Nurses' promotion of Mental Health First Aid Training Programmes for upper secondary students: a modified Delphi approach

BACKGROUND

Mental Health First Aid Training Programmes can be carried out by nurses in schools. Adolescents have reported the importance of these interventions, the contents to be addressed, and intervention strategies that should be used. Mental health nurses have also discussed the characteristics of these training programmes. This study sought to create a consensus on the features of Mental Health First Aid Training Programmes promoted by nurses aimed at upper secondary students.

METHODS

A descriptive mixed method study was developed using the modified e-Delphi technique. Original statements on the topic were drawn from the results section of previous studies with nurses and adolescents. The statements were included in a structured online questionnaire. An expert panel of 78 mental health nurses participated in the two-rounds online survey from October to December 2021. Absolute and relative frequencies of responses were analysed. The experts' comments were also considered.

RESULTS

In the first round, experts suggested 4 new ideas about training programmes. Experts took a position on a total of 59 declarations. At least 75% of participants agreed with 58 statements about training programmes, namely about facilitators, intervention foci, evaluation methodology, participants, the implementation context, period and regularity, intervention strategies and content. The experts' opinions differed only in one statement that expressed the impaired sexual behaviour as a mental health problem to be addressed in the training programmes.

CONCLUSIONS

Mental health nurses can lead the delivery of training programmes in upper secondary schools, improving adolescent competencies in mental health. Several educational approaches can be used to teach about mental health, related problems and actions underlying these conditions. Valid and appropriate assessment methods must be used. Our findings guide the planning, implementation and evaluation of these interventions in upper secondary schools and encourage nurses to explore these programmes and include them in their educational curricula.

Nurses' perspective about the Mental Health First Aid Training Programmes for adolescents in upper secondary schools: A focus group study

WHAT IS KNOWN ON THE SUBJECT?: Mental Health First Aid Training Programmes with a pathogenic perspective are implemented worldwide for different participants and contexts. These interventions can promote the medicalization and psychiatrization movement of human suffering. Training programmes should teach about mental health nursing problems rather than disorders. However, there seem to be no studies describing these healthier interventions targeting adolescents in upper secondary schools. Nurses can explore these interventions and target them towards these participants and contexts. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The perspective of nurses on the characteristics of Mental Health First Aid Training Programmes for adolescents in Portuguese upper secondary schools is reported. Experts recognize that the nurses who perform these interventions must have personal, pedagogical and mental health competencies. Therefore, mental health nurses may be considered. The components of mental health literacy, mental health nursing problems and a dynamic first aid plan can be taught using different classroom training strategies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The role of mental health nurses in promoting health literacy is highlighted. They have the opportunity to lead multidisciplinary teams in using these healthier training programmes. These expert opinions can shape the planning, implementation and evaluation of these interventions. In turn, training programmes can promote the identification, assistance and/or adequate and timely referral of people with mental health nursing problems. ABSTRACT: Introduction Mental Health First Aid Training Programmes performed by nurses can empower adolescents to aid people with mental health problems. There do not appear to be any studies that describe these healthier interventions aimed at adolescents in upper secondary schools. The development of these educational interventions benefits from the input of their participants and facilitators. Aim To explore the perspective of nurses about Mental Health First Aid Training Programmes for adolescents in upper secondary schools. Method A qualitative, descriptive and exploratory study was conducted. Data were collected from seven mental health nurses during two focus group sessions. Data were analysed using content analysis. Results Twelve themes were identified around nine main areas: facilitators, intervention foci, outcomes assessment methods, process assessment methods, participants, implementation context, duration and frequency, intervention methods and strategies, and contents. Discussion Mental health nurses can regularly perform these classroom interventions to improve the mental health competencies of adolescents. Various educational methods can facilitate learning related to mental health literacy components, mental health nursing problems and the first aid plan. Valid and appropriate assessment methods enhance a good representation of these interventions. Implications for Practice This evidence can guide the creation and modelling of these first aid training programmes.

