PROFESSIONAL IDENTITY OF NURSES IN THE MENTAL HEALTH FIELD: AN INTEGRATIVE REVIEW

Oliveira, Tâmara da Cruz Piedade; Silva, Ingredy Nayara Chiacchio; Santos, Sélton Diniz dos; Almeida, Deybson Borba de; Silva, Gilberto Tadeu Reis da

doi:10.1590/ce.v28i0.91494

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Sumário

REVIEW • Cogit. Enferm. 28 • 2023 • https://doi.org/10.1590/ce.v28i0.91494 copy

PROFESSIONAL IDENTITY OF NURSES IN THE MENTAL HEALTH FIELD: AN INTEGRATIVE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Nurses have a fragile understanding of their scope of work.
Nurses present a fragmented perception between physical and psychic care.
We found fragile identity demarcations among mental health nurses.
Work processes anchored in nursing theories were discussed.

ABSTRACT

Objective:

to analyze the production of knowledge in the scientific literature on the constitution of professional identity in nurses working in the field of mental health.

Method:

integrative literature review through the Virtual Health Library portal in four databases: Lilacs, Scielo, PubMed and BDENF. The eligibility criteria were full original articles published from 2017-2022 in English, Portuguese, or Spanish.

Results:

the sample was composed of 18 studies grouped into two thematic categories. The results are about the (in)definitions of the work process of nurses working in the mental health field, and about the fragmentation of care and its implications for the constitution of this professional identity.

Conclusion:

nurses play diversified roles in their daily work, which contributes to an insufficient understanding of their scope of attributions and directly impacts the perception of their professional identity.

