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Accessible summary This paper aims to do two things: First, we want to show the reader how to critique a published research paper. The second aim is to take the reader through the various stages of critiquing using a guide., In the paper, we explain at each stage the research terms that can deter the novice critic from reading and understanding the findings in research., From this we hope the reader will have developed an ability to do their own critiquing, so that they are better informed about the quality of research that influences nursing practice., Abstract In this paper we have taken a previously published paper on the effectiveness of clinical supervision and undertaken a systematic critique of the merits of this quantitative research using a recognized critiquing framework compiled by Coughlan et al. (2007). Our purpose was twofold: First, we wanted to demonstrate the various stages of critiquing a paper in order that the reader might make an informed judgment of the quality and relevance of the research. The reader/critic is then able to decide whether to use this research in their own practice. Second, we wanted to assist the reader to develop their own critical, analytical skills through methodically appraising the merits of published research. Nursing as an evidence-based profession requires nurses at both pre- and post-registration level to be able to understand, synthesize and critique research, this being a fundamental part of many nursing curricula. These have become core skills to acquire because implementing up-to-date evidence is the cornerstone of contemporary nursing practice. We have provided in this paper a template for critiquing, which is based on our combined experiences as academics specifically in teaching at the bachelor, master's and doctoral levels. [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?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed.There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. What this paper adds to existing knowledge?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED.This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. What are the implications for practice?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme.The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery.This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment.Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. Introduction: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. Aim: To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. Method: A qualitative descriptive methodology informed the study. In‐depth semi‐structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. Results: Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. Discussion: An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real‐time anxiety as they endeavour to negotiate an effective support network. Implications for Practice: The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self‐harm.Adolescent self‐harm is a growing problem, with rates increasing in the UK.Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self‐harm. What the paper adds to existing knowledge?: This paper provides an understanding of the impact of working with adolescents who self‐harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care.Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self‐harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures.Community CAMHS nurses experience feelings of self‐doubt and shame due to their emotional responses, self‐care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. What are the implications for practice?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self‐care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this.Nurses working with adolescents who self‐harm in CAMHS could benefit from training regarding understanding and managing self‐harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment‐based family therapy). Introduction: Nurses often work in the community with adolescents who self‐harm. There is a lack of qualitative research exploring nurses' experiences of working with adolescents who self‐harm. Aim: This study aimed to gain an understanding of community nurses' experiences of working with adolescents who self‐harm. Method: Ten semi‐structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). Results: Data were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self‐harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development. Discussion: Nurses feel conflicted about working with adolescents who self‐harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self‐care behaviours and personal and professional boundaries. Implications for Practice: Nurses working with adolescents who self‐harm would benefit from training, reflective practice and self‐care. CAMHS managers should encourage and invest in these areas. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Advanced clinical practitioners (ACPs) are, typically, non‐medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities.Most ACPs are nurses and new ACP roles are increasingly being established around the world.The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainabilityResearch on mental health nursing ACP roles is sparse. What the paper adds to existing knowledge?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services.A wide range of mental health services were perceived as potentially benefiting from ACPs.Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. What are the implications for practice?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established.Some mental health nurses may require long‐term developmental pathways to help prepare them to take on a master's level course and then the ACP role. Introduction: Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim: To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method: Focus group and semi‐structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results: Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion: The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long‐term developmental pathways for staff. Implications for practice: Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse.Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. What this paper adds to existing knowledge?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI.MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings.MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. What are the implications for practice?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. Description: The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020—under review). Introduction: This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery‐orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim: To explore PSI‐trained MHNs' experiences of using PSI within Ireland. Method: A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi‐structured interviews with 40 PSI‐trained MHNs. Findings: Three overarching themes developed from the analysis. These included (a) PSI‐trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI‐trained MHNs; and (c) obstacles limiting the use of PSI by PSI‐trained MHNs. Discussion: MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice: This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement: This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mechanical restraint is a common practice in mental healthcare settings in Spain, despite controversy.Mechanical restraint is perceived as a negative experience for nurses and service users.Mechanical restraint damages the nurse–patient therapeutic relationship, which is essential in providing quality care and promoting recovery. What the paper adds to existing knowledge?: The negative experiences of service users and mental health nurses arising from use of mechanical restraint affects both parties involved and results in trauma.Using mechanical restraint can provoke a moral injury in mental health nurses which can negatively impact on the establishment of trust within the therapeutic nurse–patient relationship. What are the implications for practice?: Nurses must be aware of the negative effects that mechanical restraint use has on both their practice and their day‐to‐day lives.Post‐mechanical restraint debriefing is required to repair the damage to the trust aspect of the nurse–patient relationship.Involving service users in co‐producing a debriefing framework may be a way to rebuild trust through constructive dialogue. Introduction: Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. Aim: To describe the experiences of mental health nurses who have used mechanical restraint in practice. Methods: A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. Results: Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. Discussion: The use of restrictive practices, which can be perceived as counter‐therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. Implications for practice: Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse–patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co‐production of post‐mechanical restraint debriefing can be an avenue for restoring this trust through dialogue. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues.The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. What does this paper add to existing knowledge?: Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work.Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. What are the implications for practice?: Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses.Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities. Introduction: Outreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide. Aim: To describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration. Method: Qualitative descriptive analysis based on 13 semi‐structured interviews. Framework analysis and complex adaptive systems theory were applied. Results: One core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership‐based collaboration. Discussion: Results showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations. Implications for Practice: To empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental Health First Aid Training Programmes with a pathogenic perspective are implemented worldwide for different participants and contexts. These interventions can promote the medicalization and psychiatrization movement of human suffering.Training programmes should teach about mental health nursing problems rather than disorders. However, there seem to be no studies describing these healthier interventions targeting adolescents in upper secondary schools. Nurses can explore these interventions and target them towards these participants and contexts. What the paper adds to existing knowledge?: The perspective of nurses on the characteristics of Mental Health First Aid Training Programmes for adolescents in Portuguese upper secondary schools is reported.Experts recognize that the nurses who perform these interventions must have personal, pedagogical and mental health competencies. Therefore, mental health nurses may be considered. The components of mental health literacy, mental health nursing problems and a dynamic first aid plan can be taught using different classroom training strategies. What are the implications for practice?: The role of mental health nurses in promoting health literacy is highlighted. They have the opportunity to lead multidisciplinary teams in using these healthier training programmes.These expert opinions can shape the planning, implementation and evaluation of these interventions. In turn, training programmes can promote the identification, assistance and/or adequate and timely referral of people with mental health nursing problems. Introduction: Mental Health First Aid Training Programmes performed by nurses can empower adolescents to aid people with mental health problems. There do not appear to be any studies that describe these healthier interventions aimed at adolescents in upper secondary schools. The development of these educational interventions benefits from the input of their participants and facilitators. Aim: To explore the perspective of nurses about Mental Health First Aid Training Programmes for adolescents in upper secondary schools. Method: A qualitative, descriptive and exploratory study was conducted. Data were collected from seven mental health nurses during two focus group sessions. Data were analysed using content analysis. Results: Twelve themes were identified around nine main areas: facilitators, intervention foci, outcomes assessment methods, process assessment methods, participants, implementation context, duration and frequency, intervention methods and strategies, and contents. Discussion: Mental health nurses can regularly perform these classroom interventions to improve the mental health competencies of adolescents. Various educational methods can facilitate learning related to mental health literacy components, mental health nursing problems and the first aid plan. Valid and appropriate assessment methods enhance a good representation of these interventions. Implications for Practice: This evidence can guide the creation and modelling of these first aid training programmes. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: During the COVID‐19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. What the paper adds to existing knowledge?: This paper provides a unique insight into the experiences and impact that the COVID‐19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. What are the implications for practice?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. Introduction: While evidence has emerged concerning the impact of COVID‐19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim: This paper aimed to explore how COVID‐19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method: We investigated staff reports regarding the impact of the COVID‐19 pandemic on mental healthcare and mental health service users in the UK, using a mixed‐methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion: Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice: Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge?: This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice?: The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: While therapeutic relationships remain core to mental health nursing practice and patient recovery, increased managerialism and focus on risk has impacted nurses' therapeutic practice with patients. While there is anecdotal evidence of the impact there has been little research that demonstrates nurses experience of therapeutic engagement within the current context. What the paper adds to existing knowledge?: The paper reports on qualitative research that highlights nurses' strong attempts to create the space for therapeutic engagement with clients.This research provides evidence of the constraints on practice imposed by new managerial processes and suggests potential means of responding to them. What are the implications for practice?: Mental health nurses are committed to working therapeutically but struggle to balance this against new managerial demands imposed across many OECD countries. The New Zealand government has recently reported on positive changes to mental health provision but does not suggest changes to the structures that impede good practice. This research indicates that structural change is essential to therapeutic engagement. Introduction: Increasing managerialism, driven in part by notions of risk, compromises the mental health nurses therapeutic engagement with clients potentially impacting their recovery. While the importance of therapeutic relationships in mental health recovery is acknowledged, there is little evidence about how managerial processes encroach on this relationship. Aim: To explore mental health nurses experience of engaging in therapeutic relationships within the current practice environment. Method: This paper utilized an interpretive phenomenological approach, using interviews with mental health nurses. Results: Managerial processes significantly impacted the practice of nurses who struggled to make space for therapeutic relationships within a chaotic milieu. The chaos is associated with increasing austerity within the health system; this has resulted in high staff turnover and staff shortages. Discussion: Managerial demands dominate the practice field at the expense of therapeutic engagement between nurses and clients ultimately affecting client recovery. While nurses' integrity means they desperately try to make space for the therapeutic work, they often become burnt out and disheartened. Implications for practice: While nurses are often blamed for failures in the system, the structures that disable nurses in their attempts to practice therapeutically require urgent responses, strengthening professional organizations and engaging in democratic partnerships with consumer groups. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Nursing observations at night are conducted on psychiatric wards to ensure the safety and well‐being of patients as well as to reduce the risk of suicide or severe harm.To our knowledge, no studies have examined the lived experience of the psychiatric ward environment and of nursing observations at night. What does the paper add to existing knowledge?: The main complaint from patients was the constant interruption of their sleep, as most of the patients in this study were observed 2–4 times an hour. Their sleep was interrupted by (a) the light from torches shone into their faces by staff checking on their safety, (b) the noises produced by the opening and closing of bedroom/ward doors, and/or (c) staff talking to each other during the observation. Patients also reported that they found having somebody enter the room in the middle of the night intimidating and unsettling. What are the implications for practice?: Poor sleep has been associated with an increase in suicide risk and mental health problems.Identifying practices that promote sleep hygiene is vital.The study could be used to develop a Quality Improvement Project to improve patients' sleep and perhaps reduce duration of stay. Introduction: A fundamental component of nursing care is observations at night to ensure the well‐being of patients. However, there is no literature on the lived experience by inpatients of such observations or of the general environment of a psychiatric ward at night. Aim/Question: This study aims (a) to understand the lived experience of being an inpatient on a psychiatric ward at night with a focus on intermittent observations and (b) contribute to developing a tool to monitor the psychiatric ward environment for use in quality improvement projects. Method: Semi‐structured interviews were conducted with twelve inpatients from five psychiatric wards who had experienced intermittent observations at night. These interviews were subsequently transcribed and analysed using content analysis. Results: Environmental disturbances including light and noise, invasion of privacy and safety considerations on the ward all contributed to sleep disturbance. The unintended consequences of disturbances caused by intermittent night observations, and by staff in general and other patients formed the core of the inpatients' experience. We developed a clinical tool that could be used to identify the factors that are relevant on an individual ward. Discussion: Participants interviewed unanimously agreed that poor sleep quality had a significant negative impact on their psychological and social well‐being. These were discussed in relation to the environment and the experience of observations at night. Implications for nursing practice: Deprivation of inpatients' sleep is currently under‐reported, and the usefulness of intermittent observations at night in psychiatric wards is questioned. Much could be done to adjust the environment at night to support quality sleep and improve psychiatric symptoms. This paper aims to highlight the lived experience of patients to help bring improvements. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Some nurses develop positive relationships with people diagnosed with borderline personality disorder (BPD), while others have negative emotional reactions to people diagnosed with this disorder.The therapeutic relationship is key in the practice of mental health nursing.Enhanced knowledge of BPD allows mental health nurses to develop improved self‐awareness, knowledge and understanding of the individuals and insight into the therapeutic challenges, which can improve attitudes towards people with this diagnosis. What the paper adds to existing knowledge?: We are lacking knowledge about the perspective of people diagnosed with BPD on the attitudes of mental health nurses that facilitate a positive therapeutic relationship.The perspective of people with a BPD diagnosis on the therapeutic relationship offers key information about the attitudes that they credit with supporting their recovery.The participants—people diagnosed with BPD—perceived that the following attitudes of mental health nurses reinforced the therapeutic relationship: confidence in the person's recovery, non‐judgement, sense of humour, availability and humanity. What are the implications for practice?: The study highlights mental health nurses' attitudes that participants perceived as having a positive effect on the therapeutic relationship.The recognition among people diagnosed with BPD of the constructive attitudes of mental health nurses may improve nurses' motivation to improve care for these patients.This study will allow mental health nurses to increase their awareness of the importance of attitude in the therapeutic relationship with people diagnosed with BPD. Introduction: The therapeutic relationship between mental health nurses and people diagnosed with borderline personality disorder (BPD) is essential to successful treatment, and nurses' attitudes are a key component of this relationship. Some nurses develop positive therapeutic relationships with people diagnosed with BPD, while others have negative emotional reactions which in turn limit their ability to develop a positive therapeutic relationship. There is a gap in the literature with respect to how people diagnosed with BPD perceive the attitudes of mental health nurses that foster a positive therapeutic relationship. Aim: To describe how people diagnosed with BPD who have experienced an improvement perceive the role of the attitudes of mental health nurses in building a positive therapeutic relationship. Method: Qualitative descriptive design with 12 interviews; thematic content analysis. Results: Participants identified five attitudes of mental health nurses as contributing to a positive therapeutic relationship: confidence in their ability to recover, non‐judgement, humour, availability and humanity. Discussion: Nurses' attitudes are key to the therapeutic relationship. It may be possible for nurses to improve their attitudes towards patients diagnosed with BPD through self‐reflection. Implications for practice: Mental health nurses should incorporate methods that explore attitudes and attitudinal development of the workforce. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There are many international studies on CRHTTs; however, there has been little research on nurses' experiences of working with CRHTTs.Earlier studies focused on the nurses' gatekeeping role but did not explore nurses' perception of care as a construct. What does the paper add to existing knowledge?: This study provides information based on mental health nurses' experiences. It explains the home environment, the therapeutic relationship and the process of mental health nursing care during a crisis. Also, the study explains nurses' satisfaction with care provided at patients' home.Unlike other studies, this study focused on nurses' experiences while providing care, rather than on nurses' general responsibilities and the services they provide. This study is the first of its kind in Spain with such a focus. What are the implications for practice?: Acknowledging nurses' experiences and their perspectives about the care they provide could help shift mental health nursing paradigms from those based on biomedical models to newer perspectives found in recovery models. Furthermore, this knowledge could improve the quality of care in mental health settings due to its potential to guide nursing practices.Raising mental health care providers' awareness of mental health nurses' personal and professional care constructs would help implement support systems to meet the professional's needs. Meeting the needs of nurses related to the care they provide is likely to impact patient care positively. Introduction: Crisis resolution home treatment teams (CRHTTs) provide short‐term, intensive home treatment to people experiencing mental health crises. There is limited research on nurses' experiences with CRHTTs. While earlier studies mainly focussed on mental health nurses' gatekeeping responsibilities, more investigation is needed in this field. Aim: To explore nurses' perceptions and constructions about care in CRHTT services. Method: A qualitative case study was employed. Ten semi‐structured interviews were performed to nursing staff working in CRHTT services. Results: Three main categories emerged from the data analysis: nurses' perspectives of the care provided, nursing setting of care at home and nursing care plan at home. Discussions: Findings revealed that nurses experienced greater satisfaction providing care in the home settings, and therefore, it positively impacted the quality of care and reduced patient's stigma. This study also relates the value of developing care plans centred on patients' environments increasing Mental Health Nursing (MHN) work satisfaction. Implications for practice: Knowledge of the intrinsic experiences of care provided by nurses in CRHTTs may help facilitate the development of the nursing role in CRHTT by improving understanding of care in mental health settings. [ABSTRACT FROM AUTHOR]

