'Your experiences were your tools'. How personal experience of mental health problems informs mental health nursing practice

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences

INTRODUCTION

Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients.

METHODS

UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed.

RESULTS

43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence.

CONCLUSION

Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers.

IMPLICATIONS FOR PRACTICE

To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

[Disclosure of Own Crisis And Treatment Experiences By Staff Of Psychiatric Institutions In BerLin And Brandenburg - An Underused Resource For Reducing Stigma?]

AIM

This article is part of the EKB-study which explores lived crisis and treatment experiences of mental health professionals in Berlin and Brandenburg. It addresses the disclosure of mental health workers' lived experiences in their workplace.

METHOD

An online survey was conducted among 182 mental health professionals, containing questions on disclosure of lived experiences. Data were analyzed descriptively and analytically.

RESULTS

Participants reported disclosure mainly to supervisors and affiliated colleagues. Experiences were mostly positive, with severe negative exceptions. Central motives against disclosure were fear of vulnerability, fear of compromising professional identity, and shame.

CONCLUSIONS

Disclosure of lived crisis experiences is not always the proper strategy for mental health professionals. Disclosure may be a means of reducing public and internalized stigma.

The Impact of Patients and Student Mental Health Nurses Sharing Time Together in Forensic Units

ABSTRACT

Student mental health nurses have greater patient contact than registered nurses, and this is appreciated by patients. This phenomenological study explored the impact of patients and student mental health nurses' time shared on forensic units for men carrying a personality disorder diagnosis. Phenomenology was the underpinning philosophy of this research. Patients and student mental health nurses in forensic hospitals participated in unstructured hermeneutic interviews. The time students and patients shared together was considered a gift, enabling them to feel that they were "just people" and valued, strongly impacting on their sense of person. The impact the students have on patients' quality of life is meaningful. When the students and patients connected, it had powerful implications for their sense of humanness and value, highlighting the reciprocal impact they each have on another and the importance of having student nurse clinical placements in forensic wards and facilities.Implications for Clinical Forensic Nursing Practice: This article offers a unique contribution to forensic practice by exploring the experiences of the time patients and students share together in forensic units. Students, who often have the greatest contact with patients, represent the present and future of nursing, and their time is appreciated by patients. Previous research focuses on attitudes and therapeutic relationships, rather than the impact of shared contact. In addition to this, patients in forensic services with personality disorder diagnoses can be the most stigmatized group in mental health care, and exploration of their experiences is lacking. These experiences must be shared.

Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it

BACKGROUND

Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic.

AIMS

This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities.

METHODS

An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated.

RESULTS

Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues.

CONCLUSION

The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.

Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: 'Building a Recovery Focused Therapeutic Relationship'; 'Authoritarian Role'; 'Inevitable Imbalance'; 'Rebuilding the Therapeutic Relationship'; plus two sub-themes 'Facilitators to rebuilding' and 'Barriers to rebuilding'. Findings suggest that an inevitable imbalance exists in building a recovery-focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post-restraint-focused clinical supervision would also be beneficial to mental health nursing staff.

Who am I? The identity crisis of mental health professionals living with mental illness

WHAT IS KNOWN ON THE SUBJECT?: Large numbers of mental health professionals live with their own mental health challenges. Despite working in mental health care, they can experience stigma in the workplace. Mental health professionals with lived experience of mental illness can find it a challenge to integrate their identities as both mental health professional and mental health service user. There are currently limited options available to them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is a personal reflection from a mental health nurse and lecturer, who lives with a severe and enduring mental illness. It offers a lived experience account of the identity struggles of a mental health professional living with a mental illness. This article attempts to redefine the identity of professionals with personal lived experience in a more positive manner. They can be valued and celebrated for their unique perspective on mental illness and mental health care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There remains a stigma attached to people living with mental health conditions. This article challenges some of this stigma. It will empower and encourage other health professionals with lived experience to embrace all aspects of their identity with authenticity and courage. ABSTRACT: There are growing numbers of mental health professionals with their own lived experience of mental illness. This is both in part due to increased visibility and openness, and students embarking on professional courses motivated by their own personal mental health history. The somewhat limited research in this area highlights the difficulty practitioners have in navigating this distinct identity. There are limited options, including a wounded healer, an impaired professional and professional survivor. All have their limitations. We need to revise the conceptualisation of mental health professionals with personal lived experience of mental illness. Our identity needs to be celebrated and valued, as are the roles of peer support worker and expert by experience. Through personal reflection, I describe my own challenges in negotiating my identity as a mental health nurse, lecturer, and service user. My solution is to embrace authenticity and have the courage to stand in vulnerability and strength, embracing all aspects of myself. I call for others to do the same.

