PTSD in psychiatric nurses and other mental health providers: a review of the literature

The prevalence of PTSD and coping strategies among Palestinian mental health professionals during political violence and wartime

Background

In times of war, mental health professionals are at an increased risk of developing psychological problems, including posttraumatic stress disorder (PTSD). The effects of conflicts or wars on mental health professionals in Palestine and their coping methods of dealing with these challenges remain unknown. This study aimed to assess the prevalence of PTSD symptoms and strategies for coping among mental health professionals in Palestine, in light of the ongoing Gaza war and political violence.

Methods

The study utilized a cross-sectional research design. Self-reported questionnaires, including the PCL-5 and Brief COPE scales, were used to gather data. The relationship between the research variables and PTSD symptoms was investigated using frequencies, percentages, bivariate analysis, Pearson correlation, and Pearson's chi-square test.

Results

A total of 514 participants were recruited, with an estimated prevalence of PTSD of 38.7%. Furthermore, the multivariate analysis revealed that having a prior history of trauma and feeling disabled or unable to deal with your patients during the current Gaza war and Israeli-Palestinian political violence increases the likelihood of developing PTSD symptoms. In addition, using venting, self-blame, and behavioral disengagement as coping strategies increases the likelihood of developing symptoms of PTSD. Moreover, using acceptance and substance use as coping strategies reduces the risk of developing PTSD symptoms.

Conclusion

The findings revealed a high prevalence of PTSD symptoms among mental health professionals during wartime and political violence. As a result, mental health professionals need immediate assistance in enhancing their mental wellbeing through supervision, psychotherapy, and comprehensive and continuous training.

Strategies to Reduce the Impact of Trauma in Psychiatric Nurses: An Integrative Review of the Literature

BACKGROUND

Psychiatric nurses are at a higher risk for exposure to violence and aggression, leading to potential burnout, moral injury, post-traumatic stress, and turnover. There is little evidence of a preferred strategy to support nurses and decrease the impact of traumatic experiences on psychiatric nurses. The aim of this integrative review was to explore potential strategies to decrease the impact of traumatic experiences among nurses in psychiatric settings.

METHODS

Following a systematic search of PsycINFO/Ovid, CINAHL, and MEDLINE/Pubmed, Joanna Briggs Institute quality appraisal tools were used to analyze quality of the articles. Thirteen articles met the inclusion/exclusion criteria for this study. Data were analyzed and synthesized into three key themes and seven sub-themes.

RESULTS

Three themes were noted to be common to the included texts. 1. Interpersonal Supports (Formal Support, Peer/Supervisor Support, and Informal Family/Social Support). 2. Organizational Supports (Perception of Job Safety/Satisfaction, Promoting Personal Resilience, Supporting Team Resilience, and Organizational Commitment to Resilience). 3. Protection of Personal Resources.

CONCLUSIONS

Many common suggestions for decreasing the impact of exposure to violence and trauma were noted across the thirteen articles, however, there is little evidence of a preferred strategy, how strategies are developed and employed or the efficacy of any particular strategy. Further investigation is needed to identify and evaluate supportive interventions, their feasibility and efficacy.

Moral Injury and its Correlates among Iranian Nurses in the Second Year of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

The COVID-19 pandemic has been associated with various health-related issues among nurses, including mental health problems such as moral injury. This study aimed to evaluate the relationship between moral injury, general health, post-traumatic stress disorder (PTSD), and type of hospital among Iranian nurses working in different clinical settings during the COVID-19 outbreak. This cross-sectional study employed convenience sampling to recruit 334 nurses working in various clinical settings, including teaching and referral hospitals, in Kerman, Southeastern Iran from October 2021 to February 2022. The study used three measures, including the General Health Questionnaire (GHQ-12), the Impact of Event Scale-Revised (IES-R), and The Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). Data analysis was conducted using SPSS25. The results indicated that moral injury was highly prevalent among Iranian nurses, with 47% of the participants reporting experiencing it. A total, 26.9% of the participants reported experiencing mental health disorders and 57.2% of the participants reported experiencing this disorder. Significant correlations were found between moral injury, general health, and PTSD. Specifically, moral injury levels were higher among female nurses with a history of mental disorders and those designated to treat all kinds of cases, compared to other participants. The results suggest that Iranian nurses are at a high risk of experiencing moral injury during the COVID-19 pandemic. Policymakers and health authorities should establish related health educational programs, provide counseling services to promote general health, and pay particular attention to moral injury and PTSD. Additionally, nurse educators should integrate materials related to moral injury into the nursing curriculum.

Staff support for workplace trauma: a freedom of information act request survey for NHS trusts providing mental health care in England

INTRODUCTION

Workplace trauma in mental health settings is defined as exposure to verbal and physical aggression, witnessing self-harm or hearing about patients' histories of abuse. Support for workplace trauma is important for staff well-being, staff retention and ultimately patient care. Assessing the extent and adequacy of staff support for workplace trauma in mental health settings is important in identifying areas of need and good practice.

AIM

To determine what staff support systems are in place for workplace trauma in mental health services across England.

METHODS

Freedom of Information Act requests were sent to all 57 National Health Service Trusts providing mental health care in England to identify policies on the support to mental health staff after traumatic incidents that they have experienced in the course of their clinical duties.

RESULTS

Fifty-five Trusts provided usable data. Only half provided evidence of a psychologically informed incident response that went beyond a fact-finding exercise and only a fifth of Trusts used an established model for the response process. A small proportion of policies acknowledged workplace traumas related to staff discrimination on the basis of protected characteristics.

CONCLUSION

There is insufficient attention to supporting mental health staff with the effects of workplace trauma.

Nurse views of obstacles encountered by nurses in Saudi Arabia during the provision of psychiatric care

BACKGROUND

Nursing staff within the mental health sector are major actors in delivering healthcare. They face considerable obstacles that may hinder the provision of high-quality care to patients with mental health challenges.

AIM

The current study offers a description of mental health nurses' viewpoints, insights into obstacles encountered during their experiences, and recommendations for enhancing psychiatric inpatient nursing care and achieving progress toward the goals set out by Saudi Vision 2030.

