Critical Appraisal of a Research Paper on Clinical Leadership in Mental Health Nursing

This critical appraisal discusses a research paper on clinical leadership in mental health nursing. The paper highlights the importance of a calm and confident approach in treating mental health patients. The study uses a qualitative method, grounded theory, to gather information on clinical direction in mental health. The results suggest that a confident and relaxed attitude of clinical leaders in different situations motivates undergraduate and post-graduate students to learn better. The paper recommends future research on the topic with a bigger sample size.

Running head: CRITICAL APPRAISAL
Critical Appraisal of a Research Paper
Words: 1500
Reference: APA
Student Name:
Student ID:
Professor:
Campus:

2
CRITICAL APPRAISAL
Selected Paper:
Ennis, G., Happell, B., & Reid‐Searl, K. (2015). Clinical leadership in mental health
nursing: The importance of a calm and confident approach. Perspectives in Psychiatric
Care, 51(1), 57-62.
Introduction, identification and significance of the topic
The purpose of the study is discovering the opinions of nurses working in healthcare
concerned with public mental health. The emphasis is put on analysing the significance of
implementing a confident and calm approach for dealing with people experiencing mental
health problems. The study has the scope of exploring the importance of a suitable approach
toward treating mental health service users. The outcome of the survey can act as an
important source of an informant for future researcher want to study the area further. Nurses
can be suggested to adopt a confident and peaceful approach for working efficiently in the
mental health department based on the result. A literature review can provide a better
understanding of the research topic. For gathering better information interviews are carried
out with registered nurses and qualitative method is applied along with grounded theory.
Literature review
As commented by Ennis, Happell & Reid‐Searl (2015), nursing is a challenging and
stressful job. It is one of those few professions offering reasonable care 24*7 hours. The
authors in the starting of the literature review have said that nurses tend to perform their
definite duties hours for dealing with unexpected or unplanned situations. Here, they have
talked about nursing environments, which is related to the research topic of mental health.
The nursing settings are unpredictable as it includes the intensive care units, severe
mental health site and emergency departments (Berry, Waite, Dear, Capon & Murray 2018).
All these areas demand nurses having professional skills within their specialised nursing area

3
CRITICAL APPRAISAL
and being confident while making decisions. When it comes to a crisis or emergency state in
mental health, they need the expertise of working with calmness (Ruiz, Esparza and Hamlin,
2013). In the words of Hagen, Knizek & Hjelmeland (2017), nurses involve in mental health
care must have the ability to regulate their emotional expressions and emotions and maintain
a balance between their engagement and distance to offer useful attention to the patients.
They play a critical role in ensuring excellent service is provided to the care users and
therefore, require adequate formal support (Moxham, McCann, Usher, Farrell & Crookes,
2011). The mental health nurses or MHNs can promote care of mental health patients by
applying a person-centred approach (Caplan, 2013). They must recognise the uniqueness of
every patient’s need by developing a cooperative nurse-patient connection and reflecting on
treatment interferences (Ennis et al. 2015). In this context, Tofthagen, Talseth & Fagerström
(2014) opined that the interventions for medical practice are that nurses can improve the
recovery process of patients by providing them substitute activities and working
cooperatively for enhancing their personal life knowledge and strength. Aston & Coffey
(2012) stated that usually, they apply various strategies and methods for promoting the
wellbeing of self-harm service users.
In emergencies, the approach toward mental health patients is that vital that, if done
with readiness, quality and safety, it can decide these people’s approval and devotion to
treatment (Ennis et al. 2015). Nurses must show a calm attitude while listening to the needs
of individuals, showing respect to their individuality and providing them with sufficient care
and answers for solving their problems (Videbeck, 2010). The authors of the present article
mentioned in this regard that in a mental health setting, the issues, which challenge MHNs
most often, are acute psychotic symptoms, behavioural disturbance and self-harm, which can
eventually result in aggression.

