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The Therapeutic Role of the Mental Health Nurse : Implications for the Practice of Psychological Therapies Please do not remove this page The therapeutic role of the mental health nurse : implications for the practice of psychological therapies Fisher, Jacklin Elisabet Monica https://researchportal.scu.edu.au/discovery/delivery/61SCU_INST:ResearchRepository/1267216740002368?l#1367368510002368 Fisher, J. E. M. (2011). The therapeutic role of the mental health nurse: implications for the practice of psychological therapies [Southern Cross University]. https://researchportal.scu.edu.au/discovery/fulldisplay/alma991012821797702368/61SCU_INST:Research Repository Southern Cross University Research Portal: https://researchportal.scu.edu.au/discovery/search?vid=61SCU_INST:ResearchRepository [email protected] Open Downloaded On 2021/09/30 11:34:45 +1000 Please do not remove this page The Therapeutic Role of the Mental Health Nurse: Implications for the Practice of Psychological Therapies Jacklin Elisabet Monica Fisher RN, BA (Macq.), MA (Macq.) School of Health and Human Sciences Submitted to Southern Cross University in fulfilment of the requirements for the Degree of Doctor of Philosophy February 2011 Certificate of Authorship I certify that the work presented in this thesis is, to the best of my knowledge and belief, original, except as acknowledged in the text, and that the material has not been submitted, either in whole or in part, for a degree at this or any other university. I acknowledge that I have read and understood the Southern Cross University‘s (SCU‘s) rules, requirements, procedures and policies relating to my higher degree research award and to my thesis. I certify that I have complied with the rules, requirements, procedures and policies of the Southern Cross University. Printed Name: Ms Jacklin E. M. Fisher Signed: ______________________On: ____/____/______ ii Abstract 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, iii 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. iv Acknowledgements I am grateful to many people for their encouragement, support and assistance. Firstly, I wish to thank my family for the patience, admiration and love they give to me. I thank my supervisor, Dr Kierrynn Davis, for her astute feedback, friendship and encouragement, and for her gentle and supportive approach and my co-supervisor, Dr Stephen Kermode, for his direct and concise feedback. Thanks to the nurses who completed the surveys and participated in the interviews and a special thank you to the consumers for their honesty and willingness to be interviewed. I also wish to acknowledge the journal reviewers and editors whose comments have assisted the writing of the papers included in this PhD, and the staff and fellow students at Southern Cross University who provided practical support, collegial understanding and much-needed humour during our many research days we spent together in sub-tropical Lismore. Finally, in keeping with many pet-owning PhD candidates, I also wish to acknowledge my beautiful big Molly dog for her nonchalance, shrewd use of silence and delight at going for yet another walk around the block! It‘s no coincidence that man‘s best friend cannot talk. (Anonymous) v List of Publications I warrant that I have obtained, where necessary, permission from the copyright owners to use any third-party copyright material reproduced in the thesis, or to use any of my own published work in which the copyright is held by another party. The papers included in this thesis have been internationally peer-refereed prior to publication. Evidence to this affect is contained in appendices 1 and 2. Fisher, J. (2002a). Fear and learning in mental health settings. International Journal of Mental Health Nursing, 11(2), 128–134. Fisher, J. (2002b, October 15–18). The nurse practitioner—what role for mental health nurses? Coming of age: A celebration of mental health nursing. Paper presented at the Australian & New Zealand College of Mental Health Nurses 28th International Conference, Sydney, Australia. Fisher, J. (2003, February 21–26). Mental health nurse practitioners and physicians: Partnerships in health care. Partnerships in health. Paper presented at the World Federation for Mental Health Biennial Congress 2003, Melbourne, Australia. Fisher, J. (2005). Mental health nurse practitioners. Improving access to quality mental health care. International Journal of Mental Health Nursing, 14(4), 222–229. Fisher J. (2007). Mental health nurses, de facto police. International Journal of Mental Health Nursing, 16(4), 230–235. Fisher, J. & Hapell, B. (2009). Implications of evidence-based practice for mental health nursing. International Journal of Mental Health Nursing, 18, 179–185. Fisher, J. & Horsfall J., (2007). Fear and learning. In S. K. Turrini (Ed.), Consciousness and learning research (pp. 63–77). New York: Nova Science Publishers Inc. Fisher, J. & Wand, T. (2004, June 29–July 2). Mental health nurse practitioners and physicians. Paper presented at the Third ICN International Nurse Practitioner Conference, Groningen, the Netherlands. Wand, T. & Fisher, J. (2006). The mental health nurse practitioner in the emergency department: An Australian experience. International Journal of Mental Health Nursing, 15, 201–208. vi Statement of Contribution of Others I hereby submit the following work that has been co-authored to be taken into consideration in the marking of this thesis. The nature and extent of the intellectual input by the author of this PhD thesis (Fisher, J.) is indicated below and a written and signed statement to this effect from each of the co-authors is included in Appendix 3. Refereed Book Chapter Fisher, J. & Horsfall J. (2007). Fear and learning. In S. K. Turrini (Ed.), Consciousness and learning research (pp. 63–77). New York: Nova Science Publishers Inc. Conception of the study 75% Design of the study 75% Collection of the data 100% Analysis of the data 100% Interpretation of the data 100% Conclusions 75% Writing the paper 75% Refereed Journal Publications Wand, T. & Fisher, J. (2006). The mental health nurse practitioner in the emergency department: An Australian experience. International Journal of Mental Health Nursing, 15, 201–208. Conception of the article 50% Design of the article 25% Collection of the data not relevant vii Analysis and interpretation 25% Conclusions 50% Writing up of the paper 50% Fisher, J. & Hapell, B. (2009). Implications of evidence-based practice for mental health nursing. International Journal of Mental Health Nursing, 18, 179–185. Conception of the article 80% Design of the article 80% Collection of the data
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