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Accessible Summary: What Is Known about the Subject?: One in five mothers and birthing parents are affected by postpartum depression (PPD), yet only a small proportion of those with PPD receive treatment.Given cost and accessibility barriers to treatment, brief therapies (e.g. 1 day) could help address PPD on a large scale, though understanding participants' unique experiences with this novel treatment will help guide its refinement and use. What this Paper Adds to Existing Knowledge?: This paper describes the experiences, perspectives and satisfaction of participants who attended a 1‐day workshop for PPD.Participants appreciate being taught practical techniques and the receipt of social support from facilitators and other attendees in the group setting, while some recommended further 'booster sessions' to enhance effectiveness. What Are the Implications for Practice?: One‐day CBT‐based workshops may be an effective, low‐intensity treatment option that provides helpful skills and builds social networks for individuals with PPD.Additional post‐workshop booster sessions may enhance participant satisfaction with this new treatment by providing a reinforcement of their learning and an opportunity to re‐connect with other birthing parents. Introduction: Postpartum depression (PPD) affects up to one in five mothers and birthing parents. Understanding their perceptions of therapeutic interventions is key to their effectiveness and scalability. Aim: The aim of the study was to understand participants' experiences attending an in‐person or online 1‐day cognitive behavioural therapy (CBT)‐based workshop for PPD and compare their experiences participating in either modality. Method: This descriptive qualitative study was embedded in two separate randomized controlled trials evaluating the effectiveness of 1‐day CBT‐based workshops for PPD delivered in‐person or online. Responses were provided by 94 in‐person and 95 online participants about their experiences. Content analysis was used to code and categorize the data. Results: Participants appreciated learning skills to improve PPD symptoms and joining a community of individuals with shared experiences. Integrating practical coping techniques after the workshop was reported to be most useful, though some wanted additional post‐workshop support. Online participants identified additional barriers to workshop engagement. Discussion: Participants who attended either workshop found them to be valuable and effective. Participants valued psychoeducation, social connections and applying practical CBT techniques. Implications for Practice: One‐day CBT‐based workshops may be an accessible treatment option for individuals with PPD, providing new skills and social support, though some prefer to receive additional post‐workshop support. [ABSTRACT FROM AUTHOR]

What is Known on the Subject?: People living with schizophrenia have reduced physical function and are more likely to experience loneliness than those without condition.Low physical function is associated with greater loneliness in people with psychosis. However, it is unclear whether social isolation and loneliness contribute to impaired physical function in this population.Loneliness is linked to an increased risk of physical function impairment among older individuals, but research on patients living with schizophrenia is limited. What This Paper Adds to Existing Knowledge?: This study is the first to evaluate the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia.It showed that more than one third of the participants experienced a decline in physical function over a 2‐year period.Loneliness, rather than social isolation, was associated with an increase in physical function impairment over 2 years among inpatients living with schizophrenia. What are the Implications for Practice?: Healthcare professionals should recognize loneliness as a potential risk factor for impaired physical function among inpatients diagnosed with schizophrenia.It is recommended that people living with schizophrenia are assessed for loneliness and that interventions are offered to alleviate their feelings of loneliness.Implementing interventions to reduce loneliness may help improve physical function and overall quality of life for individuals living with schizophrenia. Introduction: Patients living with schizophrenia often experience low physical function, which is associated with negative health outcomes. Therefore, investigating the risk factors for physical function is crucial in this population. Aim: This study examined the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia. Methods: Physical function was assessed using measures of activities daily living (ADL), instrumental activities daily living (IADL) and the combination scores of ADL/IADL. Social isolation was indexed with five types of social connection and loneliness was measured using UCLA Loneliness Scale. Results: Social isolation was not associated with the measures of physical function over 2 years. Loneliness exhibited an association with IADL and ADL/IADL at follow‐up, after adjustment for baseline levels of the outcomes. These associations remained when both social isolation and loneliness were simultaneously entered into the model. Discussion: Loneliness, rather than social isolation, was associated with increased physical function impairment over 2 years among inpatients living with schizophrenia. Implications for Practice: Healthcare professionals should consider loneliness as a potential risk factor for impaired physical function. It would be beneficial to assess patients for loneliness and implement interventions to reduce feelings of loneliness. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. What the paper adds to existing knowledge?: The '061 QUIT‐MENTAL study' evaluated the efficacy of a proactive telephone‐based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non‐mental health specialized nurses and other health professionals to provide evidence‐based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. What are the implications for practice?: While the training programme was successful in improving non‐mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. Introduction: The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long‐term viability. The 061 QUIT‐MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone‐based intervention addressed to mental health patients conducted by non‐psychiatric specialized nurses. Aim: We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method: Mixed methods study: (1) Pre‐post evaluation to assess self‐reported knowledge, self‐efficacy and opinions about smoking cessation. (2) In‐depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results: The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population‐based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion: Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population‐based interventions to individuals with mental health disorders. Implications for Practice: Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Children and adolescents' mental health problems, such as autism spectrum disorder, anxiety disorder and attention‐deficit hyperactivity disorder, are a global public health concern, and nurses require advanced expertise and skills to properly care for this population.There is a gap between the required competencies and the actual skills and knowledge of CAMHN practitioners. Previous studies suggest that educational interventions for nurses are necessary to enhance the quality of care for children and adolescents with mental health problems. However, the corresponding evaluation indicators have not been verified, making it difficult to determine the most effective methods. What this paper adds to existing knowledge?: The present study developed the two‐factor (direct care for children and their family members and approach to the care environment) Clinical Competency Assessment Scale in Child and Adolescent Mental Health Nursing (CCAS‐CAMHN).We demonstrated that the assessment scale was reliable and valid, based on its adequate internal consistency and temporal stability, the acceptable range of its model‐fit indexes, and its good concurrent and divergent validity. What are the implications for practice?: The newly developed scale is useful for assessing nurses' competency and could help them identify their difficulties in CAMHN.The scale could contribute to the development of effective educational interventions to enhance the quality of care for children and adolescents with mental health problems. Introduction: Caring for children and adolescents with mental health problems, such as autism spectrum disorder, anxiety disorder and attention‐deficit hyperactivity disorder, requires expertise and skills. A quantitative clinical competency measurement tool in child and adolescent mental health nursing (CAMHN) is needed to evaluate the indicators of advanced expertise. Aim: The aim of this study was to develop a clinical competency assessment scale in CAMHN and evaluate its psychometric properties. Method: Scale items were derived from previous studies and adjusted based on cognitive interviews with five CAMHN experts. In total, 505 nurses in CAMHN from 29 hospitals in Japan participated in the self‐administered survey. The scale's construct validity, criterion‐related validity, internal consistency and test–retest reliability were assessed. Results: A two‐factor (direct care for children and their family members and approach to the care environment) scale was constructed. A secondary structural model showed that a two‐factor model fits best. The total score was significantly and positively correlated with excellence in nursing practice, amount of clinical experience and mental status. The overall scale exhibited good validity and reliability. Discussion: The scale is reliable and valid for assessing CAMHN clinical competency. Implications for Practice: The scale is useful for assessing nurses' competency and evaluating educational interventions' effectiveness for nurses. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Loneliness is common among young and middle‐aged stroke survivors. It not only hinders the recovery of their neurological and physical functions but also increases the risk of stroke recurrence, disability, and even death.Improving the mental health of young and middle‐aged stroke survivors is of utmost importance. However, previous research has not yet investigated the impact of interpersonal sensitivity and resilience on the relationship between stigma and feelings of loneliness. What the paper adds to existing knowledge?: This study confirms that stigma has a positive impact on loneliness among young and middle‐aged stroke survivors.Interpersonal sensitivity partially mediates the relationship between stigma and loneliness, and resilience plays a moderating role in the mediating mechanism. What are the implications for practice?: Mental health nurses can formulate nursing interventions to reduce loneliness of young and middle‐aged stroke survivors with the goals of improving stigma, reducing interpersonal sensitivity and cultivating resilience. Introduction: Previous studies have not explored the impact of interpersonal sensitivity and resilience on the relationship between stigma and loneliness. However, improving the resilience of young and middle‐aged stroke survivors and increasing their social participation is of great significance for reducing patients' loneliness of patients and promoting their physical and mental rehabilitation. Aims: To investigate the influence of stigma, interpersonal sensitivity and resilience on loneliness among young and middle‐aged stroke survivors. Methods: A cross‐sectional design was used to collect data. A total of 330 participants completed measures of stigma, resilience, interpersonal sensitivity and loneliness. The descriptive statistical approach, Pearson's correlation analysis and Hayes' PROCESS Macro Model 4 and 7 in regression analysis were used to analyse the available data. Results: The results revealed that young and middle‐aged stroke survivors' stigma, resilience, interpersonal sensitivity and loneliness were significantly correlated between every two variables, with coefficients ranging between −0.157 and 0.682. Interpersonal sensitivity played a partial mediating role in stigma and loneliness, accounting for 63.27% of the total effect; This process was moderated by resilience. Discussion: Stigma positively predicts participants' loneliness. As a mediating mechanism with moderating, interpersonal sensitivity and resilience further explain how stigma affects loneliness. Implications for Practice: Understanding this mechanism is of guiding significance to reduce loneliness of young and middle‐aged stroke patients and promote their physical and mental rehabilitation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented services have been shown to promote recovery in people with mental illness; their implementation is important for current psychiatric practice and is being considered by many professional institutions.The Japanese government released the policy 'A Vision for Reform of Mental Health and Medical Welfare' (Ministry of Health, Labour and Welfare, 2004; https://www.mhlw.go.jp/topics/2004/09/dl/tp0902‐1a.pdf), aiming to update public consciousness, reorganize the mental healthcare welfare system and strengthen the foundation of mental healthcare to promote a basic policy focusing on the transition 'from hospital to community life'. What the paper adds to existing knowledge?: This is the first study to clarify recovery‐oriented attitudes among psychiatric nursing directors and related factors in Japan. It shows an association between recovery‐oriented attitudes and hospital size. What are the implications for practice?: A relationship exists between the recovery knowledge and recovery‐oriented attitudes of psychiatric nursing directors. It may thus be valuable for directors to see and hear about the experiences of patients living in the community during their recovery process. As hospital size and organizational climate may hinder the successful implementation of recovery‐oriented practices, these factors must be considered when introducing such practices.Further research is needed on the relationship between psychiatric nursing directors' recovery‐oriented attitudes and practices. Moreover, to develop intervention studies that uncover success factors for enhancing recovery‐oriented attitudes, organizational factors that enable recovery‐oriented practices must be further investigated. Introduction: Recovery‐oriented practices in mental health services have become a global priority. Despite their proven effectiveness, Japanese hospitals have not widely implemented such practices. Aim: This study clarified psychiatric nursing directors' recovery‐oriented attitudes and factors regarding promoting recovery‐oriented practices to identify methods for developing these practices in Japan. Method: This cross‐sectional study used a questionnaire survey with 250 nursing directors from 1287 Japanese psychiatric hospitals. Multivariable regression analysis assessed how socio‐demographic variables and Recovery Knowledge Inventory (RKI) scores affected Recovery Attitudes Questionnaire (RAQ‐7) scores. Results: The analysis revealed that more clinical and managerial experience was associated with more negative recovery‐oriented attitudes. High RKI scores, knowledge of strength, hospital size and outpatient work experience were associated with more positive recovery‐oriented attitudes. Discussion: Implementing recovery practices requires consideration of knowledge and experience in recovery and hospital size alongside recovery training based on a hospital's organizational structure. Although the low response rate could influence the study's generalisability, it could also indicate low interest in recovery‐oriented practices among professionals. Implications for Practice: Acquiring more knowledge and experience regarding recovery promotes recovery‐oriented attitudes among nursing directors. An appropriate organizational culture and consideration of hospital size are required when introducing such recovery practices. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses.Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated.Notwithstanding the known impact of certain intrinsic factors (e.g., personality‐related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. What this paper adds to existing knowledge?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses.Certain intrinsic factors, including those personality‐related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. What are the implications for practice?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care.Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on‐the‐job training programmes that involves actual practice and collaboration in a multidisciplinary team. Introduction: Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim: To conduct a questionnaire‐based survey on mental health nurses from eight hospitals. Method: A total of 239 psychiatric nurses were assessed based on (1) "big‐five Mini‐Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results: A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion: Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice: Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on‐the‐job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Self‐management comprises five core skills: "Problem Solving, Decision‐Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action."Effective self‐management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes.Knowledge of the impact of the family atmosphere, well‐being and illness symptoms on self‐management in patients diagnosed with anxiety disorders is limited. What does the paper add to the existing knowledge?: This is the first study in China to explore whether family atmosphere and well‐being of patients diagnosed with anxiety disorders affects self‐management.This paper adds to the list of factors influencing self‐management among patients diagnosed with anxiety disorders.SAS scores are a major factor influencing self‐management among patients diagnosed with anxiety disorders.The subjective well‐being of patients diagnosed with anxiety disorders can influence their self‐management behaviour.Patients who experienced family harmony had significantly higher self‐management scores than those who experienced family disharmony. What are the implications for practice?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home.Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well‐being.Nurses should emphasize the importance of the home environment in family self‐management and affirm that a good home environment promotes patient self‐management. Introduction: Better self‐management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well‐being and the home environment on self‐management among patients diagnosed with anxiety disorders is unclear in China. Aim: This study sought to determine the impact of the home environment, well‐being and illness symptoms on self‐management during home treatment for patients diagnosed with anxiety disorders. Method: This cross‐sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self‐Management Scale for People with Anxiety Disorders and Index of Well‐being. Frequency, percentage, analysis of variance, Kruskal–Wallis and multiple linear regression analyses were used. Results: Home environment (p <.001), self‐perceived quality of life (p =.015), well‐being index (p =.002) and SAS total score (p =.033) had a major impact on self‐management in patients diagnosed with anxiety disorders (n = 245). Discussion: Family disharmony, poor self‐perceived quality of life, high SAS scores and low levels of well‐being were significant influences on self‐management among people diagnosed with anxiety disorders. Implications for Practice: Nurses should focus on the self‐management of patients diagnosed with significant anxiety symptoms and low well‐being and value the importance of the home environment in facilitating self‐management among patients diagnosed with anxiety disorders. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: The nurse–patient relationship in mental health care is an important focus of mental health nursing theories and research.There is limited evidence about which factors influence nurse‐sensitive patient outcomes of the nurse–patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse–patient relationship in nursing practice and nursing education. What this paper adds to existing knowledge?: To our best knowledge, this is the first study to examine associations between nurse‐sensitive patient outcomes of the nurse–patient relationship and a range of patient characteristics and relationship‐contextual factors.In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse‐sensitive patient outcome scale. What are the implications for practice?: Having insight into the factors associated with nurse‐sensitive patient outcomes of the nurse–patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse–patient relationship, trying to influence outcomes of nursing care. Introduction: The lack of evidence on patient characteristics and relational‐contextual factors influencing nurse‐sensitive patient outcomes of a nurse–patient relationship is a possible threat to the quality and education of the nurse–patient relationship. Aim: To measure nurse‐sensitive patient outcomes of the nurse–patient relationship and to explore the associations between nurse‐sensitive patient outcomes and a range of patient characteristics and relational‐contextual factors. Method: In a multicenter cross‐sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse‐Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results: Overall, patient‐reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion: The results may help nurses to become more sensitive and responsive to factors associated with nurse‐sensitive patient outcomes of the nurse–patient relationship. Implications: The nurse‐sensitive results can support nurses in designing future nurse–patient relationships. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is Known on the Subject?: Staff working with other people's mental health are in more danger of experiencing high stress at work.These members of staff are more likely to have mental health problems themselves.Previous research has suggested that training these members of staff to deal with their daily stress and become mentally tougher can protect them. What this Paper Adds to Existing Knowledge?: The findings showed that higher levels of perceived stress and reduced quality of life in mental health workers were related to lower levels of mental toughness.This research provides a detailed understanding of the current issues experienced in a range of different mental health settings, which may contribute to stress and quality of life.The research highlights the importance of protecting staff mental wellbeing, controlling and reducing levels of stress and suggests that one route to doing this is improving mental toughness. What are the Implications for Practice?: These findings suggest a need to increase the awareness of and further protect the mental health of staff working in the mentioned settings.Staff working in mental health settings should be provided with information about how to enhance mental toughness and how to reduce stress.This will lead to a better quality of life for mental health staff and in turn improve the quality of care provided. Introduction: Clinicians working in mental health services are at increased risk of stress at work. Previous work suggests that mental toughness is a protective mechanism for stress in other professions. This has not yet been examined in mental health workers. Aim/Question: To examine whether mental toughness predicts perceived stress and quality of life in mental health workers, to develop an understanding of the factors contributing to and techniques used to deal with stress in this population. Method: Sixty‐two workers completed measures of mental toughness, perceived stress, quality of life and answered questions regarding their personal experience of stress at work. Results: Mental toughness was a predictor of stress (F(7, 54) = 10.58, p <.001) and quality of life (F(6, 55) = 7.58, p <.001, F(7, 54) = 7.15, p <.001 and F(7, 54) = 6.81, p <.001, for compassion satisfaction, burnout and secondary traumatic stress, respectively), with particular roles for the interpersonal confidence and control of life components. Qualitative analysis revealed sources of stress for health workers and a variety of stress management techniques to cope with workplace stress. The findings suggested that mental toughness develops in some but not all health workers due to the demands of their role. Discussion: The findings provide an insight into stress, quality of life and protective factors for stress in mental health workers and suggest that future research should consider mental toughness training in mental health workers. Implications for Practice: There is a need to increase the awareness of factors contributing to stress in mental health workers, such as a lack of resources and staff, and to promote organizational change to improve their professional quality of life. Future research should also explore the potential of mental toughness training in this population. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Internationally, stigma towards people with mental illness has reduced due to greater understanding, education and advocacy in the community, and more focus on recovery‐oriented care within practice guidelines.However, many people with a diagnosis of BPD continue to experience stigma and difficulty accessing health services. Contributing factors include lack of understanding of BPD and effective management by health professionals, stigma from the general population and within healthcare services, and financial and geographical barriers.Mental health nurses comprise a large part of the healthcare workforce responsible for the day‐to‐day care of people diagnosed with BPD. What the paper adds to existing knowledge: This paper investigates how Australian consumer perspectives on BPD management have changed over time. Comments from a large survey, delivered to consumers in 2011 (N = 153) and 2017 (N = 424), were analysed for common themes.Themes were broadly related to NHMRC BPD Guidelines sections released in 2013. These data sets therefore present an opportunity to evaluate changes in consumer perspectives pre‐ and post‐Guideline release. Although no direct causal relationship can be drawn, analysing these changes can potentially assist with understanding the impact of the Guidelines in practice. No such analysis of the Australian Guidelines has been conducted to date in the existing literature. What are the implications for practice?: Many people diagnosed with BPD continue to experience stigma, barriers to treatment and difficulty accessing appropriate services.Widespread practical implementation of the Guidelines was not apparent; however, improved general awareness and understanding of BPD from consumers and health professionals were evident. Improved education and practice across each and all aspects of the Guidelines are indicated.The Guidelines need review to ensure they are in‐line with current evidence‐based practice, as well as effective health professional education, support and funding to embed the revised Guidelines into practice. Introduction: Internationally, many individuals diagnosed with BPD continue to experience stigma within health care and are more likely to be viewed as manipulative and evoke negative responses from clinicians, compared with other mental health consumers. Aim/Question: To understand Australian consumer perspectives regarding BPD management, and how these have changed between 2011 and 2017. To comment on how NHMRC BPD Guidelines, released 2013, are faring in practice. Method: Individuals who identified a BPD diagnosis completed a 75‐question survey, delivered online Australia‐wide, in 2011 (N = 153) and 2017 (N = 424), providing comparative data sets to evaluate changes in consumer perspective on BPD management. Results: Many people diagnosed with BPD experience difficulties when seeking help, stigma within health services and barriers to treatment. Improved general awareness, communication and understanding of BPD from consumers and health professionals were evident. Discussion: Consumers demonstrated increased BPD‐literacy and help‐seeking behaviours in 2017, providing opportunity for health professionals to build stronger therapeutic relationships. Widespread practical implementation of the Guidelines does not appear to have been achieved. More health professional education, updated Guidelines, funding and strategies to embed these Guidelines into practice are needed. Implications for Practice: Mental health nurses regularly provide care to people diagnosed with BPD; with practical education and support, they and other health professionals can improve their confidence in practice and provide better quality care to consumers. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Family‐involved interventions can result in better outcomes than traditional mental health care for both service users and their families.Nurses' attitudes towards family involvement can affect family participation in care.Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. What the paper adds to existing knowledge?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong.Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. What are the implications for practice?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care.Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders. Introduction: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings. Aims: This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors. Methods: This study is a cross‐sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care‐Nurses' Attitudes (FINC‐NA) instrument. Results: Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation‐related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care. Discussion: The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades. Implications for practice: Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Much research has been conducted on the relationship between recovery orientation and people diagnosed with mental illnesses such as schizophrenia and mood disorders. A recovery‐oriented approach by mental health professionals can reduce hospital stays and medical costs for people diagnosed with mental illness.There are similarities and differences between recovery‐oriented approaches for individuals diagnosed with dementia and those diagnosed with mental illness. This reflects the characteristics of irreversible dementia.Although dementia courses at recovery colleges are increasing, dementia recovery is in its infancy and course content varies. The core of the recovery framework for individuals diagnosed with dementia is 'Continue to be me'.Recovery‐oriented approaches and programmes have been developed by mental health workers for older adults, including those with dementia, but there are no outcome measures that reflect the characteristics of dementia care. What the paper adds to existing knowledge?: We developed a scale to assess nurses' recovery orientation in dementia care, which has been found to be reliable, and although some validity issues remain, it is the first scale to objectively assess recovery orientation in dementia care.The emphasis is on helping people diagnosed with dementia maintain their identity, which is not adequately covered by existing measures of recovery. What are the implications for practice?: The ability to objectively assess recovery orientation in dementia care allows us to identify areas of inadequacy.It can be used to reduce variation in the content of recovery college courses and as an indicator for evaluating training in recovery‐oriented approaches to dementia care. Introduction: Programmes regarding recovery‐oriented approaches for older people, including those with dementia, have been developed, but there are no clear indicators, and the process is still in its infancy. Purpose: We developed a scale to assess nurses' recovery orientation in dementia care. Methods: A draft of a 28‐item scale was developed based on interviews with 10 nurses, skilled in dementia care with a Japanese mental health perspective, and a literature review. A self‐administered questionnaire was developed for nurses working in a dementia ward, and an exploratory factor analysis was conducted. A confirmatory factor analysis was conducted to test for convergent and discriminant validity. The Recovery Attitude Questionnaire was used to examine criterion‐related validity. Results: An exploratory factor analysis produced a 19‐item scale and identified five factors (KMO value: 0.854). The Cronbach's alpha for the overall scale was.856, with each subfactor showing a range of.742–.792, validating its reliability. Discussion: The results of confirmatory factor analysis supported the five‐factor construct. Reliability was verified, but some issues remained in convergent and discriminant validity. Implications for Practice: This scale can be used to objectively assess nurses' recovery orientation in dementia care and as a measure of training in recovery‐oriented approaches. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals diagnosed with substance use disorders may perceive stigma and suffer from mental health problems.Perceived stigma is related to poor mental health among individuals diagnosed with substance use disorders.The social support deterioration deterrence model proposes that stressors (e.g. perceived stigma) negatively affect mental health via reduced perceived social support. To the best of the present authors' knowledge, the model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. What the paper adds to existing knowledge?: The paper used structural equation modelling to show that the social support deterioration deterrence model could explain the relationship between perceived stigma and depression among individuals diagnosed with substance use disorders.Perceived support from family and perceived support from friends are mediators in the association between perceived stigma and depression among individuals diagnosed with substance use disorders. What are the implications for practice?: Psychosocial interventions to increase perceived support from family and friends would be helpful in addressing perceived stigma effects on mental health. Introduction: Although the relationship between perceived stigma and mental health outcomes is documented in the existing literature, very few studies have investigated the mechanism linking perceived stigma and mental health outcomes among individuals diagnosed with substance use disorders. To the best of the present authors' knowledge, the social support deterioration deterrence model has never been tested in the context of perceived stigma among individuals diagnosed with substance use disorders. Aim/Question: Guided by the social support deterioration deterrence model, the present study investigated the mediating role of perceived support from three types of social network members (i.e. significant others, family members, and friends) in the association between perceived stigma and depression in individuals diagnosed with substance use disorders. Method: The study employed a cross‐sectional survey design comprising 300 participants diagnosed with substance use disorders in Taiwan. Results: Results of a structural equation modelling analysis indicated that perceived stigma was significantly associated with depression. The relationship between perceived stigma and depression was partially mediated by perceived family support and perceived friend support. Discussion: Consistent with the prediction of the social support deterioration deterrence model, the negative effect of perceived stigma on depression for individuals diagnosed with substance use disorders is through the mediating effect of social support. Implications for practices: Based on the present study's results, psychosocial interventions to increase perceived support from family and friends would be helpful in addressing negative effects of perceived stigma on mental health among individuals diagnosed with substance use disorders. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Prior research has demonstrated that childhood trauma can increase adolescents' suicidal ideation, and perceived stress plays a mediating role in the relationship between childhood trauma and adolescents' suicidal ideation. Character strengths, which are trait‐like positive personality characteristics, have also been found to be closely related to decreased stress and suicidal ideation. However, it is unclear whether character strengths act as a transfer mechanism that links childhood traumatic experiences with perceived stress and eventually suicidal ideation. What the paper adds to existing knowledge?: This study found that character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation. Specifically, childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. This study provided important theoretical implications for preventing suicidal risk among adolescents who are exposed to traumatic events during childhood. What are the implications for practice?: This study highlighted the roles of character strengths and perceived stress in the relationship between childhood traumatic experiences and suicidal ideation, which provided suggestions for designing nursing interventions to reduce adolescents' suicidal ideation, especially for those with traumatic childhood experiences. In addition to family nursing, school‐based regular monitoring and interventions of character strengths and perceived stress are necessary. Aim: This study sought to examine the mediating effects of character strengths and perceived stress on the relationship between childhood trauma and suicidal ideation among adolescents. Methods: A cross‐sectional survey was conducted on a sample of 1069 Chinese adolescents. The Chinese versions of the Suicidal Ideation Scale, Childhood Trauma Questionnaire, Perceived Stress Scale and Character Scale for Adolescents were used to assess adolescents' suicidal ideation, childhood trauma, perceived stress and character strengths. Results: The findings showed that childhood trauma influenced suicidal ideation directly and indirectly via perceived stress. Moreover, character strengths and perceived stress serially mediated the association between childhood trauma and suicidal ideation, implying that childhood trauma was associated with inferior character strengths, and the impaired character strengths further triggered high perceived stress, which was finally linked to a heightened risk of suicidal ideation. Conclusions: This study highlighted the joint contribution of childhood trauma, character strengths and perceived stress to suicidal ideation, providing theoretical and practical implications to guide mental health nurses to reduce the suicide risk among adolescents. Implications for Practice: These findings highlighted the importance of developing character strengths and stress‐coping strategies. Family nursing and school‐based regular monitoring and interventions of character strengths and perceived stress are necessary among adolescents who exposed to a high level of childhood trauma experiences to reduce their suicidal ideation and foster mental health. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recurrence is common in patients diagnosed with major depressive disorder (MDD). Psychological resilience has been shown to be a protective factor against recurrence of depression. It has important clinical nursing significance to analyse the influencing factors of psychological resilience in major depressive disorder in remission (MDDR) patients. What the paper adds to existing knowledge?: There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with MDDR. We found the education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience in patients diagnosed with MDDR. What are the implications for practice?: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. Nurses should strengthen the nursing of patients with <12 years of education, and patients with personal monthly income less than 5000 RMB. In addition, nurses should cultivate patients' awareness of social support and identity, cultivate their ability to strive for social support, cultivate interpersonal skills and positive emotional experience to improve subjective well‐being and carry out self‐efficacy training to improve psychological resilience by enhancing patients' internal protective factors. Aim: Psychological resilience is closely related to recurrence of depression. There are few previous studies on the influencing factors of psychological resilience in patients diagnosed with major depressive disorder in remission (MDDR). Here, we investigated the current status of resilience in patients diagnosed with MDDR and its influencing factors. Methods: A descriptive cross‐sectional study was conducted from June 2019 to April 2021. One hundred and forty‐two patients diagnosed with MDDR were recruited from the Department of Psychiatry and Psychology of the General Hospital of Northern Theater Command. Demographic information, social support, well‐being, self‐efficacy and psychological resilience were collected using self‐reported questionnaires. Results: The psychological resilience of MDDR patients was lower than that of the healthy Chinese adults in China. Multiple logistic regression analysis showed that education, personal monthly income, social support, well‐being and self‐efficacy were associated with psychological resilience. Receiver operating characteristic (ROC) curve analysis further confirmed that social support, well‐being and self‐efficacy were associated with psychological resilience. Conclusion: The psychological resilience of MDDR patients was lower than that of the general population in China. The education levels, personal monthly income, social support, well‐being and self‐efficacy were influencing factors of psychological resilience. Implications for Practice: According to the factors affecting the psychological resilience of patients diagnosed with MDDR, targeted clinical nursing is helpful to prevent the recurrence of depression. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities.Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying.A mixed‐methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. What the paper adds to existing knowledge: Through the Quality of dying in Long‐Term Care Scale (QoD‐LTC), nurses described symptom management, quality of care, and end‐of‐life appearance as adequate and end‐of‐life communication as lacking.Generally speaking, the scores on the scale were consistent with the data from semi‐structured interviews conducted with nurses.In the semi‐structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person‐centred care frameworks. What are the implications for practice?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision‐making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. Introduction: The complex nature of end‐of‐life assessment of individuals diagnosed with dementia would benefit from a mixed‐methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question: To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long‐Term Care settings (QoD‐LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method: Mixed‐methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD‐LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi‐structured scale‐based interviews were conducted. Results: Symptom management, quality of care, and end‐of‐life appearance were found to be adequate, while end‐of‐life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD‐LTC. Discussion: Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice: The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The collaborative care model is a well‐known model to improve care quality for people with common mental disorders and physical conditions in primary care.The role of care manager is central to the collaborative care model, and primary care nurses are well‐positioned to play that role.Adopting the role of care manager by primary care nurses is challenging due to several contextual factors; however, few implementation studies examined the context and current practices before implementing the role of care manager and the collaborative care model. What the paper adds to existing knowledge?: The paper contributes to the advancement of knowledge about the pre‐assessment of current practices before implementing the collaborative care model and the role of care manager.The paper offers a better understanding of the relationships between the context and the performance of care management activities by primary care nurses.The paper describes an innovative analysis technique to assess the gap between care management activities recommended in the collaborative care model and actual nursing activities. What are the implications for practice?: Primary care nurses would benefit from having timely access to clinical support from mental health nurse practitioners in order to build their competency.Determinants of practice and the analysis technique to assess current practices will help other researchers or quality improvement teams to develop their plan when implementing the role of care manager. Introduction: Few studies assessed current nursing practices before implementing the collaborative care model and the role of care manager for people with common mental disorders (CMDs) and physical conditions in primary care settings. Aim: Evaluate the main determinants of practice that influence the adoption of care management activities by primary care nurses for people with CMDs and physical conditions. Methods: A qualitative multiple case study was conducted in three primary care clinics. A total of 33 participants were recruited. Various data sources were combined: interviews (n = 32), nurse–patient encounters' observations (n = 7), documents and summaries of meetings with stakeholders (n = 8). Results: Seven determinants were identified (1) access to external mental health resources; (2) clarification of local CMD care trajectory; (3) compatibility between the coordination of nursing work and the role of care manager; (4) availability of mental health resources within the primary care clinic; (5) competency in care management and competency building; (6) responsibility sharing between the general practitioner and the primary care nurse; and (7) common understanding of the patient treatment plan. Implications for practice: To build their competency in care management for people with CMDs, primary care nurses would benefit from having clinical support from mental health nurse practitioners. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is a scarcity of studies concerning violence in psychiatric outpatient settings in the 2010s in spite of the deinstitutionalization of psychiatric services.Previous research on violence in psychiatric outpatient settings has failed to consider the association between the psychological consequences of violence, exposures to violence and background factors. What the paper adds to existing knowledge?: It has been known for some time that exposures to violence are harmful for psychiatric inpatient nurses; the paper demonstrates that psychiatric outpatient nurses are also at risk.The psychological consequences of exposure to violence are highly individualized and influenced by background factors.Nurses who face harassment have a greater risk of suffering psychological symptoms. What are the implications for practice?: De‐escalation interventions should be implemented in psychiatric outpatient settings.Organizations should consider the possibility of internal violence occurring when planning preventive interventions to manage and reduce workplace violence.Education targeted at violence prevention, management and debriefing should be organized systematically in psychiatric outpatient units and be taken into consideration in the mental health nursing curriculum. Introduction: There is a scarcity of studies concerning violence and its consequences in psychiatric outpatient setting. Aim: This study aimed to explore the occurrence of workplace violence and the psychological consequences of exposure to violence among nurses working in psychiatric outpatient settings. Method: Research followed a cross‐sectional survey design. Data were collected with the VIA‐Q instrument. Results: During the 12 months prior to the study, nurses (n = 181) had most often experienced psychological violence, with fatigue being the most common consequence. Harassment most often caused feelings of violated integrity, whereas physical violence most often caused insomnia. Significant relationships between exposure to violence and psychological consequences were identified. Discussion: Workplace violence can manifest in a broad array of psychological symptoms and be harmful for nurses in psychiatric outpatient settings. It is important to discuss the subject of workplace violence and its place in the nursing curriculum and to reflect on how nurses are educated and trained to face violence in psychiatric nursing. Implications for Practice: De‐escalation interventions should be implemented in psychiatric outpatient settings. Organizations should take steps to abolish internal violence. Nurses need appropriate education in order to prepare them to manage workplace violence. [ABSTRACT FROM AUTHOR]

