Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review

Embedding Recovery Principles in Staff Orientation: A New Way of Delivering Multidisciplinary Mental Health Orientation

PURPOSE

Recovery-focused mental health treatment continues to grow, yet staff are often uncertain how best to define and implement it. As a quality assurance activity, we examined the effect of a novel orientation program embedded with a recovery framework structure, philosophy, and content, together with true lived experience codesign, on knowledge of recovery principles and acceptability.

METHOD

Staff of a new sub-acute adolescent mental health inpatient center completed a 6-week orientation in early 2020. Recovery processes of connectedness, hope and optimism, identity, meaning, and empowerment were mapped to session topics and the structure, design, and philosophy of the program.

RESULTS

Mean knowledge scores improved from pre- to post-assessment and most (≥70%) participants reported topics as relevant, impactful, and would recommend. Approximately all (95%) comments were positive.

CONCLUSION

Findings suggest that person-centered orientations that embed a recovery framework are promising for mental health staff orientation. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Person-Centred Decision-Making in Mental Health: A Scoping Review

Person-centred decision-making approaches in mental health care are crucial to safeguard the autonomy of the person. The use of these approaches, however, has not been fully explored beyond the clinical and policy aspects of shared and supported decision-making. The main goal is to identify and collate studies that have made an essential contribution to the understanding of shared, supported, and other decision-making approaches related to adult mental health care, and how person-centred decision-making approaches could be applied in clinical practice. A scoping review of peer-reviewed primary research was undertaken. A preliminary search and a main search were undertaken. For the main search, eight databases were explored in two rounds, between October and November 2022, and in September 2023, limited to primary research in English, Spanish or Portuguese published from October 2012 to August 2023. From a total of 12,285 studies retrieved, 21 studies were included. These research articles, which had mixed quality ratings, focused on therapeutic relationships and communication in decision-making (30%), patients' involvement in treatment decision-making (40%), and interventions for improving patients' decision-making engagement (30%). While there is promising evidence for shared decision-making in mental health care, it is important that healthcare providers use their communicational skills to enhance the therapeutic relationship and engage patients in the process. More high-quality research on supported decision-making strategies and their implementation in mental health services is also required.

Shortcomings of services for persons with severe and persistent mental health challenges: a qualitative study of service users and family carers

Introduction

The opinions of service users and carers are crucial to identifying ways to innovate and implement system change. This study aims to explore the views and experiences of service users and carerson the services they have used for their mental health challenges and their suggestions for service reform.

Methods

Twenty participants (15 carers and 5 service users) were interviewed for the study.

Results

Eight categories emerged from the data. They were: Several gaps in the system, Barriers to accessing services, Services are not fit for purpose, Services operate in isolation, System is not person focused, Service users and carers are treated poorly, Services are overloaded and under resourced and Recommendations for service reform. Respondents reported that a persistent lack of funding and resources for mental health services was a main cause of these shortcomings. Respondents also noted that innovations were needed to re-orient services to enable continuity of care, and training of mental health professionals was needed for a better understanding of the needs of service users and their carers.

Discussion

Additional research is needed with larger and more diverse samples to further explore these findings.

Psychological provision in acute inpatient settings: An evaluation of indirect input

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric hospitals have input from a range of professionals, including Clinical Psychologists. Most evidence used to guide what Clinical Psychologists do is based on their work with individuals rather than staff teams. Some evidence shows working with staff teams is important, but most of this is based on interviews rather than measuring the impact using numbers and statistics. The current study aimed to investigate the effectiveness of staff-level interventions provided by a Psychology team within a psychiatric inpatient setting. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Training sessions were effective at increasing staff levels of confidence and understanding in psychological approaches, and the perceived usefulness of the session to their practice. Case discussion sessions were effective at increasing staff levels of understanding a service user, compassion towards the service user, perceived opportunities for change with the service user, their perceived skills to work with the service user and their perception of the usefulness of the session to their practice. Reflective practice sessions were effective at providing a space for learning, sharing ideas and reflecting. Other interventions were highly valued by nursing staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff-level interventions are effective and valued by mental health nursing staff and should be considered in allocation of psychology resources. Interventions improved staff psychological thinking which could positively impact service user experience. There is potential for people with lived experience to participate in these interventions, which could facilitate the therapeutic relationship and reduce restrictive practices.

ABSTRACT

INTRODUCTION: The role of Psychologists in psychiatric inpatient settings is well established and involves intervention at various levels; however, quantitative exploration of the effectiveness of staff-level interventions is lacking.

AIM

The aim of the study was to examine the effectiveness of a variety of staff-level interventions provided by a Psychology team within a psychiatric inpatient setting.

METHODS

The evaluation used a mixed methods approach incorporating pre-post quantitative data and post-intervention feedback. Additional data were collected via survey.

KEY FINDINGS

Results indicated all staff-level interventions were effective in achieving their aims and were highly valued by staff. Qualitative data supported the quantitative findings and showed tentative suggestion of a change to clinical practice.

DISCUSSION

Indirect psychology provision was found to significantly impact a range of staff attitudes and was highly valued by the staff team, supporting previous qualitative findings in psychiatric inpatient settings. Further quantitative evidence of the impact of staff-level interventions should be sought.

IMPLICATIONS

Staff-level interventions are effective and valued by mental health nursing staff and should be considered in allocation of psychology resources. Furthermore, there is potential for people with lived experience to participate in these interventions, which could facilitate the therapeutic relationship and reduce restrictive practices, however this requires future research.

Perspectives of adult patients with mental health disorders on the relationship with nurses: a focus group study

BACKGROUND

The relationship between the nurse and the patient with mental health disorder is crucial to the recovery process. Thus, patients with mental health disorders should be active subjects in this relationship by having autonomy and self-determination.

METHODS

This study aimed to explore the perspectives of adult patients with mental health disorders on the relationship with nurses. A qualitative, descriptive, and exploratory study was conducted in March 2023, using focus group meetings in an association to support patients with severe mental health disorders in the Northern region of Portugal. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of 8 patients participated in the study. Two focus group meetings were conducted. The inductive method was used, and content analysis of the transcripts was performed. The QDA Miner Lite 4.0 and Microsoft Excel were used for content analysis.

RESULTS

Participants considered the relationship with nurses important for their recovery and expected nurses to provide support and help, being able to identify their needs, thus personalising their care. Attitudinal and communication aspects were also considered crucial for establishing a solid, trusting, and meaningful relationship.

CONCLUSION

According to the findings nursing care is expected to focus on the patient, his/her preferences, expectations, and the uniqueness of each individual. The results of this study may be useful for the reflection and improvement of nurses in their relational and communication skills and the driving force for nursing students' awareness of the perspective of the relationship with patients with mental health disorder and its relevance.

The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery

The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.