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Webb EL, Ireland JL, Lewis M, Morris D. Potential Sources of Moral Injury for Healthcare Workers in Forensic and Psychiatric Settings: A Systematic Review and Meta-ethnography. TRAUMA, VIOLENCE & ABUSE 2024; 25:918-934. [PMID: 37083056 PMCID: PMC10913356 DOI: 10.1177/15248380231167390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.
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Affiliation(s)
- Elanor Lucy Webb
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
| | - Jane L. Ireland
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Michael Lewis
- University of Central Lancashire, Preston, UK
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Deborah Morris
- Centre for Developmental and Complex Trauma, St Andrew’s Healthcare, Northampton, UK
- University of Buckingham, UK
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2
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Dalton EM, Raymond K, Kovacs B, Vespe K, Kaufmann V, Lasoski M, Gunnison C, Beauchamps J, Kane E, Andrade G. Reducing Physical Restraint Use in the Medical Behavioral Unit. Pediatrics 2024; 153:e2023062747. [PMID: 38415305 PMCID: PMC10904888 DOI: 10.1542/peds.2023-062747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Children with behavioral health conditions often experience agitation when admitted to children's hospitals. Physical restraint should be used only as a last resort for patient agitation because it endangers the physical and psychological safety of patients and employees. At the medical behavioral unit (MBU) in our children's hospital, we aimed to decrease the weekly rate of physical restraint events per 100 MBU patient-days, independent of patient race, ethnicity, or language, from a baseline mean of 14.0 to <10 within 12 months. METHODS Using quality improvement methodology, a multidisciplinary team designed, tested, and implemented interventions including a series of daily deescalation huddles led by a charge behavioral health clinician that facilitated individualized planning for MBU patients with the highest behavioral acuity. We tracked the weekly number of physical restraint events per 100 MBU patient-days as a primary outcome measure, weekly physical restraint event duration as a secondary outcome measure, and MBU employee injuries as a balancing measure. RESULTS Our cohort included 527 consecutive patients hospitalized in the MBU between January 2021 and January 2023. Our 2021 baseline mean of 14.0 weekly physical restraint events per 100 MBU patient-days decreased to 10.0 during our 2022 intervention period from January through July and 4.1 in August, which was sustained through December. Weekly physical restraint event duration also decreased from 112 to 67 minutes without a change in employee injuries. CONCLUSIONS Multidisciplinary huddles that facilitated daily deescalation planning safely reduced the frequency and duration of physical restraint events in the MBU.
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Affiliation(s)
- Evan M. Dalton
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | | | | | - Kristin Vespe
- Child and Adolescent Psychiatry and Behavioral Sciences
| | | | | | | | | | - Emily Kane
- Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gabriela Andrade
- Child and Adolescent Psychiatry and Behavioral Sciences
- University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Thandavhathu TG, Maluleke M, Raliphaswa NS, Rangwaneni ME, Masutha TC, Lavhelani NR, Manyuma D, Makhado LC, Thabathe TE, Kharivhe LM, Letlalo VP, Mulaudzi MP. Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa. Health SA 2024; 29:2158. [PMID: 38445037 PMCID: PMC10913178 DOI: 10.4102/hsag.v29i0.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 07/06/2023] [Indexed: 03/07/2024] Open
Abstract
Background Aggression of patients in hospital wards has become an endemic problem and professional nurses are particularly at high risk. Aim This article presents the types of patient aggression experienced by professional nurses working in an acute psychiatric ward in Vhembe District, South Africa. Setting Vhembe District, South Africa. Methods A qualitative approach using exploratory, descriptive and contextual research design was used. Four hospitals were purposively selected and 10 professional nurses were conveniently sampled to participate in the study. Individual interviews were used to collect data, which were then analysed through Tesch Open Coding Method. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. Results This study shed some light on the professional nurses' lived experiences regarding the types of aggression from patients in an acute psychiatric ward in Vhembe District. The types of aggression are physical aggression, destructive behaviour and verbal aggression. Conclusion The findings show that the types of aggression to which professional nurses are exposed are overwhelming and the consequences are shocking. As a result, the health of professional nurses is compromised. Therefore, this study recommends further studies to determine the kind of support needed by professional nurses working in an acute psychiatric ward and to investigate the impact of aggression from patients in acute psychiatric ward with regard to the quality of care. Contribution This article contributes to the body of knowledge regarding patients' aggression in acute wards in Vhembe District, South Africa.
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Affiliation(s)
- Tshinanne G. Thandavhathu
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Mary Maluleke
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Ndidzulafhi S. Raliphaswa
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Mphedziseni E. Rangwaneni
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Thingahangwi C. Masutha
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Ndivhaleni R. Lavhelani
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Duppy Manyuma
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Langanani C. Makhado
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Takalani E. Thabathe
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Lufuno M. Kharivhe
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Vusiwana P. Letlalo
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Mulatedzi P. Mulaudzi
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
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DeSouza F, Bleich M. A Quality Improvement Approach to Violence Reduction: Standardizing the Risk Identification Process. J Nurs Care Qual 2023; 38:361-366. [PMID: 37094582 DOI: 10.1097/ncq.0000000000000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND The impact of aggressive and violent behaviors directed toward staff in psychiatric facilities has layers of implications tied to recruitment and retention, cost, quality and safety. LOCAL PROBLEM Increased patient aggressive behaviors contributed to staff dissatisfaction and high turnover rates, triggering an analysis of current aggression management approaches. METHODS The Plan-Do-Study-Act quality improvement method was used for this project. INTERVENTIONS The Dynamic Appraisal of Situational Aggression (DASA) risk assessment tool was implemented. RESULTS Daily aggression risk identification increased by 69%, and aggressive incidents toward staff and patients decreased by 64% and 28%, respectively, when the tool was completed more consistently. Surveys revealed acceptance of the tool by nurses. CONCLUSIONS Quality improvement statistical tools supported evidence-based strategies. A risk for aggression assessment laid the foundations for implementing strategies for reducing aggression and violence.
