S.TRUEMAN PhD THESIS 2016

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9.3 Self-Perceived Levels of Mental Healthcare Skills, Abilities and Confidence The study’s second major finding is that remote nurses’ report self-perceived low levels of confidence, role competency (skills) and knowledge concerning mental healthcare. This finding is very similar to the findings of a previous study by Clark et al. (2005), but the studies were quite different. Clark et al.’s (2005) study was a quantitative study using a self-completed questionnaire, by rural nurses. This study is a qualitative case study design, involving remote (not rural) nurses and includes other relevant participants (non-clinical nurses and non-nurses). Hence this study is able to report more widely as the participants were not restricted to nurses. These other actors (study participants) in the social world, have positive opinions concerning the skills and ability of remote nurses to deliver mental healthcare. This second major finding is not surprising considering the real and significant difficulties and challenges remote general nurses confront when delivering mental healthcare, for example, inter alia lack of resources, training and access to specialist mental health support. This is recognised by metropolitan emergency department nurses who ‘indicated significant concern and sympathy for their rural [remote] colleagues’ predicament, delivering mental healthcare in an under resourced, isolated environment, often with inadequate training’ (Jelinek et al., 2011, p. 6). Further challenging the nurses’ self-belief are their reported difficulties in managing acutely agitated, violent, aggressive patients (Happell & Sharrock, 2002; Reed & Fitzgerald, 2005) or suicidal patients (Bailey, 1998), requiring chemical restraint, transfer and associated logistical difficulties. While acknowledging the role of the remote general nurse delivering mental healthcare is