S.TRUEMAN PhD THESIS 2016

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attitudes and concerns in caring for ‘difficult’ mental health patients. Nurses defined ‘difficult’ patients as those who display aggression, violence, self-harming and disruptive behaviours (Happell & Sharrock, 2002; Heslop, Elsom & Parker, 2000). Breeze and Repper (1998) found that threats, aggression and violence reduced the metropolitan nurses’ self-reported levels of competence and control. This was despite having more mental health resources available to them than remote nurses. A dominant theme by remote nurses was that of human resources. The nurses were more likely to feel challenged when they were short staffed compared to when staffing levels were considered adequate. The nature of the remote nursing role is to constantly cope and deliver mental healthcare in the face of resource scarcity, particularly in relation to staffing. It appears from the literature that metropolitan nurses’ primary concerns, in caring for mental health patients are similar and also report low levels of confidence and competency, even though there appears to be vastly more resources and ready access to specialist mental health trained staff. Sivakumar et al.’s (2011) national study included a discrete population of participants, namely specialist emergency nurses working in emergency departments. The following issues were identified in caring for mental health patients; knowledge/skill deficits (including risk assessments, particularly for self-harm, triaging mental health patients, drug types and doses when chemically restraining patients, communication strategies and conducting mental state examinations), environmental factors (including inappropriate environment, lack of staff, lack of space, lack of resources such as mental health beds and delays in referrals and lack of safety in the ED) and personal factors (including low perceived levels of confidence and attitudes) (Sivakumar et al., 2011). All