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Fradelos EC, Gkatzogia K, Toska A, Saridi M, Dimitriadou I, Mantzorou M, Zartaloudi A. Exploration of Nursing Care for Individuals With Bipolar Disorder in a Manic Episode: A Qualitative Study. Cureus 2024; 16:e63150. [PMID: 39055457 PMCID: PMC11272384 DOI: 10.7759/cureus.63150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Bipolar disorder is a mental illness that is chronic and has frequent relapses. OBJECTIVES The purpose of the research was to study the nursing care of patients with bipolar disorder in the mania phase. METHODS A qualitative study was employed in this study. The sample consisted of 10 nurses working in psychiatric clinics and data were collected through semi-structured interviews. Thematic analysis was applied for analysing the data. RESULTS Of the 10 participants, 70% were female and 30% were male. The mean age was 48.7 years. All participants were registered nurses and most of them held a Master of Science degree. Their work experience ranged from 10 to 30 years. Three main themes emerged when analysing the data obtained from the interviews with the nurses, those themes were a) Echoes of Vigilance: Navigating the journey, b) Amidst the Tempest: Attending to the Patients' Complex Needs, and c) Restoring Balance: The Nurturing Hands of Bipolar Nursing Care, each of which could be divided into several sub-themes. CONCLUSIONS Nursing care plays an important role in symptom improvement and disease control by providing patient support, managing pharmacotherapy, preventing suicidality, and educating patients about the disease and self-management strategies.
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Affiliation(s)
- Evangelos C Fradelos
- Laboratory of Clinical Nursing/Department of Nursing, University of Thessaly, Larissa, GRC
| | - Konstantina Gkatzogia
- Laboratory of Clinical Nursing/Department of Nursing, University of Thessaly, Larissa, GRC
| | - Aikaterini Toska
- Laboratory of Clinical Nursing/Department of Nursing, University of Thessaly, Larissa, GRC
| | - Maria Saridi
- Laboratory of Clinical Nursing/Department of Nursing, University of Thessaly, Larissa, GRC
| | - Ioanna Dimitriadou
- Laboratory of Clinical Nursing/Department of Nursing, Health Center of Veroia, Veroia, GRC
- Laboratory of Clinical Nursing/Department of Nursing, University of Thessaly, Larissa, GRC
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Chatwiriyaphong R, Moxham L, Bosworth R, Kinghorn G. The experience of healthcare professionals implementing recovery-oriented practice in mental health inpatient units: A qualitative evidence synthesis. J Psychiatr Ment Health Nurs 2024; 31:287-302. [PMID: 37807633 DOI: 10.1111/jpm.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The principles of personal recovery are primarily applied in outpatient and community settings as these settings provide continuity of care and recovery-based community programs supporting consumers' recovery journey. A range of healthcare professionals are involved in the care of people within mental health in-patient units, including nurses, psychiatrists, psychologists, occupational therapists and social workers. The integration of recovery-oriented care in mental health inpatient units may be impaired by a lack of confidence among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Developing hope and a safe place is an integral part of recovery-oriented practice within mental health inpatient units. Instilling connectedness is a relevant recovery principle; however, there may be greater barriers in mental health settings which traditionally prioritise safety and risk mitigation practices to prevent perceived harmful behaviours. Staff workload and inadequate understanding of recovery concepts present challenges to promoting recovery-oriented care in everyday practice. Using strength-based practice is critical in promoting a safe space for consumers by providing psychosocial interventions and person-centred care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of recovery-oriented practice requires adopting a collaborative approach that places a strong emphasis on the involvement of consumers and their families. Empowering mental health professionals to believe that recovery-oriented practice is possible in mental health inpatient units is crucial. Mental health professionals need to create a safe environment and positive relationships through respect and empathy for consumers and their family members. ABSTRACT: Introduction Recovery-oriented practice underpins an individual's personal recovery. Mental health nurses are required to adopt a recovery-oriented approach. Globally, a paucity of literature exists on mental health professionals' experience of recovery-oriented practice in mental health inpatient units. Aim The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery-oriented care in mental health inpatient units by appraising and synthesising existing qualitative research. Method Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist. Results Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery-oriented care. Discussion Mental healthcare professionals perceived the principles of recovery-oriented care to be positive and include: therapeutic space, holistic care and person-centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice. Implications for Practice Recovery-oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer's personal recovery.
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Affiliation(s)
- Rinlita Chatwiriyaphong
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi hospital, Mahidol University, Bangkok, Thailand
| | - Lorna Moxham
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rebecca Bosworth
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Grant Kinghorn
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Öksüz E, Mersin S, Uçgun T, Sarikoc G. Experiences of nurses providing care to hospitalized patients with acute mania in Türkiye: A phenomenological study. Arch Psychiatr Nurs 2024; 50:33-39. [PMID: 38789231 DOI: 10.1016/j.apnu.2024.03.005] [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: 01/02/2023] [Revised: 10/01/2023] [Accepted: 03/07/2024] [Indexed: 05/26/2024]
Abstract
The main purpose of this study was to determine the experiences of nurses who care for hospitalized patients experiencing an acute manic episode. This qualitative study was carried out with 15 nurses working in a psychiatric ward in Türkiye. Data were collected through semi-structured in-depth individual interviews and focus-group interviews in which the face-to-face interview technique was used. Two main themes emerged from the analysis of the qualitative data: (1) the difficulties experienced and (2) the most effective elements of care. Under the first main theme, the following sub-themes emerged: difficulties in setting boundaries, safety concerns, difficulties in managing the patient's demands, inability to choose the appropriate word(s), and the "emotional whirlwind" experienced. The second main theme, on the other hand, included the following sub-themes: meeting basic needs, ensuring treatment compliance, encouragement to engage in physical activity, and having a sufficient number of qualified personnel. The study revealed that the nurses had difficulties in caring for their manic patients. On the basis of these results, it is recommended that nurses be given counseling and training on setting boundaries, ensuring safety, managing the patient's demands, coping with their own emotions, and communicating better. In addition, the study identified the importance of nursing interventions to meet patients' basic needs, encourage them to engage in physical activity, and ensure treatment compliance, and the importance of there being an adequate number of qualified personnel. These results may help students and other nurses in terms of assessing and setting priorities in cases needing acute psychiatric care.
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Affiliation(s)
- Emine Öksüz
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
| | - Sevinç Mersin
- Bilecik Şeyh Edebali University, Faculty of Health Sciences, Psychiatric and Mental Health Nursing Department, Bilecik, Turkey.
| | - Tuğçe Uçgun
- Başkent University, Faculty of Health Sciences, Department of Mental Health and Psychiatric Nursing, Ankara, Turkey.
| | - Gamze Sarikoc
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Ankara, Turkey.
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Lamph G, Nowland R, Boland P, Pearson J, Connell C, Jones V, Wildbore E, L Christian D, Harris C, Ramsden J, Gardner K, Graham-Kevan N, McKeown M. Relational practice in health, education, criminal justice, and social care: a scoping review. Syst Rev 2023; 12:194. [PMID: 37833785 PMCID: PMC10571424 DOI: 10.1186/s13643-023-02344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice. METHOD This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects. RESULTS A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors. CONCLUSION Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021295958.
