The Cinderella of nursing care

The number of Australians with mental health problems is enormous, but education in this complex area has tended to be neglected – a situation that universities are now being urged to address in their training of nursing students.  By Antonia Maiolo.
It is estimated that 45 per cent of Australians aged between 16 and 85 will experience a mental health-related disorder in their lifetime, and experts say it is essential that all nurses are trained in psychiatric care to equip them to deal with related situations.
Scott Trueman, a lecturer from the centre for nursing and midwifery research at James Cook University, says that as the number of people living with mental health rises, universities need to increase nursing students’ awareness and knowledge of this complex topic.
“The research is overwhelming that mental health should be embedded in undergraduate degrees [for nursing students] because so many patients now have mental health issues,” he says.
Trueman, a trained mental health nurse, is undertaking a PhD study in the experience of rural and remote generalist nurses in caring for mental health patients.
Having worked in rural and remote locations for the past eight years, he says he has spoken to many nurses who feel stressed, uncertain, isolated and, on occasion, as though they do not have the necessary skills to care for this client population.
“The nurses I’ve spoken to say that unlike other areas of nursing, mental health up-skilling and ongoing training is not prioritised,” he says. “They often feel inadequate as they’ve not had their skills updated.”
Further to this, other factors often identified by nurses working in rural and remote areas is geographic isolation and a lack of resources.
“Nurses in rural and remote locations often don’t have other staff to assist or from whom they can seek advice,” he says. “That further reinforces their lack of confidence.”
However Trueman says that although urban nurses receive more continuing training, support and resources, it’s not conclusive that this translates into higher levels of confidence in caring for people with mental health problems.
He says a key problem is that less emphasis is often placed on mental health training; better initial and further training for rural and remote nurses as well as urban nurses in this field would encourage them to feel more confident in providing holistic care.
Professor Brenda Happell, director of the mental health nursing innovation centre recently established at Central Queensland University, North Rockhampton, says that mental health training for nursing students is commonly overlooked.
“The breadth and depth of training in mental health nursing varies considerably across Australian universities,” she says. “Generally it receives much less attention than acute medical-surgical nursing.
“In some universities it doesn’t exist as discrete content but is integrated into other subjects. That means it’s often neglected or misinterpreted by nurse academics with no background in mental health nursing.”
Louise Byrne, course coordinator of CQU’s mental health nursing program, says that regardless of where someone works in health, they are bound to interact with people who are dealing with mental health.“The better nurses understand these issues, the better they can perform their roles,” she says.
To reduce stigma as well as increase knowledge about the issue, Flinders University has launched a free online mental health course, or MOOC, which started on October 28. Titled “Mental wealth: know it and grow it”, it is not restricted to people with health backgrounds and has more than 150 registrants from about eight countries. It also aims to encourage participants to look out for their own and others’ mental health. 
The course was designed by Professor Eimear Muir-Cochrane, chair of nursing at Flinders, who says stigma among academics, general nurses and the public has been very high.
“People fear mental illness and have prejudices about difference as well as perceptions that people may have brought it on themselves, for example,” Muir-Cochrane says.
Such fears are driven by ignorance and a lack of understanding and education, she says.
The problem is that nurses need to be able to identify mental health problems because they come into contact with patients affected by them “every day in all nursing settings”, she says.
“Due to the link between obesity, cardiac and metabolic issues and mental illness it’s likely that nurses are frequently encountering patients in medical settings with mental health problems that have not been addressed,” she says.
In recognising the importance of giving nursing students early exposure to mental health care, the University of Adelaide this year for the first time offered mental health training placements to first-year students.
Associate lecturer Briony Lia says students are already benefiting from the new program.
“For first-year students, working in a mental health setting puts them out of their comfort zone and challenges them, but it also provides them with great opportunities for personal and professional growth,” Lia says.
“We’ve already seen skills development among these students, such as recognizing the signs of mental illness, changes in people’s behaviour and being able to communicate effectively with those who suffer from a mental illness.”
Lia says this training will have flow-on benefits in whatever area of nursing the students work in, and will give them a more holistic approach to nursing.
First-year nursing student Candice Lee says the experience has given her a profound insight into mental health. “This experience will definitely be invaluable in any area of nursing,” she says. “For example, my communication skills were challenged in the mental health setting but the techniques I’ve learned to overcome this will be transferable to my further learning as well as my professional practice.”
Nursing student Isla Fraser who has completed two mental health work placements says gaining experience working with patients with a mental illness is vital for students.
“It gives an insight into how to manage and support patients with specific illnesses,” she says. “I believe this is important because mental illness is so prevalent.”
Careers in mental health
Training in this field could also encourage students to look more favourably on mental health nursing as a career.
Although there was an increase between 2007 and 2011 in the supply of mental health nurses, from 69 to 77 full-time equivalent positions per 100,000 population, Happell claims research shows that mental health is one of the least popular areas of nursing practice among students.
The 2011 National Health Workforce Dataset shows that employed nurses, both registered and enrolled, who indicated they were working principally in mental health, comprised about one in 20, or an estimated 17,916 out of 283,587 nurses employed in Australia.
“Adequate quality and quantity of theory and practice in mental health nursing can be influential in producing more positive attitudes to this field as a viable career option,” Happell says.
Research confirms, however, that nurses themselves have similar stigmatising views about people with mental illness as do people in the general population, she says, and while physical and mental health problems all too frequently coexist, the latter are not usually detected or addressed.
“Mental health nursing education, including theory and clinical practice,” she says, “is therefore crucial in helping to engender more positive attitudes towards people with mental illness so we can provide good quality care.” 

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