4
CRITICAL APPRAISAL
Clinical leadership is developing as a critical feature for the nurse. It highlights the
significance of offering evidence-based individualised care to the patients. It can improve
results for patients and improved staff retention (Swanwick & McKimm, 2017). Efficient
clinical leaders can attract new nurses by enhancing their quality of placement and thus, can
facilitate a progressive atmosphere for everyone (Bartlett & Hollins, 2018).
Methodology
In this study, the qualitative method is used that is grounded theory. The technique
mainly focuses on producing a practical theory or description of an action or interaction by
looking at the course through the opinions and involvements of the chosen members
(Silverman, 2016). Grounded refers to the method of a continuous reasonable review of the
data collected, its coding and classification. It enables every evolving theory to be chastised
within the data (Sbaraini, Carter, Evans & Blinkhorn, 2011). Therefore, the grounded theory
method is selected for gathering information on clinical direction in mental health and the
prominence of using a unruffled and assertive approach for treating mental health patients
from the nurses. Further, the available theories in the area can be grounded for better
understanding.
The study involves selecting participants from the registered nurses, who work in the
inpatient unit, community teams, mental health triage service and dedicated crisis. The
researcher ensured that the nurses have been working for at least 12 months with mental
health patients. Interviewing them gave a good insight pertains to the necessary
characteristics of efficient clinical leaders. As stated by Mackey & Gass (2015), interviews
are helpful in accumulating detailed information on perceptions, opinions and personal
feelings of the interviewees. In interviews, answers of more detailed questions can be
obtained. Kumar (2019) commented that people could express their view elaborately in a

5
CRITICAL APPRAISAL
semi-structured interview enabling researchers acquiring in-depth knowledge on the research
topic and thus, generating a valuable outcome.
Hence, interviewing the nurses in the current study and recording their answers have
helped the researcher analysing the research question better and thus, having a better
understanding of clinical leadership in mental health.
The semi-structured interview used in the study facilitates the researcher preparing the
questions to be asked before the interview (Rabionet, 2011). It also allowed the participants
expressing their view independently that helped in collecting comparable and reliable
qualitative data on clinical leadership. Thus, the research method applied in the study helped
in achieving research aim successfully.
Ethics consideration
For conducting the research ethically without breaching any regulation, the researcher
took formal approval form each nurse, who took part in the interview. Apart from that, the
researcher ensured that the participation of the interviewee is voluntary. The national stamen
of ethical research is also maintained throughout the study, and ethical consent is taken from
the university human research ethics committee and the mental health service too.
Significant results
The results of the research highlighted the importance of staying calm and confident
while dealing with any unpredictable situation in a mental health setting. In a stressful
situation or crisis, this attitude has a positive influence. The participants used the example of
clinical leaders, who they consider as useful while answering the interview questions. It
helped in identifying the expected and required qualities of a clinical leader in a crisis.
Clinical competency is evident within such leaders, who are not influenced by a stressful
situation instead think systematically for addressing the job successfully. The nurses also

6
CRITICAL APPRAISAL
mentioned that the ability to stay calm and steady in all kind of situation and not being
agitated help them engaging more actively with others and handling situation demanding
additional activities.
Further, the results also discovered that the ability to handle a crisis-driven situation
calmly and confidently helps clinical leader generation an overall improved outcome for both
the clients and the staff. It is also highlighted from the result that medical professionals with a
confident and calm approach accompanied by practical interpersonal skills can avoid an
aggressive event caused by highly distressed or acutely unwell patients. Thus, the importance
of the outcome lies in suggesting future nurses adopt a calm and confident approach while
treating clients having mental health issues.
Discussion or reflective critique
The effectiveness of clinical leaders become evident when they can manage a fickle
situation without becoming stressed out or nervous instead with a confident and composed
attitude. Cleary, Horsfall, Deacon & Jackson (2011) commented that such incidents are
inspiring for undergraduate nursing students and less experienced medical staff. Useful
interpersonal skill and a composed and poised attitude is necessary for handling difficult
situations in mental health organisations. Reem, Kitsantas & Maddox (2014) opined that it
helps to manage an excellent therapeutic relationship with the patients.
Not many studies are conducted previously in the area, and therefore, the current
research has made an important discovery in the mental health field. As stated by Beckett et
al. (2013), it requires a specified set of skills for handling patients with an aggressive attitude.
Therefore, developing these skills is necessary for the clinical leaders of the next generation.
Recommendations

7
CRITICAL APPRAISAL
The authors have recommended that for being a competent clinical leader, acquiring
the skill of staying serene and confident in various clinical situations is necessary. These
skills have an optimistic effect on the patients and the trainee nurses, who are undergraduates.
Hence, the study suggests carrying out future research on how confident and relaxed attitude
of clinical leaders in different situations motivate the undergraduate and post-graduate
students learning better. With a bigger sample size, a further study in the area can explore
another side of the confident and calm approach of treating patients in the mental health
setting.

