Showing papers in "International Journal of Mental Health Nursing in 2021"

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic.

Abstract: A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

Determination of stress, depression and burnout levels of front-line nurses during the COVID-19 pandemic

Abstract: All healthcare professionals, especially nurses, are affected psychosocially due to reasons such as uncertainty and work intensity experienced during the COVID-19 pandemic. In this descriptive study, it was aimed to determine the stress, depression and burnout levels of front-line nurses. Data were obtained from 705 nurses who worked at hospitals during the COVID-19 pandemic between May and July 2020, using a Personal Information Form, the Perceived Stress Scale, Beck Depression Inventory and Maslach Burnout Inventory. The data collection tools were sent online to nurse managers, requesting front-line nurses to answer the forms and scales. The nurses were mostly women and had bachelor's degrees, single and worked as nurses for between 1 and 10 years. They had high levels of stress and burnout and moderate depression. Those who were younger and had fewer years of work experience felt inadequate about nursing care and had higher levels of stress and burnout. More burnout was detected in nurses who had a positive COVID-19 test and did not want to work voluntarily during the pandemic. The authors suggest that preventive and promotive interventions in mental health should be planned and implemented to improve the mental health and maintain the well-being of front-line nurses during the pandemic, and to prepare nurses who may work during pandemics in the future.

Hospital staff well-being during the first wave of COVID-19: Staff perspectives.

Abstract: The purpose of this research is to determine the impact of working during the early stage of the COVID-19 pandemic on the well-being of staff at one 600-bed acute hospital in metropolitan Melbourne, Australia. This exploratory study is part of a larger mixed methods survey project, reporting the qualitative data from an on-line survey of clinical staff working at one acute hospital between April 16th and May 13th, 2020 during the COVID-19 pandemic. Responses to five free-text questions were analysed using inductive content analysis. 321 medical, nursing, allied health and non-clinical staff responded to the survey. Respondents reported anxiety, fear and uncertainty related to the pandemic, from the perspectives of work, home, family and community. They reported feeling confused by inconsistent messages received from government, hospital executive, managers and media. Seven themes were identified: (i) worrying about patient care, (ii) changed working conditions, (iii) working in the changed hospital environment, (iv) impact of the pandemic, (v) personal isolation and uncertainty, (vi) leadership and management and (vii) additional support needed for staff. Despite the pandemic being comparatively well-controlled in Australia, all disciplines reported a high degree of anticipatory anxiety. Staff working in healthcare require both managerial and psychological support to minimise anxiety and promote well-being and resilience in order to deal with the health crisis. Regular unambiguous communication directing the way forward is crucial.

The COVID-19 pandemic and death anxiety in the elderly.

