Professional change and knowledge translation in mental health nursing: case study of the integration of a health policy into practice

摘要

This investigation aims to explore the area of change and knowledge translation in professional practice by using a case study to investigate the integration of a health policy into clinical mental health nursing (MHN) practice. It will address the research question of ‘What factors influenced the integration of Choosing Health (2006) and the Well-being Support Programme (WBSP) at the Trust’ by exploring how mental health nurses and managers of mental health services constructed and operationalised the recommendations of this policy into mental health services 2007-2008. A case study design and constructivist grounded theory methodology were used and the participants were taken from two groups who both worked in the Trust: registered mental health nurses (MHN) (n=28) and clinical managers of mental health services (n=18). Data were collected from the reflective accounts of the participants’ experiences of implementing the Choosing Health (2006) policy recommendations over a six month period during 2008. The Trust in this study was a large mental health and social care Trust in the South-East of England. Data were deductively analysed using a modified version of Lewin’s (1946) change theory which found six minor themes representing the factors that affected the implementation of Choosing Health (2006) in the Trust. The factors were common to both practitioners and managers and were: resources; policy and procedures; leadership in change; personal and professional development: support; motivation and innovation. The relationships between the six minor themes were examined further using inductive analysis producing three key themes that answered the research question of this study which are: organisational factors; professional factors and individual factors. This thesis argues that professional, as defined by Dopher (2012), influence in health policy both individually and strategically is weak, indicating deficits in professional influence, specifically in relation to organisational influence and professional representation. Further, shortfalls in professional influence at both local and national level were identified, resulting in under representation of the professional values, beliefs, codes of conduct and culture of mental health nursing (MHN). It is proposed that groups representing MHN should provide a higher profile advising on and developing mental health policy to improve the translation of policy into practice instead of its interpretation into practice. It also recommends that there should be an increased involvement in critically evaluating the professionally relevant evidence pertaining to the policy and an means of interpretation policy implications in terms of the practitioners related roles and responsibilities.