Using the nominal group technique to determine a nursing framework for a forensic mental health service : a discussion paper
- Maguire, Tessa, Garvey, Loretta, Ryan, Jo, Olasoji, Michael, Willets, Georgina
- Authors: Maguire, Tessa , Garvey, Loretta , Ryan, Jo , Olasoji, Michael , Willets, Georgina
- Date: 2022
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 31, no. 4 (2022), p. 1030-1038
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- Description: The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions. © 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
- Authors: Maguire, Tessa , Garvey, Loretta , Ryan, Jo , Olasoji, Michael , Willets, Georgina
- Date: 2022
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 31, no. 4 (2022), p. 1030-1038
- Full Text:
- Reviewed:
- Description: The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions. © 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
Exploring adaptations to the clinical reasoning cycle for forensic mental health nursing : a qualitative enquiry
- Maguire, Tessa, Garvey, Loretta, Ryan, Jo, Levett-Jones, Tracy, Olasoji, Michael, Willetts, Georgina
- Authors: Maguire, Tessa , Garvey, Loretta , Ryan, Jo , Levett-Jones, Tracy , Olasoji, Michael , Willetts, Georgina
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 32, no. 2 (2023), p. 544-555
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- Description: Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to ‘own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team. © 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
- Authors: Maguire, Tessa , Garvey, Loretta , Ryan, Jo , Levett-Jones, Tracy , Olasoji, Michael , Willetts, Georgina
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 32, no. 2 (2023), p. 544-555
- Full Text:
- Reviewed:
- Description: Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to ‘own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team. © 2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
Exploring the role of the nurse unit manager in forensic mental health inpatient units : a qualitative study
- Maguire, Tessa, Mawren, Daveena, Ryan, Jo, Ennis, Gary, Olasoji, Michael
- Authors: Maguire, Tessa , Mawren, Daveena , Ryan, Jo , Ennis, Gary , Olasoji, Michael
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 32, no. 6 (2023), p. 1756-1765
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- Description: Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
- Authors: Maguire, Tessa , Mawren, Daveena , Ryan, Jo , Ennis, Gary , Olasoji, Michael
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 32, no. 6 (2023), p. 1756-1765
- Full Text:
- Reviewed:
- Description: Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
Developing entrustable professional activities to enhance application of an aggression prevention protocol
- Maguire, Tessa, Willetts, Georgina, McKenna, Brian, Daffern, Michael, Garvey, Loretta
- Authors: Maguire, Tessa , Willetts, Georgina , McKenna, Brian , Daffern, Michael , Garvey, Loretta
- Date: 2023
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 73, no. (2023), p.
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- Description: Aim: The research aim of this study was to seek feedback from prevention of aggression training experts about the suitability of Entrustable Professional Activities (EPAs) as an assessment tool for an Aggression Prevention Protocol. The protocol was designed to structure intervention to prevent aggression and reduce the use of restrictive practices following risk assessment using a validated instrument (the Dynamic Appraisal of Situational Aggression). Background: Preventing aggression and limiting the use of restrictive practices are key priorities for inpatient mental health services. Assessing clinical activities using a competence framework has limitations, particularly when determining complex interventions. EPAs could provide a suitable method for assessing complex clinical activities like de-escalation and limit setting, which comprise some of the interventions in the Aggression Prevention Protocol. EPAs are new to forensic mental health nursing; therefore, feedback was sought regarding the utility of EPAs to assess aggression prevention interventions. Methods: Data were collected via focus groups including 11 aggression prevention experts from Australia and New Zealand. A thematic analysis, comparative analysis and a Strength, Weakness, Opportunity and Threats analysis was conducted. Results: Three themes were interpreted from the data: 1) Frameworks such as the APP are needed to work towards elimination of restrictive practices; 2) APP-EPAs afford an opportunity to set the standard for practice; and 3) ‘who watches the watchers’, were identified by the experts as well as areas to enhance EPAs prior to introduction into practice. Conclusions: EPAs address a practice-gap and offer a framework to assist movement towards elimination of restrictive practices, while prompting best-practice, self-reflection and practice improvement guidance. © 2023
- Authors: Maguire, Tessa , Willetts, Georgina , McKenna, Brian , Daffern, Michael , Garvey, Loretta
- Date: 2023
- Type: Text , Journal article
- Relation: Nurse Education in Practice Vol. 73, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Aim: The research aim of this study was to seek feedback from prevention of aggression training experts about the suitability of Entrustable Professional Activities (EPAs) as an assessment tool for an Aggression Prevention Protocol. The protocol was designed to structure intervention to prevent aggression and reduce the use of restrictive practices following risk assessment using a validated instrument (the Dynamic Appraisal of Situational Aggression). Background: Preventing aggression and limiting the use of restrictive practices are key priorities for inpatient mental health services. Assessing clinical activities using a competence framework has limitations, particularly when determining complex interventions. EPAs could provide a suitable method for assessing complex clinical activities like de-escalation and limit setting, which comprise some of the interventions in the Aggression Prevention Protocol. EPAs are new to forensic mental health nursing; therefore, feedback was sought regarding the utility of EPAs to assess aggression prevention interventions. Methods: Data were collected via focus groups including 11 aggression prevention experts from Australia and New Zealand. A thematic analysis, comparative analysis and a Strength, Weakness, Opportunity and Threats analysis was conducted. Results: Three themes were interpreted from the data: 1) Frameworks such as the APP are needed to work towards elimination of restrictive practices; 2) APP-EPAs afford an opportunity to set the standard for practice; and 3) ‘who watches the watchers’, were identified by the experts as well as areas to enhance EPAs prior to introduction into practice. Conclusions: EPAs address a practice-gap and offer a framework to assist movement towards elimination of restrictive practices, while prompting best-practice, self-reflection and practice improvement guidance. © 2023
- Maguire, Tessa, Garvey, Loretta, Ryan, Jo, Willetts, Georgina, Olasoji, Michael
- Authors: Maguire, Tessa , Garvey, Loretta , Ryan, Jo , Willetts, Georgina , Olasoji, Michael
- Date: 2022
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 31, no. 2 (2022), p. 358-368
- Full Text: false
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- Description: Forensic mental health nursing (FMHN) is a specialized field, designed to meet the needs of people who have a serious mental illness across the criminal justice system, inpatient services and community. Frameworks can assist assessment, planning, intervention, documentation and evaluation of nursing care. However, there is no prior research investigating frameworks in FMHN. This study aimed to explore the Nursing Process (NP) and the Clinical Reasoning Cycle (CRC), with nurses, to determine a suitable framework for use service-wide. A Nominal Group Technique was used to facilitate exploration of the two frameworks, where open-ended verbal and written responses collected from a Nominal Group were thematically analysed, and the participants voted on their preferred framework. Seventeen nurses from a state-wide forensic mental health (FMH) service participated. The four main themes were as follows: challenges to current practice, limitations of the NP, perceived benefits of the CRC and addressing implementation. Consensus was reached with the nurses selecting the CRC as the framework of choice. This is the first study to explore frameworks to guide practice in FMHN. Nurses in this study considered the CRC to be a suitable framework for novice through to expert, offering a contemporary framework to guide nursing care in complex FMH settings. Some adjustments to the existing cycle were suggested to emphasize recovery-oriented practice, and inclusion of family and carers. Any changes to the cycle warrant exploration with the interdisciplinary team and consumer carer workforce. © 2021 John Wiley & Sons Australia, Ltd.
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