Challenges Faced By Mental Health Nurses In Providing Holistic Care Example Paper
Task Description Directions
For assessment 3 you have five tasks to complete. Complete each task and submit your response to each task in the form of a written assignment.
Identify and briefly describe a specific area of your practice in which you have a particular interest or where there is uncertainty/ differing opinions about the provision of care.
Develop a specific searchable question using the PICO format or similar based on the area of practice described in task 1.
Conduct a search for the highest levels of evidence that you can find to answer your question (refer to levels of evidence models/frameworks). The 3 highest pieces of research evidence found should be selected. Succinctly describe your search process and provide justification of the resources that you chose to search, and the evidence selected (discuss where your evidence sits within a levels of evidence model/framework). Attach the abstract/s or summary/summaries of the high level evidence to your final assignment.
Compare and contrast the findings from the high level evidence to current practice in your clinical setting. Your discussion should highlight the level of evidence and strength of the recommendations and clearly discuss any differences that exist between the evidence based recommendations and current practice in your clinical setting. If you are unable to find high level evidence and/or clear evidence based answers to your question then this should be discussed, including reasons why you think this evidence does not exist or is poorer quality evidence. Challenges Faced By Mental Health Nurses In Providing Holistic Care Example Paper
Discuss the barriers to EBP that may exist in your specific clinical setting, and how these barriers may be overcome, and/or strategies that promote EBP within your practice setting.
Description Directions
My specific area of practice is mental health nursing and I am interested in it because it gives me the opportunity to promote psychological well-being of people apart from physical ailments. Mental illness has become the third leading cause of disability burden in Australia. According to the Australian Bureau of Statistics data, anxiety disorder is most common among Australians and one in every five has experienced symptoms of mental disorder in one year period. With trend, it is expected that the demand of mental health nurses will increase and more number of skilled nurses with knowledge in psychiatric nursing will be required (Mindframe 2017). Hence, I am interested in mental health nursing to support people with mental disorder.
The key provisions of quality care in mental health nursing includes adapting a holistic approach to identify the cultural, spiritual, mental and psychosocial needs of individual and incorporate them in care planning. The nurse has the role of managing risk factors, providing early intervention, rehabilitation and focuses on recovery of patient at each stage of care. However, there are challenges in mental health nursing as nurses fail to identify the complex needs of patients. Mental health nursing requires an advanced knowledge and skills set. Nurses fail to empathize with patient and engage in appropriate communication with them. Mental health nurses have the responsibility of improving physical health in people with mental illness, however their attitude to care affect the quality of care (Robson et al. 2013). Along with nurse’s unclear self-perception, stigma might also be a threat for professional practice and mental health nursing identities (Sercu et al. 2015). There is also a drive towards evidence-based practice by means of critical reflection and care. However, evidence based uncertainty leads to conflicting nurse-patient relationship. Nurses continue to practice by means of old tradition and haphazard trial instead of focusing on scientific evidence. This acts as barrier in evidence based practice utilization in mental health nursing (Alzayyat 2014).
Based on the barriers and uncertainties seen in mental health nursing practice, there is a need to understand the factors that affect the quality of care to address the challenges in care. The PICO question for finding the highest level of evidence is- “ What challenges do mental health nurses face in providing holistic care to mentally ill patients in hospital setting?”.
The PICO elements in the question includes the following-
P (Patient or Problem)- Mentally ill patients
Review Of Highest Level Of Evidence
I (Intervention)- competencies in mental health nursing
C (Comparison) – challenges or facilitating factors in holistic care
O (Outcome)- Effective holistic care
Search strategy- To find answer to the research question, peer-reviewed journals published between the year of 2007 to 2017 will be examined. Electronic data bases such as google scholar, PsychInfo, Medline and CINAHL will be searched. The key search term for literature review includes ‘mental health nursing’, ‘ psychosocial care in mental health nursing’, ‘barrier to care in mental health nursing practice’ and other similar terms. The purpose of the review will to extract those articles that discussed the perception of mental health nurse regarding psychosocial care. The main focus will be to identify barrier in care. If any articles evaluate the outcome of specific intervention in mental health nursing, that article will not be taken for the review.
