S.TRUEMAN PhD THESIS 2016

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patients are within the general nurse’s repertoire of nursing skills. Showing empathy, active listening, encouragement, displays of understanding and problem solving are all possessed and used by remote general nurses, when caring for mental health patients (and other types of patients). The routine day-to-day interactions with mental health patients involve skills such as administering a depot medication injection, attending to a housing crisis or undertaking a ‘touching base/check-up’ consultation. The general nurse skill base is well equipped for these tasks. Conversely when confronted with very ill, violent and aggressive patients, the limitation of resources dictates the limited options available, whether the nurse is mental health trained or not. If there are no facilities to admit, no ability to seclude, no ability to summon the attendance of a psychiatrist and the nurse is by themselves, then any mental health nurse skills are neutered by the adverse circumstances. In any nursing situation the nurse-patient relationship is considered important (Forchuk & Reynolds, 2001), and in mental health nursing, the interpersonal interaction is the corner stone of practice (Cleary, Edwards & Meehan, 1999). That relationship is the essence of mental healthcare (Priebe & Gruythers, 1993), and often determines the successful mental health outcome for patients (Dziopa & Ahern, 2009; Hagerty & Patusky, 2003; Kai & Crosland, 2001; Pedersen & Karterud, 2007; Shattell, 2004). Nurses, as part of everyday practice, have this ingrained in their nursing praxis and hence, do not need specialist mental health training to build a nurse-patient relationship. The remote nurse participants reported that they did not have adequate knowledge or skills to provide care for mental health patients. Is this belief a reaction to remote general nurse’s experience with mental health patients (or lack thereof), due to the lack of adequate resources, or both? Breeze and Repper (1998) examined metropolitan nurse’s