The effects of family work training on mental health nurses' attitude to and knowledge of schizophrenia: a replication

Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis

AIMS

Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction.

REVIEW METHODS

We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels.

RESULTS

A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences.

CONCLUSION

These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.

The development of a family intervention competency assessment and reflection scale (FICARS) for psychosis

Family intervention (FI) for psychosis has a robust evidence base. In recommending its use the revised NICE schizophrenia guideline states 'Healthcare professionals providing psychological interventions should have an appropriate level of competence'. Yet, no definitive instrument exists to outline what competences are required during and post FI training or help recruit staff with the appropriate knowledge and skill. This paper reports on the development of a Family Intervention competency assessment and reflection scale (FICARS). Using a systematic three-staged approach commonly used in health outcomes measurement development, a comprehensive literature review on UK-based FI training and commonly used assessment tools was undertaken. A FICARS draft was then constructed and revised in consultation with expert FI clinicians. Finally, a content validity study with FI trainers and students across three FI training programmes was undertaken to optimize FICARS aim to promote reflective assessment and professional development in FI skills and practice.

An evaluation of the outcomes of psychosocial intervention training for qualified and unqualified nursing staff working in a low-secure mental health unit

Psychosocial intervention (PSI) training results in enhanced knowledge, more positive attitudes, increased confidence and lower levels of clinical burnout for qualified mental health professionals and better outcomes for service users who they work with. This paper describes an evaluation of a PSI training course for qualified and unqualified nurses working in a low-secure unit. Forty-two staff (21 qualified) were randomly allocated to an experimental training group or a waiting list control group. Knowledge, attitudes and burnout were assessed before and after the training. In addition, a random sample of 44 care plans written by the qualified nurses were audited before and after to examine evidence of implementation of PSI in practice. Qualified and unqualified nurses in the experimental group showed significant improvements in knowledge and attitudes compared with the control group. Care plans showed a significant increase in the implementation of PSI. The only significant change in burnout was a reduction in depersonalization for qualified nurses in the experimental group. The PSI training may result in improvements in knowledge, attitude and practice in qualified and unqualified nurses working with severely mentally ill patients in low-secure settings, but in this study the training did not incur protection against burnout.

The relationship of case managers' expressed emotion to clients' outcomes

BACKGROUND

Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients.

METHODS

The present study assessed 42 case managers serving clients with schizophrenia spectrum disorder regarding their EE for specific clients enrolled in a larger study examining the reliability and validity of two alliance measures. Case managers and clients were personally interviewed at baseline, 3, 6, 6 plus 2 weeks, and 9 months post-client entry into case management. The EE measure was inserted into the 6 months plus 2 week case manager interview. Generalized Estimating Equation analysis was employed to examine predicted outcomes of EE.

RESULTS

High EE was found to be related to client attitudes toward medication compliance and social contact.

CONCLUSIONS

Family psychoeducation interventions, an evidence-based practice, have been demonstrated to be effective in reducing relapse of relatives with serious mental illness. Given the clinical evidence that EE is modifiable, it is expected that such educational training for non-familial caregivers will have the same potential as for family caregivers. Providers dealing with challenging clients may also need support and skills to better handle difficult situations, especially direct support providers like case managers who are not clinically trained.

Does structured clinical supervision during psychosocial intervention education enhance outcome for mental health nurses and the service users they work with?

This study aimed to assess whether clinical supervision provided by workplace-based supervisors can enhance outcomes for mental health nurses attending a psychosocial intervention education programme and the service users whom they work with. A quasi-experimental controlled design was used. The main outcome measure was student knowledge and attitudes towards individuals with psychosis and their caregivers. Secondary outcome measures for service users included the KGV (M) symptom scale and the Social Functioning Scale. Students in the experimental group demonstrated a significant increase in knowledge of psychological interventions compared with the control group. Service users seen by the students in the experimental group showed significantly greater reductions in positive psychotic symptoms and total symptoms compared with those seen by students in the control group. Workplace clinical supervision may offer additional benefit to nurses attending psychosocial intervention courses. Further research adopting more robust designs is required to support these tentative findings.

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.

