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Långstedt C, Bressington D, Välimäki M. Nurses' and patients' perceptions of physical health screening for patients with schizophrenia spectrum disorders: a qualitative study. BMC Nurs 2024; 23:321. [PMID: 38734609 PMCID: PMC11088092 DOI: 10.1186/s12912-024-01980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Despite worldwide concern about the poor physical health of patients with schizophrenia spectrum disorders (SSD), physical health screening rates are low. This study reports nurses' and patients' experiences of physical health screening among people with SSD using the Finnish Health Improvement Profile (HIP-F) and their ideas for implementation improvements. METHODS A qualitative exploratory study design with five group interviews with nurses (n = 15) and individual interviews with patients with SSD (n = 8) who had experience using the HIP-F in psychiatric outpatient clinics. Inductive content analysis was conducted. RESULTS Two main categories were identified. First, the characteristics of the HIP-F were divided into the subcategories of comprehensive nature, facilitating engagement, interpretation and rating of some items and duration of screening. Second, suggestions for the implementation of physical health screening consisted of two subcategories: improvements in screening and ideas for practice. Physical health screening was felt to increase the discussion and awareness of physical health and supported health promotion. The HIP-F was found to be a structured, comprehensive screening tool that included several items that were not otherwise assessed in clinical practice. The HIP-F was also considered to facilitate engagement by promoting collaboration in an interactive way. Despite this, most of the nurses found the HIP-F to be arduous and too time consuming, while patients found the HIP-F easy to use. Nurses found some items unclear and infeasible, while patients found all items feasible. Based on the nurses' experiences, screening should be clear and easy to interpret, and condensation and revision of the HIP-F tool were suggested. The patients did not think that any improvements to the HIP-F were needed for implementation in clinical settings. CONCLUSIONS Patients with schizophrenia spectrum disorders are willing to participate in physical health screening. Physical health screening should be clear, easy to use and relatively quick. With this detailed knowledge of perceptions of screening, further research is needed to understand what factors affect the fidelity of implementing physical health screening in clinical mental health practice and to gain an overall understanding on how to improve such implementation.
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Affiliation(s)
- Camilla Långstedt
- University of Turku, Faculty of Medicine, Department of Nursing, Kiinamyllynkatu 10, Medisiina B, Turku, 20520, Finland.
| | - Daniel Bressington
- Professor in Mental Health, Faculty of Health, Charles Darwin University, Casuarina, Australia
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai, Thailand
| | - Maritta Välimäki
- University of Turku, Faculty of Medicine, Department of Nursing, Kiinamyllynkatu 10, Medisiina B, Turku, 20520, Finland
- University of Helsinki, School of Public Health, Helsinki, Finland
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Nolan H, O'Donoghue B, Simmons M, Zbukvic I, Ratcliff S, Milton A, Hughes E, Thompson A, Brown E. The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project. BMC Health Serv Res 2024; 24:262. [PMID: 38429748 PMCID: PMC10905889 DOI: 10.1186/s12913-024-10734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia. METHODS We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention. RESULTS Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified. CONCLUSIONS Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.
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Affiliation(s)
- Hayley Nolan
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- University College Dublin, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons, Ireland, Ireland
| | - Magenta Simmons
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Isabel Zbukvic
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Sophia Ratcliff
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
| | - Alyssa Milton
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Elizabeth Hughes
- Research Centre for Applied Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Andrew Thompson
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Ellie Brown
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia.
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.
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Urry K, Breakey GR, Scholz B, Chur-Hansen A. Approaches for improving sexuality and sexual health care in mental health settings: A qualitative study exploring clinicians' own perspectives. Int J Ment Health Nurs 2024; 33:125-133. [PMID: 37737548 DOI: 10.1111/inm.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
There is an acknowledged professional practice gap regarding sexuality and sexual health related needs within mental health settings in Australia and internationally. Yet little is known about how clinicians can be best supported or enabled to improve sexuality-related practice, from their own perspective. This is important, given the sensitive and complex nature of sexuality and sexual health within the context of mental distress and service provision. This article reports a follow-up study, where mental health clinicians who participated in an initial study were invited to reflect on and discuss the (finalized) results and recommendations generated. The aim was to generate insights into the tools, strategies, and approaches participants felt would best equip and support clinicians to better incorporate sexuality and sexual health into their work. Six clinicians from three disciplines (mental health nursing, psychology, and psychiatry) participated in in-depth interviews to reflect on a plain language summary of the initial study. Three interconnected themes were generated via reflexive thematic analysis: (1) access to knowledge and information; (2) support from peers, senior colleagues, and workplaces; and (3) enacting a focus on sexuality-related care. These findings provide valuable insights into how clinicians may want to be supported in relation to (improving) their sexuality-related practice. The analysis also demonstrates the importance of a multifaceted approach to improving sexuality-related care in mental health and other health settings. This knowledge will contribute to directing future research and development of interventions, tools, strategies, or other approaches to this end.