Abstract: The coronavirus disease-2019 (COVID-19) epidemic has affected millions of people around the world and posed serious challenges for the global healthcare systems (Usher, Kim et al 2020; Vardanjani, Ronco et al. 2020). The mortality rate of the disease is directly related to the age of affected individuals such that the highest death tolls have been reported in people over 65 years of age. Eight out of 10 COVID-19-related deaths reported in the United States have been in people 65 years or older (Ioannidis, Axfors et al. 2020). In general, the elderly have a relatively weaker immune system making them more vulnerable to COVID-19. Furthermore, the elderly are more likely to have underlying chronic medical conditions which further render them susceptible to the infection. Therefore, mortality and serious complications are more common among the elderly, especially those with underlying chronic diseases (Meng, Xu et al. 2020; Vardanjani & Moayedi, 2020). Specifically, health conditions such as hypertension, diabetes, and coronary artery and cerebrovascular diseases can exaggerate the risk of serious complications of COVID-19 disease in the elderly (Ioannidis, Axfors et al. 2020). Anxiety is one of the most common psychological problems in the elderly. This is because people face various types of deficiencies and disabilities at this period of life. Studies have shown that elders are more prone to anxiety due to reduced self-confidence, decreased activity and mobility, losing friends, reduced financial and physical independence, and chronic diseases. The most common type of this is death anxiety (Mohammadpour, Sadeghmoghadam et al. 2018; Mokhtari, Moayedi et al. 2020). Death anxiety is a feeling of panic, fear, or great worry caused by thinking of death, being detached from the world, or what that would happen after life. The high prevalence of death anxiety among the elderly is due to the fact that they suffer from many physical problems, chronic diseases, movement disorders, physical disabilities, and dependence on others. Retirement and the ensuing loneliness can also contribute to death anxiety in the elderly (Birgit, Tak et al. 2018; Menzies & Menzies 2020). Traditionally, the United Nation and most researchers have considered some criteria and indicators for defining population ageing, which mainly or in a large part are based on people’s chronological age (i.e. 60 to 65 years or older) and the elderly are defined as people 60 or 65 years of age or older. According to the United Nation, 703 million of the global population have been elders (65 or over) in 2019. As population ageing is spreading fast across the world, the number of elders is expected to double to 1.5 billion by 2050 (Fent, 2008). In addition to physical morbidity and mortality, it is common for confirmed or suspected COVID-19-affected patients to suffer from excessive stress. Confirmed or suspected cases of COVID-19 infection have legitimate fears of the disease prognosis (Li, Yang et al. 2020,) which can contribute to stress and anxiety, especially among the elderly (Meng, Xu et al. 2020). As a result, they may experience loneliness, denial, anxiety, insomnia, and frustration which can reduce their adherence to medical treatments (Li, Yang et al. 2020) and negatively affect their mental health. Additionally, this fear can lead to obsessive-compulsive disorder, suicidal thoughts, depression, alcohol abuse, self-harm behaviours, avoidance, and fear of others (Pragholapati 2020). Isolated individuals with suspected COVID-19 infection may suffer from anxiety due to the uncertainty about their health status and experience obsessive-compulsive symptoms such as recurrent checking of body temperature and hand washing. Moreover, strict quarantine policies can lead to social exclusion, financial losses, discrimination, and shame. Misinformation about COVID-19 may exaggerate public anxiety, fear, isolation, frustration, and irritability (Li, Yang et al. 2020). Prolonged quarantine, boredom, inadequate nutrition, insufficient information, and social stigma are also documented sources of stress during the COVID-19 epidemic (Shojaei & Masoumi 2020). The common anxiety among COVID-19 patients appears to be largely due to the unknown nature and ambiguities about the virus. The inadequate scientific information, the emergence of new clinical symptoms, Correspondence: Mohamad Golitaleb, Basij Square, Arak, Iran, Postal code/P.O. Box: 3848176941. Email: Mohamadgolitaleb@gmail.com, m.golitaleb@arakmu.ac.ir

The Impact of COVID-19 on nurses working in a University Health System in Singapore: A qualitative descriptive study.

Abstract: Given Singapore's high population density and extensive geographical interconnections, it is unsurprising that the country reported one of the highest numbers of COVID-19 cases in Asia. Past pandemic studies have suggested that nurses working in such crises might experience a deterioration of mental health, which could persist for years beyond the initial outbreak. This study used a qualitative descriptive design to explore nurses' experiences of working in tertiary hospitals during the COVID-19 pandemic. A total of 17 registered nurses who had worked for at least one year prior to the start of the COVID-19 pandemic were recruited from a University Health System in Singapore from March to June 2020. Data were collected through semi-structured interviews lasting at least an hour conducted over an online platform by the principal investigator. The data were analysed through Braun and Clarke's six-step thematic analysis independently by two researchers. Three main themes emerged: (i) challenging moments of COVID-19, during which the participants reported physical and psychological challenges relating to working conditions of the hospital in the initial months of the pandemic; (ii) the professional role as nurses, in where the participants dispelled their worries and demonstrated commitment to their role as nurses; and (iii) support for nurses, which originated from their family, friends and leaders from their organizations for them to persevere and overcome the unprecedented challenges of COVID-19. The nurses in this study demonstrated resilience and professionalism despite the challenges of COVID-19. The findings highlighted the importance of a robust support system for healthcare professionals.

Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan.

Abstract: The outbreak of coronavirus disease 2019 (COVID-19) is having a dramatic effect on the mental health of healthcare workers (HCWs). Upon the emergence of the COVID-19 pandemic, the Chinese government dispatched about 42 000 HCWs to Wuhan City and Hubei Province to fight this pandemic. This study briefly examines front-line nurses who experienced burnout, with the main objective of investigating the mediating roles of positive and negative affect in the relationship between resilience and burnout in Wuhan hospitals at the peak of the COVID-19 pandemic. A total of 180 front-line nurses voluntarily participated via a social media group. They completed the online questionnaires, including the Maslach Burnout Inventory-General Survey (MBI-GS), the Positive and Negative Affect Schedule (PANAS), the Connor-Davidson Resilience Scale (CD-RISC), demographics, and work-related characteristics. Structural equation modelling (SEM) analysis was used to examine the mediating effect of positive and negative affect on the relationship between resilience and burnout. The total prevalence of burnout was 51.7%, of which 15.0% were severe burnout. These preliminary results revealed that positive and negative affect fully mediated the effects of resilience on burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment of front-line nurses. It is necessary to know the impact of resilience on HCWs with burnout through the positive and negative affect of individual backgrounds and situations, and how policymakers can deploy resilience interventions to support front-line HCWs.

