International journal of mental health nursing最新文献

The clinical reasoning cycle was designed to guide nursing care and assist with clinical-reasoning and decision-making. While originally developed with an acute health lens, more recently an adapted version has been created for forensic mental health nurses. It is possible that such a framework may also be helpful for mental health nurses working in generalist settings. This study aimed to explore the utility of the original cycle and adapted forensic version with mental health nurses across the state of Victoria, Australia, to determine if the cycle might be suitable to their practice and if any adaptations were necessary. Eighteen nurses participated in focus groups or interviews to explore both versions of the cycle. Following thematic data analysis from phase one, a Nominal Group Technique was used to facilitate exploration of adaptations. Verbal and written responses were collected and participants (n = 6) voted on changes. Three main themes were interpreted from phase one: (1) the mysterious disappearance of nursing frameworks, (2) the CRC fits with what we do, says what we do, and demonstrates what we do, and (3) The CRC becomes more relevant without the word "forensic" in the title. In the nominal group, consensus was reached on 4 of 10 suggested changes from phase one, and the mental health nursing-clinical reasoning cycle was developed. There was concern that many nurses did not have a framework to guide decision-making, and the newly adapted cycle was seen as offering a way of demonstrating the contribution of mental health nursing care to safe practice.

Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co-designed and systems-level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems-based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co-design and person-centred care. This study assessed the acceptability of GMB as a method for co-design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems-level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co-design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence-based, person-centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co-designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field.

Borderline personality disorder (BPD) is often perceived as being more common in females, since women are more likely to seek help and be diagnosed. However, epidemiological studies have reported no sex differences in community prevalence. The purpose of this study was to learn from the narrative journeys of men who have received a diagnosis of BPD. Eight men participated, mean age 45.9 years (range 27-73 years). Recruitment was through clinician referrals at the study site and via social media and website advertising. Participants consented to a 60-90-min semi-structured interview via an audio-visual digital platform. Audio recordings were transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three themes were identified: (i) The Emergence of Symptoms, (ii) Reaching Crisis Point and (iii) Receiving a Diagnosis. Participants reported many adverse experiences during childhood and adolescence. Early symptoms were often exacerbated by emotionally invalidating caregiving. Participants reported seeking mental health support only after reaching a crisis point, which often arose following an employment-related stressor. Participants typically initiated help-seeking by consulting a General Practitioner. Long delays were reported from initial help-seeking to being diagnosed with BPD; all expressed relief upon diagnosis. The findings highlight the deleterious consequences of emotional invalidation in participants' mental health and their capacity to access timely support. General Practitioners play a critical role in identifying probable symptoms of BPD in men and are the gateway to referral to psychiatrists and psychologists. It is vital that education is provided to assist their important work.

Family caregivers of persons with mild cognitive impairment attempt to understand the behavioural and functional changes exhibited by their relative. However, how caregivers respond to initial changes and changes over time has not been explored. The purpose of this qualitative study was to explore the experience of family caregivers responding to changes in their relative's memory, behaviours, and physical functions over 2 years. Eleven family caregivers of a relative with mild cognitive impairment were purposively recruited from neurological clinics in Taiwan. Face-to-face semi-structured interviews were conducted within 6-months of referral; three follow-ups were conducted at 6-month intervals. Content analysis of 41 transcribed audio-recorded interviews revealed the longitudinal changes in their relative with cognitive impairment was made caregiving challenging. Three themes described the challenges: (1) Changes related to their relative's cognitive impairment, which included increases in mood fluctuations, erratic behaviours, and reductions in physical abilities; (2) changes in their relative's comorbidities, which included adapting to new symptoms and treatments for a chronic disease, monitoring medication adherence and drug interactions; and (3) changes in caregiver burden, which increased levels of stress, uncertainty, and anxiety resulting in greater role strain. Caregiving became more challenging with time, especially caregivers whose relative developed dementia during the study period. These findings offer insight into the trajectory of the experience of family caregivers attempting to understand changes in cognition, behaviours, and physical functions for their relative with mild cognitive impairment over 2 years, which could help mental healthcare providers develop support services to reduce caregiver role strain.

