Evaluation and Treatment of the Angry Patient

Mentalizing capacities of mental health nurses: A systematic PRISMA review

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.

Ethics in Clinical Orthopedic Surgery

Introduction

Orthopedic surgeons, owing to their specialized role, have a set of medical and moral responsibilities that span beyond the confines of the operating room. The primary objective of this exploration is to emphasize the pivotal ethical and professional standards that these surgeons should uphold.

Methodology

We derived key ethical and professional aspects by reviewing standard medical practices, professional guidelines, and through consultations with senior orthopedic professionals. These aspects covered both the conduct inside the surgery room and the interpersonal relations outside.

Results

Several core areas of conduct were identified.Patient-Centered Care: Prioritizing the holistic well-being of the patient.Communication: Ensuring that all communications are both transparent and respectful.Informed Consent: Properly securing consent after ensuring the patient is adequately informed.Confidentiality: Taking measures to safeguard patient information.Professional Behavior: Upholding the highest standards of professional conduct.Continuous Learning: Remaining committed to updating skills and enhancing competence.Interpersonal Relations: Building healthy and constructive relationships with industry representatives, professional peers, and hospital staff.Personal Life Balance: Recognizing the importance of a balanced personal and professional life for holistic well-being.

Conclusion

For Orthopedic surgeons, strict adherence to the outlined ethical and professional principles is essential. Such commitment not only ensures the trust and safety of patients but also serves to maintain and elevate the prestigious standing of the orthopedic community in the broader medical landscape.

Anger: an underappreciated destructive force in healthcare

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is "an emotional state that varies in intensity from mild irritation to intense fury and rage." It is defined as "a strong feeling of displeasure and usually of antagonism," an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. "Why is everyone so angry?" the New York Times asked in the article "The Year We Lost It." We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca's writings about anger and implement his wisdom on anger from over 2000 years ago.

Assessing emergency department nurses' ability to communicate with angry patients and the factors that influence it

Aims

To assess emergency department (ED) nurses' ability to communicate with angry patients and to explore the factors that influence nurses' communication skills.

Design

A cross-sectional survey design.

Methods

This study was conducted in November and December 2020. Stratified sampling was adopted to recruit ED nurses from 18 tertiary hospitals in western, eastern, and central China to complete an online questionnaire. The Nurses' Communication Ability with Angry Patients Scale (NCAAPS) and the General Self-Efficacy Scale were used to assess ED nurses' communication ability and self-efficacy, respectively. Descriptive statistics, the Mann-Whitney U-test, the Kruskal-Wallis H test, Spearman's correlation analysis, and the generalized linear model were used for data analysis.

Results

A total of 679 valid questionnaires were collected. The mean total score for the NCAAPS was (3.79 ± 0.47), while the scores for its four dimensions were (3.87 ± 0.59) for communication skills, (3.82 ± 0.59) for anger perception, (3.79 ± 0.53) for self-preparation, (3.73 ± 0.54) for exploring the cause of anger. The generalized linear regression analysis result showed that a longer employment duration, previous communication ability training, and higher self-efficacy were significantly and independently associated with higher NCAAPS scores (p < 0.05).

Conclusions

The mean total score and the four dimensions score for the NCAAPS were moderate. But there is still room for improvement in ED nurses' ability to communicate with angry patients. "Exploring the cause of anger" was the lowest score among the four dimensions. To improve ED nurses' ability to communicate with angry patients, future studies should focus on constructing specific communication training, improving nurses' ability to explore the cause of anger and self-efficacy.

Impact

The findings of this study provide important insights into ED nurses' ability to communicate with angry patients and can thus guide the future development of intervention programmes to improve this ability among ED nurses.

Medical students' experiences of working with simulated patients in challenging communication training

BACKGROUND

Physicians' communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students' own experiences of learning communication skills with SPs. Therefore, this study was aimed at investigating how medical students perceive communication training involving challenging consultations with SPs and the impact on their learning experiences.

METHODS

Twenty-three medical students from the same class were interviewed in focus groups about their experiences of simulation training with actors as SPs. In the simulation training, the students were instructed to deliver bad news, manage negative patient reactions, and encourage behavioral changes in reluctant patients. This was followed by feedback and a debriefing exercise. The interviews were analyzed with content analysis.

RESULTS

Students reported that actors as SPs made the simulations more realistic and enabled them to practice various communication skills for challenging consultations in a safe way and manage their own feelings, thereby promoting new learning experiences. Elements such as actors' flexibility in changing behaviors during role-play and exposure to different challenging behaviors, like negative emotions, were regarded as valuable. The importance of an accepting and permissive climate for the debriefing exercise was highlighted, though without taking too much time from the simulation training. Feedback directly from the SP was appreciated.

CONCLUSIONS

Actors as SPs were perceived as a valuable part of challenging communication training and added elements to the learning process. Future studies should include a wider range of challenging behaviors in training with SPs and evaluate the effects of such training on students' use of communication skills.

Development of the nurse's communication ability with angry patients scale and evaluation of its psychometric properties

AIMS

To develop the Nurse's Communication Ability with Angry Patients Scale (NCAAPS) and evaluate its psychometric properties.

DESIGN

An instrument development and validation study.

METHODS

The survey was administered to 501 nurses from different emergency departments in China between 2 August 2019 and 3 October 2019. Data from 456 completed questionnaires were analysed to identify the factor structure of the NCAAPS.

RESULTS

The content validity index was satisfactory. Four factors were included and 71.25% of the total variance was explained by 19 items in NCAAPS. Confirmatory factor analysis supported the four-factor structure. Cronbach's α coefficient was 0.96 for the overall scale and 0.81-0.92 for its subscales. Test-retest reliability was 0.740.

CONCLUSION

We consider the NCAAPS to be a useful tool for measuring the ability of nurses to communicate with angry patients.

IMPACT

It is anticipated that this new scale will help educators to identify specific areas of deficiency that could be targeted with training to improve the ability of nursing staff to communicate with angry patients.