A qualitative study exploring adolescents' perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools

Mental Health First Aid Training Programmes are educational interventions that aim to disseminate basic first aid skills in the community. Adolescents in the context of their secondary school education are a particularly appropriate population for literacy promotion interventions. This study explores adolescents' perspectives on Mental Health First Aid Training Programmes promoted by nurses in Portuguese upper secondary schools. A qualitative and exploratory study was conducted. Data were collected through semi-structured interviews with 12 adolescents who participated voluntarily and with the consent of their parents. Data were analysed using content analysis. Fourteen themes were identified around three main areas: (i) Relevance of training programmes, (ii) Content of training programmes and (iii) Intervention methods of training programmes. The results obtained indicate that adolescents consider Mental Health First Aid Training Programmes in school relevant and necessary. Adolescents identified the content they deemed most appropriate and how it could be taught. These results can guide the development of training programmes. Nurses should take the lead in implementing these interventions in schools. Adolescents can take a more active role in mental health issues by improving their literacy.

Development and psychometric properties of the Therapeutic Relationship Assessment Scale-Nurse

WHAT IS KNOWN ON THE SUBJECT?: The literature shows a clear relationship between a good therapeutic relationship (TR) and the efficacy of nursing interventions. For the implementation of nursing psychotherapeutic interventions, the initial establishment of a good TR is essential. Several instruments assess the relationship established between the therapist and the patient in psychotherapy. However, no tool has been found to assess the quality of the TR established between the nurse and the patient. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study allowed the development and evaluation of the psychometric properties of a scale to assess the TR between the nurse and the patient in a sample of mental health nurses. The developed scale (Therapeutic Relationship Assessment Scale-Nurse) has psychometric properties that attest its reliability (internal consistency and test-retest) and construct validity as an instrument to assess the quality of the TR established between the nurse and the patient from the nurse's perspective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: As the TR is crucial for providing nursing care and, in particular, for implementing nursing psychotherapeutic interventions, the scale developed is a valid tool to assess the quality of the TR established between the nurse and the patient in the perspective of the mental health nurse. The use of instruments to assess the quality of the nurse-patient TR facilitates the identification of the relationship's gaps, which can serve as a basis for improving the relationship itself and the nursing care provision. ABSTRACT: Introduction The therapeutic relationship (TR) is essential to providing psychiatric and mental health nursing care. Nevertheless, no assessment tools exclusive for assessing nursing TR were found in the literature. Aim To describe and evaluate the psychometric properties (reliability and construct validity) of a scale that allows assessing the quality of TR established between the nurse and the patient. Method A survey method was adopted, using a convenience sample of 356 mental health nurses. Internal consistency was assessed by Cronbach's alpha and Omega index. Results A total of 221 mental health nurses participated in the study (response rate = 62.08%). The scale's final structure has 25 items. Cronbach's alpha was 0.93, ranging from 0.78 to 0.88 for each of the factors. The cumulative variance explained in a four-factor structure was 71.12%. Discussion The Therapeutic Relationship Assessment Scale (TRAS)-Nurse presents good psychometric properties. In the light of Benner's theory, it can be an useful tool for novice nurses to better understand what aspects they should pay attention to for establishing a successful TR. Implications for Practice Mental health nurses can use the TRAS-Nurse, thus having a scale available that allows them to self-assess the quality of TR they establish with their patients.

Primary health care nurses: attitudes towards the person with mental disorder

OBJECTIVE

To identify the attitudes of nurses working in Primary Health Care towards the person with mental disorder and the variables related to health care provided.

METHODOLOGY

Descriptive, correlational study with 250 nurses from 69 Basic Health Units in the city of São Paulo. Data collection took place between April and August 2019 using the "Opinions about Mental Illness" scale. The data were analyzed using the KrusKal-Wallis test, with a 95% confidence level and statistical significance of p <0.05.

RESULTS

The global mean of the scale was 197, which shows negative attitudes especially in the dimensions of Authoritarianism (44.6), Social Restriction (42.0), and positive in the dimension of Benevolence (51.7).