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Affiliation(s)
- Gary Lamph
- School of Nursing and Midwifery, Edge Hill University, Lancashire Ormskirk, UK
| | - Rebecca Nowland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK.
| | - Paul Boland
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Jayn Pearson
- Criminal Justice Partnership, University of Central Lancashire, Preston, UK
| | - Catriona Connell
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Vanessa Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | | | - Danielle L Christian
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Health Technology Assessment Unit, University of Central Lancashire, Preston, UK
| | | | - Kathryn Gardner
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Nicola Graham-Kevan
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Mick McKeown
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Appiah EO, Oti-Boadi E, Ani-Amponsah M, Mawusi DG, Awuah DB, Menlah A, Ofori-Appiah C. Barriers to nurses' therapeutic communication practices in a district hospital in Ghana. BMC Nurs 2023; 22:35. [PMID: 36750943 PMCID: PMC9902829 DOI: 10.1186/s12912-023-01191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Patients accessing health care enter the hospital environment with extreme anxiety, fear and distress which impacts their interactions with nurses and other health care professionals who are expected to help allay these anxieties in order to enhance patients care satisfaction. However, evidence suggests that there is a lack of effective therapeutic nurse-patient interaction in hospitals and the clinical environment globally, especially in sub-Saharan Africa. METHODS A qualitative research approach with an exploratory design was used to purposively select 30 participants who were engaged in face-face interactions. A semi-structured interview guide was used to conduct five audio-recorded FGDs with the 30 participants (6 in each group-2 males and 4 females) after which the discussions were transcribed verbatim, and content analyzed. FINDINGS Two (2) main themes and 10 sub-themes emerged from the analysis of the data. The two themes were: Therapeutic communication practices and Barriers to therapeutic communication. Some of the factors identified by patients to impede therapeutic nurse-patient interaction include family interference, negative attitude from patients, patient condition, a discriminatory attitude of nurses, increased workload, and stress. CONCLUSION Communication practices identified in this study include nurses' manner of communication, use of touch, positive reassurance, and nurses' demeanor. Several obstacles affect communication practices, hence the need to implement measures to improve nurse-patient interaction.
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Affiliation(s)
- Evans Osei Appiah
- Department of Midwifery, School of Nursing and Midwifery, Valley View University, P.O. Box DT 595, Oyibi, Ghana.
| | - Ezekiel Oti-Boadi
- grid.449914.50000 0004 0647 1137School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Mary Ani-Amponsah
- grid.8652.90000 0004 1937 1485Maternal and Child Health Department, School of Nursing and Midwifery/ College of Health Sciences, University of Ghana, Legon, West-Africa Ghana
| | - Dorcas Goku Mawusi
- grid.449914.50000 0004 0647 1137Department of Nursing, Nursing School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Dorothy Baffour Awuah
- grid.449914.50000 0004 0647 1137School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Awube Menlah
- grid.449914.50000 0004 0647 1137Department of Nursing, Nursing School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Cindy Ofori-Appiah
- grid.442291.80000 0004 0418 517XGhana Christian University College, Amrahia, Ghana
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Ahn S, Shin S. 'I felt alive': A qualitative study of inpatients' perspectives on good mental health nursing in South Korea. Int J Ment Health Nurs 2023; 32:791-800. [PMID: 36718048 DOI: 10.1111/inm.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
Although mental health nurses continuously strive for patients' well-being, patients still experience inpatient care negatively. To identify an individual's actual, mental health nursing care needs and offers them optimal benefits during their hospital stay, determining what patients perceive as good nursing should be prioritized. This qualitative descriptive study aimed to understand good mental health nursing from the inpatients' perspective. The data were collected through semi-structured interviews with 13 patients admitted to a psychiatric ward in South Korea, and analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to ensure transparency and rigour. The results revealed that patients experienced good mental health nursing when nurses respected their humanity, adopted a practical approach to solve problems pragmatically, and facilitated their recovery. These practices stem from mental health nurses' attitudes towards humanity based on individualized respect, professional ability to handle patients' individual needs, and offering patients hope and confidence for recovery and the future. Therefore, mental health nurses need to focus their efforts on these aspects of nursing attitudes and competencies to ensure that inpatients experience good mental health nursing.
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Affiliation(s)
- Suyoun Ahn
- Samsung Medical Center, Seoul, South Korea
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Gottschalk S, Meyer G, Haastert B, Abraham J. Prevention of physical restraints in the acute care setting (PROTECT): study protocol for a cluster-randomised controlled pilot study. BMJ Open 2023; 13:e066291. [PMID: 36592997 PMCID: PMC9809259 DOI: 10.1136/bmjopen-2022-066291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Physical restraints (PR) are regularly used in acute care settings, although evidence for their effectiveness and safety (eg, for prevention of falls) is lacking. Their use is associated with adverse events, such as decreased mobility and injuries for patients. We developed a complex intervention to prevent PR in acute care settings according to the UK Medical Research Council Framework, and investigated the feasibility. The intervention comprised the qualification of key nurses as multipliers and a short interprofessional information session. The intervention has proven to be feasible. It also became apparent that further development of the intervention and the study procedures is necessary. Therefore, this study aims to refine and pilot the complex intervention. Furthermore, the objective of this pilot study is to improve study procedures. METHODS AND ANALYSIS In a preparatory phase, we will conduct focus groups and individual interviews with the target groups to explore the possibilities for adaption of the intervention and implementation strategies. Subsequently, a cluster-randomised controlled trial with a 6-month follow-up period will be conducted. It is planned to recruit eight general hospitals in Germany (area of Halle (Saale) and Leipzig) with 28 wards and 924 patients per observation period (2772 overall). Primary outcome is the proportion of patients with at least one PR after 6 months. Data will be collected by direct observation over a period of seven consecutive days and three times a day. Secondary outcomes are falls, interruptions in therapy and prescription of psychotropic medication. A comprehensive process evaluation will accompany the study. ETHICS AND DISSEMINATION The Ethics committee of the Medical Faculty of the University of Halle (Saale) approved the study protocol. Results will be published in a peer-reviewed journal and presented at conferences. Study information and additional material will be freely available on an already existing website. TRIAL REGISTRATION NUMBER DRKS00027989.
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Affiliation(s)
- Susan Gottschalk
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | | | - Jens Abraham
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
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Petry H, Pelzelmayer K, Ernst J, Thuerlimann E, Naef R. Nurse-patient interaction during the Covid-19 pandemic: Creating and maintaining an interactive space for care. J Adv Nurs 2023; 79:281-296. [PMID: 36344480 DOI: 10.1111/jan.15486] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/03/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
AIMS To explore nurse-patient interactions during the Covid-19 pandemic from both nurses' and patients' perspectives. DESIGN Qualitative study using constructive grounded theory. METHODS A total of 34 patients and 49 nurses from acute and home care settings participated in individual or focus group interviews between December 2020 and May 2021. Data were analysed by a team of researchers using coding, memo-writing, theoretical sampling and constant comparison and integration. RESULTS We identified the creation and maintenance of an interactive space as the main social process. This interactive space was shaped by the care context and the course of the pandemic. For nurses, four factors were key, namely protecting oneself and others, navigating communication barriers, adapting nursing actions to the evolving situation, and providing emotional care work. Patients experienced attentive caring relationships with nurses and felt that, for the most part, their individual needs had been met despite the pandemic challenges. CONCLUSION Nurses and patients created an interactive space in which they were able to provide and receive the necessary care. Maintaining the interactive space was often challenging, and required an intentional effort by nurses, particularly in acute care settings. The findings illustrate that nurses ensured the provision of necessary care even during a public health crisis, thereby enabling patient access to good quality care. IMPACT Nurse-patient relationships are important for effective, person-centred care delivery. Despite the pandemic challenges, nurses managed to uphold their caring imperative and ensure quality care. Findings provide further insights on the importance of nurse-patient interaction in maintaining quality care. They inform models of nursing care delivery and strategies to support quality care during public health crises.
