Nurses' experiences when conducting the mental state examination (MSE): A scoping review

The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.

Everyday ordinariness, neglected but important for mental health nurses' therapeutic relationships: An initial exploration for applying Daniel Kahneman's two systems of thinking

Mental health nurses undertake difficult and complex roles. Therapeutic relationships and engagement between mental health nurses and people experiencing severe mental ill-health provide the core purpose and rationale for such mental health care. These relationships are influenced by factors outside of frontline mental health nurses control. They are difficult to define or describe with clarity, have limited 'quantitative' evidence of effectiveness and are frequently not experienced as therapeutic. This paper presents some initial ideas regarding 'everyday ordinariness' using psychologist Daniel Kahneman's two systems of thinking as a focus for understanding and potentially improving mental health nurse practice, and therapeutic relationships and engagement.

Using Delphi method to address factors contributing to aggressive behaviour in mental health settings

WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.

Lived experiences of mental health nurses who care for clients who are parents: An approximation of Tronto's definition of care

WHAT IS KNOWN ON THE SUBJECT

Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role. Many authors highlight the importance of a non-judgmental approach when providing support and care to clients with mental illness who are parents. Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked. There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Trust is the basis that helps clients to be open to receiving care and answering parenting-related questions. Therefore, without adequate professional-client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client. Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care.

ABSTRACT

Introduction Many authors highlight the importance of a non-judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim To explore the lived experiences of mental health nurses who care for clients who are parents. Method We conducted a qualitative phenomenological study. The main data collection technique was in-depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting-related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.

Exploring work-related stressors experienced by mental health nurses: A qualitative descriptive study

INTRODUCTION

The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well-being and physical health. While these impacts have been investigated in quantitative research, little is known about work-related stress from the perspective of MHNs.

AIM

To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context.

METHOD

A descriptive qualitative study with data collected via semi-structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis.

RESULTS

A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress.

DISCUSSION

Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity.

IMPLICATIONS FOR PRACTICE

This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work-related stressors that could be alleviated through effective leadership and management.

Mental Health Nurses' and Allied Health Professionals' Individual Research Capacity and Organizational Research Culture: A Comparative Study

Introduction

Healthcare professionals have development needs related to their consumption, use, and practice of clinical research. Little is known about these issues in mental health services specifically.

Objectives

A survey of healthcare staff working in an NHS Mental Health and Disability Trust in England was conducted to describe research capacity and culture compared with previously reported samples, and to examine subgroup differences.

Methods

An online questionnaire was utilized. The main measure was the Research Capacity and Culture tool comprising measures of individual's perceived research skills and of team and organizational research culture. Previous studies using the same measure were systematically identified, and pooled results, weighted by sample size, were calculated. Analyses were descriptive (current sample versus previous results) and inferential (comparisons between demographic and professional groups within the current sample).

Results

N = 293 people completed the survey. The median item scores were poorer than those of pooled samples from studies reporting median item scores on 39/51 (76.5%) occasions and poorer than those pooled samples of studies reporting mean item scores on 51/51 (100.0%) occasions. Individual capability for research was in the 'less than adequate' range more than in previous samples (71.4% vs. 42.9%). For team culture items, the proportions were 84.2% vs. 78.9%, while most responses about organizational culture were in the 'adequate' range (55.6% vs. 66.7%). Staff >20 years employment had poorer perceptions of team and organizational culture.

Conclusion

Perceptions of individual research capacity and team and organizational culture were poor compared with previous studies, most of which were conducted in non-mental health settings. There is need for development of research capacity and culture in mental health services including opportunities to develop basic research skills through to strategic developments to promote clinical academic careers. There is considerable room for improvement in the way organizations support research and signpost opportunities.

Mental health nurses' experience of resilience during COVID-19: A qualitative inquiry

The COVID-19 pandemic created unprecedented demands and additional stress for nurses in mental health settings. There is no prior evidence on nurses' experience of building and maintaining resilience in the context of work during COVID-19. The aim of this study was to explore the experience and impacts of the COVID-19 pandemic on the resilience of nurses in mental health settings. Data from semi-structured interviews with 20 nurses from an Australian mental health service were analysed using reflexive thematic analysis. Four main themes were generated: experiencing significant disruptions; making sense of shared chaos; having professional commitment; and growing through the challenges. Nurses' practice and teamwork were disrupted by COVID-19 related changes to care models and infection prevention policies. They successfully adjusted by having awareness of self and others' emotions, using mental and emotional self-regulatory strategies, engaging in self-care, using 'bricolage' to create different ways to provide care, and having mutually supportive relationships. Nurses connected to their sense of purpose and professional commitment to fuel their therapeutic work and sustain care delivery. They experienced personal and professional growth with an increased understanding of their strengths and resilience. In the post-pandemic period, although the challenges presented by the pandemic have lessened, there are ongoing negative impacts on nurses' wellbeing. To maintain and strengthen their wellbeing and practice, the findings indicate the importance of professional development in emotional regulation skills, and strategies to strengthen self-care and build collegial relationships in teams. Resilience education can be implemented to support nurses' resilient practice skills.

The biological paradigm of psychosis in crisis: A Kuhnian analysis

The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing.