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

Accessible Summary: What is known on the subject?: The 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?: Discussion and documentation of a patient's resuscitation status are essential aspects of any hospital admission, and yet, they seldomly occur in psychiatry.Nurses play an important role in resuscitation status determination by being an information broker, supporter and advocate.Persons with mental illness may be competent to engage in the determination of their resuscitation status and deserve the same respect and autonomy as other patients during this process.There are no published qualitative studies exploring healthcare providers experiences in initiating resuscitation status conversations in the psychiatric setting. What does this paper add to existing knowledge?: An in‐depth qualitative understanding of the complexity of resuscitation status determination in psychiatry.The shared experiences of nurses enacting their role in resuscitation status determination with patients admitted to psychiatry.The challenges of implementing a 'one‐size fits all' approach to resuscitation status policies, and the ways in which depression and/or suicidal ideation influence the process. What are the implications for practice?: Role clarity and improved communication between providers about resuscitation status determination in psychiatry are needed.Hospital policies for resuscitation status determination must account for the psychiatric context to ensure patients' goals of care are known and upheld.Nurses working in psychiatry should initiate and more readily engage in resuscitation status conversations. Introduction: Patients with mental illness experience stigma and marginalization, which affects the quality of their health care. In most settings, end‐of‐life decisions, including goals of care, must be discussed with all patients upon hospital admission, including determining cardiopulmonary resuscitation preferences in the event of a medical emergency. Despite this requirement, these conversations do not routinely occur in inpatient psychiatry. By default, patients become a 'full code status', mandating life‐sustaining interventions. Aim: To explore how and why resuscitation status conversations occur, or do not occur, in inpatient psychiatry from the perspectives of healthcare providers. Method: Qualitative descriptive study using focus groups with nurses working in psychiatry. Results: Nurses' experiences with initiating and engaging in resuscitation status conversations related to Working in Psychiatry, which represents the current practices and the participants' views of the nursing role; Caring for Psychiatric Patients, which describes how fluctuating competency and suicidality influence determination; and The Influence of Physical Health Status, which details how differences in physical health status affect how healthcare providers engage in resuscitation status determination. Discussion: Although the importance of completing resuscitation status conversations with patients admitted to psychiatry was expressed by participants, they seldomly occur. There is ambiguity about when and how to determine patient wishes. Implications for practice: Tailored strategies are needed to ensure patients' rights to self‐determination are upheld when they are admitted to psychiatry. Nurses working in this setting would benefit from education, training and support to adequately initiate and engage in these conversations. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The death of a client to suicide evokes a range of grief responses for mental health nurses (MHNs), which vary in intensity according to the nature of the therapeutic relationship with the deceased client.There are limited qualitative studies on the experiences of nurses working in the community and the personal or professional strategies used by nurses to cope with the death of a client by suicide. What this paper adds to existing knowledge?: Following a client suicide, MHNs were often left to carry the burden of grief alone and to care for themselves with the support of their family and colleagues.While all participants perceived the need for support following the death of a client by suicide, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. What are the implications for practice?: MHNs and services need to establish and promote a culture of openness in which suicide is anticipated as a possible outcome, even with excellent standards of care and wherein all staff are supported and encouraged to discuss and reflect on their concerns and fears during the aftermath of a client suicide.As MHNs are often left to carry the burden of grief alone, services need to recognize the emotional cost of embodied engagement with clients and families and provide the necessary supports. Introduction: Experiencing a client's death through suicide is complex and challenging, yet limited research exists on how MHNs might deal with its aftermath. Aim: This study aimed to explore the impact and responses of MHNs to a client suicide. Method: The study design is a secondary analysis of an existing data set involving semi‐structured interview with 33 MHNs that were analysed using the principles of grounded theory. To answer the secondary question on the impact and responses of MHNs to the death of a client by suicide a subset of the data from 10 participants who experienced the death of a client by suicide were re‐analysed using thematic analysis. Ethical approval was granted by the university ethics committee. Findings: The findings identified five themes: "Hearing the news," "Experiencing the impact of grief," "Grieving privately" "Searching for meaning" and "Questioning practice." Discussion: Findings highlighted that although participants perceived the need for support, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. Implications for practice: MHN services need to promote a culture of openness wherein all MHNs are supported and encouraged to discuss their concerns and fears during the aftermath of a client suicide. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject? (Scientific Rationale): Mental health care in Poland lags behind that of many other countries, and coercive measures are used on a regular basis.Scant research has been conducted in Poland regarding the treatment of psychiatric patients.The perspectives of Polish psychiatric nurses towards aggression remain unknown. What does this paper add to the existing knowledge?: The translated and validated Attitude Towards Aggression Scale (ATAS) in Polish will serve as an instrument that gauges Polish nurses' attitudes towards aggression. The Polish nurses have unenlightened and negative attitude towards aggression. What are the implications for practice?: There is now an instrument in Polish by which we can gauge the attitudes of mental health nurses, which must precede any educational efforts. Polish nurses showed more restrictive and antiquated attitudes about patient violence than nurses in some other parts of the world. With a shift to more positive attitudes, the use of coercion could be reduced, resulting in improved patient care. Introduction: In Poland, the mode and site of patient treatment have changed little in the past 75 years, despite therapeutic advances worldwide. There is limited information regarding attitudes of nurses towards aggression in psychiatric settings in Poland, nor has there been an instrument in Polish to measure it. Aim: To translate and validate the Attitudes Towards Aggression Scale (ATAS) for use in Poland, and to assess the attitudes of three groups of nursing personnel towards aggression. Method: We surveyed 980 psychiatric and general nurses as well as nursing students. We translated the ATAS into Polish, and validated it using exploratory factor analysis. Results: The Polish version of the ATAS showed good psychometric properties. We found that Polish nurses perceived patient aggression extremely negatively. Discussion: Polish nurses perceive aggression as destructive, negative and not to be tolerated, leading to use of restraints. Among the three groups, psychiatric nurses showed the most negative attitude towards aggression. Thus, education is needed for preservice and inservice nurses alike to address this issue. What this study adds to existing evidence: We now have a validated instrument to assess nurses' attitudes about aggression. We also know that Polish nurses have exceedingly negative attitudes towards aggression. Implications for Practice: The Polish version of ATAS was found valid and reliable. Therefore, we can now measure the attitudes of Polish nurses towards aggression, which was not possible previously. The baseline data provide a starting point from which to determine effects of educational efforts. [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]

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?: 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?: The shortage of psychiatric nurses has become a focus problem attracting widespread concern. And the continuous improvement of quality of psychiatric care has always been a priority in psychiatric units.Previous studies about nurses from general hospitals indicated nursing work environment was a key factor affecting work‐related outcomes, but little attention was paid to psychiatric nurses and few studies focused on the five specific dimensions of nursing work environment. What the paper adds to existing knowledge?: Nurse participation in hospital affairs was the dimension with the highest proportion of participants dissatisfied.Nursing work environment and all its five dimensions had significant effects on work‐related outcomes, which were partly mediated by work engagement.For nurse‐perceived quality of care, collegial nurse‐physician relations showed the largest effect; while for turnover intention, the two dimensions of nurse participation in hospital affairs and nursing foundations for quality of care showed larger effects. What are the implications for practice?: Corresponding measures should be taken to improve nursing work environment, especially in the aspect of nurse participation in hospital affairs by promoting nurses' ability to participate, arousing their motivation to participate and offering them more opportunities to participate.Harmonious collegial relationship should be built by creating an atmosphere of equality, respect and collaboration, and enhancing the communication between doctors and nurses.Nursing foundations for quality of care need to be further improved through setting appropriate rules and regulations to ensure the quality of care and offering more opportunities to support nursing staff's growth and development. Introduction: With the increasing demand for high‐quality psychiatric care, it is imperative to improve psychiatric nurses' work engagement and work‐related outcomes. Nursing work environment has been identified as a protective factor in non‐psychiatric nurses, but little was known about psychiatric nurses. Aims: To identify the situation of nursing work environment, work engagement, nurse‐perceived quality of care and turnover intention among psychiatric nurses, and examine the relationship among them. Methods: A cross‐sectional design was adopted. Questionnaire investigation was implemented among psychiatric nurses from 43 clinical units. Structural equation modelling and path analysis were used to examine the causal relationship among variables. Results: The results showed 19.06% of participants were not satisfied with the overall work environment and 24.34% were not satisfied with the dimension of nurse participation in hospital affairs. Hypothesis testing results indicated that nursing work environment and its five dimensions had positive effects on nurse‐perceived quality of care and negative effects on turnover intention, which were both partly mediated by work engagement. Discussion: Supportive nursing work environment could improve nurses' work engagement, enhance nurse‐perceived quality of care and reduce nurses' turnover intention. Implications for Practice: Continuous efforts should be paid to the improvement of nursing work environment in psychiatric hospitals. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: There are no studies on the perceptions of psychiatric nurses on interventions they provided to people hearing voices while in an acute psychiatric unit in Ireland. There are three studies focussed on psychiatric nurses' experiences of caring for people that hear voices, two based in England and one based in Australia. Only two of these studies is focussed on nurses working in an acute psychiatric unit. What is this paper adds to existing knowledge?: This study used semi‐structured interviews to explore perceptions of psychiatric nurses in the Republic of Ireland on interventions they provided people hearing voices while in an acute psychiatric unit. What are the implications for practice?: Further quantitative and qualitative research into the nursing practice for people experiencing auditory hallucinations, in both in‐patient and community settings. Follow up supports and supervision after the completion training programmes should be implemented, to ensure the transition of skills and knowledge to the clinical environment. Further investigation into whether or not psychiatric nurses are well prepared for the developments outlined in national polices. Aims and Objectives: To explore the perspectives and experiences of Irish psychiatric nurses working in acute care in regard to their role in addressing hearing voices in the people in their care, with a view to gain insight in the nurses' personal experiences, interventions they provide, attitudes, knowledge, facilitating factors and challenges. Background: Treatment of auditory hallucinations often takes place in acute psychiatric care. Traditionally treatment was focused on medication, but this is no longer the sole approach, with psychosocial interventions gaining ground. Psychiatric nurses have the potential to provide these interventions. As part of the changing emphasis of mental health care in Ireland towards more responsibilities for psychiatric nurses, there is a need to establish whether psychiatric nurses are prepared to take up these added responsibilities. Design: A qualitative study, comprising of semi‐structured interviews (n = 16). Results: Four themes emerged through thematic analysis. These included (a) the importance of therapeutic relationships; (b) reservations about the emphasis on medication; (c) limitations to interventions; and (d) the lack of focus/structure of interventions. Conclusions: The use of systematic psychosocial interventions for people who hear voices is not well supported in the acute psychiatric settings the psychiatric nurses in the study worked in. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? There is a growing body of evidence that many people with an autism spectrum condition suffer anxiety in their daily life and a realization among practitioners that admission to a mental health unit for this population is usually a negative anxiety-inducing experience., Anxiety is driven by the intolerance of uncertainty that is being unsure of what is going to happen, how long the uncertainty will exist and the insistence of sameness which, when compromised, can be anxiety provoking. Equally, confusion in understanding personal emotional responses and those of others is a source of anxiety., What this paper adds to existing knowledge? This paper builds upon existing understanding of anxiety as a causative factor of mental ill-health for people with an autism spectrum condition., Specifically, this paper explores the potentially anxiety-inducing experience of mental health unit admission; how anxiety is felt, triggered, expressed and managed., What are the implications for practice? As many different anxiety responses could be exhibited during hospitalization, including violent acts and self-harming, for mental health practitioners working in the inpatient units, it is essential that the thoughts, feelings and responses of the patient with an autistic spectrum condition (ASC) are better understood and that support offered during their stay in a mental health facility is from an informed position., Abstract Background This qualitative study explored how mental health inpatients with autistic spectrum conditions (ASCs) experience and cope with anxiety when admitted to an acute mental health inpatient facility in the United Kingdom. Anxiety is a common characteristic for people who live with ASCs and whilst a plethora of studies on anxiety in this population is published which correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations. This study adds to a body of evidence which considers anxiety experienced by people with autism. The rationale for this study includes the need to heighten mental health practitioners' understanding, of the responses, motivations to engage and support required to overcome fears and anxieties when admitted to a mental health inpatient unit. Method The study used a qualitative naturalistic research design, to explore the emotional and psychological experiences of being a mental health inpatient living with an ASC. During 2015-2017. audio-recorded semistructured interviews captured the experiences of 20 adults from the east of England who were former psychiatric inpatients with an established diagnosis of ASC. Interpretative phenomenological analysis enabled the identification of broad themes which explained in rich detail, participant reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, manifestations of anxiety and responses to their anxiety. Findings Broad response patterns were identified that could be associated with their anxiety that is isolating themselves from others, including patients and staff, ceasing to eat and sleep adequately and all too often self-harming or exhibiting aggressive and violent responses. Conclusions The anxiety caused by the physical environment appears to be overlooked by mental health practitioners so attention to anxiety-inducing encounters is needed when planning acute care mental health service improvement and research is required to clearly understand the experiences of this vulnerable group. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? Primary care and, in particular, general practice ( GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems., What this paper adds to existing knowledge? Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service ( PCLS), developed in 2011 in inner London., The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria., What are the implications for practice? This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary., Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness., Abstract Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse ( PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Expert by Experience (EBE) involvement in mental health nursing education has demonstrated benefits, including enhancing understanding of holistic and recovery‐focused practice and enhanced application of interpersonal skills.Structure and support for EBE involvement is lacking; often resulting in inadequate preparation and debriefing and tokenistic involvement.Service user involvement in mental health nursing education should be underpinned by lived experience perspectives. What the paper adds to existing knowledge: An exploration of EBE involvement in nursing education from the perspective of those with lived experience.The development of standards designed to provide structure to better support future EBEs involved in higher education.An exemplar for co‐production of standards between EBE and nurse academics which has applicability for other contexts. What are the implications for practice?: The standards could potentially strengthen EBE involvement in mental health nursing education, enhance their confidence and increase the retention of EBEs by creating an inclusive working culture.By increasing support for EBEs, the benefits to mental health nursing practice are likely to be maximized. Introduction: Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim: To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods: Phase one used qualitative descriptive methods, involving focus groups with service users (n = 50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilized these findings through consensus building to co‐produce standards to support Experts by Experience involvement in mental health nursing education. Results: Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, "intervision," mutual mentorship, pre‐ and post‐debriefing, role clarity and equitable payment. Conclusions: These standards form the framework entitled; Standards for Co‐production of Education (Mental Health Nursing) (SCo‐PE [MHN]). Implications for Practice: The standards aim to support implementation of Expert by Experience roles in mental health nursing education. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Schizophrenia is often related to cognitive deficits. Mental health nurses are involved in health promotion, prevention, treatment and rehabilitation in schizophrenia. However, the nursing literature addressing cognitive rehabilitation from schizophrenia is very limited.Cognition and its domains (communication, information processing, attentiveness, concentration, orientation, memory and calculation skills) are established by the Nursing Outcomes Classification (NOC), but they are difficult to measure. What the paper adds to existing knowledge?: We present a new standardized cognitive assessment to be administered by nurses to people diagnosed with schizophrenia.The Brief Cognitive Scale for schizophrenia (BCog‐S) was validated in people with a diagnosis of schizophrenia (including people with schizoaffective disorder), using as references both the assessment of controls matched by age, sex and educational level, and another brief cognitive battery as the gold standard. What are the implications for practice?: Nurses can effectively use the BCog‐S to measure cognition and its domains in people with a diagnosis of schizophrenia. It is a standardized cognitive assessment consisting of a brief battery to be administered by nurses (and other professionals) to people diagnosed with schizophrenia. It is useful for establishing normative reference values for the outcome and its indicators.Using the BCog‐S, nurses can determine the cognitive status of the people diagnosed with schizophrenia they care for, measuring cognitive improvements, lapses or stability attributable to their rehabilitation. Nurses can demonstrate their contribution to cognitive rehabilitation with these measurements of improvement or stability. Introduction: Nurses play a key role in cognitive rehabilitation programs for people diagnosed with schizophrenia. Aim: To design and validate a brief battery to assess the cognitive status of people diagnosed with schizophrenia from the nursing perspective. Method: Study developed to evaluate a diagnostic test. The Brief Cognitive Scale for schizophrenia (BCog‐S) is a hybrid battery composed of previously validated brief tests, designed to meet the dimensions of cognition considered by the NOC. The psychometric properties of the instrument were measured using the Screening for Cognitive Impairment in Psychiatry‐Spanish version (SCIP‐S) as the gold standard, and against the scores obtained by matched controls. Results: About 100 people diagnosed with schizophrenia and 100 controls participated. The battery's internal consistency was 0.70. The Pearson correlation with the SCIP‐S was 0.80 (sensitivity = 0.86, specificity = 0.80). The mean T‐score of those diagnosed with schizophrenia was 2.2 standard deviations below that of the controls. There were significant differences in educational level, employment and cohabitation. Discussion: The BCog‐S showed acceptable psychometric properties. It can discriminate cognitive impairment and could be useful for establishing normative reference values. Implications for practice: Nurses can use the BCog‐S to measure cognition in people with a diagnosis of schizophrenia. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many Western countries have abandoned the wearing of nurse uniforms on inpatient mental health wards. The adoption of a non‐uniform policy in Hong Kong was recently introduced in select rehabilitation units to align with the philosophy of the recovery model. What the paper adds to existing knowledge?: The findings suggest that nurses perceived wearing non‐uniform might help to reduce the self‐stigma of service users and develop better self‐esteem.The perceived potential benefits of the introduction of a non‐uniform policy seemed to outweigh the perceived drawbacks. What are the implications for practice?: The results further acknowledge the potential positive effects of nurses wearing non‐uniform on facilitating psychiatric service users' recovery process. However, further research on service users' perspectives is required.The wearing of non‐uniform may be considered to be extended to other psychiatric wards in Hong Kong and other similar Asian settings in order to potentially help promote patient's recovery and to reduce emotional distance between staff and service users. Introduction: A non‐uniform policy was recently adopted in selected Hong Kong rehabilitation wards to align with the philosophy of the recovery model. The change in policy is relatively novel in Asia, where no previous studies have reported how this may influence nursing care and service users' recovery. Aim: To explore Hong Kong Mental Health Nurses' views about wearing non‐uniform within an inpatient rehabilitation unit in regard to facilitating service users' recovery process. Method: A qualitative descriptive study was conducted, utilizing individual in‐depth semi‐structured research interviews. Results: A total of 12 interviews were conducted with nurse participants. The analysis process identified 3 main themes and 9 subthemes. Main themes were "building up rapport with service users," "non‐uniform helps deinstitutionalization" and "different approaches to maximize the benefit and to minimize the risk." Discussion: Despite some concerns, the majority of nurse participants positively viewed the policy of wearing non‐uniform and felt it was potentially beneficial to service users' recovery process. Implications for practice: Nurses perceived that wearing non‐uniform may facilitate meaningful therapeutic engagement, and may help to reduce the self‐stigma and develop the self‐esteem of service users. Other inpatient units in Hong Kong and similar Asian settings might consider adopting the policy. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Medication does not always resolve a serious mood episode, and there is evidence that it needs to be combined with an evidence‐based psychotherapy to promote symptomatic and functional recovery.There is little known about what people with serious mood disorders want from mental health services to manage their mood. What the paper adds to existing knowledge?: Participants in this study wanted a framework other than the medical model for understanding and managing their mood.Their motivation to commence psychotherapy was based on a sense of having hit rock bottom and a need for understanding what was happening in order to better manage their mood. Introduction: There is little known about the motivations for people to participate in psychotherapy for depression. Aim: To explore why people, with a diagnosis of major depressive episode, chose to take part in a psychotherapy study and what they expected it to involve. Method: This was a qualitative study of participants' motivations and understandings of psychotherapy for depression. Data were collected using semi‐structured interviews and analysed using thematic analysis. Findings: Eight females and eight males with an age range from 21 years to 55 years were recruited. Three themes were identified that described why participants chose to participate in psychotherapy: medication was not enough, a turning point and making sense of experience. The participants chose to participate in psychotherapy after finding that medication was insufficient and this combined with a sense of crisis motivated them to engage in psychotherapy in order to learn to manage their mood differently. Discussion: The participants recognized that they wanted a framework other than a medical model with its reliance on medication, in order to make sense of their experiences and develop new self‐management strategies. Implications for Practice: Our study suggests that some people experiencing a serious mood disorder access psychotherapy after "hitting rock bottom" and finding insufficient help from medications. Mental health nurses need to be aware people do not always want a medical model approach to treatment of serious mood disorders and they need to provide the opportunity of engaging in a psychotherapeutic framework in order to better understand and manage their mood. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Most studies have focused on whether hospital admissions have been reduced by the introduction of crisis services, rather than focusing on how these services are employed. Research has also shown that home assistance decreases costs and increases the level of patient satisfaction, thereby being more efficient in terms of the cost/effectiveness ratio than is traditional hospital care.Patient satisfaction with nursing care has long been identified as a key element of quality of care; however, satisfaction with nursing care among patients and families receiving crisis resolution at home has not been studied yet. What the paper adds to existing knowledge?: There is limited research on patient satisfaction with CRHTTs. This study provides new insights and data including that on relationships between patient satisfaction and the teams' attention to person‐centred mental health care.The difference between this study and other studies on patient satisfaction with crisis resolution home treatment teams is that this study focused on patients' and families' satisfaction with the nursing care provided by crisis resolution home treatment teams rather than with the general service provided. This study is the first of its kind with such a focus. What are the implications for practice?: This research has both academic and clinical implications. Patients' and their families' satisfaction with nursing care is an integral aspect for evaluating mental health services, and this is especially important regarding services provided by crisis resolution home treatment teams because such teams are currently being introduced in countries such as Spain.Closely examining patients and families' satisfaction with nursing care can also foster improvements in current practices. Nurses in crisis teams might need to focus on equalizing power relations, which the data gathered in this study suggests is most important to patient satisfaction. Introduction: Crisis resolution home treatment teams (CRHTT) provide short‐term, intensive home treatment to people experiencing mental health crises. Patient satisfaction has long been identified as a key element of quality of care; however, satisfaction with nursing care as part of this service has not been studied yet. Aim: To assess patients' and their families' satisfaction with the nursing care provided through a home care program offered by a hospital in Catalonia which administers person‐centred care. Method: A mixed methods research design was conducted. A cross‐sectional study including quantitative survey data and qualitative interview data with a phenomenological focus was conducted. Results: Twenty interviews were conducted. Patients and relatives reported high satisfaction that seems to be related to the person‐centred nature of the care. Discussion: The findings provide new insights, including how home treatment tends to equalize power relations between nurses and patients/the patient's family members, and how nurses increase sensitivity when focusing on service users' needs and priorities, leading to high patient and family satisfaction. Implications for practice: This research has both academic and clinical implications. It highlights what mental health patients and their families value most about home care and interactions with nurses, and also drives improvements in current practices. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint.Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan.However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge?: This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended.Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients.Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice?: To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients.Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. Introduction: An international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited. Aims: To evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care. Methods: Mixed methods—quality ratings and interviews with relatives and nurses. Results: Positive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour. Discussion: The potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed. Implications for practice: Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: A clear association exists between serious mental illness (SMI) and poor physical health.Individuals with SMI have markedly higher risks for mortality and morbidity.Mental health nurses play an important role in enhancing service users' mental and physical well‐being.The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross‐country differences should be determined to reveal the importance of this global issue. What the paper adds to existing knowledge?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures.Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI.Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels).Differences that exist between countries in relation to smoking habits are probably due to different regulations. What are the implications for practice?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence.Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes.Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care.Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Introduction: Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question: This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method: The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results: The translated PHASe functioned best as a 24‐item version and 4‐factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice: Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe.There are no formal guidelines for nursing staff on what to observe during observations. What this paper adds to existing knowledge?