Copyright © eContent Management Pty Ltd. Contemporary Nurse (2010) 34(2): 158–166.

Conceptualising the functional

role of mental health consultation–
liaison nurse in multi-morbidity,
using Peplau’s nursing theory
MICHAEL K MERRITT
Mental Health Consultation-Liaison Service, Lyell McEwin Health Service, Elizabeth Vale,
SA, Australia

NICHOLAS PROCTER
School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide,
SA, Australia

ABSTRACT
This paper examines the mental health consultation–liaison nursing (MHCLN) role and links this
to the interpersonal relations theory of nurse theorist Hildegard Peplau. The paper argues that, as
mental health nursing care around the world is increasingly focused upon meaningful therapeutic
engagement, the role of the MHCLN is important in helping to reduce distressing symptoms, reduce
the stigma for seeking help for mental health problems and enhancing mental health literacy among
generalist nurses. The paper presents a small case exemplar to demonstrate interpersonal relations
theory as an engagement process, providing patients with methodologies which allow them to work
through the internal dissonance that exists in relation to their adjustment to changes in life roles pre-
cipitated by physical illness. This dissonance can be seen in the emergence of anxiety, depression and
abnormal/psychogenic illness behaviours. This paper concludes arguing for considerable effort being
given to the nurse–patient relationship that allows for the patient having freedom to use strategies
that may help resolve the dissonance that exists.

Keywords: consultation–liaison nursing; interpersonal relations; mental health; Peplau

INTRODUCTION in the idea that mental health care should be

I n contemporary clinical settings it is important

that community consultation and liaison ser-
vices ensure mental health patients have an active
and meaningful voice in their treatment and care
planning. This means ensuring greater emphasis
on the valued involvement of patients through
dialogue and information exchange with clini-
cians. At the same time there is growing interest
delivered and administered across a range of prac-
tice settings within general health and hospital
settings in particular.
It is within the above context that this paper
is written. With the collapse of the purpose-built
psychiatric hospital as once the mainstay of tra-
ditional mental health care, it is difficult to over
emphasise the importance of community-based

158 CN Volume 34, Issue 2, February/March 2010

 Conceptualising the functional role of mental health consultation–liaison nurse
systems and structures as key drivers of contem-
porary mental health care. There is a now a global
consensus that mental health care should be
undertaken in partnership and collaboration with
mental health patients – no matter where they
are or where they live – and in the least restric-
tive environment (World Psychiatric Association,
2009). At the same time there is a vision of a
seamless and connected care system which is con-
sumer focussed and recovery oriented (National
Mental Health Policy, 2008).
At the same time there is evidence of mar-
ginalisation, oppression and incarceration of
people with a mental illness in certain societies
(BBC News, 2009) and in industrialised nations.
While mental disorders represent 15% of the
total disease burden, people with severe men-
tal disorders in low to middle income countries
often fail to receive adequate mental health care
(World Health Organisation/Wonca, 2008).
A recent UK Health Care Commission report
(for example) reveals that of 27,000 people
using mental health services, 15% said they did
not have enough say in care decisions and 44%
only had a say to some extent. The Health Care
Commission quizzed 300,000 patients and found
that most wanted more meaningful input into
their care, especially those with mental illness.
Similar sentiment has been expressed elsewhere
in the UK (BBC News, 2004) and in Australia
(Mental Health Council of Australia, 2006). In
addition and contrary to recommended national
standards, less than half of mental health service
users surveyed in the UK had access to crisis care,
and only have had been given or offered a written
care plan (Health Care Commission UK, 2008).
Such conditions are experienced by patients as
de-humanising and de-personalising, placing
interpersonal relations at the fringe rather than
as central interactions between patient, carer and
mental health professional.
People with co-existing physical and mental
health problems are also at risk of marginalisa-
tion. People with chronic physical illnesses also
experience a sense of being de-humanised and
Volume 34, Issue 2, February/March 2010
CN
de-personalised by the health system (Barker,
2009; Jones, 1998). The emphasis is, in this
sense, on the physical, potentially reducing the
patient to a collection of systems and ignoring
the holism and the person or patient’s journey
to this point in time. Australian studies have
shown that whilst depression, anxiety or psy-
chological distress is identified in patients with
chronic physical illness, 75% do not receive
psychological treatment or counselling (Kelly &
Turner, 2009).
