Guardians Of The Therapeutic Relationship with Dr Hugh McKenna

What happens to psychiatric mental health nursing when the job is squeezed into a prescriber’s chair and the classroom forgets its own theory? We sit down with Dr. Hugh McKenna to unpack a global reality: staffing shortages, overextended faculty, and policy moves that risk diluting mental health specialization just as community needs spike—especially among young people.

Hugh takes us across Europe and the U.S. to compare models and trade hard-won lessons. We explore why defending the PhD matters for nursing’s knowledge base, how interdisciplinary teams actually accelerate better outcomes, and where American programs’ commitment to theory and collaboration can inspire change abroad. Then we bring Peplau back into focus, not as nostalgia, but as a practical roadmap: validate the therapeutic relationship, prioritize prevention, and co-produce care with service users so change sticks. When waiting lists stretch years and therapists are scarce, upstream work is not optional—it’s the only scalable plan.

We also test the limits of evidence-based practice. Publishing is not the finish line; the real measure is impact. That means moving research through uptake and implementation until policy and practice shift—and making sure faculty remain clinically credible enough to lead that work. Along the way, we defend expert intuition as a hallmark of mastery, not a rejection of science. And we end with a challenge: identify high-potential leaders early and get them to the table where resources are decided. Peplau had a core of steel; the field needs more of that energy now.

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Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

SPEAKER_02 0:02

Yeah. Just my take on things. My answer number two. Identifying challenging your beliefs. Identifying challenging your beliefs.

Welcome And Guest Introduction

State Of Mental Health Nursing In Europe

SPEAKER_05 0:28

I think we're recording. Welcome back, everybody. This is Peplow's Ghost. I am thrilled to be joined with everyone. All of our hosts are here today. So excited, and also so excited for our first guest of 2026. I am unashamed to say that we really brought out the big guns for 2026. This is a huge name. I know he's shaking his head right now, and humility is always part of it, but uh, but this is a real leader in nursing and especially psych mental health nursing. And so I'm real thrilled to introduce Dr. Hugh McKenna from the UK. Also joined with our regular guest, our host, Dr. Tom Convoy, Dr. Kate Molino, and Dr. Melissa Chapman-Hayes. So, but like I said, Dr. Hugh, Dr. Hugh McKenna is a world-renowned psych mental health nurse. If you haven't heard heard from him, shame on you. But I just read prior to this that he is, he was nominated as what G1 as one of the 70 most influential nurses in the past 70 years by the national health system in the UK. So congratulations on that. Probably been awarded a long time ago. But uh he's also a retired dean of nursing. No, we were just talking about that. We need more psych mental health nurses as deans of colleges and nursing uh for sure. And that was at, I believe, Ulster University in the UK. And then he is triple fellowed in the American Academy of Nursing, the Royal College of Nursing, and the European Academy of Nursing Science. So again, big, big welcome to Dr. Hugh McKenna here on Peplau's Ghost. And so let's get right into it. I think, you know, Hugh, we kind of invited you here, and I think you were very gracious to offer your time here on a Friday. So, you know, I think we'll just get into really the big thing of if you wouldn't mind sharing your thoughts as as we have this um podcast primarily, because we are all concerned about psych mental health nurses and nurse practitioners in the U.S. being kind of relegated to more kind of prescribing roles. Where do you see that landscape today? What is your concern? You know, just if you wouldn't mind just kind of starting us off on your experiences and your understanding of that role and and where we're going.

