Discontent without focus? An analysis of nurse management and activity on a psychiatric in-patient facility using a...

Psychiatric nursing in the United Kingdom is undergoing major change as a consequence of the policy of community care. Whilst much has been written about the role of the community psychiatric nurse (CPN), less has been said about the preparedness of nurses in in-patient facilities to adapt to the changes. Checkland's (1981) 'soft systems' methodology was used to analyse the situational environment on an acute admission unit. It was found that an increased sense of accountability, combined with the demands of the Mental Health Act 1983, led the ward manager to develop a system, particularly in relation to discharge planning, in which his role was central. This left the ward staff feeling unrecognized and insufficiently experienced in a vital aspect of patient care. Lack of support from the college of nursing and inadequate staff development programmes were also found to have played a part in the situation. The use of reflection in action is recommended as a way of initiating changes in structure, processes and attitudes. Wider inferences are drawn concerning the competence of registered mental nurses (RMNs) practising in in-patient facilities, and the role of the colleges of nursing in operating effectively in the new care and market paradigms.