What is known on the subject?: Public shaming, especially by consumers of healthcare, is getting worse and has become a specific case of bullyingDespite extensive research on physical and verbal violence directed towards mental health workers, the issue of social shaming and bullying by patients or relatives has not been sufficiently researched What the paper adds to existing knowledge: Mental healthcare workers are exposed to the threat of social shaming and bullying on a regular almost weekly basisAbusive behaviours by patients are associated with professional burnout, decreases in professional functioning and even a tendency to leave the workplace among mental health workers What are the implications for practice?: The stability and strength of the therapeutic alliance between healthcare giver and psychiatric patient are critical to the success of the treatmentThere is a need to develop a dedicated organizational policy for the prevention, early detection, intervention and support for teams exposed to social shaming and bullyingAn emphatic response, and effective intervention in a case of social shaming may improve professional functioning and reduce burnout and intention to leave. Introduction: Social shaming can impair caregivers' performance. The prevalence of shaming experienced by mental health workers and the relationships to their function or burnout is unknown. Aim: To examine the associations between exposure to social shaming and bullying by patients, the risk appraisal of negative impact of this behaviour, burnout, professional functioning and intention to leave among mental health workers. Method: In this cross‐sectional study, 122 workers from a psychiatric hospital completed a questionnaire. Results: Participants reported exposure to social shaming and bullying by patients on a regular basis. Shaming and bullying were significantly associated with lower professional functioning and higher intention to leave, while burnout may at least partially mediate the association between these variables. Conclusions: The phenomenon of shaming and bullying of mental health workers by patients is common and is associated with lower functioning and higher burnout, which have a negative impact on the patient‐caregiver interaction. Implications for Practice: There is a need to establish a policy for early detection of shaming of mental health workers in order to prevent burnout or intention to leave. Evidence based interventions, such as the Safewards model, accompanied by assessment of their effectiveness, may help in this effort. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The potential benefits of introducing technological innovation into all types of health services are recognized internationally.There are few studies exploring the use of technology in inpatient mental health settings, or the views of staff and patients regarding such developments."Early warning systems" are increasingly used in inpatient mental health services to detect physical deterioration in patients and prompt staff to take appropriate action. We have identified no peer‐reviewed publications concerning this development. What the paper adds to existing knowledge?: Using a questionnaire survey, this project gathered views from staff and patients on a planned change from a paper‐based "early warning system" to one using handheld electronic devices (tablets).This study adds to the existing evidence by reporting specific staff and patient concerns about a technological development in an inpatient mental health setting. Some patients were concerned about confidentiality of data entered onto tablets. Whilst were either positive or neutral in attitude to the planned change some staff raised concerns that electronic devices could be used as weapons, and also that patients or visitors might misinterpret their use. What are the implications for practice?: Views of staff and patients must be considered when introducing new technology into clinical practice, in order to make the change successful and sustainable. Inadequate or unclear information about the use and purpose of electronic devices may lead to misunderstandings as to their purpose and the security of their data, particularly in mental health settings.Further exploration across a range of services and countries would be useful in determining whether attitudes towards implementing similar technological change in mental health practice are commonly shared. Introduction: Technological innovation offers opportunities to improve mental health care; however, little evidence exists regarding attitudes of inpatient staff and patients to such changes. We present a survey of staff and patients prior to introduction of a digital version of the National Early Warning Score (eNEWS) system for identifying physical deterioration. Aim: To collate views of staff and inpatients related to prospective use of eNEWS, to inform the plan for implementation. Method: Paper questionnaires were distributed to both groups in six wards prior to eNEWS implementation. Two discussion groups were then held. Results: Eighty‐two staff and 26 inpatients completed questionnaires. Some inpatients expressed concerns about data confidentiality. Most staff were neutral or positive about the planned change, but raised possible safety risks and the risk of electronic recording being misinterpreted by patients. The implementation plan was modified in response to this information, principally by improving communication processes with patients. Discussion: This study adds to the existing evidence by reporting specific staff and patient concerns towards a form of information technology. Further evaluations would help determine the transferability of these findings. Implications for practice: Listening to patient and staff views about planned technological innovation is essential for effective implementation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The role of informal caregiver can have both negative and positive consequences for a person's well‐being. The main theoretical framework for explaining these consequences is the stress process model, which considers contextual variables, stressors and mediating/moderating factors. The latter are psychosocial factors such as coping strategies, personal mastery, social support or beliefs and values which may influence caregiver well‐being. The perception of gains in caregiving has also been proposed as a mediating variable since it may act as a coping strategy. However, few studies have examined values and perceived gains as mediating variables with life satisfaction as the outcome. What the paper adds to existing knowledge?: This study explores the role of character strengths and caregiver gains as mediators between stressors and life satisfaction in informal caregivers of persons with dementia. The results identify hope as a key character strength, its lack being one pathway through which stress may lead to low life satisfaction and low perceived gains from caregiving. What are the implications for practice?: Caregivers who experience a lack of hope may be less able to generate goals and be less motivated to achieve them. Our findings are relevant to gerontological nursing based on the Senses Framework as they confirm the importance of the senses of purpose and achievement. Nursing and care staff can play an active role in helping informal caregivers to meet their goals by promoting these two senses, thereby fostering a more positive caregiving experience. Introduction: Being an informal caregiver can have both negative and positive consequences for well‐being. Within the framework of the stress process model, few studies have examined values and perceived gains of caregiving as mediating variables of life satisfaction. Aim: To explore the role of character strengths and perceived gains as mediators in the association between life satisfaction and primary and secondary stressors in informal caregivers of persons with dementia. Method: Participants were 112 informal caregivers. Hierarchical regression, correlation and mediation analyses were performed. Results: Lower life satisfaction was associated with being female, unmarried, caring for someone with greater cognitive impairment, a higher level of stress, having restricted leisure time and perceiving financial difficulties. Hope mediated the associations between perceived stress and both life satisfaction and perceived gains of caregiving. Discussion: Hope is a key strength and its lack is one pathway through which stress may cause low satisfaction and low perceived gains from caregiving. Implications for practice: Without hope, it is difficult for caregivers to generate goals and be motivated to achieve them. Nursing and care staff should aim to promote a sense of purpose and achievement among informal caregivers so as to foster a more positive caring experience. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental healthcare requires acceptance of suicide and flexible attitudes especially in relation to caring for people who have suicidal thoughts or who have attempted suicide. Nurse education programmes for student nurses can shape positively the attitudes of individual participants, yet limited research exists on what nursing students' attitudes currently are towards people who are suicidal. What this paper adds to existing knowledge?: This paper adds to the developing international comparative work that is providing a greater understanding of cultural perceptions of suicide amongst students. This paper along with existing literature highlights a potential relationship between certain religious belief systems and their potential to be protective against suicide. At the same time, such religious belief is more likely to be associated with more judgmental attitude towards suicidal behaviour. This paper using a validated research tool, devised by a research psychologist, scored for the first time, individual student attitudes towards caring for people that are suicidal, whilst establishing the overall differences between the two countries from which the data are collected. What are the implications for practice?: This paper offers potential explanations for differences in nursing students' attitudes between the UK and Turkey. Disparities under discussion include gender, type of education, culture and religion. This is an important discussion in the consideration of nurse education worldwide. It is recognized that students may come from a variety of different backgrounds, with varying personal and social attitudes to begin with; yet, there exists the potential to positively influence overall attitudes towards service users whilst learners are still within a training programme, consisting of education and practice experiences. The merits of a specialist mental health nurse training programme and its potential to impact more favourably on students attitudes deserve more attention and research. Abstract: Introduction: Suicide is a major public health issue internationally, and the impact of positive or negative attitudes amongst the mental health professional workforce warrants scrutiny. The study aimed to examine English and Turkish nursing students' attitudes towards people with suicidal behaviour. Method: This cross‐cultural study reports on attitudes of 240 nursing students towards suicide in Turkey and 82 nursing students in the UK. A reliable and valid 24 item “Attitudes towards Suicide Scale” and “Social Reactions to Suicidal Persons Scale” were used to measure attitudes. Results: The UK nursing students were found to display more accepting attitudes to suicide, and scored higher on acceptability of suicide, seeing suicide as a solution and open reporting and discussion of suicide subscales than their Turkish counterparts. Turkish nursing students scored higher on punishment after death and hiding suicidal behaviour subscales than the UK students. Turkish nursing students scored significantly higher on deterring subscale of reactions to a suicidal peer scale than the UK nursing students. Implications for practice: It is vital for nurse students to develop positive acceptance of suicide through education, reflection and clinical supervision to be more therapeutic towards suicidal patients. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: There is a move towards the use of new ways of delivering mental health care, particularly via an increased use of telephone therapies. Although some studies have noted the advantages of telephone‐delivered therapies (e.g., removing access barriers) and reported on equivalent therapeutic effects when compared to face‐to‐face, there are concerns about how telephone‐based therapy adversely affects the therapeutic relationship. What the paper adds to existing knowledge: It contributes new knowledge regarding psychological practitioners’ experience and views about using telephone‐based therapies and how this affects the therapeutic relationship. What are the implications for practice: This paper provides data about the new practitioner workforce (IAPT Psychological Wellbeing Practitioners) and adds to a growing area of research regarding their clinical role. It has relevance for mental health nursing, because health services internationally and across the professions are exploring how telehealth can improve health care. This paper suggests that mental health services need to focus on what type of therapeutic relationship their practice facilitates and on offering transparency to service users. It concludes that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to focus on what facilitates and inhibits deeper therapeutic closeness and connection. Abstract: Introduction: Over‐the‐telephone (OTT)‐delivered psychological therapies as an alternative method to face‐to‐face (F2F) are becoming more prevalent in mental health care. Research suggests a range of benefits of OTT use in therapy, but there are growing concerns about its consequences for the therapeutic relationship. This paper presents new knowledge regarding psychological practitioners’ experience and views of OTT work and its potential effects on the therapeutic relationship in the context of the UK's Increasing Access to Psychological Therapy (IAPT) programme. Aim: This paper presents IAPT practitioners’ experiences and views of OTT work and its potential effects on the therapeutic relationship. Methods: Completed questionnaires (exploring OTT versus F2F work) which were distributed to IAPT practitioners revealed a concern about the therapeutic relationship in OTT. To explore this further, nine in‐depth semi‐structured interviews with PWPs were conducted and the findings from this qualitative study are reported here. Results: Practitioners noted OTT use facilitated access and flexibility for service users; however, they expressed some concern over the adverse effect of OTT on the therapeutic relationship. Discussion: Although a working alliance was possible OTT, this research suggests the type of therapeutic relationship formed OTT in a “low contact–high volume” service such as IAPT needs to be better defined. By addressing this, dissonance which might arise between practitioner aims and the aims of IAPT can be reduced. This research also contributes to wider debates regarding mental health care and its provision in the UK. Implications for practice: This paper concludes that mental health services need to focus on what type of therapeutic relationship their practice facilitates and to offer transparency to service users. The findings suggest that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to offer a more nuanced understanding of the concept of a therapeutic relationship and focus on what facilitates and inhibits deeper therapeutic closeness and connection. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Because of increasingly stressful, dangerous and unpredictable psychiatric nursing work, psychiatric nurses have experienced higher job stress than general ward nurses.Little is known about the factors that affect the turnover intention of Chinese psychiatric nurses. Understanding the influencing factors of nurses' turnover intention will help to formulate targeted measures to stabilize psychiatric nursing teams. What does this paper add to existing knowledge: The results showed that 70.2% of psychiatric nurses had higher turnover intention. The strong turnover intention of Chinese psychiatric nurses is a problem that needs to be considered by managers.The results showed that having more children, between 31 and 39 years old, and having a part‐time job were strongly associated with turnover intention. In addition, "job stress" was also an important factor, psychiatric nurses' turnover intention decreased as their job stress level decreased. What are the implications for practice: Nursing managers should pay attention to nurses who have more children, between 31 and 39 years old, and take on part‐time jobs. Additionally, nursing managers should reduce job stress and implement targeted programmes to prevent psychiatric nurses' turnover.Experience‐sharing meetings and mindfulness‐based stress reduction training are also useful to improve the mental health status of psychiatric nurses with great job stress. Nursing managers should arrange human resources and shifts appropriately to give nurses with more children more time with their families. Provide more development opportunities for psychiatric nurses between 31 and 39 years old. Managers explore the reasons why nurses take on part‐time jobs and take targeted interventions (such as increasing income) to reduce the behaviour that happens. Introduction: Nurses' turnover is the main cause of nursing shortages, greatly affected by nurses' intention to leave. Nurses' turnover rate is particularly high in psychiatric wards. Several factors influencing the turnover intention of psychiatric nurses have not been well identified in China, and the association between job stress and turnover intention is still limited. Aims: To examine the relationship between job stress and turnover intention and identify the influencing factors of psychiatric nurses' turnover intention. Methods: Data were collected from 2355 psychiatric Chinese nurses using a cross‐sectional design with an online questionnaire investigation. Results: Psychiatric nurses had higher turnover intention. Significant factors influencing their turnover intention were job stress, having more children, age between 31 and 39 years old, part‐time jobs, education, income and patient‐to‐nurse ratio. Discussion: Demographics and job‐related factors should be considered when developing strategies to reduce the turnover intention of psychiatric nurses. Implications for practice: Nursing managers should pay attention to nurses with higher job stress levels and different demographic characteristics. Effective measures should be taken to reduce psychiatric nurses' job stress and turnover intention, such as arranging reasonable shifts, implementing targeted family‐friendly policies, increasing their occupational possibilities and promoting mental health. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: To date, the majority of the research regarding innovative psychosocial interventions in psychiatry focuses upon the development and effectiveness of the interventions. Despite the fact that these are important clinical and scientific contributions, only a small percentage of the evidence‐based interventions reach clinical practice.Cognitive Adaptation Training (CAT) is an effective psychosocial intervention to increase daily functioning and cognitive functioning in people diagnosed with severe mental illness (SMI) in inpatient and outpatient psychiatric care.Despite knowledge on the intervention's effectiveness, systematic use of CAT in the daily routine of mental health nurses is insufficient. What the paper adds to existing knowledge?: To date, no research is available that describes the factors associated to the implementation of CAT from a nursing perspective.This research also adds to the literature on rehabilitation in people diagnosed with SMI in an inpatient setting.The results contribute to the science of implementing interventions in long‐term psychiatric care and may help future interventions in their implementation process. What are the implications for practice?: This study highlights that multiple factors need to be considered when implementing an intervention in routine care and that it is a complicated process.Future implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers.Without acknowledging the presence of barriers to implementation and considering strategies to overcome these barriers, sustainable implementation is likely to be unsuccessful. Introduction: Evidence‐based interventions in psychiatry often fail to reach clinical practice. Cognitive Adaptation Training (CAT) is an evidence‐based psychosocial intervention that aims to improve daily functioning of people diagnosed with a severe mental illness. Implementation of CAT remains challenging, despite demonstrated effectiveness. Aim: Identifying facilitators and barriers of CAT on the intervention, nursing, and organizational levels, and investigating relationships between capability, opportunity, motivation, and appraisal using the COM‐B model. Method: The Measurement Instrument for Determinants of Innovations and CAT‐specific questions were administered to 46 nurses. The relationship among capability, opportunity, motivation and appraisal was calculated using the Pearson's r correlation coefficient. Results: Nine barriers (mostly organizational level) and 13 facilitators (mostly intervention and nursing level) were identified. Significant moderate correlations were found between capability and opportunity, capability and motivation, capability and appraisal and a strong correlation between motivation and appraisal. Discussion: The results suggest that barriers at the organizational level should be removed and facilitators at intervention and nursing levels may be exploited to improve implementation. Implications for practice: Future implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Internally displaced persons (IDPs) in Myanmar have been exposed to conflict and violence for a long time and experience physical, psychological and social problems.Post‐traumatic stress symptoms (PTSS) are more prevalent among IDPs than among general populations and refugees, and limited research is available on this topic among IDPs in Myanmar. What the paper adds to existing knowledge?: More than one‐third of the IDPs in our sample from Myanmar camps had a high PTSS score. More than two‐thirds experienced traumatic events and left home after age 18.The overall functional health of IDPs was poor, and the presence or absence of PTSS led to differences in the factors associated with functional health in each group.Resilience and PTSS were associated with the functional health of IDPs in Myanmar. Further, functional health was positively correlated with levels of resilience among those relatively low in PTSS. What are the implications for practice?: Mental health nurses need to assess IDPs' health status and PTSS by first performing health screening at camps in Myanmar. Subsequently, tailored interventions can be provided according to individual health conditions and PTSS severity.IDPs in Myanmar need psychological first aid to cope with the ongoing conflict and violence, and further mental health nurse training is necessary to implement this aid and tailored interventions for PTSS. Introduction: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post‐traumatic stress symptoms (PTSS) are prevalent in this population. Aim: To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS. Method: This cross‐sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t‐tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses. Results: Over one‐third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS. Discussion: Tailored resilience‐building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS. Implications for practice: Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and low quality of life (QOL).There is a lack of understanding about CVD‐R scores in people diagnosed with early psychosis and no studies have quantified CVD‐R using the QRISK®3 calculator in this client group.Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD‐R or QOL may identify targets for early intervention. What the paper adds to existing knowledge?: This is the first study to quantify the individual 10‐year CVD‐R of people diagnosed with early psychosis utilising the QRISK®3 calculator.This is also the first study to investigate relationships between QOL and CVD‐R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis.We observed low levels of physical health‐related QOL and high levels of CVR‐R despite participants reporting relatively positive lifestyle behaviours. What are the implications for practice?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted.It may be useful to routinely quantify the CVD‐R of people diagnosed with early psychosis using the QRISK®3 calculator, even in the absence of immediate concerns about lifestyle behaviours.Mental health nurses should utilise evidence‐based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. Introduction: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims: To quantify CVD‐R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD‐R/QOL. Method: Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK®3, BMI and waist circumference). Participants self‐reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD‐R were explored. Results: Participants' relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD‐R or QOL with treatment characteristics and lifestyle factors. Discussion: Despite positive lifestyle behaviours, participants had elevated CVD‐R scores and poor physical health‐related QOL. Quantifying CVD‐R with QRISK®3 may highlight the need for health promotion interventions. Implications for practice: Mental health professionals should be aware that elevated CVD‐R exists in the context of relatively healthy lifestyle behaviours and utilise evidence‐based interventions to address these issues. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Patient and public involvement (PPI) is recognized as an increasingly important feature of healthcare research, education and public policy.In mental health, PPI is increasingly seen as evidence of the further democratization of services, which started with de‐institutionalization in the 1960s and the recovery movement in the 1990s.While much is known about learning enablers and learning gains on generic community‐based training programmes, less is known about PPI‐specific programmes in mental health. What this paper adds to existing knowledge?: Participants at a national training programme to support the engagement of service users, their families and carers in mental health services identified training topics of greatest importance to them and reported on what they learnt and what helped their learning.Patient and public involvement training initiatives aimed at supporting the engagement of service users, their families and carers should emphasize individual needs and local contexts.Training programmes should not make artificial or actual distinctions between the programme participants who are health professionals and those who are non‐professionals, such as service users.To our knowledge, this PPI initiative is the first time a national health service provider has sought to develop an engagement structure in mental health on a state‐wide basis. What are the implications for practice?: Participants in training programmes designed to support patient and public involvement believe that such programmes should include understanding how conflict is resolved, how committees work effectively and how to develop interpersonal and facilitation skills.Training programmes in mental health involving both professional and non‐professional participants requires all the participants to work together in particular at commissioning and design stages to achieve their desired outcome.The evaluation of the training programme to support the roll‐out of this initiative offers lessons to others who may wish to pursue similar structures in other jurisdictions. Introduction: The Irish national mental health service provider commissioned a national training programme to support a patient and public involvement (PPI) initiative in mental health services. The programme evaluation afforded an opportunity to describe the learning gains and learning enablers and the factors that support PPI in mental health. Aim: We aimed to evaluate a PPI training programme across nine regional administrative units in a national mental health service. Methods: We conducted a participant exit survey, using the Student Assessment of Learning Gains (SALG) instrument. We analysed the survey responses using SPSS version 24 software and applied directed content analysis to the narrative comments provided in open‐ended questions. Results: A total of 54 participants returned the completed questionnaire, yielding a response rate of 60%. The overall mean SALG score yielded was 3.97 (SD 0.66; range 1–5), indicating that participants reported very good to excellent gains in their learning from the programme. Participants who offered narrative comments indicated an overall positive experience but suggested that all stakeholders should work together to co‐produce the training. Discussion: All the stakeholders in a PPI training initiative to support the engagement of service users, their families and carers in mental health should work together to achieve their desired outcome. This requires co‐production in the design, delivery and evaluation of the training initiative, and co‐production can impact at both individual and local levels. Implications for Practice: PPI training initiatives in mental health should retain a focus on understanding conflict resolution, committee effectiveness, interpersonal and facilitation skills. Ensuring a shared understanding of key concepts, such as co‐production, is a necessary prerequisite at the co‐commissioning, co‐design, co‐planning, co‐delivery and co‐assessment stages of programme development, as is the need to avoid artificial or actual distinctions between health professionals and those who are non‐professionals, such as service users. Relevance statement: Mental health engagement and PPI are key principles underpinning modern mental health services and may increasingly impact on wider health service provision including policy and research imperatives. This paper discusses the evaluation of a PPI training programme and offers practical insights as to how such initiatives can be improved. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The Safewards model has been introduced to forensic mental health wards with mixed results.Research has identified a need to consider the addition of factors that may be relevant to forensic mental health services to enhance the introduction of Safewards. What the paper adds to existing knowledge?: This study elicits factors specific to forensic mental health settings missing from the original Safewards model, which have the potential to enhance nursing care, improve safety and improve adherence to Safewards in a forensic mental health setting. What are the implications for practice?: This study provides the adaptation required in a forensic mental health setting to enhance the implementation of the Safewards model of care, originally developed to assist nurses to prevent and manage conflict and containment in acute general mental health settings.The development of Safewards Secure has incorporated perspectives from expert Safewards and forensic mental health nurse leaders and healthcare clinicians and is inclusive of consumer and carer perspectives to ensure the model is applicable and broadly acceptable. Introduction: Safewards is a model designed specifically for acute mental inpatient wards. Research investigating the introduction of Safewards has identified a need to consider factors relevant in forensic mental health services, such as offence and risk issues. Aim: To identify adaptations needed to address gaps in the Safewards model to assist forensic mental health nurses to prevent and manage conflict and containment. Method: A Delphi study was employed to engage a group of international Safewards and forensic mental health experts (n = 19), to elucidate adaptation of the Safewards model. Results: Experts identified necessary elements and reached consensus on key considerations for Safewards interventions. To ensure the Safewards Secure model was robust and developed on a platform of research, all items suggested by Delphi experts were cross‐referenced and dependent on empirical evidence in the literature. Discussion: This study identified a number of key differences between civil and forensic mental health services, which informed the development of Safewards Secure, an adjunct to the original Safewards model. Implications for Practice: The development of person‐centred models of nursing care adapted to specific settings, such as forensic mental health, provides a potential solution to preventing and managing conflict and containment, and improving consumer outcomes. Relevance Statement: Managing conflict and containment in mental health services remains an ongoing challenge for mental health nurses. Safewards is a model of care designed for acute mental health inpatient settings to prevent conflict and containment. To date, there has been mixed results when introducing Safewards in forensic mental health settings, and reported reluctance and scepticism. To address these issues, this study employed a Delphi design to elicit possible adaptions to the original Safewards model. From this study, Safewards Secure was developed with adaptations designed for forensic services, to enhance the management of conflict and containment, assist implementation and improve consumer outcomes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: There is only limited information on how the COVID‐19 pandemic has affected people diagnosed with mental health disorders, especially people admitted to psychiatric wards.We surveyed the views of inpatients at Qatar's only psychiatric hospital regarding how the pandemic had affected their mental health and social changes they had experienced during the pandemic. What the paper adds to existing knowledge?: Nearly half (43%) of those who completed the survey reported that the pandemic had led to a deterioration in their mental health.Those who reported deterioration in their mental health during the pandemic were significantly more likely to have experienced negative social changes during the pandemic. Examples included increased stress from the home and reduced ability to discuss emotions/feelings with family members. What are the implications for practice?: Mental health services need to ensure ongoing support for patients during and after the pandemic. Mental health nurses have a pivotal role including identifying early warning signs of relapse of mental disorders, delivering talking treatments and providing practical advice and COVID‐19‐related education.Further work is needed to assess the views of people diagnosed with mental health problems in different countries and at a different time point during the pandemic. Introduction: The impact of the COVID‐19 pandemic on people under the care of mental health services has received relatively little attention in the scientific literature. Aim: To assess psychiatric inpatients' views regarding their mental health and experience of social change during the pandemic. Method: Cross‐sectional survey of consecutive patients admitted to Qatar's only psychiatric hospital between mid‐June and mid‐October 2020. Results: Data were analysed for 114/284 (40%) patients admitted during the study period. 8 (7%) reported a history of COVID‐19. 43% reported that the pandemic had led to deterioration in their mental health, 11% to an improvement and 39% that there had been no attributable change. Those reporting worsened mental health, attributable to the pandemic, were significantly more likely to report having experienced four negative social changes during the pandemic, namely reduced ability to discuss emotions/feelings with family members, decreased time spent exercising, decreased time spent relaxing and increased stress from the home. Demographic factors did not distinguish those reporting worsened mental health from those whose mental health was improved or unchanged. Discussion: A large proportion of psychiatric inpatients reported negative social and mental health changes during the pandemic. However, the study cannot determine causality. Implications for practice: Mental health services should consider the psychological and social aspects of people's lives, including their interactions with family, friends and the community. This is especially relevant during the COVID‐19 pandemic due to its wide impact on society. Interventions for people diagnosed with mental health disorders should address their psychological and social needs. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: In recent years, some have suggested that palliative care approaches be considered for patients diagnosed with severe, persistent mental illness.Palliative care aims to decrease the suffering related to illness rather than focusing on curing the illness.Palliative care approaches for patients diagnosed with severe, persistent mental illness are controversial: Some argue palliative care would improve quality of life while others argue it would negatively affect patients' well‐being.A recent survey found that psychiatrists from Switzerland tended to support the idea of palliative care approaches for those diagnosed with severe, persistent mental illness, but little is known about nurses' attitudes or beliefs regarding palliative psychiatry. What the paper adds to existing knowledge?: Participating nurses tended to agree that palliative care approaches may be appropriate and even important in caring for those diagnosed with severe, persistent mental illness.Participating nurses tended to prioritize quality of life and respect for patient autonomy.Participating nurses tended to agree palliative sedation may be an appropriate intervention. What the implications are for practice?: For those diagnosed with severe, persistent mental illness, care that aims to increase daily functioning and quality of life rather than care that looks to cure may be appropriate.Palliative psychiatry should be further explored and better defined. Introduction: In recent years, palliative care approaches for patients diagnosed with severe, persistent mental illness have been proposed, but remain controversial. Aim/Question: The central research question of the present study was whether nurses consider palliative psychiatry appropriate in general and for certain patient types in particular. This pilot study is designed to inform future research. Method: A quantitative survey that explored attitudes and beliefs regarding palliative care for those with severe, persistent mental illness. Results: The responding 38 nurses tended to agree that palliative care approaches are suitable (73%, n = 24) and even important (62%, n = 21) in treating patients diagnosed with severe, persistent mental illness, including interventions such as palliative sedation (73%, n = 24). Discussion: Widespread support among respondents regarding palliative care approaches for those diagnosed with severe, persistent mental illness might be an indication that palliative approaches are already implicitly understood and incorporated into patients' care. More research is needed to determine whether these findings represent nurses' views generally. Implications for practice: These finding suggest that palliative psychiatry should be further explored and developed. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: The meaning in life consists of an individual's values, experiences, goals and beliefs. It has been shown to be negatively associated with depression, hopelessness and suicidal ideation.Depression and hopelessness are related to increased suicidal ideation. Meaning in life has been shown to be a protective factor against depression, hopelessness and suicidal ideation. What the paper adds to existing knowledge: A path model was developed to clarify the associations among meaning in life, depression, hopelessness and suicidal ideation. For clarity, the outcomes were depression and suicidal ideation, the independent variable was hopelessness, and the mediator was meaning in life. Hopelessness had a direct association with meaning in life, and meaning in life had a direct association with depression, supporting the mediating effect of meaning in life from hopelessness to depression.Meaning in life had the strongest association with depression, and depression had the strongest association with suicidal ideation. Meaning in life did not have a significant direct association with suicidal ideation; it did have an indirect association with suicidal ideation through depression. This study estimated that one‐point increase in meaning in life score was associated with 0.47‐point decrease in depression score and 0.13‐point decrease in suicidal ideation score, respectively. What are the implications for practice: Logotherapy is a meaning‐centred therapy to find meaning in life. This study reveals that increased levels of meaning in life are associated with decreasing degrees of depression. Mental health nurses could help patients to find meaning in life by logotherapy and thus associated with reductions in depression.Mental health nurses could help patients to find hope by exploring meaning in life and promoting positive attitudes towards life from meaningless life to meaningful life, there is a reduction in depression, which in turn reduces suicidal ideation indirectly. Introduction: Meaning in life can be good protective factor against depression, hopelessness and suicidal ideation. Aim: To analyse the mediating effect of meaning in life on the associations among hopelessness, depression and suicidal ideation. Method: A cross‐sectional study was conducted among 90 patients diagnosed with depression. A structural equation modelling approach was applied for this path analysis to examine the mediating effect of meaning in life on the association among hopelessness, depression and suicidal ideation. Results: The results showed that meaning in life mediated the association between hopelessness and depression. Hopelessness had a direct positive association with depression (β = 0.23, p <.03), and meaning in life had a direct negative association with depression (β = −0.51, p <.01) and indirect association with suicidal ideation through depression; this indirect association was −0.21 (p <.01). Discussion: Meaning in life revealed strong mediating association with the relationship between hopelessness and depression. By reducing the level of depression, meaning in life demonstrated its mediator association with suicidal ideation. Implications for Practice: Logotherapy is a meaning‐centred therapy to find meaning in life. Mental health nurses could help patients to manage their depression through logotherapy, thus leading to reductions in suicidal ideation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern.Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries.The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. What the paper adds to existing knowledge?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre‐discharge.Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. What are the implications for practice?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital.Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Introduction: There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim: To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods: A cross‐sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life ‐ Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre‐discharge. Results: Participants reported low social relationship‐related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion: The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice: Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors.Mental health nurses often describe role confusion in relation to other health professionals.Opportunities for interdisciplinary communication with other professionals may benefit health care. What the paper adds to existing knowledge: The current large‐scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities.Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so. What are the implications of practice: The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needsInterdisciplinary teamwork could strengthen nurses' ability to address patient needsFinding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met. Introduction: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors. Aim/Question: The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs. Method: A cross‐sectional web‐based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded. Results: The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs. Discussion/Implication for practice: Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services. [ABSTRACT FROM AUTHOR]