Education, Research Strain, And Registration Debates

SPEAKER_00 2:29

Thank you very much, Daniel, and lovely to be here. Uh I um although I'm uh I'm in the UK, I'm in Northern Ireland, which is part of the UK, and uh so I keep a foot in Ireland and also in the UK. So I'm familiar with what's going on in the UK, but I also do a lot of work in Scandinavia and in the Far East. I I I'm back and forth to Hong Kong quite a wee bit. I do some some chairing over there. But so my my view in terms of mental health nursing, as far as far as Europe is concerned, it's not in a good place, I'm afraid. What we're seeing is that there's a shortage of mental health nurses, so therefore the government wants to bring in more students into universities to study mental health nursing. That me, you may say, is a good thing, but that also means that the people who teach mental health nursing are spending because sometimes we're getting two intakes a year, so they're spending a lot of time involved in supporting those students. Because we're widening the net quite a lot to to bring in students, some of them are not as bright as some others, so there's a lot of support required, a lot of uh pastoral care and a lot of teaching. And here in the UK, we spend, you know, it's a three-year program, degree program, but so we spend exactly 50% of that with students on placements in, you know, practicums in hospitals, community areas. And during that time, the academic staff, the faculty have to go and visit them and obviously work with them. So that means that that faculty don't have enough time to do research. Research is relegated to the evenings and weekends. And that has also had implications for PhD students. There are a lot of nurses who obviously are either doing a PhD or or want to do a PhD. So there's a question over funding for that, but there's also a question over supervision mentorship from established academics, because established academics may not have time to spend in such mentorship supervision. So that is uh that is an issue, and I I wrote a couple of editorials recently on uh on that. So there's also a view within government and some of the governments in in Europe that actually we don't need a mental health nursing qualification. Let's have a generic qualification, a general nurse, and then afterwards they can specialize. So just to let you know what it's like here, we have four registrations for nurses, and they are completely separate. One is children's nursing, one is general nursing, or what we call adult nursing, one is what we call intellectual disability or learned disability nursing, and one is mental health nursing, psych nursing. And those are separate, and they are registered by our governing body and in other government bodies in Europe. So moving from that to a generic nurse where mental health nursing is not a registered qualification, it's something you do afterwards at master's level, is causing quite a bit of consternation at the moment in the UK. So there's issues about research, there's issues about registration, and we're seeing more and more patients coming forward in communities, especially young patients, and they require a lot of time, and rightly so, and there's not as much interdisciplinary work as there should be. I believe firmly that the big problems facing humankind will not be solved by any one discipline. It's about different disciplines coming together and working together. So we are still in Europe educated separately. So doctors are educated separately from social workers, from uh what we call allied health professions, occupational therapists, etc., from nurses. But yet we work together when it comes to you know day-to-day work in the community or in hospitals. So we want to encourage more interdisciplinarity. That has been a bit of an upward struggle in this part of the world. So that's just, if you like, the context very briefly. So I'm happy to delve into any of those, Daniel.

SPEAKER_05 6:47

Yeah, thank you. And I know Sean's gonna jump in here too. I mean, I think that speaks to where we are in the US as well. I mean, as you're probably aware, you know, undergraduate is a general nurse, and and people will frequently say that all nurses are psych nurses, and and some people that riles people's feathers a little bit. So so thank you for getting us started. Sean, I'll I'll turn it over to you. Hey, Dr. McKay.

SPEAKER_04 7:07

So I uh I like to think Please call me Hugh, Sean. All right, I got you, Hugh. Uh I'd like to think of psychiatric nursing as kind of this big genotype, right? And that they're all different phenotypic expressions of psychiatric nursing. For example, there's a European phenotype of psychiatric nursing, and there's probably a United States of America phenotype uh of of psychiatric nursing. I'm gonna ask you to think about this kind of jump from one side of the pond to the other. Identify what are two things do you think that American expressions of psychiatric nursing can learn from Europe, and two things that Europe can likely learn from America.