There is a global initiative to reduce the use of restrictive care practices in mental health settings. Variations in the reported rates across regions complicate the understanding of their use and tracking trends over time. However, it remains unclear whether these discrepancies reflect real differences in the implementation of these practices or are sourced from inconsistencies in incident classification and reporting methods. This study employed a co-design approach to identify contexts that would influence the classification and reporting of restrictive care practices. The research involved 29 mental health stakeholders, including 22 professional experts from 13 countries across Europe, Africa, North America, Asia and Australasia and seven service users and family carers from Australia. Recruitment was conducted through email invitations, snowball sampling and social media outreach. Six web-based panel meetings, each lasting 90-120 minnutes were held. These discussions focused on exploring various contexts that might lead to uncertainty among professionals when classifying and reporting actions whether or not as restrictive care practices. A final list of 23 contexts was identified and considered for the development of 81 case scenario items. Finally, all the 29 panel members selected 44 from 81 case scenarios for inclusion in an upcoming international survey to examine variations in the classification and reporting of restrictive care practices. The findings from this co-design work emphasise the involvement of a wide range of factors and contexts in the classification and reporting of restrictive care practices that may contribute to the observed variations in the in the reported rates of these practices. The case scenarios developed in this study will support future research and serve educational purposes, illustrating real-life situations in the mental healthcare context.

Mental health nurses and health cadres in Indonesia who provide care to persons with mental illness (PWMI) report encountering several challenges and obstacles to the delivery of quality care. At present, there is a paucity of research on this topic. The objective of this study was to examine the challenges encountered by mental health nurses and health cadres in their interactions with the families of PWMI in the community. This descriptive qualitative study employed focus group discussions, conducted in three Indonesian cities: Banda Aceh, Surabaya and Yogyakarta. Thematic analysis was utilised to analyse the data. The study revealed that the theme of this research is nurses and health cadres experienced challenging family behaviours toward a PWMI. The initial subtheme of family behaviour is 'concealing the PWMI.' This subtheme encompasses instances where families attempted to hide the mental health condition of the PWMI. The second subtheme is 'unsupportive families'. This subtheme is characterised by reluctance to engage in treatment or outright rejection of hospital care. This is often due to factors such as familial busyness. The third subtheme is 'poor parenting styles'. This subtheme highlights how inadequate parenting practices, domestic violence and lack of family support contribute to stress and exacerbation of mental disorders in PWMI. The fourth subtheme is 'hidden motive related to wills and testaments', which reveals how families may attempt to manipulate treatment to remove the inheritance rights of PWMI. The fifth subtheme is 'abandonment by family', which describes scenarios where families completely neglect PWMI, leading to inadequate care and medication adherence. The final subtheme, 'removal of PWMI from family units', describes instances where families sent PWMI to mental health facilities for permanent separation, sometimes even relocating to another city. To address these issues, a comprehensive approach is required that considers both the affected individuals and their families. An understanding of the motivations behind these behaviours is essential for the development of targeted interventions that promote family support, reduce stigma and improve the overall mental health environment in communities.

Therapeutic relationships are critical in the treatment of mental health disorders. Some clients experiencing mental health disorders display conflict behaviour-for example, suicidal or self-harming behaviour, threats of or actual aggression, and various psychotic behaviours-which presents significant challenges for care professionals. In inpatient mental health units, where interactions with mental health nurses are frequent, managing conflict behaviour is crucial to maintaining care quality and fostering therapeutic progress. This study aims to describe nurses' perspectives on fostering therapeutic relationships while working with clients who display conflict behaviour. Qualitative research was conducted in a specialised treatment setting for such clients by means of individual semi-structured interviews and a focus group interview with nurses. The results show that the nurses' primary focus is on cooperating with clients and colleagues. Regardless of conflict behaviour, nurses consistently invite clients to cooperate. To do so, they must manage their own emotions and expectations, emphasise the clients' responsibility and reduce the opportunities for conflict behaviour. The unit structure helps nurses by reducing ambiguity regarding treatment policies and inconsistencies in nurse-client interactions and allows nurses and clients to experience feelings of safety. To work with conflict behaviour, nurses need to feel valued and supported by their colleagues and have adequate time and resources. In conclusion, this study shows how nurses foster therapeutic relationships with clients who display conflict behaviour by focusing on cooperation, structure and safety.

