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Free G, Swildens W, Knapen S, Beekman A, van Meijel B. Mentalizing capacities of mental health nurses: A systematic PRISMA review. J Psychiatr Ment Health Nurs 2024; 31:87-110. [PMID: 37551628 DOI: 10.1111/jpm.12963] [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: 02/08/2023] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mentalizing is the capacity to understand both one's own and other people's behaviour in terms of mental states, such as, for example, desires, feelings and beliefs. The mentalizing capacities of healthcare professionals help to establish effective therapeutic relationships and, in turn, lead to better patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The personal factors positively associated with the mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. There is limited evidence that training programmes can improve mentalizing capacities. Although the mentalization field is gaining importance and research is expanding, the implications for mental health nursing have not been previously reviewed. Mental health nurses are underrepresented in research on the mentalizing capacities of healthcare professionals. This is significant given that mental health nurses work closest to patients and thus are more often confronted with patients' behaviour compared to other health care professionals, and constitute a large part of the workforce in mental healthcare for patients with mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the importance of mentalizing capacity of both the patient and the nurse for a constructive working relationship, it is important that mental health nurses are trained in the basic principles of mentalization. Mental health nurses should be able to recognize situations where patients' lack of ability to mentalize creates difficulties in the interaction. They should also be able to recognize their own difficulties with mentalizing and be sensitive to the communicative implications this may have. ABSTRACT INTRODUCTION: Mentalizing capacities of clinicians help to build effective therapeutic relationships and lead to better patient outcomes. Few studies have focused on factors associated with clinicians' mentalizing capacities and the intervention strategies to improve them. AIM Present a systematic review of empirical studies on factors associated with healthcare professionals' mentalizing capacities and the effectiveness of intervention programmes designed to improve these capacities. METHOD Following PRISMA-guidelines, a systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library and CINAHL. RESULTS Out of a systematic search with 1537 hits, 22 studies were included. Personal factors positively associated with mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. Evidence that training programmes improve mentalizing capacities is limited. DISCUSSION Mental health nurses are underrepresented in research on mentalizing capacities of healthcare professionals and training programs to improve these capacities are practically absent. IMPLICATIONS FOR PRACTICE For mental health nurses, training in basic mentalizing theory and skills will improve their capacities in building effective working relationships with patients.
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Affiliation(s)
- Gieke Free
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Wilma Swildens
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Saskia Knapen
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
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Liu F, Zhao Y, Chen Y, Tu Z. The mediation effect analysis of nurse's mental health status and burnout under COVID-19 epidemic. Front Public Health 2023; 11:1221501. [PMID: 37915821 PMCID: PMC10616456 DOI: 10.3389/fpubh.2023.1221501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Aim The objective of this study is to investigate the mental health status of nurses during the outbreak of novel coronavirus pneumonia. Additionally, we aim to analyze the relationship between anxiety, depression, and burnout among nurses. The findings will provide a scientific basis for promoting the psychological health of nurses. Methods Using a cross-sectional study, nurses in Quanzhou in May 2020 completed a general information questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Maslach Burnout Inventory (MBI). Data analysis was conducted using structural equation model. Results 372 questionnaires were returned, with a response rate of 92.5%. The prevalence of anxiety and depression among the participants were 45.2 and 41.4%, respectively. The prevalence of severe burnout among nurses was found to be 7.3%. There was a correlation between nurses' anxiety, depression, and job burnout. The correlation coefficients between anxiety and job burnout, depression and job burnout, and anxiety and depression were found to be statistically significant (p < 0.001). Depression plays a mediating role between anxiety and jod burnout (0.584/1.413, 41.3%). Conclusion The COVID-19 epidemic has resulted in moderate to high levels of job burnout among nurses. In this context, depression has been found to play a mediating role in the relationship between anxiety and job burnout. It is imperative for hospital administrators to prioritize the mental health of nurses and the provide necessary support to ensure their well-being.
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Affiliation(s)
- Fuzhi Liu
- Department of Preventive Medicine, School of Health, Quanzhou Medical College, Quanzhou, China
| | - Yanyan Zhao
- Department of Nursing, Quanzhou First Hospital, Quanzhou, China
| | - Yangjia Chen
- Department of Preventive Medicine, School of Health, Quanzhou Medical College, Quanzhou, China
| | - Zhuote Tu
- Department of Preventive Medicine, School of Health, Quanzhou Medical College, Quanzhou, China
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Fino E, Daniels JK, Micheli G, Gazineo D, Godino L, Imbriaco G, Antognoli M, Sist L, Regnano D, Decaro R, Guberti M, Mazzetti M. Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting. Eur J Psychotraumatol 2023; 14:2263316. [PMID: 37815082 PMCID: PMC10566389 DOI: 10.1080/20008066.2023.2263316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 10/11/2023] Open
Abstract
Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.
