International Journal of Mental Health Nursing最新文献

Despite advancements in promoting family engagement in mental health settings, limited involvement of family members persists in forensic mental healthcare. Forensic mental healthcare professionals face various barriers in engaging families, including a patient-centered approach and resource constraints. However, limited understanding exists of professionals' experiences with family engagement, which is crucial for improving care practices in this setting. Consequently, this study investigates the evolution of professionals' experiences with family engagement from 2015 to 2021 in Flanders, Belgium. Qualitative methods were employed, including focus group interviews in 2015 and individual interviews in 2021 with 23 forensic mental healthcare professionals. Thematic analysis is employed to identify patterns and changes over time. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. The analysis revealed that while initial steps towards family engagement in forensic mental healthcare have been taken, full integration in organisational structures is still lacking. Future efforts should focus on involving family organisations and caregivers, addressing barriers like time and resource constraints, and fostering a cultural shift towards family engagement. Further research involving a broader range of stakeholders is needed to enhance family engagement initiatives in forensic mental healthcare settings.

Striking a balance between risk and recovery while supporting people in suicidal distress is a challenging proposition. To address this challenge, a 4-week AIMS (Assessment, Intervention, Monitoring, Step up/down) pathway was created to support people in suicidal crisis. Each of the four functions was customised into semi-structured conversations about pain relief. The pathway operationalised tools for relational safety from the PROTECT framework for suicide prevention. To deliver this pathway, a new team was established that included both clinicians and lived experience staff. Scores for the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) for 300 patients were collected before and after time on the pathway. Paired T tests were performed individually for each item as well as for the total. All 7 items and the total score had statistically significant improvement (p < 0.01). The mean pre- and post-total scores increased from 14.8 to 22.5, strongly indicating clinically meaningful improvement at an individual and group level. The improvement on baseline in each of the seven items ranged from 38% to 73.5%. The top two were in the person's ability to deal with problems and in them feeling relaxed. The study provides a blueprint for collaborative and empowering suicide prevention pathways that strike a balance between positive risk taking and safe care through a relational approach. Professional and lived experience both played a part in capturing hope through evidence-based person-centred interventions, helping a person in suicidal crisis improve their mental wellbeing.

There is a growing focus in the Australian healthcare system of providing mental health care in a community setting. A key feature of the Royal Commission into Victoria's mental health system was to prioritise community-based care ‘a system with community at its core’. Developing a skilled, flexible and competent nursing workforce is a key objective for any community-based mental health service as nurses provide a vital role in healthcare delivery. The 3-year comprehensive nursing qualification has little to no mental health curriculum leaving nursing graduates unprepared for work in mental health, while hospital-based training for graduate nurses doesn't prepare them for the realities of community-based work. Significant work in Victoria to develop, refine and implement a competency framework for transition from acute mental health inpatient settings into community-based services has been undertaken. The aim was to evaluate the effectiveness of this framework in preparing nurses for the community workforce, as well as the barriers and enablers of implementation. A qualitative method investigated experiences of mental health staff who had participated in the transition programme in either aged, adult or a homeless outreach team. Interviews were conducted with transition nurses (n = 5), mentors (n = 4), Clinical managers (n = 3) educators/coordinator (n = 2). The framework structure helped mitigate role stress, allowed for consolidation of theory into practice providing learning opportunities, provided clinical oversight for safe practice, supported autonomous practice, critical thinking, staff wellbeing and demonstrated positive outcomes for consumers and carers. It also had a positive impact on retention and recruitment. Whilst there were limited barriers, the framework implementation relied on organisational support with staff resourcing. Evaluation findings demonstrate the importance of this framework. This structured programme helped facilitate professional development with an integration of knowledge, skills, attitudes and confidence along with staff wellbeing, leading to enhanced clinical practice and outcomes for clients and carers.