Review of highest level of evidence
The analysis of the research literature by Pazargadi et al. (2015, pp.551-557) gave insight into the nurses experience of barriers to the nurse-patient relationship in the psychiatric care. This evidence come under level III of evidence as it was based on qualitative content analysis by means of purposive sampling approach. Establishing therapeutic relationship is the basic role of psychiatric nurse and an essential factor for quality mental health care. The semi-structured interview with psychiatric nurse revealed nurse related barrier in practice. It occurred because of nurse-related barrier such as negative attitude of nurse, work exhaustion, inadequate skills and negative personal characteristics. Secondly patient related barrier in therapeutic relationship included patient’s lack of knowledge and inability to communicate with nurses. Symptoms like delusion affect their ability to interact with others. Finally, the organizational barrier in the nurse-patient relationship is the shortage of manpower, extra workload and large number of patients. The organizaton’s emphasis on routine work also limits the development of therapeutic relationship with client.
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Another research article presents the factors that affect the quality of care and clinical outcome in psychiatric hospital. The research by Bogaert et al. (2013) investigated the relation between nurse practice environment, workload and burnout on the quality of care. This evidence come under Level IV of evidence as it is cohort study where a sample of respondents from two public psychiatric hospitals in Belgium was selected for the study. This research was important due to the high nursing turnover rate in psychiatric hospitals and the need to retain skilled nurses to sustain and improve care. The nurses practice environment and work load was measured to determine the relation between them. The quality of care was assessed by Likert scale. The result revealed that workload and nurse environment plays a vital role in influencing the quality of care and determining the job outcome. A positive environment led to favorable job outcome. Furthermore, nurse-physician relationship, hospital management and organizational support also influenced quality of care. Therefore, gaining insight into the causative factors of burnout in psychiatric hospital may help to retain nurse and effective care environment may support them to deliver quality and safe patient care.
Another insight into the challenges faced in the nursing profession is understood from the research literature, which explores impact of stigma and discrimination toward mental illness (Ross & Goldner 2009). According to highest level of evidence, the study is evidence synthesis through critically appraised topics and it comes under level II. The existing body of evidence related to stigma, negative attitudes and discrimination towards mental illness was analyzed and it gave many themes related to the topic. Firstly, stereotype-based negative attitude towards mental illness originate from cultural and media depict. Certain stereotypical beliefs about mental illness also contribute to fearful attitudes in nurses. Nurses also reported they lack the skill to confidently and competently manage the behavioral symptoms of client. Many linked the knowledge gap to fear of patients too. Fragmentation of client care was also seen. Therefore, the study proved that nurses also contribute to stigma associated with mental illness, which affect the quality of care. Greater familiarity with this group of people might help to avoid stigma and discrimination in care. Furthermore, skill deficit can be improved by bringing chance in training and clinical education opportunities.
From the review of current available literature to answer the research question of challenges faced by mental health nurse in holistic care, three themes related to challenges in care care was observed. The three themes include impact of stigma, personal, patient and organizational factor and the issues of nursing environment and burnout on the quality of care.
The first literature gave insight into the organizational, nursing and patient’s barrier in establishing patient-nurse relationship. The nursing related barrier in care mainly reflects lack of skills, work exhaustion and attitude in mental health nursing as the issues in psychiatric practice (Pazargadi et al. 2015). When compared to personal practice in the current clinical setting, I can say that I agree with this point mentioned in the literature. In my clinical setting, there is large in flow of patient everyday and the focus is mostly on attending to the needs of all. Often, we are overloaded with task making it impossible for us to effectively establish appropriate therapeutic relationship with patients. As a nurse, we need to be more inclusive of patient’s spirituality, optimism and hope during providing psychosocial care to enhance the quality of life. However, task pressure and daily work pressure highly limits the quality of care (Tuck and Anderson 2014). According to my experience as a mental health nurse, I also believe nurse ability to provide quality care is also influenced by the lack of skill required in psychiatric practice. Apart from basic psychiatric nursing skills, working in a high demanding clinical setting also requires advanced practice skills set such as assessing patients for signs of mental illness, developing appropriate care plan and delivering therapy. They also need to have interpersonal and communication to coordinate effectively with patients and other practitioners to manage the full spectrum of care (Videbeck 2013).
