Nursing experiences in specialized services in child and adolescent mental health: a systematic review of qualitative studies

OBJECTIVE

to synthesize evidence from qualitative studies on nursing experiences regarding child and adolescent mental health care in specialized services.

METHOD

a systematic review with meta-synthesis of qualitative studies according to JBI guidelines. CINAHL, EMBASE, MEDLINE, LILACS, PSYCinfo, Scopus and Web of Science databases were used. The findings were classified according to the level of reliability and credibility and categorized by similarity between contents.

RESULTS

229 articles were identified, and five were included in the final sample and organized into the categories: Emotional impact; and Understanding nursing role. The level of evidence found was moderate.

FINAL CONSIDERATIONS

nursing experiences are permeated by emotional exhaustion, feelings of frustration and difficulty in understanding their professional role. The need for training spaces that qualify this care is highlighted.

Association of Psychiatric Diagnoses and Medicaid Coverage with Length of Stay Among Inpatients Discharged to Skilled Nursing Facilities

BACKGROUND

Inpatients with psychiatric diagnoses often require higher levels of care in skilled nursing facilities (SNFs) and are more likely to be covered by Medicaid, which reimburses SNFs at significantly lower rates than Medicare and commercial payors.

OBJECTIVE

To characterize factors affecting length of stay in inpatients discharged to SNFs.

DESIGN

A retrospective cross-sectional study design using 2016-2018 data from National Inpatient Sample.

PARTICIPANTS

Inpatients aged ≥ 40 who were discharged to SNFs.

EXPOSURES

Primary discharge diagnosis (medical, psychiatric, or substance use) and primary payor.

MAIN OUTCOMES AND MEASURES

Length of stay, categorized non-exclusively as >3 days, >7 days, or > 14 days.

RESULTS

Among 9,821,155 inpatient discharges to SNFs between 2016 and 2018, 95.7% had medical primary discharge diagnoses, 3.3% psychiatric diagnoses, and 1.0% substance use diagnoses; Medicare was the most common primary payor (83.3%), followed by private insurance (7.9%), Medicaid (6.6%), and others (2.2%). Median length of stay for all patients was 5.0 days (interquartile range [IQR], 3.0-8.0), 5.0 (IQR, 3.0-8.0) for those with medical diagnoses, 8.0 (IQR, 4.0-15.0) for psychiatric diagnoses, and 5.0 (IQR, 3.0-8.0) for substance use diagnoses. After multivariable adjustment, compared to patients with medical diagnoses, patients with psychiatric diagnoses were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to Medicare patients, Medicaid patients were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to patients with medical diagnoses, those with psychiatric diagnoses were also more likely to have lengths of stay 1 times, 1.5 times, and 2 times greater than the national geometric mean length of stay for that diagnosis-related group (p < 0.001).

CONCLUSIONS

Patients discharged to SNFs after inpatient hospitalization for psychiatric diagnoses and with Medicaid coverage were more likely to have longer lengths of stay than patients with medical diagnoses and those with Medicare coverage, respectively.

Therapeutic alliance in mental health care: When language issues challenge provider-patient relationships

ABSTRACT

The field of psychiatric nursing provides unique opportunities for nurse-patient interactions. Nurses working in inpatient psychiatric settings face constant challenges that may hinder the development of meaningful nurse-patient interactions. Peplau's theory of interpersonal relations emphasized the importance of nurse-patient relationships in nursing care. Therapeutic alliance can help promote nurse-patient relationships and may help nurses and patients achieve their goals. This article presents several phases of a concept-building process that illustrates the importance of therapeutic alliance and its application in mental health care.

Improving mental health education in nursing school

ABSTRACT

Nurses are at the forefront of providing care to individuals with mental illness in various healthcare settings, yet the World Health Organization and others have found that many nurses are inadequately prepared to provide mental health care. This article discusses the nurse's role in providing care to individuals with mental illness and the importance of integrating more mental health education into undergraduate nursing curricula.

Delusional infestation: What nurses should know

ABSTRACT

Patients with delusional infestation, a rare psychiatric disorder, have a false and fixed belief that insects or other organisms are crawling in or on their skin. This article describes signs and symptoms, available treatments, and appropriate nursing interventions for patients with primary delusional infestation.

