The Foundations of Psychosocial Nursing and the Implications for Advancing Mental Health Nursing Education in the UK - An Integrative Review.

Abstract

Introduction/background: Changes to the curriculum of psychiatric and mental health nursing (MHN) since 1980 in the United Kingdom have seen a diminishing interest in psychosocial and psychodynamic approaches. The evolution of the curriculum is characterised by a gradual eradication of applied principles of psychodynamic, group and therapeutic community (TC) ways of working. It is argued that this drift in practice has been co-terminus with a diminution of the quality of relational practice in MHN, especially in acute ward environments.

Method: A two-stage integrative review was conducted. Stage 1 examined literature focusing on psychodynamic psychosocial MHN theory and practice. Stage 2 was a purposive examination of other source material not discovered in the Stage 1 review including biography, archived publications and letters.

Results: In Stage 1, 20 papers met the criteria for inclusion. Papers were ranked by relevance (low, medium, high) and country of origin. The focus of the papers can be clustered under three thematic domains, (i) historical foundations of psychosocial MHN, (ii) psychosocial MHN education, (iii) psychosocial MHN practice. Overall, the yield of papers points to a lack of coherent description of psychodynamic psychosocial nursing practice. Stage 2 reveals a body of psychodynamic knowledge in the work of Peplau and Altschul, and the influence of TC practice. A close re-examination of Skellern's 1957 paper, co-authored with Rapoport, reveals the first iteration of the 'four cornerstones' of TC practice, and a key founding outline of psychosocial psychiatric nursing.

Discussion: Mental health nurse education should develop a curriculum that revitalises core psychosocial principles and practices that are informed by psychodynamic and TC-based knowledge. Key pillars for a new approach to psychosocial mental health nurse education are proposed.

Conclusions: A re-framed focus for MHN education should focus on relational practice, interpersonal skills development, group dynamics and experiential learning. Education and skills development in these areas will benefit patients and improve outcomes.