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Accessible summary: What is known on the subject: If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother–baby unit is recommended and should focus on the maternal health, mother–baby outcomes and the care for the next of kin.The role of mental health nurses on a mother–baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members.To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. What this paper adds to existing knowledge: This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother–baby unit.Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best‐practice setting (i.e., a specialized mother–baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. Implications for mental health nursing: Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery.To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Introduction: Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother–baby unit is recommended, where care will focus on the mother's health, the mother–baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim: Identifying nursing interventions used at a psychiatric mother–baby unit, when a patient is hospitalized with postpartum psychosis. Method: A qualitative design using thematic analysis. Data were collected using semi‐structured interviews (N = 13) with expert nurses working at such a unit. Results: The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well‐being; (b) care for the mother–baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well‐being. Discussion: Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice: Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The relationship between patient and professional is one of the cornerstones of successful treatment in mental health care.For part of the mental health patients, a similar outlook on life with their caregiver(s) is important.Attention to religion/spirituality (R/S) in mental health care is likely to influence the relationship between a patient and mental health professional, for patients preferring so. What the paper adds to existing knowledge?: Patients, who appreciate and experience personalized attention to R/S in conversations with practitioners and nurses, are likely to receive the highest therapeutic benefit from their relationship with their mental health professionalsPatients who welcome personalized attention to R/S in conversations but find themselves unsupported in this regard experience significantly lower levels of treatment alliance than do those whose needs are met or those who do not express such needsFor religious and nonreligious patients attaching importance to a similar outlook on life with practitioner or nurse, this experience was also related to a better relationship, compared with patients preferring so but experiencing a different outlook on life. What are the implications for practice?: Personalized attention to R/S in conversations is recommended, both for practitioners and nurses.In case of a different outlook on life between a patient and mental health professional, addressing R/S with an open and respectful attitude may prevent negative effects on a patient's treatment experience. Introduction: Attention to religion and spirituality (R/S) in mental health care has increased and may benefit treatment alliance. Aim: To describe the association of (un)met R/S care needs with treatment alliance and compliance among mental health patients. Methods: Patients in a Christian and a secular mental health clinic (n = 201) filled in a questionnaire. Scales of met and unmet R/S care needs (range 0‒14) were regressed on the Working Alliance Inventory (WAI), Service Engagement Scale and Medication Adherence Report Scale. Ancova analyses were performed for the fourteen R/S care needs separately. Results: In the Christian clinic, met R/S care needs were associated with a higher WAI score (p =.001) and unmet R/S care needs, with a lower WAI score (p =.000). For the Secular clinic, the same trends were observed, but insignificant. Items with the strongest associations were conversations about religious distress with a nurse (p =.000) and a similar outlook on life with practitioner (p =.001) or nurse (p =.005). (Un)met R/S care needs were not associated with treatment compliance. Discussion and implications for practice: We recommend personalized attention to R/S in conversations. A (perceived) similar outlook on life with mental health professionals may be beneficial for religious and nonreligious patients. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic.Most patients with severe mental illness receive long‐term treatment from specialized mental health services.This long‐term, highly intensive treatment is not always the best option for two reasons. Firstly, because as long as a patient receives intensive treatment aimed at safety, it is hard for that patient to take full responsibility for their own life. Secondly, because care is not available unlimitedly, some patients are waiting to receive specialist mental healthcare while others who do not need it anymore still receive it. What this paper adds to existing knowledge?: Most stable patients with severe mental illness can be treated outside of specialized mental health services.Some patients are too dependent on a specific mental healthcare professional to be referred to primary healthcare. In such instances, a referral will most likely lead to destabilization and the referral will therefore be unsuccessful.Patients preferred primary healthcare to specialized mental health services, mainly because of the absence of stigma associated with the latter.There should be more attention for personal recovery (especially the social support system) of patients with severe mental illness who are referred to primary healthcare services. What are the implications for practice?: Most stable patients with severe mental illness can be treated in primary healthcare.Professionals in primary healthcare should keep personal recovery in mind when treating patients, focusing on problem solving skills and also making use of social support systems. Aim/question: Care planning and coordination are currently insufficiently based on scientific insights due to a lack of knowledge on this topic. In the United Kingdom and the Netherlands, most patients with severe mental illness receive