A grounded theory study of the provision of mental health nursing by practice nurses
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In New Zealand changes to health policy have affected health professionals working in primary health care. This group have had to expand their role and involvement in the care of patients with mental health problems. Practice nurses, the largest primary health care nursing group, have developed their role to provide identification, assessment, and monitoring of patients with mental health problems. Little is known though about the knowledge, skill, and capabilities practice nurse have, or the strategies they use to manage patients with mental health problems. The aim of this study is to explain the processes practice nurses use when they work with patients that have mental illness. The methodology was grounded theory. Data was collected from 17 interviews with practice nurses working in city and rural practices. Data was analysed using Strauss and Corbin's axial coding model. Data was constantly compared during the analytical process. Theoretical sampling was used to develop categories, examine relationships, and dimensions, until data was saturated, and a substantive theory of referring was clarified. The research has shown that practice nurses have limited knowledge about patients with mental health problems. They manage this situation using the strategy of referring. Referring occurs in conditions of generalist nursing practice, changing values and attitudes, and interchangeable boundaries that include time, funding, and medical dominance constraints. Consequently, practice nurses resort to handing over the responsibility of care for patients to experts in mental health care. It was evident that referring was multidirectional, sometimes circular, and depended on the strength of the relationship with the referral source. This research is significant, as it has analysed the taken for granted practice of referring, which is a common nursing strategy used when nurses have limited knowledge in an area. It was also evident that if health policy changes were to be enacted in practice, funding streams structures must change to support policy development, and the profession needs substantial involvement in promoting professional development as well. Recommendations for practice include professional development using protected educational time, shared clinical governance, and inclusion of mental health nursing in all areas of the undergraduate curriculum, national implementation of primary liaison roles in all primary health organisations, and general practice, and the development of postgraduate pathways in primary mental health nursing care management.