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self‐harm and suicide, violence, negative influence, disengagement and positive behaviour. What are the implications for practice?: These aspects of patient presentation should be a part of the decision‐making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Introduction: Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim: To develop expert consensus on the important aspects of patient presentation that inform clinical decision‐making about observations and to develop a recording tool from this consensus. Method: A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results: The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self‐harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion: These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice: Consensus items should be recorded in observations records and be considered in decision‐making about observations. The MSORT may aid observations recording. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women.Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels.To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post‐partum health experiences. What this paper adds to existing knowledge?: This study provides unique insights into immigrant women's perceptions of what influences their post‐partum mental health and ability to access services for PPD.Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services.Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation.Assessment approaches and organizational wait times created barriers to accessing care. What are the implications for practice?: Relationship building by providers is foundational to effective care for immigrant women with PPD.Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno‐cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services.Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Introduction: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women yet face multiple barriers to care at individual and system levels. Aim: To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods: A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results: Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion: Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno‐cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice: Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Planning and implementation of care are based on the selection and application of nursing interventions, which correspond to a key element in the nursing process.No information was found in the literature about which major nursing interventions are documented by nurses working in psychiatric wards. What the paper adds to existing knowledge?: Despite the criteria applied to the intervention records' analysis may have led to the exclusion of certain important aspects of mental health nursing, this study provides information on some of the most relevant interventions in the field of psychiatric and mental health nursing documented in Portugal, placing them into the different steps of the nursing process.This study revealed the lack of standardized language used by nurses in intervention definitions, which results in the use of varied terminology to describe the same intervention. What are the implications for practice?: This study constitutes an important contribution towards the standardization of language used by mental health nurses in intervention definitions, which may lead to the production of health indicators that will show policymakers the importance of nursing care towards population health.This study also contributes to the improvement of nursing informatics systems in use in psychiatric departments, particularly through the differentiation between different types of intervention, placing them into the proper steps of the nursing process. The problems identified in this study regarding nursing documentation may suggest that more training for professional nurses in the field of intervention formulation is needed. Introduction: The nursing intervention corresponds to a key element in the nursing process. No information was found in the literature about which major interventions are documented by nurses working in psychiatric wards. Aims: (a) To identify the interventions documented by nurses in Portugal that respond to nursing needs within the scope of psychiatric nursing; (b) to identify the main problems in identifying these interventions. Method: A descriptive study combining: (a) quantitative content analysis of intervention records identified by mental health nurses in Portugal and (b) a focus group meeting with 14 nurses exploring the results of the first study phase. Results: The 2,881 initial intervention records were systematized into 198 intervention categories. Some problems in the interventions' documentation by nurses were identified. Discussion: Despite certain important aspects of mental health nursing may have been excluded, this study provides information on some of the most relevant interventions in the field of mental health nursing documented in Portugal. Implications for practice: This study may offer an important contribution to the improvement of nursing informatics systems and the production of health indicators that reveal the contribution of nursing care towards population health. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Behavioural Family Therapy (BFT) has been shown to help people with some severe mental health conditions, such as schizophrenia, by reducing relapse rates and stress within families., It can be difficult to put family interventions, like BFT, into clinical practice., Families where someone has an intellectual disability can experience more stress compared to those who do not, but we know very little about using BFT with families where a member has an intellectual disability., What this paper adds to existing knowledge? We interviewed nine Community Learning Disability Nurses and Allied Health Professionals about their experiences delivering BFT to families where one member has an intellectual disability. We found that therapists' experiences of delivering BFT were broadly positive, although they found some aspects of their service frustrating., Explain the importance of the paper's findings for a non-specialist audience The study identifies the perceived benefits of BFT as a model to work with families, where a member has an intellectual disability., The study highlights some of the challenges experienced by practitioners, notably issues with engagement and some issues specific to working with adults with an intellectual disability., The findings suggest that it needs to be clear which families would benefit most from BFT, that interventions need to be adapted for people with intellectual disabilities and that Community Learning Disability Nurses and Allied Health Professionals should have support from management to deliver these interventions., Abstract Introduction Studies have found family interventions ( FIs) to be effective in reducing stress and relapse rates for a variety of mental health conditions. However, implementing FIs into clinical practice is challenging. Studies have suggested that levels of stress within some families of people with intellectual disabilities can be high. However, there is little reported about the use and implementation of FIs, such as Behavioural Family Therapy ( BFT), in adult intellectual disability services. Purpose of study To explore the experiences of practitioners delivering BFT to adults with intellectual disabilities. Method A qualitative methodology was employed, using semi-structured individual interviews with BFT therapists from a health professional background ( n = 9). Data were analysed thematically. Results Two overarching themes were identified: positivity and frustration. Discussion Implementation of therapy was identified as being broadly successful but with some underlying challenges, notably wider organizational issues and some issues specific to working with adults with intellectual disabilities. Implications for practice The broadly positive experiences reported provide encouragement for the delivery of FIs, such as BFT, to adults with intellectual disabilities, by professions outwith psychology. However, there is a need to provide clarity on referral processes, adapt materials accordingly for this client group and ensure that supportive management and supervision is available to therapists. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Solution Focused Brief Therapy (SFBT) is an effective model of brief psychotherapy., Evidence suggests that nurses can be trained to deliver SFBT with only a few days training., It has been argued that SFBT reflects the core values of nursing practice, but no empirical research has been undertaken to validate this assertion., What does this paper add to existing knowledge? This is the first time the impact of such training on nurses' sense of professional and personal identity has been explored., Drawing upon data derived from twenty interviews, this paper explores the key themes reported by nurses in relation to their personal experience of training in SFBT., This paper extends our understanding of the lived experience of mental health nurses and facilitates discussion on the preparation and practice of their role., What are the implications for practice? Training in SFBT can provide a framework for nurses to empower their clients/patients to take control of their own recovery in a shared and trusting relationship., Training in SFBT can enhance nurses' sense of trust in their clients., Training in solution-focused interactions may provide a framework for many nurses to provide the type of collaborative, patient-led care they aspire to., Abstract Introduction SFBT is a psychotherapeutic model that aims to 'build solutions' rather than 'solve problems'. It has evolved into a structured communication framework utilized across a range of disciplines, focusing on the future, as opposed to the past, and on participant's strengths and abilities, as opposed to their problems and deficits. There have been no studies exploring the experience of training in SFBT from the perspective of the nurses being trained. Aim This study sought to explore the experience of nurses who had completed a six-month training course in SFBT. Methods Using a qualitative methodology, 20 nurses who had undertaken SFBT training were interviewed at various locations across Scotland. Results Five main themes emerged from analysis of the 20 interviews. Many of the participants reported increased trust in their clients and enhanced role satisfaction. Implications for Practice Training in SFBT provides nurses with an alternative model of practice to the dominant 'medical' and 'psychological' models of contemporary practice. The experiences of the participants in this study suggest that SFBT can be a useful intervention in nursing practice and that nurses can easily incorporate SFBT into their practice. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? There is little research on the implementation of tactile massage in child and adolescent psychiatry that describes children's and adolescents' experiences and outcomes. There is also limited knowledge of providing tactile massage in child and adolescent psychiatry., What does this paper add to existing knowledge? This paper describes 10 nurses' experiences of tactile massage as a nursing intervention in child and adolescent psychiatry. The nurses considered tactile massage a non-verbal nursing intervention that could complement other available treatments. It reveals their reflections on the impact of tactile massage on their nursing and on themselves as a person, including the belief that they had developed deepened self-reflection and attentiveness., The nurses highlighted the importance of providing a trusting environment and collaborating with the children and adolescents. They both experienced and observed that tactile massage triggered various physical and mental processes in the children and adolescents, such as improvement in sleep disturbances, an ability to relax in body and mind and a deeper connectedness with their own bodies and feelings., The nurses described instructing next of kin in the use of tactile massage, which they believed could serve as a tool at home, mainly as a way for next of kin to help their children to relax, fall asleep more easily and to deepen connectedness. However, the nurses stressed the need to consider if it was appropriate or desired by the children and adolescents., What are the implications for practice? Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It could also help nurses in child and adolescent psychiatry to develop their attentiveness and sensitivity in acknowledging the needs of children and adolescents in psychiatric care., Abstract Introduction There is limited research on tactile massage in child and adolescent psychiatry and no studies investigating experiences of providing tactile massage in child and adolescent psychiatry were found. Aim The aim was therefore to describe nurses' experiences of providing tactile massage as a nursing intervention in child and adolescent psychiatry. Method Ten nurses trained in tactile massage and employed at five different child and adolescent psychiatry clinics in Sweden participated in a qualitative study. Semi-structured interviews were conducted, transcribed verbatim and analysed by qualitative content analysis. Results Three categories emerged from the analysis. 'Confirming body and mind', 'Building a trusting relationship' and 'Instructing next of kin in tactile massage'. Attentiveness to and respect for the integrity of the children and adolescents were essential for creating a trusting relationship with them. Tactile massage was found to trigger various physical and mental processes in the children and adolescents. The nurses reflected on the impact of tactile massage on their nursing and on themselves as a person, stating that it had led to the development of self-reflection and attentiveness. Implications for practice Tactile massage addresses the individual's emotional and physiological responses and could therefore bring holistic nursing to child and adolescent psychiatry. It might also enhance attentiveness and sensitivity on the part of child and adolescent psychiatry nurses when acknowledging the needs of children and adolescents in psychiatric care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on this subject?: There is a need to shed light on healthcare professionals' reactions to the use of the Guided Self‐Determination method in a mental health hospital to better understand and adjust the implementation process of evidence‐based practice.Healthcare professionals´ values and beliefs play an important role when implementing evidence‐based practice in real‐world healthcare settings. What this paper adds to existing knowledge?: The study identifies opposite positions in mental healthcare professionals: being ready or resistant to change when implementing an evidence‐based intervention. The positions are elaborated in four thematic dynamic continuums describing reactions to using the intervention.In addition, this is the first study to explore mental healthcare professionals´ reactions to using the Guided Self‐Determination method in a mental health context. What are the implications for practice?: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation of the intervention, the mental healthcare professionals' acceptability, support from management and participation in supervision.In future research, it is important to consider collecting data from mental healthcare professionals trained in using an evidence‐based intervention, however not using it in clinical practice, to understand barriers towards evidence‐based practice. Introduction: Evidence‐based interventions are required in mental health nursing to improve quality and outcome for patients. However, there is a need to shed light on professionals' reactions to the use of evidence‐based interventions to better understand and adjust the implementation process. Aim: To explore mental healthcare professionals´ reactions to using the evidence‐based intervention Guided Self‐Determination method in the care of inpatients with severe mental illness. Method: A qualitative study conducted in relation to an 8 months implementation program. Data collection: 9 qualitative interviews and field notes generated from supervision of the intervention. Results: Four themes emerged from a thematic analysis: "The expert becomes novice," "Theory used as a looking glass," "Guided Self‐Determination perceived as an interruption" and "Becoming an informer of the impact of GSD." Discussion: Using the themes may help leaders or researchers predict or discover the support needed by individual professionals. Implications for practice: When preparing implementation of an evidence‐based intervention, it is important to consider adaptation and acceptability, as well as support from management and participation in supervision. Finally, it is worth to consider collecting data from trained professionals, who did not use the intervention in practice to understand barriers towards evidence‐based practise. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. What does the paper adds to existing knowledge?: This study examines the influence of three different recovery‐oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed‐methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery‐oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced.Mainly, the illness management and recovery training created a positive change in the work attitude and some work‐related practices of mental health staff and the increased presence of a person‐centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services.Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients.Psychiatric advance directives were reported as more challenging to implement and with limited impact. What are the implications for practice?: Recovery‐oriented trainings can be internalized and implemented by staff in medical model psychiatric settings.Despite recovery‐oriented training, challenges do occur—notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses.Using multiple recovery‐oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice.Ongoing comprehensive mental health staff training on recovery‐oriented care programmes is essential in order to sustain change over time.Training is not enough in itself—hospital administrations need to be actively involved in promoting recovery‐oriented policies. Introduction: Developing person‐centred recovery‐oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim: To assess the knowledge, attitudes and practices developed following recovery‐oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery‐oriented intervention in psychiatric wards. Method: A mixed‐methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery‐oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results: The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person‐centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion: This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice: Our findings support the need for broader staff training in recovery‐oriented interventions. Recruiting the support of the hospital administration for recovery‐oriented intervention programmes is key, both ethically and structurally. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. What this paper adds to existing knowledge?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision‐making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. What are the implications for practice?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. Abstract: Introduction: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim: To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods: A cross‐sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self‐administered questionnaires were provided to mental health nurses. Results: Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion: Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision‐making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Stress can impact students on mental health nurse training. This can have implications at the individual level (e.g. their own mental health) and at the level of the organization (e.g. sickness absence and attrition)., What this paper adds to existing knowledge? We interviewed 12 mental health nursing students regarding the stress they experienced during training. Participants described how the academic demands can at times be unbearable during clinical placements. There were also issues with 'being a student' on some placements, with participants describing negative attitudes towards them from staff., The younger participants reported feeling overwhelmed on their initial placements and described some of the main challenges of mental health work for them. Raising concerns about the quality of care on wards was also described as particularly challenging for the students., What are the implications for practice? This paper can be useful to help training providers support mental health nursing students. Recommendations include reducing academic demands during clinical placements and extending and promoting existing support services beyond normal 9 am-5 pm working hours, even if these services are limited. Younger students could be better supported by being allocated to the more well-resourced placements in the early stages of their training., Raising awareness among staff of the tasks students can and cannot perform can help improve staff/student relations. Finally, students should be educated about the issues around raising concerns on placements to help the governments drive for a more open and transparent National Health Service (NHS)., Abstract Introduction Previous studies investigating stress in nursing students focus on general nursing students or adopt quantitative measures. Purpose of study A qualitative study focusing specifically on mental health nursing students is required. Method One-to-one interviews were carried out with mental health nursing students ( n = 12). Data were thematically analysed. Results Participants reported unreasonable demands during clinical blocks, and described how control/support is lowest on placements with staff shortages. Negative attitudes towards students from staff and related issues were also discussed. Younger participants described struggling with mental health work during the early stages of training. Discussion Training providers should strive to provide adequate support to students to help them manage stress during training. Implications for practice Academic demands should be reasonable during clinical blocks and support services outside normal working hours should be available for students, even if these are limited in scope. Greater consideration to the allocation of placements for younger students in the mental health branch could be helpful. Furthermore, staff on placements should be aware of the tasks students can and cannot perform, to help improve staff/student relations. Educating students on the issues of raising concerns can help the governments drive for a more open and transparent National Health Service ( NHS). [ABSTRACT FROM AUTHOR]

