A Survey of Stress and Burnout in Forensic Mental Health Nursing

Mindfulness-Based Self-Care for Forensic Nurses: A Professional Lifestyle Approach

ABSTRACT

Forensic nurses providing care to patients who are victims or offenders of abuse, trauma, or violence often face enormous challenges in their daily practice, leading to emotional stress, vicarious traumatization, and burnout, and potentially reducing the quality of patient care. Embracing mindfulness as an ongoing method of self-care can have an array of benefits for forensic nurses to prevent burnout and improve their well-being and quality of patient care. Existing literature supports the benefits of mindfulness-based interventions, as self-care practices, in improving many positive health outcomes among nurses working in a variety of healthcare settings. Mindfulness qualities, such as open awareness, attention to detail, nonjudgment, emotional regulation, compassion, and empathy, can contribute to forensic nurses' well-being and the quality of patient care. Mindfulness is a way of living; thus, formal and informal mindful self-care tools integrated into daily nursing practice can result in better outcomes and work satisfaction among nurses. This article discusses the potential benefits of mindfulness and practical ways to integrate mindfulness tools into forensic nursing practice. Incorporating mindful self-care practices should be a goal for consideration for the contemporary forensic nursing profession at large. Further intervention research is recommended to identify the mechanism of how mindfulness can benefit forensic nurses practicing in highly challenging work environments.

The nurse bombarded, consumed and vulnerable: An interpretative phenomenological analysis of mental health nurses' self-care at work

INTRODUCTION

Self-care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self-care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self-care practices is essential. There is currently a paucity of literature on this topic.

AIM

To explore mental health nurses' views about what influences their ability to self-care in relation to workplace stress and the impact on their practice and work environment.

METHODS

An Interpretative Phenomenological Analysis approach was utilized. In-depth interviews explored how nurses perceived the influence of environment and relationships on self-care practices in the workplace.

RESULTS

Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes-the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care.

CONCLUSIONS

Stressful working environments pose major barriers to effective self-care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally.

IMPLICATIONS FOR PRACTICE

Mental health nurses' self-care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self-care are therefore necessary.

The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh

Background

Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms. Nurses' workplace stress is also linked to increased absenteeism and decreased job satisfaction.

Objectives

The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms.

Methods

A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses' workplace stress, coping strategies, and depressive symptoms.

Results

More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items.

Conclusion

Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses' work experiences and the unique contribution that workplace stressors have on their physical and mental health.

Ten outcome measures in forensic mental health: A survey of clinician views on comprehensiveness, ease of use and relevance

BACKGROUND

Measurement of outcomes in forensic mental health services is essential to ensure that these services are delivering good quality care and treatment. Instruments for outcome measurement should cover all important domains, be easy to implement in a routine clinical context and facilitate transfer of relevant information between clinicians as the patient progresses along a recovery and rehabilitation pathway.

AIMS

We sought the views of clinicians on 10 common instruments used as outcome measures in forensic mental health services, especially on their perceived comprehensiveness and ease of use.

METHODS

An online survey was used to gather the views of clinicians from a range of professional backgrounds working in forensic mental health services in the United Kingdom. The selected instruments were identified from a previous systematic review of instruments for measuring outcomes in this context. Questions covered comprehensiveness, ease of use, patient involvement, relevance and use for progressing tracking and care planning.

RESULTS

Complete responses were received from 229 individuals. The range of respondents either agreeing or strongly agreeing that individual instruments were comprehensive was 6-39%; easy to use 19%-69%; relevant 31%-78%; useful to measure progress 7-70%; and useful for care planning 33-81%. Respondents reported that, for each of the 10 instruments, full involvement of patients varied between 3% and 22%; partial involvement 12-45%, patients informed, but not involved 11%-28%; and patients not involved or informed 21%-64%.

CONCLUSIONS

The Health of the Nation Outcome Scale Secure, the only instrument designed as an outcome measure, is not regarded by clinicians as useful in that respect and the majority of clinicians do not inform patients they are using it. Clinicians appear most familiar with the Historical Clinical Risk 20 (HCR-20), which some respondents considered potentially useful as a progress measure but with limited patient involvement. Most respondents did not think that the HCR-20 is comprehensive. There is a need for outcome measures that are comprehensive, easy to use and have adequate patient involvement in their development and rating.

Forensic Mental Health Nurses' Perceptions of Clinical Supervision: A Qualitative Descriptive Study

Mental health nursing in the forensic services is perceived as stressful as there is often a tension between therapeutic and custodial processes. Clinical supervision has been discussed as a support strategy for nurses. The aim of this paper is to explore forensic mental health nurses understanding of clinical supervision and their perception of its utility within their practice. A qualitative descriptive method was used and 10 mental health nurses were interviewed with the aid of an interview guide. Qualitative data was analysed using a thematic approach culminating in the emergence of three themes.Participants talked about the tension between caring and custodial roles within the forensic services which was stressful and created difficulties in the maintenance of a therapeutic relationship. Clinical supervision was seen as a necessary support to assist nurses working in the forensic services. The findings support the premise that there is a tension between therapeutic and custodial practices. Acknowledgement of the complexities of working within the forensic services and the provision of clinical supervision within a confidential, non-judgemental relationship may assist nurses in the provision of care and the maintenance of therapeutic relationships.