Exploring the Needs for Support of Pediatric Nurses Caring for Children with a Mental Health Disorder Hospitalized in Non-Psychiatric Units

Barriers to Mental Health care in Canada Identified by Healthcare Providers: A Scoping Review

The mental health treatment gap remains wide across the world despite mental illness being a significant cause of disability globally. Both end-user and healthcare provider perspectives are critical to understanding barriers to mental healthcare and developing interventions. However, the views of providers are relatively understudied. In this review, we synthesized findings from current literature regarding providers' perspectives on barriers to mental healthcare in Canada. We searched Medline, PsycINFO, Embase, and CINAHL for eligible Canadian studies published since 2000. Analysis and quality assessment were conducted on the included studies. Of 4,773 reports screened, 29 moderate-high quality studies were reviewed. Five themes of barriers emerged: health systems availability and complexity (reported in 72% of the studies), work conditions (55%), training/education (52%), patient accessibility (41%), and identity-based sensitivity (17%). Common barriers included lack of resources, fragmented services, and gaps in continuing education. Interestingly, clinicians often cited confusion in determining the ideal service for patients due to an overwhelming number of potential services without clear descriptions. These five domains of barriers present a synthesized review of areas of improvement for mental healthcare spanning both patients and clinicians. Canadian mental health systems face a need to improve capacity, clinician training, and in particular service navigability and collaboration.

Nurse perceptions of caring for pediatric patients with behavioral health needs on non-psychiatric units during the COVID-19 pandemic

PURPOSE

The study examined nurses' perceptions of barriers and needs when caring for pediatric patients with behavioral health needs in inpatient non-psychiatric units during the pandemic.

DESIGN AND METHODS

A quantitative descriptive comparative design was used. Members of Society of Pediatric Nurses and National Pediatric Nurse Scientist Collaborative were recruited. The survey included questions about perceived barriers and needs in caring for children with behavioral health needs in their units.

RESULTS

A total of 335 nurses across the United States participated. Descriptive statistics, chi-square, and Kruskal-Wallis evaluated responses. Nurses in Southeast/Southwest regions were less fearful when caring for pediatric patients with behavioral health needs (p = .03), more often knew what to do (p = .01), and were supported by a behavioral health team with regular rounding (p = .035). Nurses in adult/pediatric hospitals were less likely to have adequate education to feel competent (p = .012). Nurses in the emergency department were less fearful (p = .02), more confident (p = .025), and more competent (p = .006). Nurses with up to two years of experience were likelier to feel assignments reflected the patient workload (p = .001) and more familiar with trauma-informed care protocols (p = .013).

CONCLUSIONS

This study illustrated significant variations in competence, readiness, and attitudes among nurses across different regions, hospital types, departments, and experience levels when caring for pediatric patients with behavioral health needs.

PRACTICE IMPLICATIONS

Results from this study could lead to the development of clinical practice guidelines, protocols, or policies to guide practice.

Preparing children's nurses for working with children and adolescents who self-harm: Evaluating the 'our care through our eyes' e-learning training package

Rates of self-harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of 'Our Care Through Our Eyes', an online self-harm learning programme for children's nurses. A self-selected, convenience sample of registered children's nurses (n = 42) completed scales pre- and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self-harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre- and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating 'Our Care Through Our Eyes' delivered using e-leaning and could be used to inform further investigations.

Shared learning to improve the care for young people and mental health within nurse education (SHYNE). Improving attitudes, confidence and self-efficacy

Preparing students for the complexities of practice is an ongoing challenge of pre-registration nurse education. One such complexity is the increase in children and young people with mental health problems. Pre-registration student nurses from child and mental health specialisms from one University participated in an innovative simulation session, whereby actors from a youth theatre group simulated young people admitted to an acute non-mental health hospital setting for treatment of self-harm injuries. This study used an uncontrolled pre and post design to determine the impact of the session on student nurses' attitudes, confidence and self-efficacy when caring for young people who self-harm. Attitudes towards self-harm was measured using a 13 item self-report questionnaire. Confidence was measured through Likert scale responses. Self-efficacy for working with children and young people who have self-harmed was measured through an adapted version of the Self-Efficacy Towards Helping (SETH) scale. In total 101 student nurses took part in the study and 99% completed post simulation outcome measures. At post-session, the students reported a statistically significant improvement in attitudes, self-efficacy and confidence towards children and young people who self-harm. A lack of confidence is frequently reported in the literature when caring for this client group in practice settings. Improvements in attitudes, confidence and self-efficacy can positively impact individual nursing practice. Furthermore the simulation literature indicates that the skills consolidated using such an educational approach are taken forward into clinical practice. While broad claims of success should be avoided, it is promising to find a learning method that is effective in addressing a contemporary and complex health issue. Shared Learning to Improve the Care for Young People and Mental Health within Nurse Education (SHYNE): Improving Attitudes, Confidence and Self-Efficacy.

Implementation of a pediatric behavioral staffing algorithm in an acute hospital: a best practice implementation project

BACKGROUND

A progressive decline in acute psychiatric facility beds has led to a steadily increasing number of pediatric psychiatric patients hospitalized on acute care medical-surgical units. Clinical nurses in this environment feel ill-equipped to provide quality behavioral health care.

AIMS/OBJECTIVES

This project aimed to improve continuity of care as well as staff and patient safety in pediatric acute and transitional care units. The specific objectives related to implementation of a resource allocation algorithm for staffing behavioral health admissions and consistent use of an interdisciplinary psychiatric huddle.

METHODS

This project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool for promoting health practice change. A baseline medical record audit was conducted which was followed by charge nurse education on the resource allocation algorithm and huddle initiation. Three follow-up audits measured compliance with best practice criteria for assessing and managing care of behavioral pediatric patients.

RESULTS

Compliance with comprehensively assessing children with challenging behaviors who were hospitalized in acute care units achieved 100% for the first three months following algorithm implementation. Nurses reached 100% compliance with initiating psychiatric huddles. All audits for individualized care plans, which included family or carer involvement, were fully compliant.

CONCLUSIONS

Use of a resource allocation algorithm for individualizing care of pediatric behavioral patients enhanced quality of care through a standardized process which enabled acute care nurses to better meet the safety needs of this patient population. Early signs of sustaining improvements were promising for hard-wiring workflows. Future plans include adoption of the algorithm and huddle by all in-patient areas in the children's hospital.

'Our Care through Our Eyes'. Impact of a co-produced digital educational programme on nurses' knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK

OBJECTIVES

(1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children's nurses working with children and young people (CYP) admitted with self-harm.(2) To explore the perceived impact, suitability and usefulness of the intervention.

INTERVENTION

A digital educational intervention that had been co-produced with CYP service users, registered children's nurses and academics.

SETTING

A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK.

PARTICIPANTS

From a pool of 251 registered children's nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention.

PRIMARY OUTCOME MEASURES

Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants.

RESULTS

For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice.

CONCLUSIONS

The effect of the intervention is promising and demonstrates the potential it has in improving registered children's nurse's knowledge, confidence and attitudes. However, further testing is required to confirm this.