Showing papers in "Issues in Mental Health Nursing in 2015"

A synthesis of the literature on trauma-informed care.

Abstract: Patients with a history of traumatic life events can become distressed or re-traumatized as the result of healthcare experiences. These patients can benefit from trauma-informed care that is sensitive to their unique needs. However, despite the widespread prevalence of traumatic life experiences such as sexual assault and intimate partner violence, trauma-informed care has not been widely researched or implemented. The purpose of this synthesis of the literature is to examine existing research on trauma-informed care for survivors of physical and sexual abuse. The following themes are discussed: trauma screening and patient disclosure, provider-patient relationships, minimizing distress and maximizing autonomy, multidisciplinary collaboration and referrals, and trauma-informed care in diverse settings. This synthesis also explores implications for trauma-informed care research, practice and policy. The themes identified here could be used as a framework for creating provider and survivor educational interventions and for implementing trauma-informed care across disciplines. The findings of this synthesis support further research on patient and provider experiences of trauma-informed care, and research to test the efficacy of trauma-informed care interventions across healthcare settings. Universal implementation of trauma-informed care can ensure that the unique needs of trauma survivors as patients are met, and mitigate barriers to care and health disparities experienced by this vulnerable population.

Nursing Students’ Attitudes about Psychiatric Mental Health Nursing

Abstract: The purpose of this study was to describe Masters entry nursing students’ attitudes about psychiatric mental health clinical experiences; preparedness to care for persons with mental illness; students’ perceived stigmas and stereotypes; and plans to choose mental health nursing as a career. A 31-item survey was administered to pre-licensure graduate nursing students who were recruited from a Masters entry nursing program from a university in a large city in the Midwestern US. Results indicated that clinical experiences provide valuable experiences for nursing practice, however, fewer students think that these experiences prepare them to work as a psychiatric mental health nurse and none plan to pursue careers as psychiatric mental health nurses. The findings support conclusions from other studies that increasing the amount of time in the clinical setting and adding specific content to the curriculum, particularly content related to the importance of psychiatric mental health nursing and the effects of stigma, may assist the profession’s efforts to recruit and retain psychiatric mental health nurses. Further research is needed to determine the effectiveness of these strategies and to identify the best ways to implement them.

Therapeutic alliance in mental health nursing: an evolutionary concept analysis.

Abstract: The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.

Clinical placements in mental health: a literature review.

Abstract: Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

A Self-Destructive Care: Self-Reports of People Who Experienced Coercive Measures and their Suggestions for Alternatives

Abstract: Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures.

"Life on hold": a qualitative study of patient experiences with outpatient commitment in two norwegian counties.

Abstract: In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients' experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients' daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.

Whose Stress is Making Me Sick? Network-stress and Emotional Distress in African-American Women

Abstract: Research on stress-related health outcomes in African-American women often neglects "network-stress": stress related to events that occur to family, friends, or loved ones. Data from the African-American Women's Well-Being Study were analyzed to examine self-stress and network-stress for occurrence, perceived stressfulness, and association with symptoms of psychological distress. Women reported a higher number of network-stress events compared with self-stress events. Occurrences of network-stress were perceived as undesirable and bothersome as self-stress. Both types of stress were significantly associated with psychological distress symptoms. Including network-stress may provide a more complete picture of the stress experiences of African-American women.

Recovery as a Lived Experience Discipline: A Grounded Theory Study

Abstract: Recovery is government mandated and a core facet of mental health reform. However, Recovery implementation in this country (Australia) has been inhibited by a lack of education of, and understanding from, clinicians. A grounded theory study was undertaken to explore the potential and existing role of lived experience practitioners in assisting meaningful implementations of Recovery within the Australian mental health sector. In-depth interviews were conducted with 13 people employed to work from a lived experience perspective. The findings suggest participants have experienced and observed significant barriers to the implementation of Recovery-focused practice while operating in lived experience roles. Three main issues emerged: (1) Recovery co-opted, (2) Recovery uptake, and (3) Recovery denial. For a genuine Recovery-focused mental health system to be developed, lived experience practitioners must be enabled to take their role as Recovery experts and leaders. Lived experience practitioners are the logical leaders of Recovery implementation due to their own internal experience and understandings of Recovery and the wider lived experience movement's development and championing of the concepts.

