Journal of the American Psychiatric Nurses Association最新文献

AimExamine methods of suicide among nurses cross-nationally.MethodsThe literature was searched to identify epidemiological and cohort studies that analyzed suicide mortality among nurses cross-nationally. Studies were included if nurse suicide mortality was analyzed, and if methods of suicide among nurses were concurrently examined. In total, 22 studies were included, 16 of which were epidemiological and 6 of which were cohort.ResultsAcross all studies, nurse suicide decedents from 11 countries were represented. Across most global studies, self-poisoning and hanging were two frequently utilized methods of suicide among nurses. However, in the United States, two common suicide methods included self-poisoning and firearms. While there was likely overlap with respect to public reporting of global cases, in China and India, leading methods included jumping from a building and hanging, respectively. Taken together, despite some inconsistencies, self-poisoning was one of the most frequently reported suicide methods among nurses across studies.ConclusionAdditional research is important in building the evidence base, particularly with respect to ranking methods of suicide, and further differentiating between suicide methods used by female and male nurses cross-nationally. Additional cross-national research regarding specific substances utilized in suicide self-poisoning deaths is also needed. Because means restriction represents a key suicide prevention strategy, these data are needed to inform means restriction interventions among nurses.

Objective: To explore how integrating Narrative Identity (NI) theory and the Suicidal Narrative (SN) framework into nursing practices can enhance suicide risk assessments and therapeutic engagement, promoting resilience, hope, and recovery among patients.

Methods: This study reviews existing literature on NI and SN frameworks, examining their theoretical foundations and applicability in nursing. It analyzes how these frameworks improve understanding of patient suicidality through qualitative assessment of personal narratives and identifies practical steps for implementation in clinical settings.

Results: The integration of NI and SN into nursing practices has shown potential in improving the quality of suicide risk assessments. It enables nurses to gain a deeper, empathetic understanding of the factors influencing each patient's suicidality, fostering enhanced therapeutic engagement. Challenges such as time constraints and the need for specific training in narrative techniques are identified.

Conclusions: Incorporating NI and SN into nursing assessments can significantly enrich the suicide risk assessment process, providing a more nuanced and empathetic approach that focuses on individual patient stories. However, effective implementation requires overcoming several barriers, including enhancing nurse training in narrative methods and adjusting clinical workflows to accommodate more in-depth patient interactions.

Background: Social anxiety is an emerging public health issue associated with significant impairment of social functioning during adolescence. Among many determinants of social anxiety, proneness to smartphone addiction may significantly contribute to the development of social anxiety. To cope with the consequential development of social anxiety, adolescent school students may rely on various forms of social support. Particularly in the Middle East, including Jordan, the relationship between proneness to smartphone addiction and adolescent social anxiety is understudied.

Aim: To examine the mediating role of social support in the relationship between proneness to smartphone addiction and social anxiety in a sample of adolescent school students.

Methods: In this cross-sectional study, 432 adolescents were recruited via a random cluster sample from public schools across three provinces in Jordan. The data were collected face-to-face using the Social Anxiety Scale for Adolescents, the Smartphone Addiction Proneness Scale, and the Multidimensional Scale of Perceived Social Support.

Results: Significantly higher levels of social anxiety were associated with females of lower economic status who reported more gaming hours and higher levels of proneness to smartphone addiction. Familial social support significantly mediated the relationship between proneness to smartphone addiction and social anxiety, controlling for the other covariates in the social anxiety model.

Conclusions: Familial social support reduced the impact of proneness to smartphone addiction on social anxiety. Nurses may supplement treatment for reducing social anxiety in adolescents suffering from proneness to smartphone addiction by fostering sources of familial social support.

IntroductionIncreased aggression in a regional Comprehensive Psychiatric Emergency Program (CPEP) led to a significant rise in physical assaults, restraints, and use of security personnel. Root cause analysis revealed a need for more extensive training on de-escalation, teamwork and communication.

Aims: This quality improvement project evaluated the impact of an interprofessional, high-fidelity simulation project on interdisciplinary collaboration to manage de-escalation and aggression safely and effectively.

Methods: Interdisciplinary team members (N = 171 nurses, psychiatrists, social workers, crisis specialists, and safety officers) participated in a 2.5-hr educational initiative that included Crisis Prevention Intervention (CPI) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) interventions, high-fidelity simulation using standardized patients, observation, and debriefing. Quantitative data collection and analysis included the use of the Confidence in Coping with Patient Aggression Instrument (CCPAI), TeamSTEPPS Perception Questionnaire (T-TPQ), pre-post data on restraints, injuries, and an educational survey. A qualitative analysis of debriefing themes was also performed.