CONCLUSION

Nurses tend to have a stigmatizing attitudinal profile. It is necessary formative and permanent intervention so that it is possible to reduce stigma and improve community-based care recommended in the guidelines of the Psychosocial Care Network.

Review of Mental Health First Aid Programs

Mental health first aid programs are interventions to empower the community to help people with mental health problems/crises. A review of these programs was conducted in accordance with the guidelines of the Joanna Briggs Institute. Published and unpublished works from 2009 to 2019 were considered. The review included 252 studies. Several Mental Health First Aid programs were identified, with varying characteristics, participants, and contexts of implementation. These group interventions were carried out among lay people to health professionals, and in adolescents to the elderly. Additionally, they were conducted in-person and/or virtually, using psychoeducational methods and informational materials. The programs ranged from 30 minutes to 24 hours. These interventions can address nursing foci, and the characteristics of the facilitators are similar to those of mental health nurses. Therefore, this review highlighted the opportunity for nurses to explore Mental Health First Aid programs.

Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial

AIM

To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia.

DESIGN

Randomized controlled trial. It was carried out between July 2019 -February 2020.

METHODS

Fifty-six patients with schizophrenia were enrolled and randomly assigned to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS).

RESULTS

Completion at follow-up was high (92.86%). The intention-to-treat analyses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large.

CONCLUSION

The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment.

IMPACT

Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID NCT03891186.

Nurses' attitudes facing the family involvment in caring for people with mental disorder

OBJECTIVE

To characterize the attitudes of Primary Health Care nurses, regarding the involvement of the family in the care for people with Mental Disorder.

METHODS

Correlational study with 257 nurses from the city of São Paulo. The scale "Importance of Families in Nursing Care- Nurses' Attitudes" was used. For the analysis, descriptive and inferential statistics were used.

RESULTS

The scale scores were high, with a mean value of 82.1 (SD=8.4) favorable to the families' involvement, and are related to being a nurse in the Family Health Strategy (p<0.001), having received education/training in family nursing (p<0.005), the workload of 40 hours/week (p<0.005), working in the West, East and Center Regions (p<0.005).

CONCLUSION

Most nurses have positive attitudes towards the involvement of families, a relevant indicator for their inclusion in the health-mental care process.

Mental health first aid programs: a scoping review protocol

OBJECTIVE

This review aims to map mental health first aid programs, and identify the characteristics and participants of such programs and the contexts of their implementation.

INTRODUCTION

Mental health first aid is the help provided to a person developing a mental health problem or undergoing a mental health crisis. The first aid is provided until professional help is accessed or the crisis is resolved.

INCLUSION CRITERIA

This scoping review will address programs that provide basic mental health first aid skills, with no exclusion criteria in terms of participants or contexts.

METHODS

English, Portuguese, and Spanish published studies and unpublished papers, from 2009 to 2019, will be considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be followed. The search will be carried out in databases, scientific repositories and reference lists. Duplicates will be removed and two independent reviewers will screen the titles, abstracts and full-text of the selected studies. Data collection will be performed with a tool developed by the researchers, based on JBI's model instrument for extracting study details, characteristics and results. A summary of the results will be presented in visual representations, narratives and tables.

Cultural Adaptation and Psychometric Properties Assessment of the NOC Outcome "Cognition" in a Sample of Portuguese Adults With Mental Illness

PURPOSE

Cultural adaptation and psychometric properties assessment of the Nursing Outcomes Classification (NOC) outcome "Cognition" in a sample of Portuguese adults with mental illness.

METHODS

Methodological study.

FINDINGS

The final European Portuguese version of the NOC outcome "Cognition", consisting of 13 items, showed good psychometric properties. An exploratory factor analysis was performed from which only one factor was established.

CONCLUSIONS

The European Portuguese version of the NOC outcome "Cognition" seems to gather very satisfactory psychometric properties for assessing cognition in the Portuguese population.

IMPLICATIONS FOR NURSING PRACTICE

This study contributed to advance the nursing body of knowledge and to better assess cognition in a clinical context.