Mental health problems among youth experiencing sex trafficking

ABSTRACT

There are an estimated 4.8 million victims of sex trafficking (ST) globally, and 21% of these victims are children or adolescents. Victims of ST are at risk for mental health problems, and it is crucial for healthcare professionals to identify them and provide care.

Patient perspectives on an intervention after suicide attempt: The need for patient centred and individualized care

Background

Many types of intervention exist for suicide attempters, but they tend not to sufficiently consider patient’s views.

Aim

To identify useful components of a previously evaluated intervention after a suicide attempt from the patient’s views and to better understand the process of recovery.

Method

Forty-one interviews with suicide attempters were qualitatively analysed. Views of participants (i) on the components of the intervention (nurse case-management, joint crisis plan, meetings with relatives/network and follow-up calls) and (ii) their recovery were explored. The material was analysed by means of thematic analysis with a deductive-inductive approach.

Results

Participants valued the human and professional qualities of the nurse case-manager, and appreciated follow-up calls and meetings. However, their views diverged regarding for instance frequency of phone calls, or disclosing information or lack thereof. Interpersonal relationship, suicide attempters’ own resources and life changes emerged as core recovery factors.

Discussion

The study highlights the figure of an engaged clinician, with both professional and human commitment, aware that some suicide attempters put more emphasis on their own resources than on delivered health care.

Conclusions

Interventions should consider the clinician as the cornerstone of the tailored care valued by suicide attempters.

Effect of advanced nursing care on psychological disorder in hypertensive retinopathy of pregnancy: A protocol of systematic review

BACKGROUND

This study will assess the effect of advanced nursing care (ANC) on psychological disorder (PD) in hypertensive retinopathy of pregnancy (HTRP).

METHODS

This study will search electronic databases from inception to the present (Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI, and Chinese Biomedical Literature Database), and other sources. All literature sources will be searched without limitations to language and study status. All eligible case-controlled study (CCS) will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality assessment. Any confusion will be solved by a third author through discussion. Statistical analysis will be conducted using RevMan 5.3 software. In addition, a narrative synthesis will be elaborated if it is necessary.

RESULTS

This study will summarize most recent high quality evidence to appraise the effect of ANC on PD in HTRP.

CONCLUSION

The results of this study will seek to identify the effect of ANC on PD in HTRP among pregnancy population.

OSF REGISTRATION

osf.io/hgp93.

(Re)construction identitaire et pratique infirmière en psychiatrie légale : réflexion critique sur les commissions d’examen

Introduction&#160;: The caritative impact of nursing care provided in forensic mental health settings is rarely questioned.Context&#160;: Caritative nursing care is indirectly regulated by the Review Board (RB), a para-judicial court which ensures public safety.Objective&#160;: This study presents a critical reflection on the political and social effects of the RB, forensic psychiatry hospitals and practices of forensic mental health nurses.Method&#160;: The reflection is centered on the concepts of biopower, degradation ceremonies, moral career and identity (re)construction.Results&#160;: &#8216;Therapeutic&#8217; nursing practices are useful for disciplinary purposes in the forensic psychiatric hospital, insofar as they permit the identification and management of dangerous persons. However, the practices also fall within the biopolitical scope of the RB, since they assist the latter in ensuring public safety.Discussion&#160;: The forensic psychiatric environment can prove problematic for nurses, requiring a double allegiance, whereby their responsibilities to patients (consent and confidentiality) and to the institution (protection of the public) can lead to tension.Conclusion&#160;: The analytical framework of the study allows for a reassessment of other presumed processes in psychiatric environments, which nonetheless constitute just as many rituals of identity (re)construction.

Intégration des droits humains dans la pratique du personnel infirmier faisant usage de coercition en santé mentale : recension systématique des écrits et méta-ethnographie

Introduction and background&#160;: The last decade has seen a steady and rising use of coercion in mental health care, as well as an increase in the number of forms it takes. The application of these measures frequently relies on the work of nurses, but few studies have analyzed the human rights issues raised by these practices.Aim&#160;: To produce a qualitative synthesis of how human rights are integrated into the practice of nurses who use coercion in mental health care.Methodology&#160;: A systematic review of qualitative scientific literature published between 2008 and 2018 was conducted and supplemented by a meta-ethnographic analysis.Results&#160;: The analysis of the forty-six selected studies revealed four distinct themes&#160;: coercion in mental health care as a socio-legal object, issues of recognition of human rights in mental health care, role conflict experienced by nurses, and the conceptualization of coercion as a necessary evil or a critical incident.Discussion and conclusion&#160;: Further research is needed to understand the specifics of the continuum of support and control that characterizes the coercive work of psychiatric nurses.

