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Accessible summary: What is known on the subject?: The use of chemical restraint in emergency situations is to control aggression or violence to protect consumers and staff and is to be used as a last resort when all other behavioural control alternatives have been exhausted.Chemical restraint involves the use of medication. What the paper adds to existing knowledge?: This is the first paper to systematically review the prevalence of the use of chemical restraint.The use of chemical restraint is common across emergency departments and acute psychiatric inpatient units worldwide.Consumers who are restrained are also likely to receive chemical restraint.The studies reviewed demonstrate that there is a need for more standardized data collection so that clearer comparisons can be made between healthcare settings and countries. What are the implications for practice?: Implications of practice include the need to report adverse events post‐chemical restraint as these can deleteriously affect a person's physical health.Identification of and staff education about first‐line management techniques before chemical restraint is administered are significant to reduce its use. Introduction: Chemical restraint is used to manage uncontrolled aggression, agitation or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings. Aim: This systematic review aimed to synthesize the international prevalence of chemical restraint for non‐consenting adults. Method: PsycINFO, CINAHL, MEDLINE/PubMed and Google Scholar databases were searched for peer‐reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice. Results: Forty‐eight papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint. Discussion and implications for practice: This is the first known comprehensive meta‐view of chemical restraint use worldwide, highlighting the need for standardized data collection to enable comparisons between healthcare settings and countries. Relevance statement: There is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesizing the international prevalence of chemical restraint for non‐consenting adults. This meta‐view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use. [ABSTRACT FROM AUTHOR]

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

Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person‐oriented (for example groups of people with a similar mental health diagnosis) or practice‐oriented (for example practices such as seclusion or restraint).It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. What the paper adds to existing knowledge?: To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory‐informed approaches to attitudinal research.By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets—indicated by large proportions of respondents who appraise negatively—concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. What are the implications for practice?: Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice.There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments.Training programmes that focus on attitudinal change need to be more rigorously evaluated. Introduction: Attitudes are considered integral to mental health nursing practice. Aims: To comprehensively describe the (i) measured attitudes of UK mental health nurses towards people and practice; (ii) effectiveness of interventions to change attitudes; and (iii) relationships between their attitudes, other variables/constructs and practice. Methods: Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK‐based mental health nurses' attitudes with multi‐item scales. Studies were quality appraised, mean (SD) attitudinal data were standardized, and other results converted to standardized effect sizes. Results: N = 42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude‐practice links. Discussion: This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice. Implications for Practice: Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co‐morbidity. Addressing disparities between nurses' attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude‐practice links. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet‐delivered or online talk therapy interventions are associated with lower costs and improved accessibility.Current reviews do not address the effectiveness of Internet‐delivered cognitive behavioural therapy (iCBT) on quality of life (QoL). What the paper adds to existing knowledge: Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self‐guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial. What are the implications for practice: There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings.Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated. Introduction: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet‐delivered CBT (iCBT) is associated with lower costs and improved accessibility. Aim: We aimed to examine the effectiveness of iCBT on QoL in adults with depression. Method: PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self‐report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis. Results: Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging. Discussion: Internet‐delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements. Implications for Practice: The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders. [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 quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern.Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries.The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. What the paper adds to existing knowledge?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre‐discharge.Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. What are the implications for practice?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital.Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Introduction: There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim: To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods: A cross‐sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life ‐ Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre‐discharge. Results: Participants reported low social relationship‐related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion: The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice: Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness. [ABSTRACT FROM AUTHOR]

