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Watkin F, Scott H, Richards R. The role of psychological formulation in inpatient settings in supporting staff empathy and therapeutic optimism for adults diagnosed with borderline personality disorder: A pre- and post-vignette study. J Psychiatr Ment Health Nurs 2024. [PMID: 39011588 DOI: 10.1111/jpm.13084] [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: 10/08/2023] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Psychological formulation brings together a service user story and expertise, with psychological knowledge, research, and practitioners clinical experience to make sense of a service users' presentation (thinking about their difficulties but also strengths). Evidence into the effectiveness of formulation is largely anecdotal, qualitative, or small scale. Although this is very valuable research, there is not a lot of research which quantitatively evidences the role of formulation for service users or services. Quantitative evidence that does exist is also conflicting. Considering how widely psychological formulation is used, and the governing guidelines that recognize this as a core competency for psychological practitioners, it is important to continue to add to the evidence base. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Psychological formulation can increase staff empathy and hope. This could help service users to feel more understood and hopeful. Formulation; however, did not impact feelings of personal distress in staff. This research may suggest a need for the two distinct processes (i.e. team formulation and reflective practice) to support all components of empathy within inpatient services. Psychological formulation could support the provision of psychologically informed care within inpatient services, of which promotes effective care delivery. ABSTRACT OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services. METHOD Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs. RESULTS Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition. CONCLUSION This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD.
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Affiliation(s)
| | - Helen Scott
- North Staffordshire Combined Healthcare Trust, Stoke-on-Trent, UK
| | - Ruth Richards
- North Staffordshire Combined Healthcare Trust, Stoke-on-Trent, UK
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Begley R, Farrell L, Lyttle N, Alty J, Curran D, Williams S, Graham CD. Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions. Br J Health Psychol 2023; 28:604-618. [PMID: 36626907 DOI: 10.1111/bjhp.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making. DESIGN/METHODS We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition. RESULTS Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate-contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated with likelihood of referral to physical interventions such as physiotherapy. Medical doctors had lower treatment optimism and stronger explicit attitudes that FND is illegitimate than psychologists. CONCLUSIONS At an implicit level, clinicians are uncertain about the illegitimacy of FND, and such attitudes are associated with lower likelihood of referral to physiotherapy in particular. Improved education on FND among health care professionals is indicated.
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Affiliation(s)
- Roisin Begley
- Department of Psychology, Queen's University Belfast, Belfast, UK
| | - Lynn Farrell
- Psychology Department, National College of Ireland, Dublin, Ireland
| | - Nigel Lyttle
- Adult Acute Neuropsychology Services, Belfast Health and Social Care Trust, Belfast, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia.,Neurology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Curran
- Department of Psychology, Queen's University Belfast, Belfast, UK
| | - Stefan Williams
- Neurology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Mascio R, Best M, Lynch S, Phillips J, Jones K. Factors influencing nurse spiritual care practices at the end of life: A systematic review. Palliat Support Care 2022; 20:878-896. [PMID: 34872626 DOI: 10.1017/s1478951521001851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients. METHODS A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses' spiritual/existential care practices toward adult end-of-life patients. RESULTS The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources. SIGNIFICANCE OF RESULTS A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.