Clearly, there is cause for examining the deeper
structures of engagement in mental health between
clinicians and patients to advance recovery in
mental health. It is for this reason that the authors
draw upon the Peplau Model, as the underlying
theoretical construct used by Hildegard Peplau
emphasises the crux of the therapeutic relation-
ships as a partnership between the nurse and the
patient, and with it a notion of shared humanity
between the nurse and the patient (Peplau, 1952,
1991, 1997). Whilst the model has its genesis
in psychodynamic and psychodramatic theories
giving rise to looking more deeply at the reasons
for individual thought and behaviour (Sullivan,
1953), it has been long utilised by mental health
nurses in clinical practice (Barker, 1993, 2009;
Price, 1998). Barker (2009) in particular empha-
sised the person rather than the problem to be the
focus of mental health nursing. This underlines
that, according to Peplau, the therapeutic rela-
tionship is a central platform of mental health
nursing practice. Shattell, Starr, and Thomas
(2007) adapted Peplau’s theoretical approach to
described patient’s views of the therapeutic rela-
tionship as being expressed in three figural themes:
‘relate to me’, ‘know me as a person’ and ‘get to
the solution’. The therapeutic relationship is by its
nature and scope primarily about the creation of a
shared experience.
The next section outlines steps taken to review
literature pertaining to the functional role of the
MHCLN informed by Peplau’s nursing theory.
The utilisation of this theory in multi-morbidity
is then discussed.
CN 159
CN Michael K Merritt and Nicholas Procter
METHOD
A search of electronic data was undertaken using
the following databases; CINAHL, Medline,
PsycINFO and the Cochrane Library. Searches
were for articles published in English and several
search themes were used as follows:
• Australian and International literature since
1990 about Mental Health Consultation–
Liaison Nursing using a variety of descriptors –
see Tunmore and Thomas (1992). 1990 was
used as a starting point and can be considered
a focal point in the transition from asylum
to community care within South Australia.
Australian literature was used to provide his-
torical and current context of practice, whilst
international literature was used to look for dif-
ferences in operationalisation of MHCLN prac-
tice, which may have informed or influenced
the Australian context of practice. Some early
Australian literature from the 1980s provides a
firmer historical context.
• Literature by Hildegard Peplau and others
describing interpersonal relations theory.
• Literature about utilisation of interpersonal
relations theory in psychiatric-mental health
nursing practice.
• Literature about multi-morbidity and psycho-
logical outcomes.
Additional exploration was conducted by hand
utilising reference lists from retrieved articles.
THE MENTAL HEALTH CONSULTATION–
LIAISON NURSE
The MHCLN has become an established part
of contemporary nursing in Australia (Sharrock,
Grigg, Happell, Keeble-Devlin, & Jennings,
2006), the United Kingdom (Cullum, Tucker,
Todd, & Brayne, 2007), Canada (Brinkman,
Hunks, Bruggencate, & Clelland, 2009) and
United States (Yakimo, Kurlowicz, & Murray,
2004). The role is variously described as ‘psy-
chiatric consultation–liaison nursing’ (Sharrock
& Happell, 2000; Yakimo et al., 2004), ‘liaison
psychiatric nursing’ (Cullum et al., 2007; Ryrie,
160 CN Volume 34, Issue 2, February/March 2010
Roberts, & Taylor, 1997), ‘psychiatric liaison nurs-
ing’ (Chiplin & Geraghty, 1990), ‘mental health
liaison nursing’ and Liaison Mental Health Nursing
(Roberts & Whitehead, 2002). The predominant
terminology is ‘psychiatric consultation–liaison
nurse’ which is a naturalistic outcome of the growth
of these positions out of psychiatric consultation–
liaison services and the biological-psychiatry
model. These terms are used both simultaneously
and interchangeably to describe the work of men-
tal health nurses within a general hospital setting.