Perceived Stigma in Remitted Psychiatric Patients and their Caregivers and its Association with Self-Esteem, Quality of Life, and Caregiver Depression

OBJECTIVES

To examine perceived stigma and its correlates in remitted patients with mental illnesses and their caregivers.

METHODS

In patients with mental illnesses, their perceived stigma (Perceived Devaluation Discrimination Scale), endorsed secrecy (Secrecy scale), self-esteem (Rosenberg Self-Esteem Scale), functioning (Work Social Adjustment Scale), and emotional wellbeing (Well Being Index) were assessed. In caregivers, their perceived stigma towards patients (Devaluation of Consumer Scale) and families (Devaluation of Consumer Families Scale), emotional wellbeing (Well Being Index), and depressive symptoms (Centre for Epidemiological Studies-Depression scale) were assessed. Differences between diagnoses were examined using ANOVA. Correlation between perceived stigma among patients and caregivers was studied.

RESULTS

Of 152 patients with mental illnesses, 76.3% and 85.53 % reported moderate-to-high levels of perceived stigma and endorsed secrecy, respectively. Of 152 caregivers, 40.13% and 25.65% reported moderate-to-high levels of perceived stigma towards patients and families, respectively. Overall, patients had high levels of perceived stigma and endorsed secrecy, low self-esteem, moderate functional impairment, and extremely poor emotional wellbeing. There were significant differences across different diagnostic categories with respect to self-esteem, functioning, perceived stigma, secrecy, and emotional wellbeing. Patients with substance use disorders reported highest perceived stigma, lowest self-esteem, and most severe functional impairment, and their caregivers reported highest perceived stigma towards patients and families, most-reduced emotional wellbeing, and highest rates of depressive symptoms. Patients' perceived stigma was not associated with caregivers' perceived stigma.

CONCLUSION

Perceived stigma is prevalent among patients and caregivers and affects their quality of life. The stigma associated with substance use disorder merits special attention.

Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings

The aim of this study was to evaluate the usefulness of Family-Centered Support Conversations (FCSC) offered in community mental health care in Norway to young adults and their families experiencing mental illness. The FCSC is a family nursing intervention based on the Calgary Family Assessment and Intervention Models and the Illness Beliefs Model and is focused on how family members can be supportive to each other, how to identify strengths and resources of the family, and how to share and reflect on the experiences of everyday life together while living with mental illness. Interviews were conducted with young adults and their family members in Norway who had received the FCSC intervention and were analyzed using phenomenography. Two descriptive categories were identified: "Facilitating the sharing of reflections about everyday life" and "Possibility of change in everyday life." The family nursing conversations about family structure and function in the context of mental illness allowed families to find new meanings and possibilities in everyday life. Health care professionals can play an important role in facilitating a safe environment for young adults and their families to talk openly about the experience of living with and managing mental illness.

Effectiveness of advanced nursing care (ANC) on bone cancer pain, psychological disorders and quality of life in patients with primary bone cancers: A protocol for a PRISMA-compliant meta-analysis

BACKGROUND

Advanced nursing care (ANC) has been reported to effectively relieve bone cancer pain, prevent psychological disorders and improve the quality of life (QoL) in patients with primary bone cancers (PBC) during the treatment. However, the exact effect of ANC remains controversial. This systematic review will aimed to assess the effectiveness of ANC on bone cancer pain, psychological disorders and QoL in patients with PBC.

METHODS

Eligible randomized controlled trials (RCTs) and high-quality prospective cohort studies were searched from Excerpt Medica Database (Embase), PubMed, Google Scholar, Medline, Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Chinese Bio Medical Database (CBM), China Scientific Journal Database (CSJD), and Wanfang Database. Papers in English or Chinese published from January 2000 to July 2020 will be included without any restrictions. The clinical outcomes including bone cancer pain, psychological disorders, QoL, and adverse events of ANC in patients with PBC were systematically evaluated.Two reviewers will separately carry out study selection and data extraction. Stata 14.0 and Review Manager 5.3 were used for data analysis. Methodological quality for each eligible clinical trial will be assessed by using Cochrane risk of bias tool. Subgroup and meta-regression analysis will be carried out depending on the availability of sufficient data.

