This assignment should include:
� A brief, clear description of the change
� The rationale for the change: political, research and organisational contexts
� An examination of user and carer involvement in the change
� Leadership, “risk” and management aspects of the change
� Ethical elements of the change, drawing on appropriate theory
� The current and potential consequences of the change: the “winners” and “losers”
An essay discussing a change in the delivery of mental health nursing clinical practice that
the student has been involved in
Brief Description of the change
Nurses constitute the largest proportion of the staff involved in the mental health work
of the UK’s National Health Service (Bee, Playle, Lovell, Barnes, Gray and Keeley, 2008).
Clinical governance is the foundation on which healthcare services are improved. It entails
professional management, resource use, risk management and satisfaction of the patients with
the care or the service that the health care professionals provide (Sway, 2004). However, the
overall goal of mental health service lies in satisfaction. To satisfy the patients, mental health
nurses require adopting proper assessment that entails a strong focus on engagement.
Engagement is important, as the National Health Service (NHS) has stressed on patients
being fully involved in their own care. Additionally, The South Essex Partnership University
NHS Foundation Trust views the service users as important in engaging patients to improve
quality of care (The King’s Fund, 2012).
Assessment of the mental health situation is necessary for planning or suggesting
action for change. Planning for change where people are involved requires careful assessment
of their needs. It is important to assess and plan carefully to make sure that the lives of the
people involved remain intact in attaining the desired improvement. Mental health nursing
assessments involve asking questions that aim at understanding the experiences of the
persons receiving the service. It involves understanding of what happens to the people as they
Change in Mental Health Nursing 2
receive service or care as well as understanding what they may be experiencing in the present
(Bach & Grant, 2009). This information is vital in establishing what change needs to be
effected to improve the patients’ experience.
One important change in the nursing practice in recent years is involving the patient in
the care process. There is a shift from the traditional approach of the nurses simply taking
care of the patients to engaging them in the assessment of their conditions to better
understand them in the context of their families (Baker, 2003). Mental health professionals
require practicing high standards of professionalism to effectively engage the patients. Their
training requires a change to incorporate therapeutic clinical skills that are closely tied to
relationship building, engagement and communication. This is supported by a study that
examined the service user and carer views about the mental health nurses registered in the
UK that revealed that service users have inadequate access to information provision, poor
inter-professional communication and they are presented with few or no opportunities for
collaborative care (Bee, Playle, Lovell, Barnes, Gray and Keeley, 2008).
The rationale for the change: political, research and organisational contexts
The political reason for improved communication skills in mental health nursing is
factored in because of the involvement of the patient’s family in care. The mental health
nurses must be able to communicate with the carers who most often happen to be family
members. The carers are the ones closest to the patients and they wish to be engaged in the
assessment process. The carers desire involvement in a collaborative team approach in the
care where they are taken as partners. They express a desire to be informed throughout the
assessment, treatment and after care planning for their patient. This is because they are the
most concerned people in the wellbeing of the patient and desire to ascertain that they receive
the best care possible. Mental health nurses must recognize this need and communicate
Change in Mental Health Nursing 3
effectively with the carers. Involving the carer not only serves an important role in good care
planning but also in risk management (Worthington & Lead, 2010).
There is a common misconception that learning communication and interpersonal
skills in nursing school may not be as essential. This is because the students are able to
express themselves within different social setting through life. They assume that they are
already good at communicating although there is a great need to improve the human
relationships. There are many factors that influence how people respond to situations and
nursing students require learning how to communicate effectively in the health care settings.
The World Health Organization and the National Health Service among other health
organizations emphasize on how important patient focused communication between the
career and the patient is (Bach & Grant, 2009). These organizations indicate that effective
communication is essential in attaining patient satisfaction, decision making of inclusiveness
and for an efficient health service. It is noteworthy that many nurses rate themselves highly
on communication skills but the patients maintain that they remain unsatisfied and that the
nurses require improving (Timmins, 2007).
Nursing students must undertake adequate research to improve their communication
skills. They require taking responsibility to maintain updated knowledge and skills through
continuous professional development that is life long and beyond the classroom. Continued
evaluation, supervision and appraisal are necessary to continuously improve performance in
care and service delivery. They require applying the relevant theories and research to increase
their knowledge in all skills required in nursing and communication in particular (Ellis,
2010).
