Mental Health Nurses' Attitudes towards Consumers with co-Existing Mental Health and Drug and Alcohol Problems: A Scoping Review

Mental health nurses' empathy experiences towards consumers with dual diagnosis: A thematic analysis

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is one of the leading causes of disability globally. Consumers with dual diagnosis have complex needs and are at risk of relapse of their psychiatric symptoms. Mental health nurses require essential skills, including empathy, to manage consumers with dual diagnosis. No studies have explored mental health nurses' empathy towards consumers with dual diagnosis. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Developing empathy towards consumers with dual diagnosis is complex. Mental health nurses' unemotional empathy experiences with consumers with dual diagnosis are related to their lack of ability to connect to their consumers' choices and feelings. Negative attitudes towards consumers with dual diagnosis contributed to nurses' poor empathy experiences. The unemotional responses of mental health nurses can be caused by factors such as novelty, insufficient information, and neutral evaluation of a consumer's situation. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study results benefit researchers, teachers, clinicians, and administrators when designing, developing, and delivering empathy training packages for mental health nurses. Improving the empathy of mental health nurses towards consumers with dual diagnosis should be a top priority for healthcare leaders and educators. A core curriculum containing holistic awareness of the biopsychosocial components of dual diagnosis makes it easier for mental health nurses to understand and develop empathy towards consumers with dual diagnosis. Future studies must address the relationship between attitude, stress, burnout, compassion fatigue and empathy among mental health nurses in relation to consumers with dual diagnosis.

ABSTRACT

INTRODUCTION: There is a lack of evidence regarding mental health nurses' empathy towards consumers with dual diagnosis.

AIMS

This qualitative study aimed to describe mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings.

METHOD

Through purposeful sampling, interviews were conducted with 17 mental health nurses who have experience in caring for consumers with dual diagnosis. Thematic analysis, as an inductive approach was used, to generate codes and themes from participant data. To report on this qualitative study, we adhered to the ENTREQ guidelines.

RESULTS

Four themes emerged: challenges to develop empathy with consumers, lack of conducive attitude of nurses towards consumers, appraising consumers' emotions accurately and holistically responding to the appraised emotions. The findings indicated that developing empathy towards consumers with dual diagnosis is a complex task.

DISCUSSION

Mental health nurses may struggle to empathize with consumers when encountering confrontational situations. Interventional studies are required to address the relationship between mental health nurses' attitudes, stress, burnout, compassion fatigue and empathy in relation to consumers with dual diagnosis.

IMPLICATIONS FOR PRACTICE

Understanding why mental health nurses emotional experiences differ about a similar challenging situation experienced by their consumers is vital. Further research on strategies to address empathy issues among mental health nurses could enhance nursing practice and consumer care.

Mental health nurses' empathy towards consumers with dual diagnosis: A descriptive study

AIM

This study aimed to assess mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. The research question was What is mental health nurses' empathy towards consumers with co-existing mental health and drug and alcohol problems?

DESIGN AND METHODS

A cross-sectional survey was carried out to understand mental health nurses' empathy. The convenience sample included 96 mental health nurses from various mental health settings with experience working with consumers with dual diagnosis. We assessed empathy using the Toronto Empathy Questionnaire. We utilised SPSS™ software to analyse both the descriptive data and multiple-regression.

RESULTS

The mean empathy score was 47.71 (SD 8.28). The analysis of the association between demographic variables and individual subscales showed an association between the clinical setting and empathy (p = .031) and sympathetic physiological arousal (p = .049). The work sector was associated with sympathetic physiological arousal (p = .045) and conspecific altruism (p = .008). Emotional contagion (β = .98, p < .001), emotional comprehension (β = 1.02, p < .001), sympathetic physiological arousal (β = 1.01, p < .001) and conspecific altruism (β = 10.23, p < .001) predicted mental health nurses' empathy.

CONCLUSIONS

This study found that most mental health nurses showed empathy towards consumers with dual diagnosis. Mental health nurses who are more empathetic towards their consumers experience emotional contagion. They understand emotions better, show sympathetic physiological responses and exhibit kind behaviour towards consumers.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Further research is required to understand how mental health nurses adapt to consumers' emotional states in different mental health settings. This information can help clinicians make better decisions about care quality for consumers with dual diagnosis.

