Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study

INTRODUCTION

Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards.

AIM

This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran.

METHOD

An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis.

RESULTS

The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'.

DISCUSSION

MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance.

IMPLICATIONS FOR MENTAL HEALTH NURSING

According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

The role of mental health nurses in planetary health

This article will critically explore the concept of planetary health and locate the role and identity of the mental health nurse (MHN) within it. Like humans, our planet thrives in optimum conditions, finding the delicate balance between health and ill-health. Human activity is now negatively impacting the homeostasis of the planet and this imbalance creates external stressors that adversely impact upon human physical and mental health at the cellular level. The value and understanding of this intrinsic relationship between human health and the planet is in danger of being lost within a society that views itself as being separate and superior to nature. The Period of Enlightenment witnessed some human groups viewing the natural world and its resources as something to exploit. White colonialism and industrialization destroyed the innate symbiotic relationship between humans and the planet beyond recognition and in particular, overlooking the essential therapeutic role nature and the land facilitated within the well-being of individuals and communities. This prolonged loss of respect for the natural world continues to breed human disconnection on a global scale. The healing properties of nature have effectively been abandoned within healthcare planning and infrastructure, which continue to be driven principally by the medical model. Under the theory of holism, mental health nursing values the restorative capabilities of connection and belonging, employing skills to support the healing of suffering, trauma and distress, through relationships and education. This suggests MHNs are well situated to provide the advocacy the planet requires, through the active promotion of connecting communities to the natural world around them, both healing the other.

"It Is OK Not to Be OK": Nursing Students' Backgrounds and Perceptions of Mental Health Stigma and Implications for Mental Health Nursing Education

There has been a notable increase in reported mental illnesses in recent years. Although mental illness is being discussed more openly, stigma toward mental illness still exists. Stigma can result in inadequate care for people with mental illnesses. Students come into nursing from a variety of backgrounds and these backgrounds influence their nursing clinical judgments, especially related to caring for people with mental illnesses. A qualitative descriptive analysis was conducted using 60 undergraduate nursing student reflections on their backgrounds and perceptions of mental health stigma. Students wrote about their Previously Held Beliefs and the Influence of Culture, Overcoming Stigma through their Experiences with Friends and Family, Influence of Popular Culture, and Personal Experiences, and their New Understanding of mental illness and what that means for their future nursing practice. These findings have important implications for nursing education including providing more opportunities for nursing students to care for people with mental illnesses, reframing how mental health content is delivered in undergraduate nursing programs, and providing additional support for students with personal mental illnesses.

Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

Attitudes towards family involvement in nursing care among psychiatric nurses in Hong Kong: A cross-sectional descriptive study

WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders.

ABSTRACT

INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings.

AIMS

This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors.

METHODS

This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument.

RESULTS

Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care.

DISCUSSION

The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades.

IMPLICATIONS FOR PRACTICE

Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.

How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners

BACKGROUND

Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP).

PURPOSE

To explore what meaning people with SMI associate with the care provided by a PMHNP.

METHODOLOGY

A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP).

RESULTS

Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia.

CONCLUSIONS

The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance.

IMPLICATIONS

For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

Key stakeholder perspectives on expert-by-experience involvement in the values-based recruitment of student mental health nurses: A co-produced qualitative study

BACKGROUND

Values-based recruitment is a mandatory process for nursing programmes within UK higher education, with the Nursing Midwifery Council expecting that experts-by-experience are engaged in these recruitment and selection processes. The wider involvement of experts-by-experience in healthcare education is gaining momentum internationally with calls for engagement in all aspects of design and delivery; however, the impact of such involvement in recruitment of nursing students has received little attention, particularly in mental health nursing.

AIM

To understand the impact of expert-by-experience involvement in the values-based recruitment of mental health nursing students from the perspective of candidates, experts-by-experience, and academic staff.

DESIGN AND METHODS

This qualitative approach was co-designed and implemented by a research team comprised of academics, experts-by-experience, and student mental health nurses. Focus groups and an on-line survey were used to collect data, with Burnard's thematic analysis providing a framework for data analysis.

SETTING/PARTICIPANTS

This study took place at one UK university. Participants included nurse academics, experts-by-experience, and student nurses with experience of a values-based recruitment process.

