International Journal of Mental Health Nursing最新文献

Restrictive practices are used to contain risk and maintain physical safety on inpatient mental health wards, but have been shown to negatively impact patient well-being and trust. Researchers and professionals have suggested that inpatient mental healthcare focuses on physical safety at the expense of psychological safety. The relationship between restrictive practices and psychological safety has not yet been explored. This study aimed to explore the impacts of receiving and witnessing restrictive practices on psychological safety, to understand what could be done to make restrictive practices psychologically safe. Eighteen semi-structured interviews were carried out with former patients (aged 20–60 years) who had been discharged for longer than 6 months from adult inpatient mental healthcare in the United Kingdom. Data were analysed using reflexive thematic analysis. Four themes were generated: (1) Reactive over proactive care: seeing the behaviour and not exploring the reason, (2) A chaotic environment cannot provide safety for patients and staff, (3) Psychological impact of the (perceived) power imbalance between staff and patients and (4) Emotionally all in it together, for better or worse. The results support that physical risk is heightened in inpatient settings, but containing this should not come at the expense of psychological safety. Supportive communication and giving small acts of control to patients should be prioritised to enhance the psychological safety of patients.

Although the insight paradox in patients with schizophrenia has been widely discussed in the literature, there is currently no consensus on its definition. A clear conceptualization is essential to support research addressing this phenomenon. Therefore, the aim of this study was to analyse the concept of the insight paradox in schizophrenia using the concept analysis method developed by Walker and Avant, with the goal of identifying its defining attributes, antecedents, and empirical referents. A total of 29 articles were included in the final review. The attributes of the insight paradox were classified into two categories: positive clinical outcomes, consisting of stabilisation of the condition, compliant treatment attitude, and improvement in functioning; and negative subjective outcomes, consisting of negative emotions, decline in quality of life, loss of goals and hopes, and decline in self-worth. The identified antecedents were the formation of insight, cognitive foundation, and negative attribution of illness. Consequences included loss of future prospects, passive treatment attitudes, social withdrawal, and worsening of illness. These findings suggest that insight in schizophrenia should not be regarded merely as a clinical label, but rather should be understood within the broader framework of self-awareness. Future psychological education interventions should account for both clinical and subjective outcomes in order to support more holistic recovery.

The purpose of this study was to explore the perceived barriers to reducing heavy drinking and seeking treatment among young adults, both for themselves and for others. A qualitative study was conducted using virtual focus group sessions with five groups and the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline was followed. In November 2022, 19 young adults, aged 18–24, were recruited for the study. The average age of participants in the focus group was 23.11 years (standard deviation = 0.99), ranging from 21 to 24. Data was analysed using deductive content analysis. 58% of participants identified themselves as heavy drinkers, although only 26% (n = 5) had sought treatment for alcohol use. Furthermore, 68% reported that their family members or friends experienced drinking problems. Participants expressed that heavy drinking experiences for both themselves and others were influenced by the social and cultural contexts they were exposed to, in addition to peer influence. The results regarding participants' experiences with seeking treatment for heavy drinking reveal a multifaceted picture of the challenges and barriers faced by young adults and others they observed in accessing help for their alcohol-related issues. This study sheds light on the experiences of young adults (self and others) with heavy drinking and the obstacles encountered in seeking and receiving treatment. The findings underscore the importance of developing targeted interventions and support systems to address these challenges and improve the well-being of young adults experiencing heavy drinking. Future research and policy efforts should focus on reducing stigma, enhancing accessibility to treatment services, and promoting peer support to facilitate more effective alcohol treatment for this demographic.

People with borderline personality disorder (BPD) are high utilisers of acute psychiatric services (i.e., psychiatric emergency and inpatient services). Yet, people with BPD often encounter significant stigma in these settings, which can result in demoralisation and reluctance to seek further care. Peer support services are increasingly adopted to align mental health services with recovery-oriented principles. This study aimed to understand the perceived acceptability, opportunities and challenges of integrating peer support for people with BPD in acute psychiatric services. We invited people with lived experience (i.e., people with symptoms of BPD and their loved ones) and mental health professionals who provide care for people with BPD to participate in an online survey. We received 41 quantitative responses and 25 responses to open-ended questions. Peer support was rated as important by people with lived experience and providers. Themes extracted via thematic analysis from the open-text responses considered how peer support would (or would not) meet patients' needs, including: feeling seen, heard and understood; fostering a sense of connection and belonging; reducing negative or stigmatising experiences; accessing instrumental and informational support; experiencing a sense of psychological safety; and enhancing a sense of hope. Most responses saw peer support as well matched to these needs; however, some expressed possible implementation challenges, including staffing consistency, role confusion and incompatibility of crisis stabilisation versus recovery goals. Overall, results underscored the potential of peer support to enhance alignment with recovery-oriented practice, which is an organisational priority for many mental health services.

Approximately one-third of patients who visit general hospitals have a mental disorder, which is associated with poorer outcomes and higher costs. Caring for these patients can be challenging for nurses, particularly when behaviours such as aggression, wandering, or lack of cooperation occur. To explore how nurses experience caring for patients with medical-psychiatric comorbidities in general hospital wards a qualitative study using semi-structured interviews was conducted. Sixteen registered nurses with varying experience from eight wards in a Dutch university medical centre participated. Data were analysed inductively using Braun and Clarke's thematic analysis. Nurses' experiences were captured in three themes: managing emotions, adapting to contextual factors and building competence. Managing emotions reflected feelings ranging from frustration to compassion, and strategies such as peer support and rationalisation to cope. Adapting to contextual factors highlighted challenges including time pressures, competing demands and environments ill-suited to mental health needs. Building competence involved learning through experience and emphasised the need for education and multidisciplinary collaboration. Nurses' challenges in caring for patients with medical-psychiatric comorbidities stem less from the patient's behaviour itself than from limited training, organisational structures and systemic barriers. Caring for these patients requires more than individual coping strategies; organisational, educational and interprofessional support are essential to improve care delivery and nurse well-being. Simulation-based training, structured reflection and interprofessional collaboration may strengthen competence and confidence, while organisational adjustments could foster safer and more person-centred care.