IMPACT

This study addressed mental health nurses' empathy towards consumers with dual diagnosis. Mental health nurses showed increased empathy towards consumers with dual diagnosis. The empathy levels vary based on age, clinical setting, work sector and work experience. Mental health nurses' empathy levels were predicted by emotional contagion, emotion comprehension, sympathetic physiological arousal and conspecific altruism. Empathy enhancement among mental health nurses, particularly towards consumers with dual diagnosis, is crucial and should be regarded as a top priority by healthcare leaders and educators.

REPORTING METHOD

Outlined by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Mental health nurses' attitudes towards consumers with co-existing mental health and drug and alcohol problems: Adescriptive study

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is one of the leading causes of disability globally. There is limited evidence on mental health nurses' attitudes towards consumers with dual diagnosis. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Mental health nurses have positive attitudes towards consumers with dual diagnosis. A positive attitude at work is influenced by various factors, including feeling that one's role is appropriate and legitimate. This also includes receiving support in that role, being motivated to work, having confidence in completing tasks and feeling satisfied with one's job.

ABSTRACT

BACKGROUND: Dual diagnosis is a global health concern. This descriptive research assessed mental health nurses' attitudes towards consumers with dual diagnosis in Australian mental health settings. The research question was: What is the attitude of mental health nurses towards consumers with co-existing mental health and drug and alcohol problems?

MATERIALS AND METHODS

This cross-sectional survey included 103 mental health nurses who work with consumers with dual diagnosis. Participants were recruited from various mental health settings through convenience sampling. The Comorbidity Problems Perceptions Questionnaire was used to assess attitudes. Descriptive data and multiple regression analyses were conducted. We utilized the consensus-based checklist for reporting results of this study.

RESULTS

Mental health nurses positively perceived consumers with dual diagnosis. Factors associated with a positive attitude were a higher level of work experience, feeling that one's role is adequate, perceiving one's role as legitimate, receiving increased support in one's position, having high work motivation, possessing high task-specific self-esteem and experiencing higher levels of work satisfaction. Work experience predicted role adequacy. Position predicted role support. The work sector predicted role-related self-esteem.

CONCLUSIONS

As mental health nurses gain work experience; they develop positive attitudes that boost their self-esteem and sense of importance towards consumers with dual diagnosis. This constructive mindset also positively affects their work motivation and job satisfaction towards consumers with dual diagnosis. Conducting interventional studies is necessary to examine how clinical experiences, work environments, and job positions can impact attitudes, aiming to improve mental health nursing interventions towards consumers with dual diagnosis.

IMPLICATIONS TO PRACTICE

The study found that mental health nurses' positive attitudes towards consumers with dual-diagnosis are influenced by their experience and knowledge. Moreover, mental health nurses who feel supported, motivated and confident in their roles are more likely to provide high-quality care to consumers with dual diagnosis. Mental health nurses could provide better care and support if they took a proactive approach and addressed the challenges associated with this consumer population. To be successful in their roles, mental health nurses require access to resources and support from healthcare organizations. As a result, their job satisfaction and attitudes towards consumers with dual diagnosis will be enhanced. In this way, consumers as well as healthcare organizations will benefit.

Internal validity evidence of a knowledge questionnaire on alcohol use, abuse and dependence and associated questions

OBJECTIVES

to perform content validity and verify the psychometric properties of the adapted version of an alcohol knowledge questionnaire and associated questions.

METHODS

a methodological study, in which a committee of judges analyzed the questionnaire item representativeness, clarity and relevance. Item response theory was used to assess the instrument psychometric properties applied to a sample of 240 health professionals.

RESULTS

the questions were adjusted according to judges' assessment, obtaining a satisfactory Content Validity Index (0.98). High discrimination ability and adequate difficulty levels were observed in 75% of multiple-choice questions and in 25% of statements.

CONCLUSIONS

the instrument presented content validity with satisfactory indices. However, it is recommended that the questionnaire adapted in this study be used in different samples of health professionals from other parts of Brazil, in order to provide greater robustness to its reliability.