All I missed in the therapeutic relationship: The lived experience narrative of a mental health nurse receiving mental healthcare

WHAT IS KNOWN ON THE SUBJECT?: The therapeutic relationship is crucial for mental health practice, especially to practice that is recovery-orientated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This lived experience suggests that mental health professionals can be a long way from knowing the service users' feelings and their precise needs. The narrative reveals how mental health professionals maintain stereotypes and prejudices against people with mental health conditions and how these are reflected in their practice through lack of respect and users' dignity. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: This lived experience narrative highlights the need to humanize care.

ABSTRACT

INTRODUCTION: The therapeutic relationship is not always functional in clinical practice due to various factors, such as lack of time, lack of job motivation, exhaustion and rejection towards the person cared for.

AIM

The aim of this study is to illustrate to professionals the needs of the persons they care for and how they see the world.

METHOD

The aim was achieved through the development of a lived experience narrative.

RESULTS

This lived experience narrative describes the experience of a mental health nurse since her first psychotic symptoms and her perceptions of the therapeutic relationship with mental health staff in her trajectory from the first psychiatric appointment until her last contact with the community mental health services.

DISCUSSION

This narrative suggests that mental health professionals are sometimes far from discovering what service users are feeling and their precise needs. This highlights the need to humanize mental healthcare.

Internalized stigma in mental health staff with lived experience of mental crises-Does the professional role protect against self-stigmatization?

Objective

The stigma of mental illness is widespread in the general population and also among healthcare and psychiatric professionals. Yet, research on the self-stigma of the latter is still limited. The purpose of this article was to assess self-stigma and its correlates in mental health professionals with lived experiences of mental crisis and treatment.

Methods

In a cross-sectional exploratory research project, 182 mental health professionals with lived experiences of mental crisis and treatment from 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg were surveyed on their lived experiences, self-stigma, perceived stigma in the workplace, subjective vulnerability to crises, and meaningfulness of lived experiences. To investigate the relationships between the variables, manifest and latent correlation analyses were calculated.

Results

Results showed low levels of self-stigma and perceived public stigma in the workplace. Self-stigma was significantly and positively associated with workplace stigma and subjective vulnerability to crisis, but not with identification with lived experiences.

Conclusion

The relationship between self-stigma, workplace stigma, and vulnerability should be investigated in terms of mutual causality in order to derive possible strategies of reducing self-stigma along with its detrimental effects. Possible reasons for the low levels of self-stigma are discussed in the light of limitations, including processes of self-selection, with highly self-stigmatizing individuals being possibly discouraged from participating. Strategies to enhance sampling quality are briefly discussed.

Mediating effects of psychological capital on the relationship between workplace violence and professional identity among nurses working in Chinese public psychiatric hospitals: a cross-sectional study

OBJECTIVE

To examine the relationship between workplace violence (WPV) and professional identity among Chinese psychiatric nurses and the mediating effects of psychological capital (PsyCap) from this association.

SETTING

Seven public tertiary psychiatric hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 952 psychiatric nurses were recruited for this study. Registered nurses who have been engaged in psychiatric nursing for more than 1 year were eligible as participants in this investigation.