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Affiliation(s)
- Fabio DeSouza
- Department of Nursing, Central State Hospital, Petersburg, Virginia (Dr DeSouza); and The Langston Center for Innovation in Quality and Safety, Virginia Commonwealth University, Richmond (Dr Bleich)
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Hudon A, Rosca MA, La Charité-Harbec O, Allard JM, Borduas Pagé S. The Use of Alternative Rooms in Forensic and Regular Psychiatric Units: A Scoping Review. Healthcare (Basel) 2023; 11:2432. [PMID: 37685466 PMCID: PMC10487261 DOI: 10.3390/healthcare11172432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Emotional regulation, distress and relational conflicts often occur during hospitalization and rehabilitation on psychiatric units, especially in patients suffering from severe and persistent mental disorders. While widely used in children and geriatric patients, little literature exists on the use and outcomes of alternative rooms in the context of forensic and regular psychiatric units for adult patients. Considering the scarcity of the literature on alternative use, this study is motivated by the following research question: what are the main uses and outcomes of alternative rooms in the context of forensic and regular psychiatric units? The main objective of this study is to conduct a scoping review of the use and outcomes of alternative rooms for the context of psychiatric inpatients. (2) Methods: A systematic search was performed in the electronic databases of MedLine, Web of Science, PsycNet (PsycINFO) and Google Scholar from their inception dates until 2022. (3) Results: A total of nine studies were analyzed. Sensory, multisensory rooms, Snoezelen, and comfort rooms are the types of alternative rooms discussed in these studies. Distress and anxiety reduction, increase in self-esteem, impact on seclusion rates, patient-staff communication and alliances, heart and respiration rate reduction, and improvement of alexithymia were identified among the main uses and outcomes of these rooms. (4) Conclusions: The scarcity of literature available to draw information from for this review and possible impact on improving patient outcomes and quality of treatment in psychiatric units opens the door to future studies to better understand the efficacy of such rooms. Research into the ideal implementation tactics of such rooms, long-term outcomes, and the influence on diverse patient demographics could be areas of improvement in the use of alternative rooms.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
| | - Maria Alexandra Rosca
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Olivier La Charité-Harbec
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Jeanne-Marie Allard
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Stéphanie Borduas Pagé
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
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Lucas REC, Riascos CEM, de Mattos DL, Neto RA, de Sousa Carneiro PM, Merino GSAD, Merino EAD. Systemic relations among the variables involved in occupational accidents of the nursing team in a psychiatric hospital. Arch Psychiatr Nurs 2023; 45:54-60. [PMID: 37544702 DOI: 10.1016/j.apnu.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/17/2022] [Accepted: 04/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The occupational activities carried out in hospital environments pose occupational risks to professionals. In psychiatric hospitals, due to the characteristics of the patients treated, professionals are also subjected to other risks, such as physical aggression. OBJECTIVE This research aimed to identify the systemic context, highlighting the cause-and-effect relationships that culminate in occupational accidents that occurred with the nursing staff in a psychiatric hospital in Brazil. METHODS The current study is an applied research and was divided into three stages. First, the collection of data related to the case study was made and accidents were analyzed and occupational hazards were identified. In the second stage, from the collected information, occupational safety indicators were defined. Lastly, in the third stage, the qualitative aspect of System Dynamics was applied to perform the systemic analysis and to identify how the different variables were related. RESULTS The results showed that physical aggression was the main cause of accidents. Regarding safety indicators, while both the level of use of Personal Protective Equipment (PPE) by professionals and the high level of PPE protection were positive aspects, the level of training of professionals to use PPE was a negative aspect. The Causal Link Diagram (CLD) showed that the perception of risk influenced the level of use of PPE and those organizational measures influenced the accident rate. CONCLUSION In conclusion, the systemic analysis of the system dynamics can optimize the diagnostic process of occupational accidents in psychiatric hospitals, and especially help to identify the cause and effect among the variables involved.
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Affiliation(s)
- Ruan Eduardo Carneiro Lucas
- Production Engineering Department, Federal University of Santa Catarina (UFSC), Campus Universitário Trindade, 88040-970 Florianópolis, SC, Brazil; Production Engineering Department, Federal University of Rural da Amazônia, Campus Parauapebas, 68515-000 Parauapebas, PA, Brazil.
| | - Carmen Elena Martinez Riascos
- Production Engineering Department, Federal University of Santa Catarina (UFSC), Campus Universitário Trindade, 88040-970 Florianópolis, SC, Brazil
| | - Diego Luiz de Mattos
- ALGORITMI Research Centre, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal
| | - Rafael Ariente Neto
- Production Engineering Department, Federal University of Santa Catarina (UFSC), Campus Universitário Trindade, 88040-970 Florianópolis, SC, Brazil
| | | | - Giselle Schmidt Alves Díaz Merino
- Production Engineering Department, Federal University of Santa Catarina (UFSC), Campus Universitário Trindade, 88040-970 Florianópolis, SC, Brazil; Desing Department, State University of Santa Catarina, Campus Florianópolis, 88035-901 Florianópolis, SC, Brazil
| | - Eugenio Andrés Díaz Merino
- Production Engineering Department, Federal University of Santa Catarina (UFSC), Campus Universitário Trindade, 88040-970 Florianópolis, SC, Brazil
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7
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Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
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Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
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8
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Vahidi M, Namdar Areshtanab H, Ebrahimi H, Asghari Jafarabadi M. Development of "The Safe Psychiatric Ward Battery". Clin Nurs Res 2023; 32:375-383. [PMID: 35440215 DOI: 10.1177/10547738221085614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study reports the development process and psychometric testing of the safe environment in psychiatric wards instrument. In this mixed-methods study, the concept of a safe environment was explained with a qualitative study by performing semi-structured interviews with patients and staff and ward observation. Then, the items of the instrument were designed using qualitative data and a literature review. Content and construct validity, internal consistency, stability, and inter-rater agreement were evaluated. This study produced an instrument consisting of two sections. The first section was a scale (α = .920). Exploratory factor analysis of the scale identified two dimensions of "engagement" (α = .931) and "perception" of the physical environment (α = .760). The second section was a checklist with two dimensions, "accident-free living environment" and "staff empowerment." The intra-class correlation coefficients for the scale and checklist were .912 and .809, respectively. This study suggests that this instrument is a valid and reliable tool to assess safety in psychiatric wards.
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9
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Rou C, Janković M, Bogaerts S. The Moderating Roles of Resilience and Coping Strategy on Well-Being of Victimized Forensic Workers. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022:306624X221124834. [PMID: 36181288 DOI: 10.1177/0306624x221124834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Previous research on workplace victimization has often disregarded forensic psychiatric populations and not yet been extended to the coronavirus pandemic. The present study expected the isolation of the government-issued lockdown to increase aggressive behavior in forensic patients, ultimately decreasing the general well-being of victimized forensic workers. Possible buffering protective factors (resilience and active coping) and enhancing risk factors (avoidant coping and passive coping) were investigated with the intention of optimizing the general well-being of at-risk forensic workers. The valid sample (N = 311) consisted of Dutch and Belgian forensic workers (74.6% females) with at least 9 hours of weekly patient contact, and with a mean age of 37.99 (SD = 12.20). Participants reported the number of violent incidents in the past 2 months, as well as completed a questionnaire battery including measures of well-being, resilience, and coping strategies. A significant increase of victimization during the lockdown compared to after it was lifted was found, however, the study did not find evidence to support that this negatively influenced the worker's general well-being. Active coping was found to be a significant moderator and protective factor for the general well-being of victimized forensic workers. In contrast, resilience, avoidant and passive coping were not significant moderators in this association. The present study has valuable clinical implications that could lead to preparatory and preventative measures for forensic workers at risk of being victimized. Future research may investigate constructs such as life satisfaction and post-traumatic growth, as well as be broadened into prison populations.
