Abstract
In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with mental health-clients, an important outcome explored and measured was clinical reasoning. Previous studies have revealed that emergency nurses feel ill-prepared, lack clear frameworks for practice and are thus vulnerable to subtle discourse tensions such as managing versus caring, and diagnosing versus understanding. Thus, an intervention was conducted and evaluated to enhance understanding and build pro-active nursing skills. It was centred on a nursing philosophy known as Solution Focused Nursing (SFN) - a model of care designed to move nurses' perspective towards a proactive, strengths orientation, the aim of which is to assist them to instill hope in the client and motivate him/her to take the next steps needed for change and recovery. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. Using the case scenarios in this way served two purposes: They formed part of the educational intervention and thus were learning experiences in their own right; and they provided data to indicate initial and post intervention levels of understanding. A total of 28 emergency nurses completed the activity. Data were audio taped, transcribed, and analyzed. The results indicated that significant improvements were noted in nurses' ability to consider the clients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to clients with mental health problems who present to emergency settings, reducing stigma for clients and providing the important first steps to enduring change - acknowledgement and respect.