OUTCOME MEASURES

Questionnaires consisting of the Workplace Violence Scale, the Occupational Identity Scale, the Psychological Capital Questionnaire and a demographic data sheet were used to collect participant information. We used hierarchical multiple regression and asymptotic and resampling strategies to examine the mediating role of PsyCap in the relationship between WPV and professional identity.

RESULTS

WPV was negatively associated with professional identity after controlling for demographic factors (β=-0.353; p<0.001). PsyCap mediated the relationship between WPV and professional identity, according to the mediation analysis (a×b=-0.150, bias-corrected and accelerated 95% CI (BCa 95% CI) (-0.185 to -0.115); p<0.001). In addition, two dimensions of PsyCap: hope (a×b=-0.075, BCa 95% CI (-0.104 to -0.049); p<0.001) and resilience (a×b=-0.064, BCa 95% CI (-0.090 to -0.039); p<0.001) mediated the association between WPV and professional identity. For professional identity, hope, resilience and PsyCap mediation accounted for 21.6%, 18.1% and 42.4%, respectively.

CONCLUSIONS

Based on these findings, PsyCap could partially mediate the relationship between WPV and professional identity. Therefore, hospital administrators should implement measures to prevent and reduce WPV and provide nurses with skills training programmes to improve the PsyCap such as hope and resilience.

A model to understand antecedents of nursing attitudes and perceptions influencing outcomes of patients with SUD

INTRODUCTION

Substance use disorder (SUD) is a persistent and long-standing public health issue in the United States. While SUD is medically considered a chronic illness, it is also one that is viewed as self-inflicted, thereby resulting in judgmental attitudes and stigmatization from care providers, specifically from nurses.

DESIGN

In 2020, the authors completed an analytical cross-sectional study that included open-ended questions to examine nurses' knowledge and attitudes toward caring for patients with SUD across practice settings.

METHODS

A conceptual model was constructed by examining original study data and published literature on SUD, re-analyzing themes, determining constructs and variables, then coming to a consensus on critical aspects of the model.

CONCLUSION

The resulting conceptual model highlights antecedents of nursing behaviors that directly affect patient care outcomes, providing a roadmap to improving patient outcomes.

CLINICAL RELEVANCE

Understanding antecedents that affect nurses' attitudes and perceptions of patients with SUD highlights changes that can influence patient outcomes.

Utilizing the mental health nursing workforce: A scoping review of mental health nursing clinical roles and identities

Despite rising international needs for mental health practitioners, the mental health nursing workforce is underutilized. This is in part due to limited understandings of their roles, identities, and capabilities. This paper aimed to collate and synthesize published research on the clinical roles of mental health nurses in order to systematically clarify their professional identity and potential. We searched for eligible studies, published between 2001 and 2021, in five electronic databases. Abstracts of retrieved studies were independently screened against exclusion and inclusion criteria (primarily that studies reported on the outcomes associated with mental health nursing roles). Decisions of whether to include studies were through researcher consensus guided by the criteria. The search yielded 324 records, of which 47 were included. Retained papers primarily focused on three themes related to mental health nursing clinical roles and capabilities. Technical roles included those associated with psychotherapy, consumer safety, and diagnosis. Non-technical roles and capabilities were also described. These included emotional intelligence, advanced communication, and reduction of power differentials. Thirdly, the retained papers reported the generative contexts that influenced clinical roles. These included prolonged proximity with consumers with tensions between therapeutic and custodial roles. The results of this scoping review suggest the mental health nurses (MHNs) have a wide scope of technical skills which they employ in clinical practice. These roles are informed by a distinctive cluster of non-technical capabilities to promote the well-being of service users. They are an adaptable and underutilized component of the mental health workforce in a context of escalating unmet needs for expert mental health care.

