1
|
Overpelt N, Kool-Goudzwaard N, Stringer B, van Meijel B. Nurses' Perspectives on Fostering Therapeutic Relationships While Working With Clients Who Display Conflict Behaviour. Int J Ment Health Nurs 2024. [PMID: 39333839 DOI: 10.1111/inm.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 08/30/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024]
Abstract
Therapeutic relationships are critical in the treatment of mental health disorders. Some clients experiencing mental health disorders display conflict behaviour-for example, suicidal or self-harming behaviour, threats of or actual aggression, and various psychotic behaviours-which presents significant challenges for care professionals. In inpatient mental health units, where interactions with mental health nurses are frequent, managing conflict behaviour is crucial to maintaining care quality and fostering therapeutic progress. This study aims to describe nurses' perspectives on fostering therapeutic relationships while working with clients who display conflict behaviour. Qualitative research was conducted in a specialised treatment setting for such clients by means of individual semi-structured interviews and a focus group interview with nurses. The results show that the nurses' primary focus is on cooperating with clients and colleagues. Regardless of conflict behaviour, nurses consistently invite clients to cooperate. To do so, they must manage their own emotions and expectations, emphasise the clients' responsibility and reduce the opportunities for conflict behaviour. The unit structure helps nurses by reducing ambiguity regarding treatment policies and inconsistencies in nurse-client interactions and allows nurses and clients to experience feelings of safety. To work with conflict behaviour, nurses need to feel valued and supported by their colleagues and have adequate time and resources. In conclusion, this study shows how nurses foster therapeutic relationships with clients who display conflict behaviour by focusing on cooperation, structure and safety.
Collapse
Affiliation(s)
- Nick Overpelt
- Centre for Intensive Treatment, Parnassia Group, The Hague, The Netherlands
| | | | | | - Berno van Meijel
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| |
Collapse
|
2
|
Nordkamp A, Roed K, Videbech P, Midtgaard J. 'Throw me a life buoy, please': A systematic review and thematic synthesis of qualitative evidence regarding nurses' experiences of caring for inpatients with borderline personality disorder and/or non-suicidal self-injury. J Psychiatr Ment Health Nurs 2024. [PMID: 38940193 DOI: 10.1111/jpm.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
AbstractIntroductionNon‐suicidal self‐injury (NSSI) is prevalent in individuals diagnosed with borderline personality disorder (BPD), particularly in inpatient settings. This poses challenges, leading to frustration and powerlessness among healthcare professionals. This, in turn, puts mental health nurses at risk of compassion fatigue (CF), impacting treatment quality.AimWe conducted a systematic review and meta‐synthesis to investigate the experiences of mental health nurses caring for people with BPD and/or NSSI in inpatient settings.MethodLiterature search was performed in MEDLINE, CINAHL, PsychINFO and Web of Science. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. For synthesis of findings from original studies, Thomas and Harden's thematic synthesis was used.ResultsIn total 1492 studies were screened of which seven met the inclusion criteria. We identified four main analytical themes: ‘Notions on nursing’, ‘Reality calls’, ‘Fall of ideals’ and ‘Throw me a lifebuoy, please’, with each two subthemes included.DiscussionDespite nurses' strong motivations for positive change and assistance, unexpected demands lead to emotional exhaustion, affecting their care provision.Implications for PracticeThe study underscores the necessity of addressing nurses' emotional strain through education and skill‐oriented training, enhancing their resilience and reducing CF risk, ultimately securing adequate care, and improving patient outcomes.
Collapse
Affiliation(s)
- Annika Nordkamp
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kickan Roed
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Videbech
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Neuropsychiatric Depression Research (CNDR), Mental Health Centre Glostrup, Glostrup, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Price O, Papastavrou Brooks C, Johnston I, McPherson P, Goodman H, Grundy A, Cree L, Motala Z, Robinson J, Doyle M, Stokes N, Armitage CJ, Barley E, Brooks H, Callaghan P, Carter LA, Davies LM, Drake RJ, Lovell K, Bee P. Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial. Health Technol Assess 2024; 28:1-120. [PMID: 38343036 PMCID: PMC11017147 DOI: 10.3310/fggw6874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations Uncontrolled design and self-selecting sample. Future work Definitive trial determining intervention effects. Trial registration This trial is registered as ISRCTN12826685 (closed to recruitment). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention.
