Models of care delivery in mental health nursing practice: a mixed method study

Authors


D. Carlyle, Department of Psychological Medicine, University of Otago, PO Box 4345, 8140 Christchurch, New Zealand, E-mail: dave.carlyle@otago.ac.nz

Abstract

Accessible summary

  • • Mental health nursing care is usually delivered in multidisciplinary teams within inpatient and outpatient settings. This team approach to care delivery is underpinned by an assumption of a common set of values and a common model of care delivery among disciplines.
  • • Mental health nurses appear to endorse a range of explanatory conceptual models as important in respect to aetiology, treatment, and factors influencing improvement, the role of the mental health service and the role of nurses. This study found that although the participants used a psychodynamic framework for understanding the causes of mental distress they described the presenting problems and the nursing interventions in terms of supporting a medical model of care.
  • • Mental health nursing care is subjugated by a medical model which constrains the possibilities for mental health nursing interventions. This then potentially creates tension between what nurses believe to be the problem and the responses available for nurses in their clinical setting.

Abstract

The aim of this study was to identify the conceptual models that underpin mental health nursing care in clinical settings. This study is a modification of a previous study which evaluated the influence of implicit models of mental disorder on processes of decision making within community-based teams. Participants completed questionnaires in response to a scenario. A range of explanatory conceptual models were identified in respect to aetiology, treatment and recovery. In a forced choice the participants ranked a medical model of care above other models as underpinning care delivery. The content analysis found that the participants used a psychodynamic framework for understanding the causes of mental distress but described the nursing interventions in terms of supporting a medical model of care. Nursing care is dominated by a medical model which constrains mental health nursing. This potentially creates tension between what nurses believe to be the problem and the responses available for nurses in their clinical setting. A range of psychosocial approaches to mental health care delivery have been developed, but there seems to be problems with their implementation in practice. Further research is required to explore how broader therapeutic interventions can be implemented by nurses within multidisciplinary systems of mental health care delivery.

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