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Affiliation(s)
- Edita Fino
- Department of Psychology “Renzo Cannestrari”, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Judith K. Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Giulia Micheli
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Domenica Gazineo
- Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lea Godino
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Guglielmo Imbriaco
- UO Centrale Operativa 118 Emilia Est, Ospedale ‘Maggiore’, Bologna, Italy
| | | | - Luisa Sist
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Domenico Regnano
- Team accessi vascolari, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Roberta Decaro
- UO Deg. Percorso fegato e vie biliari/Medicina interna trattamento gravi insufficienze d’organo/TI post-operatoria/TI trapianti, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Michela Mazzetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Iuga IA, David OA, Danet M. Student Burnout in Children and Adolescents: The Role of Attachment and Emotion Regulation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1443. [PMID: 37761404 PMCID: PMC10527975 DOI: 10.3390/children10091443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
In an effort to explain the factors contributing to the development of student burnout, a construct that has received attention in relation to academic outcomes, including burnout, is emotion regulation. Further, attachment theory has been used to explore the variations in the use of particular emotion regulation strategies, and attachment has received support as a contributing factor. The aim of the study is to explore the role of attachment security and emotion regulation strategies associated with student burnout symptoms in a sample of 602 Romanian children and adolescents (55% female) aged 8-16 (M = 10.45) from 18 schools. A secondary objective was to explore the gender differences in burnout symptoms. The results show that attachment security negatively predicts student burnout symptoms. Further, a higher attachment security positively predicts the use of adaptive emotion regulation strategies, which, in turn, are negatively related to student burnout. Emotion regulation strategies mediate the relationship between attachment and burnout symptoms. No gender differences have been identified. The study has practical implications for both parents and specialists, bringing to attention the importance of secure attachment in children, which could further encourage the use of adaptive emotion regulation strategies.
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Affiliation(s)
- Ioana Alexandra Iuga
- Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeş-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania;
- DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Oana Alexandra David
- DATA Lab, The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, No. 37 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Marie Danet
- Department of Psychology, University of Lille, No. 42 Paul Duez Street, 59000 Lille, France;
- University of Lille, ULR 4072—PSITEC—Psychologie: Interactions, Temps, Emotions, Cognitions, 59000 Lille, France
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Schwarzer NH, Dietrich L, Gingelmaier S, Nolte T, Bolz T, Fonagy P. Mentalizing partially mediates the association between attachment insecurity and global stress in preservice teachers. Front Psychol 2023; 14:1204666. [PMID: 37671112 PMCID: PMC10475550 DOI: 10.3389/fpsyg.2023.1204666] [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: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/07/2023] Open
Abstract
Objective Considering the fact that the teaching profession is a highly stressful occupation and that teachers' ineffective coping strategies contribute to higher levels of stress, the objective of the present study was to investigate whether insecure attachment is related to global stress experiences in preservice student teachers. Furthermore, it was examined whether this link is mediated by the preservice teachers' mentalizing-the capacity to perceive and consider one's own and others' behavior based on intentional mental states. Methods Data of this cross-sectional study came from 202 preservice student teachers using self-report instruments (attachment: Expectation in Close Relationships; mentalizing: Reflective Functioning Questionnaire; stress: Trier Inventory of Chronic Stress). The hypotheses were tested using structural equation modelling. Results Anxious attachment was positively related to stress and impairments in mentalizing. In addition, the link between attachment-related anxiety and stress was partially mediated by mentalizing. Avoidant attachment was not associated with stress or mentalizing. Discussion Results indicate that anxious attachment is associated with higher perceived stress in preservice student teachers. Consequently, attachment-related anxiety may be a risk factor which, in turn, may foster perceptions of higher global stress experiences. Conclusion Additional research needs to focus on exploring the link between attachment insecurity and global stress experiences among preservice student teachers. An examination of preservice student teachers' own attachment experiences proves to be useful, for example in the context of mentalization-based supervision or reflective practice.
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Affiliation(s)
| | - Lars Dietrich
- Humboldt University of Berlin, Berlin, Baden-Wurttemberg, Germany
| | | | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Tijs Bolz
- University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Peter Fonagy
- University College London, London, England, United Kingdom
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Dietl JE, Derksen C, Keller FM, Schmiedhofer M, Lippke S. Psychosocial Processes in Healthcare Workers: How Individuals' Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095698. [PMID: 37174217 PMCID: PMC10178743 DOI: 10.3390/ijerph20095698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
Interpersonal communication, as a central form of social resource derived from social relations, is crucial for individuals coping with threats in the workplace, especially for hospitals that provide high-quality care and patient safety. Using social system mentalization as a theoretical background, we applied psychosocial processes and a psychodynamic system approach to get insights on how healthcare workers interact with team members and patients. The goal was to test the following hypotheses: H1: Better communication is associated with fewer patient safety threats (H1a) and higher-quality care (H1b). H2: The associations between communication and patient safety threats (H2a) and higher-quality care (H2b) are mediated by psychological safety. In this two-studies design, we conducted a cross-sectional hospital survey (N = 129) and a survey of obstetric team members (N = 138) in Germany. Simple mediation analyses were run. Results revealed that communication is associated with safety performance. Further, the mediating effect of psychological safety between communication and safety performance was demonstrated. These findings contribute to an understanding of social relation representations, as individuals' communication interrelates with safety performance mediated by psychological safety to complement healthcare and public health strategies. With a better understanding of communication and psychological safety, tools, routines, and concrete trainings can be designed.