RESULTS

Thematic analysis identified four themes: starting out, collaboration, rich assessment, and stakeholder gains. Whilst not without its challenges, the involvement of experts-by-experience in the recruitment of mental health nursing students was identified as delivering a robust recruitment process, encompassing academic abilities alongside the personal qualities required to make a 'good nurse'. Personal benefits for experts-by-experience, candidates, and academics were also reported.

CONCLUSION

This study provides insights into the impact of experts-by-experience in supporting values-based recruitment. The approach is identified as enhancing the selection process by drawing from academic and lived experience perspectives and highlights to potential candidates, at the outset of their career, the value of meaningful engagement. These findings support the Nursing Midwifery Council's position that experts-by-experience should be engaged in the recruitment and selection of student nurses.

Engaging Older Adults in a Depression Simulation Experience

BACKGROUND

Clinical simulation has become integral to curriculum development in nursing programs. This innovative intervention was designed to explore the efficacy of high-fidelity standardized patient (SP) simulation to increase students' ability to recognize signs of depression and to improve therapeutic communication.

METHOD

During a 12-month period, prelicensure nursing students (n = 136) in a midwestern nursing program participated in this simulation experience. Volunteer retirees residing in the college-affiliated retirement village played the roles of depressed patients.

RESULTS

Students' self-evaluations indicated this experience was a positive learning experience. All of the students indicated the experience improved their knowledge about depression; 91% stated their confidence in interviewing improved, and 89.7% indicated improvement in their communication skills.

CONCLUSION

Use of SP simulation in mental health nursing is an effective strategy to bolster confidence, improve depression screening skills, and enhance therapeutic communication skills. [J Nurs Educ. 2022;61(4):209-212.].

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.

Evaluating the Effectiveness of an Educational Intervention for Care of Anemic Patients in a Long-Term Care Geropsychiatric Unit: A Pilot Study

Anemia is one of the most common age-related health conditions. When concurrently present with psychiatric conditions, the problem is confounded. The primary objective of the current research was to evaluate the effectiveness of an educational intervention for geropsychiatric nurses about nutritional deficiency anemia, anemia of chronic disease, and unexplained anemia in older adults. Fifty nurses employed by an inpatient psychiatric facility participated in the pilot study. A 10-item knowledge evaluation questionnaire was administered prior to and following a 45-minute educational intervention. Analysis of a paired samples t test indicated a significant difference between pretest scores (mean = 36.8, SD = 16.3) and posttest scores (mean = 90.8, SD = 10.66) (p < 0.001). Despite initial knowledge gaps, significant improvement in nursing knowledge was noted following the intervention. As a result of improved knowledge, RNs may be better able to recognize and respond to signs and symptoms that commonly go unnoticed in geropsychiatric patients with anemia. [Journal of Gerontological Nursing, 46(8), 12-16.].

Evaluating the effectiveness of a CRSCE-based de-escalation training program among psychiatric nurses: a study protocol for a cluster randomized controlled trial

BACKGROUND

The high incidence of workplace violence (WPV) in clinical mental health settings has caused a series of negative impacts on nurses, which has subsequently increased public concern. De-escalation (DE) is recommended as a training program which aims at providing nurses with skills and strategies to more effectively respond and manage WPV. Very few studies have examined the effectiveness of DE training, with current studies possessing various limitations due to their design and small sample sizes. By using a cluster randomized controlled design, the proposed study aims to evaluate the effectiveness of a CRCSE-based DE training programs among psychiatric nurses.

METHOD

A cluster randomized controlled trial, with a 6-month follow-up period after the end of the intervention, will be conducted among psychiatric hospitals in Guangdong, China. The randomization unit is each involved psychiatric hospital. Participants in the control group will be assigned to routine WPV management training, participants of the intervention group will undergo the same training while additionally receiving DE training. The DE training will include the following five modules: communication, response, solution, care, and environment (CRSCE). Primary outcomes are objective clinical indicators, which will be extracted from the information systems of the enrolled hospitals. These include the incidence of WPV, injuries caused by WPV, and the use of coercion (physical restraint and seclusion) by nurses. Secondary outcomes, aims at evaluating the effects of DE training on nurses, include the capacity of DE, DE confidence, level of job burnout, and professional quality of life. Data will be collected at baseline (T0), at 3 months (T1, intervention completed), and at 6 months after intervention (T2, follow-up).

