Policy for Psychiatric Nursing in Ireland: Analysis

Critically evaluate the relevance of a current national (Irish) strategic policy document for your area of practice (Psychiatric nursing)

Introduction

As one of the most important facets of health care, nursing has been and remains one of the most undervalued and undeveloped professions (Salvage and Leenders, 2005). Salvage and Leender (2005) state that countries need a national action plan for nursing as it assists in the development of the profession. They offer the following ten advantages, as evidence for the foregoing that shall aid in serving as a basis for the evaluation of the relevance of the present Irish national strategic policy for Psychiatric Nursing along with other inputs (Salvage and Leenders, 2005):

1. The presence of a national action plan aids in reinforcing nursing goals, results and orientation in health care.
2. Through the existence of a national action plan, nursing contributions can be optimized through the focusing of “… nursing resources to achieve the best possible results and … value for money” (Salvage and Leenders, 2005).
3. A national action plan helps to “… build and maintain vision for nursing …” (Salvage and Leenders, 2005). The preceding is a result of aiding nurses in maintaining their perspectives, which can be lost in the busy and demanding everyday demands of their profession.
4. The existence of a national action plan can result in “… a clearer sense of direction …” (Salvage and Leenders, 2005).
5. A ‘plan’ can aid in making “… nursing achievements more visible …” (Salvage and Leenders, 2005). Salvage and Leenders (2005) point to the fact that the contribution of nurses is acknowledged by clients and patients but not “… in medical textbooks, conferences and influential discussions …”.
6. A ‘plan’ “… can spur nurses and their supporters to be more active …” and through strategic planning, a ‘plan’ “… helps to uncover or inspire unexpected new coalitions …” that can aid in these aspects working “… together to improve health care … (Salvage and Leenders, 2005).
7. It, a ‘plan’, “… can coordinate current nursing activities …” and aid in nurses identification of projects and innovations that are underway to incorporate these into practice as well as aiding in the development of frameworks for further improvements and implementation.
8. A ‘plan’ can aid in the creation of “,,, closer links between policy and practice …” (Salvage and Leenders, 2005). They explain that the policy making process is usually remote from those who are responsible to its implementation, and that through the utilization of a planning process that involves as well as includes the “… services users, practitioners and … policy makers …” aids in reducing the “… gaps between thinking and action, data and perceptions, policy and operations, planning and implementation …” (Salvage and Leenders, 2005).
9. Through the existence of a ‘plan’ the profession of “… nursing is more likely to win support from the people, policy makers and other professionals” if said ‘plan’ states clearly “… where it is going and what it hopes to achieve (Salvage and Leenders, 2005).
10. And finally, a ‘plan’ “… can help nursing control its own work and future … (Salvage and Leenders, 2005). Salvage and Leenders (2005) explain that the existence of a ‘plan’ can aid in nursing controlling “… its own work and future …” because traditionally they have “… had little control over their destiny …” as a result of them “… as the servants of another profession …” (Salvage and Leenders, 2005). Salvage and Leenders (2005) argue that a ‘plan’ represents the “… starting point for … (nurses) … becoming equal partners in health care work …” as well as in their relationships with the other professions in the field.

In order to better understand the context of this examination, the definition of the profession of nursing is deemed an important underpinning. The ‘Scope of Nursing and Midwifery Practice Framework’ defines nursing as a profession that “… helps individuals, families and groups to determine and achieve their physical, mental and social potential …” (Nursing Board, 2000a). The definition goes on to add that nurses require “… competence to develop and perform functions that promote and maintain health … as well as prevent ill health” and that such “… includes the (assessment) planning and giving of care … (encompassing) … the physical, mental and social aspects …” (Nursing Board, 2000). As the context of this examination represents the field of psychiatric nursing, the following definition as supplied by the ‘International Society of Psychiatric-Mental Health Nurses’ (ISPN) provides clarity. They, ISPN, define this area of nursing, psychiatric, as “… a specialized area of nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders” (ISPN, 2006). The An Bord Altranais “… was established by the Nurses Act, 1950, (An Bord Altranais, 2007a) “… is the statutory body …(that) … provides for the registration, control and education of nurses … (and other matters) …” related to the practice of nursing in Ireland (An Bord Altranais, 2000). As of 2004, there were 76,045 nurses registered with the An Bord Altranais, as shown by the following (An Bord Altranais, 2007b):

Table 1- Total of Nurses and Qualifications Registered

(An Bord Altranais, 2007b)

Nurses Registered

Table 2 – Total of Nurses and Qualifications Registered

Qualifications Registered

(An Bord Altranais, 2007b)

The examination of the Code of Conduct and other legislation shall be reviewed against the ten point standards of the World Health Organization and other documents in order to gauge the relevance of policies in this area.