METHODS

The study employed a phenomenological qualitative design. Semistructured interviews were conducted with 10 currently practicing mental health nurses during two focus group sessions. The inductive data produced underwent member and peer checking. Emergent themes and subthemes were extracted.

RESULTS

Two main themes and related subthemes were identified. The first theme-obstacles faced by mental health nurses-was composed of the following subthemes: policy at institutions; clear job roles; low professional self-confidence and inadequate support; stressed, insecure, and unsafe; and stigmatization. The second theme-recommendations to improve the quality of mental health nursing-was composed of two subthemes: to enhance mental health awareness and improve professional skills and education.

CONCLUSION

The data suggest that maintaining high-quality nursing standards within an inpatient psychiatric facility requires a consistent and accountable organizational structure, which can lead to fostering the development and improvement of relevant nursing skills through continuing education, improved awareness of mental health disorders and care within the community, and initiatives to combat the stigma of mental disorders among patients, families, and communities.

The relationship between psychological resilience and professional quality of life among mental health nurses: a cross-sectional study

BACKGROUND

Mental health nursing is a demanding and stressful profession that impacts nurses' professional quality of life. Psychological resilience can be a protective factor. However, the relationship has not been extensively studied. This study aims to examine the relationship between psychological resilience and professional quality of life and identify potential predictors of ProQOL subscales among mental health nurses.

METHODS

The study employed a cross-sectional design to collect data from 179 mental health nurses. Data was collected using two standardized questionnaires: the Connor-Davidson resilience scale and the professional quality of life scale. Participants were recruited through convenient sampling during a 3-month period from April to June 2022, and the data were collected using an online survey tool called QuestionPro.

RESULTS

The study found a strong positive correlation between psychological resilience and compassion satisfaction (r = 0.632, P < 0.001). However, there was a negative significant correlation between resilience with burnout (r = -0.470, P < 0.001) and secondary traumatic stress (r = -0.210, P = 0.005). The study also found that higher resilience levels were associated with higher levels of compassion satisfaction and lower levels of secondary traumatic stress. Additionally, higher burnout scores were associated with higher levels of secondary traumatic stress. The study also identified that age and the number of children had weak associations with compassion satisfaction, while workplace was a significant predictor of burnout and secondary traumatic stress.

CONCLUSION

The study emphasizes the importance of resilience, burnout, and secondary traumatic stress in the well-being of healthcare professionals, especially nurses. The findings suggest that assessing nurses' resilience and professional quality of life can raise psychological resilience awareness and help managers create the necessary working conditions to improve nurses' professional quality of life.

The Mediating Effect of General Self-Efficacy Between Occupational Stress and Negative Emotion Among Psychiatric Nurses

The current study investigated occupational stress, anxiety, and depression among psychiatric nurses and explored the intermediary role of general self-efficacy between occupational stress, anxiety, and depression. In November 2020, 171 psychiatric nurses completed a self-report questionnaire. Spearman's correlation analysis was used to determine the relationship between the four variables and the bootstrap method was used to test the intermediary hypothesis. Results showed that 35.1% of psychiatric nurses had health risk stress. Among participants, detection rates of anxiety and depression were 24% and 46.8%, respectively. There was a positive correlation between occupational stress and anxiety (r = 0.577, p < 0.05) and depression (r = 0.653, p < 0.05). There was a negative correlation between general self-efficacy and anxiety (r = -0.358, p < 0.05) and depression (r = -0.500, p < 0.05), and general self-efficacy had a significant mediating effect between occupational stress and depression. However, the mediating effect of general self-efficacy on anxiety was not significant. Nurse managers should be aware of the importance of nurses' general self-efficacy and self-confidence. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 33-39.].

Negative Acts as Risk Factor for Work-Related Violence and Threats from Clients towards Employees: A Follow-Up Study

BACKGROUND

Work-related violence and threats are major problems in many occupations, especially within the human service sector, with consequences at multiple levels, including reduced physical and mental health, increased absenteeism, and reduced organizational commitment. It is, therefore, crucial to identify risk factors for work-related violence and threats. However, only a few studies have examined whether negative acts at work increase the risk of work-related violence and threats from clients toward employees.

OBJECTIVE

To examine the associations between exposure to negative acts towards employees from colleagues, clients, or a combination of both, and the risk of work-related violence and threats perpetrated by clients towards employees in a longitudinal study.

METHODS

Questionnaire data were collected in 2010, 2011, and 2015. In total, 5333 employees from special schools, psychiatric wards, eldercare, and the Prison and Probation Services participated in the first round of data collection in 2010. Negative acts were measured in 2010 using the Short Negative Acts Questionnaire, while work-related threats and violence were measured at all three-time points. The analyses were performed using multilevel logistic regression.

RESULTS

Negative acts from clients and the combination of negative acts from both clients and colleagues were associated with later exposure to work-related violence and threats. The associations were observed after one year, and work-related threats were still present after four years.

CONCLUSION AND IMPLICATIONS

Negative acts are associated with an increased risk of work-related violence and threats perpetrated by clients toward employees. Organizations may reduce the risk of work-related violence and threats by preventing negative acts.

Relationship between job stress, thinking style and symptoms of post-traumatic stress disorder in mental health nurses

Introduction

Mental health nurses are often exposed to stressful events which may lead to feeling of stress in their daily work, and this feeling has a profound impact on nurses' mental health.

Aim

This study aimed to evaluate the relationship between job stress, thinking style and symptoms of post-traumatic stress disorder (PTSD) of mental health nurses, and to explore the mechanism of job stress and thinking style on symptoms of PTSD.

Method

This cross-sectional study collected related data of 351 mental health nurses in China, and the data was analyzed by PROCESS macro for SPSS.

Results

The results showed that 18.2% of mental health nurses had the symptoms of PTSD. Thinking style (monarchic thinking style, anarchic thinking style and external thinking style) played a moderating role in the predictive effects of job stress on the symptoms of PTSD.

Discussion

The research pointed out the relationship between job stress and symptom of PTSD, and clarified the critical role of thinking style among mental health nurses.