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Affiliation(s)
- Kristi Urry
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Georgia R Breakey
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University, Ngunnawal Country, Canberra, Australian Capital Territory, Australia
| | - Anna Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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4
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Tung TH, Chen HW, Chou HH, Tsai JL, Yang YC, Lee JT. Does a one-session sexual health education program improve sexual confidence in patients with cervical cancer? A transtheoretical model-based clinical study. Arch Gynecol Obstet 2024; 309:249-258. [PMID: 37493777 DOI: 10.1007/s00404-023-07141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE This study aimed to evaluate the effects of a one-session sexual health education program using a transtheoretical model to enhance sexual self-efficacy in patients with cervical cancer. METHODS This study recruited patients with cervical cancer from the gynecological wards of a medical center in northern Taiwan. A total of 63 participants were divided into 2 groups: the control group (n = 30) received traditional sexual health education. The intervention group (n = 33) participated in a transtheoretical model (TTM)-based sexual health education program. Scores from self-report questionnaires for variables of knowledge, attitudes, and self-efficacy regarding sexual health collected 1 and 6 weeks after the intervention were compared with baseline scores. RESULTS Patients who received transtheoretical model (TTM)-based sexual health education had significantly greater sexual knowledge (β = 3.794, p < 0.01), sexual attitudes (β = 9.226, p < 0.01), and sexual self-efficacy (β = 17.053, p < 0.01) than those who received traditional sexual health education at 1 and 6 weeks. CONCLUSION Our findings suggest that a one-session sexual health education using a TTM-based model can enhance sexual knowledge, attitudes, and sexual self-efficacy among patients with cervical cancer. This educational program can be translated into routine clinical practice to help patients with cervical cancer enhance their sexual health and improve confidence in their sexual well-being.
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Affiliation(s)
- Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated With Wenzhou Medical University, Linhai, Zhejiang, China
| | - Hsiao-Wei Chen
- School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Linkou Branch, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Jia-Ling Tsai
- School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Ya-Chieh Yang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian Tao Lee
- School of Nursing, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
- Nursing Department, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan, Taiwan.
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Lu MJ, Li JB, Wu CY, Huong PTT, Hsu PC, Chang CR. Effectiveness of a Sexual Health Care Training to Enhance Psychiatric Nurses' Knowledge, Attitude, and Self-Efficacy: A Quasi-Experimental Study in Southern Taiwan. J Am Psychiatr Nurses Assoc 2024; 30:17-29. [PMID: 34533070 DOI: 10.1177/10783903211045733] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sexual health is a taboo issue in some societies. Limited assessments were conducted during nursing care in mental health services. It is unknown whether psychiatric nurses' competencies would be enhanced through short training courses. AIMS The present study employed a quasi-experimental design to evaluate the effectiveness of an 8-hour sexual health care training for psychiatric nurses to improve sexual health knowledge, attitude, and self-efficacy in a teaching psychiatric hospital in southern Taiwan. METHOD Volunteered psychiatric nurses were randomly assigned to the experimental or control group. The 8-hour training program contained sexual health knowledge and attitudes, case discussion, role play, and sexual identity or harassment issues. Each nurse received a pretest and a posttest in the 1-month period between August and September 2019. Descriptive and multivariate statistical analyses were used to evaluate the effects. RESULTS Among the 75 psychiatric nurses, 43 were in the control group and 32 were in the experimental group. The two groups were not significantly different in the working year, gender, education, marriage, and other psychosocial variables. After the training, the overall performance of sexual health care knowledge, attitudes, and self-efficacy of the experimental group improved significantly than the controls. CONCLUSIONS The sexual health care training program enhanced psychiatric nurses' confidence and generally improved their sexual knowledge and attitudes. It is suggested that sexual health care needs to be highlighted during in-job training to augment the well-being and life quality of psychiatric patients.
