Community Mental Health Nursing, Leadership and Self Care

In this article, two Queen’s Nurses, community mental health nurses, write about contemporary practice and the vital role of self-care for those in the profession. Both nurses work for Lincolnshire Partnership NHS Foundation Trust.

Observations and feedback have highlighted an opportunity to enhance (from a physical, emotional and intellectual perspective) the resources available to nurses regarding mental health care, and support for one another.

This includes improving approaches to difficult conversations and identifying suitable avenues for signposting individuals. It is essential to ensure these resources are accessible to everyone.

In response to this need, Lesley Hutton and Eleanor Duke, recently appointed as Queen’s Nurses, aim to celebrate and champion the role of mental health nurses. They are dedicated to exploring innovative methods to better support their colleagues, wider stakeholders, and the individuals in their care. This article aims to articulate their role as community nurses and the self-care options available for our broader nursing community.

Critical thinking

Aligning mental health nurses with contemporary mental health care necessitates the development of critical skills such as critical thinking, value-based decision-making, and emotionally intelligent communication. Registered mental health nurses operate within a psychological framework that informs their professional practice and culture (NHS England, 2022).

The role of mental health nurses is currently subject to increased scrutiny, particularly concerning the movement toward a more generic curriculum and its implications for the profession (Jones, 2023). However, The Queen’s Nurse programme provides a platform that amplifies the significance of community mental health nurses and offers resources to support those in community nursing roles.

Compassionate care

Compassionate mental health nurses foster meaningful human connections, making their patients feel valued and supported. A skilled mental health nurse excels in cultivating therapeutic alliances or relationships in their daily practice, which significantly enhances their role.

These reflections pertain to our roles as specialists in mental health. We acknowledge that it is not only ‘patients’ who may struggle with mental ill health but also our colleagues. Community nurses often face challenges in directing their peers to the best support when they are uncertain about the available resources and their personal role in this process.

Many staff within the nursing profession are at high risk of post-traumatic stress symptoms and moral distress (Kinman, Teoh and Harriss, 2020). When dealing with distressing thoughts filled with fear or anxiety, one might question whether simply being a listening ear is sufficient to validate the distressed individual. We believe it is.

Exploring difficult questions

Mental health nurses often employ cognitive restructuring techniques in their practice, which involves challenging unhelpful thinking patterns. By raising awareness of Socratic questioning among community nurses, we can help individuals enhance their self-awareness and build personal resilience, ultimately promoting self-care. For instance, asking individuals about the evidence that supports their negative thoughts or challenging their assumptions can be incredibly beneficial. When mental health and community nurses utilise Socratic questioning as a tool for curiosity and deeper thinking, it encourages individuals to reflect on their beliefs and the underlying logic, paving the way for personal insights and growth (Overholser and Beale, 2023).

Self-care and support

Many articles have been written since the onset of COVID-19 about the significance of self-care and support in clinical practice. One effective approach is walking during clinical supervision or team activities (www.england.nhs.uk , n.d.). This method not only encourages engagement in outdoor activities but also supports nurses who may experience challenges related to neurodiversity or work-related stress, allowing time to process their feelings and emotions.

Presenting self-care in manageable, bite-sized pieces can be beneficial, fostering a platform for additional support and helping individuals develop deeper self-care practices, while also caring for others. Be honest with yourself, what do you enjoy doing, what is realistic in your life, and how much time can you protect for yourself, however short?

The concept of ‘moral injury’ has emerged as a concern within the healthcare field, and the culture of nursing too is evolving. Professionals are now encouraged to explore and seek the best interventions for themselves through various means such as community engagement, nature, research, journalism, or others.

Despite the availability of resources, it remains uncertain whether professionals and those seeking support can easily access these platforms. Signposting towards these resources is crucial to ensuring that help is accessible to all (NHS, 2021).

Take Time to Care for Yourself

As mental health nurses, we advocate for taking time to care for yourselves as professionals. This will enable you to remain compassionate and have capacity to do your roles, which we know can be physically and emotionally draining at times and potentially isolating when working in the community.

By advocating time for yourselves to reflect and protecting this vital time, we hope you will see the benefits for yourselves and the value it then brings to your practice.

Eleanor Duke, Registered Mental Health Nurse, BSc, AdvDip

Lesley Hutton, Registered Mental Health Nurse, Dip Nursing, BA (Hons), PGCert

References

• Dazzi, T., Gribble, R., Wessely, S. and Fear, N.T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, [online] 44(16), pp.3361–3363. doi:https://doi.org/10.1017/s0033291714001299.
• Jones, S. (2023). Is mental health nursing being diluted? | Blogs | Royal College of Nursing. [online] The Royal College of Nursing. Available at: https://www.rcn.org.uk/news-and-events/Blogs/is-mental-health-nursing-being-diluted-270723
• Kinman, G., Teoh, K. and Harriss, A. (2020). The Mental Health and Wellbeing of Nurses and Midwives in the United Kingdom. [online] Available at: https://www.som.org.uk/sites/som.org.uk/files/The_Mental_Health_and_Wellbeing_of_Nurses_and_Midwives_in_the_United_Kingdom
• NHS (2021). Mental Health Services. [online] nhs.uk. Available at: https://www.nhs.uk/nhs-services/mental-health-services/.
• NHS England (2022). The Mental Health Nurse’s Handbook. [online] www.england.nhs.uk. Available at: https://www.england.nhs.uk/long-read/the-mental-health-nurses-handbook/.
• Overholser, J.C. and Beale, E. (2023). The art and science behind socratic questioning and guided discovery: a research review. Psychotherapy Research, 33(7), pp.1–11. doi: https://doi.org/10.1080/10503307.2023.2183154.
• www.england.nhs.uk. (n.d.). NHS England» Implementing walking breaks into community learning disability nurses working day. [online] Available at: https://www.england.nhs.uk/nursingmidwifery/delivering-the-nhs-ltp/professional-nurse-advocate/case-studies/implementing-walking-breaks-into-community-learning-disability-nurses-working-day/.

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