RESULTS

This study will comprehensively summarize all potential evidence to systematically investigate the effects and safety of ANC on bone cancer pain, psychological disorders and QoL in patients with PBC.

CONCLUSION

The findings of this study will help to determine whether ANC is effective or not on bone cancer pain, psychological disorders and QoL in patients with PBC.

INPLASY REGISTRATION NUMBER

INPLASY202090037.

The Mental Health Recovery Model and Its Importance for Colombian Nursing

The article aims to describe the Mental Health Recovery Model, the Tidal Model in Mental Health Recovery and their relevance to implementation within the practice of Colombian nursing. Some concepts about mental health recovery and the theoretical model proposed by Phil Barker are presented in the text, analysing these with the challenges of the nursing professional to improve mental health care, taking into account the current context of care practice. The principles proposed with the Recovery model help to focus care on the person and not on the symptomatology of the illness, understanding that the person has different dimensions which make it possible for him/her to explore his/her own path to recovery. We can conclude that, through the theory, we can develop interventions and nursing activities that contribute to improving the quality of life of people who have been diagnosed with a mental illness, modifying the traditional healthcare models.

Self and sibling care attitudes, personal loss, and stress-related growth among siblings of adults with mental illness

Although sibling ties are typically among the longest lasting family relationships, relatively little is known about how adult siblings navigate family caregiving when a brother or sister has a serious mental illness. The present study examined the role of primary caregiver status, perceived sibling illness severity, sibling relationship quality, and self and sibling caregiving attitudes in understanding reports of personal loss and stress-related personal growth among siblings of adults with serious mental illness. Online surveys were completed by 226 adult siblings (141 women; 85 men; mean age = 34 years; SD = 9.05). Results suggest that well siblings' reports of self and sibling caregiving attitudes significantly differed as a function of primary caregiver status (i.e., sibling, parents, or others as primary caregiver or no caregiver). Sibling caregiving attitudes differentially predicted well siblings' experience of personal loss and stress-related growth, regardless of demographics and primary caregiver status, perceived sibling illness severity, and sibling relationship quality. Greater ambivalence about providing care to their sibling with mental illness was associated with adults' reports of greater personal loss while higher levels of sibling balanced care priorities were significantly related to higher levels of personal growth. Greater self-care attitudes were significantly related to lower levels of both personal loss and personal growth for well siblings. Understanding sibling caregiving attitudes has important implications for research and interventions with families coping with mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of advanced nursing care on psychological disorder in patients with COVID-19: A protocol of systematic review

BACKGROUND

This study will explore the effect of advanced nursing care (ANC) on psychological disorder (PD) in patients with Coronavirus Disease 2019 (COVID-19).

METHODS

This study will search the following electronic databases up to June 30, 2020: Cochrane Library, PUBMED, EMBASE, PsycINFO, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, CNKI, and WANGFANG. We will not impose any language limitations. Two authors will independently identify titles/abstracts and full-text of all potential studies, and will collect data from eligible studies. Additionally, study quality will be assessed by Cochrane risk of bias. If necessary, we will conduct meta-analysis if sufficient trials are included.

RESULTS

This study will explore the effect of ANC on PD in patients with COVID-19 through outcome indicators.

CONCLUSION

The findings of this study may supply summarized evidence of ANC for the management of PD in COVID-19.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020187610.

Effect of advanced nursing care on psychological condition in patients with chronic heart failure: A protocol of systematic review and meta-analysis

BACKGROUND

This study will appraise the effect and safety of advanced nursing care (ANC) on psychological condition (PC) in patients with chronic heart failure (CHF).

METHODS

The following databases will be sought from the beginning up to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, the Chinese Scientific Journal Database, and China National Knowledge Infrastructure. There are not language and publication status limitations related to any electronic databases. In addition, we will also identify conference proceedings, reference lists of included studies, and websites of clinical trials registry. Two reviewers will separately carry out study selection, data extraction, and study quality evaluation. Any inconsistencies will be solved by a third reviewer through discussion. RevMan 5.3 software will be utilized to carry out statistical analysis.