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Affiliation(s)
- Mei-Jou Lu
- Mei-Jou Lu, MSc, RN, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung; Fooyin University, Kaohsiung, Taiwan
| | - Jin-Biau Li
- Jin-Biau Li, PhD, RN, Cardinal Tien Junior College of Healthcare and Management
| | - Chia-Yi Wu
- Chia-Yi Wu, PhD, RN, School of Nursing, National Taiwan University College of Medicine, Taipei; Department of Nursing, National Taiwan University Hospital, Taipei; Taiwan Suicide Prevention Center, Taipei
| | - Pham Thi Thu Huong
- Pham Thi Thu Huong, PhD Candidate, MSN, RN, School of nursing, National Taiwan University College of Medicine, Taipei, Taiwan; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam; National Institute of Mental Health, Bach Mai Hospital, Hanoi, Vietnam
| | - Pei-Chen Hsu
- Pei-Chen Hsu, RN, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chiou-Rong Chang
- Chiou-Rong Chang, RN, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Gurusamy J, Amudhan S, Menen M, Veerabhadraiah KB, Damodharan D. Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India. Issues Ment Health Nurs 2023; 44:1009-1019. [PMID: 37819752 DOI: 10.1080/01612840.2023.2262581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.
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Affiliation(s)
- Jothimani Gurusamy
- College of Nursing, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Melwine Menen
- Clinical Nursing Services, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | | | - Dinakaran Damodharan
- Center for Psychosocial Support and Disaster Management, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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McKinnon K, Jaafar F, Alves-Bradford JM, Weinstein T, Zurita McKinnon A, Hughes E, Boccher-Lattimore D, Cournos F. Sexual health services in urban, suburban, and rural outpatient mental healthcare settings in New York: findings from a survey of practices and gaps. Sex Health 2023; 20:360-362. [PMID: 37156243 DOI: 10.1071/sh22199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
We surveyed all licensed outpatient mental health programs in New York to examine sexual health services and training needs of providers. Gaps were found in processes for assessing whether patients were sexually active, engaging in sexual risk behaviours, and in need of HIV testing and pre-exposure prophylaxis. Significant differences between urban, suburban, and rural settings statewide were found in how the following sexual health services were delivered: education; on-site sexually transmitted infection screenings; and condom distribution and barriers to distribution. Staff training in sexual health services delivery is critically needed for optimal sexual health and recovery of patients in community mental healthcare.
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Affiliation(s)
- Karen McKinnon
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 112, New York, NY 10032, USA; and Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA
| | - Fatima Jaafar
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA; and Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Jean-Marie Alves-Bradford
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 112, New York, NY 10032, USA
| | - Taylor Weinstein
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA
| | - Alma Zurita McKinnon
- Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA
| | - Elizabeth Hughes
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, Scotland EH11 4BN, UK
| | - Daria Boccher-Lattimore
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 112, New York, NY 10032, USA; and Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA; and Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Francine Cournos
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 112, New York, NY 10032, USA; and Northeast/Caribbean AIDS Education and Training Center, Columbia University, 601 West 168 Street, Apartment 46, New York, NY 10032, USA; and Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
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8
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Kröger C, van Baarle E, Widdershoven G, Bal R, Weenink JW. Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations. BMC Med Ethics 2022; 23:49. [PMID: 35505331 PMCID: PMC9066979 DOI: 10.1186/s12910-022-00786-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Sexual boundary violations (SBV) in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations. Methods We carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data. Results We found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: (1) setting rules and regulations, (2) engaging in dialogue about sexuality, and (3) addressing systemic and organizational dimensions. Conclusion Our findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations.
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Affiliation(s)
- Charlotte Kröger
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1089a, Amsterdam, The Netherlands.
| | - Eva van Baarle
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Netherlands Defense Academy, Breda, The Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan-Willem Weenink
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Tennille J, Bohrman C, Barrenger S, Compton E, Meduna E, Klein L. Behavioral Health Provider Attitudes and Beliefs about Sexuality and Intimacy: Findings from a Mixed Method Design. Community Ment Health J 2022; 58:444-453. [PMID: 34081264 DOI: 10.1007/s10597-021-00838-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
Recovery-oriented services overlook a crucial health domain for persons with severe mental illnesses (SMI): sexuality and intimacy. Though this aspect of social recovery correlates with improved life quality and treatment outcomes, behavioral health (BH) providers avoid such topics. The study's purpose was to obtain an updated snapshot of their attitudes and beliefs about sexuality and intimacy communication. Utilizing a community advisory board, we adapted the Sexual Attitudes and Beliefs Survey (SABS) and distributed it via survey link to a national listserv. We used independent samples t-tests to examine differences on SABS mean scores by gender, age group, educational attainment, and previous training on sexuality and intimacy. We asked open-ended questions and coded responses using content analysis. Participants with more education and previous exposure to training on sexuality and intimacy were more likely to hold open views on communication. Findings offer directions for addressing this neglected aspect of recovery.
