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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [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: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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2
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Hammarström L, Andreassen Devik S, Häggström M, Hellzen O. Meanings of carers’ lived experience of “regulating oneself” in forensic psychiatry. Int J Qual Stud Health Well-being 2022; 17:2094088. [PMID: 35762066 PMCID: PMC9310649 DOI: 10.1080/17482631.2022.2094088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to illuminate the essential meanings of carers’ lived experience of regulating themselves when caring for patients with mental illnesses in forensic inpatient care. Methods Qualitative analysis was used to analyse data from narrative interviews with open-ended questions conducted with nine carers, which were analysed using a phenomenological-hermeneutic approach. Results Findings revealed three themes, “preserving oneself as a carer,” “building an alliance with the patient” and “maintaining stability in the community.” Carers not only regulated emotions related to patients but also the ward to facilitate a caring climate. For carers, encounters with patients meant facing expressions of suffering that evoked unwanted emotions. Regulating one’s emotions also meant being emotionally touched and facing one’s vulnerability. Conclusion Regulating oneself was a strategy used by carers to get closer to the patient and establishing a trusting relationship. Regulating oneself meant becoming aware of one’s shortcomings, not projecting them onto others, which may impair establishing relationships with patients and fulfilling the aim and caring task of forensic psychiatry. This study stresses the importance of carers being guided to manage their conflicting emotions and vulnerabilities and finding courage and an approach that allows a permissive climate of self-reflection.
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Affiliation(s)
| | | | - Marie Häggström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Ove Hellzen
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Hennessy B, Hunter A, Grealish A. A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings. J Psychiatr Ment Health Nurs 2022; 30:398-434. [PMID: 36519519 DOI: 10.1111/jpm.12889] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Research indicates many people accessing mental healthcare have trauma history and often experience re-traumatization in acute mental health inpatient settings. Treatment for trauma is not routinely explored as a treatment option in mental health inpatient settings and consequently mental health professionals do not draw connections between the person with trauma history and their presenting mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People in acute mental health inpatient units are not asked about their previous trauma histories on admission and their trauma history is not taken into consideration during interventions in particular coercive practices such as seclusion, restraint, forced medication, and involuntary admission. This paper provides an understanding on how to address trauma-related issues within in-patient settings and identifies practical examples of how to reduce the risk of re-traumatization. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff induction and training development needs can be used to help mental health professionals to be more confident and competent in assessing and identifying the history of trauma so that they can improve recognition, provide post-disclosure support, and avoid the potential for re-traumatization for inpatients. Physical environments need to be welcoming, homely, and have comfortable furnishing. They also require adequate space for inpatients to move around freely and have a quiet space to go to de-escalate themselves when required. ABSTRACT INTRODUCTION: Rates of re-traumatization among mentally ill-health patients have risen significantly over the past decade and clinical guidelines place mental health nurses at the heart of their care. AIM To gather, analyse, and synthesize the evidence on people's experiences on re-traumatization in acute mental health inpatient settings. METHOD A systematic search for qualitative studies (CINAHL, MEDLINE, ASSIA, PsycINFO, and EMBASE) was conducted. Two authors independently assessed eligibility and appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Fourteen papers were included for thematic synthesis. Three themes emerged: (1) Quality of staff interaction; (2) Specific interventions, (Sub-theme nature of symptoms); and (3) Nature of the environment. DISCUSSION Our findings demonstrate that patients are experiencing re-traumatization in acute mental health inpatient settings and that there is little being done to prevent it from occurring. IMPLICATIONS FOR PRACTICE This study is the first to analyse the factors that contribute to re-traumatization and make recommendations to mental healthcare professionals to reduce the harmful practices in place in inpatient settings. It is suggested that training staff in trauma-informed care and allowing patients to be experts in their own care can reduce the rates of re-traumatization.
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Affiliation(s)
- Brid Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Johanna B, Noora G, Kaisa M, Heikki E, Mari L. Nurses' and Patients' Perceptions about Psychiatric Intensive Care-An Integrative Literature Review. Issues Ment Health Nurs 2022; 43:983-995. [PMID: 35980786 DOI: 10.1080/01612840.2022.2101079] [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: 10/15/2022]
Abstract
This integrative literature review describes nurses's and patients' perceptions of care in psychiatric intensive care units (PICU). The database search was conducted in April 2020. PRISMA checklist and Mixed Method Appraisal Tool guided the identification and evaluation of the studies (n = 21). Data was analyzed with qualitative content analysis. Nurses perceived PICU as a challenging work environment where their primary task was to ensure the unit's safety. Patients views on their treatment varied from positive to negative. Patients wished to have more privacy and supportive interaction. Findings can be used as a basis in developing care practices and staff's further education in PICUs.
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Affiliation(s)
- Berg Johanna
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | | | - Mishina Kaisa
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku; INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Ellilä Heikki
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | - Lahti Mari
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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5
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Kumari A, Sarkar S, Ranjan P, Chopra S, Kaur T, Baitha U, Chakrawarty A, Klanidhi KB. Interventions for workplace violence against health-care professionals: A systematic review. Work 2022; 73:415-427. [PMID: 35431213 DOI: 10.3233/wor-210046] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Workplace violence (WPV) against health-care professionals has been a concern worldwide as it strains the relationship between the patient and healthcare professionals. Implementing mitigation interventions to help the healthcare professionals to prevent and manage these violent episodes might make the workplaces more secure. OBJECTIVE This study aimed to synthesize the recent evidence on intervention strategies for workplace violence. METHOD Four electronic databases (PubMed, Wiley, Cochrane and Google Scholar) were searched for peer-reviewed intervention studies published in the last 11 years to mitigate workplace violence. A qualitative synthesis of the findings from included studies was done. RESULT A total of 17 studies were identified based on prevention and management of workplace violence. The interventions were mainly educational in nature based on a workshop format. These interventions were found to be effective in improving the perceived ability to deal with situations that lead to violence. CONCLUSION Strategies to mitigate violent episodes could be helpful to health-care professionals and administrators in their attempts to make safer workplaces in the health-care settings.
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Affiliation(s)
- Archana Kumari
- Department of Gynaecology and Obstetrics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, India
| | - Tanveer Kaur
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Bandhu Klanidhi
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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6
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Missouridou E, Fradelos EC, Kritsiotakis E, Mangoulia P, Segredou E, Papathanasiou IV. Containment and therapeutic relationships in acute psychiatric care spaces: the symbolic dimensions of doors. BMC Psychiatry 2022; 22:2. [PMID: 34983447 PMCID: PMC8725636 DOI: 10.1186/s12888-021-03607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses' experiences of open and locked working spaces. RESULTS A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be "invisible". The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople's crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users' abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as 'locked doors' in the community (limited or no care continuity and stigma). CONCLUSIONS The impact of COVID-19 restrictions on people's crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.