Stigma in relation to families living with parental mental illness: An integrative review

Abstract: Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.

COVID-19 and family violence: Is this a perfect storm?

Abstract: Disasters including public health crises like the COVID-19 pandemic are known to increase instances of family violence against women, children, and other diverse populations. This paper discusses and provides evidence of disaster-related vulnerability of and violence towards specific groups of people. We argue that the COVID-19 pandemic presents the 'perfect storm' for family violence, where a set of rare circumstances combine, resulting in a significant aggravation of the resulting event. Given the mental health implications of family violence, mental health professionals need to be aware of this issue during the pandemic and ready to assist with the development of strategies to overcome the situation where possible. To provide protection and prevent violence, there is a need to include at-risk groups in disaster response and community planning. Such a plan could involve gender and disaster working groups at the local community, state, and national levels.

Experiences, emotional responses, and coping skills of nursing students as auxiliary health workers during the peak COVID-19 pandemic: A qualitative study.

Abstract: The COVID-19 crisis in Spain has exacerbated the shortage of nursing staff to respond to increasing healthcare demands. For this reason, nursing students were requested to collaborate voluntarily as auxiliary health staff. This emergency has led to mental health problems in health professionals, hence the relevance of coping techniques. The objectives of this study were to explore the experiences and emotional responses of final-year nursing students who volunteered to carry out healthcare relief tasks during the peak of the COVID-19 pandemic, and to identify the coping strategies they adopted to deal with this situation. A qualitative study was conducted in the constructivist paradigm. Purposive sampling was used, and twenty-two students participated in semi-structured interviews, which were then content-analysed. The study is reported using the COREQ checklist. Five themes emerged in the 'Experiences and emotional response' dimension (context, patients, emotions and feelings, risk of contagion, and personal satisfaction), and three themes emerged in the 'Coping strategies' dimension strategies in the work environment, in daily life and personal life. Although the students expressed negative emotions due to the highly complex context and lack of professional experience, they evaluated the experience positively in terms of learning and usefulness. Most notably, the students employed adaptive coping strategies to deal with the pandemic.

The influence of COVID-19 on the mental health of final-year nursing students: comparing the situation before and during the pandemic.

Abstract: The COVID-19 pandemic has had an important impact on the academic world. It is known that university studies can influence the mental health of students, and especially those studying health sciences. In this study, we therefore sought to analyse whether the current pandemic has affected the mental well-being of final-year nursing students. This was a multi-centre study, with a descriptive, longitudinal, and prospective design. Mental well-being was evaluated using the General Health Questionnaire. A total of 305 participants were included in the study, of whom 52.1% had experienced the COVID-19 pandemic. Statistically significant differences were found between the two groups analysed in terms of age, access to university, average marks, mental well-being self-esteem, emotional exhaustion, and sense of coherence. In the case of mental well-being, a direct association was found with both the pandemic situation (OR = 2.32, P = 0.010) and emotional exhaustion scores (OR = 1.20, P < 0.001), while an inverse association was found with sense of coherence scores (OR = 0.45, P < 0.001). This study shows that the mental health of students is a significant factor and one that must be taken into consideration when training nursing staff at university. There is a need to promote healthy habits and provide appropriate coping strategies. It is also important to train and prepare students for pandemic situations as these can have an important impact on the mental health of both the members of the public who will be treated by these future nursing professionals and the students themselves.

Impact of coronavirus disease 2019 on the mental health of university students in Sichuan Province, China: An online cross-sectional study.