RESULTS

This study will comprehensively summarize all potential evidence to systematically address the effects and safety of ANC on PC in patients with CHF.

CONCLUSION

The findings of the present study will help to determine whether ANC is effective or not on PC in patients with CHF.

STUDY REGISTRATION NUMBER

INPLASY202040077.

Effect of high-quality nursing intervention on the psychological disorder in patients with gastric cancer during perioperative period: A protocol of systematic review and meta-analysis

BACKGROUND

This study will be proposed for investigating the effects of high-quality nursing intervention (HQNI) on the psychological disorder in patients with gastric cancer during perioperative period (GC-PPP).

METHODS

A cumulative search from inception up to the March 31, 2020 will be performed in the following databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, VIP database, and China National Knowledge Infrastructure. We will search all potential studies from those electronic databases regardless their language and publication status. We will only consider randomized controlled trials (RCTs) for inclusion, which explores the effect of HQNI on the psychological disorder in patients with GC-PPP. Study identification, information extraction, and study quality appraisal will be independently and respectively done by 2 researchers. Any different opinions between 2 researchers will be disentangled by a third researcher after discussion. Cochrane risk of bias tool will be used for study quality assessment, and RevMan 5.3 software will be utilized for statistical analysis.

RESULTS

This study will provide a high-quality synthesis of psychological disorder outcomes to evaluate the effects and safety of HQNI for patients with GC-PPP.

CONCLUSION

The findings of this study will provide reference and evidence to appraise whether HQNI is an effective on the psychological disorder in patients with GC-PPP STUDY REGISTRATION NUMBER:: INPLASY202040080.

Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition

BACKGROUND

Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative.

METHODS

Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model.

RESULTS

While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication.

CONCLUSIONS

This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.

[Nurse in a mobile psychiatric team for the elderly, an area of expertise within a network]

The elderly subject's mobile psychiatric team goes to meet the patient out of hospital. Its aim is to assess patients, guide their care, and train health professionals and social workers in the psychiatry of the elderly patient. The nurse's autonomy and expertise are essential to her functioning. Feedback from the Corentin-Celton Hospital in Issy-les-Moulineaux (Assistance Publique-Hôpitaux de Paris, 92).

Confidence and motivation to help those with a mental health problem: experiences from a study of nursing students completing mental health first aid (MHFA) training

BACKGROUND

Those studying nursing are at greater risk for developing mental health problems than other tertiary students. Mental Health First Aid (MHFA) training may assist students to support peers and build mental health literacy. Understanding motivation to participate in training can identify factors influencing uptake and completion. This paper explores motivators for university nursing students to participate in MHFA training and uses previous experience and confidence in assisting someone with a mental health problem to triangulate data.

METHOD

A randomised controlled trial was employed to measure the impact of the course for nursing students at a large Western Australian university. An online survey was administered prior to MHFA training with undergraduate nursing students (n = 140). Thematic analysis of open-ended questions explores motivators to participate and help provided to an individual. Baseline frequencies describe demographics, confidence in helping and exposure to someone with a mental health problem. A Chi Square test compared confidence in helping and exposure to someone with a mental health problem.

RESULTS

More than half of participants reported contact with individuals experiencing mental health problems (55%; n = 77); approximately a third (35.8%) reported limited confidence to assist. Those in previous contact with someone with a mental health problem (71.5%; n = 55) were significantly more likely to feel confident in helping (p = 0.044). Mental health literacy, helping others, career and experiences were described as training motivators.

CONCLUSION

Exploiting motivators, both intrinsic and extrinsic may increase MHFA training uptake and completion. Tertiary institutions would benefit from policy to embed MHFA training into nursing degrees. The training may have utility for university degrees more broadly.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry; ACTRN12614000861651. Registered 11 August 2014 (retrospectively registered).

Generativity and Well-Being of Midlife and Aging Parents With Children With Developmental or Mental Health Problems

Parents who have a child with a developmental problem or mental disorder often provide support and assistance to their child throughout their lives, and the burden of caregiving can have an adverse impact on parents' mental and physical health. Using Erikson's theory as a framework, the present study investigated generativity as a moderator of the effects of parenting a child with a disability on parents' well-being during mid- to late life. Using data from the study of Midlife in the United States, we identified 220 parents who had a child with a disability and 3,784 parents whose children did not have a disability. Regression analyses showed that the effect of parenting a child with a disability on negative affect, positive affect, and physical health was conditional on both parental gender and generativity, with mothers experiencing greater adverse effects of parenting but showing a benefit from high levels of generativity.