National Strategic Policy for Nurses in Ireland

The strategic national policy document for the nursing profession in Ireland is generated by An Bord Altranais that states that the practice of nursing “… should always be based on the principles of professional conducted …” as contained “… in the latest version of the Code of Professional Conduct for each Nurse and Midwife …” (Nursing Board, 2000b) with practices contained in Scope of Nursing and Midwifery Practice Framework (Nursing Board of Tasmania, 2006) and the Standards for the Scope of Nursing Practice 2001 as prepared by the Commonwealth Department of Education, Science and Training (DEST, 2001). The evaluation of the preceding documents shall be compared against the ten-point plan outline as put forth by Salvage and Leenders (2005) to serve as a guide.

Scope of Nursing and Midwifery Practice Framework

The Scope of Nursing and Midwifery Practice Framework for Ireland states that it utilizes the ANMC National Competency Standards for the Registered Nurse, Australian Nursing & Midwifery Council, (ANMC, 2006) as its basis for the determination of “… regulations, organizational policies and procedures …” (Nursing Board of Tasmania, 2006) as support in its practice setting. The Scope of Nursing and Midwifery Practice Framework (SoP DMF) states that the determinations concerning the “… scope of practice need to be …” (Nursing Board of Tasmania, 2006) 1. “proactive”, 2. “responsive to internal and external forces”, 3. “flexible; and”, 4. “able to provide guidance in decision making by both the individual nurse … and the profession as a whole”. The SoP DMF indicates that the foregoing “… is applicable to all nurses and midwives across all practice settings …” and that such have been put into force to ensure “… that practice decisions are based on the individual context and patient …” as opposed to the “… defining nursing … by tasks or procedures” (Nursing Board of Tasmania, 2006).

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The latitude offered from the preceding represents room for individual interpretation that can and also cannot be a wise choice in a profession that represents the fragile state of mind of patients under psychiatric care. Evidence of the problem in having such broad latitude is presented in an article by Sean Fleming “Psychiatric Abuse of Ireland” which details accounts of the use of drugs in treatment that were either later found to be inappropriate, and or had side effects that worsened the patients condition (Fleming, 2005). Such is also the subject of a report issued by ‘Aware’, a voluntary organization devotes to assist those who are afflicted with depression (Aware, 2007a). The report mentions the continuity of care with regard to psychiatric services as an area needing improvement along with eighteen other points and represents an aspect that the broad latitude in interpretation (Aware, 2007b). And while every instance of care treatment cannot be categorized, and set forth procedurally, guidelines represent an effective means to provide tighter controls as well as instructions and steps that nurses can utilize when appropriate. Salvage and Leenders (2005) under item 4 indicate that a national action plan provides “… a clearer sense of direction …” and under item 8 states that the existence of a ‘plan’ can aid in the creation of “,,, closer links between policy and practice.

The SoP DMF states that through providing transparency in its policy that it “… greatly benefits all nurses and that it thus “… provides an effective tool … nurses can maximize their nursing practice …” in the standards of the profession. It states that there are six figures, with “… each supported by a set of guiding principles” that can assist nurses in the discussion as well as clarification of “… practice issues with their colleagues and employers” (Nursing Board of Tasmania, 2006). The preceding are 1. “Guiding Principles for Map of Role Relationships among Health Personnel”, 2. Guiding Principles for Improving the Health Outcomes of the Patient”, 3. Guiding Principles for Delegation among Nurses and Midwives, 4. Guiding Principles for Delegation to Students of Nursing, 5. Guiding Principles for Delegation to Unlicensed Health Care Workers; and, 6. Guiding Principles for Maximising the Scope of Practice for Registered Nurses and Midwives (Nursing Board of Tasmania, 2006). The Sop DMF states that these “… six figures highlight the importance of…” 1. “clinical assessment by the registered nurse or midwife”, 2. “lawful authority”, 3. “preparation and experience”, 4. “risk management”, 5. “confidence”, 6. “competence”, 7. “delegation by the registered nurse or midwife: and”, 8. “acceptance of the delegation and the required level of supervision (direct or indirect” (Nursing Board of Tasmania, 2006). The foregoing harkens back to the room for latitude and actually indicates under item number 1 that nurses are making clinical assessments. This also stated, assessment, under “Scope of Nursing and Midwifery Practice Framework April 2000” (Nursing Board, 2006b). The foregoing analysis with regard to the latitude is indicated in the Sop DMF document under Figure 2. ‘General Principles for Improving the Health Outcomes of the Patient’ which states under “patient … Clinical Assessment … have I considered the consequences of my planned action?” (Nursing Board of Tasmania, 2006). The following further illustrates this issue (Nursing Board of Tasmania, 2006):