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Affiliation(s)
- Rita Mascio
- Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Megan Best
- Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Sandra Lynch
- Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
| | - Jane Phillips
- School of Nursing, University of Queensland, Brisbane, Queensland, Australia
| | - Kate Jones
- Institute for Ethics and Society, University of Notre Dame, Broadway, NSW, Australia
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4
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Bushell H, Lee S, Keppich-Arnold S, Anderson S, Batu G, Hopkins L. How Do Mental Health Nurses Define Success? A Comparative Study of Bed-Based and Community-Based Services. Issues Ment Health Nurs 2021; 42:836-844. [PMID: 33539193 DOI: 10.1080/01612840.2020.1871133] [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] [Indexed: 10/22/2022]
Abstract
Nursing is the single largest professional group within both hospital and community mental health care services, however the role of mental health nurses in under-defined. The nursing workforce is also coming under increasing pressure from internal and external requirements, and nurses themselves are on the frontline of providing patient care in what can be a risky and unpredictable workplace environment. This project explored via interview the ways in which mental health nurses experience and reflect on their personal and professional feelings of nursing success. Participants were 19 nurses who were employed in a range of bed-based and community mental health services in inner south eastern Melbourne. This study complies with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The findings of the project align with existing evidence from the literature. Factors which helped mental health nurses feel successful included: therapeutic success; good teamwork; targeted education; and feedback. Barriers to success included: patients/clients do not engage or recover; poor communication amongst staff; lack of psychological safety in the workplace; and lack of respect from management. Nurses in community settings were more able than nurses in bed-based settings to: make effective use of clinical supervision; make use of targeted training and educational offerings; and practice therapeutically and holistically. Project results offer an opportunity to understand nurses' motivations and reward systems. Better understanding of these issues can improve the way mental health care services manage their workforce planning, maintain staff personal wellbeing, increase staff retention and ultimately improve patient/client care.
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Affiliation(s)
- Hannah Bushell
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
| | - Stuart Lee
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, VIC, Australia.,Victorian Institute for Forensic Mental Health (Forensicare), Fairfield, VIC, Australia
| | | | | | - Gamze Batu
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
| | - Liza Hopkins
- Alfred Mental and Addiction Health, Melbourne, VIC, Australia
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5
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Eiroa-Orosa FJ, García-Mieres H. A Systematic Review and Meta-analysis of Recovery Educational Interventions for Mental Health Professionals. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:724-752. [PMID: 31338638 DOI: 10.1007/s10488-019-00956-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The history of mental health care has been marked by various struggles in maintaining the dignity of service users. Some reform movements have started to use educational strategies aimed at the beliefs and attitudes of professionals, as well as changing the way that practice is carried out. This paper intends to systematically review and synthesize studies assessing awareness and training activities for mental health professionals covering aspects related to recovery, empowerment, and in general, rights-based care to achieve full citizenship of mental health services users. We reviewed 26 articles and were able to include 14 of them in meta-analytic calculations. Our results at the qualitative level show an evolution of the literature towards better quality designs and focus on aspects related to the impact and maintenance of the effects of these training activities. Meta-analytic calculations found high heterogeneity but no risk of biases and low-to moderate effect sizes with a statistically significant impact on beliefs and attitudes but not on practices. The importance of this information in improving and advancing these educational activities is addressed.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neuroscience, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebron, 171, 08035, Barcelona, Catalonia, Spain. .,Yale Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA. .,First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, Barcelona, Spain.
| | - Helena García-Mieres
- Section of Personality, Assessment and Psychological Treatment, Department of Clinical Psychology and Psychobiology, Institute of Neuroscience, Faculty of Psychology, University of Barcelona, Passeig Vall d'Hebron, 171, 08035, Barcelona, Catalonia, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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6
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Schweizer C, Knorth EJ, van Yperen TA, Spreen M. Consensus-based typical elements of art therapy with children with autism spectrum disorders. INTERNATIONAL JOURNAL OF ART THERAPY 2019. [DOI: 10.1080/17454832.2019.1632364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Weare R, Green C, Olasoji M, Plummer V. ICU nurses feel unprepared to care for patients with mental illness: A survey of nurses' attitudes, knowledge, and skills. Intensive Crit Care Nurs 2019; 53:37-42. [PMID: 30878535 DOI: 10.1016/j.iccn.2019.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit. RESEARCH DESIGN A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous. SETTING A metropolitan intensive care unit located in Melbourne, Australia. MAIN OUTCOME MEASURES Intenisve care nurses completed a 76-question self-administered questionnaire. RESULTS Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%). ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness. CONCLUSION This sample of nurses felt they require education and support in order to care for patients with mental illness in the intenisve care unit. Further education may also help to reduce negative perceptions of this patient group.