US–Europe Lessons Both Ways

SPEAKER_00 7:46

Okay, I'm gonna be controversial. Okay. If what was happening in the US at the moment in terms of undergraduate nursing, and indeed the question over uh research funding for nursing in the NIH, and indeed the threat that the doctor in nursing practice makes on the PhD, we would be out on the streets here. We would be we'd be, you know, we would be I I don't want to go too far, but we would be outside parliament in not just hundreds but thousands of people. So that I think that's something that we can share. The other thing, I think we believe firmly that the PhD is the doctorate of choice for nursing. We we tinkered some time ago with what we call professional doctorates, which were doctorates in nursing practice or doctors of nursing science. And universities started them. The first intake was full of enthusiastic clinical nurses, nurse administrators who wanted to do this. And then suddenly the second cohort or third cohort, smaller numbers, so the university stopped doing it and reverted back to the standard here, uh, is the the PhD where knowledge is generated, challenged, tested, as well as being taught. So I think I would like to perhaps get nurses on this side of the pond and nurses on that side of the pond talking about those particular issues. So that's what we could perhaps not teach you, but perhaps uh have a discussion with you about. In terms of the US, I think that as far as the US is concerned, I see a huge value in the US when it comes to academia. I see that you were you had the theories, you know, generations before we had on this sort of Pebble was a case in point in 52, we only started tinkering with this in the mid-7 mid-90s. We had something else that I think that you could that we could learn from is that if I took you back, Sean, to 1985 to 1995 in in Europe, every paper, academic paper you lifted in nursing psych nursing was about nursing theories. It was about Peblo, it was about interactional theory, interpersonal theory, it was about how you could apply theories and practices about how you could underpin your curriculum with theories, it could be how you perhaps could underpin your research with theoretical frameworks. That's all gone. Nobody talks about theories now, nobody teaches theories in schools of psychic nursing now or in general nursing. So I think from what I what I'm getting from Jacqueline Fawcett and what I'm getting from some other people is that that's alive and well in the US. Maybe I've got that wrong, but that's something that you could obviously teach us. I also think in the US you are perhaps more interdisciplinary than we are. On this call, for example, you have a psychologist. I have attended over a hundred webinars in psych nursing in this part of the world that were all full of psych nurses. There was no non-nurses there. So I think you I touched on earlier on the importance of interdisciplinarity. I think we can learn from that. So those are two things that I think we could learn from. And the other thing I think we could learn, you could learn from us, if you don't mind me, go on a little bit, is more global viewpoint. It's as if the US is very you're doing fantastic work, but very insular. So I was speaking to the the editor-in-chief of nursing research a few years back, Molly Doherty, and I was telling I said, How many people do you have from other countries on your editorial board? She says, No, they're all US people. What? So I think, and I I I read somewhere recently where 11% of the US population have a passport. Uh I can get a reference for that if you want. Whereas here it's close to 95% have passports. So I think we could perhaps bring that more global outlook to U.S. psych nursing. But there's a lot that we can learn from you. Sorry to go on, Sean.

SPEAKER_04 12:21

No, actually, this was really helpful. I I I I agree with you that America is very much Aristotelian in its thinking. It thinks it's the center of the universe and it needs to get over itself. So thanks, Kate.

SPEAKER_03 12:34

So, you know, our next question for you, Hugh. You mentioned Peplow. Obviously, you know that the title of this podcast is Peplow's Ghost. And we called it that because, you know, we are really focused on the importance of the interpersonal relationship in our work. And so, you know, you're mentioning all of these pressures that I think psych nursing is facing globally in terms of time and you know, restrictions on scope and things like that. In your opinion, do you think that the Pebla model is still a realistic way to practice? Or is this, you know, something that is no longer really feasible based on the structures we are working within?