DESCRIPTORS:
Psychiatric Nursing; Nurse’s Role; Mental Health Assistance

Title/Year/Country	Major Findings	Thematic Categories
15. Mental Health Nursing: waiting room intervention in integral health care (2020, Brazil)¹³13 Pasquali, L. (2010). Instrumentação psicológica: fundamentos e práticas. Porto Alegre, RS: Artmed.	Meetings in the waiting room favored the articulation between the theoretical and practical knowledge of nursing care, constituting a valuable space for the development of group educational actions to be undertaken by mental health nurses.	Professional identity and (in) definitions of the work process
16. Implementation of the nursing process in mental health: convergent-assistance research (2020, Brazil)¹⁴14 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em Saúde. 12. ed. São Paulo: HUCITEC; 2014..	Insufficient training to perform the Systematization of Nursing Care (SAE) and operationalization of the Nursing Process (NP) in mental health. The implementation was perceived, however, as a possible way to articulate with the National Mental Health Policy.	Professional identity and (in) definitions of the work process
17. Nurses of Psychiatric Urgent Care and Emergency Services: Analysis of Professional and Educational Profile (2017, Brazil)¹⁵15 Andrade JMM, Farinha MG, Esperidião E. Enfermagem em saúde mental: intervenção em sala de espera na assistência integral à saúde. Rev. bras. enferm. [Internet]. 2020 [cited in 2022 Oct. 28]; 73(Suppl 1):e20180886. Available in: https://doi.org/10.1590/0034-7167-2018-0886. https://doi.org/10.1590/0034-7167-2018-0...	Professionals lack specialized training and clinical practice in the care of psychiatric urgencies and emergencies. Male professionals continue in the front line of clinical practice, which denotes the persistence of elements of the asylum model.	Professional identity and (in) definitions of the work process
18. Care in the psychiatric hospital from the perspective of the nursing team (2014, Brazil)¹⁶16 Silva TG, Santana RF, Dutra VFD, Souza PA.Implantação do processo de enfermagem na saúde mental: pesquisa convergente-assistencial. RevBrasEnferm. [Internet]. 2020 [cited in 2022 Oct. 28]; 73(Suppl 1):e20190579. Available in: http://dx.doi.org/10.1590/0034-7167-2019-0579. http://dx.doi.org/10.1590/0034-7167-2019...	Nurses point to sensitive listening, personal availability, and attention to the singularity of care as necessary attributes. The care is operated in a scenario of tensions experienced by the duality of the asylum and psychosocial paradigms	Professional identity and (in) definitions of the work process
19. Changes occurred in professional practice around mental health facing the Brazilian Psychiatric Reform in the view of the nursing team (2017, Brazil)¹⁷17 Vargas D, Soares J, Ponce TD, Oliveira BB. Enfermeiros de serviços de urgência e emergência psiquiátrica: análise de perfil profissional e educacional. CogitareEnferm. [Internet]. 2017 [cited in 2022 Oct. 28]; 22(4). Available in: http://dx.doi.org/10.5380/ce.v22i4.50704. http://dx.doi.org/10.5380/ce.v22i4.50704...	The nurse plays a comprehensive role in care practices, exercising greater professional autonomy, and it is necessary to develop new competencies and skills to provide qualified mental health care.	Professional identity and (in) definitions of the work process
20. Mental health actions and the nurse’s work (2020, Brazil)¹⁸18 Cortez EA, Tavares CMM, Muniz MP. Cuidado no hospital psiquiátrico sob a ótica da equipe de enfermagem. Rev Rene. [Internet]. 2014 [cited in 2022 Oct. 28]; 15(2). Available in: https://www.redalyc.org/articulo.oa?id=324031263013. https://www.redalyc.org/articulo.oa?id=3...	Participants of the study point out difficulties regarding the delimitation of their scope of action in the logic of interdisciplinary work. They identified themselves as facilitators of professional teamwork, with a focus on physical health care.	Professional identity and (in) definitions of the work process
21. Working conditions of the nursing team in mental health devices (2020, Brazil)¹⁹19 Alves MM, Gonçalves AS, Borba LO, Brusamarello T, Czarnobay J. Mudanças ocorridas na prática profissional na área da saúde mental frente à reforma psiquiátrica brasileira na visão da equipe de enfermagem. Rev. Pesqui. [Internet]. 2017 [cited in 2022 Oct. 28]; 9(2). Available in: https://doi.org/10.9789/2175-5361.2017.v9i2.309-314. https://doi.org/10.9789/2175-5361.2017.v...	The insertion in the mental health field is not the first choice for nurses. The lack of training and difficulties in establishing interdisciplinary partnerships contribute to dissatisfaction in the daily work.	Professional identity and (in) definitions of the work process
22. Roles, conflicts and gratifications of specialist nurses in psychiatric nursing and mental health (2021, Brazil)²⁰20 Almeida JCP, Barbosa CA, Almeida LY, Oliveira JL, Souza J. Ações de saúde mental e o trabalho do enfermeiro. RevBrasEnferm. [Internet]. 2020 [cited in 2022 Oct. 28]; 73(Suppl 1):e20190376. Available in: http://dx.doi.org/10.1590/0034-7167-2019-0376. http://dx.doi.org/10.1590/0034-7167-2019...	Specialist nurses identify themselves by acting more focused on direct care to the service users and less bureaucratic. They observe personal gratification through professional recognition by the team and users.	Professional identity and (in) definitions of the work process
23. Nursing Process in the daily life of nurses in Psychosocial Care Centers (2014, Brazil)²¹21 Morais ASE, Cordeiro GFT, Peters AA, Santos TM, Ferreira RGS, Peres MAA. Condições de trabalho da equipe de enfermagem em dispositivo de saúde mental. RevBrasEnferm. [Internet]. 2021 [cited in 2022 Oct. 28]; 74 (suppl 3); e20200407. Available in: https://doi.org/10.1590/0034-7167-2020-0407. https://doi.org/10.1590/0034-7167-2020-0...	The Nursing Process is executed in a bureaucratic way. There is a lack of clarity of the scope of action of the nursing team together with the multi-professional team, hindering the performance based on integrality and the proper use of the NP as a contribution of the nurse.	Professional identity and (in) definitions of the work process
24. ‘In the middle’: A qualitative study of talk about mental health nursing roles and work (2019, Australia)²²22 Lima RVM, Pedrão LJJ, Miasso AI, Costa Junior ML. Papéis, conflitos e gratificações de enfermeiros especialistas em enfermagem psiquiátrica e saúde mental. Rev. Eletr. Enferm. [Internet]. 2012 [cited in 2022 Oct. 28]; 14(1). Available in: https://doi.org/10.5216/ree.v14i1.12145. https://doi.org/10.5216/ree.v14i1.12145...	Diversification, lack of definition and ambiguity of attributions, with a focus on managerial/administrative functions are pointed out by nurses, which contributes to the invisibility of their work and feelings of professional frustration.	Professional identity and (in) definitions of the work process