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Affiliation(s)
- Reuben Weare
- Department of Intensive Care, Peninsula Health, Victoria, Australia; Continuing Education Development Unit, Peninsula Health, Victoria, Australia
| | - Cameron Green
- Department of Intensive Care, Peninsula Health, Victoria, Australia.
| | - Michael Olasoji
- School of Health Sciences, Faculty of Health, Arts & Design, Swinburne University of Technology, Victoria, Australia
| | - Virginia Plummer
- Continuing Education Development Unit, Peninsula Health, Victoria, Australia; Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; School of Nursing and Health Care Professions (Adjunct), Federation University, Australia
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8
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Recovery-oriented training programmes for mental health professionals: A narrative literature review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mhp.2019.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Barnfield J, Cross W, McCauley K. Therapeutic optimism and attitudes among medical and surgical nurses towards attempted suicide. Int J Ment Health Nurs 2018; 27:1826-1833. [PMID: 29797642 DOI: 10.1111/inm.12490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/26/2022]
Abstract
Identification of the attitudes to consumers admitted to hospital following a suicide attempt and the therapeutic optimism of nurses caring for this cohort is vital to ascertain the level of nursing care provided. A convenience sample of 72 Registered and enrolled nurses from a large metropolitan health service in South Eastern Melbourne, Australia, completed a demographic questionnaire, the Elsom Therapeutic Optimism Scale (ETOS), and the Attitudes to Attempted Suicide-Questionnaire (ATAS-Q). Data were analysed using SPSS (version 25). Whilst the ETOS & ATAS-Q correlate positively, themes of shame, blame, misunderstandings, and myths about suicide influence nurses' perspectives when providing suicide attempt aftercare. This may potentially lead to care that is tokenistic and task focused. To develop their professional skill set when providing suicide attempt aftercare, nurses need both formal and informal education and opportunities to reflect on their practice.
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Affiliation(s)
- Jakqui Barnfield
- Monash Health, Cheltenham, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Wendy Cross
- Monash Health, Cheltenham, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.,Torrens University Australia, Melbourne, Victoria, Australia
| | - Kay McCauley
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.,School of Nursing, College of Health, Massey University, Mt Cook, Wellington, New Zealand
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10
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Changes in Mental Health Providers’ Recovery Attitudes and Strengths Model Implementation Following Training and Supervision. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9885-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Brown CE, Nicholson Perry K. Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity? J Eat Disord 2018; 6:19. [PMID: 30186605 PMCID: PMC6119328 DOI: 10.1186/s40337-018-0208-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder. METHOD A survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism. RESULTS Results demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity. CONCLUSION These findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.
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Affiliation(s)
- C E Brown
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
| | - K Nicholson Perry
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
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12
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Best D, Savic M, Daley P. The Well-Being of Alcohol and Other Drug Counsellors in Australia: Strengths, Risks, and Implications. ALCOHOLISM TREATMENT QUARTERLY 2016. [DOI: 10.1080/07347324.2016.1148514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Neuroessentialism is the view that the definitive way of explaining human psychological experience is by reference to the brain and its activity. This leads to the view that psychological disorders, such as depression, are fundamentally brain disorders. Neuroessentialism has grown increasingly popular for academic and public audiences. It has also attracted critics. This article describes neuroessentialism, the reasons for its rising prominence, and the theoretical and clinical concerns it raises. It connects these concerns to evidence from empirical studies that suggest that neuroessentialistic conceptualization of depression can have negative clinical impacts that need to be considered by mental health professionals.
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14
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Hemingway S, Rogers M, Elsom S. Measuring the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner students in the United Kingdom. J Am Assoc Nurse Pract 2014; 26:155-62. [DOI: 10.1002/2327-6924.12028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cleary M, Horsfall J, O'Hara-Aarons M, Hunt GE. Mental health nurses' views on therapeutic optimism. Int J Ment Health Nurs 2012; 21:497-503. [PMID: 22417284 DOI: 10.1111/j.1447-0349.2011.00805.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Registered nurses (RN) coordinate acute mental health units on a 24-hour basis and it behoves researchers to actually ask these nurses what they think contributes to their ability to work with patients in optimistic ways. In this study, 40 RN working in acute mental health settings were asked a series of questions to explore positive aspects of nursing work, which includes therapeutic optimism. Three themes were identified: (i) different ways nurses foster therapeutic optimism; (ii) perceptions of how an optimistic environment is fostered, and (iii) improvement of ward culture. Findings show the pivotal role mental health nurses have in improving teamwork, good communication, sharing, and collaboration, in addition to preceptoring and supervision. Furthermore, effective clinical management is essential to therapeutic optimism and, in this research, is considered to be the aspect of acute mental health nursing most relevant to improving the ward culture.