DISCUSSION

This study will offer trial-based evidence of the efficacy of a DE training program targeted at WPV among psychiatric nurses. DE training is expected to reduce both the total incidence and negative impacts of WPV, with additional improvements in psychiatric nurses' coping skills.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900022211 . Prospectively registered on 30 March 2019.

Integrating Mental Health Nursing in the Prelicensure Nursing Curriculum

BACKGROUND

Learning to care for patients with mental health concerns is an important part of nursing school. Teaching mental health concepts across the nursing curriculum, rather than in just one course, prepares students for meeting the mental health needs of all clients. This article describes the integration of mental health concepts throughout an accelerated bachelor of science in nursing program.

METHOD

Faculty developed an innovative approach to integrate mental health throughout the curriculum in lieu of a stand-alone course.

RESULTS

Quantitative metrics remained consistent when comparing cohorts before and after the integration of mental health. However, students did not recognize mental health content within the program.

CONCLUSION

Integrating mental health concepts in the prelicensure nursing curriculum enables students to learn and understand how to care for clients with mental health concerns in any clinical setting. [J Nurs Educ. 2020;59(7):405-408.].

Perceptions of realism in digital scenarios: A mixed methods descriptive study

Enquiry-based learning is a well-recognised tool in nurse education internationally. It is a pedagogical activity formed around the construction of a 'scene' that provides a platform for critical enquiry. A growing range of technologies are now used to simulate real-world enquiry. However, the characteristic of authenticity is essential for effective learning. The aim was to create a stakeholder group to explore the quality and presence of authenticity in scenarios presented through digital media. A co-productive active learning approach explores perceptions of authenticity using an authenticity scale. Stakeholder facilitated workshop discussions explored perceptions of the educational scenarios. Participants included mental health nursing students, people with lived experience and family caregiver. A mixed-methods descriptive study using the adapted authenticity scale to rate four exemplar scenarios along with thematic analysis of workshop discussions. We found digital audio compared less well to visual media in authenticity scales. Still photobook style images were also perceived as less authentic than dramatic film employing professional actors. Digital media must be selected carefully not just in relation to the education needs of the student but in relation to their social, cultural norms and digital skills. Creating digital scenarios co-productively could contribute to a teaching resource that holds authenticity and real-world relevance. (198).

Practicing What We Preach: Teaching Psychiatric-Mental Health Student Nurses to Care For Themselves

It is well known that stress has a profoundly negative impact on the physical, mental, and spiritual health of nurses. In addition, undergraduate nursing students experience a tremendous amount of stress as a result of their academic and clinical requirements. In the current study, new self-care activities were introduced in an undergraduate psychiatric-mental health nursing course at a midsize, teaching-intensive university over the course of four academic semesters. Thematic analysis was conducted using qualitative feedback from 79 students who completed standard university course evaluations, and four major themes emerged: Stress Levels, Use of Self-Care Strategies and Coping Skills, Self-Reflection, and Perception of Instructor. Overall, students found value in self-care activities that have potential to reduce burnout, increase retention, and improve student and patient outcomes. Therefore, a proactive approach should be taken early in undergraduate programs to provide education to nursing students about strategies to combat the deleterious effects of stress and promote self-care. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 40-45.].

Mobile community learning programme's effectiveness in case management for psychiatric nurses: A preliminary randomised controlled trial

BACKGROUND

The global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses.

OBJECTIVE

To evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses.

DESIGN

This study used an experimental two-group pre- and post-test design.

SETTINGS AND PARTICIPANTS

Psychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited.

METHODS

Nurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes.

RESULTS

The questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F = 22.99, p < .01) and competence (F = 6.33, p = .015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1-5).

CONCLUSIONS

MCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence.

Lights, Camera, Action: Lessons Learned From a Nursing and Theater Collaboration

BACKGROUND

Because nursing students do not always have opportunities to interact with individuals with mental illness due to various factors such as limited clinical sites, an innovative teaching strategy was developed.

METHOD

A plan was developed to collaborate with the theater department to offer undergraduate theater students an opportunity to practice acting skills while taking an independent study. These theater students, trained as standardized patients (SPs), engaged with senior nursing students enrolled in a psychiatric mental health nursing clinical course in a baccalaureate program.