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Affiliation(s)
- Evdokia Missouridou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece.
| | - Evangelos C. Fradelos
- grid.410558.d0000 0001 0035 6670Community Nursing Lab, Department of Nursing, University of Thessaly, Larissa, Greece
| | - Emmanouel Kritsiotakis
- grid.499377.70000 0004 7222 9074 Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece ,Psychiatric Department, General State Hospital “Sismanoglio”, Marousi, Greece
| | - Polyxeni Mangoulia
- grid.499377.70000 0004 7222 9074 Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece ,Psychiatric Liaison Unit, General State Hospital “Evangelismos”, Athens, Greece
| | - Eirini Segredou
- Alcohol Treatment Unit, Psychiatric Hospital of Attica, Chaidari, Greece
| | - Ioanna V. Papathanasiou
- grid.410558.d0000 0001 0035 6670Community Nursing Lab, Department of Nursing, University of Thessaly, Larissa, Greece
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Lindow M, Kjellin L, Engström I, Pelto-Piri V. Strategies for the Prevention of Violence in Institutional Care: A Qualitative Interview Study With Ward Managers. Front Psychiatry 2022; 13:853260. [PMID: 35463501 PMCID: PMC9024355 DOI: 10.3389/fpsyt.2022.853260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The presence of violence within psychiatric and residential settings remains a challenge. Research on this problem has often focused on describing violence prevention strategies from either staffs' or service users' perspectives, and the views of ward managers has been largely overlooked. The aim of the present study was therefore to identify ward managers' strategies to prevent violence in institutional care, focusing on safety and values. METHODS Data were collected using semi-structured interviews with 12 ward managers who headed four different types of psychiatric wards and two special residential homes for adolescents. Qualitative content analysis was applied, first using a deductive approach, in which quotes were selected within a frame of primary, secondary, and tertiary prevention, then by coding using an inductive approach to create themes and subthemes. RESULTS Ward managers' strategies were divided into the four following themes: (1) Balancing being an active manager with relying on staff's abilities to carry out their work properly while staying mostly in the background; (2) Promoting value awareness and non-coercive practices in encounters with service users by promoting key values and adopting de-escalation techniques, as well as focusing on staff-service user relationships; (3) Acknowledging and strengthening staff's abilities and competence by viewing and treating staff as a critical resource for good care; and (4) Providing information and support to staff by exchanging information and debriefing them after violent incidents. CONCLUSIONS Ward managers described ethical challenges surrounding violence and coercive measures. These were often described as practical problems, so there seems to be a need for a development of higher ethical awareness based on a common understanding regarding central ethical values to be respected in coercive care. The ward managers seem to have a high awareness of de-escalation and the work with secondary prevention, however, there is a need to develop the work with primary and tertiary prevention. The service user group or user organizations were not considered as resources in violence prevention, so there is a need to ensure that all stakeholders are active in the process of creating violence prevention strategies.
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Affiliation(s)
- Martin Lindow
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingemar Engström
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Veikko Pelto-Piri
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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8
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Gerritsen S, Widdershoven G, van der Ham L, van Melle L, Kemper M, Voskes Y. Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations. Int J Ment Health Nurs 2021; 30:317-325. [PMID: 32936986 PMCID: PMC7891438 DOI: 10.1111/inm.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.
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Affiliation(s)
- Sylvia Gerritsen
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Guy Widdershoven
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Lia van der Ham
- Low Vision ResearchOphthalmologyAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Laura van Melle
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Institute for Medical Ethics and History of MedicineRuhr University BochumBochumGermany
| | | | - Yolande Voskes
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- GGZ BreburgTilburgThe Netherlands
- Tranzo, Tilburg UniversityTilburgThe Netherlands
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9
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Molin J, Hällgren Graneheim U, Ringnér A, Lindgren BM. Time Together as an arena for mental health nursing - staff experiences of introducing and participating in a nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2020; 29:1192-1201. [PMID: 32618398 DOI: 10.1111/inm.12759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
A lack of meaningful activities for people with mental ill health admitted to psychiatric inpatient care has been related to feelings of boredom and 'doing nothing' and is not in line with recovery-oriented care. Staff in psychiatric inpatient care report having limited time, ambiguous responsibilities, and insufficient support that counteracts their ideals of good nursing care and puts them at risk for high levels of stress and stress of conscience. Research highlights a need for interactions between patients and staff, but few nursing interventions with such a focus are described in the literature. This qualitative study aimed to illuminate staff experiences of introducing and participating in the nursing intervention Time Together, via qualitative content analysis of 17 individual semi-structured interviews with nursing staff in psychiatric inpatient care. The results show that these staff members experienced Time Together as an arena for mental health nursing. They prepared for the introduction of the intervention by laying a framework for success. Although the actual implementation led to them feeling burdened, they found that Time Together fostered relationships between patients and staff. For successful implementation, mental health nurses need to advocate the intervention. As Time Together constitutes an arena for mental health nursing, play and conversations based on reciprocity and equality can contribute to patients' recovery.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, Umeå.,Department of Health Sciences, University West, Trollhättan
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå.,Department of Pediatrics, Umeå University Hospital, Umeå, Sweden
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10
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Maagerø-Bangstad ER, Sælør KT, Lillevik OG, Ness O. Exploring staff conceptions of prevention and management practices in encounters with staff-directed aggression in supported housing following education and training. Int J Ment Health Syst 2020; 14:60. [PMID: 32782470 PMCID: PMC7414712 DOI: 10.1186/s13033-020-00387-2] [Citation(s) in RCA: 2] [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: 03/06/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community mental health supported housing services conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of 26 semi-structured interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Participants were interviewed on two occasions, once prior to participation and once subsequent to the finalization of the education and training sessions. Results The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: (1) Observation, alertness and awareness, (2) Established understanding and knowledge of service users, (3) Team-based risk management and deliberation, (4) Adaption of own dispositions and behaviors, (5) Reflexivity, sensitivity and care and (6) Involvement and dialogue. These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff’s expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in mental health supported housing services and that the various conceptions have different implications for the way staff-directed aggression is mitigated individually and collectively. Our findings also suggest that it is beneficial to take conceptual variation regarding practice into consideration when devising education and training aimed at enhancing staff knowledge, skills and practices.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Ole Greger Lillevik
- Dept. of Health and Care Services, Faculty of Health Sciences, UiT The Arctic University of Norway, P.O. box 385, 8515 Narvik, Norway
| | - Ottar Ness
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway.,Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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11
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Üzar-Özçetin YS, Trenoweth S, Clark LL, Hext G, Tee S. Could therapeutic diaries support recovery in psychiatric intensive care? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjmh.2019.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite growing literature surrounding the use of patient diaries in intensive care units within general health care and the positive effects these may have on a patient's psychological recovery from such an admission, no studies exist examining the effects of similar patient diaries in psychiatric intensive care units when used with people experiencing an acute exacerbation of psychosis. This article hypothesises the potential positive effects of diaries kept for patients in psychiatric intensive care units. In the development of strategies to help people in psychiatric crisis understand and manage their own distress and psychological trauma, diaries may be helpful for the prevention of further psychological problems and aid recovery post discharge. Research is required to consider the possible effects of therapeutic diaries and the role of the multidisciplinary team in keeping these within psychiatric intensive care settings.