At the organizational level, the need for improvement in communication skills is dire.
It is reported that due to poor communication skills and the facilities that enable these skills,
there is a high risk of care breaking down after patients with severe mental illness are
Change in Mental Health Nursing 4
admitted (Sainsbury Centre for Mental Health, 1998). This is particularly evident in those
males that are diagnosed with psychotic disorders, those who come from minority ethnic
groups, those who live alone. Sometimes those patients are discharged from hospital without
being accorded after care services. This is indicative of the perverse problem of engagement
where the mental health nurses are unable to offer effective communication that promotes
health (Sainsbury Centre for Mental Health, 1998). The health system has failed to put
structures that ensure that the nurses conduct proper assessment based on engagement policy
to avoid the frequent breakdowns. The nurses sometimes report that they do not know how to
engage with those problematic users who display risky behavior and inability to cope (Repper
& Ford, 1994). These are the patients with the greatest need and yet they remain unsatisfied.
They mostly feel that that the services are not acceptably appropriate, are inaccessible and
that the mental health nurses must be empowered to communicate effectively with them. This
is because even when they remain exceedingly difficult to deal with, they are the most
vulnerable group of the mental health service and therefore require the most professional
communication structures (Macpherson, Summerfield, Haynes, Slade and Foy, 2005). The
organizational decision making bodies require putting up the necessary structures and
practice policies for engaging effectively with the patients and promoting their social
inclusion.
An examination of user and carer involvement in the change
It has become increasingly important for service users and carers to be involved in
developing, organizing and delivering health care. The incorporation of the users in decision-
making has been attributed to a shift in consumerism ethos where by consumer satisfaction is
emphasized (Bee, Playle, Lovell, Barnes, Gray and Keeley, 2008). This is because it has
garnered substantial recognition as a quality indicator. In the health care system, a trend of
collating information about how users perceive the services has been on the rise. This
Change in Mental Health Nursing 5
indicates that the system’s new emphasis on providing people cantered services and in public
involvement in planning (NHS Executive, 2000).The new approach is based on the premise
that users have a say about their care and it is important to validate their views. One of the
benefits to health care system is that such views or opinions serve the purpose in contributing
to quality assurance. This is because it evaluates the care and provides information (Mediings
& Perkins, 1999).
Research on user and carer views on mental health care staff has indicated that they
expect them to be professional and able to use a multidisciplinary approach in finding
solutions to mental illnesses. In addition to this, they expect them to forge good relationships
with them. The relationships are formed through information sharing and establishment of
clear communication pathways. They consider the quality of the relationship as the most
important element of the care process. It is important in influencing other care outcomes such
as treatment adherence (Ricketts, 1996).
Leadership, ‘risk’ and management aspects of the change
There are different types of leadership styles including the pace setter which is NHS’s
(The King’s Fund, 2011). Its leadership style outlines the demanding targets and is reluctant
to delegate and collaborate with the leaders at lower ranks. It has a strong commitment to
rewarding efforts made towards reaching the set targets. This top-down culture is identified
as the major cause of poor care. This happens in when senior managers impose commands
and uphold a rigid controlling culture on staff (The King’s Fund, 2011). This culture
demoralizes staff rendering them without authority to make decisions aimed toward quality
care. It is reported that leadership that inhibits clinical engagement leads to failure of clinical
governance. For change that encourages communication and users’ and carers’ engagement
to take root, the health care system require embracing other forms of leadership ( Department
of Health, 2008).
Change in Mental Health Nursing 6
The users and carers opinions provide the mental health organizations with the
appropriate risk management mechanism for engagement (Mediings & Perkins, 1999). This
is because their opinions are verified in accordance to the widespread view of the general
mental health clientele. This is one benefit of adopting mechanism for involving the patients
because the positive results are assured provided the mental health nurses follow the
recommendations.