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Affiliation(s)
- Heidi Petry
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | | | - Jutta Ernst
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Eva Thuerlimann
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Rahel Naef
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.,Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Taylor F, Galloway S, Irons K, Mess L, Pemberton L, Worton K, Chambers M. Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study. Int J Ment Health Nurs 2022; 31:1467-1479. [PMID: 35976724 PMCID: PMC9804631 DOI: 10.1111/inm.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 01/09/2023]
Abstract
A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Sarah Galloway
- South-West London and St George's Mental Health NHS Trust, London, UK
| | | | - Lorna Mess
- North-East London NHS Foundation Trust, London, UK
| | | | - Karen Worton
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
| | - Mary Chambers
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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10
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Goossens PJJ, de Velde Harsenhorst R, van Lankeren JE, Testerink AE, Daggenvoorde TH. Nursing Care for Patients With Acute Mania: Exploring Experiential Knowledge and Developing a Standard of Good Care-Results of the Delphi Study. J Am Psychiatr Nurses Assoc 2022; 28:366-381. [PMID: 32964789 DOI: 10.1177/1078390320960519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When patients diagnosed with bipolar disorder are suffering from acute mania (involuntary), hospitalization is often necessary. Patients are often quite disruptive, which makes it difficult to regulate their behavior and manage them in their current condition. The nursing team must also ensure the safety of the other patients on the ward. Nursing practice in this domain appears to draw primarily on tradition and experience. AIMS To achieve consensus on a standard for nursing practice for patients suffering from mania who are admitted to a closed psychiatric ward. METHODS Previously, professionals, patients, and informal caregivers in the Netherlands were interviewed about the nursing care and their lived experiences. Based on these findings and on the results of a literature review, 89 statements were formulated. A three-round Delphi study among professionals, patients, and informal caregivers was carried out. The accepted statements were summarized. RESULTS In the first round, 71 statements were accepted, none were rejected, and for 18 statements, no consensus could be reached. These were reformulated and presented in a second round. Thirteen of these statements were accepted, none were rejected, and five statements needed to be reformulated and were presented in the third and final round of this Delphi study. In this final round, all statements were accepted. CONCLUSIONS Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.
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Affiliation(s)
- Peter J J Goossens
- Peter J. J. Goossens, PhD, RN, MANP, FEANS, Dimence Mental Health Center for Bipolar Disorders, Deventer, The Netherlands; Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Rita de Velde Harsenhorst
- Rita de Velde Harsenhorst, MSc, RN, Dimence, Flexible Assertive Outreach Team, Hardenberg, The Netherlands
| | - Jacobine E van Lankeren
- Jacobine E. van Lankeren, MSc, RN, Pro Persona Institute for Mental Health Care, Wolfheze, The Netherlands
| | - Annelies E Testerink
- Annelies E. Testerink, MSc, Saxion University of Applied Science, Faculty of Healthcare, Deventer, The Netherlands
| | - Thea H Daggenvoorde
- Thea H. Daggenvoorde, MSc, RN, Dimence Mental Health Center for Bipolar Disorders, Deventer, Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Moyo N, Jones M, Gray R. What are the core competencies of a mental health nurse? A concept mapping study involving five stakeholder groups. Int J Ment Health Nurs 2022; 31:933-951. [PMID: 35411621 PMCID: PMC9322662 DOI: 10.1111/inm.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/17/2022]
Abstract
Mental health nurses aim to provide high-quality care that is safe and person-centred. Service users require individualized care, responsive to their preferences, needs, and values. The views of service users, mental health nurses, nurse academics, psychiatrists, and nurse managers about the core competencies of mental health nurses have not been explored. Our study aimed to describe and contrast the views of multiple stakeholder groups on the core competencies of mental health nurses. Concept mapping is a six-step mixed-methods study design that combines qualitative data with principal component analysis to produce a two-dimensional concept map. Forty-eight people participated in the study from five stakeholder groups that included service users and clinicians. The final concept map had eight clusters: assessment and management of risk; understanding recovery principles; person- and family-centred care; good communication skills; knowledge about mental disorders and treatment; evaluating research and promoting physical health; a sense of humour; and physical and psychological interventions. There were important differences in how service users and health professionals ranked the relative importance of the clusters. Service users reported the understanding recovery principles cluster as the most important, whilst health professionals ranked the assessment and management of risk group the most important. There may be a disconnect between what service users and other stakeholders perceive to be the core competencies of mental health nurses. There is a need for more research to examine the differing perspectives of service users and health professionals on the core competencies of mental health nurses.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Victorian Tuberculosis Program Melbourne Health, Melbourne, Victoria, Australia
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
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12
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McCluskey A, Watson C, Nugent L, O'Connor T, Moore Z, O'Brien N, Molloy L, Patton D. Psychiatric nurse's perceptions of their interactions with people who hear voices: A qualitative systematic review and thematic analysis. J Psychiatr Ment Health Nurs 2022; 29:395-407. [PMID: 35394099 PMCID: PMC9322272 DOI: 10.1111/jpm.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is no qualitative systematic review of nurses' perceptions of their interactions with people hearing voices. There are some studies exploring the interventions provided by community psychiatric nurses to people hearing voices; these give a sense of what interactions may contain. WHAT THE PAPER ADDS TO THE EXISTING KNOWLEDGE?: Nurses across both community and inpatient mental healthcare settings feel uncertain about how to interact with people hearing voices, sometimes feeling like they can do little to help. Their interactions are affected by the workplace culture, education and training and concern for their own safety. Nurses rely on a therapeutic relationship for all interactions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is an under investigated area of mental healthcare. None the less this qualitative systematic review highlights that nurses are unclear about how to interact with service users hearing voices with the resultant outcome that service users in great distress may only be receiving minimal benefit from their interactions with the nurses caring for them. ABSTRACT: Aims and Objectives The aim of this qualitative systematic review and thematic analysis was to identify and synthesize results from studies that explored psychiatric nurses' perceptions of their interactions with service users experiencing auditory hallucinations (hearing voices). Method Qualitative systematic review and thematic analysis. Results Five studies that met the inclusion criteria were identified. Nurses reported that they felt uncertain about what to do for service users hearing voices, struggled to have interactions with voice hearers, but greatly valued the therapeutic relationship with service users. Nurses also reported that they required more education and training on how to interact effectively with people hearing voices. Finally, various workplace challenges were identified as an important factor mediating nurse interaction with service users hearing voices. Discussion Existing evidence shows that nurses lack clarity about how they can interact effectively and in a way that helps service users who are hearing voices. Significant barriers that they must overcome in order to be more certain of their role in caring for people hearing voices are difficult to engage service users and workplace challenges that were not conducive to helpful interactions and conversations. Implications for Practice Nurses caring for people hearing voices require more and better education and training with a view to them becoming more confident and competent when interacting with this service user group. Furthermore, healthy workplace cultures and maintaining a safe environment are necessary for effective caring interactions with people hearing voices.
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Affiliation(s)
- Anita McCluskey
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chanel Watson
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niall O'Brien
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Luke Molloy
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Declan Patton
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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13
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Locher C, Buergler S, Heimgartner N, Koechlin H, Gerger H, Gaab J, Büchi S. Greater than the sum of the parts: a qualitative content analysis of what constitutes a good treatment in the inpatient setting. BMC Health Serv Res 2022; 22:565. [PMID: 35477407 PMCID: PMC9044573 DOI: 10.1186/s12913-022-07834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The evaluation of psychotherapy is guided by established concepts, such as efficacy and effectiveness, and acceptability. Although these concepts serve as valid proxies, little is known about corresponding criteria for those directly involved in this treatment. This study aimed to explore inpatients’ and health professionals’ definitions of a good treatment in the inpatient setting. Methods Fifteen semi-structured interviews were conducted in a private psychiatric clinic in Switzerland and structured by qualitative content analysis. Different subsamples of the inpatient setting (patients N = 5; psychiatrists N = 5; other health professionals N = 5) were interviewed. Results In total, 546 text passages were grouped in 10 superordinate categories and identified as relevant for the concept of a good treatment. Participants stressed patient-specific (i.e., new insights; basic attitudes), treatment-specific (i.e., therapy methods and expertise; treatment success; therapy setting), and relationship-based (i.e., communication and feedback; relationships within the clinical setting; overcoming challenges and hurdles) components that are indispensable for a good therapeutic process. Components that are related to the clinical inpatient setting (i.e., setting and organization of the clinic; code of conduct) were also highlighted. Conclusions Patients’ and health professionals’ definitions of what constitutes a good treatment entails a wide array of aspects. The clinical setting is seen to offer unique components that are emphasized to have a healing effect. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07834-5.