The fluidity of this terminology can be seen as
an outcome of the underlying dichotomy that
exists within the mental health nursing profession
around the world. Barker (2009, p. 5) argues that
mental health nurses including MHCLNs work
within a highly fluid continuum between psychi-
atric nursing and mental health nursing, and thus
between problem- or situation-focused and holism
or life-focused.
In the 1980s Meredith and Weatherhead
(1980), Anderson and Hicks (1986) and Hicks
(1989) described early roles in Sydney, Australia.
This early literature described a traditional
structure in the style of Caplan (1964, 1970)
in Tunmore and Thomas (1992), that has its
roots in the work of psychosomatic medicine as
described by Lipowski (1981). The literature since
1997 describes two different models; that of the
traditional consultation–liaison nursing model
(Sharrock & Happell, 2000, 2001a, 2001b), and
an emerging emergency mental health nursing
model within emergency departments (Wand,
2004; Wand & Happell, 2001) alternatively
called the ‘emergency department mental health
team’. These roles show the advanced mental
health nursing development that has been accel-
erating in recent years with some of these roles
being developed into ‘mental health nurse prac-
titioner’ positions (Wand, White, & Patching,
2007). Further, McNamara, Bryant, Forster,
Sharrock, and Happell (2008) and Sharrock,
Bryant, McNamara, Forster, and Happell (2008)
describe the outcomes of a survey of CL nurses
within Australia, which provides valuable data
 Conceptualising the functional role of mental health consultation–liaison nurse
about demographics, role description, prepara-
tion, support and role satisfaction of these mental
health nurses. These show the developments that
have impacted upon the role unfolding elsewhere
across Australia.
THEORETICAL UNDERPINNINGS OF
MENTAL HEALTH NURSING MODEL
Peplau theorised that people have biological,
psychological and social qualities which moti-
vate them to self-maintenance, and that their
self-system is concerned with the management of
anxiety. When this self-maintenance/self-system
is in disequilibrium, this gives rise to an internal
dissonance which manifests itself in panic, with-
drawal and an inability to function effectively.
This can also be more broadly understood in
the signs and symptoms which we understand
as depression, anxiety, psychosis and abnormal/
psychogenic illness behaviours. Peplau clearly
identified that both biological and psychological
insecurities can lead to or create internal disso-
nance or anxiety.
Within the model are two components – the
phases of the therapeutic relationship and the
dynamic character roles seen as typical of mental
health clinical nursing.
Peplau described four interlocking and over-
lapping phases of the nurse–patient relationship:
• Orientation phase
• Identification phase
• Exploitation phase
• Resolution phase
The orientation phase is synonymous with
the comprehensive assessments conducted by
MHCLN in understanding or appreciating
how the patient arrived at the point in time
where the MHCLN is involved in their care
and support. The identification and exploita-
tion phases are the working phases where the
MHCLN supports the patient in identification
of the internal dissonance and development
and trialling of strategies that reduce the inter-
nal dissonance. The final phase is where the
Volume 34, Issue 2, February/March 2010
CN
patient uses these strategies to provide a reduc-
tion of or resolution of the internal dissonance/
psychological distress.
Within the development of the nurse–patient
or therapeutic relationship, the MHCLN
provides many roles. Peplau emphasised six of
these roles:
• Stranger role – developing an accepting climate
to build interpersonal trust similar to that used
in other life situations
• Resource role – providing and exchanging infor-
mation and interpreting clinical data
• Teaching role – providing instruction and train-
ing through analysis and synthesis of patient’s
experience
• Counseling role – providing an environment
where patient can understand and integrate
their current life experience along with guid-
ance and encouragement to develop and experi-
ence change
• Surrogate role – through advocacy, the nurse
assists the patient’s clarification of their
dependent, interdependent and independent
domains
• Leadership role – the nurse provides an envi-
ronment where patients assume responsibility
for reaching their treatment goals and therefore
optimal functioning
• Technical/clinical expert role – the nurse pro-
vides an environment for holistic patient care
through utilisation of clinical skills
Actual or specific roles utilised within the ther-
apeutic relationship will be variable between
patients and the overall skill/expertise and imagi-
nation of the MHCLN.