Releasing the therapeutic potential of the psychiatric nurse: a human relations perspective of the nurse-patient relationship

In psychiatry mental health nurses form the largest professional discipline providing care on an everyday basis for sustained periods. Mental health nurses therefore are in a pivotal position to establish valued therapeutic alliances. In practice, however, a disproportionate amount of nursing time is taken up by administration, time spent talking to patients is minimal and when interactions do occur they remain notionally therapeutic and often are not theoretically informed. This noted paucity of therapeutic contact is antithetical to the aspirations of service users who increasingly are asking for a more skilled approach to the talking-listening that occurs in the therapeutic encounter. It is hypothesized by the present authors that an object-relations perspective of the nurse-patient relationship could release the largely untapped therapeutic potential of the psychiatric nurse by (1) bridging the gap between theory and practice and (2) providing a professional identity from within which nurses can begin to 'get to know' and understand the predicament of the patient with severe mental illness.

Improving the knowledge and skills of psychiatric nurses: efficacy of a staff training programme

BACKGROUND

Working with people with mental illness is very challenging and mental health workers can have a significant impact on the mental status of their patients. Few studies have been published that describe training programmes for this staff group.

AIM

This paper aims to describe and evaluate a training programme for generic mental health workers used in the context of a residential unit for 'difficult to place' mentally ill patients.

METHOD

The staff training programme was adapted from a previous programme showing good efficacy. It was conducted over 10 sessions and addressed a wide range of issues relating to the management of mentally ill patients, with the use of a variety of teaching methods. Twenty-nine generic mental health workers participated in the programme. The impact of the programme was examined using a knowledge questionnaire and a semi-structured questionnaire exploring the range and use of management strategies by staff members.

RESULTS

Comparison of pre- and post-training measures indicated that the training programme increased staff knowledge of schizophrenia and the use of certain management skills, in particular, systematic strategies to effect change. This included increased use of structured programmes with patients.

CONCLUSION

The training programme was effective in increasing knowledge and skills of staff and could be used with a variety of psychiatric staff. There are numerous limitations to this study, in particular the poor attendance rates which are likely to have decreased the impact of the programme.

Multiple family group interventions in first episode psychosis: Enhancing knowledge and understanding

Families play a major role in promoting recovery and preventing relapse following the first psychotic episode. This paper presents a multiple family group education programme for the families of clients with first episode psychosis. The educational needs of the families are also discussed. The results of this evaluation show that the programme improved the families' perceptions of their overall knowledge and understanding of mental illness and its treatment. This evaluation demonstrates the efficacy of such groups and the key role of community mental health nurses in providing family interventions.

Does training in psychosocial interventions reduce burnout rates in forensic nurses?

BACKGROUND

Mental Health Nurses working in secure environments with patients suffering from serious mental illness have been shown to be at risk of clinical burnout syndrome, this can have adverse effects both on the nurses' health and the standards of care that they deliver.

AIM

To evaluate the effect of Psychosocial Intervention Training (PSI) on the knowledge, attitudes and levels of clinical burnout in a group of forensic mental health nurses.

DESIGN

Baseline assessments of knowledge, attitude and burnout were completed by asking a group of 33 nurses working in a medium secure psychiatric unit to complete questionnaires. Twenty of the nurses volunteered to be included in a PSI training course and were randomly allocated either to receive the training or to a waiting list control group. The duration of the training was 6 months and on completion subjects in the experimental and control group completed the questionnaires again.

RESULTS

Staff in the experimental group showed significant improvements in their knowledge and attitudes about serious mental illness and a significant decrease in burnout rates, whilst staff in the control group showed a small but nonsignificant improvement in knowledge and attitudes, and increase in burnout.

CONCLUSION

The findings suggest that providing forensic mental health nurses with a better understanding of serious mental illness and training them in a broader range of interventions, helps them to be more positive in their attitudes towards the clients that they work with and experience less negative effects of stress resulting from their caring role. The implications of this study for clinical practice and future research will be discussed.

Psychological morbidity of Thai families of a person with schizophrenia

The paper presents data on families of a person with schizophrenia in rural Thailand, using the resiliency model of family stress, adjustment, and adaptation. The aim is to assess the impact of family factors on psychological morbidity of the mothers and relatives of a person with schizophrenia. One hundred and eight Thai families were interviewed based on family assessment instruments. Multiple regression analysis was performed. The findings suggest that in a stable stage of illness, other stresses of family life may have stronger impact on psychological status of family members, than the illness. Implications for clinical nurses and researchers are presented.

