S.TRUEMAN PhD THESIS 2016

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Remote nurse perceptions of lacking competence and confidence, in caring for mental health patients is also reflected in metropolitan nurses. The same concerns and issues arise which are representative of those harboured by remote general nurses. Rutledge et al. (2013) found in their study that situations requiring the use of de-escalation techniques and crisis communication by acute remote general nurses (in hospital settings) are times when they felt the least competent. This is consistent with the remote nurse participants in this study who reported aggressive and violent patients as the most difficult to care for (Chapter 6). One study (Wynaden et al., 2003) reports that the presence of a qualified mental health nurse, augmented into an emergency department, reassures staff, reduces delays, levels of aggression and violence and greatly assists generalist nurses caring for mental health patient crisis presentations. None of which can be realistically achieved in remote primary healthcare centres. A lack of perceived ability to care for mental health patients is concerning because it can lead to anxiety which can impede skill development (Sharrock & Happell, 2006). While low levels of anxiety can be motivating for individuals to learn, high levels of anxiety can prevent individuals (e.g., remote nurses) from learning new information (e.g., mental health training) or being able to conceptualise multiple approaches in analysing a situation (e.g., a complex mental health presentation) (Peplau, 1988). Nurses with persistent low levels of confidence may become resistive to ‘learning, more rigid in their views and less able to assist patients’ (Sharrock & Happell, 2006, p. 13). If a self reinforcing lack of success in caring for mental health patients develops this may further reinforce remote nurses’ feelings of uncertainty.