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Affiliation(s)
- Julie Tennille
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA.
| | - Casey Bohrman
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
| | - Stacey Barrenger
- Psychiatry, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Emma Compton
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
| | - Evan Meduna
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
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10
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Edvardsson K, Hughes E, Copnell B, Mogren I, Vicendese D, Gray R. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009–2016. PLoS One 2022; 17:e0264512. [PMID: 35226688 PMCID: PMC8884496 DOI: 10.1371/journal.pone.0264512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia. Methods Our sample included all reported live singleton births in Victoria 2009–2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness. Results Of all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37–2.43), having gestational diabetes mellitus (1.57, 1.34–1.84), undergoing an unplanned caesarean section (1.17, 1.02–1.33), induction of labour (1.17, 1.05–1.30) and postpartum haemorrhage (1.15, 1.03–1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43–1.80), a low Apgar score at 5 minutes (1.50, 1.19–1.90), preterm birth (1.40, 1.20–1.63), and low birthweight (1.26, 1.06–1.49). Conclusion Women with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.
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Affiliation(s)
- Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- * E-mail:
| | - Elizabeth Hughes
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Ingrid Mogren
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- Department of Clinical sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
- The Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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Brand E, Nagaraj D, Ratsch A, Heffernan E. A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia. Front Psychiatry 2022; 13:832139. [PMID: 35432027 PMCID: PMC9008211 DOI: 10.3389/fpsyt.2022.832139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Dinesh Nagaraj
- Community Mental Health and Addiction Services, Waikato District Health Board, Hamilton, New Zealand
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia.,Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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A Scoping Review to Identify Barriers and Enabling Factors for Nurse-Patient Discussions on Sexuality and Sexual Health. NURSING REPORTS 2021; 11:253-266. [PMID: 34968203 PMCID: PMC8608105 DOI: 10.3390/nursrep11020025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Sexuality and sexual health (SSH) are essential aspects of care that have evolved since a 1975 World Health Organization (WHO) report on SSH. However, nurses still consider discussing the subject with patients a challenge. This scoping review aimed to map, synthesize, and summarize findings from existing literature regarding barriers and enabling factors for nurse–patient SSH discussions in care contexts. Methods: A scoping review model inspired by Arksey and O’Malley was used to search for and synthesize studies published between 2009 and 2019. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online, i.e., MEDLARS Online. A total of nineteen articles were eligible to be included. Results: Two main categories of enabling factors were identified, i.e., a professional approach via using core care values and availability of resources. Three major categories of barriers were identified: beliefs and attitudes related to age, gender, and sexual identity; fear and individual convictions; and work-related factors. Conclusions: Applying professionalism and core care values as well as making resources available are likely to promote SSH discussions between nurses and patients. Moreover, there is a need for a norm-critical approach in education and practice.
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13
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Scholz B, Happell B, Gordon S, Warner T, Roper C, Ellis P, Waks S, Platania-Phung C. 'People Just Need to Try It to Be Converted!': A Picture of Consumer Mental Health Research in Australia and New Zealand. Issues Ment Health Nurs 2021; 42:249-255. [PMID: 32790538 DOI: 10.1080/01612840.2020.1795763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A range of barriers that impede collaborations between consumer researchers and other researchers have been identified, despite clear acknowledgement of the benefits of this approach in the literature. Recent research has questioned whether the costs of collaborative research outweigh the benefits. The overarching aim of the current study is to better understand non-consumer researchers' attitudes to, and issues concerning, engagement with consumer researchers. Non-consumer researchers from mental health disciplines were invited to participate in the cross-sectional Consumers as Researchers in Mental Health survey, and to respond to open-ended questions about their experiences of collaborative research with consumer researchers. The findings demonstrate a range of benefits associated with collaborations with consumer researchers - including increased relevance and credibility of research, and greater translation of research findings into changes in health policy, service, research and education. Collaborations were found to be varied and not limited by research design, decision-making styles, or research topic. Understanding these benefits within the context of identified barriers can make an important contribution to the proliferation of mental health consumer researcher roles.