The Victorian government's Alcohol and other drugs (AOD) workforce policy calls for greater recruitment of alcohol and other drugs nurse practitioners (AODNPs). However, frontline organisations in Victoria report several systemic barriers to their recruitment and retention. Additionally, there is scant Australian literature that examines the experiences of AODNP in opioid agonist treatment (OAT) provision in regional/rural areas. This research aims to address this gap by examining the AODNP workforce issues in delivering pharmacotherapy treatments in regional/rural areas of Victoria. Using an interpretative phenomenological approach, we conducted qualitative, in-depth interviews with 11 OAT prescribing AODNP's working in regional or rural Victoria. We analysed transcripts using reflective thematic analysis and generated three themes: (1) Professional motivations and values, (2) Enablers to professional role and (3) Barriers to professional role. The findings suggest that AODNPs in regional/rural areas are a dedicated workforce who provide holistic and integrated care for OAT clients. AODNPs play an important role in reducing and providing timely and subsidised health care for OAT clients living in regional/rural locations. AODNPs face many systemic and organisational barriers. These include inadequate funding for AODNP positions to prescribe pharmacotherapy treatments, lack of understanding of the AODNP professional role at the executive/management level within organisations and irregular access to supervision, mentoring, training and education. Also, endemic stigma in the health system acts as a barrier in recruiting and supporting AODNP positions that focus on care for OAT clients.

Artificial intelligence (AI) has been increasingly used in delivering mental healthcare worldwide. Within this context, the traditional role of mental health nurses has been changed and challenged by AI-powered cutting-edge technologies emerging in clinical practice. The aim of this integrative review is to identify and synthesise the evidence of AI-based applications with relevance for, and potential to enhance, mental health nursing practice. Five electronic databases (CINAHL, PubMed, PsycINFO, Web of Science and Scopus) were systematically searched. Seventy-eight studies were identified, critically appraised and synthesised following a comprehensive integrative approach. We found that AI applications with potential use in mental health nursing vary widely from machine learning algorithms to natural language processing, digital phenotyping, computer vision and conversational agents for assessing, diagnosing and treating mental health challenges. Five overarching themes were identified: assessment, identification, prediction, optimisation and perception reflecting the multiple levels of embedding AI-driven technologies in mental health nursing practice, and how patients and staff perceive the use of AI in clinical settings. We concluded that AI-driven technologies hold great potential for enhancing mental health nursing practice. However, humanistic approaches to mental healthcare may pose some challenges to effectively incorporating AI into mental health nursing. Meaningful conversations between mental health nurses, service users and AI developers should take place to shaping the co-creation of AI technologies to enhance care in a way that promotes person-centredness, empowerment and active participation.

Clinical supervision is a psychologically safe practice that aims to provide support and training for workers within the healthcare industry, including mental health nurses. Over the years, clinical supervision has been cited as a practice to improve workforce outcomes for both individual mental health nurses and the organisations they work in. The aim of this scoping review is to examine the evidence exploring the relationship between clinical supervision and workforce outcomes for mental health nurses. Twenty-eight articles sourced from six databases were included in this study. The most frequently evaluated workforce outcomes were competence (n = 14), workplace culture (n = 13) and compassion (n = 7). Studies reported that the association between clinical supervision and workforce outcomes was predominantly positive, but there were mixed results for competence, workplace culture, job satisfaction and burnout. Details on the type of clinical supervision received by participants were limited, and most of the evidence included in this review included qualitative research and participants self-reporting their perceived benefits from clinical supervision, as opposed to using validated instruments in experimental and/or longitudinal study designs. Organisations should be hesitant to implement mandatory clinical supervision within workplaces, as this could have the opposite effect on workforce outcomes for mental health nurses who are already time-poor and overworked, as well as those who are indifferent or hostile to clinical supervision.