Thematic Analysis of Mental Health Nurses' Views of Contributing Factors Fueling Workplace Violence in Psychiatric Hospitals: Insights From Unsung Soldiers

BACKGROUND

Workplace violence against mental health nurses is an international phenomenon that sparks concerns for nurses' safety and mental health. This phenomenon has recently arisen as a crucial concern in the Middle East as it has become pervasive and has negative implications, causing nurses to accumulate psychological and emotional distress. However, no research has yet investigated the contributing factors of this phenomenon in Jordanian psychiatric hospitals from the nurses' perspectives.

AIMS

This study aimed to explore the factors contributing to workplace violence in Jordanian psychiatric hospitals from the perspective of mental health nurses.

METHOD

An exploratory, qualitative design was utilized. Using audio-recorded, semi-structured, face-to-face interviews, a purposive sample of 24 mental health nurses were interviewed to collect data. Thematic analysis was used to analyze the data.

RESULTS

Four overarching themes were identified: Peak Time of Violence, Unavoidable Part of the Job, Poor Organization and Lack of Policy, and Bite the Bullet.

CONCLUSION

From nurses' perspectives, an in-depth understanding of factors contributing to workplace violence provides a foundation for developing preventive interventions, improving work environment safety, and promoting nurses' mental health. Prevention strategies and further studies are warranted to limit this phenomenon.

Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units: A non-participant observation study

National mental health policies accentuate the importance of having positive attitudes, skills, and knowledge among mental health professionals to facilitate recovery-oriented practices in all areas of mental health care. However, evidence suggests that mental health professionals' negative attitudes towards mental illness are still evident and that recovery-oriented practice in acute inpatient units may be poorly implemented. At the same time, there is also a paucity of research to understand Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice specifically. Therefore, this non-participant observation study aimed to explore Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient units by observing the interactions between the consumers and nurses. The Mental Illness Clinicians Attitudes Scale-v4 and The Recovery Attitudes Questionnaire inspired the development of a non-participant observation chart for this study and the observations were recorded on the chart. Six observations were conducted in three acute inpatient units. Observations focused on Mental Health Nurses' knowledge about mental illness, communication, dignity, respect, anxiety, fear, punishment, facilitation of real choices for consumers, physical care, cooperation with consumers' families and others and recovery orientation. Interpretive descriptive analysis was used to analyse the data. The results show that Mental Health Nurses generally have positive attitudes towards mental illness and recovery-oriented practice. Some deficits in the physical care of people with mental illness in the acute inpatient units were observed. Therefore, future research could address the adequate preparation of Mental Health Nurses to provide physical care to people with mental illnesses.

Are mental health nurses meeting the requirements of second health professionals in presenting opinions to the court?

WHAT IS KNOWN ON THE SUBJECT?: Mental health legislation is currently under review following recommendations for repeal and replacement. Through the statutory role of the second health professional, mental health nurses are in a strong position to offer a unique clinical perspective, engagement and advocacy for tangata whaiora (person seeking wellness) and whānau. Māori are more likely to be subject to a compulsory treatment order than non-Māori. Whānau involvement in care is a core element to well-being from a Te Ao Māori (Māori world view) perspective. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Understanding the level of whānau involvement in the MHA process. Understanding challenges for nursing practice for consideration in the current review of MHA legislation. Identification of the opportunity nurses have to contribute to reducing high rates of Māori under CTOs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The current MHA review needs to include the resourcing required to support the clinicians practising in statutory roles. More emphasis is needed to build the cultural knowledge and capability of the nursing workforce to integrate principles of a Te Ao Māori worldview into care delivery. These learnings highlight the importance of nursing responsibility in the SHP role. ABSTRACT: Introduction Clinical practice within statutory roles is an important issue for the nursing profession. There is increasing involvement of nurses undertaking statutory roles and opportunities for nurses to advocate and offer their unique clinical opinion regarding the need for restrictive measures imposed by mental health act legislation. Aim The aim of this study was to analyse whether registered nurses who undertake the role of second health professional (SHP) within New Zealand's Mental Health (Compulsory Assessment and Treatment) Act (1992) (MHA) are meeting the expectations of that role. Method A retrospective analysis of 156 cases was undertaken of clinical reports completed by registered nurses. The reports were measured against an established competency framework modified to include MHA expectations for whānau (family) involvement. Results From a sample of 156 cases, 22 were identified as reviews of initial orders for assessment and treatment while 134 were opinions related to the application for a compulsory treatment order (CTO). In most cases, reports achieved a good standard. There were limitations in nurses completing the documentation to the required standard, and adaptations were evident in efforts to meet clinical and legal expectations. There was a significant absence of evidence of whānau consultation. Discussion Resourcing through education, support and ongoing development are required to ensure that nurses are equipped to meet the expectations of the legislation. There is an opportunity for nurses to influence decision-making and support the reduction in use of community treatment orders. A review of the existing competency framework is required to include cultural approaches and involvement of whānau. Implications for Practice It is important to understand the factors that strengthen nursing practice to improve health outcomes and tangata whaiora and whānau experience. This study uses methods of clinical audit to describe current practice and establish an evidence base to measure change. It also offers important learnings for consideration within MHA legislation review and for nursing workforce development.

