Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review

Effectiveness of Acceptance and Commitment Therapy on Psychotic Severity Among Inpatients With Primary Psychoses: A Randomized Controlled Trial

This study investigated the effectiveness of acceptance and commitment therapy (ACT) compared to treatment as usual in managing psychotic symptoms, emotional dysregulation, recovery and psychological flexibility in inpatients with primary psychoses. The Primary outcome assessed the positive and negative syndrome scale, while the secondary outcomes were to assess difficulties in the emotion regulation scale, recovery assessment scale and acceptance and action questionnaire. An open-label, two-arm parallel randomized controlled trial was conducted. Participants diagnosed with primary psychoses were randomly assigned to either the ACT (n = 33) or treatment-as-usual (n = 32) group. The intervention included six structured sessions of ACT. ACT significantly reduced psychotic symptoms from 128 to 104 (Z = 5.01) compared to treatment as usual from 130 to 117 (Z = 4.88). Emotional regulation improved significantly in the ACT group from 73 to 55 (Z = 4.835) compared to treatment as usual from 73 to 70 (Z = 2.406). Recovery increased in the ACT group from 50 to 88 (Z = 5.01) compared to treatment as usual from 51 to 61 (Z = 4.93). Psychological flexibility improved in the ACT group from 33 to 25 (Z = 4.98) compared to treatment as usual from 33 to 31 (Z = 4.75). Between-group differences after intervention were significant for psychotic symptoms, emotional regulation, recovery and psychological flexibility (Z = 2.356, 4.652, 3.881 and 4.453, respectively). Accordingly, the current study demonstrates the effectiveness of ACT in reducing psychotic symptoms and improving emotional regulation, recovery and psychological flexibility in patients with primary psychoses. Integrating ACT into standard care protocols can enhance treatment outcomes, offering a comprehensive approach to managing complex mental health conditions. Trial Registration: ClinicalTrials.gov identifier: NCT06160869.

Risk and Protective Factors for the Use of Illicit Drugs: Perspective of the Users

ABSTRACT

This article aimed to describe the perspective of people who make harmful use of illicit substances on the contributions of risk and protective factors to the development of problems related to drug use. One hundred eleven participants were recruited from a health service for drug users in a city in the interior of the state of São Paulo through posters with information, distribution of brochures, and snowball sampling technique. The sample consists of 51.9% men and 48.1% women, with 81.3% single and 10.3% married. Among them, 54.2% of participants completed high school, 64.1% were Catholic, and 34% rarely practiced their religion. The results on risk factors were classified into three domains, namely, "personal characteristics and behaviors," "family circumstances," and "other social pressures," and those on protective factors were also classified into three domains, namely, "personal characteristics and behaviors," "family circumstances," and "circumstances in the community." The data make it possible to guide the incorporation of multiple strategies to protect the consumption of illicit drugs in human biopsychosocial development, especially among children and adolescents.

Nurse Educators' Pedagogical Approaches Addressing Student Nurses' Mental Health Care Competence: A Qualitative Study

Nurses' mental health care competence is vital for addressing the current mental health care crisis' demand for quality in mental health care and services. These challenges also involve educational institutions. In the mental health course of the bachelor's nursing curriculum, nurse educators face multiple tasks and challenges concerning preparing students for their clinical placement. This study aimed to explore and describe nurse educators' pedagogical approaches across three universities. The study applied a qualitative and descriptive design, and data were collected from individual qualitative interviews with 13 experienced nurse educators. A content analysis approach in lines with Graneheim and Lundman was used to analyse the data. The content analysis resulted in one theme and three categories, and each category was characterised by three subcategories. The theme intentionally preparing student nurses for mental health care competence served as an overarching theme describing the educators' overall reflections and descriptions. The three categories were: activating students for the mental health context; caring for students on a personal level; and supporting students in grasping the scope of nursing within the mental health context. These categories described the varieties and complexity of nurse educators' pedagogical approaches addressing student nurses' mental health care competence.

Study protocol: a randomised, controlled trial of a nurse navigator program for the management of hepatitis C virus in patients with severe mental disorder

Background

To evaluate the impact of a nurse navigation program on treatment adherence and resolution of hepatitis C infection in patients with severe mental disorder.

Methods

An open, randomized, controlled trial with blinded outcome assessment. The intervention group will engage in a nurse navigation program designed by mental health nurses. The program involves active screening for patients with severe mental disorder. The patients and caregivers included in the program will receive information, training, support and guidance throughout the treatment and recovery process, which involves different healthcare professionals and units. The control group will receive the standard of care, which includes follow-up by a family physician, referral to the hepatologist, serological testing, new referral to the hepatologist, onset of treatment, and follow-up. Multidisciplinary care will be provided along a coordinated and seamless clinical pathway led by a nurse navigator.

The primary endpoints are total recovery (hepatitis C cure) and treatment adherence. Occurrence of symptoms of schizophrenia and health-related quality of life will be also recorded. Follow-up of patients will be performed three and six months after the administration of antiviral treatment.

