Task: Investigating a clinical governance/clinical practice issue Written paper.
Students will need to select an issue from the list in FLO.
The first step is to select a nursing concern that is directly related to quality and safety in health care. Next, you will need to research the topic.Clinical Communications
Prevention of FallsHealthcare Associated Infection
Answer to Question: NURS2006 Ageing, Health And Care
Introduction, Background and Importance
Patients with severe mental illnesses (SMIs), who are in acute mental care, have a higher incidence of developing physical problems.
Lifestyle choices, psychotropic medication, psychiatric symptoms as well disparities in care can all have an impact on their physical and mental health (Unsworth McKeever, McKeever, and Kelleher 2012).
SMI patients may experience bacterial, viral, and nutritional disease.
SMI patients have a specific problem in that they need to be recognized and addressed. 2011).
MHNs will need to acquire the skills and knowledge to assess and manage SMI patients’ health.
This is a vital nursing issue. MHNs should be trained to deal with the physical health of these patients in acute, inpatient mental health settings.
Liaw et.al. reported that there is a significant difference in the level of confidence and willingness to assume the role. 2014).
It is difficult for nurses to understand their role in providing physical care. They need appropriate skill training and role clarification.
SMI suffers from poor physiological health when they are admitted to acute care. This is in contrast to the general population (Chua. 2013).
MHNs should be trained in skill development and training to meet the needs of these patients and to provide overall well-being.
Critical Analysis and Findings
CASP Appraisal Tools for Qualitative Studies
Was it clear what the aims were?
The research objective was the investigation of the views and perceptions regarding mental health nurses (MHNs), and their mental health practices for acute inpatients in these settings.
The research also aims to assess the role and confidence of MHNs in physical assessment and care management.
It will also identify the education and training of MHNs that are required to become SMIs.
This was important as there is physiological decline in severally mentally ill patients in acute settings.
Nurses must understand patients’ needs and offer appropriate interventions to address them in order for quality health care and safety (Mackintosh Rainey, Sandall 2011).
This study is relevant because it examines how MHNs approach and train patients to address their physical needs.Is a qualitative methodology appropriate?
The researcher examined the attitudes of nurses during the research in acute mental hospitals to determine if they were open to addressing the physical needs of SMIs.
This method is suitable for the research goal of self-reported questionnaires and audit of case study.
These methods helped to identify the perception of MHNs concerning physical health and confidence in reviewing patients’ needs.
Was the research design suitable to meet the research objectives?
The research design was appropriate because it showed the perceptions of MHNs regarding the review of the physical health of severally mentally ill people in acute mental environments.
The self-reported questionnaire as well as an audit of cases were used for the purpose of assessing the confidence of MHNs regarding their ability to address the physical health needs. Also, the compliance towards training was assessed.
The recruitment strategy was it appropriate for the research’s goals?
The researcher has described the sample size of the study, which was six acute wards located in acute inpatient settings.
The nurses were drawn from a variety of sexes and were recruited regardless of their gender, age or previous experience.
The selection of the chosen sample was based on their qualifications. Unqualified staff were excluded from this study.
Were the data collected in a fashion that addressed the research problem?
The data collection was justified, as it was demonstrated in the paper by a self reported questionnaire and audit of the case notes that the descriptive design is.
As there was no established questionnaire, data collection tools needed for this study were developed.
The new tools were carefully reviewed by an expert panel which consisted of a Consultant Nurse and Trust physical healthcare policy, a doctorate student mental health lecturer, and a senior statistician.
The data form was clear, and there wasn’t saturation because the sample size included all ages, genders and experiences.
A proper consideration has been given to the relationship between participants and researchers
There were questions to be asked that addressed the research aims.
The data was collected using a self-report questionnaire and audit of case study that showed nurses’ attitudes towards assessment of SMIs in acute setting.
London, UK was chosen for the collection of records. This included patients who were at least 1 week old and were admitted to wards where LH was the Physical Health Lead Nurse.
Do ethical issues have been taken into account?
