Journal of the American Psychiatric Nurses Association最新文献

Objective: To identify common pitfalls of workplace violence (WPV) prevention programs, as well as platforms for effective WPV prevention and management. This discussion paper elaborates on these pitfalls and platforms, sharing ideas on how to maintain safety and provide support for both colleagues and patients.

Methods: The American Psychiatric Nurses Association (APNA) Council for Safe Environment (CSE) members met monthly to discuss WPV prevention, guided by evidence-based information, clinical expertise, and scholarly work. Concepts around WPV prevention were organized into common pitfalls in WPV prevention programs and optimum WPV prevention platforms. Pitfalls include reliance on attempts to control patients through strict rules, restrictions, and risk identification and monitoring. Alternatively, effective platforms include engagement-focused, relationship-based, trauma-informed and recovery-oriented practices. Education to develop staff skills and expertise beyond crisis prevention training and violence assessment is highlighted, giving voice to nurses' intuitive expertise in preventing, identifying, and diverting aggressive behaviors. Peer and organizational support interventions for nurse victims of violence are also examined.

Results: Safe environments are enhanced when staff are actively engaged in efforts to discern and meet individual needs, engage with the patient, build trust, and communicate hope for recovery. Organizational cultures founded on concepts of trauma-informed care can provide the support victims of violence need to recover and develop resilience and post-traumatic strength.

Conclusion: Risk management strategies alone are ineffective means of preventing WPV in psychiatric settings. Organizations must strike a balance between ensuring safety and providing a therapeutic atmosphere.

Objectives: This discussion paper elaborates the elements of patient engagement and teamwork that support the effective use of de-escalation during tense situations marked by increasing threat, lability, or hostility. Staff training often involves de-escalation techniques which equip staff with important basic skills. Yet what often fails to be explained during training are subtle elements operating on inpatient child/adolescent milieus that are critical to the effectiveness of this intervention.

Methods: Synthesis of practice experience and the literature on select elements such as milieu leadership, teamwork, and relationship leverage which supports de-escalation efforts on child inpatient psychiatric units.

Results: Five elements of inpatient practice were identified: teamwork, charge nurse leadership, staff holding a common understanding of behavior and a sense of the underlying dynamics of aggression, and use of relationship leverage. How these elements support de-escalation is briefly discussed. Included in the elaboration of these elements are the strategies unit managers might draw upon to cultivate these critical team and engagement elements.

Conclusion: Unit leadership should find opportunities to cultivate knowledge and skills related to teamwork, a shared understanding of a youth's behavior, the dynamics underlying aggression, and building engagement. These dimensions of practice are nuanced and often involve implicit aspects of teamwork and unit culture. Yet they are critical to keeping units safe and supporting de-escalation. These elements and how they support de-escalation should be articulated and cultivated with novice staff and new team hires.

ObjectiveThis paper updates the psychiatric mental health (PMH) nursing community regarding the progress of five recommendations for policy and practice to enhance workplace violence (WPV) prevention. This information should be useful to nurses in their efforts to advocate for workplace safety.MethodsA comprehensive search of current literature, organizational action, and national policy relevant to the recommendations are reviewed and discussed to enhance WPV prevention and safety.ResultsWorkplace safety is a critical concern for PMH nurses and has far-reaching implications in PMH nursing settings. While there has been implementation of state policy around WPV, federal legislation remains stalled. The national accreditation standards continue to provide individual institutions guidance around WPV data collection, reporting, and analysis, but these data do not inform national efforts particularly around defining requirements for mechanisms to support healthcare workplace protection. However, recent research continues to document both prevalence and associated conditions/quality metrics. While dashboards are now available for public reporting of select WPV data, nationally the public reporting standards remain the same. Organizing a nursing voice in WPV reporting resulted in interesting exemplars. Thus far, no data are available on efforts to include safety in nursing curricula.ConclusionsThe safety of nurses, particularly PMH nurses, is a multi-faceted problem that will require efforts in regulatory, organizational, educational, and personal behavior change.

Background: Chronic shortages of mental health providers restrict access for 51 million people in the United States with mental illness. Psychiatric-mental health nurse practitioners (PMHNPs) can help expand access using technology and team-based care.

