S.TRUEMAN PhD THESIS 2016
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nurse in the same circumstances. While remote general nurses undertake extended practice, mental healthcare is only one of a number, or one in a suite of specialised skills, they are required to practice, including diabetes, chronic diseases, and sexual health. Hence from the researcher’s experience, for remote nurses to consciously or unconsciously measure their skill level against that of a mental health nurse, is inappropriate and devalues their own skills (Bushy, 2002). They do so based on two assumptions. Firstly, remote nurses have a generalised false perception that MHNs have unrivalled or almost magical skills to care for mental health patients. As referred to in Chapter 6, the regional psychiatrist commented on this point. While MHNs are familiar with mental health tools (e.g., mental state examination, suicide risk assessment), techniques (e.g., de-escalation, motivational interviewing, counselling) and psychiatric terminology, they do not necessarily determine a better outcome. There is very little certainty in the process of managing unwell mental health patients as they can be unreliable, impulsive and irrational. Being cared for by a mental health nurse or a remote general nurse does not change this uncertainty. It may change the manner in which the care is provided but that is still very much dependent on available resources. If a floridly psychotic patient is standing in front of the primary healthcare centre holding an axe, yelling and threatening at 3 am, no nurse, mental health qualified or not, would unlock and leave the protective fencing surrounding the nurse’s quarters. Any nurse, mental health trained or not, would not approach the patient, they would follow protocol and ring the police. The second incorrect assumption is underestimating the very good mental health skills which remote nurses actually possess. Except for very unwell, violent and aggressive mental health presentations, the necessary skills to care for, and assist most mental health
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