In late 2016, the Centre for Addiction and Mental Health (CAMH), as Canada’s largest academic mental health teaching hospital, approved the commencement of a project to develop competencies for forensic mental health (FMH) nurses in Canada. The hospital’s commitment to this undertaking was driven by the recognition, on the one hand, that FMH nursing a is distinct sub-specialty of mental health nursing, and on the other, that supporting best practice and education of FMH nurses and developing clear pathways to leadership requires a clear articulation of the competencies specific to this unique practice area. Consequently, a number of advanced practice FMH clinicians and other leaders from the Professional Practice Office and Clinical Operations at CAMH have come together to create an evidence-based FMH nursing competency framework that is specific to the Canadian context.
Methods:
The project team conducted a preliminary search of the grey and scholarly literature and sought input from content and process experts external to CAMH. Based on these processes, it was determined that conducting a scoping review was the most suitable approach to address the goal of this project. The project team selected to follow the steps explicated by Levac, Colquhoun, and O’Brien (2010). This approach builds on the work of Arskey and O’Malley (2005) and includes a consultation stage, which was perceived to be an important additional step towards validating the data gleaned from the literature. Accordingly, the foundation of the competency framework to be developed in this project will be the data, which will come from scholarly and grey literature, as well as content experts from a variety of FMH practice settings across Canada.
Results:
First, the project team identified our primary research question (Anderson, Allen, Peckham, & Goodwin, 2008); namely, what are the competencies specific to FMH nursing practice? We also recognized the need to describe what is distinct about FMH nursing, so also asked, as a secondary question, what are the unique descriptive aspects of the FMH nursing role? Then, using keywords and synonyms derived from the research questions, a thorough search of the scholarly and grey literature was conducted and the relevant studies were selected.
Presently, the project team is engaged in the process of data charting (Levac et al., 2010). A data extraction tool has been created and is being used for the purposes of extracting from the each scholarly data source (N=45) information that specifically answers the research questions. Additionally, each source is being reviewed by at least two team members (Levac et al., 2010; O’Brien, Wilkins, Zack, & Solomon, 2010). This process is also necessarily iterative. For example, the extraction tool is being updated regularly as we progress through the data and learn more specifically about what aspects of each data source are most pertinent to our project goals, which then means that some of the previously reviewed sources need to be reconsidered in light of this more finely tuned tool (Levac et al., 2010). This charting process will be repeated for the located grey literature.
The next step for this project, again guided by Levac et al. (2010), will involve four distinct phases, beginning with collating and summarizing the findings. To accomplish this we will concisely describe the included data sources and conduct a thematic analysis of the data gathered (Braun & Clarke, 2006; QSR International NVivo 11, 2015). Then, using the preliminary data to structure a quantitative questionnaire and qualitative focus-group questions, we will engage with internal and external content experts. This consultation process will provide a two-fold opportunity; we will be able to validate that which is present in the extant literature while also gathering data that may not have been previously captured (e.g., context-specific information). Third, we will present the findings using Benner’s (1984) domains of nursing practice, which will serve as a framework to organize the data and structure the competencies document. The decision to use this framework has been made based on a desire to build on, and be congruent with, the approach to competency development taken by the Canadian Federation of Mental Health Nurses in their Canadian Standards for Psychiatric-Mental Health Nursing (2014) document. Finally, we will include within the competencies document a discussion of the implications of the data as they stand, considering the ways in which they might impact practice, policy, research, and education moving forward.
Conclusion:
When completed, this project will produce a competency framework that will be used to support the practice and development of FMH nurses and nursing at CAMH. In the longer-term, as this work has the potential to have a national impact, it is our intention to take the project in this direction.