Personal and professional influences on health visitors' family focused practice for maternal mental illness: a cross sectional study

BACKGROUND

Family focused practice (FFP) is an approach that recognises the inter-related needs of family members and recommends a continuum of activities to support families. While it is recognised that health visitors play a key role in supporting families when mothers have mental illness, there is limited understanding of health visitor's family focused practice (FFP) in this context and its relationships with factors, such as, workload, training, skill and knowledge, and personal and professional experience. This paper examined the effect of health visitors' interaction with the family, and personal and professional experience on their family focused practice.

METHODS

A cross sectional questionnaire (Family Focused Mental Health Practice Questionnaire) was distributed to 488 health visitors within community practice in Northern Ireland, with 230 choosing to take part. Independent t-tests and one-way analysis of variance were used to compare family focused practice scores.

RESULTS

Results found that health visitors who had face to face contact with partners and children (t(221) = 2.61, p = .01), and those that directly supported the partner (t(221) = 2.61, p = 0.01) had a significantly higher mean score of FFP, than those that did not. However, frequency of visits (daily, weekly, monthly or yearly) had no effect on family focused practice scores. Training also had a significant effect on family focused practice scores (F(2,221) = 4.841, p = 0.029). Analysis of variance revealed that personal experience of mental illness had a significant effect on scores (M = 97.58, p = 0.009), however variables such as, age, parental status, time since registration, and being in a specialist position had no effect.

CONCLUSIONS

In order for family focused practice to be effective, the quality, and content of visits and contact with family should be addressed, as opposed to a focus on the quantity of visits. However, in order for this to occur health visitors need to have appropriate support in their own right, with manageable caseloads and resources.

Healthcare professional disclosure of mental illness in the workplace: a rapid scoping review

BACKGROUND

Although mental health difficulties are common among healthcare professionals (HCP), little research exists exploring the decision to disclose these difficulties in the healthcare context.

AIMS

This rapid scoping review aims to explore HCP disclosure of mental health difficulties in the workplace.

METHODS

The methodological framework was based on rapid and scoping review guidelines. A thematic synthesis approach was used for data analysis.

RESULTS

Seventeen articles were included. Disclosure was found to be a process that starts with weighing its pros ("personal benefits", "personal beliefs", and "professional responsibility") and cons ("fears related to professional identity", "fears related to employment", "risk of stigmatization", and "personal experiences with mental health difficulties"). A decision-making process then occurs to help HCPs figure out how to disclose. Situations of nonconsensual disclosure can transpire through "third party disclosure" or "inadvertent disclosure". Disclosure results in outcomes including "positive experiences", "negative personal consequences" and "negative consequences related to others".

CONCLUSION

Disclosure in healthcare and other workplaces is a complex process with few benefits and many potential repercussions. However, there is an opportunity to improve. Recognizing the value of and educating the workforce about HCPs with mental health difficulties will help work environments become safer for disclosure.

Mental health in nursing: A student's perspective

ABSTRACT

A stigma around mental health issues within healthcare and nursing itself has created a culture of perfectionism in the workplace, and nurses struggle to live up to the expectations while pushing aside their feelings, thoughts, and needs. Inspired by one author's personal experiences, this article explores mental health issues many nurses confront today.

Professional identity and its work-related factors among psychiatric nurses: A cross-sectional study

OBJECTIVE

To investigate the level of professional identity among psychiatric nurses and to explore what work-related factors may affect their professional identity.

METHODS

Four hundred and twelve nurses were investigated. Two self-report questionnaires were used: (a) Nursing Professional Identity Scale (NPIS, range: 30 ~ 150); and (b) Practice Environment Scale of Nursing Work (PESNW, range: 0 ~ 100) with six dimensions: nursing-related hospital affairs, high-quality nursing care, ability of nursing manager, manpower and material resources, cooperation between nurses and doctors, and salary and social status. Higher scores indicated higher professional identities and better work environments.

RESULTS

Three hundred and ninety-one of the participants completed the questionnaires and were analyzed. The mean age of the participants was 32.53 years, and 93.3% of them were female. The mean score of NPIS was 100.03 (SD: 17.44). Multiple linear regression showed that professional identity was significantly and positively associated with two dimensions of PESNW: salary and social status and ability of nursing manager.