long‐term specialized mental healthcare, even when they are stable. This study aims to explore the outcome of these stable patients when they are referred to primary healthcare. Methods: Patients (N = 32) receiving specialized mental healthcare that were referred to primary healthcare were interviewed in focus groups, as were the involved professionals (N = 6). Results: 84% of the participants still received primary healthcare after 12 months. Despite the successful referral, the patient's personal recovery did not always profit. The participants of the focus groups agreed that some patients were too dependent on a specific mental healthcare professional to be referred to primary healthcare. Discussion: Most stable patients with severe mental illness can be referred to primary healthcare. Personal recovery and dependency on a specific healthcare provider should be considered when referring a patient to primary healthcare. Implications for practice: Professionals in community mental healthcare teams should consider a referral to primary mental healthcare in stable patients. Professionals in primary healthcare should keep the patient's personal recovery in mind. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Interaction between staff and patients with a diagnosis of personality disorder in forensic settings is important for quality of care, but research is lacking on what determines this interaction. What the paper adds to existing knowledge?: Insight, emotion‐focused coping and emotion regulation of staff influence the interaction between staff and these patients.Staff who understand their own thoughts, feelings and behaviour better (more insight) needed less support, encouragement or back‐up from their patients. Staff who cope by getting upset, blaming themselves or fantasizing about solutions (emotion‐focused coping) on the contrary needed more support from their patients.Emotion regulation had an impact on the relation between coping and hostile staff behaviour. When staff get upset (emotion‐focused coping) and try to think differently about the situation (reappraisal), this makes them behave in a more hostile manner towards their patients. When staff suppress their emotions and also distract themselves or engage in social activities (avoidance‐focused coping), they behave in a less hostile manner towards their patients. What are the implications for practice?: In order to provide compassionate care for their patients, staff ought to be trained in self‐compassion. This may help them not to get upset, blame themselves or fantasize about solutions and to understand their own thoughts, feelings and behaviour better. As a result, staff may need less support, encouragement or back‐up from their patients.Context is important: Staff ought to suppress their emotions when emotions run high, but only when they also care for themselves by distracting themselves or engaging in social activities. Facing and regulating their emotions by changing what they think about the situation (reappraisal) may be more appropriate once emotions have settled down. This may help staff to remain compassionate towards their patients in the long run and avoid burn‐out or compassion fatigue due to ignoring their own needs and boundaries. Introduction: Research is lacking on what determines interaction between staff and patients with a diagnosis of personality disorder in forensic settings. Aim: To test whether coping, self‐reflection, insight and emotion regulation are related to the behaviour of staff towards these patients, and to test the possible moderating and mediating effect of emotion regulation. Method: Using a cross‐sectional design, 76 direct care staff of a forensic clinic completed questionnaires on all variables. Relations were tested using simple linear regression, mediation and moderation analyses. Results: Insight and emotion‐focused coping of staff were related to seeking less and more support from patients, respectively. Emotion regulation by reappraisal combined with emotion‐focused coping was associated with more hostile behaviour by staff, and suppression combined with avoidance‐focused coping with less hostile behaviour. Conclusion: Insight, emotion‐focused coping and emotion regulation of staff influence the quality of care of patients with a diagnosis of personality disorder in forensic settings. Future research ought to include contextual factors. Implications for practice: Enhancing self‐compassion may improve insight and reduce emotion‐focused coping. Context is important: Taking the needs of staff into account may involve suppressing emotions combined with avoidance in a highly emotional situation while facing and reappraising the situation when emotions are low. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Client aggression in forensic psychiatry is associated with burnout symptoms in nursing staff. It is unclear what mechanisms contribute to this relationship.The type and severity of aggression might be of importance in the association between client aggression and burnout symptoms, but also the personality characteristics and emotional intelligence of nursing staff.It is unknown whether wearable devices that measure arousal can be used to detect chronic stress and burnout symptoms. What does this paper add to existing knowledge?: Especially, physical aggression as experienced by nursing staff is associated with staff's burnout symptoms (e.g., emotional exhaustion and depersonalization). Further research on the aggression questionnaire is necessary.The stress management skill of nursing staff is an important factor to consider in the association between burnout symptoms and client aggression.The wearable device was not useful for detecting burnout symptoms. What are the implications for practice?: Nursing staff who experience (physical) aggression should be carefully monitored and should receive social support from their management to aid their well‐being. Contrary to intuition, nurses who reported a higher number of stress management skills might have to be monitored more closely if necessary. Introduction: Aggressive behaviour of forensic clients is associated with burnout symptoms in nursing staff. The role of staff characteristics as moderators is unclear. Aim: We explored the association between type and severity of aggressive behaviour as experienced