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Affiliation(s)
- Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Hunter Medical Research Institute, and Priority Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Sarah Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Terri Warner
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,ACT Mental Health Consumer Network, Canberra, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Pete Ellis
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand Wellington South
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- Australian College of Applied Psychology, Conjoint Lecturer, School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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14
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Brand E, Ratsch A, Heffernan E. The Sexual Development, Sexual Health, Sexual Experiences, and Sexual Knowledge of Forensic Mental Health Patients: A Research Design and Methodology Protocol. Front Psychiatry 2021; 12:651839. [PMID: 34149475 PMCID: PMC8212926 DOI: 10.3389/fpsyt.2021.651839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: There is substantial evidence that severe mental illness (SMI) can have significant impacts on general development, knowledge acquisition, and quality of life including sexual function. However, whilst the sexual development, sexual health, sexual experiences and sexual knowledge of the broader Australian community and the Australian prisoner population have been well-described, these concepts have been less explored in people with a SMI. In particular, there is an absence of research around these topics involving people who are subject to a treatment order (aka a Forensic Order) under the relevant jurisdictional Mental Health Act. Methods and Analysis: People currently under the treatment requirements of a Queensland Forensic Order will be invited to participate in this descriptive, mixed-method study. The study will be conducted in three phases. The first two phases will involve 50 participants (100 face-to-face quantitative interviews) with the aim of mapping sexual development, sexual health, sexual experiences, and sexual knowledge. The third phase will involve qualitative semi-structured interviews with a purposely enrolled, informant-rich cohort identified through the quantitative surveys until saturation is reached. Quantitative data will be analyzed using descriptive and comparative statistics. Qualitative data will be analyzed by content analysis of the major themes. Ethics and dissemination: The project has ethics approval from a Queensland Health Human Research Ethics Committee. Results will be reported to participants and other stakeholders at seminars and conferences and through peer-reviewed publications. Strengths and Limitations of this Study: This is a mixed-method study which engages with participants by using face-to-face interviews. The study is conducted in three phases which sub-divide the research into the following areas: (1) demographics, general health, and sexual health, (2) sexual knowledge and experiences, and (3) sexual knowledge gaps. This study uses electronic data capture to efficiently record and analyse participant responses. This study captures self-reported data and uses non-probability sampling from a population who have been pre-selected through an arms-length approach-both these processes elevate the risk of bias.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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15
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Brand E, Ratsch A, Heffernan E. Case Report: The Sexual Experiences of Forensic Mental Health Patients. Front Psychiatry 2021; 12:651834. [PMID: 33897501 PMCID: PMC8062769 DOI: 10.3389/fpsyt.2021.651834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
The recovery-based approach to forensic mental health rehabilitation is to support the patient to achieve a fulfilling life-a principle which should include achieving a fulfilling sexual life. This paper presents four vignettes from forensic mental health patients. The four cases demonstrate the omission, avoidance and then judgement by forensic mental health clinicians around the intimate and sensitive, yet important domain of the patient's sexual life. The cases illustrate that gap in the clinical domain and demonstrate the requirement for forensic mental health clinicians to have a greater awareness, acknowledgment, and assessment of their patient's sexuality and sexual health needs. Incorporating sexual health into standard clinical assessments will contribute to improved patient management in addition to supporting the principles of holistic forensic mental health recovery and rehabilitation.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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16
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Cournos F, Dare C, Hewitt C, Johnson S, Kaur HD, McKinnon K, Mercer C, Nolan F, Walker C, Wainberg M, Watson J. The RESPECT study: a feasibility randomised controlled trial of a sexual health promotion intervention for people with serious mental illness in community mental health services in the UK. BMC Public Health 2020; 20:1736. [PMID: 33203433 PMCID: PMC7673083 DOI: 10.1186/s12889-020-09661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background People with serious mental illness (SMI) have sexual health needs but there is little evidence to inform effective interventions to address them. In fact, there are few studies that have addressed this topic for people with SMI outside USA and Brazil. Therefore, the aim of the study was to establish the acceptability and feasibility of a trial of a sexual health promotion intervention for people with SMI in the UK. Method The RESPECT study was a two-armed randomised controlled, open feasibility trial (RCT) comparing Sexual health promotion intervention (3 individual sessions of 1 h) (I) or treatment as usual (TAU) for adults aged 18 or over, with SMI, within community mental health services in four UK cities. The main outcome of interest was the percentage who consented to participate, and retained in each arm of the trial, retention for the intervention, and completeness of data collection. A nested qualitative study obtained the views of participants regarding the acceptability of the study using individual telephone interviews conducted by lived experience researchers. Results Of a target sample of 100, a total of 72 people were enrolled in the trial over 12 months. Recruitment in the initial months was low and so an extension was granted. However this extension meant that the later recruited participants would only be followed up to the 3 month point. There was good retention in the intervention and the study as a whole; 77.8% of those allocated to intervention (n = 28) received it. At three months, 81.9% (30 I; 29 TAU) and at 6 months, 76.3% (13 I and 16 TAU) completed the follow-up data collection. No adverse events were reported. There was good completeness of the data. The sexual health outcomes for the intervention group changed in favour of the intervention. Based on analysis of the qualitative interviews, the methods of recruitment, the quality of the participant information, the data collection, and the intervention were deemed to be acceptable to the participants (n = 22). Conclusions The target of 100 participants was not achieved within the study’s timescale. However, effective strategies were identified that improved recruitment in the final few months. Retention rates and completeness of data in both groups indicate that it is acceptable and feasible to undertake a study promoting sexual health for people with SMI. A fully powered RCT is required to establish effectiveness of the intervention in adoption of safer sex. Study registration ISRCTN RegistryISRCTN15747739 prospectively registered 5th July 2016.