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Affiliation(s)
| | - Steve Trenoweth
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Louise L Clark
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - Greg Hext
- HCA Group, London Bridge Hospital, London, UK
| | - Stephen Tee
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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12
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Kagwe J, Jones S, Johnson SL. Factors Related to Intention to Leave and Job Satisfaction among Registered Nurses at a Large Psychiatric Hospital. Issues Ment Health Nurs 2019; 40:754-759. [PMID: 31241389 DOI: 10.1080/01612840.2019.1611977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Current shortages of registered nurses working in psychiatric hospitals in the United States are exacerbated by turnover. Aim: This research describes factors that are associated with intent to leave among nurses working in a large inpatient psychiatric hospital. Method: This was a descriptive, correlational study. Results: 75% of respondents (n = 94) reported that they were satisfied with their current positions. 36% (n = 34) reported actively seeking employment elsewhere. Intent to leave correlated with perceptions about workplace relationships and work environment factors. Discussion: Work relationships, opportunity for education, and recognition for education were factors that were primarily related to intent to leave.
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Affiliation(s)
- John Kagwe
- Washington State Department of Social and Health Services , Tacoma , USA
| | - Salene Jones
- Washington State Department of Social and Health Services , Tacoma , USA
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13
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Groleau R, Da Silva Guerreiro J. Agression en milieu psychiatrique fermé : identification des déclencheurs qui précèdent les agressions contre les intervenants. ACTA ACUST UNITED AC 2019. [DOI: 10.7202/1060006ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cette étude vise l’identification des déclencheurs qui précèdent les agressions survenues dans un hôpital psychiatrique fermé. Une analyse de contenu de 140 rapports d’incident visant l’identification du déclencheur qui précédait immédiatement les événements d’agression survenus entre 2012 et 2017 a été effectuée. Avec un accord interjuge de 0,87, les résultats concordent avec ceux retrouvés dans des études précédentes. Plus de 37 % des agressions surviennent à la suite d’une intervention verbale d’un intervenant, alors qu’un peu plus de 54 % ont lieu à la suite d’un contact physique entre un intervenant et un patient. Moins de 9 % des agressions subies par le personnel sont liées à des événements où il a été impossible d’observer un déclencheur. Ces résultats sont discutés dans le cadre d’une approche interactionnelle sur l’agression en psychiatrie légale et ils permettent de proposer des pistes pour réduire le risque d’agression.
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Affiliation(s)
- Robert Groleau
- Institut national de psychiatrie légale Philippe-Pinel. Correspondance : Institut national de psychiatrie légale Philippe-Pinel, Direction des soins infirmiers et des services multidisciplinaires, 10905 Henri-Bourassa Est, Montréal (Québec), H1C 1H1
| | - Joao Da Silva Guerreiro
- Département de psychologie, Université du Québec à Montréal
- Centre de recherche de l’Institut national de psychiatrie légale Philippe-Pinel
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Maagerø-Bangstad ER, Sælør KT, Ness O. Encountering staff-directed aggression within mental health and substance abuse services: exploring conceptions of practice following education. Int J Ment Health Syst 2019; 13:20. [PMID: 30984286 PMCID: PMC6444818 DOI: 10.1186/s13033-019-0277-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Staff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice. Method The study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway. Results The analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) Observation, reporting and expectation of organizational intervention, (2) Application of personalized de-escalating skills and behaviour, (3) Delivery of team-based and standardized services, (4) Provision of perceptive and responsive services, and (5) Facilitation of sensitive, involving and reflexive care. The categories vary according to the participants' attentional focus on either the responsibility of the organization, staff members' personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants. Conclusion The results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway
| | - Ottar Ness
- Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway.,2Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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McAllister S, Robert G, Tsianakas V, McCrae N. Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. Int J Nurs Stud 2019; 93:106-118. [PMID: 30908958 DOI: 10.1016/j.ijnurstu.2019.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/18/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement. DESIGN A systematic integrative review using an established framework specific to the integrative review methodology. DATA SOURCES Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report. REVIEW METHODS Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement. RESULTS Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework. CONCLUSION A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom.
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Niall McCrae
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
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Hylén U, Engström I, Engström K, Pelto-Piri V, Anderzen-Carlsson A. Providing Good Care in the Shadow of Violence - An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden. Issues Ment Health Nurs 2019; 40:148-157. [PMID: 30376382 DOI: 10.1080/01612840.2018.1496207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.
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Affiliation(s)
- Ulrika Hylén
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Ingemar Engström
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Karin Engström
- c School of Culture and Education , Södertörn University , Stockholm
| | - Veikko Pelto-Piri
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Agneta Anderzen-Carlsson
- b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.,d School of Health Sciences , Örebro University , Örebro , Sweden
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17
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Isobel S. 'In some ways it all helps but in some ways it doesn't': The complexities of service users' experiences of inpatient mental health care in Australia. Int J Ment Health Nurs 2019; 28:105-116. [PMID: 29897669 DOI: 10.1111/inm.12497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/30/2022]
Abstract
Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users.
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Affiliation(s)
- Sophie Isobel
- Mental Health Research, Sydney Local Health District, Concord Centre for Mental Health, Concord, New South Wales, Australia
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18
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Vahidi M, Ebrahimi H, Areshtanab HN, Jafarabadi MA, Lees D, Foong A, Cleary M. Therapeutic Relationships and Safety of Care in Iranian Psychiatric Inpatient Units. Issues Ment Health Nurs 2018; 39:967-976. [PMID: 30204047 DOI: 10.1080/01612840.2018.1485795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Enhancing therapeutic relationships between patients and staff is of central importance to improve the quality and safety of care in psychiatric inpatient units. However, there is limited evidence as to how therapeutic relationships may be enabled in this specific context. This paper presents findings of a study that explored the link between therapeutic relationships and safety in Iranian psychiatric inpatient units. In this exploratory, descriptive study, seven patients at the point of discharge and 19 staff in psychiatric inpatient units in Iran were interviewed regarding their experiences of care. The quality of staff-patient relationship in providing a safe environment was categorized into two groups of "facilitators" and "inhibitors". Facilitators of a safe environment included "supportive relationship with patients" and "improving patient capacity for self-efficacy/self-control". Inhibitors, on the other hand, included "detachment from patients" and "domination over patients", which ultimately limited safety on the ward. Findings indicate interrelated environmental, patient and staff factors mediating the potential for therapeutic relationships and quality and safety of care. Findings suggest the need for more effective preparation and support for staff working within psychiatric inpatient settings. In addition, environments more conducive to collaborative recovery-oriented practice are required to enhance therapeutic relationships and improve quality and safety of care. Both individual staff responsibility and effective leadership are required to realize change.