Implications for practice

It is recommended that organizations should enact effective policy and intervention programs to reduce job stress and PTSD symptoms of mental health nurses which may improve their mental health level.

The Mediating Role of Coping Style in the Relationship Between Sleep Quality and Burnout: A Cross-Sectional Study Among Psychiatric Nurses

BACKGROUND

Although sleep quality is clearly associated with job burnout as shown in the existing research, the mechanism underpinning such relationship remains undefined. This work, thus, aimed to assess the current situation of sleep quality and burnout in Chinese psychiatric nurses, and to analyze the relationships between sleep quality, burnout and coping style, in order to provide possible targets to enhance mental health and wellbeing among psychiatric nurses.

METHOD

This cross-sectional study was carried out in seven rehabilitation centers located in four different regions of China. The Pittsburgh Sleep Quality Index, the Epworth Sleeping Scale, the Maslach Burnout Inventory General Survey, and the Coping Style Questionnaire were distributed to 853 nurses in various mental hospitals, with a total of 664 participants being recruited in the final research.

RESULTS

The results of this current study showed a high prevalence of sleep disorders and burnout in Chinese psychiatric nurses. Moreover, emotional exhaustion (r = 0.456), cynicism (r = 0.323) and negative coping style (r = 0.191) in nurses were all positively correlated with total Pittsburgh Sleep Quality Index (PSQI) score, while professional efficacy (r = -0.079) and positive coping style (r = -0.140) were negatively correlated with total PSQI score. More interestingly, of all negative coping strategies, we found that self-blame had the most significant effect (β = 0.156).

CONCLUSIONS

The above results showed that coping style mediates the association of poor sleep quality with job burnout in Chinese psychiatric nurses. This study claimed that there is an urgent need to development the coping skills to sustain a healthy work life for nurses.

Prevalence and severity of verbal, physical, and sexual inpatient violence against nurses in Swiss psychiatric hospitals and associated nurse-related characteristics: Cross-sectional multicentre study

This analysis (1) describes the prevalence and severity of psychiatric inpatient violence against nurses in Switzerland's German-speaking region and (2) investigates the associations between nurse-related characteristics (socio-demographics; previous exposure to severe forms of psychiatric inpatient violence; attitude towards psychiatric inpatient violence) and nurses' exposure to various types of psychiatric inpatient violence. We used cross-sectional survey data from the Match^RN Psychiatry study sample of 1128 nurses working on 115 units across 13 psychiatric hospitals. In addition to lifetime severe assaults, nurses' exposure to violence against property, verbal violence, verbal sexual violence, physical violence, and physical sexual violence was assessed for the 30 days prior to the survey. Descriptive statistics (frequency and percentage) were calculated for each class of violence as also for items under study. With generalized linear mixed models, odds ratios and 95% confidence intervals were calculated. Of nurse respondents, 73% reported facing verbal violence, 63% violence against property, 40% verbal sexual violence, 28% physical violence, and 14% physical sexual violence. Almost 30% had been subjected to a serious assault in their professional lifetimes. All nurse characteristics were associated with psychiatric inpatient violence against nurses, especially a history of sexual assault (OR 4.53, 95%-CI 2.19-9.34; P = 0.00) and ≤3 years' professional experience (OR 3.70, 95%-CI 1.95-7.02; P = 0.00). Prevalence data suggest that widely used strategies such as aggression management courses or alarm devices cannot fully reduce patient violence against nurses in psychiatry. This situation demands proactive strategies in safety and violence prevention.

Psychological adjustment in care providers following restraint of psychiatric patients

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.

Describing the Mental Health State of Nurses in British Columbia: A Province-Wide Survey Study

A cross-sectional province-wide survey study of 3,978 British Columbia (BC) nurses was conducted to explore the mental health state of the nursing workforce in BC. About one third of nurses reported depression and anxiety; about half reported symptoms of post-traumatic stress disorder and at least one third reported high levels of one or more dimensions of burnout. Mental health problems were about 1.5 to 3 times more prevalent among BC nurses compared to their peers nationally. Improving nurses' mental health requires multi-factorial and multi-level efforts. Evidence-based and workplace-specific policies and interventions that better support nurses at risk are recommended.

Mindfulness, Compassion, and Self-Compassion as Moderator of Environmental Support on Competency in Mental Health Nursing

This research explored the established relationship between environmental support and competency for Mental Health Nurses, intending to investigate whether the tendency to display higher levels of mindfulness, compassion, and self-compassion might buffer the effect of a poor environment on competency. One questionnaire was comprised of five pre-developed questionnaires, which included all items examining environmental support, competency, mindfulness, compassion, and self-compassion. Mental Health Nurses (n = 103) were recruited from online forums and social media group pages in the UK. The result showed environmental support related positively to competency. Furthermore, the positive relationship of competency with environmental support was moderated when controlling for compassion but did not with mindfulness and self-compassion, although subscales showed some further interactions. When poor environmental support influences the competency of mental health professionals, compassion and mindfulness-based interactions may have the potential to uphold competency.

Nurses' Views Highlight a Need for the Systematic Development of Patient Safety Culture in Forensic Psychiatry Nursing

BACKGROUND

Although forensic nurses work with the most challenging psychiatric patients and manifest a safety culture in their interactions with patients, there have been few studies on patient safety culture in forensic psychiatric nursing.

OBJECTIVES

The aim of this qualitative study was to describe nurses' views of patient safety culture in their working unit and daily hospital work in 2 forensic hospitals in Finland.

METHODS

Data were collected over a period of 1 month by inviting nurses to answer an open-ended question in an anonymous Web-based questionnaire. A qualitative inductive analysis was performed on nurses' (n = 72) written descriptions of patient safety culture in state-owned forensic hospitals where most Finnish forensic patients are treated.

RESULTS

Six main themes were identified: "systematization of an open and trusting communication culture," "visible and close interaction between managers and staff," "nonpunitive responses to errors, learning and developing," "balancing staff and patient perspectives on safety culture," "operational safety guidelines," and "adequate human resources to ensure safety."

