Generalist registered nurses caring for mental health clients in remote areas of Australia: an interpretive case study

Trueman, Scott (2016) Generalist registered nurses caring for mental health clients in remote areas of Australia: an interpretive case study. PhD thesis, James Cook University.

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Aim: The aim of this study was to examine the social world of generalist nurses delivering mental healthcare in remote Australia.

Background: Of Australia's population of approximately 25 million, one in five will experience a mental illness during their lifetime. People who live in remote Australia are significantly more likely than those in urban areas to experience a mental illness or substance use disorder, or to commit suicide. Commentators have suggested that the higher prevalence of mental health problems in remote communities is a reflection of socioeconomic disadvantage, a harsher natural and social environment, loneliness and isolation. The more remote from metropolitan centres, the less specialised mental health services, investment, funding and infrastructure are available to care for the mentally ill. Correspondingly, the specialised mental health workforce, across all disciplines and professions, rapidly declines with remoteness. This workforce maldistribution results in a situation where the largest permanent health workforce in remote Australia are generalist nurses. Remote nurses work in isolated communities and are regularly exposed to stressful and dangerous conditions. They are oldest cohort of Australian nurses and work the longest hours per week. Research has reported that remote nurses have low self-perceived levels of competency, confidence and skills when caring for mental health patients, particularly when confronted by violent and aggressive mental health presentations.

Method: A single, explanatory, revelatory case study design, utilising a holistic approach, was employed in this study. Qualitative data were collected in semi-structured interviews conducted face-to-face or via telephone (n = 30). The data were subjected to interpretive thematic analysis. Findings from the thematic analysis were combined with secondary data sources relevant to the case and subjected to situational analysis (Clarke, 2005) using messy, ordered and relational maps to construct a social world/arena map of the remote nurses' social world in delivering mental healthcare. Actor-network theory was employed to analyse the relationships between actors (human and non-human), which consisted of both individuals and groups within the remote nurses' social world.

Findings: Three major findings arose from the study. First, under the actor-network analysis, when delivering mental healthcare, remote nurses assume the role of the obligatory passage point; second, remote nurses have low self-perceived levels of mental healthcare skills, abilities and confidence; and remote nurses possess unique characteristics that enable them to stay and function in the case environment.

Conclusion: There exists substantial demand for mental health services in remote Australia. The delivery of such services must overcome many barriers. Central to the success of mental healthcare delivery are remote generalist nurses. This study revealed new insights into the complex and fluid social worlds of remote generalist nurses delivering mental healthcare. The study also found that remote nurses have unique characteristics, both individually and as a group, that enable them to remain in their social world and deliver front-line services.

Item ID: 46135
Item Type: Thesis (PhD)
Keywords: actor-network analysis; actor-network theory; Australia; education; generalist nurses; mental health clients; mental health; remote health; remote mental health services; rural and remote; rural mental health services; rural nurses; situational analysis; social aspects; social world theory
Date Deposited: 19 Oct 2016 06:01
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111005 Mental Health Nursing @ 100%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 70%
92 HEALTH > 9202 Health and Support Services > 920209 Mental Health Services @ 15%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920410 Mental Health @ 15%
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