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Affiliation(s)
- Maryam Vahidi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Ebrahimi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Namdar Areshtanab
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Asghari Jafarabadi
- b Department of Statistics and Epidemiology, Faculty of Health sciences , Tabriz University of Medical Sciences , Tabriz , Iran
| | - David Lees
- c School of Health Sciences , University of Tasmania , Launceston , Tasmania , Australia
| | - Andrew Foong
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
| | - Michelle Cleary
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
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19
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Felton A, Repper J, Avis M. Therapeutic relationships, risk, and mental health practice. Int J Ment Health Nurs 2018; 27:1137-1148. [PMID: 29280259 DOI: 10.1111/inm.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 11/27/2022]
Abstract
Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals' experiences of such tensions in the context of decision-making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision-making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users' subjective experiences in the decision-making process to challenge the definition of people with mental health problems as risky.
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Affiliation(s)
- Anne Felton
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Innovation Park, Nottingham, UK
| | | | - Mark Avis
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Innovation Park, Nottingham, UK
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20
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Isobel S, Delgado C. Safe and Collaborative Communication Skills: A Step towards Mental Health Nurses Implementing Trauma Informed Care. Arch Psychiatr Nurs 2018; 32:291-296. [PMID: 29579526 DOI: 10.1016/j.apnu.2017.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/05/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
Trauma Informed Care (TIC) acknowledges the presence and effects of trauma in the lives of many mental health service users and the responsibility of services to provide physical and emotional safety. One challenge of TIC is a lack of clarity about translating the philosophy into practice. This paper describes the delivery and evaluation of a trauma informed communication workshop for mental health nurses that aimed to increase their knowledge of the potential impacts of trauma on consumers, and translate TIC concepts into their communication approaches within the therapeutic relationship.
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Affiliation(s)
- Sophie Isobel
- Sydney Local Health District, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, 2050, Australia
| | - Cynthia Delgado
- Sydney Local Health District, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, 2050, Australia; The University of Sydney, Sydney Nursing School, Australia.
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21
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McAllister S, McCrae N. The therapeutic role of mental health nurses in psychiatric intensive care: A mixed-methods investigation in an inner-city mental health service. J Psychiatr Ment Health Nurs 2017; 24:491-502. [PMID: 28407389 DOI: 10.1111/jpm.12389] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mental health services have been radically transformed since the 1990s, with an emphasis on care in the community. However, acute psychiatric wards remain an important component of service provision. Research shows that patients receive limited therapeutic interaction with nurses in such settings. A recent review showed that just 4%-12% of nurses' time was spent on activities that could be considered therapeutic. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: Whereas nurses wanted more time for individual therapeutic activity, patients were content with brief interactions. However, such contact was not always available, partly due to workload pressures. Both nurses and patients believed that a collaborative approach, involving the whole multidisciplinary team, was key to the success of therapeutic engagement. The meaning of therapeutic engagement remains nebulous. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse education, ward management and clinical supervision should have greater emphasis on therapeutic engagement. Further research is needed to develop therapeutic engagement in acute psychiatric settings; such work should involve patients as active and equal partners. ABSTRACT Introduction Despite indications that therapeutic interaction is beneficial for patients and for nurses' job satisfaction in acute psychiatric care, research shows a small amount of nurses' time is spent on such activity. Aims This study investigated the actual and potential therapeutic role of the mental health nurse in psychiatric intensive care, where admission is due to violence or aggression. Methods In a mixed-methods concurrent triangulation design, clinician and patient activity was observed using a structured measurement tool, and qualitative interviews were conducted with four practitioners and six patients. Findings were generated using thematic analysis and descriptive statistics. Results Of the directly observed 234 clinician and 309 patient activities, 20.9% and 15.9%, respectively, were classified as therapeutic engagement. Interviews revealed that both clinicians and patients wanted more therapeutic contact, but whereas nurses wanted longer time to spend in individual sessions, patients preferred brief but more frequent interaction with nurses. Discussion This study shows disparity between actual and desirable levels of therapeutic interaction. Apart from organizational constraints, a fundamental problem is the lack of definition or established practices of therapeutic engagement. Implications for Practice There should be more emphasis on therapeutic engagement in nurse education, ward management and clinical supervision.
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Affiliation(s)
- S McAllister
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - N McCrae
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
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22
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Moreno-Poyato AR, Montesó-Curto P, Delgado-Hito P, Suárez-Pérez R, Aceña-Domínguez R, Carreras-Salvador R, Leyva-Moral JM, Lluch-Canut T, Roldán-Merino JF. The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients. Arch Psychiatr Nurs 2016; 30:782-787. [PMID: 27888975 DOI: 10.1016/j.apnu.2016.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/22/2016] [Accepted: 03/06/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital. METHOD Narrative literature review. Content analysis. FINDINGS The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting. PRACTICE IMPLICATIONS Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Escola Superior d'Infermeria del Mar, Parc de Salut Mar (Pompeu Fabra University Associated Center), Aiguader, 80, Barcelona, Spain.
| | - Pilar Montesó-Curto
- School of Nursing, Rovira i Virgili University, Avda Remolins 13-15, Tortosa, Tarragona, Spain.
| | - Pilar Delgado-Hito
- School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907L'Hospitalet del Llobregat, Spain.
| | - Raquel Suárez-Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Rosa Aceña-Domínguez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Regina Carreras-Salvador
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Juan M Leyva-Moral
- School of Nursing, Autonomous University of Barcelona, Avda. Can Domenech, Edifici M. 08193 Bellaterra (Cerdanyola del Vallès) Barcelona, Spain.
| | - Teresa Lluch-Canut
- School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907L'Hospitalet del Llobregat, Spain.
| | - Juan F Roldán-Merino
- Campus Docent Fundació Privada Sant Joan de Déu. School of Nursing, University of Barcelona, Santa Rosa, 39-57, Esplugues de Llobregat, Spain.
