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

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

ABSTRACT

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

AIM

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

METHOD

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

RESULTS

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

DISCUSSION

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

IMPLICATIONS FOR PRACTICE

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

An Untenable Burden: Exploring Experiences of Secondary School Nurses Who Encounter Young People with Mental Health Problems

School nurses have reported stress and worry caring for young people experiencing mental health problems, but why this occurs and how they respond has not been well-explored. In this study researchers generated a substantive theory of the experiences of secondary school nurses who encountered young people with mental health problems using the original method of grounded theory. Thirty-one Western Australian school nurse participants reported that students presented with complex mental and social health needs that were not easily resolved. This was conceptualized as an untenable burden. Participants countered this by engaging in the three-stage process of tactical prioritizing. During an initial period of strategic assimilation into the school and broader community, participants referred students to external service providers. This was frequently inadequate, and participants found themselves grappling with unmet student mental health needs. Participants responded by implementing nursing strategies for optimizing outcomes in the lives of young people, while simultaneously engaging in managing self to support their own well-being.

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

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

Educational programs to improve nurses' knowledge, attitude, and practice in adolescent and young adult health: An integrative review

OBJECTIVE

Nurses working in adolescent health often lack educational opportunities to develop their knowledge and practical skills to address the challenges faced by adolescents and young adults. This integrative review synthesised the evidence from peer-reviewed research that focused on educational programs to improve nurses' knowledge, attitude, and practice in adolescent and young adult health.

DESIGN

The five-stage framework by Whittemore and Knafl guided the integrative literature review and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement.

DATA SOURCES

A single search strategy was replicated across five electronic databases (CINAHL Plus, APA PsycInfo, PubMed, Scopus, and ERIC). Studies of educational interventions or training programs for nurses on adolescent and young adult health, published in English in the last 10 years were included.

REVIEW METHODS

All studies found were reviewed for relevance independently by two authors, who likewise critically appraised the quality using the "Critical appraisal checklist for an article on an educational intervention" adapted from Morrison et al. (1999), with a third author providing consensus. Data were extracted using study specific standardised proforma and thematically analysed.

RESULTS

Seven studies met the inclusion criteria. Topics covered included cancer care, mental health and self-harm, with only one program including general adolescent health. A mix of face-to-face and digital asynchronous mode of delivery was employed in these programs with multi-strategic approaches used to enhance accessibility and engagement. While all studies reported improvement in knowledge and practice, including enhanced communication skills, some studies reported limited change in attitude. Success of the interventions was attributed to the flexibility of programs to accommodate nurses' workloads.

CONCLUSION

Education interventions for nurses delivering care to adolescent and young adults enhance knowledge and skills, however, programs with institutional support for flexibility and accessibility are needed to influence a positive change in attitude.

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

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

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

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

Mental health training to improve communication with children and adolescents: A process evaluation

AIMS AND OBJECTIVE

To characterise the intervention components, mechanisms of change and barriers to implementation of an intervention to improve communication behaviour of hospital staff surrounding mental health with children and adolescents.

BACKGROUND

Healthcare professionals consistently report a lack of confidence and knowledge to care for young people experiencing mental health difficulties. We Can Talk is a one-day training, delivered to hospital staff, which provides tools to improve their communication with children and adolescents about mental health. Initial evaluation suggests the training improved confidence and skills regarding communication; however, the effective intervention components and mechanisms of change are not yet understood.

DESIGN

A process evaluation was conducted using a qualitative research design.

METHODS

Document analysis of the training manual, using the Behaviour Change Technique Taxonomy, characterised intervention components. Ten interviews with paediatric staff from an east London hospital were conducted post-intervention. Using the Theoretical Domains Framework, the mechanisms of change and remaining barriers to communication were coded thematically. COREQ checklist was used in the reporting of the study.

RESULTS

Twenty behaviour change techniques were identified. Communication about mental health was mainly facilitated through improving the knowledge, cognitive and interpersonal skills, and beliefs about capabilities of healthcare professionals. A small number of staff continued to experience barriers to communication including a lack of opportunity for communication, beliefs that their professional role is not suited to supporting mental health and nervousness. Behaviour change techniques are highlighted to address remaining barriers reported post-intervention.

CONCLUSIONS

Using validated and systematic behaviour change tools, this process evaluation contributes to the translation of evidence to clinical practice for more effective, sustainable and transparent mental health care, reducing the research-practice gap in this area.

RELEVANCE TO CLINICAL PRACTICE

These findings can facilitate implementation of evidence-based practice and inform interventions, improving clinical practice and outcomes for children and adolescents.

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

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

Enhancing the care of children and young people with mental health issues

Early intervention in children and young people with mental health issues is important to ensure that these issues do not persist into adulthood. However, while children and young people with mental health issues have traditionally been cared for in specialist facilities to ensure their safety, a lack of inpatient beds means that these patients are being admitted to children's wards in general hospitals. Children's nurses require education and training in mental health to provide optimal care for these children and young people. This article explains how the development of evidence-based clinical practice guidelines for children and young people with mental health issues could increase patient safety. Similarly, postgraduate mental health education and training for children's nurses could support enhanced care. The article also discusses how the Nursing and Midwifery Council's revised proficiency standards will require nursing students and registered nurses to enhance their knowledge of caring for people with mental health issues.