S.TRUEMAN PhD THESIS 2016

107

the following factors at the three testing points: interactions between time and participant group for perceived barriers and attitudes; and perceived performance and frequency of engagement with clients across two points (pre- and follow-up). Paired comparisons were then used to examine effects between time and group. Limitations of the study were outlined with the acknowledgment that there were only 32 participants and that a larger randomised control study (RCT) is needed. In the qualitative study by Kennedy et al. (2013) 15 nurses were interviewed by telephone two months after completing the course. One trained interviewer was engaged, transcripts were checked and rechecked for accuracy, an interpretative phenomenological analysis was adopted and data analysis was undertaken separately and as a group by three very experienced researchers. Eight themes were identified from the interviews were discussed in detail. These themes included usefulness/positive; not-useful/negative elements of the course, discussion concerning barriers in using the content and suggestions to modify the course. Kennedy et al. (2013) concluded the article with an extensive and thorough discussion about the course and its evaluation, including limitations of both of these features and recommendations for future directions of alcohol misuse training for rural and remote nurses. 3.2.8 Conclusion Rural and remote mental health clients rely heavily on generalist nurses for care. Research into the issue of generalist nurses caring for mental health clients in rural and remote settings is a developing field in which there is negligible literature published before 2000. This integrative review of the literature has found that many rural and remote nurses believe they do not have the necessary skills, competencies, resources and support to provide adequate care to mental health clients—a phenomenon that is not contained to