Mental Health Nurses' Social Representations of People Who Experience Mental Illness: A Story of Paradoxes

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses' representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses' social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses' social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.

Factors influencing the transition and retention of mental health nurses during the initial years of practice: Scoping review

AIM

This review aims to identify the factors influencing the transition and retention of mental health nurses during the initial years of practice, recognize gaps in the literature and propose evidence-based strategies.

BACKGROUND

Mental health is a challenging specialty; recruitment, transition and retention of mental health nurses are known issues of concern.

EVALUATION

The present study undertakes a scoping review to identify factors influencing the transition and retention of mental health nurses during the initial years of practice and the gaps in that research domain. A literature search was conducted using electronic databases. To gain an understanding of the topic of interest, the review of the literature extended from 2000 to 2022.

KEY ISSUES

Existing evidence focuses on specific perspectives of transition. There is limited literature on factors influencing transition and retention among mental health nurses. Findings suggested that personal and professional factors could influence the transition and retention of mental health nurses during the initial years of practice. The main themes identified were personal attributes and professional factors with a number of subthemes.

CONCLUSION

The scoping review identified only a few studies, which showed personal and professional factors related to the transition and retention of mental health nurses at the early stages of their career.

IMPLICATIONS FOR NURSING MANAGEMENT

Potential benefits of effective transition and support with the understanding of factors influencing transition and retention of early career mental health nurses will enhance staff morale, sustainability of the workforce and better patient outcomes. Additionally, a few recommendations for nurse managers and leaders to improve transitional experiences and retention of early career nurses are highlighted.

Mental health nurses' resilience in the context of emotional labour: An interpretive qualitative study

Strengthening mental health nurses' (MHNs) resilience may help mitigate the negative effects of the emotional labour (EL) of their work. There is no prior evidence on MHNs' experiences of resilience in the context of EL. This interpretive qualitative study sought to explore how MHNs build and maintain their resilience in the face of high levels of EL. Semi-structured interviews were conducted with 11 MHNs. Reflexive thematic analysis was used to analyse the data. Four main themes were constructed. The first three; Being attuned to self and others, Having a positive mindset grounded in purpose, and Maintaining psychological equilibrium through proactive self-care, describe how MHNs build and maintain their resilience. The fourth theme, Running on emotionally empty, describes what impedes MHNs' resilience. MHNs engaged in internal self-regulatory processes to manage their mental and emotional state. They maintained intra- and inter-personal boundaries and proactively used self-care strategies to maintain their well-being. Through this, they were able to replenish and sustain the energy required to maintain a state of equilibrium between themselves, their interpersonal practice, and their working environment, and to positively adapt to EL. However, lack of organizational support and high workplace demands can negatively impact MHNs' equilibrium and adaptive ability. There is a need for organizations to proactively work to reduce workplace stressors, and support MHNs' professional well-being and practice. Education and support strategies focused on strengthening MHNs' resilience, well-being, and mental health practice capabilities, including the provision of clinical supervision, and clear role expectations within MHNs' scope of practice are recommended.

Relationship between job stress, thinking style and symptoms of post-traumatic stress disorder in mental health nurses

Introduction

Mental health nurses are often exposed to stressful events which may lead to feeling of stress in their daily work, and this feeling has a profound impact on nurses' mental health.

Aim

This study aimed to evaluate the relationship between job stress, thinking style and symptoms of post-traumatic stress disorder (PTSD) of mental health nurses, and to explore the mechanism of job stress and thinking style on symptoms of PTSD.

Method

This cross-sectional study collected related data of 351 mental health nurses in China, and the data was analyzed by PROCESS macro for SPSS.

Results

The results showed that 18.2% of mental health nurses had the symptoms of PTSD. Thinking style (monarchic thinking style, anarchic thinking style and external thinking style) played a moderating role in the predictive effects of job stress on the symptoms of PTSD.

Discussion

The research pointed out the relationship between job stress and symptom of PTSD, and clarified the critical role of thinking style among mental health nurses.

Implications for practice

It is recommended that organizations should enact effective policy and intervention programs to reduce job stress and PTSD symptoms of mental health nurses which may improve their mental health level.

Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review

Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.

Coercive containment measures for the management of self-cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Self-harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self-harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self-cutting management compared with for disturbed behaviours in general using a cross-sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self-cutting management. Respondents disapproved of using each coercive measure for self-cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self-cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self-cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self-harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative.

Service integration: The perspective of Australian alcohol and other drug (AOD) nurses

The recently released Victorian Mental Health Royal Commission report has recommended a shift to integrated treatment, defined as treatment for alcohol and substance use disorders and mental ill health occurring in parallel, rather than distinct systems catering to each need. However, little work has sought to determine the perceptions of nurses working in alcohol and other drug (AOD) treatment towards integrating with mental health services. In this study, we explore the perspectives of specialist AOD nurses towards the integration of mental health and AOD treatment services. Secondary analysis of semi-structured interviews with Australian specialist AOD nurses (n = 46) conducted as part of a wider workforce study in 2019. Data were analysed using thematic analysis and reported using the COREQ guidelines. Of the interviews analysed, six were AOD nurses working in an Australian state that had recently undergone service integration; however, many participants expressed perceptions of service integration. Two key themes are reported in this paper: (i) perceptions of service integration, where AOD nurses participating in our study were concerned that integration would result in the model of care they worked under being replaced by a mental health-based model that was felt to be highly risk averse, and (ii) experiences of service integration. Concerns about the focus of care as well as the complexity of care differing between the two services demonstrated a contrast in both philosophical approaches to work with consumers and legislative difference in voluntary versus compulsory care provision.