8
CRITICAL APPRAISAL
References
Aston, V., & Coffey, M. (2012). Recovery: what mental health nurses and service users say
about the concept of recovery. Journal of Psychiatric and Mental Health
Nursing, 19(3), 257-263.
https://www.researchgate.net/profile/Michael_Coffey4/publication/
51787168_Recovery_What_mental_health_nurses_and_service_users_say_about_the
_concept_of_recovery/links/59dddf69458515f6ef09c925/Recovery-What-mental-
health-nurses-and-service-users-say-about-the-concept-of-recovery.pdf
Bartlett, A., & Hollins, S. (2018). Challenges and mental health needs of women in
prison. The British Journal of Psychiatry, 212(3), 134-136.
https://sci-hub.tw/10.1192/bjp.2017.42
Beckett, P., Field, J., Molloy, L., Yu, N., Holmes, D., & Pile, E. (2013). Practice what you
preach: developing person-centred culture in inpatient mental health settings through
strengths-based, transformational leadership. Issues in mental health nursing, 34(8),
595-601.
https://www.researchgate.net/profile/Paul_Beckett/publication/
255174905_Practice_What_You_Preach_Developing_Person-
Centred_Culture_in_Inpatient_Mental_Health_Settings_through_Strengths-
Based_Transformational_Leadership/links/570f9ff708ae170055bddc57.pdf
Berry, H. L., Waite, T. D., Dear, K. B., Capon, A. G., & Murray, V. (2018). The case for
systems thinking about climate change and mental health. Nature Climate
Change, 8(4), 282.

9
CRITICAL APPRAISAL
https://www.researchgate.net/profile/Helen_Berry4/publication/
324146598_The_case_for_systems_thinking_about_climate_change_and_mental_hea
lth/links/5bba8ecd4585159e8d8bdbd0/The-case-for-systems-thinking-about-climate-
change-and-mental-health.pdf
Ruiz, C.E., Esparza, L. & Hamlin, R.G., (2013). Managerial and Leadership Effectiveness as
Perceived by Managers and Non-Managers. Management, 3(2), 127-150.
https://www.ufhrd.co.uk/wordpress/wp-content/uploads/2013/10/Ruiz-Esparza-Hamlin-full-
paper.pdf
Caplan, G. (2013). An approach to community mental health. Routledge.
https://content.taylorfrancis.com/books/download?dac=C2004-0-01294-
9&isbn=9781315013879&format=googlePreviewPdf
Cleary, M., Horsfall, J., Deacon, M., & Jackson, D. (2011). Leadership and mental health
nursing. Issues in Mental Health Nursing, 32(10), 632-639.
https://sci-hub.tw/https://doi.org/10.3109/01612840.2011.584362
Ennis, G., Happell, B., & Reid‐Searl, K. (2015). Clinical leadership in mental health nursing:
The importance of a calm and confident approach. Perspectives in Psychiatric
Care, 51(1), 57-62.
https://s3.amazonaws.com/academia.edu.documents/41538119/pdf.pdf?response-content-
disposition=inline%3B%20filename
%3DClinical_Leadership_in_Mental_Health_Nur.pdf&X-Amz-Algorithm=AWS4-
HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A
%2F20190913%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-
Date=20190913T093747Z&X-Amz-Expires=3600&X-Amz-

10
CRITICAL APPRAISAL
SignedHeaders=host&X-Amz-
Signature=d3bbd6a8405681e83f327ebb9c5893a0396a1d9cdd3b52fe855521a14a0977
36
Ennis, G., Happell, B., & Reid‐Searl, K. (2015). Enabling professional development in
mental health nursing: the role of clinical leadership. Journal of psychiatric and
mental health nursing, 22(8), 616-622.
https://sci-hub.tw/10.1111/jpm.12221
Hagen, J., Knizek, B. L., & Hjelmeland, H. (2017). Mental health nurses' experiences of
caring for suicidal patients in psychiatric wards: an emotional endeavor. Archives of
psychiatric nursing, 31(1), 31-37.
https://www.sciencedirect.com/science/article/pii/S0883941716301480
Kumar, R. (2019). Research methodology: A step-by-step guide for beginners. Sage
Publications Limited.
https://books.google.co.in/books?
hl=en&lr=&id=J2J7DwAAQBAJ&oi=fnd&pg=PP1&dq=Kumar,+R.+(2019).
+Research+methodology:+A+step-by-step+guide+for+beginners.
+Sage+Publications+Limited.&ots=curoECMJii&sig=q2Y5vSnO4oNaY0hCHyWw_
wz8OVs#v=onepage&q&f=false
Mackey, A., & Gass, S. M. (2015). Second language research: Methodology and design.
Routledge.
https://content.taylorfrancis.com/books/download?dac=C2013-0-24444-
2&isbn=9781317612650&format=googlePreviewPdf