Results: Statistically significant improvement was noted in individuals' confidence to manage aggression. In addition, data collected over a 5-month period before and after simulation demonstrated a 35% reduction in restraints and a 52% reduction in injuries. Interestingly, quantitative evidence revealed no changes in perceptions of teamwork. Results from the educational survey highlighted the positive impact of standardized patients and debriefing, and gaining new insights into patient care. Qualitative analysis of debriefing themes revealed educational opportunities to improve communication, role clarity, de-escalation, and insights into patient impact.

Conclusion: The use of high-fidelity simulation with standardized patients has the potential to strengthen interdisciplinary collaboration to safely manage aggression in an acute psychiatric setting.

IntroductionTobacco smoking remains a leading cause of preventable disease and death in the U.S., with a high prevalence among individuals with mental health disorders (MHD). Despite regulatory efforts to increase tobacco use disorder (TUD) treatment in psychiatric inpatient units (an ideal setting), compliance of offering and using these interventions remains suboptimal.AimsThis project aimed to examine the effectiveness of a nurse-driven protocol, Smoking treatment Protocol for Inpatients via Nurse-driven Interventions & Teaching (SPIN-IT), on improving compliance with evidence-based TUD treatment interventions in an inpatient psychiatric unit.MethodsSPIN-IT was developed and implemented in a 20-bed inpatient psychiatric unit. The protocol allowed registered nurses (RNs) to deliver TUD counseling and prescribe nicotine replacement medication based on an algorithm without an independently licensed provider (LIP). Data on compliance with CMS tobacco measures (TOB-2 and TOB-2a) were collected for 12 months before and after SPIN-IT implementation and analyzed for statistical significance.ResultsThe project included 835 patients over 2 years. Post-intervention TOB-2 compliance increased significantly from 84.7% to 99.3% (p < .001), and TOB-2a compliance rose from 24% to 56% (p < .001). The protocol resulted in more patients being offered and receiving TUD treatment counseling and medications.ConclusionThe SPIN-IT protocol significantly improved TUD treatment compliance in an inpatient psychiatric setting. It supports the effectiveness of nurse-driven protocols in enhancing patient outcomes and adherence to TUD treatment measures. Further research is needed to evaluate the long-term impact on TUD treatment and to explore the perceptions of nursing staff, physicians, and patients related to the protocol.

Background: Using long-acting injectable (LAI) antipsychotic medications can improve the outcomes of patients with schizophrenia, such as reducing symptom severity and hospitalization risk. However, the outcomes of switching from oral to LAI antipsychotic medications are unclear.

Aims: The purpose of this review is to provide a summary of the clinical, quality of life, and health care utilization outcomes of switching from oral to LAI antipsychotics among patients with Schizophrenia Spectrum Disorder.

Methods: We thoroughly searched the PubMed, Scopus, PsycInfo, and CINAHL databases. To conduct the meta-analysis, we used the Comprehensive Meta-Analysis Program.

Results: Forty-one articles met our inclusion criteria. After switching to LAIs, symptom severity, the number of rehospitalizations, emergency department visits, and overall health care costs were reduced. Also, social functioning significantly improved. However, no differences were observed in the frequency of outpatient visits. Pharmacy costs were increased between pre- and post-LAI initiation.

Conclusion: Our findings support evidence that changing the route of administration of antipsychotic medications from oral to long-acting intramuscular injections can improve the clinical, quality of life, and health care utilization outcomes in people with schizophrenia. Health care practitioners might consider encouraging LAI use earlier during treatment for schizophrenia for better clinical outcomes and to reduce health care utilization associated with treatment.

Background: The therapeutic relationship serves as a cornerstone in psychiatric mental health nursing practice, providing a basis for implementing various interventions.

Aims: This study aimed to explore the perspectives of psychiatric mental health nurses regarding factors that facilitate and impede the therapeutic nurse-patient relationship.

Methods: A descriptive study was conducted among psychiatric mental health nurses employed at two community psychiatric hospitals in the northeast area of the United States. A list of facilitators and barriers was developed based on an extensive literature review and subsequently validated by three experts in the field of psychiatric mental health nursing. Participants rated these factors on a 10-point scale.

Results: The study included 74 registered nurses from two psychiatric hospitals, yielding a 24% response rate. The highest-ranked facilitator was awareness that the relationship enables collaborative goal setting with patients. The most significant barrier was insufficient time due to administrative tasks.

Conclusions: This study highlights the importance of understanding facilitators and barriers in the therapeutic nurse-patient relationship. Replicating the study nationally on a larger scale among psychiatric mental health nurses is recommended.