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23
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Voogt LA, Nugter A, Goossens PJJ, van Achterberg T. An Interview Study on "Providing Structure" as an Intervention in Psychiatric Inpatient Care: The Nursing Perspective. Perspect Psychiatr Care 2016; 52:208-16. [PMID: 25944548 DOI: 10.1111/ppc.12119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/20/2015] [Accepted: 03/26/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To gain insight into nurses' perceptions and use of providing structure (PS) as an intervention during psychiatric inpatient care. DESIGN AND METHODS Interviews were conducted with nurses (n = 18) from two inpatient wards in psychiatry immediately following the occurrence of a PS event. This was done immediately following the occurrence of a PS event. Transcripts were analyzed using a qualitative coding process. FINDINGS Four general and 14 specific PS activities were described associated with the nursing intervention PS. PRACTICE IMPLICATIONS Nurses can now refer to specific activities of PS. An elaborated definition of PS is provided to facilitate a better understanding and using of PS as a psychiatric nursing intervention.
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Affiliation(s)
- L Amar Voogt
- Philadelphia Zorg regio Noordwest, Organization for People with a Mental Disability, Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo, The Netherlands.,Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annet Nugter
- Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Peter J J Goossens
- Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Bipolar Disorder, Dimence Mental Health Care, Deventer, The Netherlands.,GGZ-VS Institute for the Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands.,Department of Nursing Sciences, Ghent University, Ghent, Belgium
| | - Theo van Achterberg
- Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
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24
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Thibeault C. An Interpretation of Nurse-Patient Relationships in Inpatient Psychiatry: Understanding the Mindful Approach. Glob Qual Nurs Res 2016; 3:2333393616630465. [PMID: 28462325 PMCID: PMC5342637 DOI: 10.1177/2333393616630465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/27/2015] [Accepted: 12/29/2015] [Indexed: 02/03/2023] Open
Abstract
Nurses who work in acute inpatient psychiatry, where lengths of stay are increasingly shortened, struggle to establish therapeutic nurse–patient relationships. The purpose of this inquiry was to illuminate the nature of relationships between inpatient psychiatric mental health (PMH) nurses and their patients. The author used semistructured interviews and nonparticipant observation in an interpretive phenomenological inquiry. The data consisted of texts that were transcribed from narratives and observations. The meanings that were generated led to the uncovering of patterns of commonality, or themes. Of the themes uncovered, the theme of mindful approach highlighted PMH nurses as engaging with patients in distress, strategically creating encounters to establish a basis for ongoing therapeutic work. The PMH nurse–patient relationship in acute inpatient psychiatry continues to be under pressure, but nurses still carefully construct relational approaches in response to patient distress, and patients in these settings experience these approaches as meaningful to their recovery.
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25
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Voogt LA, Nugter A, van Achterberg T, Goossens PJJ. Development of the Psychiatric Nursing Intervention Providing Structure: An International Delphi Study. J Am Psychiatr Nurses Assoc 2016; 22:100-11. [PMID: 26944935 DOI: 10.1177/1078390316637049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychiatric nurses commonly refer to "providing structure" (PS) as a key intervention. But no consensus exists about what PS entails. PS can be understood as a complex intervention. In four previous studies, a definition, activities, and context variables were described that were presented to experts in a Delphi study. OBJECTIVE To reach consensus about the definition of PS, its activities, and context variables. DESIGN In a qualitative study, a Delphi study is used to gather the opinions of experts. The Delphi study consisted of three rounds with statements to score in each round. RESULTS Experts reached consensus about a definition of PS, its activities, and context variables. Eleven statements related to the definition were accepted. Fourteen statements of a total of 17 statements related to the specific activities reached sufficient agreement, and 4 statements related to context variables were accepted. CONCLUSIONS A definition could be given of PS with 4 general PS activities, 15 specific activities, and 3 context variables. Psychiatric nurses can use the information about PS to reflect on the use of PS activities within their own working environment, and these insights can help nurses develop their professional growth.
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Affiliation(s)
- L Amar Voogt
- L. Amar Voogt, MSc, APRN, RN, GGD Zaanstreek-Waterland, Zaandam, Netherlands; Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - Annet Nugter
- Annet Nugter, PhD, Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, RN, FEANS, KU Leuven, Leuven, Belgium; Radboud University Medical Center, Nijmegen, Netherlands; Uppsala University, Uppsala, Sweden
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Mental Health Care, Deventer, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; GGZ-VS Institute for the Education of Clinical Nurse Specialist in Mental Health, Utrecht, Netherlands; Ghent University, Ghent, Belgium
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26
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Sebergsen K, Norberg A, Talseth AG. Confirming mental health care in acute psychiatric wards, as narrated by persons experiencing psychotic illness: an interview study. BMC Nurs 2016; 15:3. [PMID: 26766926 PMCID: PMC4711083 DOI: 10.1186/s12912-016-0126-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/07/2016] [Indexed: 01/23/2023] Open
Abstract
Background It is important that mental health nurses meet the safety, security and care needs of persons suffering from psychotic illness to enhance these persons’ likelihood of feeling better during their time in acute psychiatric wards. Certain persons in care describe nurses’ mental health care as positive, whereas others report negative experiences and express a desire for improvements. There is limited research on how persons with psychotic illness experience nurses’ mental health care acts and how such acts help these persons feel better. Therefore, the aim of this study was to explore, describe and understand how the mental health nurses in acute psychiatric wards provide care that helps persons who experienced psychotic illness to feel better, as narrated by these persons. Method This study had a qualitative design; 12 persons participated in qualitative interviews. The interviews were transcribed, content analysed and interpreted using Martin Buber’s concept of confirmation. Results The results of this study show three categories of confirming mental health care that describe what helped the participants to feel better step-by-step: first, being confirmed as a person experiencing psychotic illness in need of endurance; second, being confirmed as a person experiencing psychotic illness in need of decreased psychotic symptoms; and third, being confirmed as a person experiencing psychotic illness in need of support in daily life. The underlying meaning of the categories and of subcategories were interpreted and formulated as the theme; confirming mental health care to persons experiencing psychotic illness. Conclusion Confirming mental health care acts seem to help persons to feel better in a step-wise manner during psychotic illness. Nurses’ openness and sensitivity to the changing care needs of persons who suffer from psychotic illness create moments of confirmation within caring acts that concretely help the persons to feel better and that may enhance their health. The results show the importance of taking the experiential knowledge of persons who have experienced psychotic illness seriously to develop and increase the quality of mental health care in acute psychiatric wards.