CONCLUSIONS

Professional identity among psychiatric nurses was at a moderate level. Salary and social status and ability of nursing manager positively contributed to their professional identity. These results may indicate the directors to construct better work environments for psychiatric nursing to improve professional identity.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review

OBJECTIVE

Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors.

METHODS

A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure.

RESULTS

A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations.

CONCLUSIONS

Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

'In the middle': A qualitative study of talk about mental health nursing roles and work

Professional identities are important in defining workers' roles, and are concerned with attributes relating to those roles and how they are performed. Evidence shows mental health nurses undertake many different roles as part of their work. Yet, the roles of mental health nurses are insufficiently understood by healthcare staff, service users, and nurses themselves. Mental health nursing work has been deemed invisible and lacking in role clarity. Poor understandings about professional identity of mental health nurses result in difficulties recruiting to the profession, nurses lacking confidence articulating the value of their work, with misunderstandings apparent with service users about the specific role of mental health nursing in their care. The primary focus of this study, conducted in Wales, United Kingdom, was to examine how talk about mental health nursing was handled by participants from multiple perspectives. Data consisted of 17 individual interview transcripts with mental health nurses and 13 interview transcripts from mental health service users, and three focus groups with nursing students. Participants' talk was analysed using thematic analysis. This paper reports how participants described mental health nursing work to have significant role overlap with other multidisciplinary team members. Participants highlighted that mental health nurses often have an 'in the middle' label because the complexity of their work can be hard to describe. The implications are pertinent for nurses because if they are considered to be in a liminal position, they risk being perceived as neither one role nor another, resulting in nurses struggling with professional identities and role confidence.

Knowledge, attitudes and practices in mental health of health professionals at the end of their curriculum in Burkina Faso: A pilot study

Aim

To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.

Design

A descriptive and cross-sectional study was adopted.

Methods

A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.

Results

The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry. Medical students' average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students.

Predictors of family focused practice among health visitors: A mixed methods study

AIMS

To determine what predicts health visitors' family-focused practice with mothers who have mental illness. To explore health visitors' experiences of family-focused practice and what factors, if any, enable and/or hinder it.

DESIGN

A sequential mixed-methods design was employed.

METHODS

In Phase 1, a total of 230 health visitors, in five Health and Social Care Trusts in the UK were recruited using convenience sampling and completed the Family Focused Mental Health Practice Questionnaire. Three multiple regression models were developed to test whether workload (Model I), professional knowledge (Model II) and health visitors' professional and personal experience (Model III) predicted their family-focused practice. In Phase 2, 10 health visitors, who completed the questionnaire, participated in semi-structured interviews to describe their experiences of family-focused practice. The data collection of the two phases was conducted from September 2017 - September 2018.

RESULTS

Model III was significant. While personal experience of parenting was positively associated with family-focused practice, length registered as a health visitor and personal experience of mental illness was negatively associated. Qualitative findings suggested that increasing years of professional experience and personal experience of mental illness enabled health visitors to support mothers and their children, but not other adult family members, including partners. Limited skills and knowledge to support mothers with severe mental illness (i.e. schizophrenia) hindered family-focused practice.

CONCLUSION

This study advances understanding of how health visitors' professional and personal experiences can influence their family-focused practice and highlights the importance of organizations promoting their capacity to support mothers with severe mental illness and to include mothers' partners.

IMPACT

A clear understanding of factors affecting health visitors' capacity to engage in family-focused practice will help to inform policy, education and practice in health visiting; with potential to improve outcomes for the whole family.

Multiprofessional team perception of a music therapeutic workshop developed by nurses

OBJECTIVE

To understand the perception of a multiprofessional team regarding the use of music in a therapeutic workshop developed by nurses.

METHOD

Qualitative study, of the exploratory type. Data were collected through semi-structured interviews, with the participation of 13 professionals from a Psychosocial Care Center in a municipality of Minas Gerais' Zona da Mata, and analyzed according to Michel Maffesoli's comprehensive sociology approach.

