiences of trauma, emotional mistreatment, sexual abuse, neglect, loss, family discord, addiction, criminality and severe mental disorders (Van Sant & Patterson 2013). Consequently, adolescent mental health nursing staff represent a specialized cohort of healthcare professionals informing both the setting and population of this study.…”