Abstract: Coronavirus disease 2019 is an emerging public health problem threatening not only the life but also the normal psychology of people. University students' mental health is the focus in the field of higher education. The coronavirus disease 2019 pandemic has brought into attention the mental health problems of this vulnerable group. The aim of this study was to assess the impact of coronavirus disease 2019 on the mental health of university students in Sichuan Province, China. We conducted a cross-sectional study from April 2020 to May 2020. The participants responded to an online questionnaire that included informed consent, basic information, 20-item Self Reporting Questionnaire (SRQ-20), and Self-Rating Anxiety Scale (SAS). We received 521 effective responses. The results included the following: 19.0% of respondents reported distress, and 31.5%, 8.1%, and 5.8% of them reported mild, moderate, and severe anxiety, respectively; respondents aged ≤ 22 years, medical students, and those who were in general health reported more distress than others; and medical students and those who paid more attention to pandemic information reported more anxiety than others. Findings suggest that the mental health of university students should be monitored during pandemic, especially for younger students, medical students, students in general health status, and those who paid too much attention to the news of the pandemic. Due to the limited sample representativeness, we must be cautious when generalizing these findings to other regions of China or other countries.

Understanding the factors that affect retention within the mental health nursing workforce: a systematic review and thematic synthesis.

Abstract: There are over 41 000 vacant nursing posts across the United Kingdom’s National Health Service (NHS), with more people leaving the profession that joining it. Despite mental health being acknowledged as a priority area, some of the most significant staff shortages are occurring within mental health services. Urgent action is needed to retain the mental health nurses (MHNs) currently in post to ensure the profession is fit for purpose and aid future recruitment efforts. This review set out to identify the individual factors that affect the retention of MHNs. A systematic search of six databases was conducted (CINAHL, PsychINFO, MEDLINE, Web of Science (Core collection), EMBASE and the British Nursing Index). Studies were systematically screened for inclusion based on predetermined eligibility criteria. The studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized using Thematic Synthesis. A total of 23 studies consisting of a range of study designs were included in the review. Four key themes emerged from the synthesis: Individual characteristics, Working within mental health services, Training and skills and Work environment. The findings from this review suggest that MHNs encounter some factors unique to working in mental health services, which suggests that retention strategies should be specific to each nursing speciality. Beyond nursing speciality, the factors identified vary between clinical settings in mental health due to the differences in work environments and services they provide. Future studies should now set out to explore what factors exist in which clinical settings to inform better tailored retention strategies to generate better outcomes.

Chronicling moral distress among healthcare providers during the COVID-19 pandemic: A longitudinal analysis of mental health strain, burnout, and maladaptive coping behaviours.

Abstract: The COVID-19 pandemic has presented many novel situations that have amplified the presence of moral distress in healthcare. With limited resources to protect themselves against the virus and strict safety regulations that alter the way they work, healthcare providers have felt forced to engage in work behaviours that conflicted with their professional and personal sense of right and wrong. Although many providers have experienced moral distress while being physically in the workplace, others suffered while at home. Some healthcare providers worked in facilities that were unable to open during the pandemic due to restrictions, which could contribute to a sense of powerlessness and guilt. The current study assessed whether the ability to see patients each week impacted the relationship between an employee's moral distress and their mental health strain, burnout, and maladaptive coping. A total of 378 healthcare providers responded to weekly surveys over the course of 7 months (April 2020-December 2020). Hierarchical linear modeling techniques were used to examine the study variables over time. Results showed that moral distress predicted an individual's mental health strain and burnout, even after controlling for the prior week. However, moral distress was not a significant predictor of maladaptive coping. Interestingly, there was not a significant difference between the average ratings of moral distress between those who were able, and those who were not able to see patients, meaning that both groups experienced symptoms of moral distress. However, cross-level moderation results indicated that the ability to see patients magnified the relationships between moral distress and mental health strain and burnout over time. Implications of the results and recommendations for how moral distress should be addressed among healthcare providers are discussed.

Undergraduate nursing students' resilience, challenges, and supports during corona virus pandemic.

Abstract: The coronavirus global pandemic interrupted teaching at Australian universities. Face-to-face teaching was replaced by online delivery. This presented challenges for nursing programmes due to the hands-on teaching requirements and clinical placements. Questions were raised around students' resilience and stress in the face of adversity. This study explored undergraduate nursing students' resilience, challenges experienced, and supports utilized during the pandemic. Convenience sampling recruited students from one nursing programme (n = 340). Quantitative and qualitative data were collected. The Connor-Davidson Resilience Scale (CD-RISC-25) examined resilience scores through non-parametric analysis. Narrative responses were analysed using inductive thematic analysis. 121 surveys (40.3%) were completed. Most participants were from second year (n = 77, 63.6%). The difference in median resilience scores among employed participants was statistically significant (P = 0.029) and higher than the unemployed. The median scores of students working in nursing-related roles were higher than others. Median resilience score across all year levels was 70 (IQR = 62-80), in the lowest score range. Major themes identified were fear of the virus, isolation, and mental health problems. The coping strategies identified were developing daily routines, staying connected, and establishing self-help techniques. This research has implications to optimize students' learning experience, enhance resilience, and promote mental health and well-being.

