Fisher J 2011, 'The therapeutic role of the mental health nurse: implications for the practice of psychological therapies', PhD thesis, Southern Cross University, Lismore, NSW.
Copyright J Fisher 2011
This research project identifies therapeutic roles that nurses and consumers believe are most helpful in the nursing care of people with serious and ongoing mental illness, including identifying the knowledge concerning, attitudes towards and usage of evidence-based psychological therapies in mental health nursing practice. A critical realist perspective utilising a mixed-methods‘ approach was chosen in this study. Two Delphi studies and an online questionnaire survey were the research methods selected. Three sample groups were identified, comprising consumers of mental health nursing care and expert mental health nurses (MHNs) for the two Delphi studies, and a larger sample (n = 532) of practicing MHNs in Australia for the online questionnaire survey. The findings from the Delphi studies of consumers and expert nurses informed the development of the questionnaire survey for practicing MHNs. The thesis‘s literature review incorporates one book chapter, four peer-reviewed and published research papers and three peer-reviewed conference papers by the author in order to provide a critical analysis of how current organisational structures, legislative frameworks, economic resources and gender influence the therapeutic role of the MHN. Four of the publications were co-authored.
Results indicate that there is substantial agreement across all three sample groups on what constitutes therapeutic mental health nursing practice. The Delphi consumer group believed the nurse‘s attitude is the most important therapeutic factor. They wanted MHNs to provide care in a way that empowered them, encouraged their achievements and instilled hope. They identified wellness planning, a recovery focused approach to nursing care and cognitive behavioural therapy (CBT) as important therapeutic strategies in maintaining client wellbeing and preventing relapse. The two nurse samples believed empowering therapeutic relationships with clients, a recovery oriented approach, communication and counselling skills and excellent mental and physical assessment skills were the most important therapeutic skills for MHNs. There was enthusiastic support amongst the nurse samples towards incorporating evidence-based psychological therapies in their current nursing practice. Indeed, 94 per cent of respondents had read articles, journals or books on psychological therapies in the previous twelve months. The nurse samples identified complex agency and structural relationships as hindering their ability to practice therapeutically. Amongst these was a conviction that the current educational preparation for mental health nursing is inadequate and concern was voiced that bio-medical and custodial practices restricted nurses‘ therapeutic ability. The nurses in this study believed incorporating evidence-based psychological therapies into their current nursing practice would improve the quality of mental health nursing care for people experiencing serious and ongoing mental illness. Recommendations, based on the above findings are made in relation to mental health nursing practice and service delivery, education and research.