Caring for the Youngest Students: The ABCs of Preschool Nursing

Caring for the preschool population presents unique challenges for the school nurse. These challenges are multiplied when the population includes those with special needs. Challenges include multiple risks to safety related to developmental stage, increased prevalence of infectious diseases due to the development of the child's immune system, management of chronic disease because of the student's ability to comprehend and follow directions, and many social and emotional issues. Using evidence-based strategies, the preschool nurse can gain the confidence to care for the youngest students.

Treading a tightrope: Professional perspectives on balancing the rights of patient's and relative's under the Mental Health Act in England

Involuntary detention is used internationally to detain and treat people who are deemed to have a mental disorder. In England and Wales, approved mental health professionals (AMHPs) co-ordinate Mental Health Act assessments which allow for patients to be detained. AMHPs have legal duties to identify, inform and consult with a patient's nearest relative (NR), who are, in turn, given powers to initiate or challenge detention. Our study takes an original approach through examining how AMHPs interpret their duties towards nearest relatives. We adopted a two-stage design, which involved an online questionnaire with 55 AMHPs and focus group discussions with 33 AMHPs. The research was conducted in England between 2017 and 2018. Our questionnaire found that a high proportion of AMHPs reported that they had spoken to NRs for background information when assessing patients under the Mental Health Act. However, AMHPs were less likely to ask patients about their views of involving the NR prior to assessment. Focus group findings showed that AMHPs saw the NR role as offering an important 'safeguard' on the basis that NRs could provide information about the patient and advocate on their behalf. AMHPs identified practical difficulties in balancing their legal obligation towards NRs and patients; particularly where issues of potential abuse were raised or where patients had identified that they did not want NR involvement. While AMHPs stated that they sought to prioritise patient wishes regarding confidentiality, their accounts identified that patient consent about information sharing was sometimes implied rather than sought explicitly. Our findings reinforce conclusions by the recent Independent Review of the MHA, which states that current NR provisions are 'outdated, variable and insufficient'. We identify that current practice could be improved using advanced choice documents and outline implications for AMHP practice.

The effect of psychiatric nursing students' internships on their beliefs about and attitudes toward mental health problems; a single-group experimental study

BACKGROUND

It is important that nursing students develop positive beliefs and attitudes toward individuals with mental health problems during nursing education in order to provide an effective nursing care and create a therapeutic environment.

OBJECTIVE

This study was conducted to analyze the effect of psychiatric nursing internship practice and the personal characteristics and preferences of psychiatric nursing interns on their beliefs and attitudes toward mental illnesses.

DESIGN

This is a single group experimental study with a pre-test and post-test.

PARTICIPANTS

The study sample included 33 fourth-year nursing students enrolled in the School of Health who participated in an internship in psychiatric nursing.

METHODOLOGY

The study data were collected using a student information form, the Community Attitudes Toward the Mentally Ill Scale (CAMI) and the Beliefs Toward Mental Illness Scale (BMI) at the beginning and end of the 14-week internship of 32 h per week.

FINDINGS

The students' beliefs and attitudes toward mental health problems were found to be moderate with no significant differences between mean pre-test and post-test scores.

CONCLUSION

The psychiatry nursing internship practice yielded minimal positive changes in students' beliefs and attitudes toward mental health problems. Initiation of the process of developing positive attitudes and beliefs in the first year of nursing education and increasing the internship period may provide more effective results.

The Therapeutic Engagement Questionnaire (TEQ): a service user-focused mental health nursing outcome metric

BACKGROUND

Therapeutic engagement (TE) has been described as the crux of mental health nursing but despite its perceived importance, to date, there is no measurement tool that captures it. As a result, there is no way of determining the contribution of mental health nursing interaction to service user recovery, in acute inpatient mental health settings or the wider care quality agenda.

METHODS

To develop and validate a TE measurement tool in partnership with Service Users (SUs) and Registered Mental Health Nurses (RMHNs). The TEQ was developed in 3 stages: 1) item generation (and pre-testing), 2) item reduction using Principal Component Analysis (PCA), and 3) validation across Mental Health Trusts in England.