CONCLUSIONS

The findings highlight the influence of the prevailing culture on safety behaviors and outcomes for both healthcare workers and patients. Additionally, they underline the importance of an open culture with open communication and protocols.

Exposure to workplace trauma for forensic mental health nurses: A scoping review

BACKGROUND

Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role.

OBJECTIVES

To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses.

DESIGN

A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

METHODS

Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence.

RESULTS

Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature.

CONCLUSIONS

While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

Resilience and burnout in healthcare students and inpatient psychiatric nurses: A between-groups study of two populations

BACKGROUND

Stressful environments can have significant effects on an individual and lead to burnout. Psychological consequences of burnout include trauma reactions, depression, anxiety and substance use disorders. Resilience, a protective mechanism can mitigate the negative impact of burnout.

METHOD

This study utilizes an exploratory correlational design to determine whether or not there is 1) a similar correlation between resilience and burnout between psychiatric nurses working in a high stress environment and students who are naive to the high stress academic environment and 2) a higher level of resilience in the psychiatric nurses compared to the healthcare students.

RESULTS

A significant inverse relationship was observed with respect to resilience and burnout in both the professional nurse and student groups. However, the inpatient psychiatric nurse group was not found to have a higher level of resilience than the student group, when controlling for age.

CONCLUSION

This suggests that resilience to burnout is not related to the work environment but life experience (age) was found to be a factor related resilience in this sample.

Does workplace violence, empathy, and communication influence occupational stress among mental health nurses?

Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio-demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy - Health Professions version, and Nurses' Clinic Communication Competence Scale were administered to 539 mental health nurses from three top-grade tertiary research hospitals in the Beijing-Tianjin-Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants' empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = -0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.

Sources of Social Support After Patient Assault as Related to Staff Well-Being

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

The Role of Institution-Based Peer Support for Health Care Workers Emotionally Affected by Workplace Violence

BACKGROUND

Academic health centers with peer support programs have identified a significant increase in requests linked to workplace violence (WPV) exposure. However, no known research has focused on supportive interventions for health care workers exposed to WPV. This study aimed to describe the expansion of two long-standing programs-University of Missouri Health Care's (MU Health Care) forYOU Team, The Johns Hopkins Hospital's (JHH) RISE (Resilence in Stressful Events) team-to WPV support, retrospectively summarize the related data, and share generalizable lessons.

METHODS

A retrospective extraction and summary of the forYOU and RISE databases and the MU Health Care and JHH databases was performed tracking hospitalwide data on WPV. Two cases describe the experience of WPV victims.

RESULTS

Between 2009 and 2019, forYOU documented 834 peer support interventions, 75 (9.0%) related to WPV (57 one-on-one encounters, 18 group support encounters). In 2018-2019 the forYOU Team experienced an increase in WPV encounters, with 43 of the team's activations (20%) related to WPV. Between 2011 and 2019, RISE recorded 367 peer support interventions, 80 (21.8%) of which were WPV-related (61 group support encounters, 19 one-on-one encounters). Forty-eight (60.0%) of these 80 encounters occurred in 2018-2019 alone, marking an increase in WPV encounters. Nurses were the most frequent callers of both programs.

CONCLUSION

This study indicates the growing need for health care workers' support in the aftermath of WPV exposure in today's health care environment. Health care institutions should take a holistic approach to WPV, including timely access to interventional peer support programs.

Exposures to Potentially Psychologically Traumatic Events Among Nurses in Canada

BACKGROUND

Nurses are regularly exposed to diverse potentially psychologically traumatic events (PPTEs) as a function of their work. Cumulative exposure to PPTEs can lead to clinically significant symptoms of mental disorders.

PURPOSE

We designed the current study to investigate the prevalence of different PPTEs among Canadian nurses and estimate the associations between diverse exposures and several mental disorders.

METHODS

Canadian nurses (i.e., registered nurses, registered psychiatric nurses, licensed practical nurses, nurse practitioners) completed an online, self-reported survey. In total, 4067 participants (94.8% women) completed all relevant survey measures.

RESULTS

Nurses reported exposures to several PPTE categories including severe human suffering, life threatening illness or injury, and physical assault, often 11 or more times. There were significant (p<.05) associations between diverse traumatic events and all mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder) except Alcohol Use Disorder.

CONCLUSIONS

The current findings suggest that Canadian nurses are substantially exposed to traumatic events, which vary by several sociodemographic categories. PPTE exposures were significantly associated with mental disorders; that is, if PPTEs were eliminated among Canadian nurses in the sample, symptoms would be reduced between 42.0% and 58.0%.

Mental Disorder Symptoms Among Nurses in Canada

Background

Nurses face regular exposures to potentially psychologically traumatic events as part of their occupational responsibilities. Cumulative stress due to repeated exposure to such events is associated with poor mental health and an increased risk of developing clinically significant symptoms consistent with some mental disorders.

Purpose

The current study was designed to estimate rates of mental disorder symptoms among nurses in Canada and identify demographic characteristics that are associated with increased risk for mental disorder symptoms.

Method

An online survey was conducted with Canadian nurses in both English and French. Participants were recruited largely through the Canadian Federation of Nurses Unions (CFNU) member unions, non-CFNU member unions, and social media. The survey assessed current mental disorder symptoms using well-validated screening measures.

Results

A total of 4267 participants (93.8% women) completed the survey. Almost half of participants screened positive for a mental disorder (i.e., 47.9%). No gender differences emerged. Significant differences in proportions of positive screens based on each measure were found across demographic groups (e.g., age, province of residence, type of nurse).

Conclusions

The rate of positive screens appears much higher than mental disorder prevalence rates in the general Canadian population, but there were important methodological differences. The current results provide potentially important information to support researchers and healthcare administrators to investigate possible ways to mitigate and manage mental health in nursing workplaces.

Nurses' experiences of workplace violence in psychiatric nursing: a qualitative review protocol

OBJECTIVE

The objective of this review is to explore nurses' experiences of workplace violence in the field of psychiatric nursing.