'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse.

Abstract: Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.

Frequency of violence towards healthcare workers in the United States' inpatient psychiatric hospitals: A systematic review of literature.

Abstract: The purpose of this systematic review is to determine the frequency of violent or aggressive behaviour towards healthcare workers in inpatient psychiatric settings in the United States. To achieve this aim, five databases were searched to find English-language quantitative studies reporting prevalence or incidence data of violence or aggression directed towards staff members in inpatient psychiatric settings. No limitations were set based on publication date, and intervention studies were included only if baseline data were provided. Of 335 total studies found, 38 full-text articles were suitable for full-text analysis based on inclusion and exclusion criteria, and 14 were included in the final review. Years of data collection ranged from 1986 to 2018, and a range of psychiatric facilities were represented, from small, private hospital units to large forensic institutions. Researchers utilized surveys, real-time incident reporting tools, and government databases, or a combination of strategies, to collect data related to workers' experiences on the job. Included research indicates that workplace violence in the U.S. inpatient psychiatric setting is a widespread problem, with 25-85% of survey respondents reporting an incident of physical aggression within the year prior to survey, and statewide workers' compensation findings indicating 2-7 claims due to assault per 100 000 employee hours. There are substantial differences between findings based on measurement strategy, making it difficult to arrive at a single estimate of prevalence nationally. As management of this persistent problem receives continued attention from stakeholders, it becomes increasingly important to define and measure the problem with the most appropriate tools.

Perceived COVID-19-associated discrimination, mental health and professional-turnover intention among frontline clinical nurses: The mediating role of resilience.

Abstract: COVID-19-associated discrimination (CAD) is an important issue that may adversely affect frontline nurses' work effectiveness and well-being. This study examined the relationships between frontline nurses' perceptions of COVID-19-associated discrimination and their resilience, mental health, and professional-turnover intention. This cross-sectional descriptive study involved 259 frontline nurses in the Central Philippines and used four online self-report measures. The results revealed that frontline nurses perceived a moderate level of COVID-19-associated discrimination. Frontline nurses who perceived a higher level of discrimination during the coronavirus pandemic reported poorer mental health and higher professional-turnover intention. Resilience acted as a mediator and reduced the effects of COVID-19-associated discrimination on nurses' mental health and their professional-turnover intention. Proactive measures to reduce the negative consequences of discrimination during the pandemic, and efforts to foster resilience in nurses who are in the forefront of the fight against the highly transmissible virus, should be given high priority by hospital and nursing administrators to better support nurses' mental health and foster retention.

A first-hand experience of co-design in mental health service design: Opportunities, challenges, and lessons

Abstract: In an era of mental health service reform, co-design is emerging as a leading framework to guide the design and implementation of new services. Co-design uses the expertise of clinicians, those with lived experiences of services (both consumers and carers) and provocateurs (curious questioners) to understand a 'problem' and develop innovative strategies to address it. It relies on the creation of a safe environment where power imbalances are acknowledged and mitigated, and decisions are made collaboratively. Understanding how to do this effectively within the mental health sphere, where experiences of uneven power distribution and trauma are common, can feel overwhelming. Building a shared understanding of the opportunities and limitations within co-design is also important to establish its place within broader mental health reform. This paper uses an experiential approach to reflect on a co-design process, offering an opportunity to learn from a specific example. Factors that enhanced co-design included formal, remunerated roles, the allocation of time to establish and maintain an intimate, trusting team culture, and the capacity for all team members to be vulnerable. Equally important, strategies needed to be employed to mitigate the challenges inherent within the process, including the impact of power differences, a push to make fast-paced decisions, and a sense of cynicism remaining from previous projects or experiences. When these factors are attended to, the process of co-design can be dynamic, innovative, and transformational for the people participating in it, the project and the mental health sector.

Qualitative study on the causes and consequences of compassion fatigue from the perspective of nurses.

