Development of the clinical competency assessment scale in child and adolescent mental health nursing

WHAT IS KNOWN ON THE SUBJECT?: Children and adolescents' mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, are a global public health concern, and nurses require advanced expertise and skills to properly care for this population. There is a gap between the required competencies and the actual skills and knowledge of CAMHN practitioners. Previous studies suggest that educational interventions for nurses are necessary to enhance the quality of care for children and adolescents with mental health problems. However, the corresponding evaluation indicators have not been verified, making it difficult to determine the most effective methods. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The present study developed the two-factor (direct care for children and their family members and approach to the care environment) Clinical Competency Assessment Scale in Child and Adolescent Mental Health Nursing (CCAS-CAMHN). We demonstrated that the assessment scale was reliable and valid, based on its adequate internal consistency and temporal stability, the acceptable range of its model-fit indexes, and its good concurrent and divergent validity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The newly developed scale is useful for assessing nurses' competency and could help them identify their difficulties in CAMHN. The scale could contribute to the development of effective educational interventions to enhance the quality of care for children and adolescents with mental health problems.

ABSTRACT

INTRODUCTION: Caring for children and adolescents with mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, requires expertise and skills. A quantitative clinical competency measurement tool in child and adolescent mental health nursing (CAMHN) is needed to evaluate the indicators of advanced expertise.

AIM

The aim of this study was to develop a clinical competency assessment scale in CAMHN and evaluate its psychometric properties.

METHOD

Scale items were derived from previous studies and adjusted based on cognitive interviews with five CAMHN experts. In total, 505 nurses in CAMHN from 29 hospitals in Japan participated in the self-administered survey. The scale's construct validity, criterion-related validity, internal consistency and test-retest reliability were assessed.

RESULTS

A two-factor (direct care for children and their family members and approach to the care environment) scale was constructed. A secondary structural model showed that a two-factor model fits best. The total score was significantly and positively correlated with excellence in nursing practice, amount of clinical experience and mental status. The overall scale exhibited good validity and reliability.

DISCUSSION

The scale is reliable and valid for assessing CAMHN clinical competency.

IMPLICATIONS FOR PRACTICE

The scale is useful for assessing nurses' competency and evaluating educational interventions' effectiveness for nurses.

Challenges for psychiatric nurses working with non-suicidal self-injury adolescents: a qualitative study

BACKGROUND

Psychiatric nurses play a crucial role in treating and supporting adolescents with non-suicidal self-injury (NSSI) in China. However, few studies have explored their experiences and challenges.

OBJECTIVES

The aim of this qualitative study was to describe the challenges experienced by psychiatric nurses when working with adolescents having NSSI behaviors.

METHODS

This was a descriptive qualitative study using phenomenological approach. 18 psychiatric nurses from psychiatric wards were recruited from a tertiary hospital from Changsha, Hunan province, China. In-depth interview was performed for each participant collecting information about their feelings and experiences taking care of NSSI adolescents. ATLAS.ti 8 was used to enter data and perform thematic analysis following the six-phased process described by Braun and Clarke.

RESULTS

Two main themes and five sub-themes were summarized in this study. Nurses experienced both (1) Internal challenges (Lacking knowledge and skills to deal with NSSI adolescents and Feeling hard and stressful working with NSSI adolescents) and (2) External barriers (Unrealistic high expectations from family and schools, Uncooperative parents and Little help from communities and schools).

CONCLUSIONS

Psychiatric nurses had to face with their own negative feelings, insufficient knowledge and skills, alongside with pressures and little help from family, schools and communities when working with NSSI adolescents. Targeted training programs of treating NSSI adolescents and their supporting systems be performed in nurses, furthermore, family, schools and societies should also be raised.