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Affiliation(s)
| | - Marija Janković
- Tilburg University, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
| | - Stefan Bogaerts
- Tilburg University, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
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Meehan T, McGovern M, Keniry D, Schiffmann I, Stedman T. Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint. Int J Ment Health Nurs 2022; 31:888-896. [PMID: 35334129 DOI: 10.1111/inm.12993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de-escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular.
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Affiliation(s)
- Tom Meehan
- West Moreton Hospital and Health Service, University of Queensland, Archerfield, Queensland, Australia
| | | | - Donnacha Keniry
- Prison Mental Health Services, Archerfield, Queensland, Australia
| | - Ian Schiffmann
- West Moreton Hospital and Health Service, Archerfield, Queensland, Australia
| | - Terry Stedman
- West Moreton Hospital and Health Service, University of Queensland, Archerfield, Queensland, Australia
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Bui MV, McInnes E, Ennis G, Foster K. Protocol for a mixed methods process evaluation of the Promoting Resilience in Nurses (PRiN) trial. Int J Ment Health Nurs 2022; 31:687-696. [PMID: 35279934 PMCID: PMC9314145 DOI: 10.1111/inm.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
Mental health nurses are exposed frequently to occupational stress and can experience a range of negative impacts on their well-being and intention to stay in the nursing workforce. Promoting Resilience in Nurses (PRiN) is a strength-based resilience education programme that incorporates evidence-based cognitive behavioural and interpersonal approaches with post-traumatic growth theory. A partially clustered randomized controlled trial at a large public mental health service will be used to examine the effects of PRiN on mental health nurses' coping self-efficacy, resilience, well-being, mental health, emotional regulation, post-traumatic growth, workplace belonging, and turnover intention as compared to controls. Process evaluations are increasingly used to help understand and interpret trial results for complex interventions. This paper describes the protocol for an embedded mixed methods process evaluation that aims to evaluate the PRiN programme implementation and identify factors that may explain variation in participant outcomes in the trial. Data collection includes a programme participant satisfaction survey; a follow-up semi-structured interview with selected programme participants; a unit/team manager survey on barriers and facilitators to staff recruitment and programme participation; and a fidelity checklist completed by programme facilitators. Normalisation Process Theory will be used to inform data analysis and integration. The findings will provide insights into factors that affect programme implementation, particularly in the context of the COVID-19 pandemic and may help explain differences in participant outcomes. Findings will also inform post-trial programme sustainability as well as potential future upscale and adaptation for implementation across healthcare settings.
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Affiliation(s)
- Minh Viet Bui
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Elizabeth McInnes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Parkville, Victoria, Australia
| | - Gary Ennis
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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12
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Cranage K, Foster K. Mental health nurses' experience of challenging workplace situations: A qualitative descriptive study. Int J Ment Health Nurs 2022; 31:665-676. [PMID: 35347822 PMCID: PMC9314796 DOI: 10.1111/inm.12986] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
Mental health nursing is acknowledged internationally as being a demanding profession; however, little is known about the range of experience and complexity of workplace challenges or their impacts on mental health nurses (MHN). This qualitative descriptive study aimed to examine and describe the range of challenging workplace situations experienced by MHN and is reported according to the Standards for Reporting Qualitative Research. An online cross-sectional survey collected demographic data and open-ended descriptions of workplace challenges experienced by n = 374 Australian MHN. Using a modified a priori framework, four categories of experience were derived through content analysis: consumer-related, colleague-related, nursing role-related, and organizational service-related challenges. Many accounts described a complex interplay of challenges. The findings extend prior knowledge on MHN experiences. Frequent workplace challenges included violence and aggression from consumers, bullying from colleagues, low staffing levels, and poor skill mix. Further extending the evidence, key challenges rarely described in prior literature were the psychological impacts of suicides and murder; the personal nature of threats from consumers; moral distress and concerns with colleagues' quality of practice; and exacerbation of practice-related issues by lack of support from colleagues and/or the organization. These have important implications for the profession and can inform targeted strategies to reduce stressors where possible, build staff well-being, support workforce retention, and improve the provision of quality care. The implementation of targeted policy and initiatives that focus on reducing key stressors and supporting practice are vital to staff retention and ensuring a high standard of practice in complex mental health workplaces.
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Affiliation(s)
- Kylie Cranage
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Kim Foster
- Australian Catholic University & North Western Mental Health, Parkville, Victoria, Australia
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13
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Bekelepi N, Martin P. Experience of violence, coping and support for nurses working in acute psychiatric wards. S Afr J Psychiatr 2022; 28:1700. [PMID: 35747336 PMCID: PMC9210159 DOI: 10.4102/sajpsychiatry.v28i0.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background Acute psychiatric wards are stressful working environments because of the nature of the mental illness of patients admitted. These patients present with a variety of complex psychiatric problems and social control that require skilled and competent nurses to manage them. The shortage of nurses, especially with advanced psychiatric qualifications or necessary experience, may create challenges for nurses as they navigate this stressful working environment. Aim The aim of this study was to explore and describe nurses’ experience of patient violence, coping strategies and received support whilst working in acute wards in psychiatric hospitals. Setting This study was conducted in six acute wards of the three psychiatric hospitals in Cape Town, South Africa. Methods A qualitative, explorative, descriptive design was conducted using semi-structured interviews to obtain data from 14 nurses working in acute wards in three psychiatric hospitals in the Western Cape. Results Five themes were generated using thematic analysis: violence perceived to be ‘part of the job’, contributing factors to patient violence, physical and psychological effects on nurses, adaptive and maladaptive coping strategies and perceived support from stakeholders. Conclusion Participants normalised patient violent behaviour as being part of the job to minimise the physical and psychological effects of the traumatic experience. Adaptive and maladaptive coping strategies were used to cope with the traumatic experiences of being assaulted by patients. Recommendations allude to practising self-care and attendance of training in the management of aggressive patients for nurses, to enhance a variety of adaptive coping strategies.
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Affiliation(s)
- Ntombiyakhe Bekelepi
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Penelope Martin
- School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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14
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Kurnik-Łucka M, Grońska D, Wojnarski M, Pasieka P, Rząsa-Duran E, Gil K. Health-Related Quality of Life in Relation to Fruit and Vegetable Intake among Polish Pharmacists. Healthcare (Basel) 2022; 10:healthcare10050930. [PMID: 35628067 PMCID: PMC9141935 DOI: 10.3390/healthcare10050930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023] Open
Abstract
A direct association between health-related quality of life (HQoL) and nutrition remains unclear, although lifestyle habits are known to impact on human health. Thus, the aim of this study was to estimate an association between dietary habits, such as vegetable and fruit consumption, in particular, and HQoL. SF-36 (RAND-SF-36) and the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN) were addressed to Polish pharmacists with a valid professional license. After the preliminary verification, 667 pharmacists were included into the study, and altogether, 11 questions from the KomPAN questionnaire and all RAND-SF-36 multiple choice questions were processed for statistical analysis. All HQoL scores, excluding physical functioning and role-physical, were significantly higher in the group declaring fruit consumption ≥1 time per day (p < 0.005), while physical functioning (p = 0.008) and general health (p = 0.03) were significantly higher in the group declaring vegetable consumption ≥1 time per day. Thus, there is indeed a positive association between vegetable and fruit consumption and HQoL. Increased fruit intake could certainly impact on the health-related quality of life of Polish pharmacists, primarily in terms of mental functioning, while increased vegetable intake could impact in terms of physical functioning.
