Journal of Psychiatric and Mental Health Nursing最新文献

Background: Psychiatric nurses are in a unique position to build therapeutic relationships with mental healthcare users with dual diagnoses to foster trust and recovery. However, a dual diagnosis poses barriers to establishing and maintaining a therapeutic nurse-patient relationship.

Aim: The overall aim of this study was to explore and describe barriers experienced by psychiatric nurses to facilitate therapeutic relationships with mental healthcare users with dual diagnosis in a psychiatric hospital in Limpopo province, South Africa.

Design: A qualitative, explorative, descriptive and contextual design was followed.

Method: Semi-structured interviews were conducted with 12 purposively selected participants who cared for mental healthcare users with dual diagnoses. Tech's method of open coding was used to analyse the data.

Findings: Disruptive and disrespectful behaviour and mental healthcare users' substance use during hospitalisation resulted in nurses harbouring ambivalent feelings that impaired therapeutic nurse-patient relationships.

Conclusion: The barriers affecting therapeutic relationships with mental healthcare users with dual diagnosis should be addressed to enhance recovery and treatment compliance.

Recommendations: An integrated approach with the involvement of the interprofessional team, debriefing and training for nurses may help to foster therapeutic nurse-patient relationships, empower nurses and enhance the recovery of mental healthcare users with dual diagnosis.

Purpose: This paper is a personal reflection on the persistence of self-destructive thoughts and ideations in individuals with a history of self-destructiveness.

Background: Personal narratives are essential for understanding mental health and illness, particularly for those with a history of self-destructive behaviour. I, a researcher with lived experience of mental illness and self-destructiveness, highlight the importance of presenting them in their raw and unmediated form.

Methods: This paper is a first-person narrative where I use my own personal experiences to illustrate and analyse the persistence of self-destructive thoughts.

Introduction: Distinguishing those with a personality disorder from those with major depressive disorder (MDD) can be challenging, but establishing the correct diagnosis can direct appropriate management.

Aim: To identify whether behavioural themes differ between those with personality disorders from those with MDD, and how those differences might relate to a clinical team's perception of diagnosis.

Method: An observational study identifying all inpatients presenting with symptoms of depression. At discharge, patients (n = 60) underwent a structured diagnostic interview and were grouped according to diagnosis. Qualitative data was analysed to determine whether behavioural themes differed between those with MDD and those with a personality disorder (with or without MDD).

Results: Ward staff perceptions of diagnosis aligned in all cases of personality disorder, but they also attributed that diagnosis to 54% of patients who had only MDD. Several behavioural themes were evident in those with a personality disorder but not those with MDD. Many behavioural themes were observed in both groups, and it is likely these that drove differences in diagnostic views.

Implications for practice: Certain behavioural themes may be determinants of the perception of diagnosis held by inpatient staff, and when present in acute episodes in MDD, may risk diagnostic misattribution.

Introduction: Given that recovery-oriented care focuses on empowering individuals with mental health challenges, collaborative care can be an effective tool for nurses in mental health day hospitals.

Aim: To deepen knowledge about the impact of collaborative nursing care for improving health outcomes of mental health day hospital users.

Methods: A sequential and transformative mixed methods study was designed. In the first phase of this mixed methods study, quantitative data were collected from 144 users of mental health day hospitals. In phase two, a group of users underwent an intervention based on collaborative nursing care, through participatory action research, and qualitative data were collected. Finally, quantitative data were again collected from all users.

Results: The users who participated in the intervention group improved quantitatively in terms of the quality of the therapeutic relationship. They also improved at different stages of the recovery process, thus the qualitative results confirmed that collaborative nursing care was an essential component in their recovery process.

Discussion: The findings highlight the critical role of collaborative nursing care in health outcomes. The therapeutic relationship was identified as a key factor in facilitating patient empowerment.

Implications: The study supports implementing collaborative nursing care models in mental health settings to enhance patient outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT04814576.

Introduction: In Asia, many caregivers are culturally obliged to assume the role of taking care of individuals experiencing chronic schizophrenia, even as they grapple with stigma and compassion fatigue. Despite the significance of this phenomenon, the collective experiences of Asian caregivers remain poorly understood.

Aim: To synthesise qualitative evidence on the experiences of informal caregivers when caring for individuals with chronic schizophrenia in Asia.

Methods: A search was conducted on seven databases for studies published between 2013 and 2023. The included studies were appraised using the Critical Appraisal Skills Program tool. Data extraction was based on the Joanna Briggs Institute (JBI) Qualitative Extraction Form. The data synthesis was based on the framework by Sandelowski and Barroso.

Results: Our review included the experiences of 1345 informal caregivers from 57 included studies. The analysis yielded the overarching theme of 'Navigating Challenges, Forging Resilience'. Three themes were identified: (i) challenges in caregiving, (ii) lack of support and (iii) coping and resilience.