RESULTS

This process has been successfully implemented for the past 2 years. With 10 theater students completing the independent study and 180 nursing students engaging in interactions with SPs, improvements in communication skills for nursing students have been seen.

CONCLUSION

Because this is a pilot project, additional research should be conducted to further explore the effectiveness of learning for both nursing and theater students. [J Nurs Educ. 2019;58(6):369-371.].

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.

Students' mental health clinical placements, clinical confidence and stigma surrounding mental illness: A correlational study

Theory and clinical practicum in mental health are an important component for students in most nursing curriculum. Some studies have shown that knowledge and confidence in caring for people with mental illness improve after mental health clinical placements while others had contrasting results. Our study examined the relationship between clinical placement, confidence and stigma surrounding mental illness. We undertook a cross-sectional, descriptive correlational study in a sample of 144 undergraduate nursing students in Singapore who had completed their theoretical and clinical practicum in mental health using the Clinical Placement Survey Clinical Confidence Scale and Social Distance Scale. Descriptive, correlations and multiple regression were used to analyse the data. The results showed the mean scores for the social distance scale, clinical confidence scale and clinical placement survey were 19.92 out of 35, 49.29 out of 80 and 103.43 out of 154 respectively. Attitudes toward clinical placement experiences were significantly correlated with both stigmatising attitudes and clinical confidence of which, intentions of working in mental health settings were specifically significantly associated with stigmatising attitudes and attitudes toward clinical placement experiences, with emphasis on greater sense of preparedness, lesser perceived anxiety and greater preference for a future career in mental health nursing. This study highlighted the need to improve current mental health clinical placements to better build nursing students' confidence in caring for mentally ill patients. The interest toward specialising in mental health nursing is still lacking in nursing undergraduate students despite mental health clinical placements.

Are student nurses ready for new technologies in mental health? Mixed-methods study

BACKGROUND

Technical innovations such as ecological momentary assessment (EMA), machine learning (ML), computerized adaptive testing (CAT), Digital Phenotyping, Clinical Decision Support Systems (CDSS), Algorithms, and Biomarkers have caused a paradigm shift in psychiatric care. The aim of the present study was to explore how student nurses view this paradigm shift, by assessing the acceptability of smartphone-based EMA, CAT, and biosensor-based Digital Phenotyping. We also investigated the factors affecting this acceptability.

METHOD

Student nurses recruited via nursing schools participated in a quantitative study involving the screenplay method, in which they were exposed to two scenarios about depression care, one featuring EMA and CAT, the other featuring a connected wristband (CW) for Digital Phenotyping. Four acceptability domains (usefulness, usability, reliability, risk) were investigated.

RESULTS

We recorded 1216 observations for the first scenario and 1106 for the second. Regarding overall acceptability, the CW was viewed less positively than CAT and EMA. Regarding reliability, whereas respondents believed that the CW could correctly detect depressive relapse, they did not think that EMA and CAT were sufficiently reliable for the accurate diagnosis of depressive disorder. More than 70% of respondents stated that they would nevertheless be interested in offering EMA, CAT or CW to their patients, but more than 60% feared that these devices might hinder the therapeutic relationship.

CONCLUSION

This was the first study assessing student nurses' views of EMA, CAT and CW-based digital phenotyping. Respondents were interested in these new technologies and keen to offer them to their patients. However, our study highlighted several issues, as respondents doubted the reliability of these devices and feared that they would hinder the therapeutic relationship. Subgroup analysis revealed correspondences between acceptability profiles and demographic profiles. It is therefore essential for nurses and student nurses to receive training and become involved in the development of this new technologies.

Effective Strategies for Working With Patients With Substance Use Disorders

Substance use is at epidemic proportions in the United States. Substance use disorders (SUDs) are difficult to treat and considered to be chronic with a high mortality rate. Nurses are in a prime position to help patients with SUDs in a variety of settings, but they often lack knowledge about the disorder and the skills to provide effective care. The identification and treatment of co-occurring disorders, such as trauma, are important when providing care for patients with SUDs. Empathy and perspective taking were once thought to be helpful when working with patients, but evolving thought is that compassion is more effective as it involves feeling for, and not with, patients and includes taking action to help another. Harm reduction strategies, such as accepting people where they are, as well as the use of motivational interviewing strategies are also effective when working with patients with SUDs. Involving patients with SUDs in their treatment plans through shared decision making is also effective in building a therapeutic relationship and improves outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 57(9), 11-15.].