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Affiliation(s)
- Magdalena Kurnik-Łucka
- Department of Pathophysiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.G.); (M.W.); (P.P.); (K.G.)
- Correspondence: ; Tel.: +48-126-333-947
| | - Dominika Grońska
- Department of Pathophysiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.G.); (M.W.); (P.P.); (K.G.)
| | - Marcin Wojnarski
- Department of Pathophysiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.G.); (M.W.); (P.P.); (K.G.)
| | - Paweł Pasieka
- Department of Pathophysiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.G.); (M.W.); (P.P.); (K.G.)
| | | | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (D.G.); (M.W.); (P.P.); (K.G.)
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15
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Kinghorn G, Halcomb E, Thomas S, Froggatt T. Forensic mental health: Perceptions of transition and workforce experiences of nurses. Collegian 2022. [DOI: 10.1016/j.colegn.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Bekelepi N, Martin P. Support interventions for nurses working in acute psychiatric units: A systematic review. Health SA 2022; 27:1811. [PMID: 35548058 PMCID: PMC9082224 DOI: 10.4102/hsag.v27i0.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/09/2022] [Indexed: 11/03/2022] Open
Abstract
Diverse support interventions have been implemented to provide support for nurses working in acute psychiatric settings. These interventions aimed at modifying the psychological and social factors, as they either prevent stress responses or reduce its effects to improve the psychological well-being of staff. This study aimed to examine effective stress reduction interventions for nurses and to identify key elements of these successful interventions. Studies included in this review were conducted in acute psychiatric settings. A comprehensive search of electronic databases was conducted for support intervention studies between 2010 and 2021. The search yielded 315 studies that were reduced to seven studies after being reviewed by two independent reviewers. The studies were coded, and key elements were identified. Seven studies that were included consisted of a randomised controlled trial, quasi-experimental design and single-group design. Interventions included mindfulness-based stress reduction, burnout prevention programmes, communication skills, educational programme, group intervention, resilience training programme and stress management. Four key elements emerged from these interventions, namely, educational support, interpersonal skills, psychological support and adaptive coping. The findings highlighted the diverse interventions in supporting psychiatric nurses to cope with stress. However, there is a dearth of studies in acute psychiatric settings that were mostly done in emergency settings. Knowledge gained from this review may assist with practice improvement as managers can implement the identified interventions.Contribution: This is the first systematic review focusing on supportive interventions for nurses in acute psychiatric settings. The knowledge gained from this review will add to the existing research knowledge base in the field.
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Affiliation(s)
- Ntombiyakhe Bekelepi
- School of Nursing, Faculty of Community Health Science, University of the Western Cape, Cape Town, South Africa
| | - Penelope Martin
- School of Nursing, Faculty of Community Health Science, University of the Western Cape, Cape Town, South Africa
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17
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Finch K, Lawrence D, Williams MO, Thompson AR, Hartwright C. A Systematic Review of the Effectiveness of Safewards: Has Enthusiasm Exceeded Evidence? Issues Ment Health Nurs 2022; 43:119-136. [PMID: 34534037 DOI: 10.1080/01612840.2021.1967533] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Safewards is intended to be an evidence-based approach to reduce levels of conflict and containment in mental health inpatient settings. A systematic review was carried out to examine whether Safewards is effective in reducing conflict and containment events; and improving ward climate. Searches for articles evaluating the implementation of Safewards was conducted using PsycINFO, PubMed, Web of Science, Cochrane Library and CINAHL. Thirteen studies were included for review after applying inclusion and exclusion criteria. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess study quality and the majority of studies (N = 7) were rated as "moderate" quality. Whilst there is evidence to suggest that Safewards is effective for reducing conflict and containment in general mental health services, there is insufficient high-quality empirical evidence to support its effectiveness in settings beyond this. Further research using robust methodological designs with larger, more representative samples is required in order for the effectiveness of Safewards to be established across the range of contexts in which it is currently being applied.
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Affiliation(s)
- Katie Finch
- School of Psychology, Cardiff University, Cardiff, UK
| | - Daniel Lawrence
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, UK.,Psychology Department, Priory Group, Monmouthshire, UK
| | | | | | - Christopher Hartwright
- School of Psychology, Cardiff University, Cardiff, UK.,Psychology Department, Priory Group, Monmouthshire, UK
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18
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Välimäki M, Hipp K, Chen J, Huang X, Guo J, Wong MS. Sensor technology to monitor health, well-being and movement among healthcare personnel at workplace: a systematic scoping review protocol. BMJ Open 2021; 11:e054408. [PMID: 34764179 PMCID: PMC8587619 DOI: 10.1136/bmjopen-2021-054408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The well-being and health of healthcare personnel is becoming increasingly important in the delivery of high-quality healthcare. The recent developments in technology have provided new opportunities for the objective detection of a wide variety of real-world properties and movement. However, technologies that are used to monitor health, well-being and movement among healthcare personnel have not been fully synthesised. The overall aim of this scoping review is to examine what type of sensor technology is available to monitor the health, well-being and movement of healthcare personnel in healthcare settings. More specifically, we want to explore what types of sensor technology applications, for what purposes and how they have been used to monitor health, well-being and movement among healthcare personnel in different workplace settings. METHODS AND ANALYSIS This scoping review protocol will follow Arksey and O'Malley's methodology, complemented by the approach of the Joanna Briggs Institute to scoping reviews and guidance for conducting systematic scoping reviews. Peer-reviewed literature will be identified using a search strategy developed by a librarian, and a wide range of electronic datasets of medical, computer and information systems disciplines will be used. Eligibility of the articles will be determined using a two-stage screening process consisting of (1) a title and abstract scan, and (2) a full-text review. Extracted data will be thematically analysed and validated by an expert of sensor technology and a group of nurses as stakeholders. Descriptive statistics will be calculated when necessary. ETHICS AND DISSEMINATION The results obtained from the review will inform what technology has been used, how it has been used in healthcare settings and what types of technology might still be needed for future innovations. Findings of the scoping review will be published in a peer-reviewed journal. REGISTRATION This review was submitted in Open Science Framework on 12 December 2020.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Kirsi Hipp
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jiarui Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- Xiangya Centre for Evidence-Based Nursing Practice & Healthcare Innovation, A JBI Affiliated Group, Changsha, China
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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19
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Holm T, Dolmer S, Staugaard SR, Simonsen A, Mors O. Psychological adjustment in care providers following restraint of psychiatric patients. Stress Health 2021; 37:729-741. [PMID: 33527630 DOI: 10.1002/smi.3032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.