Discussion: Our findings highlighted the Asian caregivers' stressors, particularly cultural and traditional factors, a facet often overlooked in the literature.

Implications for practice: Mental healthcare practitioners must provide caregivers with comprehensive information. Anticipatory guidance is essential during the initial stages of the diagnosis. To negate geographical limitations, caregiver-training sessions can be pre-recorded and posted to online platforms. Finally, cultural and spiritual beliefs can be integrated into the treatment plans for individuals with schizophrenia in the community.

Relevance statement: Within the institutional setting, mental healthcare practitioners are encouraged to provide caregivers with comprehensible information or training in person and through written or online platforms, which can transcend geographical limitations. Anticipatory guidance is essential, especially during the initial stages of the diagnosis, when confusion and uncertainties are prevalent. Periodic home visits by mental healthcare practitioners can help ease caregivers' concerns and enhance their caregiving confidence. Finally, cultural and spiritual beliefs should be integrated into the treatment plans for individuals with schizophrenia in the community as it promotes cultural acceptability, encourages referrals to appropriate institutions and reduces the stigma of mental healthcare.

Introduction: A crucial long-term care resource for individuals with severe mental illness (SMI) in Taiwan is provided by psychiatric nursing homes. Given the higher incidence of physical illnesses and accidents among individuals with SMI, ensuring patient safety is an important aspect of quality care. However, there is limited literature exploring how the staff provides safe care for individuals with SMI.

Aim: Investigates how the staff in a psychiatric nursing home managed residents' activities to mitigate risks and reduce physical injuries.

Method: Using a qualitative approach and drawing from Foucault's concept of 'disciplinary power', data were collected from field observations and staff interviews.

Results: Three themes emerged: (1) a gaze for efficiency, where checklists, timetables and spatial arrangements were used to efficiently manage residents' bodies; (2) controlling the deviant body, which entailed procedures to monitor and prevent risk behaviours and bodily signs through broad safety measures and (3) your body, my business, which described the reduced autonomy of residents over their behaviours as the responsibility largely shifted to the staff.

Discussion: The predominant risk management framework, driven by safety considerations, comprises residents' autonomy and undermines compassionate caring.

Implications for practice: Risk management should actively involve both staff and residents in decision-making.

Introduction: In this text, the author's lived experiences as a youth with anorexia nervosa, anxiety, and depression are explored. Experiences with accessing North American health services, both in specialized eating disorder (ED) and disordered eating (DE) settings, as well as in healthcare more broadly are shared.

Aim: This work seeks to shed light on a patient perspective in mental health and to draw attention to some of the ways that the current framings of EDs and DE within the biomedical system might perpetuate harm.

Methods: In this piece, a collection of the author's lived-experiences and interactions with the healthcare system are explored.

Findings: The medical framing of EDs as a defect of both mind and body can jeopardize one's autonomy and contribute to a sense of hopelessness. As mental health treatment increasingly prioritizes evidence-based approaches and standardized practices, there is a growing concern that this shift risks undermining the autonomy of those it aims to support. The dualistic conceptualizations of mental and physical health in ED/DE treatment, at times, can cause harm, particularly for those who do not present with the physical manifestations of an ED/DE but remain largely affected in day-to-day life.

Discussion: The imposition of rigid treatment regimens can inadvertently diminish personal agency, overshadowing the nuanced, individualized needs and preferences of patients. Lived experience narratives encompass the personal, subjective insights of individuals navigating mental health challenges, in turn, providing invaluable insight that conventional methods may overlook.

Introduction: Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery.

Aim: To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU).

Method: This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale.

Results: The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users.

Discussion: Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence.

Implications for practice: Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.

Aim: To review the scientific and empirical evidence that is usually accepted for the ethical and legal justification of coercion in psychiatry.

Method: Five key criteria are examined as follows: (1) the demonstrable existence of a mental disorder; (2) the effectiveness of psychiatric measures; (3) the use of coercion as last resort and as least possible restriction; (4) the benefit of the person affected by the coercive measure and (5) the restoration of the affected person's autonomy.

Results: (1) The existence of a demarcation between a mentally ill and a mentally healthy state cannot be confirmed; (2) Pharmacological and psychotherapeutic interventions in psychiatry are not even moderately effective; (3) Coercive measures are usually not used as last resort and as least restrictive measure; (4) Most people affected by psychiatric coercion do not benefit from the measures; (5) It is at least unclear whether autonomy is affected by a mental illness and whether it can be restored through a coercive psychiatric measure.

Discussion: None of the central ethical and legal criteria for the use of coercion in psychiatry are clearly and unambiguously fulfilled according to current research.

Implications: Psychiatric coercion can hardly be justified any longer.