QUALITY AND CLINICAL GOVERNANCE NURSING ESSAY: A JOURNAL CRITIQUE This paper evaluates a nursing journal article entitled, “An Evaluation of a Mental Health Screening and Referral Pathway for Community Nursing Care: Nurses’ and General Practitioners’ Perspectives,” by Annels et.al. published on the Journal of Clinical Nursing, Volume 20, Issue 1-2, pages 214–226, January 2011.
The study on the evaluation of a mental health screening and referral pathway for community nursing care: nurses’ and general practitioners’ (GPs) perspectives, was conducted in a 12-month study in Australia in 2006 to “evaluate a feasible, best mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(ers) in Australia.” A clinical pathway design was developed through literature review and consultation with experts across health care discipline and organizations and then trialed and evaluated using quantitative and qualitative methods. An evaluation survey and focus group discussions were administered to community nurses. Results conclude that GP’s found the pathway useful for their practice but offered suggestions for simplifying the trialed pathway and the accompanying guidelines and improve communication lines between nurses and GPs.
The clinical pathway for the study was developed with a mental health focus for general practitioners without specialized mental health knowledge. The trialed pathway consists of screening and assessment. Under screening and assessment are goals, outcomes, mental health diagnoses, mental health providers, psychosocial assessment, screening tools for depression and anxiety (Depression and Anxiety and Stress Scale) and for alcohol use (Alcohol Use Disorders Identification Tool). Nurse interventions consists of potential urgent referral needs, non-urgent referrals to community providers, health promotion and education, support general community nurse follow-up, treatment plan and signature block. All these are designed for GPs in accordance with competency and ethical standards for Australian nurses.
Although the clinical pathway was well researched and prepared, participants suggested that for a successful use of the pathway, rapport and trust between nurses and clients should be established. The length of the pathway also did not make a good impression on the participants saying it was too lengthy and lacking clear and succinct wording. The other issues raised were the accessibility of the pathway, time constraints, voluminous documentation, physically demanding, and a non-logical sequence. They also emphasized the need for a more extensive education for the general practitioners particularly about the psychosocial assessment. Because although mental health focus is apart of the community nurse’s role, it also requires specialist knowledge. Others in fact, find the pathway confronting against their clients. Other clients with issues on trusts tended to choose which of the nurses they disclose their mental health issues.
The mental health screening and referral pathway for community nursing care follows stringent standards for clinical governance, the mental health component of the study made it difficult for the respondents especially that understanding mental health and implementing mental health care requires extensive knowledge that is not within the scope of a general practitioner, all the more so with the use of mental health screening tools, psychosocial assessment and mental health promotion which requires technical expertise. The nurses also identified the constraint of the social stigma associated with mental health illness which discourages clients to discuss their condition. Lack of knowledge and training in mental intervention coupled with the stigma of mental illness made it difficult for effective referral. This is also made difficult by the lack of communication between the general practitioners and the nurses. Focusing on mental health is difficult however some nurses find screening tools for identifying clients with mental health issues effective. It is then suggested that inclusion of a more specialized mental health intervention should only be done with nurses who have received specialized training and education in mental health interventions. Although in general, nurses and general practitioners found the pathway useful inspite of its drawbacks presented above; the study which was done however with only one trial brought forward the realization, that clinical pathways for mental health interventions no matter how stringent and standardized may not be effective if these are implemented by general practitioners.
BIBLIOGRAPHY
This paper is drawn heavily from:
Annels, Merilyn et.al, 2011. An Evaluation of a Mental Health Screening and Referral Pathway for Community Nursing Care: Nurses’ and General Practitioners’ Perspectives. Journal of Clinical Nursing, Volume 20, Issue 1-2, pages 214–226, January. [online] Available at: <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2010.03275.x/full> [Accessed 25 April 2011].
Other sources referred:
Wikipedia, 2011. Clinical Governance. [online] (Last updated 15, April, 2011). Available at: <http://en.wikipedia.org/wiki/Clinical_governance> [Accessed 25 April 2011]
Wikipedia, 2011. Clinical Pathway. [online] (Last updated 24 January 2011). Available
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