RESULTS

The testimonies revealed that the use of music in the nurse's activities in mental health represents a re-signification of nursing care and favors the user's subjectivity.

FINAL CONSIDERATIONS

This study allowed us to show that nurses need to listen to the music that comes from the heart, from the soul, and to the truths that are not always stated in the scenarios of therapeutic practices with individuals going through psychic suffering. Therefore, the care offered should be centered on the human history, which wants to be unveiled and understood.

Occupational health in mental health services: a qualitative study

Purpose

The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service.

Design/methodology/approach

Thematic analysis of data from seven semi-structured interviews is performed in this paper.

Findings

Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment.

Research limitations/implications

This was a small scale study of a previously unresearched population.

Practical implications

These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace.

Originality/value

This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.

The "me too" decision: An analog study of therapist self-disclosure of psychological problems

OBJECTIVES

To test the exploratory hypothesis that client perceptions of therapists are most favorable when therapists self-disclose their own personal experience with the same psychological problem to a moderate (vs. none, mild, or extreme) extent.

METHOD

Undergraduate participants (N = 104; 63.5% female) were randomly assigned to read one of the four vignettes, which differed only in the extent to which the therapist disclosed their own personal experience with the same presenting problem (none, mild, moderate, or extreme). Participants then responded to questions assessing their perceptions of the therapist.

RESULTS

The data generally supported the hypothesis. The moderate disclosure condition yielded the most favorable client perceptions, which differed significantly from those yielded by the no disclosure condition.

CONCLUSIONS

Despite limitations and need for replication, this study provides perhaps the first empirical data regarding the effect of the extent, rather than the mere presence or absence, of therapist self-disclosure regarding personal psychological experiences.

Managing the demands of the preregistration mental health nursing programme: The views of students with mental health conditions

An increasing number of students with a pre-existing mental health condition are enrolling on preregistration mental health nursing programmes. The challenges faced by these students in managing the demands of the programme have not been fully explored. Mental health and well-being is an integral part of providing a healthy university in which students can flourish. The purpose of the study was to explore how students with an underlying mental health issue manage the demands of the mental health nursing programme. The outcomes of the study are aimed at informing inclusive teaching and learning and current student support provision. Ethics approval was given. Students from two universities in South East England who met the criterion of having a pre-existing mental health condition when enrolling on the mental health preregistration nursing programme were invited to take part. Nine students took part in the study. Using an interpretative descriptive design, 1:1 face-to-face, audio-taped, semistructured interviews were undertaken. The data were analysed using a framework approach, and this revealed four main themes: timing of disclosure; managing lived experience in learning environments; students' coping mechanisms, and experience of support. Recommendations for practice was that approved education institutes (AEIs) should ensure they have a robust, inclusive practice by implementing strategies to develop these students' resilience, and enhance their learning and the current support provisions. This will ensure the barriers to disclosing their mental health conditions are recognized and minimized to enable these students to fully contribute to their own learning and teaching experience.

Increased Mental Illness and the Challenges This Brings for District Nurses in Primary Care Settings

Patients with mental illness generally make their initial healthcare contact via a registered nurse. Although studies show that encountering and providing care to care-seekers with mental illness might be a challenge, little research exists regarding Primary Care Nurses' (PCN) view of the challenges they face. The aim of this study was to qualitatively explore PCNs' reflections on encountering care-seekers with mental illness in primary healthcare settings. The results consist of three themes: constantly experiencing patients falling through the cracks, being restricted by lack of knowledge and resources, and establishing a trustful relationship to overcome taboo, shame, and guilt.

Interwoven histories: Mental health nurses with experience of mental illness, qualitative findings from a mixed methods study

The effects of mental health nurses' own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses' lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six-phase approach. The analysis revealed the broad context of nurses' experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses' lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses' mental illness could be much broader than the effect of workplace stress.