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Affiliation(s)
- Cosima Locher
- Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland. .,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Nadja Heimgartner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Helen Koechlin
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Heike Gerger
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland
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14
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Phenomenology of Australian civilian hospital nurses’ lived experiences of the out-of-hospital environment following a disaster. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Nardella N, Hooper S, Lau R, Hutchinson A. Developing acute care-based mental health nurses' knowledge and skills in providing recovery-orientated care: A mixed methods study. Int J Ment Health Nurs 2021; 30:1170-1182. [PMID: 33848046 DOI: 10.1111/inm.12868] [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: 09/15/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Recovery-oriented principles have progressively been accepted as a standard of mental health practice in many countries, including Australia. A private mental health Clinic in Melbourne, Australia, is dedicated to embedding the principles of recovery-oriented practice into care by (i) providing recovery education and training for their staff and (ii) co-designing resources with consumers to promote active consumer engagement and participation. The purpose of this study was to evaluate the impact of these initiatives on staff knowledge and provision of recovery-oriented care in acute care. Two groups of study participants were recruited: the first group completed the staff training programme introducing the concept of recovery-oriented practice, and the second group was a convenience sample of nurses recruited 12 months later working on the acute inpatient wards at the study site. Nurses completed Recovery Knowledge Inventory (RKI) and Recovery Self-Assessment (RSA-Provider) surveys and participated in a focus group discussion. The three major themes identified from the focus group discussion were as follows: (i) nurses' understanding of personal recovery-orientated practice, (ii) how to embed personal recovery-oriented care into practice, and (iii) barriers to consumer participation in recovery-oriented activities in acute care. There were significant differences between the two groups on the RKI subscale scores of 'Expectations regarding recovery' and the 'Roles of self-definition and peers in recovery' and 'Life goals' and 'Choice' factors on the RSA subscale scores. There were some gaps in the nurses' knowledge and implementation of personal recovery-oriented concepts, highlighting the need for further training and cultural change.
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Affiliation(s)
- Natalie Nardella
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Suzie Hooper
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Rosalind Lau
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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16
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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17
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Duque M, Annemans M, Pink S, Spong L. Everyday comforting practices in psychiatric hospital environments: A design anthropology approach. J Psychiatr Ment Health Nurs 2021; 28:644-655. [PMID: 33185312 DOI: 10.1111/jpm.12711] [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] [Received: 03/24/2020] [Revised: 09/15/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Comfort as a conceptual and lived experience is essential in psychiatric hospital contexts and for overall mental health wellbeing. Comfort is a valuable aspect when designing hospitals and built environments for psychiatric care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE This article presents the results from a Design Anthropology study at four Psychiatric Units co-located in a newly built regional hospital based on 126 ethnographic interviews with staff, within which 63 participants mentioned the importance of comfort in generating environments conducive to wellbeing. An in-depth qualitative understanding of comforting practices, as emergent forms of everyday care. These may receive less attention within more established interventions from organisational models of care (e.g., Safewards) and might appear to be implicit gestures of courtesy. However, they contribute to meaningful encounters and contribute to individual and organisational wellbeing in psychiatric care. WHAT ARE THE IMPLICATIONS FOR PRACTICE This paper builds on comfort theories and demonstrates implications for practice through ethnographic examples. Comfort, often unnoticed until it is absent, needs to be maintained through continuous "small" but intentional acts of care. These constitute a finely tuned repertoire of everyday comforting practices of care at psychiatric contexts. Corridors and doors are presented as spaces where people have brief interactions that can contribute to everyday comforting experiences. Comfort is discussed in dialogue with existing literatures from psychiatric nursing, healthcare building design and design anthropology. Implicit and improvised practices of care that foster comforting environments have vital potential to support institutionally endorsed models of care (e.g., Safewards). The article proposes that design has a dual role for comforting environments in psychiatric care; (a) through the practice of architectural design and (b) through the practices of staff when creating everyday comforting interactions for wellbeing. ABSTRACT INTRODUCTION: Creating a comforting environment is essential for delivering psychiatric care. While healthcare organisations explicitly implement care models and adapt the physical environment, attention to staff's implicit everyday practice is limited. AIM Developing a design anthropology approach tailored specifically to the research site, we examine the social and physical environment to unpack how staff integrate both-implicit comforting interventions, and the explicit measures taken by the organisation-into their everyday practices of psychiatric care. METHOD Design and sensory ethnography, using extended observations and "walking tours" were undertaken with 126 staff members. A thematic analysis was conducted on all visual and audio material. RESULTS Staff's everyday implicit care practices and situated design decisions provide a comforting environment for patients, visitors and staff. DISCUSSION Implicit practices combine with an explicit organisational model of care to achieve a comforting environment. The value of design anthropology to uncover these dynamics is emphasized. Comforting practice involving implicit gestures of courtesy, which are infrequently addressed within organisational models of care (e.g., Safewards), are foregrounded. IMPLICATIONS FOR PRACTICE Explicit models of care have clear value in generating comfort; however, psychiatric hospital care also benefits from less visible modes of delivering comfort through everyday practices. By acknowledging both explicit and implicit modes of comfort, we can better understand how care models and psychiatric cultures of care are nurtured. Continuous "small" but intentional acts of care (e.g., brief interactions in corridors and at doors) constitute a finely tuned repertoire of everyday comforting practices.
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Affiliation(s)
- Melisa Duque
- MADA, Monash University, Melbourne, Vic., Australia
| | - Margo Annemans
- Department of Architecture, Research[x]Design, KU Leuven, Leuven, Belgium
| | - Sarah Pink
- Monash University, Melbourne, Vic., Australia
| | - Lisa Spong
- Bendigo Health, Bendigo, Vic., Australia
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18
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Park BM. Effects of Nurse-Led Intervention Programs Based on Goal Attainment Theory: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:699. [PMID: 34207799 PMCID: PMC8229705 DOI: 10.3390/healthcare9060699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to evaluate the effects of the goal attainment theory-based nurse-led intervention programs using a systematic review and meta-analysis. Randomized and non-randomized controlled trials, published from January 2001 to December 2020, were examined using four international databases and four domestic databases. The search, selection, and coding were performed independently by two researchers. R version 4.0.3 and Review Manager (version 5.3) were employed for meta-analysis and quality assessment, respectively. Of the 7529 articles retrieved, 18 were selected for analysis. The random overall effect size of the programs was 0.77 (95% CI = 0.61-0.94). Effect size by dependent variables were 2.36 (95% CI = 0.91-3.82), 1.25 (95% CI = 0.66-1.83), 0.83 (95% CI = 0.55-1.10), 0.64 (95% CI = 0.39-0.89), and 0.58 (95% CI = 0.30-0.85) for interpersonal, cognitive, health behavior, psychological, and indicators of physical health, respectively. Effect size by independent variables were 1.25 (95% CI = 0.86-1.64), 0.76 (95% CI = 0.48-1.03), 0.72 (95% CI = 0.37-1.06), 0.35 (95% CI = 0.21-0.49), and 1.35 (95% CI = -0.15-2.85) for prevention, health promotion, counseling and education, goal-setting and health contract, and parent participation programs, respectively. The effect size by control variables was 1.72 (95% CI = 0.88-2.56) at age ≤17, 0.85 (95% CI = 0.54-1.15) at time (min) 61-90, 1.04 (95% CI = 0.76-1.32) at sessions seven to eight, and 0.93 (95% CI = 0.66-1.19) at duration (weeks) five to eight. Thus, these programs were effective in improving various health aspects. Additionally, they can be recommended in various settings. Because efficacy is also influenced by control variables, considering treatment designs based on intervention characteristics and methodological approaches is warranted.