INTRODUCTION

Although violent incidents are more common in psychiatric inpatient settings (e.g., psychiatric hospitals), violence has increased in psychiatric outpatient settings (e.g., mental health centers and day centers). Exposure to workplace violence can impact nurses' resilience and levels of burnout. However, there is a lack of qualitative evidence specifically identifying nurses' experiences of workplace violence in the context of psychiatric nursing. This review will appraise and synthesize available evidence related to nurses' experiences of workplace violence in the context of psychiatric nursing.

INCLUSION CRITERIA

This review will consider studies that relate to nurses working in the field of psychiatric nursing in mental health settings worldwide. The specific inclusion criteria are as follows: qualitative studies that explore the experiences of nurses regarding workplace violence published in English, Finnish, or Swedish with no publication date limitations.

METHODS

PubMed, CINAHL, PsycINFO, PsycARTICLES, Scopus, Web of Science, ProQuest, and the Directory of Open Access Journals will be searched to identify published studies. ProQuest Dissertations and Theses, Google Scholar, and MedNar will be searched to identify unpublished studies. The review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Qualitative research findings will be pooled using JBI System for the Unified Management, Assessment, and Review of Information with the meta-aggregation approach. The ConQual approach will be used to assess confidence in the findings.

Organizational Prevention and Management Strategies for Workplace Aggression Among Child Protection Workers: A Project Protocol for the Oslo Workplace Aggression Survey (OWAS)

Background

Previous research has established exposure to workplace aggression as a significant risk factor for employee functioning, well-being, and health. However, less is known about effective prevention and management strategies. The main objectives of the current project were to determine the impact of physical and psychological aggression on the well-being, health, and work ability of employees in the child welfare service and to establish whether a strong psychosocial safety climate and an ethical infrastructure are effective with regard to protecting employees against aggression. This project may help identify the specific risks child welfare workers are exposed to, the impact of workplace aggression on their health and well-being, and the most effective strategies to manage the problem. Furthermore, the findings should be central for developing laws and regulations and to any political decision on measures to tackle aggression in the workplace.

Methods

The study will employ two prospective data collections. Firstly, a three-wave longitudinal survey with a 6-month time lag between measurement points will be conducted among all 1,500 employees in the child welfare services in Oslo Municipality, Norway. Data will have a multilevel structure and will be linked to registry data on sickness absence. Secondly, a quantitative daily diary study over a 14-day period will include 150 of the respondents from the main survey study. The survey questionnaires mainly comprise well-established and psychometrically validated indicators of workplace aggression, health and well-being, psychosocial safety climate, ethical infrastructure, and other relevant factors. The Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East) have approved this project (project no. 28496).

Discussion

This project will identify the impact of workplace aggression on child protection workers as well as provide information on how organizations can actively manage exposure to workplace aggression. The findings may serve as a starting point for intervention studies as well as the development of policies and guidelines on how to handle workplace aggression.

Experiences of Psychiatric Nurses Who Care for Patients with Physical and Psychological Violence: A Phenomenological Study

Introduction: The present study aims to understand the experiences and characteristics of nurses caring for patients with mental disorders characterized by aggressive behavior. Aim: The study aimed to understand and interpret the physical and psychological experiences and positive and negative aspects associated with nursing practices of patients with anger and aggressive behavior. Method: The participants of this study were twelve nurses with over three years of experience working in a mental hospital. More specifically, all our participants had experience caring for psychiatric patients with anger and aggressive behavior. The collected data were analyzed using the phenomenological analysis method and the procedure proposed by Colaizzi (1978). Result: The nurses’ experience was described in five categories: “fear of violence”, “exposure to a poor working environment”, “difficulty of emotional control”, “career regrets”, and “finding a solution to violence.” Discussion: The hospital should encourage and provide training sessions to teach nurses how to use proper intervention technique regarding medication and seclusion. Implications: The results of the present study suggest the need for ongoing hospital support and program development, intervention studies, and improvement of the work environment to resolve the burden of mental and physical difficulties experienced by psychiatric nurses.

Suicidal Behaviors Among Nurses in Canada

BACKGROUND

Nurses are regularly exposed to potentially psychologically traumatic events, experience high rates of burnout, and may be at an elevated risk of death by suicide. Few studies have assessed for suicidal behaviors among Canadian nurses, and factors that may increase risk for suicidal behaviors are unknown.

PURPOSE

The current study was designed to assess past-year and lifetime suicidal behavior (i.e., ideation, plans, and attempts) using a large sample of Canadian nurses.

METHOD

Participants (n = 3969; 94.3% women) completed an online survey including measures of suicidal behavior and symptoms of mental disorders.

RESULTS

Considerable proportions of participants reported past-year and/or lifetime suicidal ideation (10.5%, 33.0%), plans (4.6%, 17.0%), and attempts (0.7%, 8.0%), considerably higher than general population estimates. Significant differences were identified across age groups, years of service, marital status, regional location, and nursing type (e.g., registered psychiatric nurses, licensed practical nurses, registered nurses). Participants who screened positive for almost all measured mental disorders had significantly higher rates of suicidal behavior.

CONCLUSIONS

The results necessitate further research to evaluate risk factors contributing to suicidal behavior in Canadian nurses and methods to decrease the risk (e.g., developing effective monitoring and prevention measures).

Violence Factors and Debriefing in Psychiatric Inpatient Care: A Review

The aim of the current review was to identify, analyze, and synthesize the available research on violence factors in psychiatric care and the potential of debriefing to reduce the incidence of violence necessitating coercive measures. A two-part electronic search was conducted using multiple databases. Part 1 focused on reviews and meta-analyses relating to violence factors published between 2007 and 2017. Part 2 focused on articles on debriefing published after 2000. Two hundred ninety-five articles on violence factors and debriefing were identified, from which 39 publications were selected for detailed analysis. Results indicate that patient characteristics, management, staff approaches, and the ward environment are influencers that may trigger violent incidents. Several violence factors in psychiatric care have been identified. Nursing communication, leadership, and debriefing are among the most effective ways of reducing violence in psychiatric care. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 39-49.].

