title: Community mental health nursing: keeping pace with care delivery?
abstract: The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.
authors.affiliation: School of Nursing and Midwifery, Faculty of Health Science, Flinders University, Adelaide, South Australia, Australia. julie.henderson@flinders.edu.au
authors.forename: Julie
authors.initials: J
authors.lastname: Henderson
authors.forename: Eileen
authors.initials: E
authors.lastname: Willis
authors.forename: Bonnie
authors.initials: B
authors.lastname: Walter
authors.forename: Luisa
authors.initials: L
authors.lastname: Toffoli
mesh_terms: D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration; D003152:Community Health Nursing / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D003220:Conflict, Psychological; D003266:Continuity of Patient Care / Q000458:organization & administration; D003688:Deinstitutionalization; D017144:Focus Groups; D006271:Health Facility Closure; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D020380:Needs Assessment; D024802:Nurse's Role / Q000523:psychology; D015401:Nursing Administration Research; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration / Q000523:psychology; D009936:Organizational Innovation; D010560:Personnel Selection; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011568:Psychiatric Nursing / Q000458:organization & administration*; D013021:South Australia; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data