The nurse–patient or therapeutic relation-
ship becomes a transitional conduit that shifts
the perspective from a problem focus that exists
both within biological-psychiatry and the nursing
process (problem orientation) towards holism and
the patient as a person and their life experience.
This notion of the patient’s self identification of
what experience and symptoms mean for them
becomes a framework for thoughts, feelings and
CN 161
CN Michael K Merritt and Nicholas Procter
actions to be understood using the language and
experience of the patient.
The utility of this model has been in the cre-
ation of a therapeutic relationship that allows for
the identification of anxiety, depression and other
psychogenic symptomatology by the patient in
the supportive environment provided by the
MHCLN, and then the patient having freedom
to use strategies that may help resolve the disso-
nance that exists. The overall aim is in a directive
approach in which there is a ‘forward movement
of personality in the direction of creative, con-
structive, productive, personal and community
living’ (Peplau in Gastmans, 1998).
A FOCUS FOR MENTAL HEALTH
CONSULTATION–LIAISON NURSING
The above synthesis leads to a role definition
of the MHCLN as having a focus on the bio-
psycho-socio-spiritual, cognitive, behavioural,
and emotional responses of patients and families.
The MHCN assists patients, family, staff, and
health systems cope with medical illness, treat-
ment and the often consequential psychologi-
cal distress/internal dissonance experienced by
patients. The role of the MHCLN in this setting
ensures that the patient’s overall needs are met,
and that patients, families and staff satisfaction is
increased.
The World Health Organisation’s proposition
that there can be ‘no health without mental health’
(Prince et al., 2007) has important implications
for MHCLN practice. Global burden of disease
data suggests that the world-wide burden for non-
communicable diseases (such as endocrine, car-
diac and mental health) was 48.9% in 2005 and
is projected to rise to 56.9% by 2030. In 2005
the neuropsychiatric disorders component of this
was 28%. A report by the Academy of Medical
Royal Colleges (AMRC) and Royal College of
Psychiatrists (RCP) (2009) indicates that patients
with chronic diseases and a mental health disorder
such as depression were twice as likely to present
1
Not his real name.
162 CN Volume 34, Issue 2, February/March 2010
to Emergency Departments and that total health
expenditure can be 4.5-times higher for these
individuals. Further, they can have longer hospi-
talisations, increased symptom burden and higher
mortality and morbidity outcomes. An integral
part of this burden is associated with a worsening
quality of life. The importance of the appropriate
psychological care of medical patients has been
emphasised by a report from the joint working
party of the Royal College of Physicians and the
Royal College of Psychiatrists (2003).
Recent Australian Institute of Health and Welfare
(2008) data suggests that chronic respiratory illness
affects 4.3% of people aged 20–44 and 8% aged
over 65. Chronic heart disease affects 7.3% of those
aged 55–64 and rising to 20.3% of those aged 75
and over. MacHale (2002) states that the incidence
of depression in those patients with diabetes, car-
diac or neurological disease is about 25%, whilst the
incidence for those with hypertensive disorders is
equivalent to the general population, and in addi-
tion, in-patients are more vulnerable than outpa-
tients. The prevalence of chronic mental health
disease is put as high as 11% of the general popula-
tion and that at least 40% of these individuals have
at least one co-morbid physical illness. Further the
rates of chronic physical illness are between 30–80%
above that for the general population.
In the next section the MHCLN will be exam-
ined through a short vignette. The vignette out-
lines assessment and support for a person within
the continuum from hospital to community where
no other service is available. Peplau’s model will
be demonstrated as being versatile and adaptable
enough to be readily applied to people with acute,
acute-on-chronic or chronic physical diseases.