The use of outcome measures to evaluate the efficacy and tolerability of antipsychotic medication: a comparison of Thorn graduate and CPN practice

Assessing the tolerability and efficacy of treatment with antipsychotic medication is a vital part of mental health care. Research has suggested that many side-effects go undetected by clinicians and there is a need to use standardized assessment tools to ensure that treatments are comprehensively evaluated. The training of Community Psychiatric Nurses (CPNs), who provide much of patients' care, should focus on enhancing skills in using such assessments. This study aimed to examine differences in the use of standardized assessments of antipsychotic side-effects and psychopathology by CPNs and Thorn graduates who had received additional training in delivering psychosocial interventions. A questionnaire was sent to 240 Thorn graduates and CPNs practising in England, with an overall adjusted response rate of 54%. Thorn graduates reported using significantly more standardized assessments of side-effects and psychopathology than CPNs. A trend in both groups towards the use of measures that relied on patient self-report of side-effects was observed. This study identified important deficiencies in current CPN practice. A programme of targeted training may be a more realistic and efficient method of enhancing medication management practices in large numbers of CPNs compared to the more expensive and time-consuming Thorn programme.

Evaluating expressed emotion and schizophrenia

This article presents another review from the Network for Psychiatric Nursing Research (NPNR) National Journal Club (see Vol 8(15): 1010-12). The article reviewed was Willets and Leff's (1997) 'Expressed emotion and schizophrenia: the efficacy of a staff training programme'. The collated feedback comments from the regional journal clubs is based on the format proposed by Cormack (1991). The views expressed in this article are those of the journal club members and not necessarily those of the NPNR.

Nurses' responses to people with schizophrenia

General nurses, psychiatric nurses and lay people were investigated to identify differences between their personal standards concerning how they should respond, and beliefs about how they actually would respond, towards the target group, 'people with schizophrenia', in each of three response domains (thinking, feeling and behaving). Significant differences were identified between the response types and between the different response domains. Significant interaction effects were also identified based on participants professional status in nursing. It is argued that the results support Devine's (1989) theory concerning the automatic activation of stereotypes and their controlled inhibition in favour of different personal beliefs. It is also argued that professional specialization in psychiatric nursing facilitates this process in relation to the target group.

The knowledge and attitudes of mental health nurses to electro-convulsive therapy

Three hundred and forty-five questionnaires containing the knowledge and attitude scale for ECT devised by Janicak et al. (1985) were distributed to mental health nurses working in Wales, the data were collected from the 167 returned. Limitations in the reliability of the instrument with respect to the degree of internal consistency were found, this suggested that the knowledge statements used were inconsistent in providing a reliable measure of respondents knowledge of ECT. Findings suggested that a higher level of knowledge appeared to be associated with the length of experience of the nurse and their area of clinical practice. In addition, there were substantial variations in actual knowledge, particularly with regard to cognitive side-effects with ECT. Attitudes to ECT in this study were significantly related to the place in which the nurse was practising and the degree of contact the nurse had with patients receiving the treatment. Greater knowledge scores were obtained by those nurses who indicated a more positive response towards ECT. The conclusions suggest that knowledge of ECT required improvement in many cases, and this has implications for nurse education. A relationship between knowledge and attitudes appears to exist in this study, however, such a relationship would need to be tested further in future research.

Expressed emotion and schizophrenia: the efficacy of a staff training programme

The presence of expressed emotion (EE) in five community care facilities was investigated and levels of high EE were found in some staff-client relationships. A training programme was developed drawing on a variety of research findings and based on a successful community psychiatric nurse training package for work with families. Its aims were to enable community mental health workers to increase their knowledge about schizophrenia and repertoire of strategies for managing a variety of difficulties in addition to decreasing levels of EE present in their relationships with clients. A small but non-significant increase in knowledge was achieved, in addition to increases in the use of strategies aimed at effecting change and involving the use of resources. No significant changes in EE levels were reported.

Schizophrenia Family Work: Mental Health Nurses Delivering an Innovative Service

1. Mental Health Nurses (MHNs) have an unique role in providing care to the mentally ill. The Thorn Nurse Initiative designed to prepare and evaluate the work of MHNs has been successful in providing nurses with the skills of Family Work for Schizophrenia. 2. The effectiveness of family work in improving MHNs' knowledge of and attitudes about schizophrenia has been demonstrated, and there is increasing evidence of the efficacy of MNHs in delivering family work. 3. The impact of schizophrenia on families tends to go unrecognized, and there is an urgent need to train nurses in family work to help families cope with this illness. 4. Families are extremely valuable and a positive resource for clients. The emphasis of family work is to promote and support all families in improving their knowledge of schizophrenia, and its effects, and in developing their coping skills.