Commentary

Strategies for Mental Health

Danny G Willis
Boston College, William F Connell School of Nursing, Chestnut Hill MA, United States of America

Linda Beeber
University of North Carolina, Chapel Hill, School of Nursing, Chapel Hill, NC, United States of America

Jane Mahoney
Baylor College of Medicine, The Menninger Clinic Houston, TX, United States of America

Daryl Sharp
University of Rochester, School of Nursing, Rochester, NY, United States of America

PP: 136 - 139

Abstract

In psychiatric-mental health nursing, nurse scientists and practitioners have an ethical obligation to improve practice through the identification of practice-relevant research priorities and through conducting research relevant to these priorities. In turn, the body of mental health nursing knowledge accumulates over time, with revisions in practice stemming from scientific breakthroughs and findings - the basis for best nursing practices that optimize human health. Generally, the goals of research in the psychiatric-mental health nursing specialty are to address substantive questions about clinical practice, health, effective interventions, and outcomes that provide the scientific basis for practice. Research is the avenue by which nurses pursue answers to critical questions in psychiatric-mental health nursing through the systematic collection and analysis of data about phenomena of interest, where 'psychiatric-mental health nursing' is defined as:

the diagnosis and treatment of human responses to actual or potential mental health problems (American Nurses Association, 2000, p. 10)

Article Text

Various strategies exist for developing mental health nursing science and consensus building around the advancement of the specialty. One such strategy is the active work of the Research Council (RC) of the American Psychiatric Nurses Association (APNA) to actualize the goals of the organization. For example, its goals are to: promote research focused on issues of relevance to psychiatric mental health nursing; encourage exchange among nurse scientists studying psychiatric-mental health issues, psychiatric nurse clinicians, and psychiatric nursing educators; and assist members to conduct, understand, and apply scientific evidence to practice (APNA, 2008).

The authors take the position that strategies to advance nursing science within substantive areas of inquiry in psychiatric-mental health nursing is necessary if we are to continue to meet the health needs of individuals and society in an effective, humane, and holistic manner that is not merely focused on symptom management and acute crisis management. Thus, identifying research priorities and other strategies for advancing psychiatric mental health nursing science is critical. In this manuscript, we discuss both of these from our perspectives as co-chairs of APNA's Research Council, drawing upon our collaborative work in that capacity and from our individual endeavors in research and practice. We will review three major strategies for advancing psychiatric-mental health nursing science relevant to practice: identifying research priorities, responding to the knowledge needs of research nurses and practitioners, and building programs of research and practice innovation.

Identifying APNA members' research priorities for psychiatric-mental health nursing

What do psychiatric-mental health nurses identify as priority areas for research that will advance the science of our nursing specialty? To provide one answer to this question, the authors, co-chairs of the Research Council of the APNA, undertook the task of identifying predominant themes of 'priority research areas' based on the responses of 100 psychiatric mental health nurse attendees at the 2008 American Psychiatric Nurses Foundation (APNF) Breakfast.  Through two iterative rounds of content analysis and consensus building, we themed the research priorities identified by the nurses. One overarching priority emerged from the responses. That priority was: to test nurse-defined mental health interventions, the impact of which must be measured by nurse intervention-sensitive outcomes. Five substantive areas of inquiry were identified in which to meet the overarching priority. These are not presented in any particular order:

1. Strategies and models for shared decision-making/partnering to accomplish positive mental health treatment outcomes
2. Intervention that is focused on prevention and treatment across multiple contexts, e.g. family, community, and varying care delivery settings
3. Recovery and healing capacities of individuals, groups, and families
4. Integrated mental health care that considers biological, social, and developmental life-span dimensions
5. Psychiatric-mental health nursing workplace, workforce, and practice definition issues.

            These five substantive themes were used as the final set of priorities for the '2009 APNF Call for Grant Proposals' and they were incorporated as part of the peer-review scoring/ranking system for the 2009 applications for APNF funding. The Council plans to share the priorities with APNA members, and elicit their views of how research in each these priority areas might help advance their practice. APNA includes psychiatric nurses from the entire spectrum of nursing educational preparation. The Council is committed to obtaining a representative sample of perspectives that will allow research questions to emerge that represent generalist and specialist practice. Ultimately, catalyzing research that will advance the practice of generalist and specialist psychiatric nurses will have a wide-ranging and powerful impact on practice. Once the APNA members have been polled, the Council plans to draft a substantive paper that will synthesize the data and recommend a broad array of research areas and questions. This paper will become the heart of an NIH or private foundation proposal for a national conference focused on the advancement of psychiatric mental health research. 

Responding to APNA members' knowledge needs related to nursing research

In addition to identifying research priorities, the research council co-chairs have worked to advance psychiatric-mental health nursing science by responding to the 2007 APNA membership survey results related to research interests. Responding members were divided into two groups: primary researchers and those who were interested in applying research to practice. Based on responses, we concluded that both groups preferred educational offerings related to research for practice. To address their needs and preferences, we presented an educational offering at the 2008 national conference entitled, "Supporting, Teaching, Applying, and Sustaining Evidence-Based Nursing Practice (EBNP) in Psychiatric Settings: Process and Content.  The purpose of the presentation was to describe the organizational culture and systems-level processes and essential content needed to teach, apply, and sustain evidence-based practice in psychiatric-mental health settings. Objectives of the educational offering included nurses: appreciating the importance of initiating EBNP in a way that is congruent with system-level factors; formulating an EBNP question; and evaluating and EBNP innovation.