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Affiliation(s)
- Elizabeth Hughes
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK. .,Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England.
| | - Natasha Mitchell
- Department of Health Sciences, University of York, York, England
| | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, England
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, England
| | - Francine Cournos
- New York State Psychiatric Institute and Columbia University, New York, USA
| | | | - Catherine Hewitt
- Department of Health Sciences, University of York, York, England
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, England.,, Camden and Islington NHS Foundation Trust, England
| | | | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University, New York, USA
| | - Catherine Mercer
- Institute for Global Health, University College London, London, England
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, England
| | | | - Milton Wainberg
- New York State Psychiatric Institute and Columbia University, New York, USA
| | - Judith Watson
- Department of Health Sciences, University of York, York, England
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17
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Dare C, Hewitt C, Johnson S, Llewellyn C, Mercer C, Nolan F, Walker C, Watson J. Sexual health promotion in people with severe mental illness: the RESPECT feasibility RCT. Health Technol Assess 2020; 23:1-136. [PMID: 31854292 DOI: 10.3310/hta23650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND People with serious mental illness have sexual health needs, but there is limited evidence regarding effective interventions to promote their sexual health. OBJECTIVES To develop a sexual health promotion intervention for people with serious mental illness, and to conduct a feasibility trial in order to establish the acceptability and parameters for a fully powered trial. DESIGN A two-armed randomised controlled, open feasibility study comparing usual care alone with usual care plus the adjunctive intervention. SETTING Five community mental health providers in Leeds, Barnsley, Brighton and London. PARTICIPANTS Adults aged ≥ 18 years with serious mental illness and receiving care from community mental health teams. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to usual care plus the RESPECT (Randomised Evaluation of Sexual health Promotion Effectiveness informing Care and Treatment) intervention (three sessions of 1 hour) (intervention arm) or usual care only (control arm). The intervention was an interactive manualised package of exercises, quizzes and discussion topics focusing on knowledge, motivation and behavioural intentions to adopt safer sexual behaviours. MAIN OUTCOME MEASURES Feasibility parameters including establishing the percentage of people who were eligible, consented and were retained in each arm of the trial, retention for the intervention, as well as the completeness of the data collection. Data were collected on knowledge, motivation to adopt safer sexual behaviour, sexual behaviour, sexual stigma, sexual health service use and quality of life. Data were collected at baseline and then at 3 months and 6 months post randomisation. RESULTS Of a target of 100 participants, 72 people participated in the trial over 12 months. Of the 36 participants randomised to the intervention arm, 27 received some of the intervention (75.0%). At 3 months, 59 of the 72 participants completed follow-up questionnaires (81.9%) (30 participants from the intervention arm and 29 participants from the control arm). Only the first 38 participants were followed up at 6 months. However, data were collected on 29 out of 38 participants (76.3% retention): 13 in the intervention arm and 16 in the control arm. No adverse events were reported. Participant feedback confirmed that both the design and the intervention were acceptable. The economic analysis indicated high completion rates and completeness of data among participants who continued the trial. CONCLUSIONS Despite the limitations, the findings suggest that it is both acceptable and feasible to undertake a sexual health promotion study for people with serious mental illness. FUTURE WORK A fully powered randomised controlled trial would be required to establish the clinical effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN15747739. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - Catherine Mercer
- Institute for Global Health, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | | | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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18
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Iriarte-Roteta A, Lopez-Dicastillo O, Mujika A, Ruiz-Zaldibar C, Hernantes N, Bermejo-Martins E, Pumar-Méndez MJ. Nurses' role in health promotion and prevention: A critical interpretive synthesis. J Clin Nurs 2020; 29:3937-3949. [PMID: 32757432 DOI: 10.1111/jocn.15441] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Role confusion is hampering the development of nurses' capacity for health promotion and prevention. Addressing this requires discussion to reach agreement among nurses, managers, co-workers, professional associations, academics and organisations about the nursing activities in this field. Forming a sound basis for this discussion is essential. AIMS AND OBJECTIVES To provide a description of the state of nursing health promotion and prevention practice expressed in terms of activities classifiable under the Ottawa Charter and to reveal the misalignments between this portrayal and the ideal one proposed by the Ottawa Charter. METHODS A critical interpretive synthesis was conducted between December 2018 and May 2019. The PubMed, CINAHL, Scopus, PsychINFO, Web of Science and Dialnet databases were searched. Sixty-two papers were identified. The relevant data were extracted using a pro-forma, and the reviewers performed an integrative synthesis. The ENTREQ reporting guidelines were used for this review. RESULTS Thirty synthetic constructs were developed into the following synthesising arguments: (a) addressing individuals' lifestyles versus developing their personal skills; (b) focusing on environmental hazards versus creating supportive environments; (c) action on families versus strengthening communities; (d) promoting community partnerships versus strengthening community action; and (e) influencing policies versus building healthy public policy. CONCLUSIONS There are notable misalignments between nurses' current practice in health promotion and prevention and the Ottawa Charter's actions and strategies. This may be explained by the nurses' lack of understanding of health promotion and prevention and political will, research methodological flaws, the predominance of a biomedical perspective within organisations and the lack of organisational prioritisation for health promotion and prevention.