Collapse
Affiliation(s)
- Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Isobel Johnston
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Helena Goodman
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Zahra Motala
- Atherleigh Park Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jade Robinson
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Michael Doyle
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nicholas Stokes
- West London Forensic Service, St Bernard's Hospital, West London Mental Health NHS Trust, Southall, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, UK
| | | | - Linda M Davies
- Division of Population Health, Health Services Research and Primary Care, Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Alenezi A, McAndrew S. Mental health nurses' perception of self-harm among people receiving psychiatric care in the Kingdom of Saudi Arabia. Int J Ment Health Nurs 2023; 32:1672-1680. [PMID: 37417533 DOI: 10.1111/inm.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
Mental health nurses (MHNs) play an important role in dealing with those receiving psychiatric care for self-harming behaviour. How nurses perceive this group of people is pivotal to timely prevention of such harmful behaviour. This project aimed to assess MHNs perception of self-harming behaviour among those receiving psychiatric care in the Kingdom of Saudi Arabia (KSA). Descriptive research was conducted with 400 nurses at governmental hospitals affiliated to the Ministry of Health and Population (MOHP) in the KSA. Data were collected using an online survey and questionnaire: the survey was divided into two sections: one concerned with demographic characteristics of the participants, the second section focusing on their workplace characteristics. The Self-Harm Antipathy Scale-Swedish Revision (SHAS-SR) was used to assess perceptions of self-harm among MHNs. This scale included 19 items categorized into five subscales. Finding showed that more than half of nurses had a low perception of those who self-harmed. Additionally, there was a highly significant association between the nurses' total self-harm perception scores and their workplace characteristics. Promoting person-centred care to those who self-harm through the creation of a collaborative nurse-patient relationship, may improve insight and understanding of the behaviour. Continuous professional development for staff who provide care for those who self-harm would promote better understanding of the behaviour. In addition, workshops, presentations and modelling good practice, are all key for transferring information into real-world applications for MHNs to provide better care for those who self-harm.
Collapse
Affiliation(s)
- Atallah Alenezi
- Nursing Department, Faculty of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | | |
Collapse
|
5
|
Zetterström L, Linde M, Blomqvist M, Jormfeldt H. Anxiety Communication Notes-A Tool to Facilitate Anxiety Management and Improve the Nurse-Patient Relationship in Mental Health Nursing. Issues Ment Health Nurs 2023; 44:900-910. [PMID: 37734062 DOI: 10.1080/01612840.2023.2251058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Mental health care tends to be dominated by a biomedical perspective at the expense of a more recovery-oriented approach. Research on nurse-led interventions intended to strengthen the patient's ability to manage anxiety is sparse in this context. The aim of this study was to describe nurses' experiences of the use of anxiety communication notes in nursing patients experiencing anxiety in mental health inpatient care. Data were collected by interviewing twelve nurses working in two mental health inpatient care wards in southwestern Sweden. Semi-structured interviews were conducted, and qualitative content analysis was used to analyze the data. Findings showed that the use of anxiety communication notes was perceived to provide a nursing structure to foster the development and practice of adaptive anxiety management through a visual representation for mutual understanding of the patient's anxiety pattern. The nurses could also use the anxiety communication notes to support nurse-patient communication and facilitate increased participation and empowerment in the patients' anxiety management.