Psychometric evaluation of the Family Focused Mental Health Practice Questionnaire in measuring home visitors' family focused practice

Background

Worldwide maternal mental illness poses a major public health issue. Supporting maternal mental health and family health is a core aspect of home visiting. Increasingly the benefits of family focused treatments to maternal mental illness are being recognised. However, there are few reliable and valid measures that attempt to assess this type of practice.

Objectives

To explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of home visitors.

Methods

Home visitors (n = 230) from across a single region of the United Kingdom completed the Family Focused Mental Health Practice Questionnaire. Participants were all females, had a mean age of 44 years, and had an average of 11 years’ experience of home visiting. Exploratory factor analysis was used to explore the factor structure of the questionnaire in this population while Cronbach’s alpha was used to assess the internal consistency of questionnaire subscales.

Results

Exploratory factor analysis revealed a 3-factor solution where each factor contained at least three questionnaire items and had eigenvalues ≥ 1.0. Checks for internal consistency revealed that one factor was unsatisfactory (α < 0.6), which was subsequently discarded. A further exploratory factor analysis supported a 2 factor solution. The factors were named: professional influences on family focused practice and organisational influences on family focused practice. Cronbach’s alpha for the new scale was 0.949.

Conclusion

As home visitors play a key role in supporting parents who have mental illness and their families, it is important to assess their practice using a reliable measure. Our psychometric evaluation has created a more valid, reliable and concise measure that can be used to examine home visitors’ family focused practice.

Mental health nurses' encounters with occupational health services

Background

Staff well-being is vital to the functioning of the UK National Health Service (NHS). Mental health nurses (MHNs) with personal experience of mental illness can offer a professionally and personally informed insight into the occupational health (OH) service offered by their employer.

Aims

To investigate MHNs' views of OH provision in the NHS, based on their personal experience.

Methods

A qualitative interview study using a purposive sample of MHNs with personal experience of mental illness.

Results

Twenty-seven MHNs met the inclusion criteria. Thematic analysis identified three themes: comparisons of 'relative expertise' between the mental health nurse and the OH clinician; concerns about 'being treated' by a service at their work; and 'returning to work'.

Conclusions

OH provision in mental health settings must take account of the expertise of its staff. Further research, looking at NHS OH provision from the provider perspective is warranted.

Two approaches, one goal: How mental health registered nurses' perceive their role and the role of peer support workers in facilitating consumer decision-making

Recovery-oriented principles underpin modern-day mental health care and are enhanced by consumer participation in decision-making. Understanding how consumer participation can be maximized is central to promoting recovery-oriented care. This study explored the key strategies used by mental health registered nurses and perceived by nurses to be used by peer support workers in facilitating consumer decision-making to determine similarities, differences, and possible tensions. A qualitative descriptive approach using semi-structured interviews was conducted with nine nurses employed in mental health care. Thematic analysis was conducted using open coding. Frequency of views expressed and prevalence of these amongst participants were noted to determine the most common strategies and challenges. Registered nurses use strategies aimed at empowerment, self-management, and managing expectations to facilitate decision-making but are challenged by entrenched coercion within the system. These same nurses view peer support workers as using their lived experience to build rapport, role model, and advocate for consumers. Tensions arise in how the peer support workers' lived experience should be used and how this impacts on professional and therapeutic boundaries. Nurses expressed support for the role of peer support workers and viewed their inclusion in facilitating consumer decision-making positively. Their own role is perceived as being caught between modern-day service principles of empowerment and long-standing practices based on coercion.

The meaning of co-production for clinicians: An exploratory case study of Practitioner Trainers in one Recovery College

WHAT IS KNOWN ON THE SUBJECT

Analysis of co-production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co-production as a concept is open to multiple interpretations. Core components of co-produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co-production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co-trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co-trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues' mental health needs should be established and refined during co-produced working. Negotiating personal disclosure and professional role identity must be explored further in both co-production research and practice.