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

What is known on the subject?: There is very limited literature on the health of Middle Eastern immigrants in the United States, and the available studies were mostly conducted on small convenient samples in local communities.There is also a need to understand changes in the rates of serious psychological distress (SPD) during the 15 years after 2001, as there were negative effects on Arabs' health since the September 2001 aftermath. What does this paper add to existing knowledge?: The study examined the rates of SPD, the risk of SPD and its associated factors in a national sample of Middle Eastern immigrants in the United States from 2001 to 2015.The study found that serious psychological distress rate was high among Middle Eastern immigrants. Being a female and having obesity were associated with a higher risk of reporting serious psychological distress among this population. What are the implications for practice?: These outcomes necessitate mental health nursing interventions that provide culturally sensitive mental health care to immigrantsFor example, developing community‐based prevention programmes is required to address risk factors of psychological distress and to increase awareness about psychological distress among Middle Eastern immigrants. Introduction: While Middle Eastern immigrants are a fast‐growing population in the United States, there is very limited literature on their mental health. Most of the available studies were conducted on small convenient samples in local communities. Aims: To examine rates of serious psychological distress (SPD) and its associated factors among Middle Eastern immigrants in the United States, compared with US‐born, non‐Hispanic Whites. Methods: Data from the National Health Interview Survey (NHIS) from 2001 to 2015 were analysed. The survey included 1,246 Middle Eastern immigrants and 232,392 US‐born, non‐Hispanic Whites. SPD was measured by the Kessler‐6 psychological distress scale. Survey analysis procedures, sampling weights and variance estimates were conducted. Descriptive statistics and regression analyses were employed to examine differences and factors associated with SPD. Results: SPD rate was the highest among Middle Eastern immigrants (5.99%) between 2006 and 2010. Among Middle Eastern immigrants, being female and obese were significantly associated with a higher risk of SPD. Discussion: Middle Eastern immigrants in the United States suffered high rates of SPD. Gender and obesity were factors associated with SPD risk. Implications: These outcomes indicate the need for mental health nursing interventions that provide culturally sensitive mental health care to immigrants, such as developing community‐based prevention programmes. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures.Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions.There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. What the paper adds to existing knowledge?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety).Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures.The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. What are the implications for practice?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. Introduction: The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim: To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method: Systematic review. Results: The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion: Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice: Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity.Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. What does the paper add to existing knowledge?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. What are the implications for practice?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. Introduction: Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim: The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods: A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results: Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice: Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about this subject?: Burnout is a prominent issue in psychiatric nursing and associated with significant adverse consequences for staff, service users and at an organizational level.Exploration of the extent and predictors of burnout in secure settings has received little research attention. It is not fully understood why prevalence rates of burnout in forensic settings are not elevated in comparison to other settings, despite the presence of known risk‐related correlates. What this paper adds to existing knowledge?: In contrast to previous research, findings suggest that clinical supervision may not be an effective, stand‐alone intervention to support staff experiencing burnout. Thus, the current focus on clinical supervision to mitigate burnout may be insufficient in forensic services.The ward environment (specifically how safe staff feel, how therapeutic the ward feels and how well service users relate to one another) was found to be more important than clinical supervision in terms of burnout for forensic psychiatric nursing staff. What are the implications for practice?: Policies regarding staff health and well‐being should be developed with due consideration given to the association between burnout and the working environment.It should not be assumed that clinical supervision is sufficient to mitigate burnout in practice. Further research assessing all types of support and the ward environment is needed to gain a better understanding of its relationship to burnout. Introduction: Despite extensive research examining burnout in psychiatric nursing staff, literature exploring key predictors of burnout in secure psychiatric settings has been relatively neglected. Research has yet to explore burnout in these settings by adopting previously identified predictors such as support or the ward environment. Aim: The current study aimed to reduce this gap by exploring burnout, the perceived effectiveness of clinical supervision and ward environment. Method: In 2014, nursing staff working in a medium secure forensic psychiatric unit in the United Kingdom (N = 137) provided demographic information and completed the measures assessing: Burnout, clinical supervision and the ward environment. Results: Approximately 10% of nursing staff could be classed as "burnt‐out". The main predictors of burnout were age and ward environment. Clinical supervision had minimal association with burnout. Discussion: The current study sheds doubt on clinical supervision as a potential intervention for burnout and results appear comparable to research within other settings. The implications of the ward environment, supervision and burnout are discussed herein. Implication for Practice: Interventions may need to focus on a positive ward environment (including patient cohesion, experienced safety and enhancing the therapeutic atmosphere). Organizations should support younger nursing staff as they appear particularly vulnerable to burnout. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: In the United States, 15.5% of nursing home residents without qualifying diagnoses of schizophrenia, Huntington's' Disease, and/or Tourette Syndrome receive antipsychotic medications.Antipsychotic medications are used off‐label (i.e., used in a manner the United States Food and Drug Administration's packaging insert does not specify) to treat neuropsychiatric symptoms, often before attempting nonpharmacologic interventions, despite evidence that this drug class is associated with significant adverse events including death.Less than optimal staffing resources and lack of access to geropsychiatric specialists are barriers to reducing antipsychotic use. What the paper adds to existing knowledge?: Antipsychotic use occurred in 11.6% of nursing home residents without qualifying or potentially qualifying diagnoses (bipolar disorder and psychotic disorder); antipsychotic use was more prevalent in residents with a dementia diagnosis than those without.One additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively. What are the implications for practice?: Given the influence of total staffing and professional staff mix on risk of antipsychotic use, nursing home administrators may want to consider aspects of facility operation that impact antipsychotic use.More stringent Unites States' survey and certification standards for dementia care implemented in 2017 demand proactive person‐centered care that promotes maximal well‐being and functioning without risk of harm from inappropriate psychoactive medications.Mental health nurses have requisite training to provide expert person‐centered care to nursing home residents with mental illness and geropsychiatric disorders. Introduction: Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim: This study identified risk factors of antipsychotic use in long‐stay residents lacking qualifying or potentially qualifying diagnoses. Method: This secondary analysis used 2015 Minimum Data Set and cost report data from 458 Missouri nursing homes. The full sample (N = 29,679) was split into two subsamples: residents with (N = 15,114) and without (N = 14,565) a dementia diagnosis. Separate logistic regression models were run. Results: Almost 15% of the dementia subsample and 8.4% of the nondementia subsample received an antipsychotic medication in the past week. Post‐traumatic stress disorder, psychosis indicators, behavioral symptoms, anxiety medication with and without anxiety diagnosis, depression medication with and without depression diagnosis, and nurse staffing were among the strongest predictors of antipsychotic use in both subsamples. Simulation analyses showed decreased odds of receiving an antipsychotic in both subsamples when registered nurse hours matched the national average. Discussion: Matching nurse staffing mix to the national average may improve antipsychotic use in nursing homes. Implications: Knowledge of antipsychotic use risk factors use can inform care planning and staff education to minimize use of these medications in all but severe cases. [ABSTRACT FROM AUTHOR]

Accessible summary: This study is a follow‐on study to a study into the experiences of disengagement from mental health services for men who described their ethnic identity as “black.” The aim of this study was to understand the same phenomenon from a clinician's perspective. What is known on the subject?: Literature highlights that people from ethnic minority backgrounds experience some difficulties engaging with mental health services; Disengagement from mental health services is a complex phenomenon that occurs for a variety of different reasons; Only one paper previously has investigated clinicians’ perspective on disengagement from mental health services; What the study adds to existing knowledge?: This study demonstrates that clinicians are aware that stigma and medication impact upon engagement with mental health services, which were also important components of the patients experience. A finding of the former study was that patients’ attitudes towards mental health services change over time, with patients engaging more as they get older, a finding was supported by wider literature. However, in this study, the participants were not certain that this was the case. What are the implications for practice?: The implications for practice from this study are that staff should persist with efforts to reduce the stigma surrounding mental health, carefully consider the significance and impact of medication and have an awareness of how patients’ attitudes towards mental illness and mental health services change and develop over time. Continued support for an AO approach to practice for people who find it difficult to engage with services, where a multidisciplinary “team” approach can focus on service user‐centred recovery goals and a positive space for collaboration. Abstract: Introduction: Engagement with services is often poor amongst people with severe mental health problems, yet key to improving clinical outcomes. Aims: This study explores the perception of clinicians on patients with severe mental health problems, in particular the experiences of black men, who disengage from mental health services. Method: Two focus groups consisting of a combined total of twelve, mainly white, experienced clinicians in the UK were recruited. Transcripts were analysed using interpretative phenomenological analysis. Results: Clinicians understood that patients’ awareness of stigma impacted upon engagement with mental health services. Clinicians were aware that medication negatively impacted on engagement. The passage of time was perceived as impacting upon engagement. Discussion: The perspectives of the clinicians in this study and the experiences of the patients in a former study converged. The participants had an understanding of the complexities that black men faced when engaging with mental health services. Implications for practice: This is the first study to highlight that AOT staff need to be aware of the key role that stigma plays in engagement in treatment, continue to focus on efforts to reduce the stigma surrounding mental health, consider the significance medication and be aware of how patients’ attitudes towards mental health services develop over time. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Stigma related to mental illnesses is a great burden on societies globally. Factors associated with nurses' attitudes towards people with mental illness in health-care settings are discrepant., Stigmatized attitudes among staff members towards patients with mental illness have widely been studied in various specialized health care contexts, but less often in primary health-care settings., What this paper adds to the existing knowledge? Nurses' attitudes towards people with mental illness in general were positive in primary care health settings. Younger nurses expressed feeling afraid of mentally ill patients., They not only lacked a feeling of safety around these patients but were also often of the opinion that people with mental illness should be segregated from the general population., What are the implications for practice? Systematic and continuous mental health on-the-job training for primary care nurses is recommended to strengthen the positive attitudes of young nurses towards patients., Young nurses especially should be prevented from developing stigmatized attitudes towards patients with mental problems and to ensure a skilled workforce for the future in this demanding area of health care., Abstract Introduction Despite the development of mental health services in many countries, nurses working in different health care specialties may still have concerns and negative attitudes towards people with mental illness. Aim To describe nurses' attitudes towards people with mental illness and examine factors associated with their attitudes in primary care health centres. Method The data were collected from nursing staff ( N = 264, response rate 84%) in 15 primary care health centres in two Finnish cities (spring 2014) with a self-report questionnaire (Attribution Questionnaire-27, Corrigan 2003) and analysed by descriptive statistics and multiway covariance analysis. Results Nurses' attitudes towards people with mental illness were generally positive. The nurses mostly reported willingness to help and feelings of concern and sympathy towards these patients. However, younger nurses or those without additional mental health training expressed a fear of patients. Discussion Special attention should be paid to nursing education and on-the-job training to prevent young nurses from developing stigmatized attitudes towards patients. Implications for practice Higher confidence in nursing staff could ensure a skilled work force in areas of mental health in the future, prevent young nurses from developing a fear of patients at work and support positive attitudes towards patients with mental problems. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The TAS-20 is the most widely used self-reported questionnaire to assess the level of alexithymia in students and community and clinical samples., What this paper adds to existing knowledge? The TAS-20-C exhibited high levels of reliability and validity, indicating that it is appropriate for the assessment of alexithymia in Chinese adolescents., What are the implications for practice? Screening adolescents who are at risk of alexithymia through the TAS-20 could help to perform necessary and effective precautions to decrease the adverse effects of alexithymia, such as the risks of developing depressive mood and behavioral problems., Abstract Purpose The aim of this study was to examine the psychometric properties of the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20-C) in a sample of Chinese adolescents. Method Adolescents ( n = 1260) recruited from three schools in mainland China completed the TAS-20-C, the somatization subscale of the Symptom Checklist 90 (SCL-90) and Center for Epidemiological Studies Depression Scale (CES-D). Five different factorial models of the TAS-20 were tested using confirmatory factor analysis (CFA). Cronbach's α, mean inter-item correlations and predictive validity were also evaluated. Results Among those five different factorial models, the four-factor structure model was suitable and invariant across gender and age in this sample. The TAS-20-C demonstrated adequate internal reliability. Gender and age accounted for insignificant amounts of variability in total TAS-20-C and factor scores. TAS-20-C total and subscale scores were correlated significantly with SCL-90 somatization subscale and CES-D. Girls scored higher than boys on difficulty identifying feelings (DIF) and pragmatic thinking (PR) subscales. DIF and lack of subjective significance or importance of emotions (IMs) subscale scores were higher among younger than among middle and older adolescents. Implications for Practice Validating the TAS-20 in adolescents is quite important to use it in evaluating adolescents' alexithymia, and screen those at risk of alexithymia. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Outreach services are often successful in engaging and housing street homeless individuals., People experiencing homelessness have greatly increased rates of mental illness and substance abuse., What this paper adds to existing knowledge? Given the relative lack of research involving street homeless individuals, this ret-rospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework., The majority of clients were successfully housed by the end of outreach team involvement., An admission to hospital was strongly associated with successful housing for those with a psychotic disorder., What are the implications for practice? Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homeless-ness and psychosis., Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals., Abstract Introduction Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. Method A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. Results Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization (OR = 9.04, 95% CI [2.43, 33.59]). It was significantly diminished by psychosis (OR = 0.22, 95% CI [0.05, 0.95]) and prior homelessness >36 months (OR = 0.10, 95% CI [0.02, 0.50]). Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized (Fisher's exact, P < .001). Discussion Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Many studies indicate that working with people with a personality disorder is a real challenge, which is especially known by professionals, and it also displays different attitudes that can affect their professional stance. There is no specific study examining those difficulties, emotional reactions and attitudes of mental health professionals towards people with a PD in Turkey., What this paper adds to existing knowledge? We examined emotional reactions, difficulties and attitudes of mental health professionals towards people with a PD and also the interaction between these variables. We found a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing boundaries against people with a PD. Besides, a higher level of education resulted in reduced experience of difficulties while working with patients with a diagnosis of 'PD' among nurses., What are the implications for practice? Mental health professionals and especially nurses who spend most of their time working with people with PD in the inpatient services need to be well educated and be experienced in coping with patients' relational problems and emotional fluctuations, and also be aware of their own emotional reactions., Abstract Introduction Working with people with a personality disorder ( PD) can arouse strong feelings, and cause difficulties as well as different attitudes among mental health workers ( MHWs). While attitudes towards people with PD and the difficulties experienced by MHWs have been previously investigated, the reciprocal relationship between the two has not been thoroughly investigated. Aim/Question This study aims to investigate (1) affective reactions of MHWs to people with personality disorders, (2) the difficulties that MHWs experience while working with these patients, (3) their attitudes towards these patients, and (4) the interaction between these variables. Method The data for this study were collected through a Personal Information Questionnaire, the Difficulty of Working with Personality Disorders Scale and the Attitudes towards Patients with Personality Disorders Scale from 332 MHWs from several mental health clinics in Turkey, all of whom were experienced in working with people with PD. Results The results indicate that the participants described 'difficulty in forming a relationship, understanding the client, and estab lishing cooperation' among the primary reasons of difficulties. This study also shows that there is a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing borders against people with PD. Discussion The findings of this study imply that the level of education, expertise, psychotherapy treatment and clinical supervision of MHWs all affect perceived difficulties and attitudes towards people with PD. It is also noted that among nurses, a higher level of education results in reduced experience of difficulties while working with patients with PD. Implication for practice The results foreground the need for specific skills to be developed in MHWs through theoretical training, case-focused supervision and receiving personal psychotherapy for MHWs. [ABSTRACT FROM AUTHOR]

Accessible summary • This paper describes the role of the psychiatric nurse working in a high secure psychiatric facility in Ireland. • Since this study in 2006, this role has transformed moving from a custodial to a recovery model of care. • The United Kingdom Central Council framework for this study provided a useful method to establish a baseline for this role and as part of strategy to develop nursing practice. The Central Mental Hospital is one of the oldest high secure mental health services in Europe dating back to 1845 but has been one of the last to introduce (forensic) psychiatric nurses. This paper describes the role of psychiatric nurses working in this high secure psychiatric facility in Ireland. The United Kingdom Central Council competency framework was considered to be a prudent starting point for beginning to understand this role in an Irish context. The study received a response rate of 74% and found that the Irish Forensic Mental Health Nurse experiences many of the same challenges as their international colleagues. A high proportion of nursing practice is focused on assessment, communication and creating a therapeutic environment based very much in keeping with the mainstream role in mental health nursing. Skills in specialist assessments and addressing offending behaviour were considered important but deficient at that time. The importance of recovery and human rights were considered paramount but challenged by the need for risk management and security. [ABSTRACT FROM AUTHOR]

Seclusion with or without restraint is a measure used to manage patients with challenging behaviours. Although controversial, the intervention remains poorly documented, especially in Canadian psychiatric hospitals. The purpose of this study is to assess the prevalence of the measure and identify any correlated demographic characteristics and psychiatric disorders. Episodes of seclusion with or without restraint were extracted from a computerized, hospital-based system introduced specifically to track such interventions. Of 2721 patients hospitalized during that time, 23.2% (n = 632) were secluded with or without restraint, and 17.5% (n = 476) were secluded with restraint. Younger age, schizophrenia or other psychosis, bipolar and personality disorder, and longer stay in hospital are predictors of an episode of seclusion with or without restraint. Younger age, bipolar and personality disorders and a longer stay in hospital are predictors of an episode of seclusion with restraint. For patients who spent longer in seclusion and under restraint, there is a positive association with longer stay in hospital. In this inpatient psychiatric facility, seclusion with or without restraint thus appears to be common. More research is warranted to better identify the principal factors associated with seclusion and restraint and help reduce resort to these measures. [ABSTRACT FROM AUTHOR]