RESULTS

The final questionnaire has two versions, (SU and RMHN version), each scored within two contexts (1-1 SU-RMHN interactions and overall environment and atmosphere of the ward) and includes 20 items with two sub-scales (care interactions and care delivery). Psychometric evaluation of the TEQ shows high inter-scale correlations (0.66-0.95 SU; 0.57-0.90 RMHN), sound sub-scale internal consistency (> 0.95), concurrent validity (> 0.60) and adequate score variability for both versions of the TEQ. In summary, the TEQ behaves well as a measurement tool.

CONCLUSIONS

The TEQ can determine the collaborative and empathic nature of RMHN-SU interactions, capture if SUs are treated with dignity and respect and recognise that the principles of the recovery approach are being respected. The TEQ can also provide robust monitoring of nursing activity, offer opportunity for transparency of activity, feed into healthcare organizations' key performance indicators and provide reassurance about the nature and quality of nurses' work.

Links between mental and heart health

Aysha Mendes, Editor, British Journal of Cardiac Nursing, discusses the effects of cardiac events and conditions on mental health.

Caregivers' experiences of service transitions in adult mental health: An integrative qualitative synthesis

Approximately 5% of the UK population live with serious mental health problems. Data show that informal caregivers of people with mental illness provide care for the highest number of hours compared to other illness and the economic cost of this care is highest in the UK when compared internationally. People living with serious mental health problems make transitions between different intensities of service as their needs fluctuate, including referral, admission, transfer or discharge. Although caregiving is associated with both stress and positive reward, service transitions are particularly associated with increased stress. This review aimed to investigate what is known about the experiences of informal caregivers during mental health service transitions. An integrative qualitative synthesis was conducted following searches in six bibliographic databases and of the grey literature. Studies published in English between 2001 and 2017 were included if the study focus was on serious mental health problems, the experiences of caregivers and service transitions. Eleven studies were included, appraised using the Mixed Methods Appraisal Tool and synthesised, resulting in four themes: (a) Caregiver information, (b) Caregiver involvement in decisions about care and treatment, (c) Accessing services, (d) Being a caregiver. Caregivers' experiences were similar during transitions to their usual caregiving role but they faced more challenges and their experiences were amplified. Concerns about confidentiality created barriers to information sharing. Continuity of professionals across transitions was helpful. Caregivers struggled to deal with their own conflicting emotions and with the behaviours of the person yet rarely received help. The review findings point to a need for continuity of professionals across service transitions, co-designed and delivered training for professionals and caregivers about information sharing, greater understanding of barriers to implementation of family interventions and interventions that address emotional needs of caregivers.

[Artificial intelligence and nursing care: reflections in psychiatry]

A key government priority, artificial intelligence (IA) in healthcare is a real opportunity for nursing professionals. Faced with the daily difficulties encountered, AI could bring a new perspective to nursing care in psychiatry and free up time for professionals which they can then spend with the patient. More training and a multi-disciplinary approach are required.

[Nursing clinical approach to boredom]

The acute crisis is often followed by boredom. Patients become impatient, restless, looking for ways to take their mind off things and entertain themselves. The occupational activity can then come to the rescue of these downtimes, offering solutions to encourage an encounter. Caregivers work together to 'bore' the patient. In this search for the encounter, they must take the risk of forgoing the occupational activity for the sake of the therapeutic.

Australian mental health caregiver burden: a smallest space analysis

OBJECTIVES

To explore Australian mental health carers' prioritisation of key elements of caregiving and establish the extent to which particular issues contribute to carer burden.

DESIGN

Cross-sectional survey.

SETTING

All Australian States and Territories.

PARTICIPANTS

Responses were received from 231 Australian mental health caregivers.

MAIN OUTCOME MEASURES

The Involvement Evaluation Questionnaire was used to assess caregiver burden.

RESULTS

Smallest space analysis identified three distinct regions, which we conceptualise as: 1) promoting the safety and health of mental health consumers; 2) impact of caring on caregivers' personal lives and 3) enabling daily living functional recovery of mental health consumers. The analysis demonstrates that carers are most concerned with enabling daily living functional recovery, for which the mean value was considerably higher than the personal impact and promoting safety and health regions. In terms of the individual questionnaire items, the issues of most importance are assisting with self-care, worrying about consumers' future, finances and general health, encouraging consumer involvement in activities and concerns over the treatment consumers are receiving.