The study was authorised by the Ethics Committee of Malaga in December 2021. Funding was approved in March 2021.

Discussion

If this intervention is proven to be effective in improving treatment access and adherence, it will represent a step forward in addressing a chronic health issue that is 16 times more prevalent in the population with severe mental disease. Finally, this intervention may lead to the detection of undertreated HCV infection in this population of patients.

Trial registration

This protocol has been registered in ClinicalTrials.gov with identifier code NCT04891445 on May 18, 2021.

Occurrence of workplace violence and the psychological consequences of it among nurses working in psychiatric outpatient settings

WHAT IS KNOWN ON THE SUBJECT?: There is a scarcity of studies concerning violence in psychiatric outpatient settings in the 2010s in spite of the deinstitutionalization of psychiatric services. Previous research on violence in psychiatric outpatient settings has failed to consider the association between the psychological consequences of violence, exposures to violence and background factors. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It has been known for some time that exposures to violence are harmful for psychiatric inpatient nurses; the paper demonstrates that psychiatric outpatient nurses are also at risk. The psychological consequences of exposure to violence are highly individualized and influenced by background factors. Nurses who face harassment have a greater risk of suffering psychological symptoms. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should consider the possibility of internal violence occurring when planning preventive interventions to manage and reduce workplace violence. Education targeted at violence prevention, management and debriefing should be organized systematically in psychiatric outpatient units and be taken into consideration in the mental health nursing curriculum. ABSTRACT: Introduction There is a scarcity of studies concerning violence and its consequences in psychiatric outpatient setting. Aim This study aimed to explore the occurrence of workplace violence and the psychological consequences of exposure to violence among nurses working in psychiatric outpatient settings. Method Research followed a cross-sectional survey design. Data were collected with the VIA-Q instrument. Results During the 12 months prior to the study, nurses (n = 181) had most often experienced psychological violence, with fatigue being the most common consequence. Harassment most often caused feelings of violated integrity, whereas physical violence most often caused insomnia. Significant relationships between exposure to violence and psychological consequences were identified. Discussion Workplace violence can manifest in a broad array of psychological symptoms and be harmful for nurses in psychiatric outpatient settings. It is important to discuss the subject of workplace violence and its place in the nursing curriculum and to reflect on how nurses are educated and trained to face violence in psychiatric nursing. Implications for Practice De-escalation interventions should be implemented in psychiatric outpatient settings. Organizations should take steps to abolish internal violence. Nurses need appropriate education in order to prepare them to manage workplace violence.

Cognitive behavioral therapy for patients with mild to moderate depression: Treatment effects and neural mechanisms

In this study, we combined clinical assessment and magnetic resonance imaging (MRI) techniques to investigate the brain mechanisms in mild to moderate depression (MMD) patients following cognitive behavioral therapy (CBT). Data were collected from 30 MMD patients and 18 healthy controls, and we divided patients into two treatment periods (4 weeks, 8 weeks). Clinical assessment indicated that depression characteristics, as quantified by Hamilton Depression Rating Scale (HAMD), were significantly higher in MMD patients than in healthy controls. At the baseline, MRI data revealed abnormalities in the hippocampus and nucleus accumbens (NAc) of patients with MMD, e.g., smaller gray matter volumes of the hippocampus and nucleus accumbens (NAc), as well as weaker functional connectivity between NAc and the posterior cingulate cortex/precuneus. Moreover, the hippocampus and NAc volumes were negatively correlated with the HAMD scores in MMD patients. After CBT intervention, the HAMD scores decreased, and the structural and functional characteristics of NAc in MMD patients obtained at 8-week were improved; e.g., no significant differences in NAc volume or NAc-based functional connectivity between the two groups. Taken together, our results provided evidence suggesting that CBT is an effective treatment for MMD patients. Alterations of gray matter volume and resting-state functional connectivity after 8 weeks of CBT indicated a potential modulation mechanism in brain structural modifications and functional connectivity plasticity within the NAc in MMD patients.

The Core Nursing Interventions in Adult Psychiatric Outpatient Care Identified by Nurses, a Delphi Study

PURPOSE

To define the core nursing interventions identified by nurses in the adult psychiatric outpatient care setting.

METHODS

A two-round Delphi study. The panel consisted of nurses and nurse managers.

FINDINGS

Nurses identified 53 core interventions, 50 of which are described in the Nursing Interventions Classification (NIC). Altogether, two thirds of these interventions were in the NIC domain 'Behavioral' and the emphasis was on NIC classes 'Coping Assistance' and 'Behavior Therapy,' suggesting that nurses define providing psychosocial support as the core in their work.

CONCLUSIONS

The findings indicate that the main role of nurses in the psychiatric outpatient care is to deliver psychosocial care for their patients. The lack of family interventions among the core interventions and the need to add the missing three interventions into the classification need more research in the future.

IMPLICATIONS FOR NURSING PRACTICE

This study helps to define nurses' role in the psychiatric outpatient care. The findings can be used in developing nursing education programs.