Inpatient units, once the mainstay of mental health care and treatment, now tend to be viewed as a last resort, even as evidence of system failure. Irrespective of one’s views about the need for, or importance of, acute inpatient mental health services, it is evident that attitudes to this area of practice have changed. A hierarchy has emerged that places community care at the top and inpatient units towards the bottom of the pecking order. This presents an interesting divergence from the dynamics of the general health-care system, where Intensive Care, Critical Care and Coronary Care units are considered to represent the need for a higher level of nursing knowledge and skill. Why is this? In simple terms, these nurses provide care and treatment to people who are most ill and most in need. Is this not the same in acute inpatient units? Given the emphasis on the least restrictive environment and community care the answer is clearly yes. So why then do we place less value on the nursing work of inpatient units? I make this point not to suggest that inpatient nurses should be considered more skilled than their community colleagues, but rather to suggest that they should not be considered less skilled. Personally I oppose the notion of hierarchy within nursing practice. The value placed on nursing should reflect its contribution to positive outcomes for people who use the services, rather than less relevant factors such as the practice setting, nature of clientele or degree of autonomy. Suffice it to say that nursing in an inpatient unit requires skill, knowledge and expertise, which may be different to but is not lesser than the skills, knowledge and expertise required in other practice settings. We need to value and support our inpatient nurses for the important contribution they make within mental health services. With this in mind, I proudly introduce the December Edition of the International Journal of Mental Health Nursing with a focus on acute inpatient nursing. A guest editorial by Dr Margaret Grigg sets the scene for an exciting edition by calling for the elimination of restraint and seclusion, an issue that will hopefully be the springboard for passionate discussion and debate within the profession. The feature articles highlight the complexity inherent within the acute inpatient setting. We are alerted by Johansson and colleagues from Sweden to the environment of control that can so easily dominate nursing practice at the expense of therapeutic intervention. This issue of therapy versus control is further considered through the work of Whitehead and Mason who suggest that risk assessment and special observations may indeed lessen the need for more controlling interventions such as restraint and seclusion. Bowers and colleagues describe the negative impact of untoward events (such as suicide, homicide and assault) on both consumers and inpatient nurses and herald the need for an organizational response to limit the occurrence and minimize their impact. The work of Steinert and colleagues challenges the traditional medical model of leadership by describing a successful model of shared leadership between medicine and nursing in psychiatric hospitals in Germany. As mental health policy increasing acknowledges the importance of consumer participation in mental health services, McCann and colleagues explore the attitudes of nurses in inpatient settings to the role and functions of consumer consultants. Thomas and colleagues provide research evidence to support the value of nursing initiatives in reducing the use of PRN medication. For something completely different, but nevertheless important, Reilly and colleagues describe a quit smoking programme for inpatient staff. Given the disproportional number of people with mental illness who smoke, this initiative has significant implications for health promotion in mental health services. I hope you will agree that this Edition provides an important contribution to mental health nursing knowledge in relation to inpatient units. The articles provide interest, diversity and relevance for all nurses, regardless of practice setting. To the authors, reviewers and readers who again have contributed so much to the continued success of this journal, I sincerely thank you. I wish you all the best for Christmas and the New Year festivities and look forwards to working with you once again in 2007.
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