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RESEARCH ARTICLE
Contents Vol 49(4)

Improving inpatient mental health nurses practice through the use of a standardised instrument

V. K. Drinkwater A , M. Giles A B C , A. P. O’Brien D , C. Harmon A and R. J. Tynan A B E *
+ Author Affiliations
- Author Affiliations

A Hunter New England Local Health District (HNELHD), Mental Health Services, Mater Mental Health Centre, PO Box 833, Newcastle, NSW 2300, Australia. Email: vincent.drinkwater@health.nsw.gov.au, Jendrinkwater@gmail.com, Michelle.Giles@health.nsw.gov.au, Charles.Harmon@health.nsw.gov.au

B College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia.

C HNE Nursing and Midwifery Research Centre, Gate Cottage, James Fletcher Campus, 72 Watt Street, Newcastle, NSW 2300, Australia.

D Monash University, Nursing, Clayton, Vic, Australia. Email: tony.obrien@monash.edu

E Mental Health Research Evaluation and Dissemination (MH-READ), Hunter New England Local Health District, NSW, Australia.

* Correspondence to: ross.tynan@health.nsw.gov.au

Australian Health Review 49, AH25037 https://doi.org/10.1071/AH25037
Submitted: 13 February 2025  Accepted: 2 July 2025  Published: 28 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

The role of mental health nurses (MHNs) working in inpatient units involves providing care to patients with complex needs and challenging behaviours, with reporting and documenting findings from brief interactions a critical part of their duties. Despite this, there is no agreed-upon instrument to document a patient’s mental state or recognise signs of progress or deterioration. The aim of this study was to assess the impact of implementing a standardised instrument known as the SMART card on MHNs documentation, knowledge, and self-efficacy in assessing and reporting a patient’s mental state.

Methods

The SMART card was implemented across eight mental health inpatient units. Completion rates of the SMART card and quality of assessments were measured using a file/chart audit before and 3 months post-implementation. A pre/post-implementation survey measured changes in MHNs’ perceived knowledge and self-efficacy, with the post survey evaluating attitudes towards training and SMART card acceptability.

Results

Clinical file audits showed significant improvement in completion rates in documentation of key clinical/symptom domains. Survey results showed a positive attitude towards the SMART card, with training having increased MHNs’ understanding of psychiatric terminology and significantly improved confidence and self-efficacy.

Conclusions

This study demonstrates how the implementation of a standardised instrument significantly improved MHNs’ reporting of patient mental health status.

Keywords: assessment, deterioration, documentation, mental state, MSE, nursing, SMART card, standardised assessment tools.

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