VIGNETTE
Jason1 was a 62-year-old man referred to the
MHCLN led clinic by a Cardiac Rehabilitation
Nurse for assessment of depression and anxiety
after being admitted with angina. Jason and his
wife Maxine had been touring remote and outback
 Conceptualising the functional role of mental health consultation–liaison nurse
South Australia in a mobile home at time of his latest
angina attack. They had been pursuing this lifestyle
of roving and rambling for the past 10 years. He
was initially medically assessed in hospital, where he
reported a change in his sense of self, a feeling of
loss of control and a general nervousness and inabil-
ity to make decisions with a negative outlook on
future and a reduction in his quality of life. Further
he reported preoccupation with issues, increased
worrying, poor sleep and feeling ‘anxious, nervous
and edgy’. His wife agreed with this self assessment,
and both felt that there ‘was no depression’, more
an ‘adjustment to life issues’. Further assessment
revealed that Jason had recently had an argument
with his son about his grandson’s birthday party
which had increased his anxiety and distress.
The MHCLN met with Jason. The conversa-
tion focused on Jason’s reported anxiety feelings
and provided education in verbal and written
formats about anxiety, causation and perpetuat-
ing factors using his symptoms and self-story as
guideposts. Through further exploration of recent
events, Jason identified three main areas which
underlay his anxiety – his cardiac condition and
newly diagnosed aortic regurgitation and cardio-
myopathy, loss of control of and interruption of
current lifestyle and relationship issues with his
son. The ability of Jason to identify the underly-
ing causes for his anxiety/nervousness had a clear
effect on his outlook regarding current situation,
with the development of a more positive outlook
about the future. Further follow-up appointments
were organised at the caravan park they were stay-
ing so ongoing monitoring could be put in place
and future surgery could be organised.
Follow-up in the community lasted 5 months
until after surgery. The MHCLN worked with
Jason on identified problems, providing further
education and support regarding surgery and
outcomes in conjunction with specialist cardiac
rehabilitation nurses, which included a likely time
frame in which he and Maxine could continue their
lifestyle and therefore the transition to being more
in control of life. During exploration of relation-
ship issues with son, it soon became apparent that
Volume 34, Issue 2, February/March 2010
CN
Jason and his son had similar personality styles and
problem solving methodologies – which followed
a need to fix things and do it my way fashion – this
was also corroborated by Maxine who was included
in all follow-up sessions. Over several one-to-one
sessions with the MHCLN, Jason identified ways
of improving his relation with his son by exploring
different problem solving techniques – some of
this through role play. Maxine was also provided
with support and encouraged to voice her own
anxieties around recent events and how she saw
Jason’s progress.
At finish of follow-up, Jason and Maxine
reported the resolution of anxiety provoking issues
that had been identified and explored above, and
were just waiting for clearance from the cardiolo-
gist to resume their travelling. In using Peplau’s
theory, the MHCLN had fulfilled many roles
including stranger, resource, teacher, counsellor,
surrogate, companion, advocate and leader in the
development, establishment and continuation
to resolution of the nurse–patient or therapeutic
relationship. The focus was on developing a shared
experience where the client was the centre of focus
and maintained control of the relationship. The
ability for the MHCLN to provide support in
both hospital and community settings, expands
the vision of the role and provides a broader scope
for continuity of care, especially where services
may not exist and where patients do not meet
entry criteria into existing community mental
health services. McNaughton (2005) highlighted
the naturalistic use of Peplau’s theory in home vis-
iting/community follow-up of patients.
The MHCLN provided information and edu-
cation to ward and cardiac rehabilitation nursing
staff around Jason’s anxiety/internal dissonance
and strategies in identification, exploration and
supporting patient’s experiences. Through this
process, the MHCLN was able to support the
patient’s transition through primary, secondary
and tertiary healthcare systems through specialist
advocacy, collaboration and liaison with nursing,
medical and other allied health specialists as well
as the patient’s primary care general practitioner.
CN 163
CN Michael K Merritt and Nicholas Procter
CLINICAL LEADERSHIP
At the interface between physical and mental health
the MHCLN is well situated to establish links and
partnerships of an enduring nature between allied
health providers, patients, patient advocacy groups,
families and carers to develop a culture of enhanc-
ing collaborative care and mental health literacy.