Violence and aggression in psychiatric inpatient care in Sweden: a critical incident technique analysis of staff descriptions

BACKGROUND

Violence towards staff working in psychiatric inpatient care is a serious problem. The aim of the present study was to explore staff perspectives of serious violent incidents involving psychiatric inpatients through the following research questions: Which factors contributed to violent incidents, according to staff? How do staff describe their actions and experiences during and after violent incidents?

METHODS

We collected data via a questionnaire with open-ended questions, and captured 283 incidents reported by 181 staff members from 10 inpatient psychiatric wards in four different regions. We used the Critical Incident Technique to analyse the material. Our structural analysis started by structuring extracts from the critical incidents into descriptions, which were grouped into three chronological units of analyses: before the incident, during the incident and after the incident. Thereafter, we categorised all descriptions into subcategories, categories and main areas.

RESULTS

Staff members often attributed aggression and violence to internal patient factors rather than situational/relational or organisational factors. The descriptions of violent acts included verbal threats, serious assault and death threats. In addition to coercive measures and removal of patients from the ward, staff often dealt with these incidents using other active measures rather than passive defence or de-escalation. The main effects of violent incidents on staff were psychological and emotional. After violent incidents, staff had to continue caring for patients, and colleagues provided support. Support from managers was reported more rarely and staff expressed some dissatisfaction with the management.

CONCLUSIONS

As a primary prevention effort, it is important to raise awareness that external factors (organisational, situational and relational) are important causes of violence and may be easier to modify than internal patient factors. A secondary prevention approach could be to improve staff competence in the use of de-escalation techniques. An important tertiary prevention measure would be for management to follow up with staff regularly after violent incidents and to increase psychological support in such situations.

Patient-on-Staff Assaults: Perspectives of Mental Health Staff at an Acute Inpatient Psychiatric Teaching Hospital in the United States

INTRODUCTION

Physical assaults perpetrated by patients in psychiatric hospitals against mental health staff (MHS) is a serious concern facing psychiatric hospitals. Assaulted staff reports physical and psychological trauma that affects their personal and professional lives. There is a dearth of literature exploring this phenomenon.

PURPOSE

To explore MHS perspectives of assault by psychiatric patients.

METHODS

A transcendental phenomenological qualitative design was used to explore and analyze the perspectives of a purposeful sample of 120 MHS perspectives at an acute inpatient psychiatric hospital. Participants' age ranged from 22 to 63 years (mean age = 32.4). Moustakas' theoretical underpinnings guided the study.

RESULTS

Two patterns, 8 themes, and 19 subthemes were identified: (a) Psychological impacts revealed four themes-increase of anxiety/fear level, helplessness and hopelessness, flashbacks/burnout, and doubting own competency. (b) Physiosocial impacts revealed four themes-unsupportive superiors, stigmatization of staff victim, failure to report the incident, and environmental safety.

DISCUSSION

Participants verbalized that assaults by patients have instilled fear and trauma in them. Most of the assaults occurred when staff were performing their routine job functions and setting limits to patient's behavior.

CONCLUSION

The study allowed MHS opportunities to narrate their lived experiences of being assaulted by patients and provided validation of their perspectives. Findings illuminated the phenomenon and may help to support policy changes in psychiatric hospitals.

When Our Work Hits Home: Trauma and Mental Disorders in Correctional Officers and Other Correctional Workers

Background: International estimates suggest that up to one in three public safety personnel experience one or more mental disorders, including post-traumatic stress disorder (PTSD). Canadian data have been sparse until very recently, and correctional officers and forensic psychiatric staff have rarely been included. Working as a correctional officer is associated with negative health outcomes and increased work-related stress, with several variables affecting reported levels of stress. Healthcare staff also report higher rates of PTSD, especially those who are exposed to aggression in their workplace. In the present study, we compare current symptoms of diverse staff working in correctional occupations. Method: Data were collected from a Canadian national online survey of public safety personnel, including employees of correctional services at the federal level. Correctional officers and wellness services staff were compared for prevalence of mental disorders and suicidal ideation. Results: Correctional officers self-reported statistically significantly more exposure to potentially psychologically traumatic events than wellness services employees. Correctional officers also self-reported higher rates of symptoms of mental disorders, including PTSD, social anxiety, panic disorder, and depression. There were no statistically significant differences in reports of suicidal thoughts, plans, or attempts. Contribution to Society: Correctional and forensic staff contribute to society by working with justice-involved individuals in correctional institutions. Trauma-related disorders and other mental health problems threaten the well-being of correctional and forensic staff. Mental health likely impacts the ability of correctional and forensic staff to develop a therapeutic or working alliance with persons in custody. Staff well-being must be recognized and addressed to ensure that prisoners and staff receive optimal treatment in prison. Conclusion: Our results add to the limited knowledge about the well-being of staff, particularly wellness staff in prisons, who provide daily treatment and care for prisoners with serious mental disorders. Our work is a step toward identifying avenues for promoting staff well-being.

Rescuers at Risk: Posttraumatic Stress Symptoms Among Police Officers, Fire Fighters, Ambulance Personnel, and Emergency and Psychiatric Nurses

