Content Validity of a Psychotherapeutic Intervention Model in Nursing: A Modified e-Delphi Study

Cognitive Restructuring during Depressive Symptoms: A Scoping Review

Cognitive restructuring (CR) aims to get people to challenge and modify their cognitive distortions, generating alternative, more adaptive thoughts. Behavioral, emotional, and physiological responses are modified by analyzing and changing dysfunctional thoughts. The person must have the cognitive capacity to participate in the analysis of their thoughts. CR for people with depression has positive effects, although there is little research on how it should be structured and applied. CR is a thought modification technique presented in the Nursing Interventions Classification (NIC), but is not organized in a sequential approach, and there is no procedure for applying it in practice. This scoping review aims to identify the structure, contents and assessment instruments used in CR for people with depressive symptoms and to analyze the health outcomes of applying the CR technique in this population. Out of 515 articles, seven studies were included in the review, up to 2021 and without any time limitation. The studies were not guided by a consistent and sound framework of the CR technique and each study used its own framework, although they used similar techniques. We grouped CR into six steps. No specific studies were found regarding intervention by nurses. CR is effective in reducing depressive symptoms, so it is an important therapeutic tool that should be used on people with depression. With this scoping review, mental health nurses will have a more comprehensive idea of the techniques that can be used in the application of CR to patients with depressive symptoms.

Promoting Spiritual Coping of Family Caregivers of an Adult Relative with Severe Mental Illness: Development and Test of a Nursing Intervention

Severe mental illness disrupts daily functioning, burdening family caregivers, who often adopt spiritual coping strategies. With comprehensive skills, mental health nurses can promote well-being and mental health. The aim is to develop and test the nursing intervention "promoting spiritual coping" in the family caregivers of home-dwelling people with mental illness. This study was conducted in two distinct stages. Initially, the intervention was developed according to the first phase of the Framework for Developing and Evaluating Complex Interventions. Secondly, the intervention protocol was tested in a mixed-method pilot study. An intervention protocol was developed and tested on ten family caregivers. The intervention comprised three sessions, and before-and-after assessments were conducted. Significant improvements were observed in the outcomes, with caregivers expressing that discussing spirituality and religiosity benefited them. This intervention prioritized the therapeutic relationship of the nurses and family caregivers. The intervention "promoting spiritual coping" was created and evaluated as a suitable approach for mental health nurses to use in a psychotherapeutic context with family caregivers of individuals with mental illness.

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain

OBJECTIVE

To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries.

BACKGROUND

Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition.

SOURCES OF EVIDENCE

Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification.

DISCUSSION

PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation.

CONCLUSIONS

Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP.

IMPLICATIONS FOR NURSING PRACTICE

Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy.

IMPLICATIONS FOR NURSING POLICY

Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

Designing a Nurse-Led Program for Self-Management of Substance Addiction Consequences: A Modified e-Delphi Study

Therapeutic interventions for people with problematic use of psychoactive substances can help tackle specific needs related to substance addiction consequences. This modified e-Delphi study aimed to establish consensus on a training program for self-management of substance addiction consequences. The study was conducted between February and April 2022, with an experts' sample of 28 participants in the first round and 24 in the second. A priori consensus criteria were defined for each round. The results revealed a very strong consensus was achieved on the structure of the program and on clinical areas, such as the problematic use of substances, general health knowledge, health-seeking behavior and adherence, self-knowledge and well-being, social role and personal dignity, and family process. Additionally, over 80% participant consensus was achieved on an extensive number of interventions categorized as psychoeducational, psychotherapeutic, socio therapeutic, brief interventions, social skills training, problem solving techniques, relaxation techniques, and counseling. These findings may be able to fulfill a gap concerning structured treatment approaches for people with problematic use of psychoactive substances. Supporting self-management of the consequences of substance addiction and its application can change nurses' interventions.

Development of a comprehensive flourishing intervention to promote mental health using an e-Delphi technique

BACKGROUND

Although observational studies have already shown promising results of flourishing, a broader concept of health based on positive psychology, there is still a gap in the literature regarding studies that combine different topics of flourishing in a single intervention.

OBJECTIVES

To develop a comprehensive and integrate intervention based on positive psychology gathering different topics of flourishing to improve mental health outcomes in individuals with depressive symptoms.

METHODS

The following steps were performed: (1) a comprehensive literature review; (2) the designing of a 12-session group intervention based on the values, virtues, and topics of flourishing; (3) assessment of the rationale, coherence, and feasibility by a panel of healthcare professionals answering semi-structured questions, and (4) application of an e-Delphi technique including mental health experts to reach a consensus of at least 80% for each item of the protocol.