Using an emotion-focused approach in preventing psychological birth trauma

PURPOSE

This discussion article considers how an emotion-focused approach can be adopted to prevent psychological birth trauma and to optimize perinatal wellbeing for women and their families.

CONCLUSION

Emotion-focused approaches have a different perspective when compared to other classic psychotherapy methods. This approach may help women to resolve the negative impacts of psychological birth trauma; to prevent posttraumatic stress disorder onset; to lead to better results for mother and baby well-being; and may be cost effective.

PRACTICE IMPLICATIONS

Mental health nurses/midwives should receive education about emotion-focused approaches in addition to gaining competence in basic counseling skills so that they can utilize these approaches with women.

Living with parental mental illness is like a roller coaster: Reflections on children's lifeworld in the family setting

AIMS AND OBJECTIVES

To explore what it is like for children in the family setting to live with parental mental illness.

BACKGROUND

There are reported risks of negative social and behavioural outcomes among children living with parental mental illness such as poor school performance, isolation and poor mental health. There is yet more to know about how children's interactions with significant members of the family shape their experiences.

DESIGN

A phenomenological design following Husserl's concepts of lifeworld and inter-subjectivity was adapted for the study.

METHOD

Twenty-one children (ages 10-17) who lived with a parent with mental illness were interviewed. The data were analysed to attain the essential features of the phenomenon. The study followed the COREQ checklist for qualitative studies.

FINDINGS

The essence of the phenomenon 'living with parental mental illness' in the family setting comprises strain, sadness and some happy moments. Living with parental mental illness can produce unpredictable life situations for children as relationships and interactions in the family setting can be chaotic and confusing. The ups and downs define their lifeworld as a roller coaster. Strenuous family environment, sibling interaction, navigating separate living arrangements and there are good days were specific themes that clarified the children's lives as a roller coaster.

CONCLUSION

A concept called the 'parent paradox' is coined to reflect how children are torn between what their living situation looks like comparing the parent with mental illness and the other without mental illness. The paradox is founded on children's loyalty towards their parents.

RELEVANCE TO CLINICAL PRACTICE

To break the unhealthy cycle created by the parent paradox, mental health nurses should ensure that children are well informed about the parent's mental condition including information about treatment procedures and recovery. Child's psychological distress may be reduced when they are informed.

Risk factors and oral health-related quality of life: A case-control comparison between patients after a first-episode psychosis and people from general population

WHAT IS KNOWN ON THE SUBJECT?: Oral health consists of more than having good teeth; it is an important factor in general health and well-being. Despite its importance, oral health care is still largely overlooked in mental health nursing. There is no research available about oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder with a psychotic disorder (first-episode). WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study provides insight into the severity of the problem. It demonstrates the differences in risk factors and OHRQoL between patients diagnosed with a psychotic disorder (first-episode) and the general population. A negative impact on OHRQoL is more prevalent in patients diagnosed with a psychotic disorder (first-episode) (14.8%) compared to the general population (1.8%). Patients diagnosed with a psychotic disorder (first-episode) have a considerable increase in odds for low OHRQoL compared to the general population, as demonstrated by the odds ratio of 9.45, which supports the importance of preventive oral health interventions in this group. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening, motivate patients, provide oral health education to increase awareness of risk factors, integration of oral healthcare services) all in order to improve the OHRQoL. ABSTRACT: Introduction No research is available about the oral health risk factors and oral health-related quality of life (OHRQoL) in patients diagnosed with a psychotic disorder. Aim To compare oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder (first-episode) to people with no history of psychotic disorder. Method A case-control comparison (1:2) multivariable linear regression analysis and an estimation of prevalence of impact on OHRQoL. Results Patients diagnosed with a psychotic disorder (first-episode) have lower OHRQoL with more associated risk factors. Of the patients diagnosed with a psychotic disorder (first-episode), 14.8% reported a negative impact on OHRQoL, higher than the prevalence of 1.8% found in people from the general population. Discussion The high prevalence rate of a negative impact on OHRQoL in patients diagnosed with a psychotic disorder (first-episode) shows the importance of acting at an early stage to prevent a worse outcome. Implications for practice The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening) in order to improve the OHRQoL.

Perspectives on mental health recovery from Egyptian mental health professionals: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt. Definitions of recovery from high-income and English-speaking countries should be carefully adapted to other settings. Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low-middle-income country were clear in the findings of this paper. There are differences in the definition of family and service user engagement in the current study and in high-income countries. Seeking faith healers as a barrier to mental health recovery is culturally unique. Functional recovery prevails as a model in Egypt as there is limited service user involvement. Nursing values and code of ethics are consistent with enablers of mental health recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Changing the pre-registration nursing education to prepare specialized graduates in mental health nursing. Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. ABSTRACT: Introduction Recovery-oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim To explore perspectives of Egyptian mental health professionals on recovery. Method Semi-structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self-awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues.

