Critical appraisal concepts and methods

¶ … Psychosocial Care in Mental Health Nursing

The study conducted by MacNeela, Clinton, Place, Scott, Treacy, Hyde, and Dowd (2010) dealt with the issue of psychosocial care in mental health nursing. Discussed here will be the method and presentation used in the study, along with the relevance and significance of the findings, the evidence that was offered, and whether that evidence was the most appropriate when contrasted with other evidence. The method and presentation use in the study involved 37 nurses who worked exclusively in the mental health field. They were asked to respond to a case (simulated) in which a person had a chronic and enduring problem with his or her mental health (MacNeela, et al., 2010). Both acute hospital nurses and those recruited from the community were asked to participate. There were two tasks to which these nurses were asked to respond: determining the person's problem, and making a recommendation as to the steps that should be taken in order to address that problem (MacNeela, et al., 2010).

The transcripts that were collected from the nurses were coded using themes for both intervention and judgment. Patterns that were used to determine psychosocial intervention themes were described and analyzed further (MacNeela, et al., 2010). This analysis was based on the level of experience of the nurse as well as the setting (community vs. practical) (MacNeela, et al., 2010). The findings were that structured engagement was most often used, followed by reassurance and encouragement (MacNeela, et al., 2010). These are both psychosocial intervention strategies that are task-oriented. Only a small minority of the nurses who participated in the study used dialogue, which truly represents person-centered care (MacNeela, et al., 2010). Not surprisingly, nurses that were highly skilled and experienced were the most likely to provide discussion that could be termed as intensive psychosocial engagement, and community nurses were more likely than acute care nurses to focus in on the patients in that way (MacNeela, et al., 2010).

These findings are both relevant and highly significant. Those who suffer from and struggle with chronic and ongoing mental health issues are often placed on the fringes of society. They are ignored and do not receive the help they need. Part of the problem with receiving that help is that not all mental health nurses are trained to help these individuals properly. Being person-centered is vital to helping someone with ongoing mental health conditions, but yet that person-centeredness is only seen in a small number of mental health nurses. It is as though the others do not realize how best to help, or perhaps they believe that other techniques really are the best choice when it comes to people who struggle with their mental health. Unfortunately, when nurses do not take a person-centered approach to helping those with mental health issues, paternalism and benevolence can result (MacNeela, et al., 2010). To achieve rehabilitation and recovery, people with mental disorders often require and enjoy psychosocial engagement (MacNeela, et al., 2010).

The findings show that people with mental disorders that are chronic and ongoing are not getting what they need from their nurses and caregivers, despite background research indicating that psychosocial engagement is what is needed. Still, there has been evidence that not all people with mental illness want or require psychosocial engagement in order to improve, so the opinions on the issue are mixed (MacNeela, et al., 2010). Despite that concern and the questions surrounding which options are better, research still shows that there are many people who have mental health issues and who benefit very strongly from psychosocial engagement from nurses and other healthcare practitioners (MacNeela, et al., 2010). This kind of engagement forces the mentally unhealthy person to focus on his or her deficiencies and how they can be corrected, as well as what that person can potentially achieve when those deficiencies have been adjusted through therapeutic means.

The evidence offered in the study was through the examination of 37 mental health nurses in Ireland, so extrapolation that information out to all mental health nurses and patients, as well as other countries, may be difficult. Additionally, 37 nurses is a relatively small sample, so it is possible that a larger sample would produce far different results. This study could then be seen as a contrast with other evidence that would show more nurses considering psychosocial engagement as the best way to address anyone with a chronic, long-term mental health issue. This is speculation, however, and may not be something that would take place or that would show a difference in what mental health nurses feel is appropriate in treated and talking with those who have chronic mental health issues. Not all mental health nurses or other mental health professionals will agree about which approach is best, and even the overall "best" approach may not be appropriate or even acceptable for all individuals who have mental health issues or concerns (MacNeela, et al., 2010).

Still, the way the study was conducted and the findings that were collected were very appropriate for the question that needed to be answered. Overall, mental health nurses must do what is in the best interest of their patients. It was interesting in the study to see that community mental health nurses were more focused on therapies that were patient-centered. This would make the most sense, however, because acute care mental health nurses must deal with and respond to very different issues than those who focus on community care. With acute care, the focus is on stabilizing the individual and getting immediate treatment for his or her most pressing and disturbing problems or behavior. With community care, long-term stability and guidance is the goal. In light of that, it would be expected that mental health nurses who deal in community care would be more likely to be person-centered than those who worked with patients in an acute care setting.