Defining the role of a forensic hospital registered nurse using the Delphi method

Vicarious Trauma and Health Outcomes in Forensic Mental Health Nurses

BACKGROUND

Nurses working in forensic mental health settings are at risk of vicarious trauma because of their exposure to traumatized patients and distressing material such as the aversive details of patient crimes.

AIM

The aim of this study was to determine the incidence of vicarious trauma and explore its impact on health and absence from work.

METHODS

A cross-sectional descriptive correlational study was undertaken. All 205 forensic mental health nurses working in a high-security inpatient facility were invited to participate. An online survey included the Vicarious Trauma Scale and the SF-36v2 to measure mental and physical health. Absence from work was also explored.

RESULTS

Sixty-seven respondents completed the survey. Almost half of respondents had a moderate level of vicarious trauma, and only over one-quarter experienced high levels. Higher levels of vicarious trauma were associated with poorer mental health ( r = -0.59, p < 0.000) and absence from work ( r = 0.27, p < 0.010).

CONCLUSIONS

Forensic mental health nurses are at a greater risk of vicarious trauma than nurses working in mainstream mental health services, given their exposure to aversive details of patients' violent crimes. Adverse mental health consequences of vicarious trauma, and other forms of workplace trauma experienced by forensic mental health nurses, are likely to include trauma-related symptoms, depression, and anxiety. Forensic mental health nurses experiencing vicarious trauma may use sick leave as time away from work to care for their own mental health or a coping mechanism for workplace-induced psychological distress.

Identifying the core competencies of backup nurses in the acute care hospital through a modified Delphi process†

Background

The backup nurses are created to meet emergencies in the case of inadequate nursing staff and emergency circumstances, and there are no clear definitions of the core competencies for training and evaluation of backup nurses in the acute care hospitals in China.

Methods

This study used a modified Delphi process where an initial list of potential competencies is established following a framework of training need analysis (TNA), literature review, and focus groups. This process generated as a list of 47 core competencies, which is presented to an expert panel (n = 20) for consideration in two rounds.

Results

As determined by the survey, a combination of 26 core competencies in three specified categories is identified: professional practice ability, critical thinking ability, and interpersonal skills. A total of 154.99 h is required to complete all 26 core competencies, and each item has a corresponding evaluation method.

Conclusions

The core competencies provide a scientific basis for the hospital nursing managers to train and evaluate backup nurses, and it may ensure consistency in standards across the country.

Using the Delphi Method to Construct a Promotion Plan for Clinical Nurse Specialists

PURPOSE

The aim of this study was to design a quantitative evaluation of the promotion plan for clinical nurse specialists in China.

DESIGN

The evaluation indexes were selected and established by inquiring 22 experts and using the analytic hierarchy process. The promotion plan was sent to 22 specialized nurses. The reference value was established by comparing the results from predictions made by experts and the self-evaluation of specialized nurses.

METHODS

This study used the Delphi method and mixed qualitative and quantitative methods, which not only determined the entry of the promotion plan but also calculated its weight, and obtained the baseline score through a small range of empirical studies.

RESULTS

This promotion plan included basic promotion conditions, 5 primary indicators, 15 secondary indicators, and 61 tertiary indicators and was designed by experts who had a high degree of authority in this field. The self-evaluation results of 19 specialist nurses showed a reference value of 30 points per 3 years using the promotion plan. For clinical nursing managers, it is a management tool to evaluate specialist nurses, which can provide a basis for the promotion of specialist nurses.

CONCLUSIONS

The promotion plan for clinical nurse specialists in China formed by this research is quantifiable, scientific, and instructive.

Exposure to workplace trauma for forensic mental health nurses: A scoping review

BACKGROUND

Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role.

OBJECTIVES

To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses.

DESIGN

A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

METHODS

Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence.

RESULTS

Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature.

CONCLUSIONS

While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

An integrative review of nursing staff experiences in high secure forensic mental health settings: Implications for recruitment and retention strategies

AIMS

To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention.

BACKGROUND

Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of nurse's experiences in this setting have not previously been reviewed in the context of workforce sustainability pressures.

DESIGN

An integrative review (Whittemore and Knapfl, 2005).

DATA SOURCES

A systematic search of data sources: MEDLINE (PubMed), PsycINFO, EMBASE, CINAHL, International Bibliography of the Social Sciences, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, ProQuest Social Sciences Premium collection (IBSS, PAIS, and Sociological Abstracts), and Web of Science from inception to December 2019.

REVIEW METHODS

Data extraction, quality appraisal, and convergent qualitative synthesis.

RESULTS

Fifteen papers were selected for inclusion in the review, describing 13 studies. Six studies were quantitative, all cross-sectional surveys. There were seven qualitative studies, using a variety of methodologies. Four themes were identified: engagement with the patient group, the ward social environment, impact on the nurse, and implications for practice.

CONCLUSION

When policymakers address workforce shortages in high secure forensic nursing they must take account of the unique features of the setting and patient group. Nurses must be adequately prepared and supported to function in an ethically and emotionally challenging environment.

IMPACT

This study identified factors affecting workforce pressures in the speciality of forensic mental health nursing. Findings are of interest to national nursing policymakers and workforce leads in mental health service provider organizations, seeking to promote forensic nursing as a career option and retain nursing staff.

Implementation of the Mental Health Nurse Practitioner Role in Forensic Settings: A Case Report

This is a case report about the implementation of the mental health nurse practitioner role in forensic psychiatric settings. We will present its implementation and issues encountered during this process, such as a lack of understanding of the role in staff teams, scope of practice limitations, tension stemming from the conflict between treatment and punishment approaches, and the risk of medicalization of nursing. This case report, based on the authors' experiences, represents an early contribution to research on advanced nursing practice in forensic psychiatry, an area that has yet to receive much attention in the literature.

Incidence of Vicarious Trauma in Correctional Health and Forensic Mental Health Staff in New South Wales, Australia

BACKGROUND

Correctional health and forensic mental health (FMH) staff may experience vicarious trauma (VT) as a result of cumulative and repeated exposure to traumatic material in their professional roles.

AIM

This study aimed to determine the incidence of VT in a sample of correctional health and FMH staff.

METHODS

A cross-sectional survey including 135 correctional health and FMH staff participating in a VT management program was conducted. Survey respondents completed the Vicarious Trauma Scale and Impacts of Events Scale-Revised.

FINDINGS

Most respondents had moderate or high VT (n = 78, 57.8%, and n = 40, 29.6%, respectively). Low psychological distress was reported, with posttraumatic stress disorder symptoms being experienced either mildly or not at all by most respondents. A significant relationship between total Vicarious Trauma Scale score and total Impacts of Events Scale-Revised score (r = 0.471, p = 0.000) was found, indicating that a higher level of VT was associated with an increased risk of posttraumatic stress disorder symptoms. A higher level of VT was also associated with increased reports of avoidance, intrusion, and hyperarousal (r = 0.382, p = 0.000; r = 0.489, p = 0.000; and r = 0.440, p = 0.000, respectively).

CONCLUSION

Correctional health and FMH staff are at risk of developing VT and associated psychological distress.

IMPLICATIONS FOR CLINICAL FMH NURSING PRACTICE

Correctional health and FMH organizations have the responsibility to ensure nurses are aware of the effects of VT and to provide opportunities for nurses to participate in VT education and management programs.