Preparing children's nurses for working with children and adolescents who self-harm: Evaluating the 'our care through our eyes' e-learning training package

Rates of self-harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of 'Our Care Through Our Eyes', an online self-harm learning programme for children's nurses. A self-selected, convenience sample of registered children's nurses (n = 42) completed scales pre- and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self-harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre- and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating 'Our Care Through Our Eyes' delivered using e-leaning and could be used to inform further investigations.

Nurses' experiences of working in the community with adolescents who self-harm: A qualitative exploration

WHAT IS KNOWN ON THE SUBJECT?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self-harm. Adolescent self-harm is a growing problem, with rates increasing in the UK. Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self-harm. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an understanding of the impact of working with adolescents who self-harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care. Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self-harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures. Community CAMHS nurses experience feelings of self-doubt and shame due to their emotional responses, self-care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self-care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this. Nurses working with adolescents who self-harm in CAMHS could benefit from training regarding understanding and managing self-harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment-based family therapy). ABSTRACT: Introduction Nurses often work in the community with adolescents who self-harm. There is a lack of qualitative research exploring nurses' experiences of working with adolescents who self-harm. Aim This study aimed to gain an understanding of community nurses' experiences of working with adolescents who self-harm. Method Ten semi-structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). Results Data were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self-harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development. Discussion Nurses feel conflicted about working with adolescents who self-harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self-care behaviours and personal and professional boundaries. Implications for Practice Nurses working with adolescents who self-harm would benefit from training, reflective practice and self-care. CAMHS managers should encourage and invest in these areas.

A systematic review into healthcare professionals' attitudes towards self-harm in children and young people and its impact on care provision

Self-harming behaviours in children and young people are an alarming reality, with provision of effective treatment historically compromised. The present systematic literature review highlights attitudes displayed by healthcare professionals towards this health problem, providing valuable insight by analysing how these attitudes can impact patient care. Ten studies were included, allowing creation of a narrative synthesis of qualitative, quantitative and mixed-methods evidence. Six themes emerged: negativity, positivity, worry or fear, the emotional impact of working with these patients, professional roles and ward-dependent concerns. Overall, professional negativity towards this patient group, in the form of apprehensiveness, was accentuated by fear of worsening their symptoms. The attitude aforementioned impacts on treatment by hindering creation of meaningful therapeutic relationships. Educational opportunities that increase healthcare professionals' knowledge of self-harm have the potential to provide invaluable power by promoting positive attitudes.

Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review

BACKGROUND

Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory-informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory-informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions.

OBJECTIVE

We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties.

METHODS

We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%).

CONCLUSIONS

The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts.

TRIAL REGISTRATION

PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492.

Prevenção da autolesão não suicida: construção e validação de material educativo

Resumo Objetivo: elaborar e validar um material educativo para fortalecer a assistência em saúde aos adolescentes sobre a autolesão não suicida. Método: pesquisa metodológica delineada em três etapas: (1) construção do material a partir de estudo misto sobre necessidades ligadas à temática por meio das redes sociais e uma revisão guarda-chuva sobre a assistência relacionada à autolesão não suicida; (2) validação com 10 especialistas em saúde mental e/ou violência autoprovocada selecionados pela Plataforma Lattes; (3) avaliação pelo público-alvo, sendo convidados profissionais de saúde, sem restrição de formação. A coleta dos dados de validação e avaliação foi realizada por um questionário sociodemográfico e o Suitability Assessment of Materials for evaluation of health-related information for adults. Foi empregada a estatística descritiva, índice de validade de conteúdo e o teste AC1 de Gwet. Resultados: o material obteve boa aceitação geral e confiabilidade na validação pelos especialistas (AC1=0,633; p=0,0000) e na avaliação pelo público-alvo (AC1=0,716; p=0,0000). Todos os profissionais apontaram a contribuição pessoal e potencial educativo do material. Conclusão: destaca-se a construção de material educativo embasado em ciência para o fortalecimento da assistência aos adolescentes com autolesão não suicida.