Is Peplau Still Practical Today

SPEAKER_00 13:12

Part of me, thank you for the question, Kate. Part of me thinks that nursing has changed a lot since 1952 when Peplow first spoke about her interpersonal and the work she did based on Harry Slack Sullivan and Abraham Maslow. Healthcare has moved on considerab considerably, and so has nursing. But every day I uh and and I said in the uh here in this part of the world we don't teach Peplo any longer. Twenty or thirty years ago, if you threw a stone at a psychiatric hospital or clinical setting, they would be using Peplo. Because and she was here, I met her, and she had a huge influence on this part, this this uh side of the Atlantic. Today that's gone. And I when we teach nurses three-year program undergraduate BSE, there's very little there's no theory as far as I can see. There's very little it's about there's a lot of content, it's packed with content, but I'm not too sure how many interventions would be based on Pablo's work. But I knew I was speaking about this today, so I revisited Pablo. I didn't have to because she's close to my heart, but a lot of the stuff she was talking about, I mean I the other thing that we don't do well here and we need to do more of is prevention. And I I was looking at Pablo's work and Pablo said very clearly the importance of prevention. And she talked about that curative interventions we know that have come before prevention, but she talked about we can instill in individuals growth and development so that they can work with they can help themselves grow, help themselves develop in terms of healthcare. So that's a biggie for for me as far as Pablo is concerned, because you're never gonna have enough. I don't know what's like in the US, but you're never going to have enough therapists here. I had a meeting yesterday where we were talking about young people who are unwell, and there's a huge waiting list, and each of those young people need about eight different therapy sessions, and they're on a waiting list probably two years before they get there. So we're not going to have enough psych nurse therapists, we're not going to have enough uh psychologists, we don't have enough at the moment, we don't have enough psych psychiatrists at the moment. And this tells me if I needed reminding, this tells me that we have to look towards prevention. And I'm very taken with George Albee's work in the University of Vermont and mental health, who said that no disease affecting humankind has ever been eradicated by treating people with that particular disease. It's about prevention. And he did some really good work on mental health in the University of Vermont. So Peplo was strong on that. The other thing she was strong in, which we're big at in the moment in Europe, is co-production. We're talking about we have to work with people in terms of planning their care, evaluating their care, getting their input and how do we design our services. And they call it co-production over here. Some people call it co-co-design. Peppla was talking about that before anyone else. She was talking about working with individuals, working with them together to identify what their problem, their felt needs were, and identifying interventions with them so that they could take, if you like, control themselves and and and and work through health. So that was really that was something that Peplow talked about.

SPEAKER_05 16:55

Sorry, jump in and just real quick. I tend to go on. No, no, it's good. And I'm Stefan on Melissa's toe, too, so I apologize, but I I don't want to let it go that that you had met Hildegard Pepplau. And so if you wouldn't mind sharing what that was experience was like and you know, kind of what surrounded that, you know, maybe how that impacted your life.

Prevention, Co‑Production, And Access Gaps

SPEAKER_00 17:11

Yeah, well, we ran a conference in Ulster University back about sometime in the mid-80s, to uh I would I I would probably say late 80s, early 90s, and Hilda was the was the was the the speaker and she came and I met her. We went out for lunch, we had dinner that evening. But when she did her presentation on her her view of nursing, you could hear a pin drop in the room. There was maybe 400 people in the auditorium. And what what what I noticed very early on is that she made the complex simple, or should I say, made it understandable. So we had the people who were giving out the coffee, the people who are who are working to support like the security staff and the staff who were there to to help with the catering, they thought she was marvelous because they were they were standing there in the auditorium listening to her as and they could understand everything she was saying. They could understand the importance of of what she was saying about interpersonal interactions and interpersonal relationships. And and I said that's quite a gift. You know, I I can speak at lots of conferences, and what I do is I speak to other people other psych nurses and we write for other psych nurses, and maybe we forget that we need to get our message through to patients, families, and communities. She did that. So that was my lasting impression of her. She was not a woman to be crossed. I mean, I think she had she had a core of steel, which she didn't show very often, but I could tell that if she had to stand up and be counted, and I think today, if she was alive today, she would have something very important to say to what's going on with nursing generally and psych nursing and perhaps self-health, not just in the US but elsewhere.

SPEAKER_01 19:08

Thank you for that. It's actually a pretty nice transition into talking a little bit about the balance between following evidence-based practice and sometimes to the point of religiously, and sort of the art of the clinical aspect, right? Psychotherapy is kind of messy and it takes both. And I also want to note as the non-nurse I think this gold standard trap crosses disciplines as well. So I'm very curious to hear your thoughts on do you think we've become too obsessed with rigid metrics and lost the art of that clinical gut feeling?

