Expanded practice roles for community mental health nurses : what do consumers and carers have to say?

Community-based mental health as the primary focus of treatment has influenced more autonomous roles for mental health nurses. A limited literature suggests that this has resulted in the expansion of community mental health nursing into territory usually the exclusive domain of the medical profession. Consumers and carers are the two groups most affected by changes to service delivery; however, their views regarding the changing role of community mental health nurses have not been sought. This paper presents the findings of a qualitative study involving indepth interviews with Australian consumers (n = 4) and carers (n = 6) designed to explore their views and opinions about the expanded practice roles of community mental health nurses. Four main themes were identified: accessibility and convenience; relationship with clinicians; beneficiaries of expanded nursing practice; and, are nurses up to it? The findings suggest expanded practice roles are perceived positively by consumers and carers and therefore worthy of further investigation

The clinical nurse specialist and nurse practitioner roles : room for both or take your pick?

Objective:The aim of this paper is to contribute to pertinent discussions regarding advanced practice nursing roles. In particular discussion will focus on the potential implications for the developing nurse ractitioner (NP) role on the existing clinical nurse specialist (CNS) roles. Setting: The literature presented originates primarily from the United States of America (USA), United Kingdom and Australia. Specific emphasis is placed on the psychiatric/mental health nursing context. Primary argument: Amidst the confusion in terminology to describe and explain advanced, expanded or extended nursing roles, and to distinguish between the clinical nurses pecialist and the nurse practitioner, there is a need to establish clarity. The need for both clinical nurse specialist and nurse practitioner roles has been hotly debated in the USA. Conclusions: The roles of clinical nurse specialist and nurse practitioner may be complementary but fulfil different functions. It is therefore important that both roles be maintained and implemented in response to consumer and health service needs

Nurse practitioners and medical practice : opposing forces or complementary contributions?

Victoria, Australia has experienced significant changes in the structure and delivery of mental health services over the past three decades. As a result of these changes, there is now an expectation that consumers of services and their carers have increased opportunities to participate in the design and delivery of services. There currently exists a paucity of research that examines the degree to which this goal has been realized in practice. This article presents findings from a qualitative research study investigating theperceptions of consumers and carers regarding the degree to which the contemporary service system allows for their increased participation. Data were collected through in-depth interviews with consumers and carers. The findings suggest that consumers have identified an increased scope for their participation, although this varies considerably from service to service. Carers on the other hand described very little opportunity for participation at any level. Theresponses of carers suggest there may be some inherent difficulty in facilitating increased participation for both groups. Strategies to support carer participation are urgently required if the goals of state and national mental health policy in Australia are to be realized

Mental health nurse practitioner : expanded or advanced?

The role of the nurse practitioner has been described as the apex of nursing practice. Such a statement has significant implications for the professional status of nursing in its own right. The aim of this paper is to discuss the nature of the nurse practitioner role in Australia and the importance of distinguishing between advanced and expanded practice. Evaluations of the nurse practitioner role suggest that specifically nursing contributions lead to a high level of consumer satisfaction. If nursing in general, and mental health nursing in particular, is to maintain and further develop their professional status, debate about the implications of the nurse practitioner role, and the terminology used to describe its scope, is crucial

Exploring the expanded practice roles of community mental health nurses

Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality

Informal role expansion in Australian mental health nursing

PURPOSE. This study aims to determine the extent to which community mental health nurses are currently practicing beyond the traditional scope of nursing practice. DESIGN AND METHODS. A self-administered questionnaire was distributed to community mental health nurses in Victoria, Australia. FINDINGS. The majority of participants reported routine involvement in practices that would normally be considered beyond the scope of nursing practice, such as prescribing, ordering diagnostic tests, and referral to specialists. PRACTICE IMPLICATIONS. The extent to which the current mental health service system is dependent upon nurses transgressing professional and legal boundaries warrants further study. Psychiatrists and community mental health nurses need to work collaboratively to understand their respective knowledge and skills and to be clear about how they take responsibility for client care

Transcultural nursing in Australian nursing curricula

As a result of the fact that Australia is a multicultural society with many people who come from non-English speaking backgrounds (NESB), the objective of the present study was to discuss the extent to which transcultural nursing education is incorporated into undergraduate nursing curricula. A survey was undertaken to determine the availability of nursing modules for undergraduate nursing students through Australian university websites on ‘transcultural nursing’ or related modules. Although the inclusion of these modules into nursing education provide an opportunity for nurses to perceive and respond to different patient behaviors in multicultural societies, it is not sufficient to understand the complexity of the health care needs of a multicultural society. The survey findings suggest that many universities have not included transcultural nursing modules in their nursing curricula. To address this problem, more transcultural nursing modules need to be introduced into nursing curricula and nursing academics need to refine their attitudes about the importance of cultural aspects of patient care within nursing education

Australian mental health nurses' attitudes to role expansion

PURPOSE. This study examined the attitudes of Australian community mental health nurses toward role expansion. DESIGN AND METHODS. This study used an exploratory descriptive design. An anonymous questionnaire was completed by 154 community mental health nurses in metropolitan and rural areas to explore their attitudes to expanded practice. FINDINGS. Nurses demonstrated an overwhelmingly positive attitude toward expanded practice and considered all stakeholders, particularly consumers, would be the beneficiaries if nurses were legally able to undertake tasks such as prescribing medication. PRACTICE IMPLICATIONS. As a large proportion of the specialist mental health workforce, mental health nurses comprise a largely underutilized resource. With consumers identified as the primary beneficiaries of expanded practice, it is likely that nurses’ motivation to pursue expanded practice roles will assist in the provision of improved mental health care

Wanting to be heard : mental health consumers' experiences of information about medication

The complexities accompanying the prescription of antipsychotic medication forpeople experiencing a mental illness have been extensively documented in the literature. The viewsand experiences of consumers of mental health services, however, are almost entirely absent. Thispaper describes the findings of a qualitative study undertaken to examine the experiences ofconsumers, specifically in relation to education and decision making with regards to medication. Thefindings from a focus group conducted with consumers (n = 9) revealed an overall dissatisfaction withinformation provided and the opportunity to participate in decision making. Data analysis revealedfour major themes: information to consumers; acknowledgement and recognition of consumers; rolesof health professionals; and the experience of wellness and adherence. The findings suggest the needfor significant change if the goals of the Third National Mental Health Plan are to be realized

Expanded practice roles for community mental health nurses in Australia : confidence, critical factors for preparedness, and perceived barriers

As the momentum for nurse practitioner roles rapidly increases in Australia, little scholarly attention has been directed towards barriers to role expansion, the confidence necessary to undertake expanded practice roles (other than prescription of medication), or the educational preparation required for expanded roles. This paper reports on community mental health nurses' views regarding confidence to undertake expanded roles, their opinions regarding the necessary preparation for such roles, and barriers to role expansion. An questionnaire was administered to 296 community mental health nurses employed in metropolitan and rural settings in Victoria, Australia. In regards to various domains of expanded practice, nurses were least confident about prescribing but more than half (54%) reported that they would either "definitely" or "probably" feel confident. Over 90% reported "probably" or "definitely" feeling confident to make recommendations for involuntary treatment. Eighty-four percent and 79% reported similar levels of confidence in relation to ordering diagnostic tests and referring patients to medical specialists, respectively. Most (95%) agreed that extra educational preparation was necessary in relation to undertaking expanded practice roles successfully. Factors considered most strongly as barriers to expanded nursing practice included the medical profession, followed by fear of litigation, and government departments and policies