This model gives rise to Servant Leadership – a
relatively recent concept in the literature on lead-
ership styles. ‘A servant leader serves constituents
by working on their behalf to help them achieve
their goals, not simply the leader’s goals’ (DuBrin,
Dalglish, & Miller, 2006, p. 69). Servant leader-
ship in mental health is accomplished when clini-
cians and colleagues become wiser, empowered and
more autonomous. Servant leadership emphasises
the leader’s role as host, facilitator and enabler of
the resources (human, financial, educational and
otherwise) needed to ensure a positive clinical out-
come for an individual, group or community. It
encourages leaders to demonstrate humility, have
mindfulness in what they say, do think and feel
while staying simultaneously focused on achiev-
ing results in line with the agreed directions and
organisation’s values and integrity.
As a clinical servant leader, the MHCLN is a
partnership broker, participating in and leading
change in the workplace. This change can be for-
malised into professional administrative policies to
facilitate access to intervention services across the
health spectrum. Through this work there is scope
to influence the role and function of how health
services are delivered at local, state and national
government levels to build social connectedness
and social inclusion for people with mental health
problems and their carers. The MHCLN is, in this
sense a ‘leader as connector’ who actively promotes
clinical continuity and collaboration with special-
ist health services and advocates for adequate ser-
vices for people with mental health problems at
both patient and systemic levels.
CONCLUSION
Peplau’s interpersonal relations theory is by its nature
and scope an engagement process that is about
164 CN Volume 34, Issue 2, February/March 2010
providing patients with methodologies which allow
them to work through the psychological distress/
internal dissonance that exists in relation to their
adjustment to changes in life roles precipitated by
physical illness. This dissonance can be seen from
a biological-psychiatry model in the emergence of
anxiety, depression and abnormal/psychogenic illness
behaviours. In the sharing of the patient’s journey of
discovery, the MHCLN acts as a fellow traveller, a
guide and companion and in some instances a lexi-
con that allows the patient to give a name to the dis-
sonance that they are experiencing. The emphasise
of this working along-side the person experiencing
mental distress to establish a meaning that best fits
her/his experience has been underpinned by Crowe,
Carlyle, and Farmar (2008).
In modern healthcare systems, patients often
spend little time in hospital once the acute phase of
their physical illness is has passed. This has as much
to do with improved community care aligned with
evidence-based medical and nursing interventions,
increasing demands on hospital systems, public sec-
tor Medicare/insurance reimbursement, primary
health care initiatives and the development of a vari-
ety of government and non-government community
support services. Given this, the full utilisation of
Peplau’s theory needs to occur across the care spec-
trum – in both hospital and community settings.
The ability for the MHCLN to work across clinical
settings is important for patients to be able to reduce
and/or resolve their psychological distress/internal
dissonance where no other service is available.
As such the MHCLN may not know enough of
the impact that their role has upon patients, carers
and health professional colleagues. This highlights
the need for the MHCLN to initiate and conduct
clinically focused research on early intervention
strategies of clinical assessment, engagement
and treatment of mental health problems. There
is scope for this research to be interdisciplinary
incorporating both qualitative and quantitative
measures specifically addressing phase specific
treatments and strategies for the patient’s narrative
to unfold. The emphasis of research should there-
fore be applied and interventionist to help ensure
 Conceptualising the functional role of mental health consultation–liaison nurse
that the MHCLN is an enabler of interventions
to prevent secondary disability associated with
physical or mental health problems. Over time
the MHCLN can make informed evidence-
based clinical decisions by ensuring that previous
research is critically reviewed and integrated into
decision making and clinical education.
References
Academy of Medical Royal Colleges (AMRC), &
Royal College of Psychiatrists (RCP). (2009).
No health without mental health: The support-
ing evidence (Report by Academy of Medical
Royal Colleges and Royal College of Psychiatry).
London: Academy of Medical Royal Colleges.
Anderson, G., & Hicks, S. (1986). The clinical
nurse specialist-role, overview and future pros-
pects. Australian Nurses Journal, 15(8), 26–53.
Australian Institute of Health and Welfare. (2008).
Australia’s Health 2008, Cat no. AUS 99.
Canberra: Author.
Barker, P. (1993, March 17). The Peplau legacy.
Nursing Times, 89(11), 48–51.