Evidence, Intuition, And The Missing Impact

SPEAKER_00 19:47

You said the gold standard. What did you say about gold standard? Evidence-based practice. Oh, yes, okay, okay. Thank you for that question, Melissa. A very important question. I think. that um when I remember I was a student psych nurse there was a a nurse manager what we call uh a nurse a nursing sister in the ward and when we went in to have the report in an office from the night staff before they went off she didn't come to the report she went and she sat on each uh and talked to each patient just sat down and had a conversation with them when the report was over a half an hour later she knew more about what went on than us and she had this intuitive nature to her she didn't have a degree she didn't have she wasn't highly qualified when it comes to to to various qualifications but she had an into an intuitive understanding of mental health nursing and mental health problems so she sometimes would say to me Hugh could you spend some time with Joe the patient I think I think he's going through a bad patch and maybe later on that day Joe would do something self-harm or Joe would you know become very unwell and I I went to her and I said how did you know that was going to happen and she said I just knew she wasn't able to say here is the theory here is the evidence here is the research that said this would happen it's just I knew she knew her patients she knew their families she knew their their behavior and she was able to work very closely with them intuitively so I I I detect what you're saying is that maybe we've lost some of that. And I would I would take it a little bit further if I may on this side of the Atlantic we got over enthusiastic about evidence-based practice or evidence and form practice and but we didn't take it a step further I I'll explain that by the following if you take the research continuum as I see it and it's not necessarily linear so you start with research dissemination we're really good in nursing in psych nursing and in psychology on doing research and disseminating through publications and our conference presentations. The next stage is uptake ensuring that your findings are taken up by clinicians or by managers or by whatever whoever policymakers for example the next step is implementation and the next take after that is impact. So I think we're very good at doing research we're very good at disseminating. We're not terribly good at ensuring that our research is has taken is taken up by clinicians and policymakers. And even though it's taken up by them we have to go that stage further and say have they actually implemented something? Have they changed policy have they changed practice that implementation and even after that you asked yourself the final question what was the impact of that? What was the benefit? What changed what was the effect of that? And I think evidence-based practice only went as far as implementation. So we got the research we got the dissemination there might have been uptake in terms of evidence but we didn't actually take it a step further to impact. And if you look at all the definitions of which there are hundreds on evidence-based practice that's exactly what it is it's about practice it's not about outcomes it's about using research to help you do something intervene but what's the end product of that what is the result of that so I think I think we have bringing those bringing that back to the clinic clinical area because you can't have impact without clinicians being involved in helping you implement the findings and achieve the benefit the impact and I think that's crucial and I think that maybe psych nurses have lost it. I'm not sure what it's like in your part of the world in psychology or in psych nursing but on this side Atlantic mental health nursing faculty never go into the clinic. They could be 30 years in university teaching the future psych nurses but yet the last time they seen a patient was maybe 30 years ago. Where's the credibility?

SPEAKER_01 24:24

And they can they're able to roll off evidence-based practice they're able to roll off the latest research findings etc so I think we we have a problem there I really appreciate all those points and the example of the individual with a strong intuition and time with patients.

SPEAKER_05 24:41

Thank you yeah that's that's wonderful Hugh I mean I I my only question is how do you teach that in a sense? Because I I think that's somewhat of an innate maybe but I think we can mentor that right we can but you're right it's not emphasized enough there's there's not good leadership in in that sort of way but uh but yeah a lot of things you've said have really impacted me I mean that that idea of sorry sorry Daniel just the point you made your point you made in reminded me of Benner's work from novice to expert the expert had used intuitiveness the expert was able to see the big picture and and I think we need to encourage more of that.

SPEAKER_00 25:20

Sorry for interrupting you Daniel No no that's good.

SPEAKER_05 25:22

I I think that's yeah no and again I I think you've said over and over again that you know in the UK you see theory kind of disappearing and I I think and I'll speak to the US I mean there I think there are pockets there are definitely colleges universities that have that but but I will speak to where I am at it is it is a desert theory desert it's and and and unfortunately I think like you said a lot of times it it's almost you know seen as not needed and and so a lot of things aren't even justified through a theoretical framework. So I appreciate your perspective on that and and that uptick that translational I mean that's again just all kind of hitting home for me. So I guess maybe to kind of you know as kind of almost a wrap up kind of question is maybe looking towards the future as we like to try to do here in our last question is, you know, where do you see the future of psych mental health nursing and and maybe let's try to see optimistically like you know in in five years if you know God God willing this podcast is still running and we have you back. You know it's what what happened in the last five years that you would that you'd be inspired by or that you would you were hopeful would happen and it actually happened. So so what are you hopeful for at this point?

