A Multiple Case Study: Mental Health Nurses’ Experiences Using Psychosocial Interventions in Ireland

Background:  In this research, PSI-trained mental health nurses (MHNs) were asked to share their interpretations of using psychosocial interventions (PSI) in practice. Given their unique relationship with clients and family members, MHNs are urged internationally to promote PSI. Yet, there was no qualitative study located that explicitly explored how PSI-nurses are practising specialised skills in the Irish context. Moreover, given the changes introduced by recent policy reforms, it was timely to explore how these nurses were adapting and reconfiguring their nursing practice.

Purpose: This study explored psychosocial intervention-trained MHNs’ experiences of using PSI in their care of persons with a mental health problem.

 

Methods: Consistent with the goal of understanding experience, a qualitative approach was adopted using a multiple case study design that comprised of four cases. These four cases were the public sector Health Service Executive (HSE) sites where the nurses work. A total of 40 PSI-trained MHNs were observed and interviewed in acute inpatient and community care settings. An observational guide, adopted from the literature (Spradley 1980) and Richie & Spencer’s (1994) framework were used to guide the analysis. Data were analysed within and cross the cases supported by NVivo (10) software.

Results: Through the analysis, three major themes emerged:

1. PSI-trained MHNs understanding and use of PSI;

2. Facilitators supporting the use of PSI by PSI-trained MHNs;

3. Obstacles limiting the use of PSI by PSI-trained MHNs.

   Overall, the findings showed that participants’ views towards PSI were positive. Yet, participants perceived that their daily work was largely curtailed by many obstacles in practice that challenged them in implementing PSI. These obstacles, noted in the findings, included: not having enough time, shortage of nursing staff, lack of education and training, and the inherent ineffective multidisciplinary image of PSI-nurses. However, participants reported that a supportive and collaborative organisational culture and on-going education and training, where clinical leadership and clinical supervision were available, facilitated the implementation of PSI. Findings also revealed that PSI-trained nurses were more inclined to offer lower level skills with clients whose mental-health problems were more severe, such as schizophrenia and psychosis. Conversely, the higher-level PSI were used with the clients who had less severe mental health problems. The findings also indicated that there needs to be a greater consensus among all mental health care professionals about the skills that PSI-nurses explicitly engage with in practice.

 

Conclusion: This multiple case study offers answers to the overall aim and addressed the objectives for this research. Many of findings are relevant within the context of current debates about PSI, and can be used to improve mental health nursing practice and contribute to the continued development of mental health nursing in various settings. This study informs practice, policy, education and research. Mental organisations must play a key role in supporting PSI-nurses if recovery orientated practices are the way forward in the mental health services. Finally, it is the MHNs’ professional duty to welcome the challenges of PSI implementation in their nursing practice.