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Affiliation(s)
- Bom-Mi Park
- Department of Nursing, Konkuk University Glocal Campus, Chungju-si 27478, Korea
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19
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McAllister S, Simpson A, Tsianakas V, Robert G. "What matters to me": A multi-method qualitative study exploring service users', carers' and clinicians' needs and experiences of therapeutic engagement on acute mental health wards. Int J Ment Health Nurs 2021; 30:703-714. [PMID: 33459482 DOI: 10.1111/inm.12835] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Nurse-patient therapeutic engagement on acute mental health wards is beneficial to service users' outcomes and nurses' job satisfaction. However, engagement is not always fulfilled in practice and interventions to improve engagement are sparse and ineffective. We explored the experiences of service users, carers, and clinicians drawing from 80 hours of non-participant observations in an acute mental health ward and semi-structured interviews with 14 service users, two carers, and 12 clinicians. Analysis of these data resulted in 28 touchpoints (emotionally significant moments) and eight overarching themes. Service users, carers, and clinicians identified a lack of high-quality, person-centred, collaborative engagement and recognized and supported efforts to improve engagement in practice. Potential solutions to inform future intervention development were identified. Our findings align with previous research highlighting negative experiences and support the need to develop multicomponent interventions through participatory methods.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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20
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Lee H, Doody O, Hennessy T. Mental health nurses experience of the introduction and practice of the Safewards model: a qualitative descriptive study. BMC Nurs 2021; 20:41. [PMID: 33706733 PMCID: PMC7953680 DOI: 10.1186/s12912-021-00554-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A lack of safety experienced by patients and staff in acute psychiatric units is a major concern and containment methods used to manage conflict have the potential to cause harm and upset to both staff and patients. To ensure safety for all, it is highly desirable to reduce levels of conflict and containment and the Safewards model is an evidence-based model aimed at reducing conflict and containment rates by improving nurse-patient relationships and safety. METHODS The aim of this study was to explore mental health nurses' experience of the introduction and practice of three Safewards interventions; reassurance, soft words and discharge messages. A qualitative descriptive research design utilising a purposive sample (n = 21) of registered psychiatric nurses (n = 16) and managers (n = 5) in an acute psychiatric unit in Ireland. Following a 12-week implementation of Safewards, three focus groups were conducted, two with nursing staff and one with nurse managers. Data were analysed using Braun and Clarke thematic analysis framework which supported the identification of four themes: introducing Safewards, challenges of Safewards, impact of Safewards and working towards success. RESULTS The findings indicate that the process of implementation was inadequate in the training and education of staff, and that poor support from management led to poor staff adherence and acceptance of the Safewards interventions. The reported impact of Safewards on nursing practice and patient experience were mixed. Overall, engagement and implementation under the right conditions are essential for success and while some participants perceived that the interventions already existed in practice, participants agreed Safewards enhanced their communication skills and relationships with patients. CONCLUSION The implementation of Safewards requires effective leadership and support from management, mandatory training for all staff, and the involvement of staff and patients during implementation. Future research should focus on the training and education required for successful implementation of Safewards and explore the impact of Safewards on nursing practice and patient experience.
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Affiliation(s)
- Heather Lee
- Mid-West Health Service Executive, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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21
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Jones E, Wright KM, McKeown M. An integrative review exploring the experiences of service users carrying a diagnosis of personality disorder and student mental health nurses and the time they share together. NURSE EDUCATION TODAY 2021; 98:104659. [PMID: 33199063 DOI: 10.1016/j.nedt.2020.104659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This integrative review provides a collective understanding of the experiences of student mental health nurses and service users carrying a diagnosis of personality disorder and the time they share together. DESIGN Published studies about the time service users and students share together were systematically selected in order to integrate their findings in a thematic analysis. DATA SOURCES Various databases were searched from 1984 until 2020. Specific search terms were used. REVIEW METHODS 37 studies were included in the integrative review. The studies were from peer reviewed nursing, student, psychology and health related journals. A quality appraisal was completed using Walsh and Downe (2006) framework. FINDINGS Four themes emerged from a thematic analysis of the integrative review. These were; With 'Impact of time' as an overarching theme. CONCLUSION A positive environment which considers time and focuses on seeing the person, as an individual can lead to the development of therapeutic relationships; a core element of the Nursing and Midwifery Council standards for nursing registration in the UK (Nursing and Midwifery Council, 2018). Students attempting to build such relationships need to be mindful of service users' and their own attachment experiences and the impact these can have on experiences of transference and countertransference, particularly for service users carrying a personality disorder diagnosis. It is important for students to be aware of the supportive impact of positive environments and how doing 'everyday stuff' can make a person feel human despite residing in potentially dehumanizing places.
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Affiliation(s)
- Emma Jones
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Karen M Wright
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Mick McKeown
- School of Nursing, University of Central Lancashire, United Kingdom.
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22
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Lockertsen Ø, Varvin S, Færden A, Vatnar SKB. Short-term risk assessments in an acute psychiatric inpatient setting: A re-examination of the Brøset Violence Checklist using repeated measurements - Differentiating violence characteristics and gender. Arch Psychiatr Nurs 2021; 35:17-26. [PMID: 33593511 DOI: 10.1016/j.apnu.2020.11.003] [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: 05/06/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
This study investigated the association between short-term risk assessment measured by the Brøset Violence Checklist (BVC) and imminent violence using repeated measurements and differentiating violence characteristics and gender. All patients admitted to an acute psychiatric ward during one year (N = 528) were included. Logistic regression and generalized linear mixed model (GLMM) analyses were conducted. Results confirmed BVC's suitability for both male and female inpatients throughout their hospitalization also when differentiating threats and physical violence, and adjusting for diagnostic subpopulations and circadian variability. Results point to modified interpretations of the BVC sum scores. Future research should adjust for repeated measurements.
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Affiliation(s)
- Øyvind Lockertsen
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway.
| | - Sverre Varvin
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Ann Færden
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Solveig Karin Bø Vatnar
- Oslo University Hospital, Centre for Research and Education in Forensic Psychiatry, Oslo, Norway; Molde University College, Faculty of Health Sciences and Social Care, Molde, Norway
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23
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Horgan A, O Donovan M, Manning F, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, Griffin M, MacGabhann L, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. 'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse. Int J Ment Health Nurs 2021; 30:136-147. [PMID: 32808438 DOI: 10.1111/inm.12768] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Health and Medical Research Institute, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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24
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Molin J, Hällgren Graneheim U, Ringnér A, Lindgren BM. Time Together as an arena for mental health nursing - staff experiences of introducing and participating in a nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2020; 29:1192-1201. [PMID: 32618398 DOI: 10.1111/inm.12759] [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] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
A lack of meaningful activities for people with mental ill health admitted to psychiatric inpatient care has been related to feelings of boredom and 'doing nothing' and is not in line with recovery-oriented care. Staff in psychiatric inpatient care report having limited time, ambiguous responsibilities, and insufficient support that counteracts their ideals of good nursing care and puts them at risk for high levels of stress and stress of conscience. Research highlights a need for interactions between patients and staff, but few nursing interventions with such a focus are described in the literature. This qualitative study aimed to illuminate staff experiences of introducing and participating in the nursing intervention Time Together, via qualitative content analysis of 17 individual semi-structured interviews with nursing staff in psychiatric inpatient care. The results show that these staff members experienced Time Together as an arena for mental health nursing. They prepared for the introduction of the intervention by laying a framework for success. Although the actual implementation led to them feeling burdened, they found that Time Together fostered relationships between patients and staff. For successful implementation, mental health nurses need to advocate the intervention. As Time Together constitutes an arena for mental health nursing, play and conversations based on reciprocity and equality can contribute to patients' recovery.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, Umeå.,Department of Health Sciences, University West, Trollhättan
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå.,Department of Pediatrics, Umeå University Hospital, Umeå, Sweden
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25
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Gullick J, Wu J, Reid C, Tembo AC, Shishehgar S, Conlon L. Heideggerian structures of Being-with in the nurse-patient relationship: modelling phenomenological analysis through qualitative meta-synthesis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:645-664. [PMID: 32894396 DOI: 10.1007/s11019-020-09975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse-patient relationship. We firstly considered and secured the most relevant Heideggerian elements to nurse-patient Being-with (Dasein-with, circumspection, solicitude, and discourse). Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode (task-orientated busyness, existential abandonment, rough handling and deficient modes of concern in potentially violent encounters), and the authentic self-mode (seeking connection [knowing], and openness [unknowing], which exposed their emotional vulnerability). Through circumspection (making room for, deseverance and directionality), technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement (solicitude) was expressed through either leaping-in care (also perceived as 'power over') or leaping-ahead care (moving the patient towards independence). There was a place for both inauthentic (idle talk) and authentic discourse (including non-verbal and spiritual discourse) that nurses wove through the ontic everydayness of nursing tasks.