Emergency personnel and rescue workers may be at a risk of posttraumatic stress symptoms (PTSS) due to exposure to trauma and work-related stressors. Though rescuers of different professions are often engaged in the same type of emergency, they have different tasks and responsibilities and receive different training in coping with traumatic events and stress; hence, we speculated that the salience of identified risk factors for PTSS vary across their respective professions. The present cross-sectional survey aimed to identify influencing variables on PTSS, well-being, and suicidal ideation that can act differently across professions of rescue workers and emergency personnel. In this anonymous online study, data from 1,002 rescue workers and emergency personnel in Switzerland, were collected: 499 police officers, 239 firefighters, 97 ambulance personnel, and 85 emergency and 82 psychiatric nurses. PTSS, coping strategies, well-being, suicidal ideation, previously experienced and work-related trauma, and self-efficacy were measured and analyzed using multiple regression and structural equation modeling (SEM). The prevalence of suspected posttraumatic stress disorder varied across the professions, ranged from 8% (firefighters) to 22% (psychiatric nurses), and was associated with psychological strain and suicidal ideation. The SEM showed that dysfunctional coping strategies, self-efficacy, previously experienced and work-related trauma, years on job, and female sex explained up to 78% of PTSS and that PTSS itself explained up to 68% of the psychological strain experienced in the different professions. Independent of the profession, dysfunctional coping such as alcohol use, avoidance, and distraction, as well as work-related trauma were the most robust predictors of PTSS. However, while self-efficacy was a risk factor for police officers, firefighters and ambulance personnel, it was a protective factor for emergency and psychiatric nurses. Furthermore, female sex was only a risk factor for ambulance personnel and emergency nurses. In agreement with prior research, emergency personnel and rescuers exhibited enhanced prevalence of PTSS and suspected PTSD, leading to significant psychological strain and suicidal ideation. However, risk factors varied across the professions. Thus, the development of profession-specific trainings to improve self-efficacy and coping with work-related stressors to reduce PTSS, and enhance quality of life, is needed for individuals in such high-risk professions. Clinical Trial Registration: ClinicalTrials.gov Nr. NCT03842553.

Akt dependent adult hippocampal neurogenesis regulates the behavioral improvement of treadmill running to mice model of post-traumatic stress disorder

Physical exercise is well-established paradigm for improving adult neurogenesis and brain functions. As considered as an alternative therapeutic strategy, treadmill running could reduce cognitive impairment and psychiatric abnormalities associating post-traumatic stress disorder (PTSD), which might associate with the promote effects to adult neurogenesis. In current study, we aimed to address how treadmill exercise benefit adult hippocampal neurogenesis in PTSD model and the underlying molecular mechanism related with Akt signaling. PTSD was induced by exposure to aggressor and treatments were conducted with different intensity of compulsory treadmill running. We observed treadmill running improved hippocampal neurogenesis including proliferation and neural differentiation of neural stem cells (NSCs). Moreover, behavioral tests showed treadmill could attenuate the cognitive deficit and depressive/anxiety like behaviors in correlating with PTSD model. Moreover, treadmill running recovered the Akt activity in hippocampus. Interrupting treadmill running administrated mice with Akt inhibitor GSK690693 resulted in the blocked the effects of treadmill running to hippocampal neurogenesis and behavioral improvement in PTSD mice model. In conclusion, treadmill running could mediate behavioral functions and improve hippocampal neurogenesis in PTSD model by regulating Akt signaling.

Experiencing and Witnessing Patient Violence - an Occupational Risk for Outpatient Therapists?

Violence against therapists by their clients are a common occurrence across clinical settings and may have a lasting impact on the clinician's professional and personal functioning. In spite of this, no study to date has looked at the frequency of trauma-induced symptoms in psychotherapists. Using a sample of N = 917 psychotherapists across Germany, Austria, and Switzerland, we analyzed the frequency and sequelae of patient attacks suffered or witnessed by therapists. More than half (51.3%) of the sample reported having been the victim or witness of patient attacks or threats of violence in their career. Among the affected therapists, 27.7% reported posttraumatic symptoms lasting longer than four weeks and 2.7% presented symptoms amounting to a full-PTSD diagnosis. Thus, while the frequency of attacks and trauma-induced symptoms were considerable, estimated PTSD rates were rather low. The findings suggest that practitioners should be conscious of client violence being an occupational risk and that it is advisable to have protective measures in place.

Post-traumatic Reactions and Their Predictors among Workers Who Experienced Serious Violent Acts: Are There Sex Differences?

Background

Serious violent acts (e.g. physical violence, robbery, sexual aggression and death threats) are among the most visible and notable examples of workplace violence. Although women are commonly found to be at higher risk for post-traumatic reactions following workplace violence, little is known as regards sex differences concerning the types of post-traumatic reactions and their predictors.

Objective

This study aimed to describe sex differences in the post-traumatic reactions of serious violent acts and the predictors of such reactions.

Methods

The study was conducted among a convenience sample of 2889 French-speaking workers from Quebec, Canada by using a self-administrated survey. Linear regression modelings and post-hoc comparisons of coefficients according to the sex of the respondents were used to achieve the objective.

Results

Preliminary results confirmed that while men are more exposed to violence at work, women experience a greater number of post-traumatic reactions. Women were more affected by flashbacks, avoidance, and hypervigilance than men. The results also showed that being victimized by a male aggressor was associated with a greater number of post-traumatic reactions for women, whereas being victimized by an insider (e.g. colleague, supervisor, employee) was associated with a greater number of post-traumatic reactions for both sexes.

Implications

These findings highlight the necessity to better consider sex as a potential determinant of mental health in studies on workplace violence.

Resilience and mental health nursing: An integrative review of international literature

Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses' resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person-environment process. Resilience was most often reported as low-moderate, with positive correlations with hardiness, self-esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses' coping self-efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience-building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.

Coroners and PTSD: Treatment Implications

Experimental studies have documented the development of posttraumatic stress disorder (PTSD) in first responders. These studies have routinely included police, firefighters, and paramedics. However, there is another group of first responders that are at risk for PTSD but that has received less research attention. This group is comprised of coroners. This paper reviewed the published data concerning coroners and PTSD and outlined various treatments for addressing coronial PTSD. The findings, the differing treatments, and a detailed methodological inquiry are presented. The need for a conceptual framework for the various other professional groups responding to critical incidents and a crisis intervention approach to address the psychological needs of both family survivors and coronial personnel are noted.