Trauma-informed Care and the Research Literature: How Can the Mental Health Nurse Take the Lead to Support Women Who Have Survived Sexual Assault?

Abstract: Many women who access mental health services have been subjected to violent acts, including childhood sexual abuse and adult sexual assault, often at the hands of family members and partners. The vulnerability of these women can be further complicated when health professionals lack sensitivity to the issues involved; and the treatment received by the women is insensitive, leading to experiences of re-traumatisation. This article considers the principles of trauma-informed care and practice, as represented in the literature; and explains how mental health nurses can lead the way in multidisciplinary environments to ensure that women who have experienced violence receive the most appropriate health care, and are thereby supported to attain the best possible outcome.

The Therapeutic Relationship in the Shadow: Nurses’ Experiences of Barriers to the Nurse–Patient Relationship in the Psychiatric Ward

Abstract: The therapeutic relationship is widely accepted as the basic core and essence of the psychiatric nurse's role and is thus essential for providing quality mental health care. A detailed and clear perception of the issues that facilitate or obstruct this relationship is therefore important. The purpose of this study was to gain insights into the experiences of nurses working in psychiatry wards, of the barriers to the nurse-patient relationship. A qualitative content-analysis study was undertaken using a purpose-based sampling approach with the participation of 15 nurses employed in psychiatric wards in hospitals located in South Iran. Semi-structured interviews provided the source of data, and an inductive content-analysis approach was used for data analysis. The main concept extracted from the study was identified as 'the therapeutic relationship in the shadow', which captured the sense that this critical relationship is mostly unseen in the daily practice of the nurses interviewed. Factors that functioned as barriers to this relationship were classified into three main categories: nurse-related, patient-related and organization-related. The results of this study revealed that, despite the widely claimed importance of the nurse-patient relationship in psychiatric settings, this relationship is powerfully influenced by individual and organizational factors that have not been considered adequately in previous research. It is strongly recommended that greater consideration of these factors be given to care planning in psychiatric wards.

Emotional Intelligence: A Critical Evaluation of the Literature with Implications for Mental Health Nursing Leadership.

Abstract: Emotional intelligence (EI) is necessary for the development of interpersonal and professional competence in nurses. We argue that the concept of emotional intelligence has particular relevance for mental health nursing leadership. In this critique, we examine the recent empirical evidence (2010-2014) related to emotional intelligence, in general, and nursing, specifically. Correlations between emotional intelligence and better overall health, increased work satisfaction, higher spiritual well-being, and decreased risk of job burnout are noted. We offer suggestions for mental health nurse leaders in developing successful project management teams and improving retention of current leaders. We also provide suggestions for future research.

How illegal drug use, alcohol use, tobacco use, and depressive symptoms affect adolescent suicidal ideation: a secondary analysis of the 2011 Youth Risk Behavior Survey

Abstract: The purpose of this study was to identify the major risk factors among adolescents who have either contemplated or attempted suicide. Along with successful suicides, suicide attempts and contemplation are coexisting factors that are prominent in the adolescent population and therefore warrant major concern. A secondary data analysis of the Youth Risk Behavior Survey (YRBS) was completed to explore the factors that may influence adolescents' thoughts or actions about suicidal behavior. The YRBS represents high-school students throughout 50 states. Nine questions from the YRBS were used to elicit information about the relationships among the risk factors: (1) Suicidal thoughts and attempts; (2) illegal drug use; (3) alcohol use; (4) tobacco use; and (5) depressive symptoms. Statistically significant relationships among the risk factors were found for adolescents. Adolescents considered suicide (15.8%); attempted suicide at least once (7.8%); were injured while attempting suicide (n = 2.7%). Our findings support the idea that illegal substance use can lead to suicidal thoughts and actions. Depression had a positive relationship with suicidal ideations, supporting similar studies suggesting that depression leads to suicidal action.