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Affiliation(s)
- Karina Sebergsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway ; Division of Mental Health and Substance Abuse, University Hospital of North Norway, Mailbox 6124, N-9291 Tromsø, Norway
| | - Astrid Norberg
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden ; Palliative Research Center, Ersta Sköndal University College, SE-10061 Stockholm, Sweden
| | - Anne-Grethe Talseth
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
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Terkelsen TB, Larsen IB. Fear, danger and aggression in a Norwegian locked psychiatric ward: Dialogue and ethics of care as contributions to combating difficult situations. Nurs Ethics 2014; 23:308-17. [PMID: 25552587 DOI: 10.1177/0969733014564104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fear and aggression are often reported among professionals working in locked psychiatric wards and also among the patients in the same wards. Such situations often lead to coercive intervention. In order to prevent coercion, we need to understand what happens in dangerous situations and how patients and professionals interpret them. RESEARCH QUESTIONS What happens when dangerous situations occur in a ward? How do professionals and patients interpret these situations and what is ethically at stake? RESEARCH DESIGN Participant observation and interviews. PARTICIPANTS A total of 12 patients and 22 professionals participated. ETHICAL CONSIDERATIONS This study has been accepted by the Regional Committee for Medical and Health Research Ethics in Norway. FINDINGS (a) Both atmosphere and material surroundings were interweaved within dangerous situations, (b) the professionals applied stereotypes when interpreting dangerous situations and (c) the professionals and the patients had different interpretations of what triggered dangerous situations. DISCUSSION The discussion centres on how care ethics and a dialogical practice might contribute towards combating difficult situations and the ways in which change is an ongoing ethical process of becoming. CONCLUSION The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.
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Gabrielsson S, Sävenstedt S, Zingmark K. Person-centred care: clarifying the concept in the context of inpatient psychiatry. Scand J Caring Sci 2014; 29:555-62. [DOI: 10.1111/scs.12189] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
| | - Stefan Sävenstedt
- Department of Health Sciences; Luleå University of Technology; Luleå Sweden
| | - Karin Zingmark
- Department of Health Sciences; Luleå University of Technology; Luleå Sweden
- Department of Research and Development; Norrbotten County Council; Luleå Sweden
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Sweeney A, Fahmy S, Nolan F, Morant N, Fox Z, Lloyd-Evans B, Osborn D, Burgess E, Gilburt H, McCabe R, Johnson S. A mixed-methods study exploring therapeutic relationships and their association with service user satisfaction in acute psychiatric wards and crisis residential alternatives. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Angela Sweeney
- Mental Health Sciences Unit, University College London, London, UK
| | - Sarah Fahmy
- Mental Health Sciences Unit, University College London, London, UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation Trust, London, UK
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Nicola Morant
- Mental Health Sciences Unit, University College London, London, UK
| | - Zoe Fox
- Institute of Neurology, University College London, London, UK
| | | | - David Osborn
- Mental Health Sciences Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Burgess
- Mental Health Sciences Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Helen Gilburt
- National Addiction Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Rosemarie McCabe
- Unit of Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Sonia Johnson
- Mental Health Sciences Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction? Psychiatr Q 2014; 85:225-39. [PMID: 24307177 DOI: 10.1007/s11126-013-9285-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project.
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Looi Rpn GME, Gabrielsson S, Sävenstedt S, Zingmark K. Solving the staff's problem or meeting the patients' needs: staff members' reasoning about choice of action in challenging situations in psychiatric inpatient care. Issues Ment Health Nurs 2014; 35:470-9. [PMID: 24857531 DOI: 10.3109/01612840.2013.879629] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Coercion in challenging situations is often seen as a necessary component of psychiatric care. This study aims to describe staff members' reasoning about their choice of action in challenging situations in inpatient psychiatric care. Focus group interviews with 26 staff members were analyzed using qualitative content analysis. The results provide an overview of the integrated structure of participants' reasoning and suggest that staff members' reasoning about choice of action can be described as a matter of either solving the staff's problems or meeting the patients' needs. These results can be of use in further research, educational interventions, and staff development activities.
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Salzmann-Erikson M. Stability in intensive psychiatry: a concept analysis. Perspect Psychiatr Care 2014; 50:122-31. [PMID: 24689492 DOI: 10.1111/ppc.12030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this concept analysis is to describe, explore, and explain stability in the context of mental health nursing in intensive psychiatry. DESIGN AND METHODS A modified version of Wilson's method of concept analysis was used. FINDINGS Stability is the ability to be resistant to changes. Stability can take different directions after a distortion: re-gaining, neo-gaining, and apo-gaining. Stability may also be achieved through active (adding or using power, making adjustments, parrying, and idling) and passive systems (environmental conditions and constituent materials). PRACTICE IMPLICATIONS This article contributes by providing knowledge and insight for nurses on the roles they play in intensive psychiatry as stabilizers.
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Affiliation(s)
- Martin Salzmann-Erikson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Dalarna University School of Health and Society, Falun, Sweden; Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Ullevål, Oslo, Norway
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Delaney KR, Johnson ME. Metasynthesis of research on the role of psychiatric inpatient nurses: what is important to staff? J Am Psychiatr Nurses Assoc 2014; 20:125-37. [PMID: 24667372 DOI: 10.1177/1078390314527551] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inpatient psychiatric nurses are a large workforce, but their work is poorly articulated and thus poorly understood outside of the professional inpatient community. OBJECTIVE To learn how inpatient psychiatric nurses depict their work, define important aspects of their role, and view the impact of the unit environment on their clinical practice. DESIGN Metasynthesis of research that has focused on the ideas and perceptions of inpatient psychiatric nurses around their role and practice on inpatient psychiatric units. RESULTS Three themes emerged from the analysis; the first was an umbrella for three important aspects of nursing work: the nurses' efforts to forge engagement with patients; their activities which maintained the safety of the unit and interventions nurses viewed as educating/empowering patients. The second theme captures the conditions that enabled nurses to do this work such as a cohesive nursing team and their sense of self-direction in their role. The final theme centers on difficulties nurses encountered in enacting their role which included multiple responsibilities for patient care and management of the milieu; intense work often with low visibility and scant support within the organization. CONCLUSIONS Nurses need to articulate their practice so they can assert for the staffing and resources needed to keep units safe and promote patients' well-being, strive toward quality, and promote the development of the specialty.
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Affiliation(s)
- Kathleen R Delaney
- Kathleen R. Delaney, PhD, PMH-NP, FAAN, Professor, Rush College of Nursing, Chicago, IL, USA
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35
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Voogt LA, Goossens PJJ, Nugter A, van Achterberg T. An observational study of providing structure as a psychiatric nursing intervention. Perspect Psychiatr Care 2014; 50:7-18. [PMID: 24387611 DOI: 10.1111/ppc.12018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/01/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To observe the actions of psychiatric nurses when providing structure and identify results in order to better understand providing structure as a complex nursing intervention. DESIGN AND METHOD Participant observation data were collected on a dual diagnosis ward and a crisis intervention ward in a mental healthcare organization. A total of 52 events were selected that involved providing structure. FINDINGS Three phases in the processing of providing structure were identified: the start of the interaction, the interaction phase, and the end of the interaction. For each phase in the intervention, both critical nurse and patient responses were coded. PRACTICAL IMPLICATIONS The results of this observational study contribute to a formalization of the nursing intervention "providing structure" in the Nursing Interventions Classification.