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Affiliation(s)
- Tine Holm
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Psychosis, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Signe Dolmer
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Psychosis, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Søren Risløv Staugaard
- Department of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Arndis Simonsen
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Ole Mors
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
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20
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Hood C, Patton R. Exploring the role of psychological need fulfilment on stress, job satisfaction and turnover intention in support staff working in inpatient mental health hospitals in the NHS: a self-determination theory perspective. J Ment Health 2021; 31:692-698. [PMID: 34565267 DOI: 10.1080/09638237.2021.1979487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Meeting psychological needs for autonomy, competence and relatedness as described by Self-Determination Theory (SDT) has been associated with increased well-being and job satisfaction in mental health staff and improved care outcomes for patients. AIMS The study investigated whether psychological need satisfaction predicted stress, turnover intention and job satisfaction in health care assistants (HCA) working in inpatient mental health hospitals in the United Kingdom including full time (FT) and temporary agency worker (TAW) staff. METHODS A cross-sectional survey explored need satisfaction between FT (n = 63) and TAW (n = 39) staff using the Work-Related Basic Need Satisfaction Scale. Multiple regression was used to explore whether satisfaction of the needs for autonomy, competence and relatedness predicted scores on measures of stress, job satisfaction and turnover intention. RESULTS Results were comparable between FT and TAW staff. Autonomy was the need least satisfied, a need which predicted self-reported job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention. CONCLUSIONS Recommendations are made to explore experiences of (and barriers to) autonomy and relatedness in inpatient HCA staff to target and improve autonomy and relatedness in this workforce. Implications of doing so are considered at a staffing, organisational and patient level.
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Affiliation(s)
- Charlotte Hood
- Faculty of Health and Medical Sciences (School of Psychology), University of Surrey, Guildford, Surrey, UK
| | - Robert Patton
- Faculty of Health and Medical Sciences (School of Psychology), University of Surrey, Guildford, Surrey, UK
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21
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Hilton NZ, Ricciardelli R, Shewmake J, Rodrigues NC, Seto MC, Ham E. Perceptions of Workplace Violence and Workplace Stress: A Mixed Methods Study of Trauma among Psychiatric Workers. Issues Ment Health Nurs 2021; 42:797-807. [PMID: 33835903 DOI: 10.1080/01612840.2021.1899350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.
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Affiliation(s)
- N Zoe Hilton
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nicole C Rodrigues
- The Royal Ottawa Health Care Group, Brockville Mental Health Centre, Ottawa, Ontario, Canada
| | - Michael C Seto
- The Royal Ottawa Health Care Group, Brockville Mental Health Centre, Ottawa, Ontario, Canada
| | - Elke Ham
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
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22
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Foster K, Roche M, Giandinoto JA, Platania-Phung C, Furness T. Mental health matters: A cross-sectional study of mental health nurses' health-related quality of life and work-related stressors. Int J Ment Health Nurs 2021; 30:624-634. [PMID: 33280229 DOI: 10.1111/inm.12823] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022]
Abstract
Mental health nursing is widely recognized as a stressful occupation; however, little is known about the relationship between work-related stress and health-related quality of life of mental health nurses (MHN). This study aimed to identify MHN health-related quality of life (HR-QoL) and work-related stressors; associations between stressors and HR-QoL; and predictors of HR-QoL. An online cross-sectional survey collected demographic data, work-related stressors and HR-QoL (SF-12v2) of n = 498 Australian MHN. Prominent consumer/carer-related stressors were verbal (90%) and physical aggression (85%). Collegial stressors included staff conflict (71%) and bullying (55%), and colleague-perpetrated verbal (34%) and physical aggression (7%). Key organizational stressors included high workloads (74%), lack of organizational support (60%) and lack of adequate resources to perform nursing role (58%). The mean physical health score was 52.62 (SD = 8.30), and mental health score was 43.59 (SD = 11.34), with mental health substantially lower than national norms (mean difference = 10.11). There were statistically significant negative correlations between the number of work-related stressors and HR-QoL. Younger (21-30 years) and less experienced (<1-4 years) MHN had substantially lower mental health. Higher mental health was predicted with < 15 stressors, >4 years' experience and working in the community. The poorer mental health of MHN has concerning implications for the well-being, retention and practice of the largest group in the mental health workforce. There is a critical need for organizations to enact effective policy and initiatives to reduce workplace aggression, improve staff psychological and physical safety, and strengthen well-being and resilience. New graduates are a priority group for urgent intervention.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jo-Ann Giandinoto
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Chris Platania-Phung
- Australian College of Applied Psychology, Navitas, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Australia
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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23
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Raphael J, Winter R, Berry K. Adapting practice in mental healthcare settings during the COVID-19 pandemic and other contagions: systematic review. BJPsych Open 2021; 7:e62. [PMID: 33632372 PMCID: PMC8027557 DOI: 10.1192/bjo.2021.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND During the global COVID-19 pandemic, there has been guidance concerning adaptations that physical healthcare services can implement to aid containment, but there is relatively little guidance for how mental healthcare services should adapt service provision to better support staff and patients, and minimise contagion spread. AIMS This systematic review explores service adaptations in mental health services during the COVID-19 pandemic and other contagions. METHOD The Allied and Complementary Medicine database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, PsycINFO and Web of Science were systematically searched for published studies from database inception to April 2020. Data were extracted focusing on changes to mental health services during contagion outbreaks. Data were analysed with thematic analysis. RESULTS Nineteen papers were included: six correspondence/point-of-view papers, five research papers, five reflection papers, two healthcare guideline documents and one government document. Analysis highlighted four main areas for mental health services to consider during contagion outbreaks: infection control measures to minimise contagion spread, including procedural and practical solutions across different mental health settings; service delivery, including service changes, operational planning and continuity of care; staff well-being (psychological and practical support); and information and communication. CONCLUSIONS Mental health services need to consider infection control measures and implement service changes to support continuity of care, and patient and staff well-being. Services also need to ensure they are communicating important information in a clear and accessible manner with their staff and patients, regarding service delivery, contagion symptoms, government guidelines and well-being.
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Affiliation(s)
- Jessica Raphael
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, UK; and Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, University of Manchester, UK
| | - Rachel Winter
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, UK; and Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, University of Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, University of Manchester, UK
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24
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Newman C, Roche M, Elliott D. Exposure to workplace trauma for forensic mental health nurses: A scoping review. Int J Nurs Stud 2021; 117:103897. [PMID: 33647844 DOI: 10.1016/j.ijnurstu.2021.103897] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role. OBJECTIVES To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses. DESIGN A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. METHODS Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence. RESULTS Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature. CONCLUSIONS While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.
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Affiliation(s)
- Claire Newman
- Justice Health and Forensic Mental Health Network, PO Box 150, Matraville 2036, NSW, Australia; University of Technology Sydney, School of Nursing & Midwifery, 235-253 Jones Street, Ultimo 2007, NSW, Australia.
| | - Michael Roche
- University of Technology Sydney, School of Nursing & Midwifery, 235-253 Jones Street, Ultimo 2007, NSW, Australia.
| | - Doug Elliott
- University of Technology Sydney, School of Nursing & Midwifery, 235-253 Jones Street, Ultimo 2007, NSW, Australia.
