Field of play: How do organisational structures impact on mental health nurse's physical health practice?

Abstract

<b>Background</b>: People with mental distress experience higher rates of physical co-morbidities. These include HIV infection, cardiovascular disease, metabolic conditions and certain types of cancer. There appears to be ambiguity surrounding nursing roles in addressing these health inequalities. Previous studies have highlighted certain organisational and structural factors which play a role but without significant depth of how they impact on nursing practice.

<b>Aims</b>: The study aimed to examine how registered mental health nurses working in one UK mental health service understood their role in providing physical healthcare to people with mental distress. In particular the impact of organisational and structural factors, relationships and educational competencies on their role.

<b>Project description</b>: This study was informed by Pierre Bourdieu's Theory of Practice (1977). Semi-structured 1:1 interviews were conducted with nurses (n = 7 inpatient, n = 7 community) working in one UK service between January-May 2018. Interviews were transcribed verbatim and analysis was informed by Braun and Clarke's (2006) Thematic Analysis. The study received a favourable ethical opinion from the author's institution.

<b>Outcomes</b>: Analysis reveals that mental health nurses’ physical healthcare practice takes place in a complex field. This field is shaped by the burden of accountability and its use as a form of symbolic violence, the unpredictability of mental health, emotional labour of caring, poor organisational support and tensions around boundaries in care. It is questionable what role policy is playing in influencing practice.

<b>Implications for practice</b>: The study highlights various structural factors impacting on mental health nurses ability to address patients physical health needs. Services need to consider how they will remove such barriers, which should help nurses to practice more competently, confidently and allow them do develop creative practice without fear of blame.

<b>Learning Objectives</b>: - Mental health nurses do provide physical healthcare but in a very complex field with various competing demands - Organisational and structural factors impacting significantly on their practice.