RESULTS

A total of 25 experts participated in the study, 8 in the panel with semi-structured questions and 17 in the e-Delphi technique. A three-round e-Delphi technique was required to reach a consensus for all items. In the first round, a consensus was reached for 86.2% of the items. The remaining items (13.8%) were either excluded or reformulated. In the second round, a consensus was not obtained on one item, which was reformulated and approved in the third round. Qualitative analyses of the open questions were performed and suggestions for the protocol were considered. The final version of the intervention was composed of 12 weekly group sessions with 90-min each. The topics included in the intervention were physical and mental health, virtues and character strengths, love, gratitude, kindness, volunteering, happiness, social support, family, friends and community, forgiveness, compassion, resilience, spirituality, purpose and meaning of life, imagining the "best possible future," and flourishing.

CONCLUSION

The flourishing intervention was successfully developed using an e-Delphi technique. The intervention is ready to be tested in an experimental study to verify its feasibility and effectiveness.

Nurses' perspective about the Mental Health First Aid Training Programmes for adolescents in upper secondary schools: A focus group study

WHAT IS KNOWN ON THE SUBJECT?: Mental Health First Aid Training Programmes with a pathogenic perspective are implemented worldwide for different participants and contexts. These interventions can promote the medicalization and psychiatrization movement of human suffering. Training programmes should teach about mental health nursing problems rather than disorders. However, there seem to be no studies describing these healthier interventions targeting adolescents in upper secondary schools. Nurses can explore these interventions and target them towards these participants and contexts. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The perspective of nurses on the characteristics of Mental Health First Aid Training Programmes for adolescents in Portuguese upper secondary schools is reported. Experts recognize that the nurses who perform these interventions must have personal, pedagogical and mental health competencies. Therefore, mental health nurses may be considered. The components of mental health literacy, mental health nursing problems and a dynamic first aid plan can be taught using different classroom training strategies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The role of mental health nurses in promoting health literacy is highlighted. They have the opportunity to lead multidisciplinary teams in using these healthier training programmes. These expert opinions can shape the planning, implementation and evaluation of these interventions. In turn, training programmes can promote the identification, assistance and/or adequate and timely referral of people with mental health nursing problems. ABSTRACT: Introduction Mental Health First Aid Training Programmes performed by nurses can empower adolescents to aid people with mental health problems. There do not appear to be any studies that describe these healthier interventions aimed at adolescents in upper secondary schools. The development of these educational interventions benefits from the input of their participants and facilitators. Aim To explore the perspective of nurses about Mental Health First Aid Training Programmes for adolescents in upper secondary schools. Method A qualitative, descriptive and exploratory study was conducted. Data were collected from seven mental health nurses during two focus group sessions. Data were analysed using content analysis. Results Twelve themes were identified around nine main areas: facilitators, intervention foci, outcomes assessment methods, process assessment methods, participants, implementation context, duration and frequency, intervention methods and strategies, and contents. Discussion Mental health nurses can regularly perform these classroom interventions to improve the mental health competencies of adolescents. Various educational methods can facilitate learning related to mental health literacy components, mental health nursing problems and the first aid plan. Valid and appropriate assessment methods enhance a good representation of these interventions. Implications for Practice This evidence can guide the creation and modelling of these first aid training programmes.

Cerebral Angiography under Artificial Intelligence Algorithm in the Design of Nursing Cooperation Plan for Intracranial Aneurysm Patients in Craniotomy Clipping

This research was to investigate the value of indocyanine green angiography (ICGA) based on maximum interclass variance (Otsu) method in the nursing plan of intracranial aneurysm clipping (ICAC) for intracranial aneurysm patients. An Otsu algorithm was selected to optimize the original images with the optimal threshold. In addition, the algorithm was applied to ICGA images of 86 patients with intracranial aneurysms, who were randomly divided into an experimental group (using ICGA + ICAC+ perioperative nursing) and a control group (ICAC + conventional nursing), to observe the clinical indicators, treatment, complications, nursing satisfaction, and quality of life of patients in two groups. The results showed that the mean square error (MSE), structural similarity (SSIM), and shape error (SE) were 3.71, 0.84, and 0.47, respectively. The length of hospital stay in the experimental group (19.9 ± 3.5 days) was significantly shorter than that in the control group (23.2 ± 3.0 days), the rate of excellent treatment was significantly higher than that in the control group, and the incidence of complications was lower. WHOQOL-BREF scores of the two groups after nursing intervention were higher than before, and the score in the experimental group was higher than the control group. In addition, the nursing satisfaction was also significantly higher in the experimental group, and the difference was statistically significant (P < 0.05). In conclusion, ICGA based on the Otsu method could effectively evaluate the cerebrovascular morphology during craniotomy and ICAP and improve the surgical efficacy. Combined with perioperative nursing intervention, it could greatly reduce the incidence of postoperative complications, improve the treatment effect and quality of life, and enhance the long-term prognosis.