Trust’s Ethics Committee, Research and Development Committee approved the research study.
Before accessing nurses to wards, the wards managers had to give permission.
The Department of Health Research Governance Guidelines 2005b and the Data Protection Act 1998 were both considered throughout the study.
Did the data analysis go far enough?
As the nurse responses were high, the data analysis supported the research goals.
The data showed that nurses were willing to accept the role of health care assessor with proper training.
The findings showed that there was no diversification.
The findings showed that SMI patients who are able to embrace skills and train can overcome any barriers and take charge of their physical health.
Do the findings of this study make a clear statement?
Researchers were able to support their evidence because they have been adequately discussed.
The results revealed that MHNs would be willing to address the physical needs of SMIs and take part in their health assessment.
There was also a significant difference in perceptions of MHNs’ responsibility and practices regarding role clarification and skill training to fulfill the physical care role and address physical needs for SMIs.
How valuable is the research?
Research is useful as it enables physical health assessments and training of mental health nurses. This is essential to address the SMI patients’ declining physical health.
As a result, severe mental illness patients in acute inpatient mental hospitals are at risk of their physical and psychological health.
This is a major problem in mental nursing. Therefore, this study was helpful in that it provided a framework for physical health assessments and skill training for nurses to address the physical needs and concerns of mentally ill patients in acute settings (Scott und Happell 2011).
Joanna Briggs Institute Critical Appraisal Instrument For The Cross Sectional Study.
What criteria were used to determine inclusion in the sample?
The paper did not specify the criteria for inclusion as it only listed the sample size which included 585 qualified nurses from a large NHS workforce within a mental healthcare setting.
They speculated that nurses from the sample had an additional qualification as RN/RGN nursing because they work in an inpatient setting rather than in the community.
They also believed that the sample size nurses had been trained in the mental health care of the mentally ill with great confidence.
What were the details of the setting and study subjects?
Yes, both study subjects and settings were defined.
The sample included qualified mental health nurses, 52% of whom (n=585) voted for physical health services from the National Health Service Mental Health Trust (UK).
Hypothesized, the sample size consisted of RN/RGN working in inpatients rather than in community settings. They also received training on physical care for the severely mentally ill.
Were there standard, objective measures of the condition?
During selection of sample size, they hypothesized a standard criterion to ensure that the nurses in the sample are highly-qualified and have an additional qualification such as adult RGN/RN.
They also assumed they were familiar with working in an inpatient mental hospital setting.
This indicates bias and a lack of matching of the essential characteristics that fulfill the objective criteria.
Were there confounding variables identified?
Confounding factors are hard to assess as they can have an impact upon the outcome.
Because there were no comparisons, the paper did not identify any potential confounders. Additionally, bias was not affected.
Were strategies developed to combat confounding variables?
The study design and data analyses dealt with strategies to deal the confounding factor.
The adjustment of the confounding factors was done using cross-sectional research and was done during the stratification/matching of the sample sizes.
Multivariate analysis is used in this study for measuring confounding factor to determine the associations between attitudes or practice.
Was the measurement of the results reliable and valid?
The validation of the measurement tool used in this study had an important impact on validity of the outcome evaluation validity.
The psychometric testing stage Physical Health Attitude Scale for Psychological Health Nurses was used. This consisted of a postal survey of 585 nurses from the UK NHS.
The PHASe standard questionnaire measures clinical practice, training and demographic characteristics.
This validates the validity of the measured outcomes.
Was statistical analysis performed in an appropriate manner?
The study used multivariate analysis as its statistical method.
The study identified predictors for the outcome as physical healthcare practice and positive attitudes within the sample.
The confidence to practice healthcare was linked to four variables: RGN qualification and inpatient sets. It also correlated with male sex before receiving physical health training.
Multivariate analysis is a useful tool for predicting the unknown value from the known value of predictors and variables.
CASP Appraisal Tools For Systematic Review
Did the review address a clearly defined question
Yes, we have discussed the nursing issue in which MHNs are required to work in acute settings that deal with deteriorating patients or unpredictable events.