Nursing Process Addressing the Nursing Focus "Hallucination": A Scoping Review

Although hallucinations are prevalent in psychiatric disorders, such as psychosis or dementia, no studies were to be found in literature about the nursing process addressing the focus "Hallucination". This literature review, which is integrated with a scoping study framework, was performed to determine a clinical data model addressing the focus "Hallucination". PRISMA checklist for scoping reviews was followed. From the total of 328 papers found, 32 were selected. The findings of this review were summarized according to the nursing process addressing the focus "Hallucination". These findings led to determine a clinical data model addressing the focus "Hallucination", comprising the elements of the nursing process. This clinical data model may contribute toward improving nursing decision-making and nursing care quality in relation to a client suffering from hallucination, as well as contribute toward producing more reliable nursing-sensitive indicators.

Contributes for the development of a psychotherapeutic intervention model in nursing: A focus group study in Portugal and Spain

PURPOSE

To explore the aspects set forth as the minimum set of features that should integrate a psychotherapeutic intervention model in nursing.

DESIGN AND METHODS

Two focus groups were conducted, with the participation of 15 nursing professionals. Data were analysed thematically.

FINDINGS

Five topics previously identified were analysed: theoretical conceptualization, structure, patients' inclusion and exclusion criteria, operationalization, and evaluation of the intervention(s) effectiveness. Theoretical conceptualization has been mainly grounded on Peplau's theory. Moreover, participants believe that standardized nursing language and nursing process should be the presumptions of the model.

PRACTICE IMPLICATIONS

This study allowed the identification of a minimum set of features that should integrate a psychotherapeutic intervention model in nursing, about which consensus must be reached with a view to its further development.

Evaluation of the Psychometric Properties of the Mental Vulnerability Questionnaire in Undergraduate Students

PURPOSE

Translate, adapt the language, and assess the psychometric properties of the Mental Vulnerability Questionnaire (MVQ) in a Portuguese population sample of young adults.

DESIGN AND METHODS

A psychometric validation study was performed. The sample comprised 166 undergraduate students. Factor analysis was applied to extract three indicators.

FINDINGS

The MVQ showed divergent validity with the Positive Mental Health Questionnaire (p < .001) and convergent validity with the Mental Health Inventory including five items (p < .001). Reliability was verified through the assessment of internal consistency, evidencing positive outcomes (Cronbach's α = 0.81).

PRACTICE IMPLICATIONS

The MVQ shows psychometric properties enabling its adaptation to clinical practice and research, essential to an effective screening of mental vulnerability.

Content Validity of a Psychotherapeutic Intervention Model in Nursing: A Modified e-Delphi Study

AIM

To estimate the content validity of a psychotherapeutic intervention model in nursing.

BACKGROUND

Mental health nurses encounter great extrinsic difficulties when it comes to providing psychotherapeutic interventions due to the fact that they are not allowed to perform such practice in some countries. In this light, the pursuit of a psychotherapeutic intervention model in nursing seems germane to guide the professionals' psychotherapeutic practice, contributing hereof to increase mental health nurses' professional autonomy.

DESIGN

Modified e-Delphi.

METHODS

Data were collected from October 2015 to January 2016 by means of three rounds of online questionnaires. The initial questionnaire was structured into five sections: general structure of the model, patients' exclusion criteria, assessment framework, nursing diagnoses, and nursing psychotherapeutic interventions. From the 42 experts invited, at least twenty (20) participated in each round.

RESULTS

The experts achieved consensus with regard to the conclusion that nursing psychotherapeutic interventions should always seek to address a nursing diagnosis. These defined furthermore that a psychotherapeutic intervention model in nursing should be exercised by means of 3 to 12 sessions using Nursing Interventions Classification (NIC) as a resource. Finally, experts deemed that the model should follow the principles of integrative psychotherapy, so that techniques from different schools of psychotherapy could therefore be used in conjunction to promote the resolution of a nursing diagnosis.

CONCLUSION

Achieving consensus about the structure of a psychotherapeutic intervention model in nursing is imperative to guide nurses in the provision of nursing psychotherapeutic interventions and to enable an effective evaluation of the health gains associated with its implementation.