Development and psychometric properties of the Therapeutic Relationship Assessment Scale-Nurse

WHAT IS KNOWN ON THE SUBJECT?: The literature shows a clear relationship between a good therapeutic relationship (TR) and the efficacy of nursing interventions. For the implementation of nursing psychotherapeutic interventions, the initial establishment of a good TR is essential. Several instruments assess the relationship established between the therapist and the patient in psychotherapy. However, no tool has been found to assess the quality of the TR established between the nurse and the patient. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study allowed the development and evaluation of the psychometric properties of a scale to assess the TR between the nurse and the patient in a sample of mental health nurses. The developed scale (Therapeutic Relationship Assessment Scale-Nurse) has psychometric properties that attest its reliability (internal consistency and test-retest) and construct validity as an instrument to assess the quality of the TR established between the nurse and the patient from the nurse's perspective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: As the TR is crucial for providing nursing care and, in particular, for implementing nursing psychotherapeutic interventions, the scale developed is a valid tool to assess the quality of the TR established between the nurse and the patient in the perspective of the mental health nurse. The use of instruments to assess the quality of the nurse-patient TR facilitates the identification of the relationship's gaps, which can serve as a basis for improving the relationship itself and the nursing care provision. ABSTRACT: Introduction The therapeutic relationship (TR) is essential to providing psychiatric and mental health nursing care. Nevertheless, no assessment tools exclusive for assessing nursing TR were found in the literature. Aim To describe and evaluate the psychometric properties (reliability and construct validity) of a scale that allows assessing the quality of TR established between the nurse and the patient. Method A survey method was adopted, using a convenience sample of 356 mental health nurses. Internal consistency was assessed by Cronbach's alpha and Omega index. Results A total of 221 mental health nurses participated in the study (response rate = 62.08%). The scale's final structure has 25 items. Cronbach's alpha was 0.93, ranging from 0.78 to 0.88 for each of the factors. The cumulative variance explained in a four-factor structure was 71.12%. Discussion The Therapeutic Relationship Assessment Scale (TRAS)-Nurse presents good psychometric properties. In the light of Benner's theory, it can be an useful tool for novice nurses to better understand what aspects they should pay attention to for establishing a successful TR. Implications for Practice Mental health nurses can use the TRAS-Nurse, thus having a scale available that allows them to self-assess the quality of TR they establish with their patients.

The structure and contents of the helping relationship as a nursing psychotherapeutic intervention: A modified e-Delphi study

PURPOSE

The aim of this study is to evaluate the content validity of the helping relationship as a nursing psychotherapeutic intervention.

DESIGN AND METHODS

The present research work is a modified e-Delphi study. A total of 205 experts were identified between January and May 2018, and a questionnaire was sent to all of them in different rounds.

FINDINGS

The nurse must have specific knowledge (self-knowledge and knowledge about the person) and attitudes (empathy and respect) to be able to carry out the intervention. The helping relationship can address different nursing diagnoses, such as anxiety or depressed mood, and it can be developed in a set of sessions with specific objectives and contents.

PRACTICE IMPLICATIONS

The systematization of the helping relationship creates the conditions for its implementation in clinical practice enabling an evidence-based practice that results in the improvement of care.

Construction and content validation of a measurement tool to evaluate person-centered therapeutic relationships in physiotherapy services

OBJECTIVES

This study sought to develop a tool for evaluating person-centered therapeutic relationships within physiotherapy services, and to examine the content validity of the same.

METHODS

A mixed qualitative and quantitative study was performed in three distinct phases: 1) the items were generated based on a literature review and a content analysis of focus groups of patients and physiotherapists; 2) an e-Delphi survey process was performed based on three rounds to select and refine the proposed questionnaire; 3) two rounds of cognitive interviews were conducted to evaluate the comprehension of items, the clarity of language and the appropriateness and relevance of content.

RESULTS

Thirty-one items were generated based on the seven domains identified after the analysis of four focus groups of physiotherapists and four patient focus groups. Nine experts participated in the e-Delphi survey. Fifty-five patients participated in the two rounds of the cognitive pre-tests. Participating patients were from public and private physical therapy services. Based on the participants' suggestions, four items were removed, and four were added, whereas 16 were reworded.

CONCLUSIONS

The final tool comprised 31 items divided into seven domains. The response format was based on a 5-point Likert frequency scale. The response options ranged from "strongly agree" to "strongly disagree".

Cultural Adaptation and Psychometric Properties Assessment of the NOC Outcome "Cognition" in a Sample of Portuguese Adults With Mental Illness

PURPOSE

Cultural adaptation and psychometric properties assessment of the Nursing Outcomes Classification (NOC) outcome "Cognition" in a sample of Portuguese adults with mental illness.

METHODS

Methodological study.

FINDINGS

The final European Portuguese version of the NOC outcome "Cognition", consisting of 13 items, showed good psychometric properties. An exploratory factor analysis was performed from which only one factor was established.

CONCLUSIONS

The European Portuguese version of the NOC outcome "Cognition" seems to gather very satisfactory psychometric properties for assessing cognition in the Portuguese population.

IMPLICATIONS FOR NURSING PRACTICE

This study contributed to advance the nursing body of knowledge and to better assess cognition in a clinical context.