Collapse
Affiliation(s)
| | - Maria Linde
- Department of Psychiatry, Region Halland, Halmstad, Sweden
| | - Marjut Blomqvist
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | |
Collapse
|
6
|
Sharifi S, Valiee S. Emergency department nurses’ perceptions of caring for patients with intentional self-poisoning: a qualitative study. EMERGENCY CARE JOURNAL 2023. [DOI: 10.4081/ecj.2023.11220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Nurses have an important role in caring for patients with intentional self-poisoning. This study was attempted to explore the emergency department nurses' perception of caring for patients with intentional self-poisoning. The present qualitative study was performed using phenomenological method. This study was done on 14 emergency department nurses with experience in caring for patients with intentional self-poisoning. Data were collected through semi-structured interviews and transcribed verbatim. Data were analyzed using Colaizzi's method. Following data analysis, two themes and five sub-themes were extracted, which included being reluctant to provide care for patients with intentional self-poisoning (discomfort in providing care, and lack of desire to care for these patients) and comprehensive patient support (providing complete care and emotional support). Given that emergency department nurses are the first medical staff who face with intentional self-poisoning patients and play an important role in the care and treatment of these patients, it is necessary to improve their understanding of caring for these patients. In addition, their comprehensive support for these patients should be strengthened. Psychological support for nurses and training them on how to communicate with intentional self-poisoning patients and their families are also recommended.
Collapse
|
7
|
Leddie G, Fox C, Simmonds S. Nurses' experiences of working in the community with adolescents who self-harm: A qualitative exploration. J Psychiatr Ment Health Nurs 2022; 29:744-754. [PMID: 34797016 DOI: 10.1111/jpm.12806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/25/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Gemma Leddie
- Department of Psychology, Universities of Coventry and Warwick, Coventry, United Kingdom
| | - Claudine Fox
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Sarah Simmonds
- Department of Psychology, Coventry University, Coventry, United Kingdom
| |
Collapse
|
8
|
Caputo A. Telling a Complicated Grief: A Psychodynamic Study on Mental Health Nurses' Countertransference Reactions to Patients' Suicidal Behavior. Arch Suicide Res 2021; 25:862-875. [PMID: 32686613 DOI: 10.1080/13811118.2020.1768990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A key element of suicide education, training and clinical supervision is enhancing emotional awareness about mental health professionals' countertransference reactions, as emotional responses to patients' suicidal behavior (SB) that may be unbeneficial to care. This study aimed to explore emotional responses to patients' SB in mental health nurses (MHNs) according to a psychodynamic perspective. Twenty-eight Italian MHNs (61% females, Mage = 52 years) were interviewed to examine their deep feelings about attempted suicides or deaths by suicide of patients with mental illness. Computer-aided thematic analysis was performed on the verbatim transcribed interviews, adopting Emotional Text Analysis (ETA) as a research framework to explore affective symbolizations underlying narratives, beyond intentional and explicitly reported contents. Some statistical multidimensional techniques were carried out, allowing th.e detection of shared symbolic domains (Cluster Analysis) and latent factors organizing the contraposition between them (Multiple Correspondence Analysis). Five symbolic domains emerged which were respectively referred to as: hyper-vigilance (21.97% of the overall textual corpus), resentment (17.86%), rationalization (34.50%), resignation (5.54%) and mourning (20.12%). Four latent factors explained the overall data variance: strive for reparation (F1), lack of control (F2), ambivalence toward care (F3) and complicated grief (F4). Some clinical recommendations were derived suggesting to balance issues of risk assessment/management and staff's reflective practice, to work on the subjective sense of hopelessness resulting from turning against oneself the hostility evoked by patients, to consider rationalization processes and implicit beliefs leading to risk underestimation and to address some basic conflicts contributing to a complicated grief in mourning suicidal events.
Collapse
|
9
|
Lindgren BM, Molin J, Graneheim UH. Balancing between a Person-Centred and a Common Staff Approach: Nursing Staff's Experiences of Good Nursing Practice for Patients Who Self-Harm. Issues Ment Health Nurs 2021; 42:564-572. [PMID: 32937081 DOI: 10.1080/01612840.2020.1817206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to describe nursing staff's experiences of good nursing practice in psychiatric in-patient care for patients with self-harming behavior. The participants were nine nurses and eight nursing assistants working in two in-patient wards in general psychiatry. Four focus group discussions were held and subjected to qualitative content analysis. The findings showed that good nursing practice balanced a person-centred approach with a common staff approach, allowing people who self-harm and staff to share responsibility for structuring everyday life, keeping to the plan, communicating decisions, and finding individual opportunities for relief. Reflective discussions among the staff concerning prejudice, emotional stress, lack of resources, and shortcomings in care planning could also prevent a stigmatizing culture and organizational deficiencies, which would be beneficial for both the people who self-harm and the staff.