CONCLUSION

Caregiving often came at significant personal cost. The burden that results from caring for mental health consumers could perhaps be alleviated through the expansion of psychiatric disability services, increasing government financial support and providing tailored psychosocial interventions that meet the needs of families.

[Nursing practice in the mobile old age psychiatry team]

Since 2015, the mobile old age psychiatry team of the Maison-Blanche public health facility has been providing mental health and psychiatric services to the population aged 70 and over in three districts of Paris and four psychiatric sectors. The team's nurses actively take part in delivering care in the home and in maintaining the autonomy of elderly patients suffering from mental health disorders. They provide global care, both somatic and psychiatric, and offer, through their assessments, an initial response to the suffering expressed by the patients and their family.

Spiritual aspects of the family caregivers' experiences when caring for a community-dwelling adult with severe mental illness: a qualitative systematic review protocol

REVIEW QUESTION

What are the spiritual aspects of family caregivers' experiences when caring for a community-dwelling adult with severe mental illness?

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Advanced nursing practice in psychiatry is a major challenge for the discipline. It must meet the needs of the population as well as conform to national policies and tackle the problems within the mental health and psychiatric sector. For a long time, psychiatric nurses have developed their practices on the basis of precise indications and health policies. Advanced practice will not be able to replace these existing situations.

[A specific unit for residents presenting psychiatric disorders]

Faced with the growing number of requests for the admission of patients with chronic psychiatric pathologies, a nursing home in Port-Louis has created the 'Normandie' unit to accomodate these residents. The special feature of the support provided and the organisation of the day-to-day routine requires caregivers to adopt a specific approach.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury

BACKGROUND

Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts.

OBJECTIVE

This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited.

PARTICIPANTS

Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups.

SETTING

An urban Midwestern city's hospital-based Children's Advocacy Center.

METHODS

Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change.

RESULTS

From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts.

CONCLUSIONS

The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

The urgent need to make NHS mental health care safer

John Tingle discusses some recent reports that call for urgent improvements in the quality and safety of care in NHS mental health services.

Treating pediatric acute-onset neuropsychiatric syndrome

Pediatric acute-onset neuropsychiatric syndrome (PANS) can be caused by infectious and noninfectious triggers. NPs can help children with PANS recover from their symptoms and prevent future recurrences by appropriately screening, recognizing, and diagnosing the clinical presentation of PANS. PANS treatment includes pharmacologic therapies as well as cognitive behavioral therapy.

Knowledge and perceptions of Indian primary care nurses towards mental illness

OBJECTIVES

To assess nurses' knowledge and perceptions towards mental illness.

METHODS

This was a cross-sectional descriptive study conducted among 126 randomly selected nurses those are working under District Mental Health program in Karnataka (India). The data was collected through self-reported questionnaires Using the modified version of Public perception of mental illness questionnaire and Attitude Scale for Mental Illness.

RESULTS

The findings revealed that majority of the subjects were women (74.4%), Hindus (92.1%) and were from rural background (69.8%). The mean Knowledge score 10.8±1.6 adequate knowledge (maximum possible =12) among 91% of the subjects, and 52% of them hold negative attitudes towards people with mental illness (88.9±13.6). While majority of the subjects hold negative attitudes in 'Separatism' (53.5%), 'Stereotyping' (73%), 'Benevolence' (54%), 'Pessimistic prediction' (53%) domains, they hold positive attitudes in 'Restrictiveness' (88%) and 'Stigmatization' (72%) domains. Women than men endorsed positive attitudes towards persons with mental illness in Stereotyping' (p<0.001), 'Restrictiveness' (p<0.01), 'Benevolence' (p<0.001) and 'Pessimistic prediction' (t= 2.22, p<0.05) domains. Similarly, Auxiliary Nursing Midwifery found to be less restrictive (p<0.05), more benevolent (p<0.001) and less pessimistic (p<0.05) compared to nurses with higher education (General Nursing and Midwifery and Bachelor of Science in Nursing).

CONCLUSIONS

The present study showed adequate knowledge on mental illness among nurses. Yet they hold stigmatizing and negative attitudes towards mental illness. Hence, it is an urgent priority to develop and implement educational programs to inculcate positive attitudes towards people with mental illness to provide optimal care to this vulnerable population.