Preparing mental health nurses for their medicines management role: an evaluation of a novel training approach

Aims: The overall aim of this programme of research is to evaluate aspects of an innovative approach to the education and training for a sample of student and registered mental health nurses (MHNs) in preparation for their medicines management (MM) role. In addition papers are included that make a contribution toward what is known about this fundamentally important responsibility for the MHN.
Background: Medicines management is an established role for the registered MHN. Medicines prescribed for people diagnosed with a mental illness can be therapeutic but this is complicated by potential short and long-term side effects, which can produce extreme discomfort, and even can be life limiting. In these circumstances it is of paramount importance that the nurse needs to have the requisite knowledge and skill to assist the patient gain the maximum therapeutic benefit whilst minimising any potential harm including medicine administration errors. There is however a paucity of evidence concerning the preparation of mental health nurses (MHNs) to undertake medicines management in their undergraduate and early career as a registered practitioner. There is also a significant criticism in the research literature about MHNs suggesting they lack the appropriate underpinning knowledge and skills to perform MM that is safe and inclusive of the patient prescribed psychotropic medication.
Methods: This thesis analyses several publications over a defined period 2009-2014 and describes a coherent programme of research including: The evaluation of a collaborative four-stepped approach between an NHS Trust and a University. Aspects of the approach evaluated included: a Psychopharmacology Workbook; An Objective Structured Clinical Examination; a Competence Assessment Framework for Administering Medicines. All these components had the intention of building the requisite knowledge and skill base to teach both student and registered nurses competently to undertake MM. The consideration of conceptual approaches that the MHN may adopt toward their MM work and relationship with the patient. Analysis of the contribution of the submitted publications to the evidence base of MHN education and training for MM.
Findings: The programme of research indicated that MHNs do not have sufficient education and training to undertake MM. In addition, although they value education and training toward MM, student nurses think they learn better when the content they receive is clinically focused. A dedicated diet of education and training for MM, in the framework of a stepped approach was perceived both by student and registered MHNs positively. The sample of nurses reported it enhanced their knowledge and skill base to practice MM safely and competently. However, the MHNs had criticisms in that they considered that there was a lack of clinical validity and overuse of simulated assessments as a learning mode. A number of related findings emerged from the programme of research: (1) the prevention errors in medicines administration needs to involve an organisational ‘systems’ approach; (2) establishing a conceptual approach to medicines management training can enhance the subsequent relationship the MHN has with patients who are prescribed psychotropic medication; (3) the MHN role when managing medicines has to include physical health assessments, and education and training initiatives needs to reflect this. Conclusions: Using a ‘stepped approach’ to prepare mental health nurses in the undergraduate and early career following registration for their MM role is generally well received by nursing students and practitioners who felt it would enhance their competency. The findings indicate that this novel approach to training has the potential to contribute to safer clinical practice. Prospective studies are now needed to find out if this approach in the early stages of the mental health nurse career does indeed produce improved outcomes in terms of therapeutic gain and reduced risks for the patient who is prescribed psychotropic medication. The potential of the stepped approach as a model needs to encompass all four stages. Thus further work to develop and implement the latter two stages and evaluate their impact is needed.