by nursing staff and staff's burnout symptoms. In addition, the moderating roles of personality characteristics and emotional intelligence (EI) were studied. Moreover, the usefulness of ambulatory skin conductance assessments in detecting arousal related to burnout symptoms was studied. Method: A total of 114 forensic nursing staff members filled out questionnaires and wore an ambulatory device. Results: Experiencing physical aggression was positively associated with staff's burnout symptoms. Stress management skills, a subscale of EI, but not personality, moderated this relationship. Skin conductance was not associated with burnout symptoms. Remarkably, the association between aggression and burnout symptoms was highest for staff reporting a higher number of stress management skills. Discussion: Longitudinal research is necessary to establish causality between client aggression and staff burnout symptoms. In addition, further research is necessary on the validity of the aggression measure used in the current study. Implication for practice: Nursing staff who experience physical aggression frequently should receive social support for this, and staff who report high stress management skills should be monitored more carefully after having been confronted with aggression. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Substance abuse, poor lifestyle and side effects of medication often occur and cause oral health problems in patients diagnosed with severe mental illness (SMI). Oral health in SMI is related to quality of life, self‐esteem, and daily functioning. Despite its importance, oral health in mental health care is still a postponed healthcare pathway. Treatment guidelines on patients after a first episode psychosis (FEP) indicate that interventions are recommended, but clinical advice is lacking. However, no research on the experiences of young adults' oral health after FEP has been conducted. What does this paper add to existing knowledge?: This study is the first study to gain insight into most important experiences in patients after FEP regarding oral health. After FEP, participants experience many risk factors, for example substance use, poor diet and financial problems, and participants are not able to adequately attend to their oral health. There is a lack of awareness among participants after FEP about oral health and participants do have high burden. After FEP, participants need support and help from their environment to maintain their oral health. What are the implications for practice?: In FEP, oral health needs more attention to avoid the negative consequences in a later phase of the illness. To fill the gap between patients' needs regarding oral health care and the attention of mental healthcare professionals, the awareness of patients and mental health professionals concerning oral health should be heightened, and clinical interventions to support these needs should be developed. Introduction: Oral health affects quality of life, self‐esteem, physical health and daily functioning. Treatment guidelines on patients after first episode psychosis (FEP) recommend interventions, but clinical interventions are lacking. No research on the experiences of young adults' oral health after FEP has been conducted. Aims: This study aimed to explore the lived experiences and needs of patients after FEP with regard to their oral health. Design and Methods: Single‐centre phenomenological study using open interviews (N = 30). Data were analysed using the Colaizzi method. Results: Patients reported oral health problems since their FEP. The problems that patients encountered were dental care in general (e.g., a lack of awareness), risk factors (e.g., substance use, poor diet and financial problems), overall experiences with dentists/dental hygienists and the gap between needs and interventions. Discussion: There is a lack of awareness among patients after FEP about oral health while patients are not able to adequately attend to their oral health and patients have high burden on this topic. Implications for mental health nursing: To bridge the gap between patients' needs regarding oral health, the awareness of patients and mental health professionals should be heightened, and patients should be better supported by mental health professionals. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the subject: Working in long‐term care is seen as a stressful, physically and mentally demanding occupation, and thus, nursing staff are at risk for work and stress‐related diseases. In older patients, psychiatric illnesses often occur in combination with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well‐being of nurses is unknown. What this paper adds to existing knowledge: Nursing staff working on specialized units for patients with combined care needs experience high levels of self‐efficacy in combination with strong feelings of self‐rated competence. Although levels of burnout are relatively low, mental healthcare nursing staff is more at risk for burnout when working in specialized settings for patients with combined care needs than nursing home staff working in specialized settings for these patients. Nursing staff characteristics, such as years of working experience and age, seem more important in relation to staff well‐being than patient characteristics in specialized settings for combined care needs. What are the implications for practice: Staff well‐being might benefit from specializing care, so that patients with similar care needs are placed together and care is focused. The presence of specialized care units for older patients with combined care needs can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. Abstract: Introduction: In older patients, psychiatric illnesses frequently exist in tandem with physical illnesses, requiring nursing care that is specific to these combined care needs. The impact of caring for these patients on the mental well‐being of nursing staff is unknown. Aim: To investigate whether care characteristics of patients with combined care needs are related to the mental well‐being of nursing staff. Method: Well‐being of nursing staff was studied within a larger exploratory observational cross‐sectional study that examined the differences and similarities of specialized combined care units in Dutch mental healthcare and nursing home settings. Results: Nursing staff across settings, with more than 5 years of work experience, felt competent in caring for patients with combined care needs. No significant effects of care characteristics of patients with combined care needs on the work‐related well‐being of nursing staff were shown. Both mental health nursing staff and older employees, however, were found to be more at risk for burnout. Implications/Conclusion: Staff well‐being might benefit from placing patients with combined care needs together, so care is focused. The presence of specialized care units can allow for both targeted and focused allocation of nursing staff to these units and provision of specific training. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? A core skill of practice nurses' mental health is to recognize and explore patients' unpleasant emotions., Patients rarely express their unpleasant emotions directly and spontaneously, but instead give indirect signs that something is worrying them., What this paper adds to existing knowledge? Patients with mild psychosocial and psychological problems provide signs of worrying or express a clear unpleasant emotion in 94% of consultations with a practice nurse mental health., Nurses' responses to patients' signs of worrying or clear unpleasant emotions were mostly characterized by providing space for patients to talk about these emotions, by using minimal responses., What are the implications for practice? Practice nurses' mental health have passive listening skills, and to a lesser extent, use active listening techniques., Accurate emotion detection and the ability to pick out emotional signs during consultations must also be considered as an important skill for health providers to improve patient-centred communication., Abstract Aim Patients with physical problems are known to express their emotional concerns in an implicit way only. Whether the same counts for patients presenting mental health problems in primary care is unknown. This study aims to examine how patients with mild psychosocial and psychological complaints express their concerns during consultations with the practice nurse mental health and how practice nurses respond to these expressions. Method Fifteen practice nurses mental health working in Dutch general practices participated in the study. Their consultations with 116 patients with mild psychosocial or psychological complaints were video recorded. patients' explicitly expressed emotional concerns and more implicit expressions of underlying emotional problems (cues) as well as nurses' responses to these expressions were rated using the Verona Coding Definition of Emotional Sequences. Results Almost all consultations contained at least one cue or concern (94%). Nurses' responses were mostly characterized by providing space for patients to talk about their cue or concern in a non-explicit way (62%), by using minimal responses (42%). Discussion Practice nurses mental health have passive listening skills, and to a lesser extent, use active listening techniques. However, there are no strict rules which way of responding is the best and patients value responses differently. [ABSTRACT FROM AUTHOR]

Accessible summary In addition to medical and psychosocial treatment of impairments, societal participation should be recognized as an important treatment goal for patients with schizophrenia, and it can be applied in daily practice by nurses and social workers, even when psychiatric impairments require acute care., Our research indicated that rehabilitation counselling by nurses and social workers within a multidisciplinary team helps to increase the societal participation level of young people with schizophrenia, while their impairments scores remained stable., Patients with more mild impairments seemed to profit more from rehabilitation counselling while patients whose impairments were more severe seemed to profit less. Our research also indicated that patients with similar levels of impairment did not show differences in their level of societal participation, regardless of drug use., Drug use as such is not a contraindication for rehabilitation counselling. Treatment of impairments, including management of drug addiction, should be closely interwoven with support for a patient's rehabilitation goals., Abstract This paper is based on research that focuses on the impact of a rehabilitation approach with respect to 99 young people diagnosed with schizophrenia in a Dutch mental health facility. The approach focused on societal participation goals. Nurses and social workers play a key role in such treatment. The research focused on developmental trajectories and showed significant improvement with respect to societal participation levels. Impairment scores remained stable. The results indicate that rehabilitation counselling by nurses and social workers, in addition to medication and psychosocial treatment and integrated in a multidisciplinary team, can make a difference in a patient's societal participation. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of a 'social participation' improvement project in a mental health care and care for the intellectually disabled setting. The main research question is how sociality (i.e. clients' social lives) was constructed and what consequences this had for the project and for the clients. We undertook a dual approach: investigating the predefined outcomes and analysing the improvement processes in terms of how these processes construct sociality. As to the predefined outcomes, clients' social networks were not widened, but clients felt significantly less lonely at the end of the project. In a bottom-up analysis of data gathered on the improvement processes, we articulated two ways of constructing sociality: individualization, in which clients had to verbalize their wishes (verbalization) and to act upon them more actively (enterprising); and normalization, in which a good social life was one embedded in 'normal' community. We argue that this (explorative) way of conceptualizing change corresponds with some of the quantitative findings but also brings to light aspects that would have gone unnoticed by using only the predefined outcomes. Therefore, a mixed methods approach in studying effectiveness is a fruitful addition to the quality improvement literature. [ABSTRACT FROM AUTHOR]