Mental health nurses perceptions of missed nursing care in acute inpatient units: A multi-method approach

Nurses have key roles in caring for hospitalized patients. Missed nursing care can lead to adverse outcomes, from minor discomfort to patient death. Mental health nurses have a significant role in advancing knowledge and practice due to missed, delayed, or unfinished nursing care. They are identifying, escalating, and managing warning signs of mental and physical health deterioration where the risk to patients is high in terms of compromised care quality and neglect and the evidence is scant. This study aimed to examine mental health nurses' perceptions of missed nursing care in acute mental health inpatient units in an Australian regional health service. A cross-sectional survey was undertaken using a modified Kalisch Phelan MISSCARE questionnaire and a qualitative content analysis was undertaken for narrative responses. Of 70 participants, the majority were aged 30-44 years, with >5 years of experience. The results indicated that care planning, safety audits, communication, and assessment of oral intake were perceived as care most frequently missed. Factors contributing to missed care need urgent exploration to ensure timely reduction of patient risk and enhancements to safe quality care.

The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center

BACKGROUND

Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning.

AIM

To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia.

DESIGN

This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group.

METHODS

Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form.

RESULTS

Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback.

CONCLUSION

Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.

Stigma in the media: Investigating journalism students attitudes towards mental illness

Given the profound role that media play in public opinion, there exists an ongoing necessity to understand the portrayal of mental illness by journalists. There is a plethora of studies that have examined how mental illness is portrayed in the media, but few studies have sought to understand what journalist opinions about mental illness are, and none could be found regarding journalism students' opinions. This study aimed to bridge this gap by examining journalism student's attitudes towards mental illness using the Social Distance Scale (SDS). This study adheres to STROBE guidelines for cross-sectional studies. One hundred and seventy-two undergraduate journalism students (n = 172) completed the SDS with findings suggesting that students had moderate stigmatizing attitudes, with varying degrees of stigma present depending on the social context. Positively framed reporting and constructive media coverage surrounding mental illness may be improved by shared communication and education with health professionals who specialize in mental health: mental health nurses.

Evaluation of metabolic monitoring practices for mental health consumers in the Southern District Health Board Region of New Zealand

WHAT IS KNOWN ON THIS SUBJECT?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally. Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes. No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care. Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring. Guidelines may have a role to play in improved monitoring but need service-level support in order to be effective. ABSTRACT: Introduction People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness.

Effect of recovery-based interventions on recovery knowledge and attitudes of mental health professionals, regarding recovery-oriented practice: A quantitative narrative review

Mental health recovery is an enabling process encouraging consumers to live a productive life, notwithstanding the presence of debilitating symptoms of illness. The recovery model has been integrated into all areas of mental health. However, literature shows that mental health professionals are not equipped to provide recovery-oriented care to consumers. Researchers have recommended recovery-based interventions to develop knowledge, attitudes, and skills to promote recovery-oriented practice in mental health, yet there is a paucity of research regarding the effect of recovery-oriented interventions on the knowledge and attitudes of mental health professionals to improve recovery-oriented practice. Therefore, the purpose of the current review is to understand the effectiveness of interventions on recovery knowledge and attitudes of mental health professionals regarding recovery-oriented practice. The papers were identified through the Population Intervention Comparison and Outcome strategy. The heterogeneity of the selected papers led to a narrative review instead of a systematic review with meta-analysis. The analysis suggested that recovery-based interventions are effective in enhancing the recovery knowledge and attitudes of mental health professionals. Recovery-based interventions have the potential to reduce the use of physical restraints and improve work satisfaction among mental health professionals. The limitations of the studies were the heterogeneity of the selected populations and the absence of strong methodologies to assess the effect of the interventions. Therefore, future investigations should be focused on the effect of interventions on a homogeneous group using randomized controlled trials.

Coping with moral distress on acute psychiatric wards: A qualitative study

Background:

Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands.

Methods:

Qualitative individual and focus group interviews were conducted.

Ethical considerations:

Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed.

Participants and research context:

Thirty nurses working within acute psychiatric wards in two mental health hospitals.

Results:

Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not ‘bringing problems home’ after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies.

Discussion:

Nurses’ coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price.

Conclusions:

It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.

It is like 'judging a book by its cover': An exploration of the lived experiences of Black African mental health nurses in England

The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub-Saharan Africa. They were interviewed using face-to-face semi-structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep-rooted discrimination and marginalisation. Aside from that, because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential.

Action learning sets for supporting postgraduate mental health nurses' transition to professional practice: A qualitative study

This paper reports on a qualitative case study of postgraduate mental health nurses participating in a monthly facilitated action learning set (ALS) in order to support them while they transition from PGMHN to independent professional practice. The aim of the study was to determine what the impact of participating in an ALS would have on how they perceived clinical practice issues. The ALS comprised a small group of PGMHN supported by a facilitator in order to explore issues from clinical practice by using Socratic questions to challenge their thinking. Data were collected via a single focus group and a 20-item survey. Focus group textual data were coded line by line, and codes were synthesized thematically. The major theme to emerge from the qualitative results was as follows: 'Learning from doing an action learning set'. Three subthemes were identified: Think outside the box: Developing Socratic questions; there's rarely one right way: Applying action learning to practice; and Not easy to implement: Action plans in action. A 20-item evaluative survey indicated that ALS increased participant's confidence as a mental health nurse. Using critical questions increased participants' confidence to explore different perspectives when engaged in problem-solving.

Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses’ mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.

Mental health nurses' perspectives of people who self-harm

Self-harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self-harm. The aim of this study was to explore mental health nurses' (MHNs) experience of working with people who self-harm. Data were collected using semi-structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs' inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs' experiences of working with people who self-harm: (i) Nurses' level of preparedness to work with people who self-harm; and (ii) The healthcare system. Several sub-categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self-harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self-harm and an accurate understanding of the functions of self-harm focuses therapeutic interactions to manage psychological distress and reduce further self-harm and lessen the risk of suicide.

Implementation of a wound care education project to improve the wound care competency among psychiatric nurses: A quality improvement project and feasibility study

WHAT IS KNOWN ON THE SUBJECT?: Compared to the general population, people with mental illness die several years prematurely. The prevalence of chronic physical illnesses such as diabetes and cardiovascular disease is higher in people with mental health illnesses, putting them at increased risk of developing skin wounds. The majority of the studies on wound care education and management were carried out in acute care and long-term care settings. A very few addressed the wound care needs for psychiatric patients and the educational needs of nurses in the mental health setting. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds to the existing evidence by offering an evidence-based solution to equip Psychiatric and Mental Health Nurses (PMHNs) with the necessary knowledge and skills to provide high-quality wound care to patients. When a lack of wound care competency has been identified, it may be worth the effort to provide education and training to psychiatric nurses on wound care management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This project has the potential benefit of healthcare cost savings, which can be further investigated in a future study, for instance, a pilot randomized controlled trial to estimate the parameters for a full-trial and cost-effectiveness study. Future mental health nursing practice and research need to focus on finding solutions to help support PMHNs improve their competence in caring for physical illnesses. ABSTRACT: Introduction People with mental illnesses are at increased risk of developing skin wounds. A very few studies addressed the wound care needs for psychiatric patients and the educational needs for psychiatric and mental health nurses (PMHNs). Aim A wound care education-feasibility and quality improvement project-was implemented to improve wound care competence among nurses on the Seniors' Mental Health Units at a psychiatric hospital. Methods A total of 36 nurses participated in wound care knowledge education and completed both the pretest and post-test. Four nurses participated in wound care skills training. Results The post-intervention mean score increase for wound care knowledge was 5.14 (178%) and for skills was 7(75.7%). The results were statistically significant (p < .001). Discussion This study adds to the existing evidence by offering an evidence-based solution to equip PMHNs with the necessary knowledge and skills to provide high-quality wound care to patients. Implications for Practice and Research Future mental health nursing practice and research need to focus on finding evidence-based practical solutions to help support PMHNs improve their ability to care for physical illnesses. A future pilot randomized controlled trial will be needed to estimate the parameters for a full-trial and cost-effectiveness study.

Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries

Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.

Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time

Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.

Mental health nurses' experiences of implementing a model to facilitate self-empowerment in women living with borderline personality disorder in South Africa

In South Africa, various treatment models from abroad have been implemented for patients diagnosed with borderline personality disorder. This report is based on a South African model that has been developed, implemented, and evaluated for mental health nurses to use in facilitating the self-empowerment of women living with borderline personality disorder. The aim of this study was to describe the implementation of a model to facilitate self-empowerment in women living with borderline personality disorder and to describe mental health nurses' experiences of implementing this model. A qualitative, exploratory, descriptive, and contextual research design was used for the study. Participants were mental health nurses working in an inpatient psychotherapy unit in a mental health hospital. Findings revealed that mental health nurses experienced the model as a secure framework to assist women living with borderline personality disorder in making a shift to being self-empowered. The mental health nurses found that they had to adapt the model's timeframe to the women's own pace. Through use of the model, the mental health nurses also gained self-leadership. This report provides evidence from mental health nurses that the model was practical and helpful in working with women living with borderline personality disorder. The mental health nurses saw signs of self-empowerment in women living with borderline personality disorder.

The burden of caregiving among mental health nurses providing services to consumers with depression in Ghana

PURPOSE

The study aims to explore the burden of caregiving among mental health nurses providing services to consumers with depression in Ghana.

DESIGN AND METHODS

Interpretative phenomenological design and qualitative data FINDINGS: The study shows that several health system constraints and individual factors contribute to the burden of caregiving among mental health nurses. Health system challenges are the poor state of the psychiatric facility, while individual factors are stigmatizing attitudes, nonadherence to medication instructions, limited family support, and physical and verbal abuse. The coping strategies used by mental health nurses are self-motivation, emotional boundaries, and the perceived clinical outcomes of treatment.

PRACTICE IMPLICATIONS

Clinical policies, procedures, and health facility practices should adequately address caregiving challenges, to facilitate effective mental health services.