Barker, P. (2009). Psychiatric mental health nursing:
The craft of caring (2nd ed.). London: Hodder
Arnold.
BBC News. (2004, August 4). Psychiatric services
failed me. Retrieved September 17, 2008, from
http://news.bbc.co.uk/2/hi/health/3531302.stm
BBC News. (2009, May 8). ‘Prayer camps’ chain
mentally ill. Retrieved October 2, 2009, from
http://news.bbc.co.uk/2/hi/africa/8040057.stm
Brinkman, K., Hunks, D., Bruggencate, G., &
Clelland, S. (2009). Evaluation of a new mental
health liaison role in the Rocky Mountain
House, Alberta: A Canadian story. International
Journal of Mental Health Nursing, 18, 42–52.
Chiplin, J., & Geraghty, M. (1990). Psychiatric
liaison nursing: Mental health needs in a burns
unit. Nursing Praxis in New Zealand, 5(2), 15–18.
Crowe, M., Carlyle, D., & Farmar, R. (2008).
Clinical formulation for mental health nursing
practice. Journal of Psychiatric and Mental Health
Nursing, 15, 800–807.
Cullum, S., Tucker, S., Todd, C., & Brayne,
C. (2007). Effectiveness of liaison psychiat-
ric nursing in older medical inpatients with
Volume 34, Issue 2, February/March 2010
CN
depression: A randomized control trial. Age and
Ageing, 36(4), 436–442.
DuBrin, A. J., Dalglish, C., & Miller, P. (2006).
Leadership (2nd Asia-Pacific ed.). Milton, QLD:
John Wiley.
Gastmans, C. (1998). Interpersonal relations in
nursing: A philosophical-ethical analysis of
the work of Hildegard E. Peplau. Journal of
Advanced Nursing, 28(6), 1312–1319.
Health Care Commission UK. (2008). Health Care
Commission: Survey shows steady improvements in
community mental health services. Health Care
Commission. Retrieved September 17, 2008,
from http://healthcarecommission.org.uk
Hicks, S. (1989). The psychiatric nurse in liaison
psychiatry. Australian and New Zealand Journal
of Psychiatry, 23, 89–96.
Jones, P. (1998). Hodges’ health career – Care
domains – Model, nursing – Art or science?
Retrieved October 4, 2009, from http://www.p-
jones.demon.co.uk/holsci.html
Kelly, B. J., & Turner, J. (2009). Depression in
advanced physical illness: Diagnostic and treat-
ment issues. Medical Journal of Australia, 190(7),
S90–S93.
Lipowski, Z. (1981). Liaison psychiatry, liai-
son nursing and behavioural medicine.
Comprehensive Psychiatry, 22(6), 554–561.
MacHale, S. (2002). Managing depression in phys-
ical illness. Advances in Psychiatric Treatment, 8,
297–306.
McNamara, P., Bryant, J., Forster, J., Sharrock,
J., & Happell, B. (2008). Exploratory study
of mental health consultation–liaison nursing
in Australia: Part 2. Preparation, support and
role satisfaction. International Journal of Mental
Health Nursing, 17(3), 189–196.
McNaughton, D. B. (2005). A naturalistic test of
Peplau’s theory in home visiting. Public Health
Nursing, 22(5), 429–438.
Mental Health Council of Australia. (2006). Time
for service: Solving Australia’s mental health crisis,
Canberra, ACT: Author.
Meredith, L., & Weatherhead, R. (1980, June).
Psychiatric consultation liaison nursing: 18
months later. The Lamp, 37(6), 19–20.
National Mental Health Policy . (2008).
Australian Government Department of Health
CN 165
CN Michael K Merritt and Nicholas Procter
& Aging (2009). Canberra: Commonwealth
Government.
Peplau, H. E. (1952). Interpersonal relations in nurs-
ing. New York: Putnam.
Peplau, H. E. (1991). Interpersonal relations in nurs-
ing. New York: Springer.
Peplau, H. E. (1997). Peplau’s theory of interper-
sonal relations. Nursing Science Quarterly, 10(4),
162–167.