The main summary of the first literature was that personal characteristics of patient and nurse, organizational factors and nurse attitude towards mental health service can be influence nurse-patient relationship. Hence, the recommendation from the study was that greater attention should be paid to this factor while planning care in psychiatric wards (Pazargadi et al. 2015). In the current clinical scenario in my practice setting, addressing this factor in planning care may not be easy. Although a nurse in practice setting cannot control organizational factor, the nurse can take the responsibility to enhance their competency in mental health nursing practice. A nurse need to identify the negative attitude in them that prevents them from delivering holistic care to patients and then try to avoid those attitudes by means of developing compassion for mentally ill patients (Happell & Gaskin 2013). If nursing students have more exposure to patients with mental illness during the training period, they are more likely to get prepared in managing this group of people. In this situation, they will confidently handle patients without any fear or anxiety (Australia & Australia 2017).
The second article summarized the effect of nursing environment on favorable job outcome and job satisfaction level. Furthermore, the quality of care was highly influenced by level of nursing management and indirectly affect by the nurse-physician relationship and organizational support. Therefore, it is evident that in actual clinical scenario, nurses are challenged by practice environment in which they work. The recommendation from the study was that managers of health care organization should develop a care environment by incorporating key practice that promotes care. This should be done based on work demand and various across different settings. Therefore, this indicates the role of managers and hospital executives in shaping a care environment that promote high quality and safe patient care (Bogaert et al. 2013, pp.1515-1524).
The above evidence can be applied in my setting because I feel I do not get the required support from my organization in delivery holistic care to mentally ill patients. My current clinical setting is overcrowded with large number of patients and increase in the number of aggression, depression and social isolation issues in patients. The overburden in task often leads to medication error and other injuries in care. This problem is also exacerbated by the shortage of nurses in psychiatric nurses. There is a need to make a healthy balance between nurse and patient ratio to eliminate the issue of burnout and work related exhaustion (Hanrahan 2010). To promote the provisions of holistic care in my clinical setting, increased number of orientation program is needed to enhance the quality of nursing care. There is also a need to maintain conformity of the clinical environment with professional responsibility of nurses so that nurse realizes the importance of attending to patients need in all aspects (Zamanzadeh et al. 2015, p.214).
The final evidence addressing the research question gave the evidence that nurse also play a perpetuator role in contributing stigma and discrimination in care. Nurses held negative attitude of fear and hostility towards mentally ill patients and this was mainly due to lack of understanding regarding the clinical and mental condition of patients. The study recommended urgent action to eliminate discriminatory behavior of nurse towards mentally ill patients and eliminate pessimistic attitude towards outcome of mental illness (Ross & Goldner 2009). Hence, nurse need to adapt the position of de-stigmatizers of mental illness. In my personal practice, this can be done by engaging in reflective and assertive action to minimize stigma. In order to rise to the challenge of eliminating stigma and discrimination while caring for people with mental illness, I can make a positive impact on patient my making a trusting relationship with them. I will act as advocate of patients to end stigma or discrimination related episodes in psychiatric clinic (Bates & Stickley 2013).
The analysis of the challenges faced by nurses in providing holistic care to mentally ill patients gives the indication that as a mental health nurse, I need to follow evidence based practice (EBP) to promote efficiency in care. However, there are many barriers to EBP in my clinical setting. Firstly, EBP requires adequate time to get acquainted with updated psychiatric practice and intervention. However, organizational priorities and insufficient time act as a barrier in covering the entire EBP process. My organization also do not support innovation in practice and continue with the traditional method of care. Hence, there is little support for EBP in my clinical setting. In a fast paced work environment and workload commitments, my clinical setting does not gives me sufficient time to engage in EBP activities. Furthermore, infrastructural barrier also prevents me from engaging in EBP activities as I do not get the access to databases to search regarding the psychiatric mental health nursing (Alzayyat 2014).
The following strategies can be adopted to promote EBP in practice setting:
- The psychiatric nurse will have to understand the importance of EBP and take their time out from bedside care to develop confidence and autonomy in practice. This can be done by taking additional training regarding the EBP process, learning to appraise the evidence and taking support of mentors to guide them in implementing EBP in clinical setting (Townsend 2014).