11
CRITICAL APPRAISAL
Moxham, L., McCann, T., Usher, K., Farrell, G., & Crookes, P. (2011). Mental health
nursing education in preregistration nursing curricula: A national report. International
Journal of Mental Health Nursing, 20(4), 232-236.
https://s3.amazonaws.com/academia.edu.documents/39886331/
Mental_health_nursing_education_in_prere20151110-29538-1g7vtqd.pdf?response-
content-disposition=inline%3B%20filename
%3DMental_health_nursing_education_in_prere.pdf&X-Amz-Algorithm=AWS4-
HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A
%2F20190913%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-
Date=20190913T093415Z&X-Amz-Expires=3600&X-Amz-
SignedHeaders=host&X-Amz-
Signature=b2dd6d66a77f84f7a2a78b88a1949df08aa4f6b46f854d1b164dcc21d5c6d7b
b
Rabionet, S. E. (2011). How I Learned to Design and Conduct Semi-Structured Interviews:
An Ongoing and Continuous Journey. Qualitative Report, 16(2), 563-566.
https://files.eric.ed.gov/fulltext/EJ926305.pdf
Reem, A. D., Kitsantas, P., & Maddox, P. J. (2014). The impact of residency programs on
new nurse graduates' clinical decision-making and leadership skills: A systematic
review. Nurse Education Today, 34(6), 1024-1028.
https://sci-hub.tw/https://doi.org/10.1016/j.nedt.2013.10.006
Sbaraini, A., Carter, S. M., Evans, R. W., & Blinkhorn, A. (2011). How to do a grounded
theory study: a worked example of a study of dental practices. BMC medical research
methodology, 11(1), 128.

12
CRITICAL APPRAISAL
https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-11-128
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
https://books.google.co.in/books?
hl=en&lr=&id=9FALDAAAQBAJ&oi=fnd&pg=PP1&dq=Silverman,+D.+(Ed.).
+(2016).+Qualitative+research.
+Sage.&ots=9ndFky2x8J&sig=ShNhIo3T7tcGDRTOmtuckEw9ytw#v=onepage&q=
Silverman%2C%20D.%20(Ed.).%20(2016).%20Qualitative%20research.
%20Sage.&f=false
Swanwick, T., & McKimm, J. (2017). ABC of clinical leadership. John Wiley & Sons.
https://books.google.co.in/books?
hl=en&lr=&id=3GHoDQAAQBAJ&oi=fnd&pg=PR3&dq=Swanwick,+T.,+
%26+McKimm,+J.+(2017).+ABC+of+clinical+leadership.+John+Wiley+
%26+Sons.&ots=99YBpL4xYl&sig=stl7OH3HYP4CBymTMt-
JwAJqxLA#v=onepage&q=Swanwick%2C%20T.%2C%20%26%20McKimm%2C
%20J.%20(2017).%20ABC%20of%20clinical%20leadership.%20John%20Wiley
%20%26%20Sons.&f=false
Tofthagen, R., Talseth, A. G., & Fagerström, L. (2014). Mental Health Nurses’ Experiences
of Caring for Patients Suffering from Self-Harm. Nursing research and
practice, 2014.
http://downloads.hindawi.com/journals/nrp/2014/905741.pdf
Videbeck, S. L. (2010). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
https://books.google.co.in/books?
hl=en&lr=&id=2rHoouxT514C&oi=fnd&pg=PA226&dq=Videbeck,+S.+L.+(2010).

13
CRITICAL APPRAISAL
+Psychiatric-mental+health+nursing.+Lippincott+Williams+%26+Wilkins.&ots=O-
ZPJ9zOy8&sig=av-_iDiK6lqI5zjXSAPVsyi4IHo#v=onepage&q=Videbeck%2C
%20S.%20L.%20(2010).%20Psychiatric-mental%20health%20nursing.
%20Lippincott%20Williams%20%26%20Wilkins.&f=false