International Journal of Mental Health Nursing最新文献

For people who seek help for self-harm, emergency departments (ED) are often the first point of contact, making them a suitable setting for intervention. In Australia, base rates of self-harm presentations to ED are increasing, while the quality of care these people receive is often considered sub-optimal. This study used qualitative interviews to explore potential barriers ED staff face in delivering best possible self-harm care. Seventeen staff across two EDs in the state of Victoria, Australia, were interviewed regarding their perceptions of barriers to providing optimal self-harm care and suggestions for improvement. Three themes were identified: (1) system-related challenges when managing self-harm in ED, including the shortage of hospital resources, challenges of ED as a physical environment, and insufficient education, training and guidelines about self-harm care for staff; (2) human-related challenges regarding management of self-harm in ED, which encompassed the nature of a person's circumstances and presentation, and staff attitudes towards self-harm; and (3) staff suggestions for improving self-harm care in ED. Specific recommendations that were proposed based on these findings included introducing a separate ED area for mental health-related presentations, provision of specialised education and training about self-harm care to staff, better implementation of guidelines on treating self-harm in ED, and employing mental health educators to provide on-the-floor mentoring to nurses. The relevance of these barriers and recommendations to the wider healthcare sector is also discussed. Together, these findings may inform improvements to the quality of care provided to those who engage in self-harm.

In mental health care settings, inpatients are increasingly engaged in their care process, allowing them to participate in multidisciplinary team meetings. Research into how mental health patients (MHPs) experience participating in such meetings is, however, limited. This study aimed to explore inpatients' experiences when participating in multidisciplinary team meetings in a Belgian inpatient mental health unit. This study used a phenomenological design with data collection including semistructured interviews. Twelve individuals participated in the study. Participants were MHPs admitted to a mental health unit that works according to the model of recovery-oriented mental health practice. Findings were analysed utilising thematic analysis. Results showed that the MHPs' experiences were mainly positive but intense. Themes included: ‘Feeling honoured to be invited’, ‘Sense of obligation’, ‘Feeling nervous’, ‘Transparency in team members’ insights', ‘Feeling supported by the (primary) nurse’ and ‘Duality about the presence of relatives’. By taking these findings into account, (mental) healthcare workers gain insight into the patient's lived experiences, allowing them to provide more person-centred care when inpatients participate in multidisciplinary team meetings. Moreover, these findings can support mental health units in implementing or optimising patient participation in multidisciplinary team meetings. Finally, other (mental health) patients can also benefit from these findings as it can help them to put feelings and thoughts into perspective when participating in a multidisciplinary team meeting during a hospital admittance.

This systematic review aimed to synthesise the qualitative evidence of mindfulness-based interventions and focused on the perceptions and experience of older people. A literature search was conducted using electronic databases including CINAHL, EMBASE, EMCare, and MEDLINE. The inclusion criteria for the review were an original study that includes qualitative data on experience and perceptions of mindfulness interventions, a study population involving older people aged 60 years and above, and articles published in English. Eleven articles are included in this review. Four major descriptive themes were generated from the data synthesis: benefits on physical health, improved psychosocial well-being, development of new perspectives, and motivators and challenges of mindfulness practice. Mindfulness practice provided health benefits for pain management, promoting sleep quality, psychosocial well-being, and development of positive strategies such as a new way of coping in negative situations, acceptance, and a sense of freedom. Health benefits and positive reinforcement were reported as motivators, whereas time commitment and an easily distracted mind were barriers to continued mindfulness practice. In addition to the descriptive themes, two analytical themes were derived: inner peace and well-being through mindfulness and development of acceptance-based coping. The positive outcomes indicated in this review suggest that mindfulness-based interventions could be an effective therapeutic tool for the well-being of older people.

Safewards is a multi-intervention mental health nursing model of practice improvement aimed at preventing and reducing conflict and containment. The use of Safewards has now extended beyond mental health settings. Implementation of Safewards has been reported to be challenging and therefore requires an evidence-informed and structured approach. This review's objectives were to: (i) Comprehensively map approaches used to implement Safewards interventions; (ii) Characterise the outcomes measured in Safewards implementation studies; and (iii) Identify the facilitators and barriers to Safewards training and its implementation in practice. All quantitative, qualitative and mixed-methods publications of Safewards, the interventions, evaluations, barriers and facilitators from all healthcare services internationally were included. The Joanna Briggs Institute scoping review and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews were used to guide methodology. Data were reported according to the 12 items of the TIDieR. Twenty-seven publications reported the implementation of Safewards. Descriptions were limited for reporting items such as intervention descriptions, materials, resources, specific procedures and processes, modifications made to interventions and delivery of interventions and training. No consistent theoretical implementation framework was reported. Collaboration, leadership, feedback and co-design were strong drivers for staff buy-in, engagement and success for implementation in mental health and acute settings. Transparency, replicability and generalisation require a detailed description of all elements of an intervention being implemented. Without adequate information, only assumptions can be drawn about the clinical governance and process of the implementation and training, and it is difficult to conclude when attempting to replicate the interventions.

