MENTAL HEALTH NURSING SKILLS AND KNOWLEDGE

Mental Health Nursing Skills And Knowledge



Mental Health Nursing Skills And Knowledge

Commentary on nursing intervention

The intervention in this study was fairly complex in that individual units determined a workplace change to implement. For 6 months, change development and implementation was facilitated by a trained bachelor's prepared nurse who devoted efforts solely to this project. Changes included things like enhancing documentation activities, increasing medication supplies, and implementation of a communication tool related to patient transfers. Changes before and 6 months after the workplace change were determined for system data (unit/hospital characteristics), nurse outcome data (surveys on satisfaction, work quality, etc.), and patient outcomes (ADLs, satisfaction, etc.). Analysis involved “nesting” outcomes for nurses within units. Patient outcomes were not nested since different patients were used at data collection points.

Hospitals studied all were in Ontario Canada. Nurses were mostly females (95%) prepared at diploma or certificate level (76%). Experience levels varied with 29% of nurses having less than 5 years and 20% having > 25 years. Most units (60%) used “total patient care delivery model,” which was not defined. Patients were 46% medical, 54% surgical.

Six-month findings indicated positive changes in nurse perceptions of the work and work environment. This is one of few studies that measure change over time with a work environment change (probably due to the complexity of such research designs). Researchers discussed the significant contributions of nurse and unit characteristics on outcomes. For example, RNs with baccalaureate degrees reported higher levels of job stress than those with diplomas… could the “added knowledge and understanding that comes with degree education and the greater sense of accountability” be active in these findings? Unit characteristics such as proportion of part-time nurses also impacted outcomes with units having more part-time nurses having higher average nurse ratings of job satisfaction. Finally, hospital and unit characteristics impacted patient outcomes… patients in teaching hospitals reported better perceptions of quality and increased independence than did community hospital patients.

Implications from this study are that fairly simple workplace changes can quickly (within 6 months) alter nurse and patient outcomes. Authors described issues with nurse generations, nurse experience, and patient-to-nurse ratios that deserve further study.

Nurses comprise a large proportion of the hospital workforce, and the centrality of nursing in determining the overall quality of patient care is unarguable. Hospitals and their patients depend on nurses around the clock every day.

Improving communications with clinicians—physicians and nurses—and strengthening their level of engagement in quality improvement initiatives can take many forms. One approach is to engage clinicians by involving them on governing boards and board committees. Hospital boards establish institutional goals, set institutional policies, and have legal and moral responsibility for the quality of care provided in their institutions. Inviting and hearing the voices of physicians and nurses in governance deliberations and decision making would seem intuitively to be both appropriate and important.

Of course, all board members should be selected on the basis of their integrity, their commitment to the institution's mission and values, proven competence in disciplines in which ...