The Figure indicates that if the answers to all questions are ‘yes’ that the nurse should proceed, and that if there is a ‘no’ answer to any question, then the nurse should seek advice on the issue (Nursing Board of Tasmania, 2006). The preceding represents a procedural attempt to shore up the wide latitudes present in the guidelines, still leaving room for varied interpretations.

Standards for the Scope of Nursing Practice 2001

The ‘Standards for the Scope of Nursing Practice 2001’ represents a copulation of statutory material that was obtained as a result of the utilization of electronic searching in the sites of Lexis Nexus, Canlii, Austlii and other legal sites. The ‘Standards for the Scope of Nursing Practice 2001’ indicates that there were legislation aspects that could not be accessed and other measures utilized, with an instance whereby no data could be obtained (DEST, 2001). The preceding means that the document is not wholly complete. The ‘Standards for the Scope of Nursing Practice 2001’ also adds the documents from which it was based, in some instances, referred to other documents and or legislation or regulations and standards that were not included is what was accessed, and were unavailable for use in formulating the document as a whole (DEST, 2001).

Interestingly this supports the broad latitude contention as mentioned under “Scope of Nursing and Midwifery Practice Framework” in that it states “Given the complexity and variability of the sources of information about the standards of nursing practice …” that it is reasonable “… nurses might experience some difficulty in keeping abreast of these issues” (DEST, 2001). The preceding is explained in the document as representing the difficulties in the interpretation of the ‘… intent of the legislation (DEST, 2001). DEST (2001) indicates that the primary objective of “… statutory regulation … is the protection of the public. The utilization of the copulation technique to derive the document obviously has flaws that need correcting, however, the fact that the government of Ireland has recognized the need to produce such a document represents a critical step in the right direct, as espoused by Salvage and Leenders (2005).

Quality And Fairness: A Health System for You – Action Plan Progress Report 2005

The National Health Strategy “Quality and Fairness – A Health System for You”, as stated in the document “… was announced by the government … to provide vision and strategic direction for the health and personal social services” and identifies “… a 121 point Action Plan …” as central to implementation of a nationwide strategy and put varied “… aspects of the Strategy into … action (Department of Health and Children, 2005). Under National Goal No. 1, item 2, it sets forth the “Statements of Strategy …” with regard to “… all relevant Government Departments …” that are to devise guidelines and strategy statements for human resources as well as other areas. Its relevance to this examination lies in the preceding.

A Vision for Change” Report of the Expert Group on Mental Health Policy

This document represents “… a comprehensive model of mental health service provision for Ireland” (Department of Health and Children, 2006). Under item 1.5 ‘Vision’, the document sets forth that its policy represents the creation of “… a mental health system that addresses the needs of the population … as a result of focusing “… on the requirements of the individual” (Department of Health and Children, 2006). The ‘Policy Framework’ indicates that its purpose is to create “…. A systematic framework and plan for mental health …” (Department of Health and Children, 2006). This aspect represents the reference to psychiatric nursing, which is the subject of this examination. The document covers ‘Mental Health in Ireland’ covering the differing disciplines, along with “Implementation” that defines relationships in the management of mental health and the plan to bring the diverse aspects into closer proximity from the present system that “… has encouraged isolation of catchments from each other …” which “… has hindered the development of specialist services” (Department of Health and Children, 2006).

The broad areas covered under “Manpower, education and training ”… sets forth “ … the education and training required to produce competent professional personnel …” (Department of Health and Children, 2006). This document does not provide the details of policy and other facets of specificity related to strategic policy for psychiatric nursing, which are contained under “Scope of Nursing and Midwifery Practice Framework” and “Standards for the Scope of Nursing Practice 2001” in limited fashion. It, the document – “A Vision for Change” Report of the Expert Group on Mental Health Policy” does recognize that there are “Shortcomings in Current Education and Training”, but its usefulness as a policy statement for psychiatric nursing is not its intention.