Telehealth in Mental Health Nursing Education: Health Care Simulation With Remote Presence Technology

The feasibility of integrating remote presence technology within a simulation scenario for psychiatric-mental health nursing (PMHN) students to develop telehealth competencies was evaluated. A wireless, audiovisual robot from Double® Robotics, maneuverable by smartphone or tablet computer, was used to simulate the facilitation of students' patient assessment and treatment decisions from a distant location for 32 weeks (total hours of robotic simulation = 32). Qualitative data were collected to assess student and faculty satisfaction, as well as for feasibility evaluations. Overall, students participating in the telehealth-enabled simulations reported moderate (9 of 36 students) to strong (25 of 36 students) value for the use of telemedicine within the simulation in a 3-point Likert scale post-simulation survey. These results illustrate the feasibility of using a remote presence robot in an educational simulation environment. Remote presence in clinical simulations can contribute to workforce preparation to apply telehealth-enabled communication in PMHN settings. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 23-28.].

Increasing Psychiatric Rehabilitation Knowledge in a Supported Housing Setting: Pre- and Posttest Analysis

The current study investigated the effectiveness of a state-wide Community Support Services training grounded in work-based learning to improve knowledge about psychiatric rehabilitation principles and skills. Supervisory staff and direct care staff in supported housing settings completed a 17-item, multiple choice, preand posttest after attending a 48-hour training series. Results indicated that participants gained psychiatric rehabilitation knowledge. These findings support the effectiveness of the training series grounded in work-based learning. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 39-44.].

Systematic Review of Continuing Education Interventions for Licensed Nurses Working in Psychiatry

Continuing education is an important part of nursing practice. These interventions help maintain clinical competence and are mandated by regulatory bodies. Often, continuing education interventions are created ad hoc and implemented without testing or formal evaluation of learning outcomes. In the current health care context, where resources are limited, educators are pressed to do more with less. Having access to a repository of existing continuing education interventions will facilitate the use of evidence-informed learning strategies and save valuable time by reducing duplication of efforts. Therefore, this systematic review aimed to explore continuing education interventions for licensed nurses working in psychiatry. All standard systematic review procedures were followed, including double screening, data extraction, and quality appraisal. This article presents an inventory of existing interventions, including summaries, as well as the reported effectiveness of each for nursing outcomes. Generally, the continuing education interventions result in positive nurse-related outcomes, such as increased knowledge, confidence, and skills, or improved attitudes; however, more rigorous research is needed to advance science in this area. [J Contin Educ Nurs. 2019;50(5):233-240.].

Advancing Racial/Ethnic and Cultural Sensitivity Among PMHNP Students Through Education, Practice, and Experience

BACKGROUND: There is an increased need for mental health providers to be more attuned to behavioral health needs of racial/ethnic/cultural minorities and the role of social milieus. AIMS: We prioritized training and assessing racial/ethnic and cultural sensitivity among psychiatric mental health nurse practitioner students throughout coursework, clinical practice, and experiences in underserved settings. METHOD: Prior to beginning clinical coursework, students completed a course on culturally competent care where we measured their (n = 26) perception of their ability to be racially/ethnically sensitive providers at the beginning and end of the semester, demonstrating significant improvement. During clinical coursework, preceptors measured students' racially/ethnically and culturally sensitive clinical behaviors with patients. RESULTS: Sensitivity of students in clinical training significantly improved over a semester of clinical supervision. Our results indicated that placements in underserved settings improved students' racial/ethnic/cultural sensitivity but only among advanced students. At final evaluation, advanced students in underserved settings self-reported significantly higher racial/ethnic and cultural sensitivity than students not in an underserved setting. CONCLUSIONS: Our data suggest that we can produce more racially/ethnically and culturally sensitivity providers through coursework, supervised clinical practice, and experiences in underserved settings. These data are preliminary, and we plan to follow up these results and replicate this work with other cohorts in future semesters.

A Systematic Review on Implementing Education and Training on Trauma-Informed Care to Nurses in Forensic Mental Health Settings

BACKGROUND

Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health.

METHOD

Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed.

FINDINGS

After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: "education for trauma-informed practice" and "applying theory into practice." Each had several subordinate themes.

IMPLICATIONS FOR FORENSIC PRACTICE

Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.