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25
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Odes R, Chapman S, Harrison R, Ackerman S, Hong O. Frequency of violence towards healthcare workers in the United States' inpatient psychiatric hospitals: A systematic review of literature. Int J Ment Health Nurs 2021; 30:27-46. [PMID: 33150644 DOI: 10.1111/inm.12812] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
The purpose of this systematic review is to determine the frequency of violent or aggressive behaviour towards healthcare workers in inpatient psychiatric settings in the United States. To achieve this aim, five databases were searched to find English-language quantitative studies reporting prevalence or incidence data of violence or aggression directed towards staff members in inpatient psychiatric settings. No limitations were set based on publication date, and intervention studies were included only if baseline data were provided. Of 335 total studies found, 38 full-text articles were suitable for full-text analysis based on inclusion and exclusion criteria, and 14 were included in the final review. Years of data collection ranged from 1986 to 2018, and a range of psychiatric facilities were represented, from small, private hospital units to large forensic institutions. Researchers utilized surveys, real-time incident reporting tools, and government databases, or a combination of strategies, to collect data related to workers' experiences on the job. Included research indicates that workplace violence in the U.S. inpatient psychiatric setting is a widespread problem, with 25-85% of survey respondents reporting an incident of physical aggression within the year prior to survey, and statewide workers' compensation findings indicating 2-7 claims due to assault per 100 000 employee hours. There are substantial differences between findings based on measurement strategy, making it difficult to arrive at a single estimate of prevalence nationally. As management of this persistent problem receives continued attention from stakeholders, it becomes increasingly important to define and measure the problem with the most appropriate tools.
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Affiliation(s)
- Rachel Odes
- University of California San Francisco, San Francisco, California, USA
| | - Susan Chapman
- University of California San Francisco, San Francisco, California, USA
| | - Robert Harrison
- University of California San Francisco, San Francisco, California, USA
| | - Sara Ackerman
- University of California San Francisco, San Francisco, California, USA
| | - OiSaeng Hong
- University of California San Francisco, San Francisco, California, USA
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26
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Kelly EL, Fenwick KM, Brekke JS, Novaco RW. Sources of Social Support After Patient Assault as Related to Staff Well-Being. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP1003-NP1028. [PMID: 29294965 PMCID: PMC6445776 DOI: 10.1177/0886260517738779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.
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Affiliation(s)
- Erin L Kelly
- University of Southern California, Los Angeles, USA
- University of California, Los Angeles, USA
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27
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Effects of a Workplace Violence Intervention on Hospital Employee Perceptions of Organizational Safety. J Occup Environ Med 2020; 62:e716-e724. [PMID: 33003045 DOI: 10.1097/jom.0000000000002036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine hospital employee perceptions of organizational safety one-year following a workplace violence intervention and to evaluate perceptions based on violence exposure status. METHODS In 2014, 343 employees across 41 hospital units (N = 21 control units, N = 20 intervention units) completed a questionnaire capturing organizational safety perceptions and violence exposure. RESULTS Intervention unit employees reported more positive perceptions of organizational safety compared to control unit employees. However, intervention group employees who experienced patient-to-worker violence (Type II) had significantly more positive perceptions than those who experienced worker-to-worker violence (Type III). CONCLUSIONS Organizational safety perceptions improved following a violence-prevention intervention, especially among employees who reported Type II violence. Certain employees report worsened safety perceptions. Hospitals and units that implement violence prevention interventions should strive to address all types of violent behavior.
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Varpula J, Välimäki M, Lantta T, Berg J, Lahti M. Nurses' perceptions of risks for occupational hazards in patient seclusion and restraint practices in psychiatric inpatient care: A focus group study. Int J Ment Health Nurs 2020; 29:703-715. [PMID: 32086881 DOI: 10.1111/inm.12705] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
Seclusion and restraint are regularly used to manage patient aggression events in psychiatric inpatient care, despite occupational safety concerns. There is currently a lack of information on how nurses perceive the use of patient seclusion and restraint as a risk for occupational safety. The aim of this study is to describe the risks for occupational hazards in patient seclusion and mechanical restraint practices as well as ideas for improvement identified by nurses. A qualitative descriptive design was adopted, using focus groups comprising nurses (N = 32) working in psychiatric inpatient care. The data were analysed using inductive content analysis, and the results were reported using the consolidated criteria for reporting qualitative studies (COREQ). Four themes of risk for occupational hazards were identified: patient-induced, staff-induced, organization-induced, and environment-induced risks. One significant finding was that nurses described that their actions can strongly contribute to occupational hazards during seclusion and mechanical restraint practices. The nurses gave various ideas for how occupational safety could be improved during seclusion and mechanical restraint events, ideas involving staff, the organization, and environmental enhancements.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Turku University of Applied Science, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Science, Turku, Finland
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Pina D, Llor-Zaragoza P, Puente-López E, Egea-Fuentes Á, Ruiz-Hernández JA, Llor-Esteban B. User violence in public mental health services. Comparative analysis of psychiatrists and clinical psychologists. J Ment Health 2020; 31:642-648. [DOI: 10.1080/09638237.2020.1793130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- David Pina
- Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Paloma Llor-Zaragoza
- Instituto Nacional de la Seguridad Social (INSS), Ministerio de Trabajo, Migraciones y Seguridad Social, Madrid, Spain
| | - Esteban Puente-López
- Servicio Externo de Ciencias y Técnicas Forenses (SECYTEF), Universidad de Murcia, Murcia, Spain
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30
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Delgado C, Roche M, Fethney J, Foster K. Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey. Int J Ment Health Nurs 2020; 29:35-46. [PMID: 31050127 DOI: 10.1111/inm.12598] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2019] [Indexed: 11/26/2022]
Abstract
Emotional labour is a form of adversity faced by mental health nurses in the context of their workplace interactions. Frequent exposure to emotional adversity can negatively impact mental health nurses' biopsychosocial well-being, workplace relationships, and performance. Workplace resilience is a dynamic interactive process within and between the person and their environment that promotes positive adaptation to adverse events and restores well-being. Workplace resilience could be a protective process that helps mental health nurses positively adapt to workplace emotional adversity. This study aimed to investigate Australian mental health nurses' workplace resilience and emotional labour and explore the relationship between them. A national cross-sectional online survey comprising the Resilience at Work and Emotional Labour scales was completed by registered nurses (n = 482) working in a mental health role or setting across Australia. There was a strong negative relationship between resilience and the emotional labour strategy of surface acting. A positive association between resilience, frequency of emotional labour, and clinical supervision was also found. These findings point to a potential link between mental health nurses' skills of cognitive reframing, and emotional and behavioural regulation needed to effectively manage their emotions and remain therapeutic in interpersonal interactions. Clinical supervision may be a key strategy in supporting mental health nurses' resilience. Further investigation of workplace individuals' internal and external resources, and organizational resources, supports, and strategies that can promote and strengthen mental health nurses' well-being is needed.