Aims: The aim of this study was to analyze education and practice trends of PMHNPs in team-based care and telehealth models using a national sample of PMHNPs.

Methods: A secondary analysis of publicly available data from the 2022 National Sample Survey of Registered Nurses examined responses from 1,753 employed, certified PMHNPs. The descriptive study used means and frequencies to assess demographic, education, and work characteristics, along with 4 items on team-based care and 10 on telehealth.

Results: Most respondents report receiving training on team-based care through formal education, work, or professional development (83.2%), with 73.6% reporting their training was sufficient. Those participating in team-based care comprised 46.3%, and only 5.6% reported no participation. Over 82% report their workplace uses telehealth, and 77.6% report personal use of telehealth. The most used telehealth methods included live videoconferencing (72.8%) and telephone calls without video (53.2%).

Conclusion: With the increasing reliance on team-based care and telehealth as strategies to improve accessibility and efficiency in patient care, nursing programs should consider incorporating telehealth frameworks, competency-based education, and digital literacy into the preparation of PMHNPs to meet the demands of modern health care.

Background: Telehealth offers a flexible and effective alternative to in-person behavioral health services, with users generally reporting high satisfaction. However, several barriers can limit equitable access among Medicaid beneficiaries.

Aim: This study aimed to examine factors associated with Telehealth Utilization Questionnaire (TUQ) scores among Medicaid beneficiaries and providers.

Methods: A cross-sectional research design was employed to collect data from beneficiaries and providers at five community mental health centers and managed care organizations. Descriptive statistics, chi-square analyses, and hierarchical regression analyses were used to analyze the data.

Results: Most Medicaid beneficiaries (n = 181) were 36 years or older, female, White non-Hispanic, and resided in urban locations. Among them, 46.4% used telehealth 50.0% or more of the time and reported moderate to high trust in providers' scores (TPS) and TUQ scores. There were no significant differences in telehealth usage based on residence or diagnosis. Regression analysis revealed that TPS was significantly associated with telehealth use frequency. Most Medicaid providers (n = 188) were 36 years or older, female, White non-Hispanic, and practiced in rural locations. There were no significant differences in the proportion endorsing providing care via telehealth to 50.0% or more of their patients based on practice location or job role. Regression analyses identified that practicing in urban locations and providing care via telehealth to 50% or more of their patients were significantly associated with telehealth use frequency.

Conclusion: Trust in providers is a key driver of perspectives on telehealth usability among Medicaid beneficiaries, while practice location and utilization frequency significantly influence providers' perspectives on telehealth usability for delivering mental and behavioral healthcare. These findings suggest the importance of fostering trust among beneficiaries and addressing location-based barriers for providers to optimize telehealth usage.

Background: Studies have found that trait mindfulness is associated with lower levels of depressive symptoms among people diagnosed with schizophrenia. Still, the role of the perceived public stigma in this association has yet to be established.

Aims: The purpose of this study was to assess the association between mindfulness and depressive symptoms experienced by people diagnosed with schizophrenia, controlling for the impact of their demographics and their perceived public stigma against mental illness.

Methods: A quantitative descriptive correlational design was used. The sample included 184 Jordanian outpatients diagnosed with schizophrenia who completed self-administered measures of mindfulness, depressive symptoms, public stigma against mental illness, and demographic information. Multiple hierarchical regression analysis was performed to identify the unique variance in perceived depression explained by participants' demographic and clinical variables, public stigma, and mindfulness.

Results: Participants had moderate perceived discrimination and moderate to severe depression. Age, gender, perceived physical pain, perceived public stigma, and mindfulness were significantly correlated with depression among the study participants. After controlling for demographic and clinical variables, public stigma was significantly associated with depression and accounted for 14% additional variance above and beyond the 37% accounted for by demographic and clinical variables. Mindfulness accounted for a 15% additional variance above and beyond the variance accounted for by all other predictors.

Conclusion: Anti-stigma programs could be combined with mindfulness-based interventions to reduce depression in people diagnosed with schizophrenia.