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Affiliation(s)
- Janice Gullick
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia.
| | - John Wu
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- University of Sydney (Sydney Conservatorium of Music and University Library), Sydney, NSW, Australia
| | - Cindy Reid
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
| | - Agness Chisanga Tembo
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Maitland Hospital (Intensive Care Unit), Maitland, NSW, Australia
| | - Sara Shishehgar
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Lisa Conlon
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
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26
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Moran R, Gutman LM. Mental health training to improve communication with children and adolescents: A process evaluation. J Clin Nurs 2020; 30:415-432. [PMID: 33141507 DOI: 10.1111/jocn.15551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Rachel Moran
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Leslie Morrison Gutman
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
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Florisse EJR, Delespaul PAEG. Monitoring risk assessment on an acute psychiatric ward: Effects on aggression, seclusion and nurse behaviour. PLoS One 2020; 15:e0240163. [PMID: 33007027 PMCID: PMC7531854 DOI: 10.1371/journal.pone.0240163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
Evidence of risk assessment procedures is scarce and inconclusive. The aim of this study is to evaluate the effects of risk assessment on aggression and the use of coercive interventions in an acute psychiatric admission setting. In addition, we evaluated nurse behaviour before and after the use of risk assessment. To take the fluctuations with regard to aggression and coercive interventions into account, we allowed 26 weeks for baseline measurements, followed by a 26 weeks steady-state period after the implementation of the risk assessment instrument. Contrary to expectations, no positive effects of risk assessment were found on aggression or on coercive interventions. Time spent in seclusion increased significantly with more than 10 hours on average after implementation. Furthermore, there were only negative effects on nurse behaviour and experiences. Among other things, they felt more stressed, spent more time on administration tasks and spent less time with patients after the implementation. In conclusion, there is insufficient evidence to use structured short-term risk assessment to reduce aggression or coercive interventions.
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Affiliation(s)
| | - Philippe A. E. G. Delespaul
- Mondriaan Mental Health Care, Heerlen, The Netherlands
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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28
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Cousins M, Bradshaw J, Bonner A. Professional relationships between nephrology clinicians and patients: a systematic review. J Ren Care 2020; 46:206-215. [PMID: 32141236 DOI: 10.1111/jorc.12323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nephrology nurses and patients expressed that the clinician-patient relationship in a haemodialysis (HD) unit might be best described as being part of an extended family. However, there is a risk that professional boundaries may become blurred due to the perceived closeness of this relationship. OBJECTIVE This systematic review sought to explore the experiences of nephrology clinicians in establishing and maintaining a professional relationship with people experiencing end-stage kidney disease who are receiving HD treatment. METHOD A search strategy was created using JBI systematic review guidelines for six databases (PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library and JBI library). Qualitative studies were eligible for inclusion when the participants were nephrology clinicians who provided HD treatment or management of patients in a hospital outpatient HD unit or a community HD centre. RESULTS Three studies met the inclusion criteria and the findings were synthesised into two themes (1) establishing a professional relationship and (2) coping mechanisms. All three studies focused on nephrology clinicians realising the importance of treating patients as individuals. Nephrology clinicians demonstrated advanced communication skills, empathy and compassion when interacting with patients, which seemed to contribute to patient satisfaction. This systematic review found some qualitative evidence to explain how nephrology clinicians establish and maintain a professional clinician-patient relationship with patients in the HD unit. CONCLUSION This review highlighted a significant gap in research concerning the trajectory of the clinician-patient relationship across all members of the renal multidisciplinary health care team.
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Affiliation(s)
- Marina Cousins
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, QLD, Australia
| | - Julie Bradshaw
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, QLD, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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29
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Encounters with Persons Who Frequently Use Psychiatric Emergency Services: Healthcare Professionals' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031012. [PMID: 32033481 PMCID: PMC7037678 DOI: 10.3390/ijerph17031012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Encounters and interactions between healthcare professionals and patients are central in healthcare services and delivery. Encountering persons who frequently use psychiatric emergency services (PES), a complex patient group in a complex context, may be particularly challenging for healthcare professionals. The aim of the study was to explore healthcare professionals’ experiences of such encounters. Data were collected via individual interviews (N = 19) and a focus group interview with healthcare professionals consisting of psychiatric nurses, assistant nurses, and physicians. The data were analyzed with qualitative content analysis. This study focused on the latent content of the interview data to gain a rich understanding of the professionals’ experiences of the encounters. Two themes were identified: “Nurturing the encounter with oneself and colleagues for continuous, professional improvement” and “Striving for a meaningful connection with the patient”. The professionals experienced their encounters with persons who frequently use PES as caring, professional, and humane processes. Prerequisites to those encounters were knowing and understanding oneself, having self-acceptance and self-compassion, and working within person-centered cultures and care environments.
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30
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Ould Brahim L, Hanganu C, Gros CP. Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study. J Am Psychiatr Nurses Assoc 2020; 26:250-261. [PMID: 31587601 DOI: 10.1177/1078390319878773] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse's role to include evidence-based responses to substance use is recommended.
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Affiliation(s)
- Lydia Ould Brahim
- Lydia Ould Brahim, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Cezara Hanganu
- Cezara Hanganu, MSc, RN, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Catherine Pugnaire Gros
- Catherine Pugnaire Gros, MSc, RN, McGill University, Montreal, Quebec, Canada; Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal; Douglas Mental Health University Institute, Verdun, Quebec, Canada
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31
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Griffiths J, Lever Taylor B, Morant N, Bick D, Howard LM, Seneviratne G, Johnson S. A qualitative comparison of experiences of specialist mother and baby units versus general psychiatric wards. BMC Psychiatry 2019; 19:401. [PMID: 31842836 PMCID: PMC6916441 DOI: 10.1186/s12888-019-2389-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother and baby units (MBUs) are an inpatient mental health service where women experiencing acute severe postpartum psychiatric difficulties can be admitted with their babies. They are currently viewed as best practice in the UK and elsewhere. However, as service provision is fragmented, some women residing in areas without MBUs are admitted to acute general psychiatric wards without their infants. This study aimed to compare qualitatively experiences of these two service types from the perspectives of women and clinicians. METHODS Semi-structured interviews were conducted with fifteen women who received treatment for perinatal mental health problems on a general psychiatric ward and/or MBU in England. Two focus groups were also conducted, one with MBU staff (n = 11) and one with acute ward staff (n = 6). Data were analysed thematically. RESULTS Women generally preferred being co-admitted with their baby to an MBU over lone admission to a general psychiatric ward. Women and clinicians felt that MBUs provided more perinatally-focused, family-centred care, and were better-equipped to meet women's needs. General wards were reported by women and staff to lack the necessary facilities and expertise to support perinatal women adequately, while separation of mothers and babies was often experienced by women as traumatic and detrimental to recovery. However, some areas for improvement were also identified across both service types, particularly relating to difficulties transitioning home post-discharge, inadequate support for family members, staffing issues and access problems (with MBUs). CONCLUSIONS Findings suggest that specialist perinatal inpatient care is considered preferable to generic care in the perinatal period from both service user and staff perspectives. Increased collaboration between perinatal and non-perinatal services could help improve perinatal expertise on general psychiatric wards, while further expansion of perinatal services (e.g. to cater for women currently considered too high risk for MBUs and for those discharged from inpatient settings) could tackle other shortfalls in care.