Study has focused on the nurse-patient interaction. This interaction is crucial in such a challenging environment for the interaction between inpatients, MHNs, and MHNs.
The search result was that 23 papers were selected from 425 in reliable databases CINAHL or PsycINFO.
Did the authors research the best type of papers?
The goal of this review is to synthesize the literature regarding acute inpatient mental health settings. It will also focus on the communication between inpatients (MHNs) and inpatients.
Through inclusion and exclusion criteria, there is a suitable study design for the review.
English papers must have been peer-reviewed. These papers should be from English and cover the nurse-patient interaction in acute mental hospital settings.
Do you believe all the relevant and important studies were considered?
The study was conducted using reliable databases via electronic searches through PsycINFO CINAHL, OvidMedline and PsycINFO.
All peer reviewed papers published in English language since 1999 that dealt with nurse-patient interaction were included.
Did the reviewers do enough to assess quality of included studies?
While there was no rigorousness of the study, the authors maintained a nurse-patient perspective. Data collection was meticulous as they had done a critical search of reliable databases to gather the information.
The inclusion and exclusion criteria were used to select 23 papers from 425. Only those papers met the criteria of the research question.
Would it be reasonable to combine the reviews?
Since the inclusion criteria were explicitly discussed, the results in all papers were the same. There was no room to vary.
The results of the review showed that nurse and patient communication is important. These communication methods include interpersonal approaches and communication skills that are able to adapt to the unique and difficult mental health environment.
What were the overall results of this review?
Yes. In the review, the author explained the research question and used thematic analysis to present the results.
The meta-synthesis of qualitative research revealed that nurses in mental health settings were subject to interpersonal risks and taking risks in order achieve positive patient outcomes.
This is a critical parameter in patient-centred health care.
How exact are the results?
Confidence intervals cannot be used because this is a systematic review of literature.
Is it possible to apply the results to the local community?
The main limitation of this paper’s analysis is the fact that not all themes were studied in a large sample. This makes it difficult to generalize to other contexts and populations.
Were all important outcomes taken into account?
According to the qualitative review, nurse-patient interaction is crucial for nurses in providing patient-centred care in acute mental healthcare settings.
It is crucial to address the physical needs for severe mental illness (SMI) patients.
Are the benefits of the benefits worth the cost?
The benefits and harms were worth it.
Because it allows for patient-centred care and addresses the psychosocial needs SMIs, the study of nurse-patient interaction has great importance.
The original research question asked about providing health care management for mentally ill patients.
The articles provided valuable information after a qualitative, quantitative, and systematic review. This shows that MHNs can address the physical health issues of SMIs. However there were differences in their perceived role and confidence in addressing these needs.
For MHNs to recognize SMIs’ physical health needs and understand their role in addressing these needs, they must have the right training and skills.
SMIs require nurses to have positive attitudes and responses. However, they do not receive the necessary training or skill development.
This systematic review showed that nurse-patient interaction was important in these complex settings. It also highlighted the need for patient-centred care.
This would indicate that MHNs are required to have a positive attitude and support their well-being in order to deliver safe and competent care in such unpredictable and difficult settings.
MHNs must improve the physical and mental health of SMIs in order to promote their overall well-being.
These findings are significant. They provide the opportunity for future studies to train nurses to fulfill their role as physical health caregivers.
ReferencesChua, W.L., Mackey, S., Ng, E.K.C.
2013, and Liaw S.Y.
Qualitative study: Front-line nurses’ experiences dealing with ward patients that are in danger. International nursing review, 60(4), pp.501-509.
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The interaction between nurse and patient in acute adult-inpatient mental health units: A review of qualitative studies.
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International Journal of Mental Health Nursing. 22(5). pp. 409-417.
Scott, D. & Happell B. 2011, 2011.
A high rate of unhealthy lifestyle and poor physical health in people with severe mental illness. Issues in mental health nursing, 32(9), pp.589-597.
Unsworth J., McKeever M. and Kelleher M., 2012.
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