ABSTRACT

Introduction Co-production between service users and clinicians is a desirable element of recovery-oriented practice in mental health, but the effect of co-production on clinicians has not been explored thoroughly. Aim To explore the meaning of co-production for clinicians based on their experience of co-production in a Recovery College. Method Thematic analysis of eight semi-structured interviews with clinicians who have co-produced and co-delivered workshops with a Recovery College Peer Trainer. Results The "meaning of co-production" had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians' experience of co-production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co-produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice Engaging in co-produced educational workshops can alter clinicians' perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges.

Psychological distress in student nurses undertaking an educational programme with professional registration as a nurse: Their perceived barriers and facilitators in seeking psychological support

WHAT IS KNOWN ON THE SUBJECT?: Psychological distress is a major health concern, and university student populations are at a risk due to high academic, economic and interpersonal demands at this time. While a number of studies have been conducted looking at distress and service uptake amongst university students, there is a lack of comparative information in the student nurse population. Therefore, this study focuses on level of psychological distress and service uptake in student nurses during their training. Student nurses in training are acknowledged as particularly vulnerable to anxiety and depression. Anxiety and depression can interfere with educational achievement and interfere with working relationships, which are an important aspect of clinical practice. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study investigates psychological distress and service uptake in student nurses, in a single study, by measuring the level of distress and comparing this with adult nonpatient norms. The key findings suggest high levels of anxiety and depression and poor uptake of support in student nurses. The main barrier to seeking support was the fear of disclosure about their anxiety and/or depression, and feared impact on their suitability to train as a nurse. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Due to the fear of disclosure and low levels of support seeking, mental health nurses and academics have a key role to play in mental health literacy. It seems reasonable, given the key findings, to suggest that interventions be directed at decreasing anxiety and depression such as mindfulness training and other evidence-based strategies. It is recommended that psychological distress needs due attention from higher education sector and those health professionals involved in mental health service provision to support evidence-based strategies that target these issues.

ABSTRACT

Introduction This study adds to the existing international evidence on psychological distress in the student population by focusing on student nurses. It quantitatively assesses psychological distress with comparative norms and investigates service uptake in a single study. Aim The aim of this study was to investigate the level of psychological distress in students and compare this with population norms and highlight potential facilitators and barriers to help seeking. Methods This study recruited N = 121 student nurses from one university in a cross-sectional design. Data were analysed using descriptive statistics, independent t tests and one-way ANOVAs. Findings The key findings show high levels of psychological distress, which is above levels seen in the general population. The main barriers to seeking support were fear of disclosure and the perceived impact on their suitability as a student nurse. Discussion The study highlights that high levels of distress identified in the literature are seen in student nurses and that fear of disclosure may account for some not seeking support. Relevance The fear of disclosure and low levels of seeking support suggest there is a need for mental health nurses and academics to play a key role in mental health literacy and evidence-based interventions such as mindfulness to combat these issues.

What keeps nurses happy? Implications for workforce well-being strategies

AIM

The aim of this article is to present selected findings from a doctoral study on the subjective well-being and subjective experience of mental health problems in UK mental health nurses. Here the concept of 'nurses' well-being' is explored.

METHOD

Data were drawn from a survey of 237 mental health nurses about their mental health and well-being and from interviews with 27 mental health nurses with personal experience of mental health problems and high subjective well-being.

RESULTS

While nurses' subjective well-being is relatively low, some use strategies to support their well-being in and outside the workplace. Activities outside work that improved their wellbeing were physical exercise, mindfulness practice, spending time in nature and listening to music. Well-being was associated with clear boundaries between home and work life, regular clinical supervision and translating learning from work with patients to nurses' own lives.

CONCLUSION

Healthcare employers' staff health and well-being strategies should be informed by nurses' insights into what works for them. This may mean offering opportunities to take part in well-being activities. There are also opportunities to improve staff well-being through shared initiatives open to nurses and patients, and through an inclusive and empowering approach to staff engagement.

Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions

Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.