Abstract: Compassion is one of the core elements of nursing care. Continued exposure to patient pain and suffering puts nurses at risk of developing compassion fatigue. The aim of this study was to understand the causes and consequences of compassion fatigue from the perspective of nurses. To this end, a qualitative design based on the hermeneutic phenomenology paradigm was used. Five focus group sessions were held with 43 nursing professionals. Two themes and six sub-themes emerged from the analysis of their discourses in relation to the impact of compassion fatigue on nurses. Based on the results obtained, the causes perceived as generating compassion fatigue are the lack of time and resources to provide comprehensive nursing care. The consequences identified were difficulties in carrying out their work, repercussions on family and private life, anxiety, stress, and, in some cases, the desire to quit the profession. This study concluded that healthcare organizations are key to fostering compassionate care and that cultivating compassion is necessary to prevent compassion fatigue.

'What would a trauma-informed mental health service look like?' Perspectives of people who access services.

Abstract: Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.

“What matters to me”: A multi-method qualitative study exploring service users’, carers’ and clinicians’ needs and experiences of therapeutic engagement on acute mental health wards

Abstract: Nurse-patient therapeutic engagement on acute mental health wards is beneficial to service users' outcomes and nurses' job satisfaction. However, engagement is not always fulfilled in practice and interventions to improve engagement are sparse and ineffective. We explored the experiences of service users, carers, and clinicians drawing from 80 hours of non-participant observations in an acute mental health ward and semi-structured interviews with 14 service users, two carers, and 12 clinicians. Analysis of these data resulted in 28 touchpoints (emotionally significant moments) and eight overarching themes. Service users, carers, and clinicians identified a lack of high-quality, person-centred, collaborative engagement and recognized and supported efforts to improve engagement in practice. Potential solutions to inform future intervention development were identified. Our findings align with previous research highlighting negative experiences and support the need to develop multicomponent interventions through participatory methods.

Mental health matters: A cross-sectional study of mental health nurses’ health-related quality of life and work-related stressors

Abstract: Mental health nursing is widely recognized as a stressful occupation; however, little is known about the relationship between work-related stress and health-related quality of life of mental health nurses (MHN). This study aimed to identify MHN health-related quality of life (HR-QoL) and work-related stressors; associations between stressors and HR-QoL; and predictors of HR-QoL. An online cross-sectional survey collected demographic data, work-related stressors and HR-QoL (SF-12v2) of n = 498 Australian MHN. Prominent consumer/carer-related stressors were verbal (90%) and physical aggression (85%). Collegial stressors included staff conflict (71%) and bullying (55%), and colleague-perpetrated verbal (34%) and physical aggression (7%). Key organizational stressors included high workloads (74%), lack of organizational support (60%) and lack of adequate resources to perform nursing role (58%). The mean physical health score was 52.62 (SD = 8.30), and mental health score was 43.59 (SD = 11.34), with mental health substantially lower than national norms (mean difference = 10.11). There were statistically significant negative correlations between the number of work-related stressors and HR-QoL. Younger (21-30 years) and less experienced ( 4 years' experience and working in the community. The poorer mental health of MHN has concerning implications for the well-being, retention and practice of the largest group in the mental health workforce. There is a critical need for organizations to enact effective policy and initiatives to reduce workplace aggression, improve staff psychological and physical safety, and strengthen well-being and resilience. New graduates are a priority group for urgent intervention.

Does workplace violence, empathy, and communication influence occupational stress among mental health nurses?

Abstract: Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population A socio-demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy - Health Professions version, and Nurses' Clinic Communication Competence Scale were administered to 539 mental health nurses from three top-grade tertiary research hospitals in the Beijing-Tianjin-Hebei region The analysis revealed a high level of job stress (306 ± 069) and a moderate prevalence of workplace violence (621 ± 294) existed among participants when compared with among other nurses Meanwhile, participants' empathy (11478 ± 1599) and communication (431 ± 060) abilities were similar to or higher than those of other nursing populations Mental health nurses with varying years of practice experience distinct levels of job stress A linear regression analysis revealed that, while practice years (β = 0104; P < 005) and workplace violence (β = 0264; P < 001) aggravated occupational stress levels, empathy (β = -0147; P < 001) facilitated reductions in stress Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed

Nurses' experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study.