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Affiliation(s)
- Johanna Elisa Dietl
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, 28759 Bremen, Germany
| | - Christina Derksen
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, 28759 Bremen, Germany
| | - Franziska Maria Keller
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, 28759 Bremen, Germany
- Klinikum Bremerhaven Reinkenheide gGmbH, Treatment Center for Psychiatry, Psychotherapy and Psychosomatic, 27574 Bremerhaven, Germany
| | - Martina Schmiedhofer
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, 28759 Bremen, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, 28759 Bremen, Germany
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Velando-Soriano A, Suleiman-Martos N, Pradas-Hernández L, Membrive-Jiménez MJ, Ramírez-Baena L, Gómez-Urquiza JL, Cañadas-De La Fuente GA. Factors related to the appearance and development of burnout in nursing students: a systematic review and meta-analysis. Front Public Health 2023; 11:1142576. [PMID: 37213651 PMCID: PMC10192626 DOI: 10.3389/fpubh.2023.1142576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Burnout may be suffered not only by experienced nurses, but also by those in training. The university environment can be highly stressful for student nurses, who are exposed to various stress-producing situations. Aim The aim of this study is to identify and analyse the main risk factors for burnout among nursing students. Methods A systematic review with meta-analysis was performed. The search equation used was "Burnout AND Nursing students". Quantitative primary studies on burnout in nursing students, and related risk factors published in English or Spanish and with no restriction by year of publication were included. Results A sample of n = 33 studies were included. Three variables are identified can influence burnout in nursing students: academic, interpersonal, environmental and/or social factors. The meta-analyses, with the higher sample of n = 418 nursing students, show that some personality factors, empathy, and resilience are correlated with emotional exhaustion, depersonalization and personal accomplishment. Conclusion The personality factors that can influence the development of burnout in nursing students, such as resilience and empathy, among others, must be taken into account when preventing the appearance and treating burnout. Professors should teach nursing students to prevent and recognize the most frequent symptoms of burnout syndrome.
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Affiliation(s)
| | | | | | - María José Membrive-Jiménez
- Faculty of Health Sciences, University of Granada, Granada, Spain
- *Correspondence: María José Membrive-Jiménez
| | - Lucia Ramírez-Baena
- Hospital Universitario San Cecilio, Servicio Andaluz de Salud, Granada, Spain
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Stefanowicz-Bielska A, Słomion M, Rąpała M. Analysis of Strategies for Managing Stress by Polish Nurses during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10102008. [PMID: 36292455 PMCID: PMC9601545 DOI: 10.3390/healthcare10102008] [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: 09/18/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is having a negative impact on the mental health of nurses around the world. The aim of the study was to assess the sense of fear and the degree of exposure to SARS-CoV-2 infection and to estimate the influence of various factors on the fear of SARS-CoV-2. We analysed methods and strategies for coping with stress used by Polish nurses during the COVID-19 pandemic. METHODS The study was conducted using a diagnostic survey, which included a self-constructed questionnaire and a standardized psychological questionnaire: Brief-Cope. RESULTS A total of 361 nurses confirmed their participation in the study. Most of the nurses were ages 31 to 50 (48.2%), lived in a city (83.7%), and had a master's degree in nursing (45.7%). Nurses ≥ 51 years of age, with ≥ 21 years of work experience and with secondary education in nursing and master of nursing were more likely than other nurses to agree with the statement, I am afraid of contracting the SARS-CoV-2 (appropriately p = 0.009, p = 0.007, p = 0.014). During the outbreak of COVID-19, nurses most often took action to improve the situation, reflecting on and planning what to do. The most frequent means of coping with stress by Polish nurses during the COVID-19 outbreak were problem-focused strategies. The least frequent strategy was the use of substances (taking substances to alleviate unpleasant emotions), considered to be the least effective, but useful in some situations. CONCLUSIONS Most nurses were afraid of being infected with COVID-19. The most frequently used strategies for coping with stress by Polish nurses during the COVID-19 pandemic were problem-focused strategies. Nurses should receive psychological support and assistance from the employer in improving their working conditions.
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Affiliation(s)
- Anna Stefanowicz-Bielska
- Division of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland
- Correspondence:
| | - Magdalena Słomion
- Division of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Małgorzata Rąpała
- Department of Pediatric Surgery, Marciniak Hospital, 50-041 Wroclaw, Poland
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