Due to the rising number of long-term mental health conditions, there has been a shift in therapeutic focus from curing these conditions, to living a meaningful life with them. Self-management is described as the ability to live with the emotional, life role and medical consequences of long-term conditions such as schizophrenia. However, the perspective of people with schizophrenia on self-management in current literature is missing. A lack of understanding of strategies used by people with schizophrenia to self-manage, could adversely affect the use of self-management interventions. Therefore, this study aims to identify how people with schizophrenia manage their daily life. Semi-structured interviews (n = 9) were conducted in a qualitative descriptive design. The study is reported by using the COREQ checklist. All participants, recruited through purposive sampling, have been stabilised after a schizophrenic episode and have been reintegrated into their community. The data were analysed through thematic analysis. Self-management for people with schizophrenia is an individualised process that revolves around performing day-to-day activities according to the participant's wishes. In addition, participants tried to prevent relapse by self-managing daily life. Personal-, social- and schizophrenia-related factors were seen as barriers and/or facilitators in their self-management. These barriers and/or facilitators were self-managed using daily activities. Current self-management interventions for this population often aim at improving medication adherence. Self-management interventions facilitated by health care professionals should (i) focus more on supporting patients in finding their daily structure through meaningful activities and (ii) be mindful of the duality contained within self-management of people with stabilised schizophrenia.

Mental health patients are increasingly invited to participate in multidisciplinary team meetings during their admission to inpatient mental health units. To participate effectively, patients must adopt a role that enables them to actively engage and take their place as contributing member of the team. This study aims to understand how mental health patients experience the development of their roles when participating in multidisciplinary team meetings and to identify which dynamics are meaningful to them. A qualitative interview approach, using principles of grounded theory, was employed. Twelve mental health patients in Belgium were recruited for semi-structured interviews. Data were analysed using the constant comparative method. The conceptual framework which emerged reveals that mental health patients strive to assume a partnership role within the team. To effectively take on this role, they identify three key components as essential: being informed and prepared, being seen and heard and being able to understand. Based on their reflections on these components and the perceived value of their contributions and efforts, mental health patients decide whether to become and remain active members, revert to passive attendance or disengage entirely. These insights can encourage organisations to create an environment where mental health patients can grow into their role as partners in multidisciplinary team meetings. Such an environment would enable collaborative efforts between patients and the treatment team, recognising each patient as a unique individual capable of making their own choices. By focusing on what is personally meaningful to the patient and addressing their specific needs, this approach ensures that care is tailored to what is crucial for patients' recovery.

There is a global initiative to reduce the use of restrictive care practices in mental health settings. Variations in the reported rates across regions complicate the understanding of their use and tracking trends over time. However, it remains unclear whether these discrepancies reflect real differences in the implementation of these practices or are sourced from inconsistencies in incident classification and reporting methods. This study employed a co-design approach to identify contexts that would influence the classification and reporting of restrictive care practices. The research involved 29 mental health stakeholders, including 22 professional experts from 13 countries across Europe, Africa, North America, Asia and Australasia and seven service users and family carers from Australia. Recruitment was conducted through email invitations, snowball sampling and social media outreach. Six web-based panel meetings, each lasting 90–120 minnutes were held. These discussions focused on exploring various contexts that might lead to uncertainty among professionals when classifying and reporting actions whether or not as restrictive care practices. A final list of 23 contexts was identified and considered for the development of 81 case scenario items. Finally, all the 29 panel members selected 44 from 81 case scenarios for inclusion in an upcoming international survey to examine variations in the classification and reporting of restrictive care practices. The findings from this co-design work emphasise the involvement of a wide range of factors and contexts in the classification and reporting of restrictive care practices that may contribute to the observed variations in the in the reported rates of these practices. The case scenarios developed in this study will support future research and serve educational purposes, illustrating real-life situations in the mental healthcare context.

A number of people experiencing a mental health crisis who present to a hospital emergency department (ED) do not wait (DNW) for assessment or care and leave. This phenomenon is poorly understood and offers an opportunity to enhance quality of care. We sought to understand the characteristics and reasons of those who DNW for assessment or care, and what happens after leaving the ED. We used a semi-structured telephone interview method with open-ended and single choice responses. Participants were recruited from Eastern Health hospitals who had been referred from the ED for specialist mental health care. Respondents (N = 42) tended to be female adults in their 30s, accompanied by another person, and seeking short-term relief and long-term care for a mental health crisis. It became increasingly obvious over time to participants that the cost of waiting was outweighed by the benefit of leaving. A range of factors were identified that took them to this tipping point. Over half reported their condition as having improved and did not seek further care after leaving the ED. Respondents thought a comfortable ‘safe place’ and communication that conveyed respect and reduced uncertainty while waiting would reduce early leaving. There were challenges in engaging a DNW population. Nonetheless this study offers valuable insights into this phenomenon in an ED setting. Many of the expressed views for reducing DNW appear to be reasonable and achievable.