Abstract: In the event of a contagious disease outbreak that reaches the level of a pandemic, the responsibility of providing care for patients increases for front-line nurses. However, being in a nursing role exposes professionals to a range of risks, including but not limited to contagion and mental health impacts. This qualitative study aimed to explore in-depth nurses' experiences of providing care in the time of the COVID-19 global pandemic. The study followed the COREQ guidelines. Purposive sampling was applied to recruit participants. Semi-structured face-to-face interviews were used to collect the data from 16 nurses across five hospitals in Taiwan in 2020. Contents were analysed using Colaizzi's seven-step method. The essential structure that was identified was 'Providing care cautiously and being alert to the changing environment', which reflects the progress of Taiwanese nurses in providing care during the global COVID-19 pandemic. The essence of the phenomenon is presented through three themes: (i) facing the emerging challenge, (ii) struggling with uncertainty, fear, stigma, and workload, and (iii) adapting to changes in the environment: learning and innovation. The findings identified multi-dimensional impacts of nursing experiences during the COVID-19 pandemic, and the study yielded evidence and practices that can be used to guide and support adequate interventions to support nursing professionals. By understanding the various aspects of nurses' experiences, policymakers and administrators can better address nursing care providers' professional and mental health needs during a pandemic.

Mental health nurses' psychological well-being, mental distress, and workplace resilience: A cross-sectional survey.

Abstract: Mental health nurses (MHNs) frequently face emotional adversity and stressors at work that can negatively impact their psychological well-being and result in mental distress. This can affect their capacity for therapeutic work, professional relationships, and overall work performance. In the context of work, resilience is a dynamic process of positive adaptation to adversity that can lead to psychological well-being and increased work performance. There is limited knowledge, however, on MHNs' psychological well-being and resilience from an Australian perspective. This study aimed to investigate the levels of, and relationships between, psychological well-being, mental distress, and workplace resilience in Australian MHNs. A cross-sectional online survey using Ryff's Scales of Psychological Well-being (PWS) 18, Depression, Anxiety and Stress (DASS) 21, and Resilience at Work measures was completed by registered nurses (n = 482) working in a mental health setting or role. Mean scores were 85.38 for psychological well-being and 70.27 for workplace resilience, with more than half reporting levels above the mean. However, some participants scored in the severe to extremely severe categories for depression (7.8%), anxiety (8.7%) or stress (7.3%). Psychological well-being had strong positive and negative associations, respectively, with workplace resilience (r = 0.571, P < 0.01) and depression (r = -0.563, P < 0.01). Having a postgraduate specialist qualification was positively associated with psychological well-being. Postgraduate speciality education may be a key protective factor that can increase MHNs' psychological well-being. Strengthening workplace resilience is an important strategy for organizations to implement to support MHNs' psychological well-being and reduce the risk of mental distress.

Impact of public health education on undue fear of COVID-19 among nurses: The mediating role of psychological capital.

Abstract: This study looked into the mechanism through which health education can reduce the fear of being infected with COVID-19 because health education helps individuals to improve their knowledge and attitudes towards a disease. The spread of COVID-19 has escalated the level of fear among public and nurses. Nevertheless, the mechanism that contributes to minimize the fear towards this pandemic remains unexplored. A cross-sectional survey was adopted to test the relationships among public health education, psychological capital, and fear of COVID-19. In total, 243 responses were obtained via online survey from nurses. The results revealed that public health education can reduce one's fear of COVID-19. Psychological capital emerged as a strong explanatory mechanism for the phenomenon. Drawing on spillover theory, public health education seems to reduce fear of COVID-19 with the mediating role of psychological capital. Limitations and future directions are at the end of this paper. The study outcomes revealed that organizations should focus on educating nursing staff to overcome fear of COVID-19. One way to induce positivity among nursing staff is by holding trainings.

The mediating role of regulatory emotional self-efficacy on negative emotions during the COVID-19 pandemic: A cross-sectional study.

Abstract: Nurses exposed to coronavirus disease 2019 (COVID-19) are psychologically stressed. This study examines the characteristics and distribution of negative emotions among Chinese nurses during the COVID-19 pandemic and explores regulatory emotional self-efficacy (RESE) as the underlying mechanism in the relationship between nurses' personalities and negative emotions. A cross-sectional design with convenience sampling was utilized. Three comprehensive tertiary hospitals located in China were selected. Nurses (n = 339) who cared for COVID-19 patients were enrolled. Recruitment was conducted between 14 February 2020 and 1 March 2020. Self-reported questionnaires about personality, RESE, and epidemic-related negative emotions were completed online. A correlation analysis, structural equation modelling, and the bootstrapping method were used to analyse the data. This study identified a 24.9% incidence of negative emotions in nurses. RESE was a significant mediator explaining the effect of personality on epidemic-related negative emotions. RESE mediated the effect of introversion-extroversion on depression (β = -0.151, P = 0.015), neuroticism (β = -0.182, P = 0.007), fear (β = -0.142, P = 0.006), anxiety (β = -0.189, P = 0.015), and hypochondria (β = -0.118, P = 0.010); it also mediated the effect of neuroticism on depression (β = 0.313, P = 0.002), neuroticism (β = 0.394, P = 0.003), fear (β = 0.345, P = 0.005), anxiety (β = 0.384, P = 0.003), and hypochondria (β = 0.259, P = 0.004). Nurses caring for COVID-19 patients displayed negative emotions, particularly emotionally unstable and introverted nurses with a low RESE level. RESE is often essential for interventions because it significantly influences the relationship between personality and negative emotions. In the event of a major outbreak, tailored psychological well-being education, which includes emotional self-efficacy strategies, should be provided by organizations to help nurses manage stress related to the outbreak.

