Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review

Mental Health Risk Assessments of Patients, by Nurses Working in Mental Health Settings: A Qualitative Study Using Cognitive Continuum Theory

Mental health risk-assessments are an important part of nursing in mental health settings, to protect patients or others from harm. Even so, nurses often have difficulty identifying patients posing a credible risk (either to self or others), so guidance is recommended. However, despite an extensive and growing body of risk-oriented literature, comparatively little expands upon contemporary knowledge of nurses and patient risk assessment. Therefore, it remains unclear how nurses understand risk and undertake their risk assessments. To address this knowledge gap in nurses' decision-making processes, this study used the established Cognitive Continuum Theory as a novel means to explore the risk-assessment of patients by nurses working in mental health settings.

Competencies Emergency and Mental Health Nurses Need in Triage in Acute Mental Health Care: A Narrative Review

INTRODUCTION

Emergency and mental health nurses are, in many countries, the designated professionals to conduct acute mental health triage. This review aimed to identify competencies these nurses need in major acute health care services such as emergency and accident departments and mental health crisis services for triage for psychiatric patients in crisis.

METHODS

For familiarization and construction of an initial thematic framework, we have searched the databases MEDLINE, CINAHL, Academic Search Premier, and PsycINFO since 1975. For indexing and sorting, the web-based application Rayyan was used to identify relevant studies. ATLAS.ti 22 was used for data extraction, reviewing, summary, and display using labels relevant for our research questions: knowledge, skills, and attitude. For appraisal of the included studies, the Mixed Methods Appraisal Tool and the Scale of the Assessment for Narrative Reviews were used.

RESULTS

Thirty one studies were included and were overall rated as adequate, mostly published since 2000. Competencies needed by nurses in AMHT contain a high level of specialist knowledge (risk assessment, de-escalation, triage tools, psychopathology, law/regulations, care pathways), skills (clinical skills, communication, collaboration, coordinating care), and attitude (nonjudgmental, confidence).

DISCUSSION

Emergency and mental health nurses require a significant amount of competencies beyond basic nursing education in acute mental health triage. Most described competencies pertain both to knowledge and skills. Less is known about attitude. To integrate the several competencies knowledge, skills, and attitude, clinical reasoning is needed to organize chaos in unpredictable and complex patient situations.

Risk-Actuated Public Interest Disclosure Practices of Nurses Working in Mental Health, Pertaining to Confidential Information of Patients

For nurses working in mental health, the inappropriate handling of confidential information may cause issues for stakeholders. However, there is a paucity of research literature to guide nurses. Therefore, this study aimed to add to the extant literature on risk-actuated public-interest disclosure practices of nurses. The study found participants understood exceptions to confidentiality, but not the concept of public interest. Furthermore, disclosure for risk management in perceived risk laden scenarios, was described by participants as a collaborative endeavour, albeit one where peer advice was not necessarily followed. Finally, participants' risk-actuated disclosure-related decision-making focussed on protecting a patient or others from harm.

Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health?

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a 'common sense' blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.

Reporting Inpatients' Experiences and Satisfaction in a National Psychiatric Facility: A Study Based on the Random Forest Algorithm

Understanding psychiatric inpatients' experiences is important to establish a culture of patient-centric care and promote trust in healthcare. This study aimed to evaluate nine dimensions of patients' experiences and investigate their association with patient satisfaction, revisit intention, and positive word-of-mouth (WoM) recommendation. Cross-sectional questionnaire data from five years of surveying (2016-2020) in the main psychiatric hospital in Bahrain were statistically analyzed, involving 763 psychiatric inpatients with an overall 65.6 ± 17.2 length of stay (days). The findings show that across the five years 2016-2020, the overall reported satisfaction was "very high" (4.75 ± 0.44) with no significant differences between these five years (F [4, 758] = 0.66, p = 0.620). The experience of confidentiality received the highest rating (4.72 ± 0.45). The experiences of ease of access, hospitality quality, and quality of responsiveness to one's needs significantly correlated with revisit intention (p ˂ 0.05). Patients with high satisfaction had greater potential for revisit intention (r [761] = 0.08, p = 0.027), which was associated with WoM recommendation (r [761] = 0.08, p = 0.033). Overall, men were less likely than women to experience convenient access to psychiatric wards. The findings of the Random Forest algorithm indicate the tendency of female patients with short-term stays to demonstrate lower satisfaction rates, and thus innovative approaches are needed when managing these groups' psychiatric problems.

What Are Nursing Attitudes to Youth Who Engage in Self-Harm? An Integrative Review

This integrative review explored nursing assessment of youth who self-harm. Eleven papers published between 2000 to 2020 met inclusion criteria. Three themes emerged: "Doctors and nurses' perceptions of assessment of self-harm", "Attitudes and experiences of assessment of self-harm" and "Assessments and outcomes". The ways youth communicate is an important consideration when assessing and planning for care. The metaphor of Narcissus is used to understand youth beliefs, self-image and how they communicate these thoughts. This paper suggests an alternative reading of what young people, who presents with self-harm, are trying to communicate to others and how this is integrated into assessment.

What mental health nurses have to say about themselves: A discourse analysis

Mental health nursing is largely invisible within public discourse. When mentioned at all in news media, it is usually a signifier of an occupation connoting where a nurse works. There is rarely a presumption of expertise in any sphere or articulation of a unique skill set or defining features which differentiate the mental health nurse from other nurses. This paper sought to examine the professional discourse around mental health nursing as inferred from a review of papers published in the International Journal of Mental Health Nursing in 2019. A discourse analysis of full-text papers (n = 117) was undertaken exploring references to mental health nurses or nursing and what this communicated about the field. The discourse clustered around three themes: The invisible or absent mental health nurse, ambiguous and blended identities, and a group of low attributed value and sophistication. There were few examples of authors presenting mental health nurses in a way which counters stereotypes of the dominant discourse about mental health nurses as a lesser skilled occupational group. Academics, editors, authors, and practitioners are urged to contribute to the construction of discourse around mental health nursing expertise which differentiates it from other branches of nursing and other distinctive disciplines.