25.Person-centered psychiatric nursing interventions in acute care settings (2019, Canada)²³23 Lopes PF, Garcia APRF, Toledo VP. Processo de enfermagem no cotidiano do enfermeiro nos Centros de Atenção Psicossocial. Rev. Rene. [Internet]. 2014 [cited in 2022 Oct. 28]; 15(5). Available in: https://doi.org/10.15253/2175-6783.2014000500007. https://doi.org/10.15253/2175-6783.20140...	Data analysis revealed the theme of Person-Centered Care. The following were highlighted: horizontalization in the professional-client relationship; agreement on individualized care plans based on resources and goals and jointly agreed upon; empathetic posture; active listening skills; and, educational actions.	Professional identity and fragmentation of care
26. Physical health monitoring in mental health settings: a study exploring mental health nurses’ views of their role (2016, United Kingdom)²⁴24 Terry J. ‘In the middle’: a qualitative study of talk about mental health nursing roles and work. Int J Ment Health Nurs. [Internet]. 2020 [cited in 2022 Oct. 28]; 29(3). Available in: https://doi.org/10.1111/inm.12676. https://doi.org/10.1111/inm.12676...	The study participants demonstrated clarity about the attribution of monitoring the physical health of service users. They emphasized the importance of integration between physical and psychological care, a responsibility that should be shared among the health team.	Professional identity and fragmentation of care
27. Physical Healthcare of People with Serious Mental Illness: A Cross-Sectional Study of Nurses’ Involvement, Views, and Current Practices (2019, Turkey)²⁵25 Thomson AE, Racher F, Clements K. Person-Centered Psychiatric Nursing Interventions in Acute Care Settings. Issues Ment Health Nurs. [Internet]. 2019 [cited in 2022 Oct. 28]; 40(8). Available in: https://doi.org/10.1080/01612840.2019.1585495. https://doi.org/10.1080/01612840.2019.15...	The study revealed incongruities between the nurses’ perception and their practice: despite recognizing physical health care as attributions of the profession, the actual practices related to these users’ needs were not evident.	Professional identity and fragmentation of care
28. Should we, or shouldn’t we? Mental health nurses’ views on physical health care for mental health consumers (2012, Australia)²⁶26 Mwebe H. Physical health monitoring in mental health settings: a study exploring mental health nurses’ views of their role. J ClinNurs. [Internet]. 2017 [cited in 2022 Oct. 28]; 26(19-20). Available in: https://doi.org/10.1111/jocn.13653. https://doi.org/10.1111/jocn.13653...	The study pointed out varied perceptions among the nurses, showing ambivalence regarding the understanding of the limits of their role in relation to the users’ physical health care.	Professional identity and fragmentation of care
29. Supporting mental health nurses in meeting the physical health needs of people with severe mental illness in acute inpatient settings (2011, United Kingdom)²⁷27 Yalçın SU, Bilgin H, Özaslan Z. Physical healthcare of people with serious mental Illness: across-sectional study of nurses’ involvement, views, and current practices. Issues Ment Health Nurs. [Internet]. 2019 [cited in 2022 Oct. 28]; 40(10). Available in: https://doi.org/10.1080/01612840.2019.1619201. https://doi.org/10.1080/01612840.2019.16...	The findings of the study showed inconsistencies between the responsibility perceived by nurses and the actual practice of the attributions based on the objectives, which highlights the need for clarification regarding the scope of action and training of skills for such.	Professional identity and fragmentation of care
30. The chasm of care: Where does mental health nursing’s responsibility for the physical health care of people with severe mental illness lie? (2016, Australia)²⁸28 Happell B, Scott D, Platania-Phung C, Nankivell J. Should we or shouldn’t we? Mental health nurses’ views on physical health care of mental health consumers. Int J Ment Health Nurs. [Internet]. 2012 [cited in 2022 Oct. 28]; 21(3). Available in: https://doi.org/10.1111/j.1447-0349.2011.00799.x. https://doi.org/10.1111/j.1447-0349.2011...	The findings revealed that the institutional culture exerts influence on the nurses’ conduct regarding the users’ physical health care. However, on an individual level, these professionals remain uncertain about the limits of their professional responsibility in this matter.	Professional identity and fragmentation of care
31. How does mental health nursing contribute to improving the physical health of service users with severe mental illness? A thematic review (2016, United Kingdom)²⁹29 Howard L, Gamble C. Supporting mental health nurses to address the physical health needs of people with serious mental illness in acute inpatient care settings. J PsychiatrMent Health Nurs. [Internet]. 2011 [cited in 2022 Oct. 28]; 18(2). Available in: https://doi.org/10.1111/j.1365-2850.2010.01642.x https://doi.org/10.1111/j.1365-2850.2010...	The study indicated that physical health was not presented as a priority, and there is fragmentation between physical and mental health in the practice of the professionals. Nurses pointed out the need to strengthen their skills for physical health care.	Professional identity and fragmentation of care
32. Role of the mental health nurse in relation to physical health care in severe mental illness: An integrative review of 10 years of UK Literature (2012, United Kingdom)³⁰30 Wynaden D, Heslop B, Heslop K, Barr L, Lim E, Chee GL, et al. The chasm of care: where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness? Int J Ment Health Nurs. [Internet]. 2016 [cited in 2022 Oct. 28]; 25(6). Available in: https://doi.org/10.1111/inm.12242. https://doi.org/10.1111/inm.12242...	Nurses do not go through routine training processes to act facing the clinical issues of mental health users, with an important expression of role ambiguity among the professionals themselves. Poor communication between services of different levels of complexity were also pointed out as a challenge for the integrality of care.	Professional identity and fragmentation of care

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[1] Corresponding author: Tâmara da Cruz Piedade Oliveira Universidade Federal da Bahia R. Melvin Jones, nº117, apt 903, Jardim Armação, Salvador - BA. CEP: 41750-010 E-mail: tamcpo@gmail.com