Accessible summary The therapeutic relationship is pivotal to mental health nursing, but very little is known about how it is experienced in adult eating disorder services., This paper reports on a research project that sought to discover how the therapeutic relationship is experienced between care workers and women with anorexia nervosa in an adult eating disorder service., Both care workers and women spoke of a relationship that had similarities to the mother-daughter relationship, that it felt therapeutic and that it was in keeping with a professional and compassionate nursing approach., These findings provide new insight. Maternalism is seen as a positive, nurturing and transient relationship that ensures the safety of the person and promotes recovery and transition to eventual independence., Abstract This paper reports on a UK interpretative phenomenological research study that aimed to explore the lived experience of the relationship between women with anorexia and their care workers in the context of a specialist eating disorder ( ED) unit. Here, the concept of maternalism as a phenomenon occurring within the therapeutic relationship in specialist ED units is discussed. Consideration is given to the parallel roles of the health care worker whose duty it is to protect, preserve life and to promote health and that of a mother/guardian. Although seemingly simplistic, the comforting, soothing and nurturing techniques that are used by the workers to diffuse distress and help the person feel cared for have many similarities to 'mothering'. Hence, a maternalistic approach that provides a sense of security and nurturing can be a compassionate way to facilitate hope and a route out of their anorexia into recovery, in the same way that good parenting can facilitate maturation and independence. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nurses are affected by interpersonal, practice‐related and organizational factors that can increase workplace stress and reduce their physical and mental health and well‐being. Resilience programmes are a strength‐based preventative approach to supporting individuals to overcome workplace adversities. What the paper adds to existing knowledge?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self‐talk, managing negative self‐talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social–ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. What are the implications for practice?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well‐being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. Abstract: Introduction: Mental health settings are potentially high‐stress workplaces that can lead to nurses' poorer health and well‐being. Resilience programmes are a strengths‐based preventative approach for promoting mental health and well‐being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim: To explore the perspectives of mental health nurses participating in a mental health service‐initiated resilience programme (Promoting Adult Resilience). Method: An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open‐ended responses and semi‐structured interviews and focus groups, were thematically analysed. Results: Twenty‐nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion: This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self‐efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice: It is recommended resilience programmes are provided to promote nurses' well‐being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well‐being need to be addressed at a unit, organizational and professional level. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coping with parental mental illness in families can be challenging for both children and parents. Providing evidence‐based family interventions to families where a parent has a mental illness can enhance the relationships in the family. Although psychiatric research has shown that evidence‐based family interventions may improve the communication and understanding of parental mental illness, there is a lack in this area of research from an everyday clinical context. What does this paper add to existing knowledge?: Our study reinforces the fact that parents with mental illnesses are searching for support from psychiatric services in order to talk to their children about their illness. The finding that under‐age children comply when they are told by their parents to join an intervention in psychiatric services supporting the family is something not observed earlier in research. This study once more illuminates the fact that partners of a person with parental mental illness are seldom, in an obvious way, included in family support interventions. What are the implications for practice?: Psychiatric services, and especially mental health nurses, have an important task in providing families with parental mental illness with support concerning communication with their children and in including the “healthy” partner in family support interventions. Abstract: Introduction: Although research has shown that evidence‐based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim: This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method: Five families with children aged 10–12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results: In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child‐rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice: Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? People admitted to psychiatric facilities have high rates of tobacco use and hospitalizations present an opportunity for patients to have conversations about tobacco use treatment., Clinicians may believe that people with mental illnesses are not interested in quitting or that they do not understand the importance of treatment., Positive attitudes towards tobacco treatment, viewing that participating in treatment is normal care, and feeling that one is quite able to participate in such treatment predicts intentions to participate in treatment, which, in turn, predicts actual participation., What does this paper add to existing knowledge? Psychiatric patients who use tobacco use report poor prior involvement with tobacco treatment., Positive attitudes towards, encouraging opinions of other people about, and having a sense of control over taking part in tobacco treatment increases plans to engage in treatment., Having a sense of control in taking part in tobacco treatment is strongly associated with prior experiences with evidence-based treatment., What are the implications for practice? Because psychiatric hospitalizations are an opportunity for addressing tobacco use and treatment, clinicians should be prepared to support willing patients, especially those with prior substance use histories., Support should include providing them with information regarding tobacco treatment options during their hospital stay and ways that they can continue to receive care after discharge., Clinicians should be promoters of pro-tobacco treatment attitudes and supporting patients' sense of control over participating in treatment during hospitalization., Abstract Introduction Hospitalized tobacco users with mental illnesses ( MI) may face several barriers to stopping smoking. However, motivational factors that affect the intention to engage in tobacco treatment have been shown to predict actual engagement. Aim To use the Theory of Planned Behavior to assess intentions to and prior experiences of engaging in evidence-based tobacco treatment among hospitalized individuals with MI. Method A cross-sectional survey was conducted among 115 patients in a state psychiatric hospital. Multivariate analyses were used to examine associations with the intentions and prior experiences of engaging in tobacco treatment. Results After controlling for demographic and smoking history, attitudes, subjective norms and perceived behavioural control towards engaging in tobacco treatment were significantly associated with intentions towards treatment engagement. Only higher scores on perceived behavioural control and lower education levels were associated with reported prior experiences of tobacco treatment. Discussion The low prior treatment engagement scores, but relatively higher intention to engage scores among participants suggests the need for deliberate support for evidence-based tobacco treatment during psychiatric hospitalizations. Implications for practice Clinician training in tobacco treatment can promote self-efficacy to engage patients while supporting patients' control so that tobacco treatment is an expected component of psychiatric care. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Caring for people with dementia and responsive behaviours is challenging; however, little is known of nurses' experiences of responsive behaviours., What does this paper add to existing knowledge? To demonstrate understanding nurses need to be aware of their own actions, thoughts, attitudes and reactions., Time, education and management support are essential in enabling a person-centred approach., A decision regarding the place of care is difficult to come to, and given the drive to a person-centred approach, there is a need to consider the views of people with dementia., What are the implications for practice? Nursing staff supporting people with dementia should engage more frequently in reflective practice, ongoing education and decision-making., Service providers/managers need to have an understanding of the complexities of caring for a person with dementia and responsive behaviours and provide their staff with relevant supports and education that is accessible to all staff., Abstract Introduction Caring for people with dementia and responsive behaviours can challenge nurses, and little is known of their experiences. Aims To explore nurses' views of supporting people with dementia and responsive behaviours in long-stay facilities. Methods A qualitative descriptive study utilizing in-depth audio-recorded interviews of nine nurses, recruited from private and public care facilities. Qualitative content analyses conducted involving iterative comparisons of transcripts, summaries and memos, where coding, key quotes and tables were developed to determine themes. Results Four themes emerged: recognizing and understanding responsive behaviour, resources and interventions to support people with dementia and responsive behaviour, the impact of education on nursing practice and the care environment. Discussion Availability of staff, adequate time and financial restraints hinder nurses' ability to provide care. Access to ongoing education and being able to provide one-to-one care was valued as dementia-specific education changed nursing practice. Implications for practice Place of care was seen as dependent on the type of responsive behaviour in question, the duration of the behaviour and the impact of the behaviour on the person, other residents and staff. Dementia education needs to be accessible to all staff, and a collaborative approach is necessary in order to develop management guidelines and support strategies. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject The introduction of PSWs within mental health services has grown substantially both internationally and locally; however, no recognized studies have focused on the evolvement of this role within a Northern Ireland ( NI) context., Research is increasingly focusing on service users' and PSWs perspectives on mental health service provision. Despite this, few studies exist which exclusively report staff views in relation to the PSW role., What the paper adds to existing knowledge Results of the current study identified varying perspectives on the peer role. Some participants believed that the PSW role was tokenistic; others opposed these views, highlighting the value of this role. Clearly defined job descriptions and the importance of ensuring the PSW is a cohesive part of the team and not an 'add on,' was identified as imperative to avoid tokenistic practice., Provision of a flexible working environment, both sensitive and responsive to the peers' own mental health needs, was identified as significant in order for the peer to fulfil their role successfully., Implications for practice Services introducing PSWs within teams should engage with nursing staff at all organizational levels in the role development process to minimize the risk of tokenism, for example, the PSW role not integrated or valued within teams., Clearly defined job/role specifications for PSWs should be devised to ensure that both the PSW and the mental health nursing team have a shared understanding regarding this role., Abstract Aim Peer support worker ( PSW) roles are gaining recognition internationally as a valuable component in mental health service delivery. The aim of this study was to explore the views of mental health voluntary sector staff regarding the emergence of this role. Method A qualitative research design was used. A purposive sample was employed. Semi-structured interviews were undertaken with 10 staff members in various positions in two voluntary mental health organizations. Interview transcripts were analysed thematically. Results Views varied on the PSW role with some participants stating that it was tokenistic, whereas others highlighted the value of its contribution. Participants' expressed concerns regarding professional boundaries and organizational cultural challenges that PSWs may encounter in their role. The provision of reasonable adjustments was recommended as an integral support mechanism. Conclusion Successful integration of the PSW requires careful consideration of the role, the workplace environment and the unique needs of the peer, to prevent the role becoming constrained and diluted. Implications for practice The PSW role may impact the traditional delivery of mental health nursing services. It is therefore essential that nurses are cognizant of these potential challenges to successfully facilitate the integration of PSWs in practice. [ABSTRACT FROM AUTHOR]