Improving the self-efficacy, knowledge, and attitude of nurses regarding concurrent disorder care: Results from a prospective cohort study of an interprofessional, videoconference-based programme using the ECHO model

Several challenges have been identified for patients with concurrent disorders to access adequate services and for nurses to care for them. These challenges contribute to a pressing need for continuing educational interventions, particularly within the mental health nursing workforce. To address this issue, an innovative interprofessional videoconferencing programme based on the ECHO® model (Extension for Community Healthcare Outcomes) was implemented in Quebec, Canada to support and build capacity among healthcare professionals for CD management. The aim of this prospective cohort study was to examine nurses' self-efficacy, knowledge, and attitude scores over a 12-month period. All nurses who registered in the programme between 2018 and 2020 were invited to participate in the study (N = 65). The data were collected online using a self-administered survey at baseline, after 6 months, and then 12 months following entry-to-programme. Twenty-eight nurses participated in the study (96.4% women), with a mean age of 39.1 (SD = 6.2). Compared to other professions (n = 146/174), the group of nurses also showed significant improvements in their knowledge and attitude scores, with respective effect sizes of 0.72 and -0.44 at 6 months, and 0.94 and -0.59 at 12 months. However, significant changes in self-efficacy were only found at the 12-month follow-up (P = 0.0213), among the nurses who attended more than 25% of the 20-session curriculum. ECHO is a promising intervention to improve the accessibility of evidence-based practice and to support nurses in suitably managing concurrent disorders. Further research is needed to establish the effectiveness of this educational intervention on clinical nursing practice and patient outcomes.

Evidências de validade interna de um questionário de conhecimento sobre o uso, abuso e dependência de álcool e questões associadas

RESUMO Objetivos: realizar a validação de conteúdo e verificar as qualidades psicométricas da versão adaptada do questionário de conhecimentos frente ao álcool e questões associadas. Métodos: estudo do tipo metodológico, em que um comitê de juízes analisou a representatividade, clareza e pertinência dos itens do questionário. Utilizou-se a teoria da resposta ao item para avaliar as qualidades psicométricas do instrumento aplicado em uma amostra de 240 profissionais de saúde. Resultados: as questões foram ajustadas conforme avaliação dos juízes, obtendo um Índice de Validade de Conteúdo satisfatório (0,98). Observou-se alta capacidade de discriminação e níveis de dificuldade adequados em 75% das questões de múltipla escolha e em 25% das afirmativas. Conclusões: o instrumento apresentou validade de conteúdo com índices satisfatórios. Entretanto, recomenda-se que o questionário adaptado neste estudo seja utilizado em amostras diversas de profissionais de saúde, de outros locais do país, com o intuito de oferecer maior robustez à sua confiabilidade.

A systematic review of the perceptions and attitudes of mental health nurses towards alcohol and other drug use in mental health clients

Mental and substance use disorders are leading contributing factors for the Australian non-fatal burden of disease. These disorders frequently co-occur in the mental health population, and mental health nurses are the largest group of professionals treating dual diagnosis. A comprehensive understanding of mental health nurses' attitudes and perceptions is required to inform future implementation of dual diagnosis training programs. A systematic literature review of sources derived from electronic databases including Medline, CINAHL, SCOPUS review, and PsychINFO, along with Connected Papers. Selection criteria included a focus on mental health nurses' attitudes towards dual diagnosis of mental illness and substance use. Extracted data was qualitatively synthesized. Of the 5232 articles retrieved initially, 12 were included in the review. Four themes emerged from the synthesis: drug and alcohol use among mental health consumers (seven studies), caring for dual diagnosis consumers (eight studies), role perception (six studies), and treatment optimism (five studies). Salient beliefs included substance use as a self-inflicted choice (71%) or a form of 'self-medication' (29%); a lack of willingness to provide care (75%), or a strong commitment to care (25%); greater comfort with screening and acute medical management rather than ongoing management (83%); and pessimism about treatment effectiveness (100%). Mental health nurses' beliefs and attitudes towards dual diagnosis were often negative, which is likely to result in poor quality care and treatment outcomes. However, the lack of recent studies in this research area indicates the need for up-to-date knowledge that can inform the development of training programs.