title: Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature.
abstract: Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self-care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person-centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe.
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: Marianne
authors.initials: M
authors.lastname: Wyder
authors.affiliation: Addiction and Mental Health Services, Metro South HHS, Brisbane, Queensland, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Ehrlich
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-3381-6826
authors.initials: D
authors.lastname: Crompton
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: Leianne
authors.initials: L
authors.lastname: McArthur
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Delaforce
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Dziopa
authors.affiliation: University of Hertfordshire, Hatfield, UK.
authors.forename: Shulamit
authors.initials: S
authors.lastname: Ramon
authors.affiliation: Griffith University, Nathan, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Powell
mesh_terms: D006801:Humans; D007297:Inpatients; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009732:Nursing Care; D011568:Psychiatric Nursing / Q000379:methods
keywords: acute inpatient care; narrative synthesis; nursing experiences