Price, B. (1998). Explorations in body image care:
Peplau and practice knowledge. Journal of
Psychiatric and Mental Health Nursing, 5, 179–186.
Prince, M., Patel, V., Sasema, S., Maj, M., Maselka,
J., Phillips, M. R., et al. (2007, September 8).
Global mental health: 1. No health without
mental health. The Lancet, 370, 869–877.
Roberts, D., & Whitehead, I. (2002). Liaison
mental health nursing: An overview of its
development and current practice. In S. Regal
& D. Roberts (Eds.), Mental health liaison: A
handbook for nurses and health professionals (pp.
43–63). Edinburgh: Harcourt.
Royal College of Physicians and the Royal College
of Psychiatrists. (2003). The psychological
care of medical patients: A practical guide (2nd
ed.) (Report of joint working party of the
Royal College of Physicians and the Royal
College of Psychiatrists). Salisbury, UK: Sarum
ColourView Group.
Ryrie, I., Roberts, M., & Taylor, R. (1997). Liaison
psychiatric nursing in an inner city accident and
emergency department. Journal of Psychiatric
and Mental Health Nursing, 4(2), 131–136.
Sharrock, J., Bryant, J., McNamara, P., Forster,
J., & Happell, B. (2008). Exploratory study of
mental health consultation–liaison nursing in
Australia: Part 1. Demographics and role char-
acteristics. International Journal of Mental Health
Nursing, 17(3), 180–188.
Sharrock, J., Grigg, M., Happell, B., Keeble-
Devlin, B., & Jennings, S. (2006). The men-
tal health nurse: A valuable addition to the
consultation–liaison team. International Journal
of Mental Health Nursing, 15(1), 35–43.
Sharrock, J., & Happell, B. (2000). The psychiatric
consultation–liaison nurse: Towards articulating
a model for practice. Australian and New Zealand
Journal of Mental Health Nursing, 9, 19–28.
166 CN Volume 34, Issue 2, February/March 2010
Sharrock, J., & Happell, B. (2001a). An overview of
the role and function of a psychiatric consultation
liaison nurse: An Australian perspective. Journal of
Psychiatric and Mental Health Nursing, 8, 411–417.
Sharrock, J., & Happell, B. (2001b). The role of
the psychiatric consultation liaison nurse in
improved care of patients experiencing mental
health problems receiving care within a general
hospital environment. Contemporary Nurse,
11(2–3), 260–270.
Shattell, M. M., Starr, S. S., & Thomas, S. P.
(2007). ‘Take my hand, help me out’: Mental
health service recipients’ experience of the
therapeutic relationship. International Journal of
Mental Health Nursing, 16, 274–284.
Sullivan, H. S. (1953). The interpersonal theory of
psychiatry. New York: Norton.
Tunmore, R., & Thomas, B. (1992). Models of
psychiatric consultation liaison nursing. British
Journal of Nursing, 1(9), 447–451.
Wand, T. (2004). Mental health liaison nursing in
the emergency department: On-site expertise
and enhanced coordination of care. Australian
Journal of Advanced Nursing, 22(2), 25–31.
Wand, T., & Happell, B. (2001). The men-
tal health nurse: Contributing to improved
outcomes for patients in the emergency
department. Accident and Emergency Nursing, 9,
166–176.
Wand, T., White, K., & Patching, J. (2007). Refining
the model for an emergency department-based
mental health nurse practitioner outpatient ser-
vice. Nursing Inquiry, 15(3), 231–241.
World Health Organisation/Wonca. (2008).
Integrating mental health care into primary care –
a global perspective (joint report of World Health
Organisation/Wonca). Retrieved October 3,
2008, from http://www.who.int/mental_health/
policy/en
World Psychiatric Association. (2009, April
1–4). Treatments in psychiatry: A new update.
Conference Proceedings, Florence, Italy.
Yakimo, R., Kurlowicz, L. H., & Murray, R. B.
(2004). Evaluation of outcomes in psychiatric
consultation–liaison nursing practice. Archives of
Psychiatric Nursing, 18(6), 215–227.
Received 04 February 2009 Accepted 21 October 2009
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.