Keeping Faculty Clinically Credible

SPEAKER_00 26:25

I'm hopeful for more leaders we have a shortage of leaders some psych nurses who were born leaders and I knew them and you knew them Daniel in this part of the world they became staff nurses then they became board managers then became administrators or went into the the college and after 20 or 30 years their leadership yes with students but where was their leadership nationally or internationally where is the peplos of you know where's the peplos today that people will queue up will travel across the Atlantic to go and listen to and hear we have them there's some of them there but we don't have enough of them and I think that we need to fast track in the next my my view is everything's down to leaders. When I mentioned to Melissa that word manager who had that intuitive she was a leader she didn't have to broadcast it she was a leader everyone knew she was a leader because of her behavior because of her knowledge because of her skills we need to fast track future leaders in psych nursing and we need to get them round the table not outside the door not under the table that need to be round the the decision making table I again I don't know what it's like in the US but when you have a a large hospital or when you have a large organization health organization you want a nurse around that table. We can learn a lesson from somebody in the side of the Atlantic it was Florence Nightingale she walked the corridors of power. She was able to have coffee with Queen Victoria you know or tea in that time you know a couple of times a week politicians were able to ensure that she got funding for the first psychiatric or sorry the first nursing hospital uh St Thomas's hospital in London and so we need that power we need to and I'm not sure that the the big nursing bodies that exist worldwide at the moment are are staffed by the right people. We need people who are able to say the Emperor has no clothes. We need people who are able to to lead who students and future practitioners and future academics and faculty can look to and get leadership from. And we don't have enough of those people so I would say the one thing that I would like in the next few years is identify blossoming leaders early and fast track them into positions where they're able to lead I want to share real quick with you you you mentioned earlier that your interactions with Dr.

SPEAKER_04 29:03

Peplau had you saying that she is a woman not to be crossed. I think that was the words you used I I just want to share with you that I I have an old friend who's who was a professor of mine from decades ago who also had the chance to meet Dr. Peplau and and I asked her that question I said what was she like and her her exact words I'll never forget she said she wasn't mean she wasn't a mean person but I wouldn't cross on her so decades later there's internal consistency between her view and your view.

Fast‑Tracking Bold Nursing Leaders

SPEAKER_00 29:35

Definitely I would I would use the same term the same sentence to describe her and that and maybe we need more nurses like that Sean yes yeah who are able to you know hold their position when it comes to getting more resources for nursing and supporting nurses and developing nursing and growing nursing we need more people like Pepplo and so anything we can do to increase the number of modern contemporary Peplos cut me in.

SPEAKER_05 30:02

I love it. Well that'll do it for that this episode thank you again for Hugh Dr. Hugh McKenna thank you again this has been an absolute pleasure of mine I think everybody here on this call is going to say the same thing. This is going to carry me through the weekend and the next week as well so so thank you again for your for your insights and and and just kind of sharing your perspectives and and I think that call at the end you know if you're listening to this right now and you're inspired please please call reach out to us you know put a comment subscribe to the podcast we'd love to have you on we'd love to have that conversation further so so let's have this kind of maybe light a fire a little bit under somebody so thank you so much appreciate that again and look forward to many more episodes coming in 2026 for uh too much season um they feel it if or it's true work hard until those thoughts are finally leaving so you can be you um they feel it before it's true work hard until those thoughts are finally leaving so you can be you guided discovery Identify and challenging your beliefs framing your mind negative thoughts release let it go cognitive distortions decrease until they cease guided discovery identifying challenging your beliefs framing your mind negative thoughts release let it go these cognitive distortions decrease until they cease