Collapse
Affiliation(s)
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Ulla H Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| |
Collapse
|
10
|
Mindfulness, Compassion, and Self-Compassion as Moderator of Environmental Support on Competency in Mental Health Nursing. ACTA ACUST UNITED AC 2021; 3:1534-1543. [PMID: 33898923 PMCID: PMC8055442 DOI: 10.1007/s42399-021-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/08/2022]
Abstract
This research explored the established relationship between environmental support and competency for Mental Health Nurses, intending to investigate whether the tendency to display higher levels of mindfulness, compassion, and self-compassion might buffer the effect of a poor environment on competency. One questionnaire was comprised of five pre-developed questionnaires, which included all items examining environmental support, competency, mindfulness, compassion, and self-compassion. Mental Health Nurses (n = 103) were recruited from online forums and social media group pages in the UK. The result showed environmental support related positively to competency. Furthermore, the positive relationship of competency with environmental support was moderated when controlling for compassion but did not with mindfulness and self-compassion, although subscales showed some further interactions. When poor environmental support influences the competency of mental health professionals, compassion and mindfulness-based interactions may have the potential to uphold competency.
Collapse
|
11
|
Bjärehed J, Ingelsson Lindell E, Westling S. A thematic analysis of care provider experiences of using self-harm abstinence agreements in psychiatric inpatient care. Nurs Open 2021; 8:1660-1667. [PMID: 33620760 PMCID: PMC8186717 DOI: 10.1002/nop2.795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/20/2020] [Accepted: 01/29/2021] [Indexed: 11/11/2022] Open
Abstract
AIM Traditional methods used when managing self-harm in a psychiatric inpatient setting tend to infringe on the autonomy of the individuals receiving treatment and are often experienced as practically and emotionally challenging by care providers. Therefore, we examined care providers' experiences of an alternative method negotiating self-harm abstinence agreements, which can be viewed as a form of positive risk taking. DESIGN A qualitative approach using semi-structured interviews with twelve mental health professionals. METHODS Thematic analysis of the interviews. RESULTS Five themes emerged; "No-harm agreements versus constant observation and coercion," "No-harm agreements to promote independence and collaboration," "No-harm agreements' effect on ward safety," "Ambiguity surrounding the no-harm agreements" and "Ethical complexities of the no-harm agreements." These indicated perceived positive effects on the therapeutic relationship, the individuals' autonomous functioning and the ward environment, but also practical and ethical difficulties.
Collapse
Affiliation(s)
| | | | - Sofie Westling
- Clinical Psychiatric Research Center, Department of Clinical Sciences, Lund, Psychiatry, Lund University, Region Skåne, Lund, Sweden
| |
Collapse
|
12
|
Abstract
Nurse resilience is attracting increasing attention in research and practice. Possession of a high level of resilience is cited as being crucial for nurses to succeed professionally and manage workplace stressors. There is no agreed definition of nurse resilience. A concept analysis was undertaken to examine nurse resilience using a priori selected analysis framework. This concept analysis aims to systematically analyse resilience as it relates to nurses and establish a working definition of nurse resilience. Sixty-nine papers met the search criteria for inclusion. Key attributes of nurse resilience were social support, self-efficacy, work-life balance/self-care, humour, optimism, and being realistic. Resilience enables nurses to positively adapt to stressors and adversity. It is a complex and dynamic process which varies over time and context and embodies both individual attributes and external resources. Sustaining nurse resilience requires action and engagement from both individuals and organizations.
