International Journal of Mental Health Nursing最新文献

Effective suicide prevention strategies in community mental health services demand high standards of patient safety. The nature of suicide is complex and uncertain. However, learning needs to be sensitive to the fear of blame. Little is known about how health services investigate suicides post hoc, how they examine why a suicide might have occurred, and how they generate any organisational learning that might improve patient safety. The aim of this novel qualitative study was to explore the accounts of key people involved in the serious incident investigation process regarding the subsequent organisational learning. Carers, clinicians, investigators and senior managers were recruited via regional and national networks; data were collected through focus groups and individual interviews. The dominant themes that emerged from this analysis did not reflect the tenor of the literature related to the investigative process and organisational learning, accepting that the literature is relatively sparse. A reflexive thematic analysis developed an understanding of mitigations against a fear of blame which appeared protective of all participants' positions, including those specific to suicide risk. We argue that mitigation operated as a barrier to organisational learning and improving patient safety in adult community mental health services. The findings are discussed in the context of organisational culture, learning and wider system thinking. The concept of mitigation against a fear of blame constructs new insights into this ambiguous and emotionally demanding sphere of patient safety.

This research explored the variation in undergraduate nursing students' understandings of mental health (MH) at a Melbourne metropolitan university. Using phenomenography, a qualitative research methodology, the study involved interviewing 19 students at different stages of a 3-year Bachelor of Nursing or Bachelor of Nursing and Midwifery degree. The research was undertaken as part of a PhD study undertaken between 2016 and 2020. The findings revealed seven distinct categories of understanding of MH, ranging from fear-driven misconceptions of mental health disorder (MHD) to a holistic perspective recognising MH on a spectrum potentially fluctuating throughout an individual's lifespan. This research revealed an improvement in nursing students' understanding of MH with initial responses marked by fear and anxiety rooted in cultural beliefs and personal safety concerns. As understanding developed, students focused on physical symptoms and causality, sometimes attributing MHDs to personal misfortune or choice. The most advanced level demonstrated a sophisticated, integrated view recognising the interconnectedness of mental and physical health. These findings highlight the challenges students face in understanding MH and the critical need to address misconceptions within nursing curricula. The study recognises the importance of innovative educational strategies to enhance MH literacy among nursing students. The findings contribute valuable insights into teaching practices and the development of targeted educational interventions in MH nursing education.

Mental health nurses (MHNs) face unique occupational challenges, including high emotional demands, frequent exposure to workplace violence, and risk of burnout. Social support is widely recognised as a protective factor that can enhance well-being and job satisfaction in this high-stress profession. In this research, social support is defined as the emotional, informational, and instrumental assistance that MHNs receive from interpersonal relationships in the workplace, such as from colleagues, immediate supervisors, and informal peer networks. HR support or organisational support, by contrast, refers to formal structures and resources provided by the organisation itself. Despite this, little is known about MHNs' perceptions of the availability, accessibility, and value of social support within their workplace settings. This qualitative study explored the perceived levels and effects of social support among MHNs using semi-structured interviews. Six MHNs were recruited via purposive and snowball sampling. Interviews were conducted online, transcribed, and analysed thematically to identify common patterns and variations in participants' experiences. Thematic analysis identified five key themes: agency in seeking support, forming alliances, the informal nature of support, its varying availability, and the necessity of support to sustain a career in MHN. Peer support was described as essential, informal, and self-initiated, while formal organisational support was often viewed as lacking. Digital platforms emerged as supplementary sources. The findings underscore social support's crucial role in MHNs resilience and well-being, and highlight the need for healthcare organisations to strengthen both informal and formal support structures to improve job satisfaction, reduce burnout, and promote retention.

Eating disorders are a group of conditions characterised by an alteration in patterns of food intake and have a high risk of mortality. Eating disorders are particularly challenging to treat because they encompass both mental and physical domains of healthcare, requiring a complex multidisciplinary approach that often involves clinicians who may only have singular training: Medical or mental health. The aim of this study was to describe the experiences and perspectives of general paediatric nurses caring for young people with medically compromised eating disorders in a general paediatric setting. We used a qualitative descriptive design, employing thematic analysis to analyse interview transcripts of general paediatric nurses (n = 13) in a tertiary hospital in Victoria, Australia. Several themes emerged from the data including (1) Confidence in therapeutic engagement, (2) Stigma in Practice and (3) Impact of restrictive interventions. To help young people with eating disorders, common mental health practices such as trauma-informed care, therapeutic alliance and least restrictive practices must form the basis for general medical management and stabilisation. Nurses working in this environment need further training and support to ensure that they can provide best-practice mental health care to young, vulnerable people with dynamic and complex needs.