Comparing online with face-to-face HELPP intervention in women experiencing intimate partner violence

Abstract: Intimate partner violence (IPV) is a public health problem. The purpose of this study was to compare the effectiveness of the HELPP (Health, Education on Safety, and Legal Support and Resources in IPV Participant Preferred) intervention among IPV survivors. A sequential, transformative mixed-methods design was used. Participants were randomly assigned to one of three study groups: Online (ONL), Face-to-Face (FTF), and Waitlist Control (WLC). The HELPP intervention was offered to 32 adult female participants who were 45.2% Asian, 32.3% White, and 22.5% Black. Outcome measures were anxiety, depression, anger, personal, and social support. In total, 64% (n = 20) of the participants reported having experienced IPV before the age of 18. The anger mean score pre-test to post-test difference was significant for ONL (p < 0.001) and WLC (p = 0.01). The personal and social support pre-test to post-test mean score differences were significant for ONL (p < 0.001; p < 0.001) and WLC (p = 0.01; p = 0.006), resp...

Features of Everyday Life in Psychiatric Inpatient Care for Self-harming: An Observational Study of Six Women

Abstract: This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was ‘being surrounded by disorder’, which consisted of ‘living in a confusing environment, being subject to routines and rules that offer safety but lack consistency’ and ‘waiting both in loneliness and in togetherness’. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.

Mindfulness-based Intervention for Perinatal Grief after Stillbirth in Rural India.

Abstract: We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention.

Satisfaction with housing and housing support for people with psychiatric disabilities.

Abstract: The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.

Suicide-specific Safety in the Inpatient Psychiatric Unit

Abstract: In total, 75% of suicides reported to the Joint Commission as sentinel events since 1995, have occurred in psychiatric settings. Ensuring patient safety is one of the primary tasks of inpatient psychiatric units. A review of inpatient suicide-specific safety components, inclusive of incidence and risk; guidelines for evidence-based care; environmental safety; suicide risk assessment; milieu observation and monitoring; psychotherapeutic interventions; and documentation is provided. The Veterans Health Administration (VA) has been recognized as an exemplar system in suicide prevention. A VA inpatient psychiatric unit is used to illustrate the operationalization of a culture of suicide-specific safety. We conclude by describing preliminary unit outcomes and acknowledging limitations of suicide-specific inpatient care and gaps in the current inpatient practices and research on psychotherapeutic interventions, observation, and monitoring.

Need for Resourcefulness Training for Women Caregivers of Elders with Dementia

Abstract: Nearly ten million American women are caregivers of elders with dementia and may experience overwhelming stress that adversely affects their mental health. Interventions to teach them resourcefulness skills for managing stress can promote optimal mental health and facilitate continued caregiving. However, effectiveness of resourcefulness training (RT) cannot be examined until its need is established. This pilot trial with 138 women caregivers of someone with dementia examined the need for RT using subjective and objective data. Data were collected before and after RT. Data analysis focused on baseline resourcefulness scores (higher scores = lower need); scores in relation to attrition; correlations among resourcefulness, stress, and depressive symptoms; and post-RT evaluation of the need for RT. Baseline resourcefulness scores were normally distributed and showed that 74% of the caregivers had a moderate to high need for RT. Reasons for attrition were unrelated to the need for RT; however, caregivers who dropped out had resourcefulness scores that averaged two points higher than those who remained in the study. Lower resourcefulness was associated greater stress (r = -.37, p < .001) and depressive symptoms (r = -.52, p < .001). Of the 63 caregivers who received RT, 82% (n = 52) reported a felt need for RT and 94% (n = 59) believed that other caregivers need RT. The results suggest a substantial need for resourcefulness training in women dementia caregivers and support moving forward to test RT's effectiveness for reducing caregiver stress and depressive symptoms.