Perspectives of healthcare have, in past decades, focused more on active citizenship, human rights and empowerment. Healthcare consumer involvement as a concept is still unstructured and consumers have no apparent opportunities to participate in their care processes. The focus is often on the expertise of professionals, even if mental health consumers are willing to become involved and have sufficient decisional capacity. The aim of this integrative literature review was to construct an understanding of consumer perceptions and guiding frameworks of consumer involvement. There was no previous synthesis of mental health consumer perceptions combined with guiding frameworks. An integrative review methodology was employed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the 18 studies included was analysed with the Whittemore and Knafl approach. By following Braun and Clarke's guidelines, an inductive thematic analysis was conducted to collate the themes from the selected papers. Mental health consumers' perceptions of involvement included expectations of person-centred care, such as respect, dignity, equal interaction, supportive environments and being part of a community. This research did not find any single established framework to give clear guidelines for consumer involvement in mental healthcare, but similar determinants describing various frameworks were uncovered. This review also shows how the terminology has changed throughout the years. The perceptions of mental health consumers need to be considered to enable the implementation of person-centredness from guidelines through to practice. Paying more attention to the education of professional mental health caregivers and the involvement of mental health consumers in their care provides better opportunities to co-develop successful mental health services and recovery processes.

Outcome measurement and feedback are key to quality improvement in healthcare. Goal attainment scaling (GAS) is a tool that could be used to measure outcomes of mental health services delivering recovery-oriented care. The objective of this prospective study was to evaluate the effectiveness of tailored, interprofessional, multilevel and adaptable GAS training on clinician views, learning, competence, performance and confidence in the use of GAS. Thematic analysis of eight clinician participant views was done using the method proposed by Braun and Clarke (Thematic analysis: a practical guide to understanding and doing, 2022). Four main themes were generated: clinicians found that this type of training is useful, GAS influenced the way they thought about their roles in goal setting and recovery-oriented care and COVID-19 pandemic impacts. Furthermore, clinicians' skills to set scalable GAS goals with consumers and clinician confidence in using GAS improved. The results of this study show a positive impact of tailored, interprofessional, multilevel and adaptable training supporting development of clinician skills in the GAS process. The training design had a favourable effect on clinician views, learning, competence, performance and confidence of GAS as a recovery-oriented outcome measure. The approach to GAS training and use of GAS as a recovery-oriented outcome measure should be considered in response to mental health service reform.

Addiction nurses are highly skilled providers of holistic care and ensuring workforce sustainability is key to providing quality care to a traditionally marginalised group of healthcare consumers. The aim of this study was to explore perceived stigma towards the addiction nursing speciality, addiction nursing (also known as alcohol and other drug nursing) and its impact on workforce sustainability, retention and recruitment. Secondary analysis of qualitative interview data with nurses (n = 50) and survey data (n = 337) was conducted as part of a workforce mapping exercise in 2019. COREQ reporting guidelines were used. After structural coding was applied, three themes emerged: stigma experienced by clients of alcohol and other drug treatment services, stigma experienced by addiction nurses and a lack of awareness of the specialty of addiction nursing itself. Participants overwhelmingly felt that these forms of stigma made addiction nursing less attractive to new entrants, particularly new nurses and posed a threat to the sustainability of the specialty. The findings from this study indicate that urgent attention is required to address stigma towards individuals who use alcohol and other drugs, and the nurses providing care for them. Furthermore, creating awareness of the addiction nursing specialty is paramount to ensure workforce sustainability and to improve care for individuals who use alcohol and other drugs. Beyond addiction nurses, our results indicate that stigma towards other specialties (such as mental health nursing) is a substantive barrier to workforce sustainability.

This review examines factors associated with quality of life (QoL) in persons with young-onset dementia (YOD). Studies investigating and analysing factors related to QoL in persons with YOD were included. Databases searched included PubMed, CINAHL, Web of Science, EMBASE, and SCOPUS. Due to inconsistent outcome variables across studies, synthesis without meta-analysis was used for data integration. Methodological quality was assessed, and results were synthesised. Eleven studies were included in this review, identifying different factors influencing QoL in persons with YOD, which could be categorised into six groups. Behavioural and psychiatric factors showed the highest significant findings ratio (SFR), as determined by the ratio of ‘studies finding significance’ to the ‘total number of studies addressing the factor’. Following in terms of SFR were care-related and physical factors. Demographic and dementia-characteristic factors had the lowest SFR. Among single factors, depressive symptoms, and neuropsychiatric symptoms, both included in behavioural and psychiatric factors, had the highest SFR. This systematic review highlights the importance of behavioural and psychiatric elements in QoL in persons with young onset and points to depressive symptoms and neuropsychiatric symptoms as potential therapeutic targets. However, as research on QoL in persons with YOD continues to expand, the inclusion of methods such as meta-analysis may be beneficial.

Preceptorship is considered an essential component in undergraduate nursing student's clinical placement, especially those in speciality units such as mental health. During the preceptorship relationship students are granted the opportunity to work alongside experienced nurses in the ward observing their interactions with patients and other professionals. In addition, students are able to build clinical confidence and competence. There is currently a gap in the literature around the preceptorship experience in the mental health clinical environment which warrants further exploration. The aim of this study was to explore the experiences of Registered Nurses precepting undergraduate nursing students during mental health clinical placements. A qualitative, exploratory approach was performed. A total of eight registered nurses working in an acute in-patient mental health unit in a large regional hospital, were recruited and interviewed using a semi-structured interview technique. Thematic analysis was utilised to analyse the data resulting in the development of four overarching themes; (1) Time consuming and additional workload, (2) creating a safe environment, (3) providing and receiving feedback and (4) precepting is not a choice, it is an expectation. The results highlighted that preceptoring students was considered to be an extra workload that required significant time and effort. Preceptors also expressed concerns about student safety, emphasised the importance of feedback and acknowledged preceptorship as an expectation of registered nurses working in mental health. These findings underscore the necessity for further research to delve deeper into the experience of preceptors in mental health settings.

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders’ perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.