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Affiliation(s)
- Michelle Cleary
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Singapore.
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16
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Happell B, Dares G, Russell A, Cokell S, Platania-Phung C, Gaskin CJ. The relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism in a district health service. Issues Ment Health Nurs 2012; 33:329-36. [PMID: 22545640 DOI: 10.3109/01612840.2011.644028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The main purpose of this study was to investigate the relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Staff at one district health service inpatient unit (n = 54) completed surveys on their attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Several moderately large correlations were found between perceiving the patients as feeling punished by seclusion and intrinsic satisfaction (r(s) = -.45, p = .001), and between patients asking to go to the seclusion room and personal accomplishment (r(s) = -.39, p = .002). In general, however, most correlations were small or negligible in size. The influence of nurses on the practice of seclusion was clear, with 72% of participants indicating it was nurses who most often make decisions regarding seclusion. Some participants appear to have a broad interpretation of when seclusion should be used, raising doubts about whether it is being employed solely as a measure of last resort. Given their high level of involvement in seclusions, nurses need to be actively involved in organisation-wide initiatives to reduce the use of this practice.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, and School of Nursing and Midwifery, CQ University Australia, Rockhampton, Queensland, Australia.
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17
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Byrne MK, Deane FP. Enhancing patient adherence: outcomes of medication alliance training on therapeutic alliance, insight, adherence, and psychopathology with mental health patients. Int J Ment Health Nurs 2011; 20:284-95. [PMID: 21729254 DOI: 10.1111/j.1447-0349.2010.00722.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The results of interventions to enhance patient adherence to medication have been inconsistent. This research investigated the utility of an enhanced adherence training programme to ascertain its effectiveness and the possible mechanisms of that effect. Forty-six clinicians were trained in 'medication alliance', and data were collected from 51 patients matched to the clinician. Data on clinician changes in skills, knowledge, and attitudes, in relation to enhancing patient adherence and patient changes in adherence, insight, and psychopathology were collected at baseline and at 6 and 12 months. The quality of the therapeutic relationship between the clinician and the patient was also assessed. The results indicated significant improvements in both clinician and patient measures, the majority of which were maintained over time. The quality of the therapeutic relationship was also enhanced. A hypothesized explanatory model accounting for the data was supported. It was concluded that clinician training to support improved patient adherence should include strategies that also enhance the therapeutic alliance.
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Affiliation(s)
- Mitchell K Byrne
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia.
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18
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Happell B, Koehn S. Impacts of seclusion and the seclusion room: exploring the perceptions of mental health nurses in Australia. Arch Psychiatr Nurs 2011; 25:109-19. [PMID: 21421162 DOI: 10.1016/j.apnu.2010.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 07/24/2010] [Accepted: 07/27/2010] [Indexed: 11/17/2022]
Abstract
The practice of seclusion does not sit comfortably with contemporary Australian mental health policy that emphasizes the provision of mental health services in the least restrictive environment. The negative impact of seclusion on patients and nurses is increasingly being acknowledged. On the other hand, seclusion receives wide support from nurses as a necessary behavior management strategy. The aim of this study was to examine nurses' perceptions of the impact of seclusion and the seclusion room on patients and the changes they would consider to the seclusion room in relation to characteristics of the nurses, including therapeutic optimism, job satisfaction, and burnout. One hundred twenty-three nurses employed in mental health services from Queensland, Australia, participated in this study by completing four self-report scales to measure these attitudes and characteristics. Data were analyzed using descriptive statistics and Pearson's product-moment correlation coefficients. The findings indicate some relationship between the three scales and attitudes to seclusion; however, therapeutic optimism had the strongest link. Participants with higher scores for optimism were more likely to acknowledge the detrimental effects of seclusion and the seclusion room and were more likely to support positive changes to the seclusion room.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, CQUniversity Australia, Rockhampton, Queensland, Australia.