Exploring Helpful Nursing Care in Pediatric Mental Health Settings: The Perceptions of Children with Suicide Risk Factors and Their Parents

Abstract: This qualitative descriptive study explored helpful nursing care from the perspective of children with suicide-associated risk factors, and their parents. Data were collected through participant observation followed by a debriefing session with children, and semi-structured interviews with parents. The inductive analysis revealed four themes of helpful interventions: (1) caring for the child as a special person; (2) caring for the parents; (3) managing the child's illness; and (4) creating a therapeutic environment. The study findings highlight the importance of the relational aspect of nursing care and provide important insights related to family-centered and strengths-based practice with children at increased risk for suicide later in life.

Clinical Use of Sensory Gardens and Outdoor Environments in Norwegian Nursing Homes: A Cross-Sectional E-mail Survey

Abstract: Gardens and outdoor environments offer multiple therapeutic possibilities for the residents in nursing homes. Web-based questionnaires were sent to 488 nursing home leaders and 121 leaders responded. The clinical impressions of the leaders and staff regarding the benefits of sensory gardens (SGs) to the residents were consistent with previous research. SGs facilitated taking residents outdoors, offered convenient topics for communication and facilitated social privacy for relatives. For improved clinical use of SGs and outdoor environments, systematic assessment of residents' interests, performance and experiences when outdoors, implementation of seasonal clinical programmes and educational programmes for leaders and staff are recommended.

Post-Traumatic Stress, Trauma-Informed Care, and Compassion Fatigue in Psychiatric Hospital Staff: A Correlational Study

Abstract: Assault of staff in psychiatric hospitals is a frequent occurrence, and studies indicate that hospital staff are at risk of developing post-traumatic stress disorder (PTSD). We performed a correlational study with a convenience sample of 172 staff in a psychiatric hospital and compared the rate of traumatic events (TEs), resilience, confidence, and compassion fatigue to PTSD symptoms (PTSS). Regression analyses identified two variables that were unique predictors of PTSS: (1) trauma-informed care (TIC) meeting attendance and (2) burnout symptoms. Severe TEs, age, and compassion satisfaction also contributed to the model. Attention to these factors may help reduce PTSS in psychiatric staff.

Post-traumatic Stress Symptoms among Iranian Parents of Children during Cancer Treatment.

Abstract: Support of parents of children with cancer requires healthcare personnel to be knowledgeable about the prevalence of post-traumatic stress symptoms among Iranian parents of children with cancer. This study was conducted to fulfill this aim in the South-East of Iran. Using the Impact of Event Scale –Revised, for parents of children with cancer, 200 parents in two hospitals supervised by Kerman University of Medical Sciences, were assessed. The total mean score of post-traumatic stress symptoms was 41.70. Among all categories of the Impact of Event Scale –Revised, the highest mean belonged to the category of ‘intrusion’ 16.03 (SD = 6.24) and the lowest one belonged to the category of ‘hyperarousal’ 10.68 (SD = 4.58). Based on the results, mothers had higher post-traumatic stress symptoms compared with fathers (p < 0.05). Adjusted odds ratio showed that the prevalence of post-traumatic stress symptoms among mothers was 2.49 times more than that among fathers (p = 0.01). There was no association between...

Feasibility of Mindfulness-based Stress Reduction Intervention for Parents of Children with Developmental Delays.

Abstract: Mindfulness-based stress reduction (MBSR) interventions are popular as a treatment strategy for myriad diagnoses in various settings, and may be beneficial for parents of children with developmental delays (DD). However, prior research suggests extreme levels of stress and extraordinary demands on time among these parents, making the feasibility of effectively implementing MBSR with this population questionable. This study examined the feasibility of administering standard MBSR to a diverse community-based sample of parents of young children with DD. The potential impact of MBSR interventions includes improvement in parents' mental health, and collateral benefits for the family environment, including improved child behavior. Nurses may have an integral role in interdisciplinary teams providing MBSR.

Qualitative Systematic Review of Intimate Partner Violence among Native Americans.