Background: Serious mental illness (SMI) in pregnancy is a public health concern due to associated poor maternal-child outcomes. There is a gap in the literature about the healthcare experiences of pregnant women with SMI and the experiences of providers who care for this population. The purpose of this scoping review is to examine the current state of the science regarding the experiences of pregnant women with SMI and the experiences of providers when treating this population.

Aims: The aim of this review was to fill a knowledge gap that is needed to facilitate paradigm shifts in the treatment of pregnant women with SMI.

Methods: We conducted a systematic search for published, peer-reviewed, English-language literature addressing the experiences of pregnant women with SMI receiving care and the experiences of those providing care to the population. The databases searched were OVID MEDLINE, Embase (OVID), CINAHL, PsycINFO (EBSCO), and Sociological Abstracts (ProQuest).

Results: Sixteen qualitative and mixed-method articles focused on pregnant women with SMI were included in this review. Key themes emerged regarding patients' desire for specialized providers for treatment, preparedness in pregnancy, access to quality guidance and information, special attention to issues/concerns, guidance in medication, and care integration. Providers reported a desire for better interdisciplinary communication and specialized knowledge and expertise regarding SMI.

Conclusions: This review provides insight into areas where interprofessional collaboration can be vital in helping improve health outcomes; however, more research is needed surrounding the perspectives of providers and their support and resources when treating this population.

Background: Depression is a growing concern among university students. Chatbots provide flexible, accessible, personalized psychosocial support. Delivering Mindfulness-Based Stress Reduction (MBSR) sessions via chatbots may reduce depressive symptoms in university students.

Aim: This study aims to evaluate the feasibility, acceptability, safety, and preliminary efficacy of a chatbot-based MBSR intervention for university students with depressive symptoms.

Methods: A rule-based MBSR chatbot was developed and evaluated with a single-group pretest-posttest study for university students in Hong Kong (N = 30) reporting depressive symptoms, followed by the collection of their subjective feedback. The intervention lasted eight weeks. The primary clinical outcome was depression levels, with a range of secondary outcomes.

Results: The chatbot-based MBSR program demonstrated satisfying recruitment, retention, and adherence rates. The safety of the program was confirmed by the absence of any adverse events directly related to the intervention, tracked from the onset of the intervention to the completion of data assessment. Significant improvements were observed in both primary and secondary outcomes. Participant feedback highlighted the benefits of the program and its effects on depressive symptoms.

Conclusions: The program has shown feasibility, acceptability, safety, and preliminary efficacy in reducing depressive symptoms among 30 university students in Hong Kong. The intervention should now be evaluated in a randomized controlled trial with follow-up. This study highlights the potential role of chatbot-based interventions in mental health promotion, nursing, and clinical practice and will inform the subsequent development of innovative digital interventions to address mental health challenges faced by university students.

Background: About 115,000 young people in the United States experience a first episode of psychosis (FEP) annually. FEP is associated with functional decline and long-term executive functioning impairment. Schizophrenia is a risk factor for homelessness with up to 20% of individuals diagnosed experiencing homelessness. Homelessness conveys many burdens including higher rates of victimization, incarceration, and substance use. The intersection of homelessness and FEP represents a uniquely vulnerable population undergoing the compounding effects of two highly stigmatizing burdensome experiences that negatively impact health outcomes, treatment engagement, and life expectancy.

Aims: This study reviews the literature to explore what is currently known about the impacts of homelessness on individuals with FEP, knowledge gaps, directions for research, and recommendations for action.

Methods: An integrative review was conducted in April 2023 with APAPsychInfo, APAPsychArticle, Medline, and CINAHL.

Results: This is the first known review to examine available literature on homelessness and FEP. Current literature examines aspects of FEP and homelessness, but not the likely compounding and interacting relationships between multiple variables. Although the associations among variables such as FEP, homelessness, substance use, legal involvement, family involvement, and treatment engagement have not been studied, the literature available may be suggestive of a compounding negative effect on FEP outcomes.

Conclusion: FEP programs should define homelessness, report rates of homelessness, and conduct research examining the compounding effects of homelessness and FEP as well as other factors like race and ethnicity. Research and policy should support housing interventions for homeless individuals to improve treatment engagement and health outcomes.