Collapse
Affiliation(s)
- Alannah L Cooper
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Clare S Rees
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Gavin D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
13
|
Wadman R, Nielsen E, O'Raw L, Brown K, Williams AJ, Sayal K, Townsend E. "These Things Don't Work." Young People's Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach. Arch Suicide Res 2020; 24:384-401. [PMID: 31322056 DOI: 10.1080/13811118.2019.1624669] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although UK clinical guidelines make tentative recommendations for "harm minimization" strategies for repeated self-harm, this is in the absence of empirical evidence supporting their acceptability or effectiveness. We explore young people's views of harm minimization strategies (e.g., snapping elastic bands on skin, drawing on skin with red ink), as a proxy for self-harm. In this mixed methods study we examine data (secondary analysis) from: (1) an online questionnaire (N = 758) observing the frequency of these strategies being used as a form of self-harm, and as a form of alternative coping (viewed as distinct from self-harming), and (2) semi-structured interviews (N = 45), using thematic analysis to identify themes related to harm minimization. Predominant themes suggest that many young people viewed harm minimization strategies as a proxy for self-harm as ineffective. Where such strategies were reported as helpful, their utility was reported to be short-lived or situation-specific. Findings from both studies indicate that some young people described using harm minimization (e.g., elastic band snapping) as a form of self-harm (e.g., to break the skin). Harm minimization strategies should not be recommended in isolation and their use must be monitored. Further research is urgently needed to develop an evidence base that informs practice.
Collapse
|
14
|
Timberlake LM, Beeber LS, Hubbard G. Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit[Formula: see text]. J Am Psychiatr Nurses Assoc 2020; 26:10-26. [PMID: 31592703 DOI: 10.1177/1078390319878878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND. Between 4% to 70% of inpatients engage in self-harming behaviors and effective interventions are needed to address this population. AIM. This article reviews literature from 2007 to 2017 to address treatment and management strategies specific for the treatment of nonsuicidal self-injury in the inpatient psychiatric setting. METHODS. Cochrane, PsycINFO, PubMed, and CINAHL were searched for relevant articles with 34 studies reviewed for applicability to the question, and 9 parsed into a summary of Findings table. RESULTS. Therapeutic approaches that show promise include cognitive behavioral therapy, dialectical behavior therapy, and mentalization as well as medications that act on the serotonergic, dopaminergic, and opioid systems. Effective models of care aim toward enhancing therapeutic relationships with staff, providers, and most important, encouraging the internal shift toward recovery within the patient. CONCLUSIONS. More research with controlled designs in the inpatient setting is needed, however, regardless of which approach is used, the impact of the individual caregiver on the patient's recovery is key.
Collapse
Affiliation(s)
- Laurie M Timberlake
- Laurie M. Timberlake, MSN, PMHNP-BC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda S Beeber
- Linda S. Beeber, PhD, PMHNCNS-BC, FAAN, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grace Hubbard
- Grace Hubbard, DNP, PMHCNS-BC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
15
|
Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
Collapse
Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| |
Collapse
|
16
|
Hultsjö S, Wärdig R, Rytterström P. The borderline between life and death. J Clin Nurs 2019; 28:1623-1632. [DOI: 10.1111/jocn.14754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Sally Hultsjö
- Department of Psychiatry Ryhov County Council Jönköping Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Rikard Wärdig
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Patrik Rytterström
- Department of Medical and Health Sciences Linköping University Linköping Sweden
- Department of Social and Welfare StudiesLinköping University Linköping Sweden
| |
Collapse
|
17
|
Explanation of Patient Safety Provided by Nurses in Inpatient Psychiatric Wards in Iran: A Qualitative Study. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.67951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
18
|
Choi SK, Seel JS, Yelton B, Steck SE, McCormick DP, Payne J, Minter A, Deutchki EK, Hébert JR, Friedman DB. Prostate Cancer Information Available in Health-Care Provider Offices: An Analysis of Content, Readability, and Cultural Sensitivity. Am J Mens Health 2018; 12:1160-1167. [PMID: 29649921 PMCID: PMC6131445 DOI: 10.1177/1557988318768599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and
African American men have the highest incidence among men in the United States. Little is
known about the PrCA-related educational materials being provided to patients in
health-care settings. Content, readability, and cultural sensitivity of materials
available in providers’ practices in South Carolina were examined. A total of 44
educational materials about PrCA and associated sexual dysfunction was collected from 16
general and specialty practices. The content of the materials was coded, and cultural
sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading
Ease, Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook were used to
assess readability. Communication with health-care providers (52.3%), side effects of PrCA
treatment (40.9%), sexual dysfunction and its treatment (38.6%), and treatment options
(34.1%) were frequently presented. All materials had acceptable cultural sensitivity
scores; however, 2.3% and 15.9% of materials demonstrated unacceptable cultural
sensitivity regarding format and visual messages, respectively. Readability of the
materials varied. More than half of the materials were written above a high-school reading
level. PrCA-related materials available in health-care practices may not meet patients’
needs regarding content, cultural sensitivity, and readability. A wide range of
educational materials that address various aspects of PrCA, including treatment options
and side effects, should be presented in plain language and be culturally sensitive.