Abstract: The incidence of intimate partner violence (IPV) among Native Americans is high, and a full understanding of how to prevent it is unclear. Based on this qualitative systematic review of 13 research reports, a model of IPV among Native Americans was developed. IPV appears to be grounded within a history of upheaval and loss, and is entrenched and repressed within families. Victims are reluctant to seek assistance, and when they do, they often experience barriers within the service system. To prevent and resolve IPV, service providers are urged to establish trust with individuals who seek assistance and to leverage cultural strengths. They also are encouraged to adapt theoretical models to optimize care.

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Abstract: Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.

A Hermeneutic Phenomenological Examination of the Lived Experience of Incarceration for those with Autism.

Abstract: This study aimed to examine the lived experience of incarceration for those with autism using a hermeneutic phenomenological approach. Eight adults who were incarcerated in New South Wales, Australia, were interviewed. The lived experience of incarceration for the participants was about being in an unpredictable environment characterised by ever-changing routines and complex social situations. Participants were deprived of their ability to create predictability in their environment, and experienced confusion and distress when forced to comply with actions that were in conflict with their logic. Mental health nursing case management is recommended to address the needs of incarcerated persons with autism.

Mindful teaching practice: lessons learned through a hearing voices simulation.

Abstract: A hearing voices simulation (Deegan, 1996) was conducted with mental health nursing students (N = 87) at a large Midwestern university. The goals of this simulation were to change attitudes and decrease stigma. Students used mp3 players to listen to an audio simulation while simultaneously engaging in activities requiring focus and concentration. The Attitude toward Mental Illness Questionnaire (AMIQ; Cunningham, Sobell, & Chow, 1993) was administered pre-and post-simulation and open-ended questions about the experience also were asked. Responses to questions demonstrated increased patience, tolerance, understanding, and empathy among participants. Statistical data demonstrated significant changes in participants post-simulation. However, although students reported increased comfort being around persons hearing voices, they were less likely to acknowledge individual behavior as indicative of recovery. In this article, we discuss how these unexpected outcomes may be related to a subtle illness versus recov...

Experiences of Tenants with Serious Mental Illness Regarding Housing Support and Contextual Issues: A Meta-Synthesis.

Abstract: This study aimed to analyze and synthesize findings from qualitative studies that explored the experiences of tenants with serious mental illness regarding housing support and contextual issues. Twenty-four articles were identified using a systematic search strategy. The total number of informants was N = 769. The reported findings were transcribed and analyzed using a systematic text condensation approach. The tenants' experiences were categorized into two main categories and subcategories (in parenthesis): Support Issues (Experience of Support Needs, Experiences with Receiving Support, Experiences with Support Approach) and Contextual Issues (Neighborhood Experiences, Community Experiences). The subcategories, with themes and subthemes, offer an in-depth understanding of the tenants' complex experiences concerning housing support and contextual issues.

'Because That's the Way It's Always Been Done': Reviewing the Nurse-Initiated Rules in a Mental Health Unit as a Step Toward Trauma-Informed Care.

Abstract: Acknowledgement of the effects of trauma in the lives of the mental health service user population is increasingly being recognised as an imperative for Mental Health services. 'Trauma-informed care' provides values to guide practice. Mental Health nurses are well placed to commence integrating trauma-informed care into everyday practice. This paper describes the process of reviewing the nurse-led rules in an acute inpatient mental health unit as one step toward providing a trauma-informed environment. Findings from questionnaires are used to highlight the applicability of the process to the underlying values of trauma-informed care. Consistency and transparency of rules is demonstrated as a nursing-led step toward establishing emotional safety and creating a trauma-informed environment.

From Resistance to Existence-Experiences of Medication-Assisted Treatment as Disclosed by People with Opioid Dependence.

Abstract: This study aimed to describe the lived experiences of participating in a medication-assisted treatment as disclosed by individuals with opioid dependence. Eleven narrative interviews were conducted and subjected to qualitative content analysis. The experiences of participating in the programme were described as a process from resistance to existence. The participants seized the chance to claim a life lived with dignity, struggled with hidden challenges, and eventually were freed from their pasts and were grateful for an existence with dignity. The recovery process was a long-term commitment and participants asked for a more individual and flexible process based on personal needs and values.