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Affiliation(s)
| | - Olga Lopez-Dicastillo
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Agurtzane Mujika
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | | | - Naia Hernantes
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - Elena Bermejo-Martins
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - María J Pumar-Méndez
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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19
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Urry K, Chur-Hansen A, Khaw C. 'It's just a peripheral issue': A qualitative analysis of mental health clinicians' accounts of (not) addressing sexuality in their work. Int J Ment Health Nurs 2019; 28:1278-1287. [PMID: 31353790 DOI: 10.1111/inm.12633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 02/05/2023]
Abstract
Sexuality, relationships, and intimacy are integral parts of many peoples' lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In-depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants' accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were 'Sexuality is hard to talk about' and 'Sexuality is a "peripheral issue"'. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub-themes): that sexuality rarely 'comes up', that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants' roles or skill sets. A third theme captured the contrasting perception that 'Sexuality could be better addressed' in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery-oriented principles in mental health settings.
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Affiliation(s)
- Kristi Urry
- Faculty of Health and Medical Sciences, School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- Faculty of Health and Medical Sciences, School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Carole Khaw
- Adelaide Sexual Health Centre, Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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20
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Hughes E, Mitchell N, Gascoyne S, Moe-Byrne T, Edmondson A, Coleman E, Millett L, Ali S, Dare C, Hewitt C, Johnson S, Llewellyn C, Mercer C, Nolan F, Walker C, Watson J. Sexual health promotion in people with severe mental illness: the RESPECT feasibility RCT. Health Technol Assess 2019; 23:1-136. [PMID: 31854292 DOI: 10.3310/hta23610.pmid:31670644;pmcid:pmc6843114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND People with serious mental illness have sexual health needs, but there is limited evidence regarding effective interventions to promote their sexual health. OBJECTIVES To develop a sexual health promotion intervention for people with serious mental illness, and to conduct a feasibility trial in order to establish the acceptability and parameters for a fully powered trial. DESIGN A two-armed randomised controlled, open feasibility study comparing usual care alone with usual care plus the adjunctive intervention. SETTING Five community mental health providers in Leeds, Barnsley, Brighton and London. PARTICIPANTS Adults aged ≥ 18 years with serious mental illness and receiving care from community mental health teams. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to usual care plus the RESPECT (Randomised Evaluation of Sexual health Promotion Effectiveness informing Care and Treatment) intervention (three sessions of 1 hour) (intervention arm) or usual care only (control arm). The intervention was an interactive manualised package of exercises, quizzes and discussion topics focusing on knowledge, motivation and behavioural intentions to adopt safer sexual behaviours. MAIN OUTCOME MEASURES Feasibility parameters including establishing the percentage of people who were eligible, consented and were retained in each arm of the trial, retention for the intervention, as well as the completeness of the data collection. Data were collected on knowledge, motivation to adopt safer sexual behaviour, sexual behaviour, sexual stigma, sexual health service use and quality of life. Data were collected at baseline and then at 3 months and 6 months post randomisation. RESULTS Of a target of 100 participants, 72 people participated in the trial over 12 months. Of the 36 participants randomised to the intervention arm, 27 received some of the intervention (75.0%). At 3 months, 59 of the 72 participants completed follow-up questionnaires (81.9%) (30 participants from the intervention arm and 29 participants from the control arm). Only the first 38 participants were followed up at 6 months. However, data were collected on 29 out of 38 participants (76.3% retention): 13 in the intervention arm and 16 in the control arm. No adverse events were reported. Participant feedback confirmed that both the design and the intervention were acceptable. The economic analysis indicated high completion rates and completeness of data among participants who continued the trial. CONCLUSIONS Despite the limitations, the findings suggest that it is both acceptable and feasible to undertake a sexual health promotion study for people with serious mental illness. FUTURE WORK A fully powered randomised controlled trial would be required to establish the clinical effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN15747739. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | | | | | - Amanda Edmondson
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Lottie Millett
- Division of Psychiatry, University College London, London, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - Catherine Mercer
- Institute for Global Health, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | | | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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21