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Affiliation(s)
- Jessica Griffiths
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Billie Lever Taylor
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Nicola Morant
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Debra Bick
- 0000 0000 8809 1613grid.7372.1Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL UK
| | - Louise M. Howard
- 0000 0001 2322 6764grid.13097.3cSection of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, Crespigny Park, London, SE5 8AF UK
| | - Gertrude Seneviratne
- 0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX UK
| | - Sonia Johnson
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Hartley S, Raphael J, Lovell K, Berry K. Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. Int J Nurs Stud 2019; 102:103490. [PMID: 31862531 PMCID: PMC7026691 DOI: 10.1016/j.ijnurstu.2019.103490] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/30/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Background Therapeutic alliance is a core part of the nursing role and key to the attainment of positive outcomes for people utilising mental health care services. However, these relationships are sometimes difficult to develop and sustain, and nursing staff would arguably benefit from evidence-based support to foster more positive relationships. Objectives We aimed to collate and critique papers reporting on interventions targeted at improving the nurse–patient therapeutic alliance in mental health care settings. Design Systematic literature review. Data sources The online databases of Excerpta Medica database (Embase), PsycINFO, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched, eligible full text paper references lists reviewed for additional works and a forward citation search conducted. Review methods Original journal articles in English language were included where they reported on interventions targeting the nurse–patient therapeutic relationship and included a measure of alliance. Data were extracted using a pre-determined extraction form and inter-rater reliability evaluations were conducted. Information pertaining to design, participants, interventions and findings was collated. The papers were subject to quality assessment. Results Relatively few eligible papers (n = 8) were identified, highlighting the limitations of the evidence base in this area. A range of interventions were tested, drawing on diverse theoretical and procedural underpinnings. Only half of the studies reported statistically significant results and were largely weak in methodological quality. Conclusions The evidence base for methods to support nursing staff to develop and maintain good therapeutic relationships is poor, despite this being a key aspect of the nursing role and a major contributor to positive outcomes for service users. We reflect on why this might be and make specific recommendations for the development of a stronger evidence base, with the hope that this paper serves as a catalyst for a renewed research agenda into interventions that support good therapeutic relationships that serve both staff and patients.
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Affiliation(s)
- Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom; Pennine Care NHS Foundation Trust, Ashton-under-Lyne OL6 7SR, United Kingdom.
| | - Jessica Raphael
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M139PL, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom
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Abstract
Traditional ideas of mental health nursing are challenged in contemporary healthcare settings by developments focussed on more partnership and collaboration with people using mental health services. Yet service users have reported limited involvement in planning their own care. The purpose of this research was to explore accounts from multiple perspectives about service user involvement in mental health nursing processes. Qualitative research interviews and focus groups with mental health nursing students (n = 18), qualified nurses (n = 17) and service users (n = 13) were conducted, audio-recorded and transcribed verbatim. Participants' transcribed talk was thematically analysed to examine understandings about service user involvement and mental health nursing. Nursing work was often described as task-focussed, with limited collaboration with service users in areas like care planning. Service user involvement was seldom mentioned by nurses themselves, indicating it did not form an important part of mental health nursing processes. Mental health nurses appear to be complicit in care processes that do not include involvement of service users and may discourage novice practitioners from attempts at engagement.
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34
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Thomson AE, Racher F, Clements K. Caring for the Entire Unit: Psychiatric Nurses' Use of Awareness. J Psychosoc Nurs Ment Health Serv 2019; 57:17-23. [DOI: 10.3928/02793695-20190528-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/25/2019] [Indexed: 01/17/2023]
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Myklebust KK, Bjørkly S. The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards. BMC Psychiatry 2019; 19:251. [PMID: 31412803 PMCID: PMC6694476 DOI: 10.1186/s12888-019-2236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.
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Affiliation(s)
- Kjellaug K. Myklebust
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway
| | - Stål Bjørkly
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway ,0000 0004 0389 8485grid.55325.34Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Thomson AE, Racher F, Clements K. Person-Centered Psychiatric Nursing Interventions in Acute Care Settings. Issues Ment Health Nurs 2019; 40:682-689. [PMID: 31074676 DOI: 10.1080/01612840.2019.1585495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The knowledge base and understanding regarding psychiatric nursing interventions in acute care settings has been limited. The purpose of this hermeneutic phenomenological study was to explore psychiatric nurses' experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and participated in key informant interviews. Analysis of the data revealed the central theme of person-centered care (PCC), which involved developing and delivering PCC plans; determining goals; fostering empathy, support, and hope; listening in one-to-one interactions; providing person-centered teaching; and enhancing coping strategies.
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Affiliation(s)
- Andrea E Thomson
- a Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Winnipeg , Canada
| | - Fran Racher
- b Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Brandon , Canada
| | - Karen Clements
- a Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Winnipeg , Canada
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Vandewalle J, Beeckman D, Van Hecke A, Debyser B, Deproost E, Verhaeghe S. Contact and communication with patients experiencing suicidal ideation: A qualitative study of nurses’ perspectives. J Adv Nurs 2019; 75:2867-2877. [DOI: 10.1111/jan.14113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Joeri Vandewalle
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Research Foundation‐Flanders (FWO) Brussels Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- School of Health Sciences Örebro University Orebro Sweden
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin Ireland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Nursing Department Ghent University Hospital Ghent Belgium
| | - Bart Debyser
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Nursing VIVES University College Roeselare Belgium
- Centre for Psychiatry and Psychotherapy Clinic St Joseph Psychiatric Hospital Pittem Belgium
| | - Eddy Deproost
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Centre for Psychiatry and Psychotherapy Clinic St Joseph Psychiatric Hospital Pittem Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Nursing VIVES University College Roeselare Belgium
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38
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Duxbury J, Baker J, Downe S, Jones F, Greenwood P, Thygesen H, McKeown M, Price O, Scholes A, Thomson G, Whittington R. Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’). Int J Nurs Stud 2019; 95:40-48. [DOI: 10.1016/j.ijnurstu.2019.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/16/2022]
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39
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White MR, Stein-Parbury J, Orr F, Dawson A. Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia. Int J Ment Health Nurs 2019; 28:605-615. [PMID: 30556954 DOI: 10.1111/inm.12566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/29/2022]
Abstract
Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.
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Affiliation(s)
- Melanie R White
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Orr
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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40
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Molin J, Graneheim UH, Ringnér A, Lindgren BM. Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2019; 28:551-559. [PMID: 30501013 DOI: 10.1111/inm.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/01/2023]
Abstract
This qualitative study aimed to illuminate patients' experiences of taking part in the nursing intervention Time Together. The data were drawn from 11 individual semi-structured interviews with patients and analysed with qualitative content analysis using an inductive approach. The results show that patients taking part in Time Together felt confirmed and participated on equal terms; thus, they experienced being seen as humans among other humans. Time Together offered patients a break, and they felt strengthened, which contributed to their hopes for recovery. Furthermore, when Time Together was absent patients felt disconfirmed, which fostered feelings of distance from staff. The results support the effectiveness of the intervention, indicating that Time Together may be a tool to facilitate patients' personal recovery. However, the success of the intervention depends on staff compliance with the predetermined structure of the intervention in combination with engagement.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
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41
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Kennedy H, Roper C, Randall R, Pintado D, Buchanan-Hagen S, Fletcher J, Hamilton B. Consumer recommendations for enhancing the Safewards model and interventions. Int J Ment Health Nurs 2019; 28:616-626. [PMID: 30675756 DOI: 10.1111/inm.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
Abstract
This paper critiques the Safewards model through the lens of lived experiences of psychiatric hospitalization, diagnosis of mental illness, and distress. Special focus is given to the model's tested 10 interventions and to five lesser known interventions, identifying the impact they can have on hospitalized consumers. We highlight the role and prevalence of trauma, as well as the need to prevent harm in hospital settings. We draw upon notions of hospital as a sanctuary for people and the importance of providing a safe ward. 'Sanctuary harm' and 'Sanctuary trauma' are thus defined, with emphasis placed on the Safewards interventions as means by which sanctuary can be achieved. Finally, the consumer-perspective authors propose expansions to the model, critiquing the defining literature and moving towards a consumer experience of safety that is beyond the model's original intention: to reduce seclusion and restraint practices. Throughout the paper, the term 'consumer' is used in this context to mean people who have experienced or are experiencing psychiatric inpatient care.