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Affiliation(s)
- L Amar Voogt
- Regio Noordwest Philadelphia Zorg, Organisation for People with a Mental Disability; Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo; Quality of Care/Nursing Science, Radboud University, Nijmegen, The Netherlands
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Lundahl MK, Olovsson KJ, Rönngren Y, Norbergh KG. Nurse's perspectives on care provided for patients with gamma-hydroxybutyric acid and gamma-butyrolactone abuse. J Clin Nurs 2014; 23:2589-98. [PMID: 24372816 DOI: 10.1111/jocn.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe registered nurses' views and experiences providing care for gamma-hydroxybutyric acid and gamma-butyrolactone abuse inpatients in a psychiatric unit. BACKGROUND Gamma-hydroxybutyric acid and gamma-butyrolactone are illegal drugs with potentially fatal outcomes that are entering wider use in Scandinavia. Gamma-hydroxybutyric acid-dependent persons with withdrawal symptoms often require forceful withdrawal treatment provided in psychiatric units. DESIGN A qualitative study with a purposive sample including interviews from registered nurses. METHODS Data were collected from interviews with 15 registered nurses working in specialised dependency units in psychiatric wards. The data collected were analysed through a descriptive, qualitative analysis. RESULTS The registered nurses' narratives revealed four main areas of convergence: feelings of anxiety and despair, preparation for unpredictable and precarious situations, striving for good relationship and striving to optimise and develop nursing care. The interviews revealed that registered nurses reflect on and discuss their feelings about their patients' situations with colleagues; prepare themselves for potential aggressiveness and unpredictable situations; improve their care through conscious attitude adjustment and relationship-forming behaviours; and strive to increase their personal knowledge, maintain a hopeful outlook and exhibit a positive approach. These themes were found in all nine categories and sixteen subcategories. DISCUSSION The findings based on the registered nurses' narratives indicated that the registered nurses experienced their work situation when caring for these patients to be very complex and demanding. CONCLUSION The study revealed that registered nurses worked extensively to craft their approach and attitude towards their patients. It is clear that registered nurses use themselves as tools or instruments for the creation of good relationships, thus providing the best care possible. RELEVANCE TO CLINICAL PRACTICE Registered nurses should be given more education, clearer guidelines and better guidance to assist them in facing such challenging and often problematic situations. One-on-one shadowing provides the possibility to create and develop relationship.
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Cutcliffe JR, Riahi S. Systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization: part 1. Int J Ment Health Nurs 2013; 22:558-67. [PMID: 23750881 DOI: 10.1111/inm.12029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aggression and violence (A/V) in mental health care are all too frequent occurrences; they produce a wide range of deleterious impacts on the individual client, staff, organizations, and the broader community. A/V is a multifaceted and highly-complex problem, and is associated empirically with a wide range of phenomena. However, most attempts to reduce A/V in mental health care have invariably focused on one or two aspects of the problem at the expense of a more comprehensive, systemic approach; these have produced inconclusive results. As a result, this two-part paper seeks to: (i) recognize the wide range of phenomena that have been found to have an association with A/V in mental health care; (ii) synthesize these propositions according to fit or congruence into a systemic model of A/V; (iii) explore empirical evidence pertaining to these propositions; and (iv) begin to consider the application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The paper advances a systemic model of these phenomena comprised of four thematic categories, with Part 1 of this paper focusing on the first two categories: environmental and intrapersonal (client-related) phenomena.
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Affiliation(s)
- John R Cutcliffe
- Faculty of Health Sciences, University of Ottawa, Ottawa; School of Nursing, University of Coimbra, Coimbra, Portugal; Department of Nursing, University of Malta, Msida, Malta; Cutcliffe Consulting, Hampden, Maine, USA
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Cutcliffe JR, Riahi S. Systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization: part 2. Int J Ment Health Nurs 2013; 22:568-78. [PMID: 23750853 DOI: 10.1111/inm.12028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This is the second of a two part paper which seeks to explore a wide range of phenomena that have been found to have an association with aggression and violence (A/V) in inpatient mental health care, synthesize these propositions according to fit or congruence into a systemic model of A/V, explore the empirical evidence pertaining to these propositions, and begin to consider application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The systemic model is comprised of four thematic categories with part two of the paper focusing on the final two categories: mental health-care system-related phenomena and clinician-related phenomena. The paper then discusses a number of implications arising out of embracing a more systemic model of A/V in mental health care. In broadening our understanding to include all the phenomena that contribute increased risk of A/V incidents, we are able to move away from inaccurate views that disproportionately assign 'responsibility' to clients for causing A/V when the evidence indicates that the client-related phenomena may only account for a small portion of these incidents.
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Affiliation(s)
- John R Cutcliffe
- University of Ottawa, Ottawa, Ontario, Canada; School of Nursing, University of Coimbra, Coimbra, Portugal; University of Malta, Msida, Malta
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Voogt LA, Nugter A, Goossens PJJ, van Achterberg T. "Providing structure" as a psychiatric nursing intervention: a review of the literature. Perspect Psychiatr Care 2013; 49:278-87. [PMID: 25187449 DOI: 10.1111/ppc.12014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/23/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The focus is on a nursing intervention called "providing structure" (PS). This label does not exist in the Nursing Interventions Classification. The following three questions were asked: (a) How is PS defined? (b) What are the goals of PS? and (c) What is the evidence regarding the effectiveness of PS? DESIGN AND METHOD A systematic literature review. Forty articles, predominantly qualitative studies of PS, were selected for review. FINDINGS Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS.
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Affiliation(s)
- L Amar Voogt
- Regio Noordwest, Philadelphia Zorg, Heerhugowaard, Netherlands; Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo, Netherlands; Quality of Care/Nursing Science, Radboud University, Nijmegen, Netherlands
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40
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Johansson IM, Skärsäter I, Danielson E. The experience of working on a locked acute psychiatric ward. J Psychiatr Ment Health Nurs 2013; 20:321-9. [PMID: 22845661 DOI: 10.1111/j.1365-2850.2012.01919.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health-care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context.
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Affiliation(s)
- I M Johansson
- School of Health Sciences Jönköping University Box 1026 SE-551 11, Jönköping, Sweden.