Effect of Cognitive Behavioral Therapy and Peer Leadership on Suicidal Ideation of Adolescents in Bengkulu

To determine the effects of cognitive behavioral therapy and peer leadership on suicidal ideation among adolescents in senior high school, this study design used quasiexperimental pre-post testing with control group. Participants (N = 86) were recruited by purposive sampling technique. Data were collected using the Beck Scale for Suicide Ideation and analyzed using the Wilcoxon test, the Friedman test, and the Mann-Whitney test. The results showed that the training received by mental health nurses reduced suicidal ideation among adolescents (p < 0.05). After further cognitive behavioral therapy and peer leadership interventions, suicidal ideation decreased from the lower rate to zero (p < 0.05). A combination of the training received by mental health nurses, cognitive behavioral therapy, and peer leadership are recommended for prevention of adolescent suicidal ideation.

'There is no progression in prevention' - The experiences of mental health nurses working with repeated self-harm

Caring for people who self-harm is an everyday experience for mental health nurses and an important part of their role. How mental health nurses respond to and support those who self-harm can have a significant impact on the outcomes for service users and their intentions to seek help in the future. Repeated self-harm can be a particularly challenging phenomenon as it is often misunderstood and can have a negative impact on the therapeutic relationship. This qualitative descriptive study aims to explore how mental health nurses understand and work with repeated self-harm. Nine nurses working in a range of mental health settings within one service participated in semi-structured interviews which were analysed thematically. Findings are presented in two themes exploring participants' perceptions and understanding of repeated self-harm, and the process of learning to work with repeated self-harm, and are reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Participants reported that nursing practice relating to repeated self-harm remains largely focused on maintenance of safety and prevention of self-harm despite the identification that this often does not work. It was accepted that there is sometimes a lack of understanding about the function of self-harm; however, participants reported understanding increased following specific education about self-harm. Participants also identified the potential for more empowering and recovery-orientated responses, including the utilization of harm reduction approaches, to the care of those who repeatedly self-harm.

Affected family member coping with a relative with alcohol and/or other drug misuse: A cross-sectional survey questionnaire

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members' coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support-giving experience. A cross-sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that 'Other' family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant-inactive maladaptive coping strategies had a significantly greater adverse influence on family members' physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support-giving role and to sustain them in this crucial support-giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient's symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision-making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer-reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.

Predictors and enablers of mental health nurses' family-focused practice

Family-focused practice improves outcomes for families where parents have a mental illness. However, there is limited understanding regarding the factors that predict and enable these practices. This study aimed to identify factors that predict and enable mental health nurses' family-focused practice. A sequential mixed methods design was used. A total of 343 mental health nurses, practicing in 12 mental health services (in acute inpatient and community settings), throughout Ireland completed the Family Focused Mental Health Practice Questionnaire, measuring family-focused behaviours and other factors that impact family-focused activities. Hierarchical multiple regression identified 14 predictors of family-focused practice. The most important predictors noted were nurses' skill and knowledge, own parenting experience, and work setting (i.e. community). Fourteen nurses, who achieved high scores on the questionnaire, subsequently participated in semistructured interviews to elaborate on enablers of family-focused practice. Participants described drawing on their parenting experiences to normalize parenting challenges, encouraging service users to disclose parenting concerns, and promoting trust. The opportunity to visit a service user's home allowed them to observe how the parent was coping and forge a close relationship with them. Nurses' personal characteristics and work setting are key factors in determining family-focused practice. This study extends current research by clearly highlighting predictors of family-focused practice and reporting how various enablers promoted family-focused practice. The capacity of nurses to support families has training, organizational and policy implications within adult mental health services in Ireland and elsewhere.

Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit

Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness.

A Scale for the Management of Aggressive and Violent Behaviour (C_MAVAS): Psychometric Properties Testing in Mental Health Nurses

Background: This study set out to examine the psychometric properties of C_MAVAS, a newly Chinese-translated version of MAVAS, a 27-item scale assessing healthcare professionals' attitudes to the management of patient violence. Method: The English version of the MAVAS was translated and back-translated to come up with C_MAVAS. A convenience sample of 262 qualified mental health nurses working in a local psychiatric hospital was recruited. Exploratory factor analysis tested C_MAVAS's construct validity. Results: Content validity of the C_MAVAS was very satisfactory with validity indices of 97.4% for the overall scale and 90% to 100% for individual items. Exploratory factor analysis yielded a four-factor solution: 'interactional perspectives on patient violence', 'best ways perceived for violence management', 'internal or biomedical perspectives on patient violence', and 'external perspectives on patient aggression and violence', were important in shaping their attitudes towards managing violence and patient disruptiveness. Internal consistency of the Chinese version was barely satisfactory (Cronbach's alpha = 0.51⁻0.67) for the four factors/subscales and its test-retest reliability was good (Pearson's coefficient = 0.84). Conclusion: The findings suggest the C_MAVAS is a valid and reliable tool to measure mental health nurses' attitudes towards patient violence/aggression in a mental hospital setting.

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Compared to the general population, people with pre-existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end-of-life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely-collected, de-identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.