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Affiliation(s)
- Cynthia Delgado
- School of Nursing, Midwifery& Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,Sydney Local Health District Mental Health Service, Camperdown, NSW, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Kim Foster
- School of Nursing, Midwifery& Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,Northwestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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31
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Foster K, Roche M, Giandinoto JA, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs 2020; 29:56-68. [PMID: 31127973 DOI: 10.1111/inm.12610] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/30/2022]
Abstract
There is widespread recognition that workplace stress can have profound negative impacts on nurses' well-being and practice. Resilience is a process of positive adaptation to stress and adversity. This study aimed to describe mental health nurses' most challenging workplace stressors, and their psychological well-being, workplace resilience, and level of caring behaviours, explore the relationships between these factors, and describe differences in workplace resilience for sociodemographic characteristics. In a descriptive correlational study using convenience sampling, data were collected from N = 498 nurses working in mental health roles or settings in Victoria Australia via an online cross-sectional survey. Key findings included weak to strong (r = 0.301 to r = 0.750) positive relationships between workplace resilience with psychological well-being across all stressor categories (consumer/carer; colleague; organizational role; and organizational service). Psychological well-being was moderately high, but lower for nurses indicating consumer/carer-related stressors as their most stressful challenge. There were weak to moderate (r = 0.306 to r = 0.549) positive relationships between workplace resilience and psychological well-being, and no relationship between resilience and caring behaviours. Workplace resilience was lower (P < 0.05) for less experienced nurses compared with those with >5 years' experience, and lower for younger nurses compared with those aged ≥40 years. To improve their resilience and prevent psychological distress, there is prime opportunity to support nursing students with well-being and resilience-building strategies during their undergraduate education, and to support new graduates with similar programmes when they enter the workforce.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Michael Roche
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jo-Ann Giandinoto
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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32
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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33
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Occupational health in mental health services: a qualitative study. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2019. [DOI: 10.1108/ijwhm-02-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose
The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service.
Design/methodology/approach
Thematic analysis of data from seven semi-structured interviews is performed in this paper.
Findings
Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment.
Research limitations/implications
This was a small scale study of a previously unresearched population.
Practical implications
These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace.
Originality/value
This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.
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Sherer LM, Certel SJ. The fight to understand fighting: neurogenetic approaches to the study of aggression in insects. CURRENT OPINION IN INSECT SCIENCE 2019; 36:18-24. [PMID: 31302354 PMCID: PMC6906251 DOI: 10.1016/j.cois.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 06/10/2023]
Abstract
Aggression is an evolutionarily conserved behavior that evolved in the framework of defending or obtaining resources. When expressed out of context, unchecked aggression can have destructive consequences. Model systems that allow examination of distinct neuronal networks at the molecular, cellular, and circuit levels are adding immensely to our understanding of the biological basis of this behavior and should be relatable to other species up to and including man. Investigators have made particular use of insect models to both describe this quantifiable and stereotyped behavior and to manipulate genes and neuron function via numerous genetic and pharmacological tools. This review discusses recent advances in techniques that improve our ability to identify, manipulate, visualize, and compare the genes, neurons, and circuits that are required for the output of this complex and clinically relevant social behavior.
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Affiliation(s)
- Lewis M Sherer
- Division of Biological Sciences, University of Montana, Missoula, MT 59812, United States
| | - Sarah J Certel
- Division of Biological Sciences, University of Montana, Missoula, MT 59812, United States.
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35
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Tattoli L, Bosco C, Grattagliano I, Di Vella G. The risk of assault against mental health professionals: a fatal case report and literature review. Forensic Sci Med Pathol 2019; 15:276-280. [PMID: 31028573 DOI: 10.1007/s12024-019-00105-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 11/26/2022]
Abstract
Assaults by patients against healthcare providers are an increasing phenomenon worldwide. Mental health professionals in acute facilities and rehabilitation wards have the highest risk of being attacked at work. Verbal abuse or intimidating behaviors represent the most common types of violence. Fatal assault by psychiatric patients has been rarely reported in the literature. We present a case of a female psychiatrist who was fatally stabbed in her office in a Mental Health Center. At autopsy seventy stab wounds were found: four wounds of the neck, fifty penetrating wounds of the thorax, three wounds of the abdomen, six wounds of the lumbar region, and seven wounds of the upper arms including defense injuries. The cause of death was massive blood loss due to multiple stab wounds. The perpetrator was a 44-year-old male patient who had been referred to the victim after a previous admission to hospital following experiences of suicidal ideation and confusion. The extreme and unmotivated violence in a non-acute setting were notable. A borderline-antisocial personality disorder was later diagnosed by forensic experts. This case emphasizes the significant occupational risk for mental healthcare staff to sustain life threatening injuries or death, with implications for training of clinicians, and strategies for preventing aggressive behaviors.
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Affiliation(s)
- Lucia Tattoli
- S.C. Medicina Legale U, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Torino, Italy.