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Yalçın SU, Bilgin H, Özaslan Z. Physical Healthcare of People with Serious Mental Illness: A Cross-Sectional Study of Nurses' Involvement, Views, and Current Practices. Issues Ment Health Nurs 2019; 40:908-916. [PMID: 31283366 DOI: 10.1080/01612840.2019.1619201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Based on the poor physical health and unhealthy lifestyle behaviors, people with serious mental illness (SMI) have a high risk for long-term disorders such as diabetes, cardiovascular and respiratory diseases. Aims: This study examined nurses' current practices and views regarding the physical health of people with SMI. Methods: Cross-sectional study was conducted among nurses working in acute wards in large mental health hospital in Istanbul, Turkey. Convenience sample of 184 nurses agreed to participate in the study. Data collection was based on the self-reported responses. Descriptive statistics and comparison tests were used to describe the sample's characteristics and identify associations amongst the participants' characteristics. Findings: The results showed that nurses considered the patients' physical health important, particularly female nurses. Monitoring blood pressure, assessing physical health status at admission, and helping self-care needs were common practices. Believing in the importance of physical health was correlated with high knowledge and self-confidence levels in delivery of physical healthcare. Discussion: These findings are useful for implementing integrated nursing care in acute psychiatric care and improving patients' mental and physical well-being.
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Affiliation(s)
| | - Hülya Bilgin
- Florence Nightingale Nursing Faculty, Istanbul University , Istanbul , Turkey
| | - Zeynep Özaslan
- Health Sciences Faculty, Kocaeli University , Kocaeli , Turkey
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Dickens GL, Ion R, Waters C, Atlantis E, Everett B. Mental health nurses' attitudes, experience, and knowledge regarding routine physical healthcare: systematic, integrative review of studies involving 7,549 nurses working in mental health settings. BMC Nurs 2019; 18:16. [PMID: 31057334 PMCID: PMC6485121 DOI: 10.1186/s12912-019-0339-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background There has been a recent growth in research addressing mental health nurses’ routine physical healthcare knowledge and attitudes. We aimed to systematically review the empirical evidence about i) mental health nurses’ knowledge, attitudes, and experiences of physical healthcare for mental health patients, and ii) the effectiveness of any interventions to improve these aspects of their work. Methods Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple electronic databases were searched using comprehensive terms. Inclusion criteria: English language papers recounting empirical studies about: i) mental health nurses’ routine physical healthcare-related knowledge, skills, experience, attitudes, or training needs; and ii) the effectiveness of interventions to improve any outcome related to mental health nurses’ delivery of routine physical health care for mental health patients. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative, narrative synthesis of study findings was conducted. Results Fifty-one papers covering studies from 41 unique samples including 7549 mental health nurses in 14 countries met inclusion criteria. Forty-two (82.4%) papers were published since 2010. Eleven were intervention studies; 40 were cross-sectional. Observational and qualitative studies were generally of good quality and establish a baseline picture of the issue. Intervention studies were prone to bias due to lack of randomisation and control groups but produced some large effect sizes for targeted education innovations. Comparisons of international data from studies using the Physical Health Attitudes Scale for Mental Health Nursing revealed differences across the world which may have implications for different models of student nurse preparation. Conclusions Mental health nurses’ ability and increasing enthusiasm for routine physical healthcare has been highlighted in recent years. Contemporary literature provides a base for future research which must now concentrate on determining the effectiveness of nurse preparation for providing physical health care for people with mental disorder, determining the appropriate content for such preparation, and evaluating the effectiveness both in terms of nurse and patient- related outcomes. At the same time, developments are needed which are congruent with the needs and wants of patients. Electronic supplementary material The online version of this article (10.1186/s12912-019-0339-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geoffrey L Dickens
- 1Professor Mental Health Nursing, Centre for Applied Nursing Research (CANR), Western Sydney University, Sydney, Australia.,2South West Sydney Local Health District, Sydney, Australia
| | - Robin Ion
- 3Division of Mental Health Nursing and Counselling, Abertay University, Dundee, Scotland
| | - Cheryl Waters
- 1Professor Mental Health Nursing, Centre for Applied Nursing Research (CANR), Western Sydney University, Sydney, Australia
| | - Evan Atlantis
- 1Professor Mental Health Nursing, Centre for Applied Nursing Research (CANR), Western Sydney University, Sydney, Australia
| | - Bronwyn Everett
- 1Professor Mental Health Nursing, Centre for Applied Nursing Research (CANR), Western Sydney University, Sydney, Australia
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