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.
- 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
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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.
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.
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.
Modifying the clinical reasoning cycle to enhance forensic mental health nursing utility
- Maguire, Tessa, Ryan, Jo, Levett-Jones, Tracy, Olasoji, Michael, Garvey, Loretta
- Authors: Maguire, Tessa , Ryan, Jo , Levett-Jones, Tracy , Olasoji, Michael , Garvey, Loretta
- Date: 2024
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 33, no. 3 (2024), p. 636-648
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- Description: Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
- Authors: Maguire, Tessa , Ryan, Jo , Levett-Jones, Tracy , Olasoji, Michael , Garvey, Loretta
- Date: 2024
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 33, no. 3 (2024), p. 636-648
- Full Text:
- Reviewed:
- Description: Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
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