| | - Caterina Bosco
- Department of Public Health and Pediatrics, Section of Legal Medicine, University of Turin, Corso Galileo Galilei 22, 10126, Torino, Italy
| | - Ignazio Grattagliano
- Department of Educational Sciences, Psychology, Communication, University "Aldo Moro" of Bari, Palazzo Chiaia-Napolitano via Crisanzio 42, 70122, Bari, Italy
| | - Giancarlo Di Vella
- Department of Public Health and Pediatrics, Section of Legal Medicine, University of Turin, Corso Galileo Galilei 22, 10126, Torino, Italy
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36
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Foster K, Roche M, Delgado C, Cuzzillo C, Giandinoto JA, Furness T. Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs 2019; 28:71-85. [PMID: 30294937 DOI: 10.1111/inm.12548] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 12/15/2022]
Abstract
Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses' resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person-environment process. Resilience was most often reported as low-moderate, with positive correlations with hardiness, self-esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses' coping self-efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience-building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Michael Roche
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,Northern Sydney Local Health District Mental Health Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Cynthia Delgado
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Local Health District Mental Health Services, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Celeste Cuzzillo
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Jo-Ann Giandinoto
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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Foster K, Shochet I, Wurfl A, Roche M, Maybery D, Shakespeare-Finch J, Furness T. On PAR: A feasibility study of the Promoting Adult Resilience programme with mental health nurses. Int J Ment Health Nurs 2018; 27:1470-1480. [PMID: 29488298 DOI: 10.1111/inm.12447] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 01/07/2023]
Abstract
Mental health settings are recognized as complex, unpredictable environments, and challenging interpersonal situations are common for nurses in acute adult mental health services. Occupational stressors include verbal aggression and physical assault and are correlated with poor physical and mental health outcomes for nurses. There is a clear need for proactive approaches that address the negative impacts of stressors on the mental health nursing workforce. Resilience interventions are a preventive approach to strengthening skills for addressing workplace stress, improving health and well-being, and preventing adverse outcomes associated with occupational stressors. The aim of this study was to evaluate the feasibility of a workplace resilience education programme for nurses in high-acuity adult mental health settings. The outcomes were measured using a single-group pretest post-test design with follow-up at 3 months postintervention. The feasibility and acceptability of the programme were identified with descriptors of mental health, well-being, resilience, facilitator fidelity checklists, and participant satisfaction questionnaires. The programme was found to be feasible for nurses working in high-acuity inpatient settings. There were significant changes to mental health, well-being, and workplace resilience. The programme was delivered with fidelity by facilitators and accepted with high levels of satisfaction by participants. The study findings indicated that nurses can benefit from resilience education that equips them with cognitive, emotion regulation, and relational skills, in conjunction with available external supports and resources, to address workplace challenges. There is a need for comprehensive organizational approaches that include individual, work unit, and organizational-level strategies to support staff well-being.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Ian Shochet
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Astrid Wurfl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Roche
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,Northern Sydney Local Health District Mental Health Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Darryl Maybery
- Department of Rural Health, Monash University, Moe, Victoria, Australia
| | - Jane Shakespeare-Finch
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
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Alhassan RK, Poku KA. Experiences of frontline nursing staff on workplace safety and occupational health hazards in two psychiatric hospitals in Ghana. BMC Public Health 2018; 18:701. [PMID: 29875015 PMCID: PMC5989379 DOI: 10.1186/s12889-018-5620-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Psychiatric hospitals need safe working environments to promote productivity at the workplace. Even though occupational health and safety is not completely new to the corporate society, its scope is largely limited to the manufacturing/processing industries which are perceived to pose greater dangers to workers than the health sector. This paper sought to explore the experiences of frontline nursing personnel on the occupational health and safety conditions in two psychiatric hospitals in Ghana. METHODS This is an exploratory cross-sectional study among 296 nurses and nurse-assistants in Accra (n = 164) and Pantang (n = 132) psychiatric hospitals using the proportional stratified random sampling technique. Multivariate Ordinary Least Squares (OLS) regression test was conducted to ascertain the determinants of staff exposure to occupational health hazards and the frequency of exposure to these occupational health hazards on daily basis. RESULTS Knowledge levels on occupational health hazards was high in Accra and Pantang psychiatric hospitals (i.e. 92 and 81% respectively), but barely 44% of the 296 interviewed staff in the two hospitals said they reported their most recent exposure to an occupational health hazard to hospital management. It was found that staff who worked for more years on the ward had higher likelihood of exposure to occupational health hazards than those who worked for lesser years (p = 0.002). The category of occupational health hazards reported most were the physical health hazards. Psychosocial hazards were the least reported health hazards. Frequency of exposure to occupational health hazards on daily basis was positively associated with work schedules of staff particularly, staff on routine day schedule (Coef = 4.49, p = 0.011) and those who alternated between day and night schedules (Coef = 4.48, p = 0.010). CONCLUSION Occupational health and safety conditions in the two hospitals were found to be generally poor. Even though majority of the staff knew about occupational health and safety, less than half of them reported exposure to workplace health hazards. Key stakeholders such as the Ministry of Health in collaboration with the Mental Health Authority should intensify efforts towards effective enforcement of existing policies on safety in healthcare institutions, particularly psychiatric hospitals where exposure to occupational health hazards is more prevalent.
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Affiliation(s)
- Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery University of Health and Allied Sciences, Ho. PMB 31, Volta Region Ho, Ghana
| | - Kwabena Adu Poku
- Formerly of Department of Public Administration and Health Services Management, University of Ghana Business School, University of Ghana Legon. LG 25, Accra, Legon, Ghana
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Foster K, Cuzzillo C, Furness T. Strengthening mental health nurses' resilience through a workplace resilience programme: A qualitative inquiry. J Psychiatr Ment Health Nurs 2018; 25:338-348. [PMID: 29920873 DOI: 10.1111/jpm.12467] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/10/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health nurses are affected by interpersonal, practice-related and organizational factors that can increase workplace stress and reduce their physical and mental health and well-being. Resilience programmes are a strength-based preventative approach to supporting individuals to overcome workplace adversities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self-talk, managing negative self-talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social-ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well-being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. ABSTRACT: Introduction Mental health settings are potentially high-stress workplaces that can lead to nurses' poorer health and well-being. Resilience programmes are a strengths-based preventative approach for promoting mental health and well-being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim To explore the perspectives of mental health nurses participating in a mental health service-initiated resilience programme (Promoting Adult Resilience). Method An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open-ended responses and semi-structured interviews and focus groups, were thematically analysed. Results Twenty-nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self-efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice It is recommended resilience programmes are provided to promote nurses' well-being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well-being need to be addressed at a unit, organizational and professional level.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Vic., Australia
| | - Celeste Cuzzillo
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Vic., Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Vic., Australia
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Flannery RB, Wyshak G, Flannery GJ. Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2013-2017. Psychiatr Q 2018; 89:285-292. [PMID: 28944398 DOI: 10.1007/s11126-017-9533-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in human suffering and dollar cost expense. International research through 2012 documented the frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five year period of 2013-2017. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s, even with new policy initiatives in place meant to reduce such violence. Nursing personnel continued to be at greater risk. The findings by continents and an updated methodological inquiry are presented.
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Affiliation(s)
- Raymond B Flannery
- Harvard T.H.Chan School of Public Health, Boston, MA, USA.
- Cambridge Health Alliance, Department of Psychiatry, 1493 Cambridge street, Cambridge, MA, 02139, USA.
| | - Grace Wyshak
- Harvard T.H.Chan School of Public Health, Boston, MA, USA
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Hsieh HF, Wang HH, Shen SH, Li YC. Predictors of depressive symptoms among psychiatric nurses who suffered from workplace violence. J Adv Nurs 2017; 74:425-432. [DOI: 10.1111/jan.13451] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Hsiu-Fen Hsieh
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Nursing; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Hsiu-Hung Wang
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Shu-Hua Shen
- National Cheng Kung University; Institute of Allied Health Sciences; College of Medicine; Tainan Taiwan
- Jing- Ho Mental Health Hospital; Kaohsiung Taiwan
| | - Yu-Chi Li
- Department of Nursing; Chi-Mei Medical Center; Tainan Taiwan
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Hilton NZ, Ham E, Dretzkat A. Psychiatric Hospital Workers’ Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms. Can J Nurs Res 2017; 49:118-126. [DOI: 10.1177/0844562117719202] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression. Objective We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic). Method Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL). Results All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced. Conclusion PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.
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Affiliation(s)
- N. Zoe Hilton
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Waypoint Centre for Mental Health Care, Waypoint Research Institute, Ontario, Canada
| | - Elke Ham
- Waypoint Centre for Mental Health Care, Waypoint Research Institute, Ontario, Canada
| | - Alecia Dretzkat
- Waypoint Centre for Mental Health Care, Waypoint Research Institute, Ontario, Canada
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