Prevención de las autolesiones no suicidas: construcción y validación de material educativo

Resumen Objetivo: elaborar y validar un material educativo para fortalecer la asistencia en salud a los adolescentes sobre la autolesión no suicida. Método: investigación metodológica delineada en tres etapas: (1) Construcción del material a partir de un estudio mixto sobre las necesidades vinculadas al tema por medio de las redes sociales y una revisión paraguas sobre la asistencia relacionada con la autolesión no suicida; (2) validación con 10 especialistas en salud mental y/o violencia autoprovocada seleccionados por la Plataforma Lattes; (3) Evaluación por parte del público objetivo, siendo invitados profesionales de salud, sin restricción de formación. La recolección de los datos de validación y evaluación fue realizada por un cuestionario sociodemográfico y el Suitability Assessment of Materials for evaluation of health-related information for adults. Se empleó la estadística descriptiva, el índice de validez de contenido y el test AC1 de Gwet. Resultados: el material obtuvo una buena aceptación general y confiabilidad en la validación por parte de los especialistas (AC1=0,633; p = 0,0000) y en la evaluación por el público objetivo (AC1 = 0,716; p=0,0000). Todos los profesionales señalaron la contribución personal y el potencial educativo del material. Conclusión: se destaca la construcción de material educativo basado en ciencia para fortalecer la asistencia a los adolescentes con autolesión no suicida.

Prevention of non-suicidal self-injury: construction and validation of educational material

Objective:

to develop and validate educational material to strengthen adolescent health care on non-suicidal self-injury.

Method:

methodological research designed in three stages: (1) construction of the material based on a mixed study on needs related to the theme through social networks and an umbrella review on health care related to non-suicidal self-injury; (2) validation with 10 experts in mental health and/or self-inflicted violence selected through the Lattes Platform; (3) evaluation by the target public, with health professionals being invited, without restriction of training. Validation and evaluation data were collected by using a sociodemographic questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults. We used descriptive statistics, content validity index, and Gwet’s AC1 test.

Results:

the material obtained good general acceptance and reliability in the validation by the experts (AC1= 0.633; p=0.0000) and in the evaluation by the target public (AC1=0.716; p=0.0000). All professionals pointed out the personal contribution and educational potential of the material.

Conclusion:

we highlight the construction of science-based educational material to strengthen the health care for adolescents with non-suicidal self-injury.

Shared learning to improve the care for young people and mental health within nurse education (SHYNE). Improving attitudes, confidence and self-efficacy

Preparing students for the complexities of practice is an ongoing challenge of pre-registration nurse education. One such complexity is the increase in children and young people with mental health problems. Pre-registration student nurses from child and mental health specialisms from one University participated in an innovative simulation session, whereby actors from a youth theatre group simulated young people admitted to an acute non-mental health hospital setting for treatment of self-harm injuries. This study used an uncontrolled pre and post design to determine the impact of the session on student nurses' attitudes, confidence and self-efficacy when caring for young people who self-harm. Attitudes towards self-harm was measured using a 13 item self-report questionnaire. Confidence was measured through Likert scale responses. Self-efficacy for working with children and young people who have self-harmed was measured through an adapted version of the Self-Efficacy Towards Helping (SETH) scale. In total 101 student nurses took part in the study and 99% completed post simulation outcome measures. At post-session, the students reported a statistically significant improvement in attitudes, self-efficacy and confidence towards children and young people who self-harm. A lack of confidence is frequently reported in the literature when caring for this client group in practice settings. Improvements in attitudes, confidence and self-efficacy can positively impact individual nursing practice. Furthermore the simulation literature indicates that the skills consolidated using such an educational approach are taken forward into clinical practice. While broad claims of success should be avoided, it is promising to find a learning method that is effective in addressing a contemporary and complex health issue. Shared Learning to Improve the Care for Young People and Mental Health within Nurse Education (SHYNE): Improving Attitudes, Confidence and Self-Efficacy.