Collapse
Affiliation(s)
- Seul Ki Choi
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jessica S Seel
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Brooks Yelton
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Susan E Steck
- 3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Johnny Payne
- 5 UsTOO Greenville and Upstate Prostate Cancer Alliance, Easley, USA
| | - Anthony Minter
- 6 USToo Columbia and ZERO Prostate Cancer, Columbia, SC, USA
| | - Elizabeth K Deutchki
- 7 Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
19
|
O'Connor S, Glover L. Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis. Psychol Psychother 2017; 90:480-501. [PMID: 28035740 DOI: 10.1111/papt.12113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 10/24/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. METHODS Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. RESULTS Three main themes derived from the data. 'The impact of the system' influenced the extent to which staff were 'Fearing the harm from self-harm', or were 'Working alongside the whole person'. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, 'Working alongside the whole person' primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. CONCLUSIONS Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. PRACTITIONER POINTS Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.
Collapse
Affiliation(s)
- Sophie O'Connor
- Department of Psychological Health and Wellbeing, University of Hull, UK
| | - Lesley Glover
- Department of Psychological Health and Wellbeing, University of Hull, UK
| |
Collapse
|
20
|
Tofthagen R, Talseth AG, Fagerstrøm LM. Former patients' experiences of recovery from self-harm as an individual, prolonged learning process: a phenomenological hermeneutical study. J Adv Nurs 2017; 73:2306-2317. [DOI: 10.1111/jan.13295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Randi Tofthagen
- Lovisenberg Diaconal University College; Oslo Norway
- The Department of Health and Care Sciences; Faculty of Health Sciences; University of Tromsø; The Artic University of Norway; Norway
| | - Anne Grethe Talseth
- The Department of Health and Care Sciences; Faculty of Health Sciences; University of Tromsø; The Artic University of Norway; Norway
| | - Lisbeth Maria Fagerstrøm
- University College of Southeast Norway; Norway
- Faculty of Education and Welfare; Åbo Akademi University; Vasa; Finland
| |
Collapse
|
21
|
Hagen J, Knizek BL, Hjelmeland H. Mental Health Nurses' Experiences of Caring for Suicidal Patients in Psychiatric Wards: An Emotional Endeavor. Arch Psychiatr Nurs 2017; 31:31-37. [PMID: 28104055 DOI: 10.1016/j.apnu.2016.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 01/10/2023]
Abstract
The purpose of the study is to investigate mental health nurses' experiences of recognizing and responding to suicidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interview data of eight mental health nurses were analyzed by systematic text condensation. The participants reported alertness to patients' suicidal cues, relieving psychological pain and inspiring hope. Various emotions are evoked by suicidal behavior. Mental health nurses seem to regulate their emotions and emotional expressions, and balance involvement and distance to provide good care of patients and themselves. Mental health nurses have an important role and should receive sufficient formal support.
Collapse
Affiliation(s)
- Julia Hagen
- Department of Applied Social Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Social Work and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Birthe Loa Knizek
- Department of Applied Social Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Heidi Hjelmeland
- Department of Social Work and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|