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Affiliation(s)
- Hamilton Kennedy
- Department of Nursing, Centre for Psychiatric Nursing, School of Health Sciences, Parkville, Vic., Australia
| | - Cath Roper
- Department of Nursing, Centre for Psychiatric Nursing, School of Health Sciences, Parkville, Vic., Australia
| | - Rory Randall
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville
| | - Daniel Pintado
- Department of Nursing, Centre for Psychiatric Nursing, School of Health Sciences, Parkville, Vic., Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic., Australia
| | - Bridget Hamilton
- Department of Nursing, Centre for Psychiatric Nursing, School of Health Sciences, Parkville, Vic., Australia
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42
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McAllister S, Robert G, Tsianakas V, McCrae N. Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. Int J Nurs Stud 2019; 93:106-118. [PMID: 30908958 DOI: 10.1016/j.ijnurstu.2019.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/18/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement. DESIGN A systematic integrative review using an established framework specific to the integrative review methodology. DATA SOURCES Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report. REVIEW METHODS Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement. RESULTS Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework. CONCLUSION A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom.
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Niall McCrae
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
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43
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Eldal K, Natvik E, Veseth M, Davidson L, Skjølberg Å, Gytri D, Moltu C. Being recognised as a whole person: A qualitative study of inpatient experience in mental health. Issues Ment Health Nurs 2019; 40:88-96. [PMID: 30845858 DOI: 10.1080/01612840.2018.1524532] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient-professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one's self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance.
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Affiliation(s)
- Kari Eldal
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway
| | - Eli Natvik
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway
| | - Marius Veseth
- b Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Larry Davidson
- c Program for Recovery and Community Health, School of Medicine and Institution for Social and Policy Studies , Yale University , New Haven , Connecticut , USA
| | - Åse Skjølberg
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway.,d Center for Health Research in Sogn og Fjordane, District General Hospital of Førde , Førde , Norway
| | - Dorte Gytri
- d Center for Health Research in Sogn og Fjordane, District General Hospital of Førde , Førde , Norway
| | - Christian Moltu
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway.,e Department of Psychiatry, District General Hospital of Førde , Førde , Norway
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Lindgren BM, Ringnér A, Molin J, Graneheim UH. Patients' experiences of isolation in psychiatric inpatient care: Insights from a meta-ethnographic study. Int J Ment Health Nurs 2019; 28:7-21. [PMID: 29975446 DOI: 10.1111/inm.12519] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
Historically, people with mental ill-health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill-health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients' experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta-ethnographic synthesis. The findings were twofold: 'being admitted to prison' and 'having access to shelter'. The experience of isolated care as prison-like symbolizes patients' longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill-health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self-stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.
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Affiliation(s)
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulla H Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
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Moreno‐Poyato AR, Delgado‐Hito P, Leyva‐Moral JM, Casanova‐Garrigós G, Montesó‐Curto P. Implementing evidence‐based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research. J Clin Nurs 2019; 28:1614-1622. [DOI: 10.1111/jocn.14759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/31/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Antonio R. Moreno‐Poyato
- Escola Superior d’Infermeria del Mar Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
| | - Pilar Delgado‐Hito
- School of Nursing, L'Hospitalet del Llobregat University of Barcelona Barcelona Spain
| | - Juan M. Leyva‐Moral
- Department of Nursing, Faculty of Medicine Universitat Autònoma de Barcelona Cerdanyola del Vallès, Barcelona Spain
| | - Georgina Casanova‐Garrigós
- Fundació Pere Mata Terres de l'Ebre Amposta, Tarragona Spain
- School of Nursing Universitat Rovira i Virgili Tarragona Catalunya Spain
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46
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Molin J, Lindgren BM, Graneheim UH, Ringnér A. Time Together: A nursing intervention in psychiatric inpatient care: Feasibility and effects. Int J Ment Health Nurs 2018; 27:1698-1708. [PMID: 29691976 DOI: 10.1111/inm.12468] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/01/2022]
Abstract
The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
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47
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Affiliation(s)
- Michelle Cleary
- a School of Health Sciences , University of Tasmania , Sydney, NSW , Australia
| | - David Lees
- a School of Health Sciences , University of Tasmania , Sydney, NSW , Australia
| | - Jan Sayers
- a School of Health Sciences , University of Tasmania , Sydney, NSW , Australia
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48
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Odeyemi C, Morrissey J, Donohue G. Factors affecting mental health nurses working with clients with first-episode psychosis: A qualitative study. J Psychiatr Ment Health Nurs 2018; 25:423-431. [PMID: 29949670 DOI: 10.1111/jpm.12489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT?: First-episode psychosis (FEP) usually occurs in adolescence, a time of great change and upheaval and the effect on the sufferer and their family can be immense The nurse's role is to alleviate this suffering, aid recovery and minimize the risk of relapse. They manage this onerous task ideally through the therapeutic relationship, and use the skills of assessment and risk identification in order to maximize patient outcomes. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: The study adds knowledge about the challenges that mental health nurses experience specifically in the presentation of first-episode psychosis The findings of this study reinforce the idea that pathways to care need to be clearly identified with a community-wide educational led experience This study illuminates the fact that additional training and formalized clinical supervision are necessary for mental health nurses to improve quality of care and reduce stress levels, both of which lead to better clinical outcomes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care. Dialogue among mental healthcare colleagues is important not only about caring for people presenting with a first-episode psychosis but in relation to the wider community and family. This demonstrates the need for family-centred care within the mental health profession. There should be more recognition of the social impact on the individual during untreated psychosis with regard to isolation and withdrawal as well as factors which also affect help-seeking behaviours. ABSTRACT Introduction Although there is much research on mental health nurses working with individuals presenting with psychosis, there is a lack of knowledge about the factors that impact the experience of nurses in the presentation specifically of first-time psychosis. Aim This study aimed to explore the factors that impact on the experience of mental health nurses working with individuals and their families who present with a first-time psychosis. Method This qualitative study was conducted through individual semi-structured interviews with eight mental health nurses recruited from community mental health settings with a minimum of 2 years post-qualification experience. Data were then subjected to a thematic content analysis. Results This study identified the importance of therapeutic engagement, as well as the need to have clear pathways to care and building capacity through clinical supervision and training when working with this population. Implications for practice Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care, leading to better therapeutic engagement. Pathways to care should be embedded within the wider community to ensure ease of access for individuals and their families. There should be more recognition of the social impact on the individual during untreated psychosis with regard to isolation and withdrawal as well as factors which also affect help-seeking behaviours.
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Affiliation(s)
- Constance Odeyemi
- Ballyfermot Mental Health Services, Ballyfermot Primary Care and Mental Health Centre, Ballyfermot, Dublin 10, IRL
| | - Jean Morrissey
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, IRL
| | - Gráinne Donohue
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin 2, IRL
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Hallman IS, O'Connor N, Hasenau S, Brady S. Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 30:175-180. [DOI: 10.1111/jcap.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilze S. Hallman
- Clinical Nurse Specialist, Psychiatry; University of Michigan and Health Centers; Ann Arbor Michigan USA
| | - Nancy O'Connor
- Professor and Chair, Nursing Graduate Program; Madonna University; Livonia Michigan USA
| | - Susan Hasenau
- Professor, Nursing Graduate Program; Madonna University; Livonia Michigan USA
| | - Stephanie Brady
- Vice-President-Care Continuum; St. John-Providence Health System; Southfield Michigan USA
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50
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Isobel S, Delgado C. Safe and Collaborative Communication Skills: A Step towards Mental Health Nurses Implementing Trauma Informed Care. Arch Psychiatr Nurs 2018; 32:291-296. [PMID: 29579526 DOI: 10.1016/j.apnu.2017.11.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/05/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
Trauma Informed Care (TIC) acknowledges the presence and effects of trauma in the lives of many mental health service users and the responsibility of services to provide physical and emotional safety. One challenge of TIC is a lack of clarity about translating the philosophy into practice. This paper describes the delivery and evaluation of a trauma informed communication workshop for mental health nurses that aimed to increase their knowledge of the potential impacts of trauma on consumers, and translate TIC concepts into their communication approaches within the therapeutic relationship.
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Affiliation(s)
- Sophie Isobel
- Sydney Local Health District, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, 2050, Australia
| | - Cynthia Delgado
- Sydney Local Health District, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, 2050, Australia; The University of Sydney, Sydney Nursing School, Australia.
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