For the next national conference, held in October 2009, we continued to build skills and consensus around advancing psychiatric-mental health nursing science in our presentation entitled, Making a Compelling Case for What Matters Most to Psychiatric Nurses: Developing Persuasive Proposals. The purpose of the presentation was to present an interactive panel focused on preparing proposals including how to choose a substantive focus, how to gather-evaluate-weigh and synthesize empirical evidence, how to streamline a quantitative or qualitative research design or practice plan for implementation, how to align outcomes to the evidence, and how to fit the crafting of a proposal to the values and goals of funders, administrators, or policymaker. Objectives of the presentation included nurses: discussing critical components of effective proposals, describing the process of gathering and using credible evidence to support proposal development, and identifying resources to help support proposal-writing skills.

Building programs of psychiatric-mental health nursing research and practice improvements

The process of constructing a program of research can be a unique, iterative process that is influenced by passion about a substantive idea, access to mentors and funding resources, and the focus of the researcher's practice. The four Council Co-chairs exemplify these processes.

Danny G. Willis, PMHCNS-BC, an ANCC board certified clinical specialist in adult psychiatric mental health has developed a program of research focused on the mental health needs of male survivors of different types of interpersonal abuse. These studies have included samples of adult male survivors of hate crimes and middle school boys who experience being bullied.  Central to this work has been developing an understanding of common meanings and strategies associated with male's experiences of healing in the aftermath of being interpersonally abused.  Currently, he is pursuing funding for research projects on adult men's healing from child maltreatment and health promotion strategies for both adult men and women survivors of CM.

Linda Beeber, a PMH-CNS, was passionate about the unique role that psychiatric nurses could serve in reaching high-risk, underserved populations struggling with depression. Through a research trajectory from pilot studies to clinical trials, her work has resulted in a replicable, in-home interpersonally-based intervention for low-income mothers with depression delivered by PMH-APRNs. As one of the few nurses who has secured funding for research from the National Institute of Mental Health, she actively mentors others to develop their programs of research.  Jane Mahoney, a PMH-CNS, developed two programs at The Menninger Clinic aimed at creating and sustaining a research-minded culture of psychiatric nurses. The Evidence-based Practice Scholars Program is focused on teaching nurses how to apply research findings to practice. This involves developing EBPN skills including systematically accessing and critiquing research and designing innovative strategies for applying research within the organizational culture. The Research Scholars Program is an innovative approach to engaging nurses in preparing and executing a research protocol aimed at answering questions that matter most to practicing nurses. These programs serve as the foundation for exemplary professional practice at this nationally recognized psychiatric institution. 

Daryl Sharp brings her passion for motivating health behavior change into her clinical research with those challenged by serious and persistent mental illness.  Building upon her advanced practice psychiatric nursing and research skills, she designed and evaluated a nurse-managed intensive tobacco dependence intervention program for outpatients receiving care in an academic mental health clinic.  Funded by the New York State Tobacco Control Program, the program was effective in assisting clients with serious mental illness to reduce and/or stop smoking.   It also led to the development of a manual for nurses to guide tobacco dependence interventions in this population and will serve as the flagship design in creating and evaluating health promotion nursing initiatives aimed at improving physical and behavioral health outcomes among those with mental illness.

Investigator-centered programs of research such as these examples are inherently unique to certain populations, practice settings and clinical problems. The power to change practice may be lost unless there is a parallel synthesis process by which different programs of research are brought together and practice guidelines developed. The Council can serve that purpose through periodic research synthesis work using the five priorities discussed earlier as organizing structures. Development of evidence-based practice guidelines can be the next step. APNA is rich with member-experts on integrating evidence into practice. Finally, through the powerful dissemination mechanisms of APNA, practice-changing guidelines can reach psychiatric nurses through state chapter meetings, the APNA annual national conference, topic-focused conferences, web-based continuing education courses, liaisons with other PMH and nursing organizations and through the Journal of the American Psychiatric Nurses Association.

...

Conclusion

Advancement of psychiatric-mental health nursing science and practice can improve the lives of people who have actual or potential threats to their mental health. In this paper, we have provided evidence of specific strategies within a specialty organization that are working to build a scientific evidence-base for nursing practice. As psychiatric-health nursing continues to mature as a specialty, we believe that the identification of research priorities and the building of science in substantive areas such as those identified in this manuscript will provide a body of knowledge that clearly distinguishes the contributions of psychiatric-mental health nurses in health care. The contribution of PMH nurses to the mental health of the public has not reached its full potential. Indications are that the landscape is changing and that opportunities may emerge as the US health care system restructures. PMH nurses can be ready and exert a more powerful, positive influence on all who need mental health care if our practice is organized, scientifically based and reflective of our unique ability to integrate mental health care into the fabric of people's lives.

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