Mental Health Professionals' Attitudes Toward Offenders With Mental Illness (Insanity Acquittees) in Ghana

Mental health professionals' attitudes toward offenders with mental illness have significant implications for the quality of care and treatment rendered, making it imperative for these professionals to be aware of their attitudes. Yet, this topical issue has received little research attention. Consequently, the present study investigates attitudes toward offenders with mental illness (insanity acquittees) in a sample of 113 registered mental health nurses in Ghana. Using a cross-sectional survey and self-report methodology, the participants respond to measures of attitudes toward offenders with mental illness, attitudes toward mental illness, conviction proneness, and criminal blameworthiness. The results show that mental health nurses who reportedly practiced for a longer duration (6 years and above) were more likely to be unsympathetic, while the male nurses who were aged 30 years and above were more likely to hold offenders with mental illness strictly liable for their offenses. Importantly, the nurses' scores in conviction proneness and criminal blameworthiness significantly predict negative attitudes toward the offenders even after controlling for their attitudes toward mental illness. Yet, when the nurses' conviction proneness and criminal blameworthiness were held constant, their attitudes toward mental illness failed to predict attitudes toward the offenders. This initial finding implies that the nurses' views regarding criminal blameworthiness and conviction may be more influential in understanding their attitudes toward offenders with mental illness relative to their attitudes toward mental illness.

Voices from the Field: Regional Nurses Speak About Motivations, Careers and How to Entice Others to Pursue Mental Health Nursing

The aims of this study are three-fold: determine the factors that motivate nurses to pursue mental health nursing; identify the strategies that might attract nursing students and practising nurses to pursue mental health nursing as a professional career; and identify the difficulties of nurses in achieving their preferred clinical specialty. A descriptive qualitative study design with semi-structured interviews was used. Fifteen mental health nurses from rural and regional South Australia were interviewed. Interviews were transcribed verbatim, and thematic analysis was undertaken. Of the fifteen participants, thirteen were females and two were males; their average age was 50 years. The factors that motivated the participants to pursue mental health nursing were categorized as intrinsic and extrinsic. There were many strategies that might attract nursing students and nurses to the field, but the most popular suggestion was the provision of high quality meaningful clinical placements. Other strategies were to convey the personal satisfaction derived from being a mental health nurse, promote mental health nursing aggressively, and provide employment incentives. The study also highlighted the importance of addressing stigma, and greater education and support for nurses to pursue a mental health career.

Mental Health Nurse's Exposure to Workplace Violence Leads to Job Stress, Which Leads to Reduced Professional Quality of Life

Professional quality of life (ProQOL) reflects how individuals feel about their work as helpers. Psychiatric ward nurses cope with significant psychological and physical challenges, including exposure to verbal and physical violence. This study was based on two aspects of ProQOL, the positive compassion satisfaction, and the negative compassion fatigue, with the aim of investigating the relation of ProQOL to job stress and violence exposure at a large mental health center. Data were collected from 114 mental health nurses (49/63 M/F) who completed a self-administered questionnaire examining violence exposure, ProQOL, and job stress. The results showed that during the last year, almost all nurses (88.6%) experienced verbal violence, and more than half (56.1%) experienced physical violence. Only 2.6% experienced no violence. ProQOL was not associated with violence exposure but was reduced by work stress and by previous exposure to violence; nurses who perceived their work as more stressful had lower satisfaction from their work. In conclusion, although most mental health nurses are exposed to physical and verbal violence, their ProQOL is more related to job stress than to workplace violence (WPV). Hospital managements should conduct work stress reduction intervention programs and promote strategizes to reduce WPV. Further exploration of (a) factors affecting ProQOL and (b) the effect of violence coping workshops on ProQOL is warranted.

Motivations for adolescent self-harm and the implications for mental health nurses

WHAT IS KNOWN ON THE SUBJECT?: Self-harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self-harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self-harm. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper identifies the reasons for self-harm in a community sample of young people and finds that the functions of self-harm differ for different people and that there may be multiple reasons for self-harm. Findings provide support for the affect-regulation model of self-harm which states that young people self-harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self-harm is an attempt to influence how other people respond to them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Self-harm for most young people serves at least one specific function and is an indication of distress. There is a requirement for a non-pathologizing response towards young people who self-harm; self-harm should be understood as a meaningful behaviour rather than a symptom of an illness. Mental health nurses need to understand the multiple functions of self-harm. A better understanding of the individualized meaning behind self-harm can positively impact on attitudes towards young people who self-harm and provide for improved mental health service provision.

ABSTRACT

Introduction Although self-harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self-harm contributes to negative perceptions about those who self-harm and a poor healthcare experience. Aim & Methods This study identifies motivations behind self-harm in school-based adolescents using a cross-sectional survey. Motivations behind self-harm were elicited using a scale and open-ended responses. Results Of the 856 adolescents who completed the survey across 11 postprimary schools, 103 reported a history of self-harm. The most commonly endorsed reason for self-harm was to 'get relief from a terrible state of mind' (79%). Open-ended responses were consistent with scale responses with most reporting that they self-harmed to relieve distressing emotions. Discussion Findings provide support for the affect-regulation model of self-harm with support also demonstrated for the self-punishment and antidissociation models. There was little support for the interpersonal influence model suggesting that the commonly held belief that self-harm is attention-seeking is one attributed by others to young people, and not widely reported by young people themselves. Implications for practice Mental health services need to be responsive to the needs of young people who self-harm which requires eliciting and understanding the individual and multiple meanings behind self-harm to best inform treatment options.