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19
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Happell B, Koehn S. Seclusion as a necessary intervention: the relationship between burnout, job satisfaction and therapeutic optimism and justification for the use of seclusion. J Adv Nurs 2011; 67:1222-31. [PMID: 21261695 DOI: 10.1111/j.1365-2648.2010.05570.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS This paper is a report of the study of nurses' attitudes to the use of seclusion. More specifically, the aim was to address the relationship between burnout, job satisfaction and therapeutic optimism and justification of the use of seclusion. BACKGROUND Research findings demonstrate that nurses continue to view seclusion as a necessary intervention. Factors that might be associated with attitudes have not been examined. METHODS Questionnaires were distributed to nurses employed in inpatient units across eight mental health services in Queensland in 2008. Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory and Minnesota Satisfaction Questionnaires were completed (N = 123). Data analysis involved descriptive statistics and Pearson product-moment correlation coefficients. RESULTS Most participants considered certain behaviours particularly those involving harm to self, others or to property as appropriate reasons for the use of seclusion and were consistent with their perceptions of the likely practice on their unit. An association was found between therapeutic optimism and emotional exhaustion (burnout) and justifications for the use of seclusion. Participants with higher optimism scores and lower scores for emotional exhaustion were significantly less likely to support the use of seclusion in specific situations. CONCLUSIONS The relationship between therapeutic optimism and emotional exhaustion gives new information that might influence strategies and approaches taken with the aim of reducing seclusion use. Further research is warranted to explore these relationships and their implications.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, and School of Nursing and Midwifery, CQUniversity Australia, Rockhampton, Queensland, Australia.
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Happell B, Koehn S. Scratching beneath the surface: influencing factors on nurses' attitudes toward the use of seclusion. Issues Ment Health Nurs 2011; 32:449-56. [PMID: 21736468 DOI: 10.3109/01612840.2011.566981] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reducing the use of seclusion is now widely identified as a quality issue for mental health services and reflects recognition of the detrimental impact of seclusion on consumers of services. Despite this, the research evidence suggests that nurses continue to support the use of seclusion in order to maintain a safe environment. The aim of this study was to consider how factors such as Therapeutic Optimism, Job Satisfaction, and Burnout might relate to nurses' attitudes toward seclusion. The Heyman Attitudes to Seclusion Survey, Elsom Therapeutic Optimism Scale, Maslach's Burnout Inventory, and Minnesota Satisfaction Questionnaires were completed by 123 nurses employed in one of eight participating mental health services. Data analysis included Spearman's rho and independent-samples t-tests statistics. The findings suggested several significant relationships between attitudes toward seclusion and therapeutic optimism, job satisfaction, and burnout. Participants with higher optimism scores, high intrinsic motivation, low emotional exhaustion, and high personal accomplishment were more likely to respond negatively to the use of seclusion. This research enhances our understanding of attitudes toward seclusion and may assist in the development of interventions to influence more positive attitudes.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research and School of Nursing and Midwifery, School of Nursing and Midwifery, CQUniversity Australia, Rockhampton, Australia.
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Salgado JD, Deane FP, Crowe TP, Oades LG. Hope and improvements in mental health service providers' recovery attitudes following training. J Ment Health 2010; 19:243-8. [PMID: 20441488 DOI: 10.3109/09638230903531126] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Service providers' attitudes towards recovery can improve with formal training. However, it is unclear whether improvements depend on dispositional hope. AIMS To determine whether attitudinal improvements following formal recovery training vary depending on participants' dispositional hope. METHOD One hundred and three providers attended formal recovery training and completed measures of recovery knowledge, attitudes, hopefulness and optimism. RESULTS Training improved providers' recovery knowledge, attitudes, hopefulness and optimism. Providers with both high and low dispositional hope achieved similar gains. CONCLUSIONS Attitudinal improvements following formal recovery training were not dependent on baseline levels of dispositional hope. Institutions committed to recovery-oriented care should consider utilizing formal training.
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