Managing engagement may be financially demanding and time consuming for the
training health care system (Marquis & Houston, 2011). A survey involving the proposed
policy for engaging service users and carers that were participating in service development in
forty-six mental health service institutions in England showed disappointing findings. It
indicated that only twenty-six per cent of the institutions provided transport to the users and
only 30 per cent of the institutions provided transport to the carers. Additionally, only 15 and
12 per cent provided pay to the users and carers for their time respectively (Ryan & Bamber,
2002). It is thus important for the management to prepare adequately for the financial and the
administrative costs that accompany effective engagement.
Ethical elements of the change, drawing on appropriate theory
User and carer engagement through communication is based on the theoretical and
conceptual framework that that the interaction between the service users is in the form of
self-help and the interaction between users and professionals indicates working together to
manage local services and in planning of the overall services (Peck, Gulliver, & Towell,
2002). The ethical issue that emerges in the change of engagement lies in the idea that they
may not be fully engaged in user led services as they ought to be. It appears that much
engagement may only occur on information sharing level rather than in planning overall
services. There exists resistance by professionals who have difficulties viewing users as
experts and perceive it unwise to transfer power to them. This is perhaps because they fear
Change in Mental Health Nursing 7
that the users’ or carers’ judgment on mental health issue may be substandard (Peck, Gulliver
and Towell, 2002).
Mental health nurses may be faced with difficulties in adopting interventions
proposed by the carers and users particularly because every condition is unique. This may be
further aggravated by the fact that their views are undocumented in policies or guidelines that
the nurses follow in service delivery. However, it is important for the nurses to prioritize on
effective communication with the users and carers. This is because it is more likely for this
integrated partnership to come up with the most appropriate interventions
The current and potential consequences of the change: the ‘winners’ and losers’
The active involvement of users in mental health service delivery will allow them to
serve as experts about their illnesses, shedding more light on mental illnesses for the wider
mental health system by sharing their important perspectives on mental health. Additionally,
the users may benefit from additional therapeutic features through engagement because of
social inclusion and better communication avenues for sharing information with other users.
When the nurses improve their communication skills to better engage the users, they also
benefit from getting a better understanding of mental distress. This in turn helps them to
prepare better care packages particularly when it comes to preventing advanced mental
distress. This is because the patients may provide information on how to predict recurrence of
distress before it happens and respond appropriately (Borrill, 2000). The downside of the
change may be felt because of the extra financial and management tasks that accompany the
change. This is because engagement is time consuming and it requires extra funds to
implement which may further strain the National Health Service finances.
Clearly, a change in the engagement of patients and carers in the NHS is inevitable if
better service delivery is to be achieved. The success of engagement strategies in different
mental health institutions depends largely on the nurses’ capacity for effective
Change in Mental Health Nursing 8
communication. Effective communication skills require being entrenched into the nursing
curriculum in a stronger way. The graduating nurses must be equipped with the necessary
skills for communicating effectively with the carers and users while performing assessments,
treating and planning their aftercare. This will ensure that the user’s benefit from the best care
plans. It is also important to note that the NHS plays a vital role in instituting this change. It
requires a leadership style that encourages engagement, and effective planning and
management in implementing the change. It is also important for nurses to embrace the
position of users and carers as experts and to desist from resisting it because their
perspectives play a big role in informing care packages. It cannot be emphasized enough that
indeed engagement is inevitable for the wellbeing of mental health institutions and the
society at large. Furthermore, research has proven that this change must be effected in the
UK’s mental health institutions.
Change in Mental Health Nursing 9
Bibliography
Department of Health., 2008. High Quality Care for All: NHS next stage review report.
Retrieved June 27, 2013, from Department of Health:
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Bach, S. and Grant, A., 2009. Communication and Interpersonal Skills for Nurses. Padstow:
TJ International Ltd.
Baker, P. J., 2003. Assesment: The foundation of Practice. In P. J. Baker, Psychiatric and
Mental Health Nursing: The Craft of Caring. London: CRC Press.
Bee, P., Playle, J., Lovell, K., Barnes, P., Gray, R.. and Keeley, P., 2008. Service user Views
and Expectations of UK registered Mental Heallth Nurses: A Systematic Review of
Empirical Research. International Journal of Nursing Studies, 442-457.
Borrill, J., 2000. Developmenyts in Treatment for People with Psychotic Experiences.