Feed-forward: Paving ways for students' subsequent learning

BACKGROUND

Written feedback assists students in refining their future academic work. However, students prefer having feed-forward instead of feedback by their instructors that are the comments provided to them on drafts prior to the actual assignment submission. The current literature describes two common ways to convey feed-forward: the foremost one is on outlines while the second is on drafts. However, no existing literature had been found yet for sufficient guidance on the ideal approach of feed-forward to facilitate students' subsequent learning.

DESIGN

A Quasi-experimental study design was employed to determine the effectiveness of feed-forward on outline versus drafts.

SETTING

Study was conducted in a private nursing institution in Karachi, Pakistan.

PARTICIPANTS

118 third-year undergraduate nursing students participated in the study.

METHODS

Using consecutive sampling, 118 students were enrolled and equally divided in to two groups, each comprising of 59 students in the control and intervention arm. Control group received feed-forward through standard practice i.e. on their assignment outline while the intervention group received feed-forward on the draft of their scholarly paper.

RESULTS

The performance of intervention arm had an upper hand over that of control wing as portrayed by their increased overall assignment and academic writing scores (of students on IELTs bands). The set outcomes also reflected better results in terms of the (reduced) frequency of visits to their instructors for clarification of written feedback. All in all, this research deduced that feed-forward on drafts is far more beneficial in contrast to that on an outline as it reinforces students' learning.

CONCLUSION

The study findings affirmed that feed-forward is a useful strategy to enhance students' subsequent learning.

Facilitating student learning with critical reflective journaling in psychiatric mental health nursing clinical education: A qualitative study

BACKGROUND

Critical reflective journaling has been used to facilitate student learning in various disciplines; however, there is only limited data available on its application in clinical education in the area of psychiatric mental health nursing.

OBJECTIVES

The aims of the study were to: 1) explore types of events or issues that senior nursing students chose to reflect upon in their critical reflective journals during their 5-week psychiatric mental health nursing clinical practicum; and 2) assess students' evaluations of critical reflective journaling.

DESIGN & METHODS

For this qualitative study, we collected data from senior nursing students who were enrolled in the mental health clinical practicum from March to June 2016 and agreed to participate in the study. During the 5-week psychiatric mental health nursing clinical practicum, students completed four weeks of clinical rotations in two units and submitted one journal entry each week reflecting upon an instance they selected and completed a survey to evaluate critical reflective journaling. De-identified data were analyzed using qualitative content analysis.

RESULTS

We analyzed 236 journal entries and survey results completed by 59 students. Students chose to reflect upon the following issues: boundaries of therapeutic relationships, responses to patient symptoms, and own attitudes and biases toward mental illness. They reported that critical reflective journaling provided them opportunities for self-reflection and self-emancipation, which led to increased motivation for full engagement in the clinical practicum and increased understanding of patients' perspectives as well as mental health nursing competency. Overall, students were satisfied with critical reflective journaling but also identified areas for improvement in regard to its application in clinical education.

CONCLUSIONS

Through critical reflective journaling, nursing students are able to self-reflect on issues arisen during their clinical rotation, which leads to improvement of their competency in psychiatric mental health nursing and full engagement in the clinical practicum.

Correlates and Predictors of Stigmatization of Patients With Mental Illness Among Nursing Students

The purpose of the current study was to explore knowledge of, attitudes about, and perception of stigma among nursing students in relation to mental illness, and to identify the predictors of stigma toward patients with mental illness based on nursing students' characteristics, knowledge, and attitude. A cross-sectional survey was conducted on 169 participants from a university in Jordan. The regression model predicted a relatively moderate proportion of variance in stigma perception. Significant predictors in the model were family income, father's educational level, and experience with mental health patients. Findings of the current study showed that undergraduate nursing students who had experience with patients with mental illness hold relatively positive perceptions toward mental health patients. Enhancing the content of nursing curriculum regarding issues related to patients with mental illness could help students develop better assessment skills, have more positive attitudes, and gain more accurate knowledge about mental illness. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 43-51.].

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

[Training caregivers to improve violence prevention and response]

Confronted with the phenomena of violence, hospital managers are putting in place continuing training sessions addressing the theme of prevention. These so-called 'violent' situations are generally triggered by patients or by their family. The analyses carried out subsequently enable the different mechanisms, notably institutional, which might have contributed to the emergence of these situations, to be identified.