Fear and blame in mental health nurses' accounts of restrictive practices: Implications for the elimination of seclusion and restraint

Restrictive practices continue to be used in mental health care despite increasing recognition of their harms and an international effort to reduce and ultimately eliminate their use. The aim of this qualitative study was to explore mental health nurses' views of the potential elimination of these practices. Nine focus groups were conducted with 44 mental health nurses across Australia, and the data analysed using thematic analysis. Overall, the nurses expressed significant fear about the potential elimination of restrictive practices and saw themselves as being blamed for both the use of these practices and the consequences should they be eliminated. Findings detail the conflicts facing staff in balancing the need for ward safety for everyone present while at the same time providing person-centred care. Nurses described the changing role of the mental health nurse in acute settings, being more focussed on risk assessment and medication while at the same time attempting to practise in trauma-informed person-centred ways. The impact on ward safety with increasing acuity of consumers plus the presence of forensic consumers and those affected by methamphetamine was emphasized. Change initiatives need to take into account nurses' deep concerns about the consequences of eliminating all forms of control measures in hospitals and respond to the symptoms and behaviours consumers present with and associated unpredictable and concerning behaviours. Attempts to eliminate restrictive practices should, therefore, be carefully considered and come with a clear articulation of alternatives to ensure the safety of consumers, visitors, and staff.

On PAR: A feasibility study of the Promoting Adult Resilience programme with mental health nurses

Mental health settings are recognized as complex, unpredictable environments, and challenging interpersonal situations are common for nurses in acute adult mental health services. Occupational stressors include verbal aggression and physical assault and are correlated with poor physical and mental health outcomes for nurses. There is a clear need for proactive approaches that address the negative impacts of stressors on the mental health nursing workforce. Resilience interventions are a preventive approach to strengthening skills for addressing workplace stress, improving health and well-being, and preventing adverse outcomes associated with occupational stressors. The aim of this study was to evaluate the feasibility of a workplace resilience education programme for nurses in high-acuity adult mental health settings. The outcomes were measured using a single-group pretest post-test design with follow-up at 3 months postintervention. The feasibility and acceptability of the programme were identified with descriptors of mental health, well-being, resilience, facilitator fidelity checklists, and participant satisfaction questionnaires. The programme was found to be feasible for nurses working in high-acuity inpatient settings. There were significant changes to mental health, well-being, and workplace resilience. The programme was delivered with fidelity by facilitators and accepted with high levels of satisfaction by participants. The study findings indicated that nurses can benefit from resilience education that equips them with cognitive, emotion regulation, and relational skills, in conjunction with available external supports and resources, to address workplace challenges. There is a need for comprehensive organizational approaches that include individual, work unit, and organizational-level strategies to support staff well-being.

Mental health nurses' perspective of workplace violence in Jordanian mental health hospitals

PURPOSE

The purpose was to assess the mental health nurses' perspectives of workplace violence in mental health departments in Jordan.

DESIGN AND METHODS

A cross-sectional correlation study was utilized to address the study's purposes. Data were collected using self-reported questionnaires from nurses working in governmental mental health departments in Jordan.

FINDINGS

The findings indicated that 80% of the respondents were victims of at least one violent act in the last 2 years. Verbal abuse was the most indicated type of violence. Patients were considered the main source of violence.

PRACTICE IMPLICATIONS

Policies and legislations addressing workplace violence should be implemented, and nurses should be trained on using such policies. Hospital managers should create a safe work environment by enforcing effective security measures and maintaining adequate staffing.

Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review

The aim of this scoping review is to synthesize the academic and gray literature on the use of immediate staff debriefing following seclusion or restraint events in inpatient mental health settings. Multiple electronic databases were searched to identify literature on the topic of immediate staff debriefing. The analysis identified several core components of immediate staff debriefing: terminology, type, critical reflection, iterative process, training, documentation, and monitoring. While these components were regarded as vital to the implementation of debriefing, they remain inconsistently described in the literature. Immediate staff debriefing is an important intervention not only to prevent future episodes of seclusion and restraint use, but as a forum for staff to support each other emotionally and psychologically after a potentially distressing event. The core components identified in this review should be incorporated into the organization's policies, practice guidelines, and training modules to ensure consistent conceptualization and implementation of the debriefing process.

Strengthening mental health nurses' resilience through a workplace resilience programme: A qualitative inquiry

WHAT IS KNOWN ON THE SUBJECT?: Mental health nurses are affected by interpersonal, practice-related and organizational factors that can increase workplace stress and reduce their physical and mental health and well-being. Resilience programmes are a strength-based preventative approach to supporting individuals to overcome workplace adversities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self-talk, managing negative self-talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social-ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well-being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. ABSTRACT: Introduction Mental health settings are potentially high-stress workplaces that can lead to nurses' poorer health and well-being. Resilience programmes are a strengths-based preventative approach for promoting mental health and well-being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim To explore the perspectives of mental health nurses participating in a mental health service-initiated resilience programme (Promoting Adult Resilience). Method An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open-ended responses and semi-structured interviews and focus groups, were thematically analysed. Results Twenty-nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self-efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice It is recommended resilience programmes are provided to promote nurses' well-being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well-being need to be addressed at a unit, organizational and professional level.

Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2013-2017

Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in human suffering and dollar cost expense. International research through 2012 documented the frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five year period of 2013-2017. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s, even with new policy initiatives in place meant to reduce such violence. Nursing personnel continued to be at greater risk. The findings by continents and an updated methodological inquiry are presented.

Consistent Use of Assistive Devices for Patient Transfer Is Associated With Less Patient-Initiated Violence: Cross-Sectional Study Among Health Care Workers at General Hospitals

This study investigated whether factors related to bodily contact between health care workers and patients were associated with patient-initiated violence. This cross-sectional study surveyed 496 Danish health care workers measuring patient-initiated violence, use of assistive devices, body mass index, physical exertion, frequency of patient transfers, psychosocial work environment, gender, age, and seniority. Associations were modeled using logistic regression analyses using patient-initiated violence as the outcome. Twenty-five percent of the respondents had experienced physical or verbal violence during the past year. Infrequent use of assistive devices, high physical strain, and severe obesity all significantly increased the risk of physical violence (risk ratio [RR] = 1.18, RR = 1.18, and RR = 1.16, respectively), whereas only the lack of assistive device use significantly increased the risk of verbal violence (RR = 1.13 and RR = 1.08). Consistent use of assistive devices appears to reduce the risk of patient-initiated violence. Managers should require the use of assistive devices when designing work processes for patient transfers.

Psychiatric Hospital Workers’ Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms

Background

About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression.

Objective

We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic).

Method

Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL).

Results

All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced.

Conclusion

PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.