Conclusion

The present strategic policy for psychiatric nursing in Ireland is an area that is still under development. The varied documents reviewed, “Scope of Nursing and Midwifery Practice Framework”, “Standards for the Scope of Nursing Practice 2001”, “Quality And Fairness: A Health System for You – Action Plan Progress Report 2005”, and “A Vision for Change” Report of the Expert Group on Mental Health Policy” as well as other documents referenced herein are in the evolutionary stages. This incompleteness does not actually represent a cause for too much concern and the Government of Ireland, through the issuance of these documents, acknowledges the deficiencies in this area and have set about the process to correct this aspect as stated in “Quality And Fairness: A Health System for You – Action Plan Progress Report 2005” under National Goal No. 1, as well as in “A Vision for Change Report of the Expert Group on Mental Health Policy”.

Salvage and Leenders (2005) indicate the global problem concerning nursing policy and strategy, and the importance of having such plans in place, or under development to enable the profession to achieve higher standards and more connectivity with the field of medicine in general. They, Salvage and Leenders (2005), state that strategic plans are extremely important in providing the foundation for frameworks to develop that will increase the proficiency of the profession through documentation that can be thus shared, compared and utilised for further refinement. Ireland is in the beginning stages of this evolutionary process, as is the United States, the United Kingdom and other countries owing to their lack of attention and importance concerning the contributions of the field of nursing. The criticisms levied at the broad interpretational latitudes that exist in present policy statements in Ireland as found under the document prepared by the Sop DMF concerning the “Scope of Nursing and Midwifery Practice Framework” is an outgrowth of this developmental process. Clearly, a great deal of work still stands before the various governmental agencies and departments in achieving a substantive document that achieves the objective of providing nurses engaged in psychiatric care with the guidelines and procedures to enable them to weave their way through the difficult profession they are engaged in. The present plans, though incomplete, do represent a means whereby psychiatric nursing leaders have a platform to move forward from to collaborate in revising and amending what is established. The preceding is acknowledged by Salvage and Leenders (2005) as a huge as well as important step in the right direction.

Bibliography

An Bord Altranais (2000) An Board Altranais: The Code of Professional Conduct for each Nurse and Midwife, April 2000. An Bord Altranais

An Bord Altranais (2007b) Nurse Registration Statistics – 2004. Retrieved on 12 January 2007 from http://www.nursingboard.ie/

An Bord Altranais (2007a) Role and Functions of An Bord Altranais. Retrieved on 12 January 2007 from http://www.nursingboard.ie/

ANMC (2006) National Competency Standards for the Registered Nurse. Australian Nursing & Midwifery Council

Aware (2007) Aware. Retrieved on 14 January 2007 from http://www.aware.ie/

Aware (2007b) Suicide in Ireland: A Global Perspective and a National Strategy. Retrieved on 14 January 2007 from http://www.aware.ie/online books/suicide.html

Department of Health and Children (2006) A Vision for Change” Report of the Expert Group on Mental Health Policy. Department of Health and Children

Department of Health and Children (2005) Quality and Fairness – A Health System for You: Action Plan Progress Report 2004. Department of Health and Children

DEST (2001) Standards for the Scope of Nursing Practice 2001. Retrieved on 13 January 2007 from http://www.dest.gov.au/archive/HIGHERED/nursing/pubs/nurse_regulation/3.htm

Fleming, S. (2005) Psychiatric Abuse in Ireland. Retrieved on 14 January 2007 from http://www.critpsynet.freeuk.com/PsychiatricAbuseinIreland.htm

ISPN (2006) Psychiatric Mental Health Nursing Scope & Standards. Retrieved on 12 January 2007 from http://www.ispn-psych.org/docs/standards/scope-standards-draft.pdf

Nursing Board (2000b) Guidance to Nurses and Midwifes on the Development of Policies, Guidelines and Protocols, December 2000. Retrieved on 12 January 2007 from http://www.nursingboard.ie/publications/Guidance2000.pdf

Nursing Board (2000a) Scope of Nursing and Midwifery Practice Framework April 2000. Retrieved on 12 January 2007 from http://www.nursingboard.ie/PolicyGuidelines/SNMidwifePractiFworkApril2000/scope.html

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Salvage, J., Leenders, F. (2005) National Action Plans for nursing and midwifery, In Salvage, J., Heijnen, S. (2005) Nursing in Europe: A resource for better health. World Health Organization, Regional Office for Europe, ISSN 0378-2255