Students' Perceptions of the Psychological Well-Being of a Transgender Client Through Simulation

BACKGROUND

The need to address mental health concerns for transgender clients is imperative. Nursing curricula must prepare students to provide holistic care for individuals within this community. The purpose of this study was to explore undergraduate nursing students' experiences providing mental health care for a transgender client through simulation.

METHOD

Focus group interviews were conducted with data analyzed using content analysis.

RESULTS

The three categories that emerged were limited experience addressing mental health needs, intervening with client anxiety with the subcategories of prioritizing care and collaboration, and therapeutic nurse-client relationship with the subcategory of therapeutic communication.

CONCLUSION

Nursing students must be prepared to provide holistic care for transgender individuals. Simulation allowed students to assess the client and evaluate their therapeutic communication in a safe learning environment. Further understanding of mental health care needs of transgender clients is essential for the promotion of their well-being. [J Nurs Educ. 2017;56(12):741-744.].

Pharmacology training in mental health nurse education: Justification for an increase in frequency and depth in the UK

This article explores the role and importance of Pharmacology within mental health nurse education. The article proposes that a lack of pharmacology content within undergraduate mental health nurse education may not fully prepare nurses for their role once qualified and as a result influence negatively upon service user care.

Development of Veteran-Centric Competency Domains for Psychiatric-Mental Health Nurse Practitioner Residents

The mental health needs of military service members, Veterans, and their families are a designated national priority; however, there has been little emphasis on the inclusion of Veteran-centric domains in competency-based nursing education for psychiatric-mental health nurse practitioners (PMHNPs). The current article describes the identification and application of Veteran-centric domains in an innovative pilot residency program for PMHNPs, funded by the Veterans Health Administration Office of Academic Affiliations. Fourteen Veteran-centric competency domains were developed from literature review, including knowledge, attitudes, and skill behaviors. Adoption and application of these domains in curricular components included the resident competency evaluation, baseline assessment of military experience, and evidence-based practice seminars and training. Methods of competency domain evaluation are presented, along with gaps related to the evaluation of competency skills. The delivery of mental health services reflecting these domains is consistent with the VA core values and goal of developing a positive service culture. [Journal of Psychosocial Nursing and Mental Health Services, 54(11), 31-36.].

Evaluation of a Standardized Patient Simulation on Undergraduate Nursing Students' Knowledge and Confidence Pertaining to Intimate Partner Violence

INTRODUCTION

Intimate partner violence (IPV) is a serious and preventable public health problem. Nurses are at the front lines of assessing and intervening with patients subjected to IPV. Lack of training and confidence is cited as a major barrier to assessing for IPV.

OBJECTIVE

The purpose of this study was to evaluate a standardized patient (SP) simulation experience depicting a victim of IPV on undergraduate nursing student knowledge and confidence in assessment and intervention of IPV.

METHODS

The Physician Readiness to Manage Intimate Partner Violence Survey tool was adapted to measure confidence, and a 10-item multiple-choice test was developed to measure knowledge, completed pretest, postlecture, and post-SP simulation.

RESULTS

There was a statistically significant increase in confidence from pretest to postlecture, 14.04 (SD = 3.01) to 20.61 (SD = 2.39), F(1, 56) = 345, p < 0.001, to postsimulation, 14.04-21.93 (SD = 2.18), F(1, 56) = 21.1, p < 0.001. Only statistically significant increases in knowledge occurred from pretest to postlecture, 6.96 (SD = 1.36) to 7.95 (SD = 1.47), F(1,56) = 29.84, p < 0.001. Increase in knowledge from postlecture to postsimulation was not found to be statistically significant, 7.95 (SD = 1.47) to 8.05 (SD = 1.27), F(1,56) = 0.632, p > 0.10.

CONCLUSION

Healthcare professionals need to be adequately educated and trained to screen for IPV. This study provides preliminary evidence that the addition of an SP simulation appears to enhance nursing student confidence and knowledge of assessing and intervening with victims of IPV.

Master's level mental health nursing competencies, a prerequisite for equal health among service users in mental health care

PURPOSE

This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging.

METHODS

Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services.

RESULTS

The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care.

CONCLUSION

This discussion paper shapes implications for developments in master's level mental health nursing education curricula.