The repercussions of perceived threat from COVID-19 on the mental health of actively employed nurses.

Abstract: In the confrontation with the COVID-19 pandemic, threat perceived by the nursing population, and its association with sociodemographic and contextual characteristics, must be measured and evaluated as well as their repercussions on their mental health. Therefore, the purpose of this study was to analyse the repercussion of perceived threat from COVID-19 on the mental health of actively employed nurses, considering a COVID-19 diagnosis, whether their own or of someone close to them. The sample was comprised of 351 nurses. Sociodemographic data were collected, and the Questionnaire on Perception of Threat from COVID-19 and the General Health Questionnaire were administered. The three demographic and contextual variables mentioned were related to mental health, mediated in some symptoms by perceived threat. These results provide important information for implementing measures or psychoeducational programs for nurses, essential in the present pandemic for improving psychological adaptation and reducing the effects on their mental health.

The social impact of COVID-19 as perceived by the employees of a UK mental health service.

Abstract: This study explored the perceptions of NHS employees working within a UK mental health trust in relation to the social impacts of the COVID-19 pandemic. Questioning focussed on social isolation and desire to interact with others before and since COVID-19; effects of safety measures including personal protective equipment and social distancing; and perceived influences of the pandemic on service users and social aspects of service delivery. All employees at an English NHS mental health service were invited to complete an anonymous online questionnaire (July-September 2020), resulting in 464 completed questionnaires. Response frequencies were summed across the total sample, and the influence of patient contact, age, and vulnerability to COVID-19 were explored using pairwise comparisons. Approximately two thirds of employees felt there had been a fundamental change in how they felt about interacting with others, and many had lost confidence in their ability to relate emotionally to others. Respondents were keen to adhere to safety guidance, but the majority believed that face masks and social distancing could have a detrimental effect on communication and rapport within the workplace. Other concerns included passing on the virus, social isolation of employees and service users, and a reduction in community services. COVID-19 safety measures may impact morale, communication, empathy, and the provision of client-centred care. More generally, the pandemic has changed the attitudes of mental health workers towards social interaction, with younger employees reporting more mental health difficulties that may be linked to concerns about longer term social change.

The impact of COVID-19 pandemic-related stress experienced by Australian nurses.

Abstract: Globally, the impact of COVID-19 on healthcare workers' mental health has been a major focus of recent research. However, Australian research involving nurses, particularly across the acute care sector, is limited. This cross-sectional research aimed to explore the impact of pandemic-related stress on psychological adjustment outcomes and potential protective factors for nurses (n = 767) working in the Australian acute care sector during the COVID-19 pandemic. Nurses completed an online questionnaire with psychometrically validated measures of pandemic-related stress, psychological adjustment outcomes (depression, anxiety, and subjective well-being), and protective factors (posttraumatic growth and self-compassion). Descriptive analyses revealed that pandemic-related stress was reported by 17.7% of the participants. Psychological adjustment outcome scores above normal for depression (27.5%) and anxiety (22.0%) were found, and 36.4% of the participants reported poor subjective well-being. Regression analyses suggest that pandemic-related stress predicted greater depression (B = 0.32, SE = 0.02, 95% confidence interval [0.28, 0.35]) and anxiety (B = 0.26, SE = 0.01, 95% confidence interval [0.24, 0.29]) and less subjective well-being (B = -0.14, SE = 0.01, 95% confidence interval [-0.16, -0.12]). Self-compassion weakened the relationship between pandemic-related stress and greater depression, however, exacerbated the relationship between pandemic-related stress and less subjective well-being. Posttraumatic growth reduced the negative relationship between pandemic-related stress and psychological adjustment outcomes. These findings will inform strategies to facilitate psychological resources that support nurses' psychological adjustment, enabling better pandemic preparedness at both an individual and organizational level.