Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain

OBJECTIVE

To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries.

BACKGROUND

Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition.

SOURCES OF EVIDENCE

Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification.

DISCUSSION

PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation.

CONCLUSIONS

Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP.

IMPLICATIONS FOR NURSING PRACTICE

Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy.

IMPLICATIONS FOR NURSING POLICY

Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

A qualitative of stable symptomatology for patients with schizophrenia: do they have adequate post-discharge rehabilitative resources?

Many patients diagnosed with schizophrenia face obstacles to rehabilitation and discharge into the community, particularly with regard to the way resources are structured. Clarifying the difficulties will help health care providers address rehabilitation shortcomings. Semistructured in-depth interviews and participatory observations were conducted in various locations (family home, hospital ward, outpatient clinic, and on the street) with families, social workers, doctors, nursing staff, and patients with schizophrenia. These patients met the medical facility's hospital discharge standards and either had not been discharged or had been discharged within two weeks of meeting the discharge criteria. This study explores the complex and interdependent role of social differences in the rehabilitation of patients with schizophrenia after acute treatment. The study identified five topics related to structural difficulties in resources for the rehabilitation of patients diagnosed with schizophrenia: (1) the role of policy; (2) inadequate facilities and responsibilities; (3) rejecting communities; (4) difficult families; and (5) the threat of stigma. The rehabilitation of patients diagnosed with schizophrenia is a systemic problem. Systemic rehabilitation policies and integrated social support would be more conducive to the rehabilitation of patients. Perhaps cognitive remediation therapy or the Assertive Community Treatment (ACT) Model could benefit individuals with complex disorders.

The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center

BACKGROUND

Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning.

AIM

To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia.

DESIGN

This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group.

METHODS

Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form.

RESULTS

Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback.

CONCLUSION

Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.

Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial

AIM

To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia.

DESIGN

Randomized controlled trial. It was carried out between July 2019 -February 2020.

METHODS

Fifty-six patients with schizophrenia were enrolled and randomly assigned to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS).

RESULTS

Completion at follow-up was high (92.86%). The intention-to-treat analyses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large.

CONCLUSION

The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment.

IMPACT

Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID NCT03891186.