- Apart from individual psychiatric nurses, organizational manager or leader will also have to take the responsibility to promote EBP. They can do this by offering required infrastructure such as access to relevant data bases and training regarding EBP process. They can also play a role in fostering the positive values in mental health nurse and encouraging them to look for best evidence for specific mental health issue (Brown et al. 2010, pp.1944-1951).
- Psychiatric unit can also promote EBP by establishing official links regarding the best available evidence in practice. Mutual coordination of academic research staff with nurses and their manager will encourage EBP utilization and integrating it in daily practice routine (Timmins et al. 2012, pp.224-235).
- Apart from nursing professional and organizational role in promoting EBP in clinical setting, strategies related enhancing nurse motivation in EBP and eliminating environmental constraints is important (Bond et al. 2014, pp.228-236). Therefore, educational intervention can help nurses understand the value of EBP and prepare for the change in daily practice routine. This strategy of implementing complex EBP in clinical setting might help to deliver safe, effective and holistic care to patients.
References
Alzayyat, AS.2014, ‘Barriers to evidence-based practice utilization in psychiatric/mental health nursing’, Issues in mental health nursing, 35(2), pp.134-143.
Australia, PO & Australia, W 2017, Mental Health Nursing. HEALTH, p.24.
Bates, L & Stickley, T 2013, ‘Confronting Goffman: how can mental health nurses effectively challenge stigma? A critical review of the literature’, Journal of psychiatric and mental health nursing, 20(7), pp.569-575.
Bogaert, P Clarke, S Willems, & Mondelaers, M 2013, ‘Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach’, Journal of advanced nursing, 69(7), pp.1515-1524.
Bond, GR Drake, RE McHugo, GJ Peterson, AE Jones, AM & Williams, J 2014, ‘Long-term sustainability of evidence-based practices in community mental health agencies’, Administration and Policy in Mental Health and Mental Health Services Research, 41(2), pp.228-236
Brown, CE Ecoff, L Kim, SC Wickline, MA Rose, B Klimpel, K & Glaser, D 2010, ‘Multi?institutional study of barriers to research utilisation and evidence?based practice among hospital nurses’, Journal of clinical nursing, 19(13?14), pp.1944-1951.
Hanrahan, NP Aiken, LH McClaine, L & Hanlon, AL 2010, ‘Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals’, Issues in mental health nursing, 31(3), pp.198-207.
Happell, B & Gaskin, CJ 2013, ‘The attitudes of undergraduate nursing students towards mental health nursing: a systematic review’, Journal of clinical nursing, 22(1-2), pp.148-158.
Mindframe 2017, Mindframe-media.info https://www.mindframe-media.info/for-media/reporting-mental-illness/facts-and-stats
Pazargadi, M Fereidooni Moghadam, M Fallahi Khoshknab, M Alijani Renani, H & Molazem, Z 2015, ‘The therapeutic relationship in the shadow: Nurses’ experiences of barriers to the nurse–patient relationship in the psychiatric ward’, Issues in mental health nursing, 36(7), pp.551-557.
Robson, D Haddad, M Gray, R & Gournay, K 2013, ‘Mental health nursing and physical health care: A cross?sectional study of nurses’ attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness’, International Journal of Mental Health Nursing, 22(5), pp.409-417.
Ross, CA & Goldner, EM 2009, ‘Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature’, Journal of psychiatric and mental health nursing, 16(6), pp.558-567.
Sercu, C Ayala, RA & Bracke, P 2015, ‘How does stigma influence mental health nursing identities? An ethnographic study of the meaning of stigma for nursing role identities in two Belgian Psychiatric Hospitals’, International journal of nursing studies, 52(1), pp.307-316.
Timmins, F Mccabe, C.A.T.H.E.R.I.N.E. & Mcsherry, R.O.B.E.R.T 2012, ‘Research awareness: managerial challenges for nurses in the Republic of Ireland’, Journal of nursing management, 20(2), pp.224-235.
Townsend, MC 2014, Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis. Challenges Faced By Mental Health Nurses In Providing Holistic Care Example Paper