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Björkdahl A, Hansebo G, Palmstierna T. The influence of staff training on the violence prevention and management climate in psychiatric inpatient units. J Psychiatr Ment Health Nurs 2013; 20:396-404. [PMID: 22632809 DOI: 10.1111/j.1365-2850.2012.01930.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Violence prevention and management is an important part of inpatient psychiatric nursing and specific staff training is regarded essential. The training should be based on primary, secondary and tertiary prevention. In Stockholm, Sweden, the Bergen model is a staff-training programme that combines this preventive approach with the theoretical nursing framework of the City model that includes three staff factors: positive appreciation of patients, emotional regulation and effective structure. We evaluated this combination of the Bergen and City models on the violence prevention and management climate in psychiatric inpatient wards. A 13-item questionnaire was developed and distributed to patients and staff in 41 wards before the staff was trained and subsequently to 19 of these wards after training. Data analyses included factor analysis, Fisher's exact test and Mann-Whitney U-test. The result showed that the staff on trained wards had a more positive perception of four of the items and the patients of one item. These items reflected causes of patient aggression, ward rules, the staff's emotional regulation and early interventions. The findings suggest that a focus on three levels of prevention within a theoretical nursing framework may promote a more positive violence prevention and management climate on wards.
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Affiliation(s)
- A Björkdahl
- Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
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Cyber nursing?Health ?experts? approaches in the post-modern era of virtual performances: A nethnography study. Int J Nurs Stud 2013; 50:335-44. [DOI: 10.1016/j.ijnurstu.2012.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 11/30/2022]
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Cleary M, Horsfall J, O'Hara-Aarons M, Hunt GE. Mental health nurses' views on therapeutic optimism. Int J Ment Health Nurs 2012; 21:497-503. [PMID: 22417284 DOI: 10.1111/j.1447-0349.2011.00805.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Registered nurses (RN) coordinate acute mental health units on a 24-hour basis and it behoves researchers to actually ask these nurses what they think contributes to their ability to work with patients in optimistic ways. In this study, 40 RN working in acute mental health settings were asked a series of questions to explore positive aspects of nursing work, which includes therapeutic optimism. Three themes were identified: (i) different ways nurses foster therapeutic optimism; (ii) perceptions of how an optimistic environment is fostered, and (iii) improvement of ward culture. Findings show the pivotal role mental health nurses have in improving teamwork, good communication, sharing, and collaboration, in addition to preceptoring and supervision. Furthermore, effective clinical management is essential to therapeutic optimism and, in this research, is considered to be the aspect of acute mental health nursing most relevant to improving the ward culture.
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Affiliation(s)
- Michelle Cleary
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore.
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Cleary M, Horsfall J, O'Hara-Aarons M, Jackson D, Hunt GE. Mental health nurses' perceptions of good work in an acute setting. Int J Ment Health Nurs 2012; 21:471-9. [PMID: 22583567 DOI: 10.1111/j.1447-0349.2011.00810.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Frequently, research and conference papers explore difficult or problematic areas of practice that can inadvertently render daily nursing accomplishments invisible and create the perception of a discipline in crisis. In this qualitative study, we explore the views of registered nurses about achievements in the workplace and good nursing work in an acute inpatient mental health setting in Sydney, Australia. Mental health nurses were asked a series of questions about their experiences and understanding of what constitutes good nursing work as well as their sense of optimism about their work. A total of 40 structured face-to-face interviews were completed. Among the responses to questions about achievements and good nursing practice, five broad themes were identified: i) teamwork; (ii) interpersonal interactions with patients; (iii) providing practical and holistic support to patients; (iv) patients' mental health improvements; and (v) optimism-pessimism continuum. Findings contribute to a discussion of good nursing work in acute mental health settings, as well as self-perceptions of optimism and hopefulness, which are important contributors to positive, supportive health-care settings and patient recovery.
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Affiliation(s)
- Michelle Cleary
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore.
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Koivunen M, Huhtasalo J, Makkonen P, Välimäki M, Hätönen H. Nurses' roles in systematic patient education sessions in psychiatric nursing. J Psychiatr Ment Health Nurs 2012; 19:546-54. [PMID: 22070730 DOI: 10.1111/j.1365-2850.2011.01833.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to gain understanding of nurses' expectations of their roles in systematic patient education in psychiatric inpatient care. Qualitative design was used in the study. The data were collected through interviews with nurses participating in the implementation of systematic patient education (information technology (IT) based patient education n= 14, or conventional patient education n= 16). The data were analysed using inductive content analysis. The analysis showed that nurses had different roles in both IT-based and conventional patient education. Nurses acted as learners, advisors, collaborators, teachers or limiters. The nurses tailored the role in each session according to the patients' interest and mental status. We can conclude that nurses working in psychiatric hospitals have different roles in systematic patient education and they are ready and willing to tailor their roles according to patients' individual needs. Information technology should be adopted without delay as a new treatment method in daily practice in psychiatric services. It has potential to support equality between patient and nurse in secluded environments.
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Affiliation(s)
- M Koivunen
- Satakunta Central Hospital, Sairaalantie 3, Pori, Finland.
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Cleary M, Hunt GE, Horsfall J, Deacon M. Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies. Issues Ment Health Nurs 2012; 33:66-79. [PMID: 22273340 DOI: 10.3109/01612840.2011.622428] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.
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Affiliation(s)
- Michelle Cleary
- University of Western Sydney, School of Nursing & Midwifery, Sydney, NSW, Australia.
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Cleary M, Horsfall J, O’Hara-Aarons M, Jackson D, Hunt GE. The views of mental health nurses on continuing professional development. J Clin Nurs 2011; 20:3561-6. [DOI: 10.1111/j.1365-2702.2011.03745.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stenhouse RC. 'They all said you could come and speak to us': patients' expectations and experiences of help on an acute psychiatric inpatient ward. J Psychiatr Ment Health Nurs 2011; 18:74-80. [PMID: 21214687 DOI: 10.1111/j.1365-2850.2010.01645.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute psychiatric inpatient care forms an integral part of mental health services. Few studies have focussed on the patient experience of acute care. Research into patient experience is increasingly important to policy and service development processes. Knowledge of patient experiences facilitates the development of nursing practice. The aim of the study was to gain insight into the experience of being a patient on an acute inpatient psychiatric ward. Thirteen participants were recruited from the acute ward. Unstructured interviews were used to gather narrative data of their experiences. Holistic analysis of the narratives was informed by Gee's socio-linguistic theories that meaning is linked to narrative structure. Reading of the holistic analyses yielded themes of help, safety and power running across the participants' experiences. The patient experience was characterized by dissonance between expectation and experience, the search for a nurse-patient relationship and the development of strategies to cope with being on the acute ward. This paper focuses on the theme of 'Help' where participants describe their expectation that they will receive help through the development of relationships with the nurses, and their experience of the barriers to this. In response, participants developed strategies to support each other.
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Affiliation(s)
- R C Stenhouse
- Tayside Institute for Health Studies, University of Abertay, Dundee, UK.
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