There are few community interventions that provide a whole-of-family approach to supporting families where a parent has mental health challenges. The Satellite Foundation is a community organisation that provides a range of non-clinical programs, including Family Camps, to support young people in families who have a family member with mental health challenges. The aim for this qualitative evaluation was to understand the experiences of parents and children participating in Family Camp, and their perspectives on its impacts. Parents and children participated in semi-structured interviews post Camp. Questions focused on their experience of Camp and how it might have impacted them and their family. Data were inductively analysed, with separate thematic analyses of parent and child data sets, followed by a comparative qualitative synthesis. Key findings included parents and children valuing the Camp as an opportunity to strengthen family bonds through shared activities, while also fostering meaningful conversations about mental illness that deepened connection within their families. While some arrived with unclear expectations, and some found the Camp pace and structure emotionally challenging, many parents and children found the experience enriching. The findings highlight the effectiveness of Camps in reducing isolation, promoting family connectedness and encouraging discussions about mental health. These are key factors for strengthening wellbeing in families where a parent has a mental illness. Mental health nurses and other clinicians have an important role to play in supporting young people and families living with mental illness through referral to Family Camps and organisations such as the Satellite Foundation.

Over the past decade, psychiatric wards across the Netherlands have worked in accordance with the High and Intensive Care model to reduce coercion and improve the quality of care. Securing implementation of the model within a challenging mental health care context has proven to be effective but complex in practice. Consequently, this study aimed to both gain insight into the process of implementing the High and Intensive Care model by drawing upon professionals' own reflections and provide recommendations for improving practice and the model. This is a national multicentre study that utilised qualitative methods. Data was collected by a total of 26 institutional and national group interviews on which thematic analysis was conducted. Staff turnover, coercion, collaboration with outpatient care, working methodically and the move from control to contact were found to be the key developments since the model's implementation. Future efforts should focus upon staff retention and acquisition to ensure continuity of care and safety. Ongoing evaluation of coercion is essential to further reduce coercion. Collaborations with outpatient care and other stakeholders should be intensified to promote effective care. Management support, reflexivity and a clear vision are required to strengthen methodical working and collaboration between wards to create uniformity of practice. Working in contact with patients ensures safety but requires time and behavioural change. Applying implementation science can support improvements in acute mental health care by systematically addressing barriers to change, promoting sustainable evidence-based practices, and guiding the reduction of coercion. Further research into these barriers, including the exploration of non-coercive strategies and stakeholder involvement, is needed to enhance High and Intensive Care implementation and similar practices.

The state of Victoria, Australia is currently in a period of mental health reform, spurred on by a recent damning Royal Commission and updates to legislation. New legislation promotes the choices and rights of consumers in the mental health system, including recommendations to eliminate seclusion by 2030. While much of this reform has been met with enthusiasm by consumer groups and nurses alike, there remains uncertainty. The aim of this paper is to describe the experiences and perceptions of mental health nurses on mental health reform in the State of Victoria, Australia. Adopting a qualitative descriptive method, mental health nurses (n = 14) working in public mental health services in Victoria undertook individual interviews, with data thematically analysed. After analysis, three themes were identified: Navigating the new Act: Overcoming Managing challenges faced by mental health nurses, Defusing the storm: Mental health nurses' safety concerns under the new Act, and Workforce strain and organisational value: The impact on mental health nurses. Nurses described distress at working in a system with increasing occupational pressures and expressed concern that the goal to eliminate seclusion by 2030 may not be achievable due to current system constraints and deficits. They also highlighted legislative barriers that prioritised consumer preferences over clinical judgement, which they perceived as contributing to a decline in consumer wellbeing and, in some cases, serious adverse outcomes. While mental health reform is essential to improving care, it must also consider the practical and emotional demands placed on clinicians within evolving legislative frameworks. This study identified that the implementation of mental health reform requires a consistent approach by health services and government that promotes the needs of consumers whilst also balancing the significant workplace stressors that nurses encounter. Plans to eliminate restrictive practices need to adopt a consistent, collaborative approach that recognises the complexity of current challenges and the importance of thoughtfully addressing the underlying factors, rather than simply removing existing responses.

There has been a dramatic shortage of patient-focused research in the history of psychiatric inpatient treatment. This study aimed to explore the lived experience of a sample of inpatients of psychiatric hospitals in Ireland before the introduction of the Mental Health Act in 2001. Six adults (aged 40–73 years; M = 57) who had been inpatients in Irish psychiatric institutions were interviewed using a semi-structured format. The data were analysed using interpretative phenomenological analysis. The analysis yielded four Group Experiential Themes (GET): Within the Walls, the Treatment of Treatments, Relationship with Self and Identity as Patient, and Relationships and Ruptures. Each GET comprised two subthemes exploring the impact of participants' admission to a psychiatric hospital. Participants described a complex and ambivalent relationship to their psychiatric admission. The findings emphasised the need to understand the individuals' experiences and the societal and cultural context in which the admission occurred. The findings highlighted how historical psychiatric admissions impacted social identity and wellbeing. The findings have direct clinical implications. This cohort is aging and may require inpatient services in the form of nursing home care. For those who have experienced long-term psychiatric institutionalisation, it is important to tailor support for this group whose voices have not been heard until now.