Accessible summary This paper considers several theories about how depression presents alongside schizophrenia and what challenges there are in separating the two conditions through assessment., The analysis highlights the outcome of failure to identify and correctly treat depression in those who have schizophrenia and makes recommendations for the use of assessment for depression as a standard aspect of care., The findings from this review reveal that the Calgary Depression Scale for Schizophrenia is a reliable and valid instrument that nurses or other healthcare professionals may use for assessing depression in those who have schizophrenia., Abstract This paper considers the issue of the measurement of depression with those who have a primary diagnosis of schizophrenia. Originally the concept of depression as a core aspect of schizophrenia was raised by Bleuler and that affective disorders are associated with psychosis raised by Kraepelin. The construct of depression within the context of schizophrenia as a distinct condition that constitutes an apparent shift from the individual's usual cognitive style, affect and functioning, is an observation that has been relatively recently highlighted. In individuals with a primary diagnosis of schizophrenia comorbid depression can be a factor in risk of suicide, impaired level of functioning, and higher rates of relapse or rehospitalization. The assessment of depression in this population creates many challenges in relation to the differentiation of this condition within the complex presentation of schizophrenia. The depression literature may refer to: (i) depressed affect; (ii) depression as a symptom isolated from the wider signs of depressive illness; and (iii) depression as a syndrome with all the facets required for a formal diagnosis. This review considers the literature in relation to the measurement of depression in people with a primary diagnosis of schizophrenia and assesses the psychometric properties of those measures with this population. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Numerous studies have shown that organizational and managerial factors have significant effects on nurses' workplace well‐being.There are few studies on the effects of nurses' perceptions of their supervisors' autonomy‐supportive behaviours on their workplace well‐being. There are few studies on the determinants of nurses' workplace well‐being within a psychiatric context. What does this paper add to existing knowledge?: This study examines the psychological processes underlying the relationship between nurses' perceptions of their supervisors' autonomy‐supportive behaviours and their workplace well‐being.Mental health nurses' perceptions of their supervisors' autonomy‐supportive behaviours are indirectly and positively related to their workplace well‐being through their positive effects on psychological need satisfaction.Autonomy and competence need satisfaction has stronger effects on workplace well‐being than relatedness need satisfaction. What are the implications for practice?: When their supervisor gives nurses a meaningful rationale for tasks and acknowledges their feelings and views, they feel more autonomous, competent and related to others. It is important for nurses to feel autonomous and competent in order to experience well‐being at work.Nurses' workplace well‐being might be positively and negatively linked to quality of care and turnover intentions, respectively. Introduction: There is growing interest in the relationships between work factors and nurses' workplace well‐being. However, there has been very little research on the psychological processes underlying the relationships between nurses' perceptions of supervisors' autonomy‐supportive managerial style and their workplace well‐being. Aim/question: Drawing on self‐determination theory, we explored the mediating role of psychological need satisfaction (autonomy, competence and relatedness) in the relationships between nurses' perceptions of supervisors' autonomy‐supportive managerial style and their workplace well‐being, using a prospective design. Method: A prospective questionnaire was given to nurses in eight French psychiatric units. Data were collected from a sample of 294 French nurses who completed measures of perceived supervisors' autonomy‐supportive behaviours at Time 1 and of psychological need satisfaction, work engagement and job satisfaction at Time 2 one year later. Results: Results revealed that nurses' perceptions of supervisors' autonomy‐supportive managerial style were indirectly and positively related to their vigour, dedication, absorption and job satisfaction one year later through their positive effects on psychological need satisfaction. Discussion/implications for practice: Overall, this paper sheds light on the indirect effect of nurses' perceptions of supervisors' autonomy‐supportive behaviours on their workplace well‐being. Theoretical contributions and future directions, as well as implications for practice, are discussed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Nurses in mental health inpatient settings use a range of methods to try and help service users who self‐harmHarm‐reduction approaches are intended to help service users reduce the impact of their self‐harm rather than simply to prevent them self‐harmingHarm‐reduction techniques might be helpful for people who cut themselves because there are some clear ways harm can be minimized such as providing advice about cuttingNo one has previously tried to measure whether harm‐reduction techniques are more or less acceptable to mental health practitioners and service users than traditional methods. What the paper adds to existing knowledge?: The paper describes the development of the Attitudes to Self‐cutting Management scale. It met the criteria required of a good measurement tool.Each method of managing self‐cutting has a unique acceptability profileHarm‐reduction methods like advising on wound care and providing a first aid kit are endorsed by nurses and former service usersNurses providing sterile razors or remaining present during self‐cutting attract more divergent opinions but are preferred to seclusion and restraint. What are the implications for practice?: Nurses should talk through the approaches to management with service users and agree which techniques are preferred. Introduction: Harm‐reduction approaches for self‐harm in mental health settings have been under‐researched. Aim: To develop a measure of the acceptability of management approaches for self‐cutting in mental health inpatient settings. Methods: Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross‐sectional survey and statistical methods from classical test theory informed scale development. Results/Findings: At stage one, N = 27 staff and service users participated. At stage two, N = 215 people (n = 175 current mental health practitioners and n = 40 people with experience of self‐cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity and internal consistency were acceptable. The harm‐reduction approaches "advising on wound care" and "providing a first aid kit" were broadly endorsed; "providing sterile razors" and "maintaining a supportive nursing presence during cutting" were less acceptable but more so than seclusion and restraint. Discussion: The Attitudes to Self‐cutting Management scale is a reliable and valid measure that could inform service design and development. Implications for practice: Nurses should discuss different options for management of self‐cutting with service users. Harm‐reduction approaches may be more acceptable than coercive measures. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The literature shows a clear relationship between a good therapeutic relationship (TR) and the efficacy of nursing interventions.For the implementation of nursing psychotherapeutic interventions, the initial establishment of a good TR is essential.Several instruments assess the relationship established between the therapist and the patient in psychotherapy. However, no tool has been found to assess the quality of the TR established between the nurse and the patient. What this paper adds to existing knowledge?: This study allowed the development and evaluation of the psychometric properties of a scale to assess the TR between the nurse and the patient in a sample of mental health nurses.The developed scale (Therapeutic Relationship Assessment Scale‐Nurse) has psychometric properties that attest its reliability (internal consistency and test–retest) and construct validity as an instrument to assess the quality of the TR established between the nurse and the patient from the nurse's perspective. What are the implications for practice?: As the TR is crucial for providing nursing care and, in particular, for implementing nursing psychotherapeutic interventions, the scale developed is a valid tool to assess the quality of the TR established between the nurse and the patient in the perspective of the mental health nurse.The use of instruments to assess the quality of the nurse–patient TR facilitates the identification of the relationship's gaps, which can serve as a basis for improving the relationship itself and the nursing care provision. Introduction: The therapeutic relationship (TR) is essential to providing psychiatric and mental health nursing care. Nevertheless, no assessment tools exclusive for assessing nursing TR were found in the literature. Aim: To describe and evaluate the psychometric properties (reliability and construct validity) of a scale that allows assessing the quality of TR established between the nurse and the patient. Method: A survey method was adopted, using a convenience sample of 356 mental health nurses. Internal consistency was assessed by Cronbach's alpha and Omega index. Results: A total of 221 mental health nurses participated in the study (response rate = 62.08%). The scale's final structure has 25 items. Cronbach's alpha was 0.93, ranging from 0.78 to 0.88 for each of the factors. The cumulative variance explained in a four‐factor structure was 71.12%. Discussion: The Therapeutic Relationship Assessment Scale (TRAS)‐Nurse presents good psychometric properties. In the light of Benner's theory, it can be an useful tool for novice nurses to better understand what aspects they should pay attention to for establishing a successful TR. Implications for Practice: Mental health nurses can use the TRAS‐Nurse, thus having a scale available that allows them to self‐assess the quality of TR they establish with their patients. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Relapse rates are high among patients who have experienced first‐episode psychosis (FEP).Psychotic relapses are associated with worse quality of life and poorer functionality of the FEP patient.The use of psychoactive substances, non‐adherence to drug treatment, and high expressed emotion (EE) are notable predictors of relapse after the FEP.Although some studies have suggested that psychotic relapse may be associated with a family environment with high levels of emotional over‐involvement (EOI), this finding is still inconsistent across different cultures.EE specific components must be evaluated and interpreted according to the context of cultural norms.There is a scarcity of studies on the role of depression in the occurrence of relapses after the FEP, and the results remain uncertain. What the paper adds to existing knowledge?: This study explored the predictors of psychotic relapses in Brazilian patients who experienced FEP.Our results indicate that 29.2% of the patients relapsed after the FEP.Patients diagnosed with depression and high‐EOI in the family environment were predictors of psychotic relapses in this population.This study expands knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. What are the implications for practice?: Nursing professionals must consider the implications of the family environment and depression in the course of psychosis.Family interventions and the appropriate treatment of depression are important for improving the prognosis of FEP patients. Introduction: Psychotic relapse may be associated with relatives' high emotional over‐involvement (EOI) and with a diagnosis of major depressive episode (MDE) among first‐episode psychosis (FEP) patients, but the results are still inconsistent across different cultures. Aim: Evaluate the predictors of relapse in FEP patients. Method: Prospective cohort study with 6‐month follow‐up conducted with 65 dyads of patients and relatives from an early intervention unit in Brazil. At the baseline interview, relatives answered to a sociodemographic data form and to the Family Questionnaire. Patients provided sociodemographic and clinical data and answered the Measurement of Treatment Adherence; the Alcohol, Smoking and Substance Involvement Screening Test; the Severity of Dependence Scale to assess cannabis dependence, and the MDE module of the Mini‐International Neuropsychiatric Interview. Psychotic relapses were evaluated using items from the Brief Psychiatric Rating Scale. The data were analysed using multiple logistic regression. Results: 29.2% of the patients presented at least one psychotic relapse. High‐EOI and MDE were predictors of psychotic relapses. Discussion: Our findings expand the knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. Implications for practice: Family nursing interventions and the appropriate treatment of MDE must be considered in the care of FEP patients. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Fibromyalgia (FM) is a syndrome of chronic widespread pain, typically associated with fatigue, sleep, cognitive dysfunction and disordered mood.FM may limit an individual's ability to participate in everyday work and social activities, thereby making it difficult to maintain normal relationships with other individuals.While it has been studied in different populations and settings, the impact of FM and associated psychological factors has not been previously studied among female war refugees. What does the paper add to existing knowledge?: The study showed the high impact of FM on female refugees in Jordan; approximately three quarters of the participants had a moderate to severe FM impact.Refugees settled in Irbid city, Iraq, showed increased age, anxiety and post‐traumatic stress disorder correlated with a higher FM impact. What are the implications for practice?: The study recommends evaluation of the impact of FM among all female refugees living in Jordan, along with its neighbouring countries hosting refugees.Healthcare providers, including mental health nurses, should be aware of the role of PTSD and anxiety on the impact of FM. Accordingly, healthcare workers should design appropriate mental health treatment plans to help to decrease the impact of FM.Mental health nurses should evaluate FM impact among all refugees worldwide. Nurses in Jordan are recommended to share their experience with nurses outside of Jordan as this may help with funds being obtained and the implementation of advanced psychological interventions. Introduction: Fibromyalgia (FM) is a syndrome of chronic widespread pain. While it has been studied in different populations and settings, the impact of FM and its associated psychological factors has not been previously studied among female war refugees. Aim: To assess the impact of FM and its associated factors in female refugees. Methods: A cross‐sectional study was conducted. The impact of FM, anxiety, post‐traumatic stress (PTSD) and insomnia was investigated. Results: 288 refugees previously diagnosed with FM were recruited. The results showed that 73.62% of the participants had a moderate to severe FM impact. Refugees settled in Irbid city were six times more likely to have a higher FM impact than refugees settled in Zarqa, and Iraqi refugees were more likely to have a higher impact than Syrian. Increased age, anxiety and PTSD were correlated with a greater impact. Conclusion: Mental health nursing services should be directed towards female refugees, particularly those with increased age, anxiety and PTSD. Implications for practice: Mental health nurses should evaluate the FM impact among all refugees worldwide. Furthermore, nurses in Jordan are recommended to share their experiences with nurses outside of Jordan, as this may help to raise funds and implement advanced psychological interventions. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Established research from the United States and other Western countries has found that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide.Suicidality among LGBT individuals is understudied in Thailand and other Asian countries, warranting additional research to better understand risk factors and to create effective treatment and suicide prevention interventions. What the paper adds to existing knowledge?: The study examined rates and predictors of suicidality in Thai LGBT adults.Study findings suggest that general (e.g. stress and loneliness) and minority stressors (e.g. discrimination and victimization) played important roles in predicting lifetime and past‐year suicidal ideation, while socio‐demographic and health‐related factors (e.g. living in high poverty area and having chronic diseases) were associated with suicide attempts among LGBT individuals. What are the implications for practice?: Changes in the nursing curriculum and continuing education resources are needed to improve knowledge and core competencies in the mental health and treatment needs of LGBT individuals in Thailand.Among LGBT serving practitioners, routine assessment of suicidality is needed to increase the early identification and treatment of individual at risk for suicidal behaviours.Standardized measures of sexual orientation and gender identity should be included in all patient intake forms.In conducting research on strategies to improve mental health outcomes among LGBT populations, standardized measures of sexual orientation/gender identity and minority‐specific stressors should be used.Suicide prevention interventions aimed at reducing general and minority stress among LGBT populations should be a priority in mental health nursing. Introduction: A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. Aim: To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). Method: Data collection was conducted via online and in‐person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health‐related factors, general and minority‐specific stressors and suicidality were completed. Results: Thirty‐nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12‐month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, p ≤.05, R2 = 0.327). Past‐year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p <.05, R2 = 0.345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use and physical health (OR = 1.44, 1.06, 1.59, 1.45 and 0.95, p ≤ 0.05, R2 = 0.187). Discussion: General and minority‐specific stressors negatively impacted suicidality among LGBT participants. Implication for practice: Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals.Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non‐western countries. What the paper adds to existing knowledge?: To the best our knowledge, this is the first study examining internalized homophobia, self‐esteem, social support and depressive symptoms among sexual minority women in Taiwan.Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self‐esteem and fewer support from partners, friends, and families.Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. What are the implications for practice?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self‐esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation.LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. Introduction: Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non‐western countries. Aim: This study examined internalized homophobia, self‐esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method: A total of 581 Taiwanese sexual minority women (Age range 20–48 years old, Mean 26.96, SD 5.718) completed an online survey. Results: Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self‐esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion: Mental health interventions are essential for sexual minority women with internalized homophobia and low self‐esteem. Implications for Practice: Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

Accessible summary This paper reports the thoughts and feelings experienced by registered mental health nurses caring for distressed and/or disturbed service users in acute inpatient psychiatric settings in England., The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; prevailing feelings experienced by nurses were fear, anxiety and vulnerability., To enhance care quality, nurses expressed the need for better communication with service users, and preventing the use of coercive measures and promotion of alternative methods of care and management. The nurses considered that debriefing dialogues following untoward incidents, practice development initiatives, education and training together with clinical supervision could be the way forward., The paper builds on the existing literature in offering clear explanations of nurses' thoughts and feelings when caring for distressed and/or disturbed service users in an English acute, inpatient psychiatric setting. Despite the small sample size and the limitations that it generates, the study findings will be of interest to the wider mental health nursing community. The findings will link to other national and international studies and therefore be valuable for future research studies of this kind. Collectively, they are building up a general picture of the distress, cognitive and emotional dissonance experienced by mental health nurses when using coercive interventions. The findings will help to develop mental health nurse education and enhance practice., Abstract High levels of distress and disturbance among service users experiencing acute mental illness is a major problem for mental health nurses ( MHNs). The thoughts and feelings experienced by these nurses when caring for service users are of paramount importance as they influence clinical practice and caregiving. Similarly to research by other countries, this paper reports national, qualitative data regarding the thoughts and feelings of English MHNs who care for these service users within acute inpatient psychiatric settings. Data were collected from focus groups in which MHNs working in acute inpatient settings in England participated and analysed using inductive content analysis. Findings highlighted three broad themes: (1) emotional and cognitive dissonance; (2) therapeutic engagement; and (3) organizational management and support. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; the prevailing feelings experienced by nurses were fear, anxiety and vulnerability. Nurses would like better communication with service users, prevention of coercive measures and the use of alternative methods of care and/or management to ensure enhanced care. Participants considered practice development initiatives, education, training, staff and managerial support including debriefing and clinical supervision as the way forward. Despite the small sample size and its limitations, these national data add to the existing literature, and the study findings link to those of other studies both nationally and internationally. Collectively, these studies are building up a general picture of the distress, cognitive and emotional dissonance experienced by MHNs when using coercive interventions. The findings will help to develop MHN education and enhance practice. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known of the subject: Burnout is a major concern within the NHS impacting negatively on mental healthcare professionals. Evidence suggests that burnout can lead to reduced productivity and reduced quality of care for patients. Mindfulness‐based interventions (MBIs) have demonstrated effectiveness in mitigating burnout for healthcare professionals. What the paper adds to existing knowledge: This paper reinforces the positive outcomes within the current literature that MBIs can help reduce burnout amongst mental healthcare professionals. The strength of the paper is that it reports significant correlations between decreased burnout following an increase in mindfulness. No previous research has examined this area and this is the first study to do so. The participants within this study demonstrated increased personal accomplishment and decreased emotional exhaustion following an 8‐week MBCT course which was maintained at 6‐month follow‐up. What are the implications for practice: Occupational departments should consider MBI's as part of a package of care for mental healthcare staff as a preventative intervention or as a means of reducing burnout amongst healthcare staff that are currently experiencing emotional and physical exhaustion. Abstract: Introduction: Burnout is a major concern within the NHS impacting negatively on mental healthcare professionals. Evidence suggests that burnout can lead to reduced productivity and reduced quality of care for patients. Mindfulness‐based interventions (MBIs) have demonstrated effectiveness in mitigating burnout for healthcare professionals; however, no previous research has directly reported correlations between burnout and mindfulness. Aim: Does mindfulness‐based cognitive therapy (MBCT) reduce burnout amongst mental healthcare professionals and are there any direct correlations between mindfulness and burnout itself? Method: This effectiveness study evaluated a series of 8‐week (MBCT) groups adapted for healthcare professionals. Participants completed the Maslach Burnout Inventory (MBI) and Friedberg Mindfulness Inventory (FMI) at pre, post and 6‐month follow‐up. Results: Analysis revealed overall significance and large effect sizes on all three subscales of the MBI and the FMI. There were significant correlations in mindfulness when burnout was reduced. Discussion: These results suggest that MBCT groups for healthcare professionals offer a promising intervention for reducing burnout. Implications for Practice: Occupational departments could consider MBI's as part of a package of care for mental healthcare staff as a preventative intervention or as a means of reducing burnout amongst healthcare staff. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The strength of a relationship between people with mental health difficulties and professionals has been linked to patients feeling suicidal. A relationship has been found between how defeated and trapped people with mental health difficulties feel and how suicidal they feel. What this paper adds to existing knowledge?: This study explored the relationship between alliance, suicidality, defeat and entrapment in people admitted to mental health wards as previous research has focused on people in the community. Patient‐rated defeat, entrapment and suicidality are related in this sample of people admitted to mental health wards. A relationship was found between how well nurses said they bonded with their named patient and how trapped the patients felt by their environment. What are the implications for practice?: Nurses should consider if patients are feeling defeated or trapped when helping people with mental health difficulties to feel less suicidal. Abstract: Introduction: Suicidality is prevalent worldwide, particularly in people who access mental health services. The quality of therapeutic alliance between people with mental health difficulties and staff has been associated with suicidality but only in community settings. Defeat and entrapment are correlated with suicidality and may mediate any relationship between alliance and suicidality. Therefore, this exploratory study explored these relationships in people admitted to mental health wards. Aim: To explore defeat, entrapment, suicidality and alliance between nurses and people admitted to mental health wards. Method: Fifty inpatient nurse–patient dyads completed questionnaires regarding demographics, defeat, entrapment, suicidality and alliance with their named nurse. Nurses completed questionnaires on demographics, alliance with their patient and the patients’ suicidality. Results: Defeat, entrapment and suicidality were correlated. A correlation between nurse‐rated bond and external entrapment was found, but no other correlations between alliance, defeat, entrapment and suicidality were statistically significant. Discussion and clinical implications: Ward‐based nurses should consider the relationship between defeat, entrapment and suicidality when developing interventions to improve suicidality. Although there was no evidence of a relationship between total alliance and suicidality, developing closer bonds with patients may reduce patients’ feelings of being trapped by their environment. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Developing sex type is the process in which one develops behavioural attributes and personality characteristics socially defined as matching one's biological sex."Psychological androgyny" means that a person should not be judged in terms of his or her traditional sex role. "Androgynous" sex type means that a person could have both female and male characteristics, depending on the circumstances. "Androgynous" sex‐type individuals show higher capacity to deal with a variety of roles and a healthier and more adaptive behaviour than those with the same gender sex typingPrevious studies focused on caring behaviours while examining the difference between female and male nurses but there are no studies on differences between female and male nurses in the mental health field in relation with sex types. What this paper adds to existing knowledge?: From a theoretical point of view, our study adds important information on specific associations between sex types and caring in mental health nurses.Nurses with different sex type perform caring behaviours at different levels. "Androgynous" sex‐type nurses perform caring behaviours at a higher level than others do. What are the implications for practice?: Our findings can contribute to raising awareness among head nurses and policy makers in the mental health field, of the differences between nurses, and among female and male nurses in mental health centres, regarding their caring behaviours.Understanding this association can assist in the recruitment and allocation of candidates in mental health nursing settings and later on, in developing appropriate instruction programs for these employees. Introduction: Understanding differences in caring behaviours by sex is crucial in light of the need to encourage men to join the nursing profession. Aims: To study the association between sex types and caring behaviours in female and male nurses in the mental health field. Methods: Cross‐sectional study including a convenience sample of 114 nurses in three mental health centres in Israel. Data were self‐reported in a structured form including validated scales for the assessment of sex types and caring behaviours. ANOVA and linear regression tests were used were performed with SPSS version 21. All the analyses were 2‐tailed, and p < 0.05 was considered statistically significant. Results: Androgynous female and male nurses displayed higher levels of caring than other sex types. Higher levels of caring were observed in female compared with male nurses overall (p = 0.011) and in behaviours showing respect (p = 0.020) and attentiveness to patients' needs and safety (p = 0.002). Conclusion: Our results suggest that different sex‐typed female and male nurses in the mental health field display different levels of caring behaviours. Implications for Practice: Our findings can help head nurses and policy makers in recruitment and allocation of nurses in mental health settings, as well as in developing educational programs for employees and nursing students. [ABSTRACT FROM AUTHOR]