Search

What is known on the subject: Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department.What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. What the paper adds to existing knowledge: This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. What are the implications for practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services.This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. Introduction: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. Aim/Question: The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Method: Using health care administrative databases, a pre‐post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Results: Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. Discussion: The results suggest that a supported housing model may be associated with increased usage of outpatient person‐centred health services in people experiencing SPMI. Implications for Practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities.Studies of nurse consultants in the United Kingdom have largely been non‐empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. What this paper adds to existing knowledge?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change.A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. What are the implications for practice?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors.The continued absence of robust evidence as to the clinical/cost‐effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint.Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Introduction: The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims: The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method: We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross‐sectional survey of post holder characteristics and semi‐structured interviews with directors of nursing. Results: Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0–12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion: Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice: Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work. [ABSTRACT FROM AUTHOR]

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

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

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

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

Accessible summary: What is known on the subject?: 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?: Readiness for hospital discharge (RHD) has been an important topic for nurses.RHD can be measured by the Readiness for Hospital Discharge Scale (RHDS), including 4 subscales: personal status, knowledge, coping ability and expected support.There are few studies that focus on RHD in patients diagnosed with mental disorders. What does the paper add to existing knowledge?: Improving patient‐reported RHD can decrease the risks of unscheduled post‐discharge clinic visits, readmission and poor quality of life (QOL) in patients diagnosed with anxiety disorders.Improving patient‐reported personal status can decrease the risk of poor QOL in patients diagnosed with anxiety disorders.Improving patient‐reported knowledge can decrease the risks of unscheduled post‐discharge clinic visits and readmission in patients diagnosed with anxiety disorders.Improving patient‐reported expected support can decrease the risk of unscheduled post‐discharge clinic visits in patients diagnosed with anxiety disorders.Improving the methods of discharge teaching and anxiety severity can enhance RHD in patients diagnosed with anxiety disorders. What are the implications for practice?: Nurses could enhance patient‐reported RHD to reduce unscheduled post‐discharge medical resource utilization or improve QOL by facilitating knowledge acquisition and skill development and improving social support systems.Nurse managers could add RHD assessment to patients' discharge process and train nurses in the methods of discharge education.Nurses could advance their methods of discharge education, such as listening to and answering patients' questions, choosing a convenient time and engaging in online education. Introduction: The association between readiness for hospital discharge (RHD) and post‐discharge outcomes remains unclear in individuals with anxiety disorders. Aim: To explore the factors of RHD and the effect of patient‐reported RHD on post‐discharge outcomes. Method: In the observational study, 373 patients diagnosed with anxiety disorders completed the self‐administered Readiness for Hospital Discharge Scale (RHDS) on discharge. After 30 days, phone interviews were conducted to collect data on post‐discharge outcomes, including self‐reported unscheduled medical service utilization, symptom severity and quality of life (QOL). Multiple logistic regression models were built to explore the relationships among sociodemographic characteristics, the RHDS and its subscales, and post‐discharge outcomes. Results: The unscheduled clinic visits were significantly associated with low RHD, knowledge and expected support. Readmission was significantly associated with low RHD and knowledge. Poor QOL was significantly associated with low RHD and personal status. Delivery, received content and anxiety severity were the predictors of RHD. Discussion: Improved RHD is associated with fewer unscheduled clinic visits and readmissions and better QOL. Enhancing discharge education can improve RHD. Implications for practice: Nurses should enhance patient‐reported RHD to improve post‐discharge outcomes by advancing the quality of discharge education in patients diagnosed with anxiety disorders. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people.There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties.There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. What does the paper add to existing knowledge?: The positive evolution of attitudes towards mental illness does not last over time.Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. What are the implications for practice?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices.The design of any anti‐stigma intervention must include the factor of "time". Introduction: The stigma of health professionals is a contributing factor to morbi‐mortality among people with mental health difficulties. There is a lack of research on long‐term outcomes in nursing students. Objective: To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method: A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self‐education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15 months. Results: Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion: Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications: Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti‐stigma activities. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with severe mental illness (SMI) have a life expectancy of 15–20 years less than the general population, partly due to increased risk of physical disease, including type II diabetes (T2DM) and cardiovascular disease.Little is known about changes in cardiovascular risk factors over time in people with both T2DM and SMI compared to those with T2DM and no SMI. What this paper adds to existing knowledge?: We investigated whether levels of cardiovascular risk factors, cholesterol, HbA1c, systolic and diastolic blood pressure associated with adverse clinical outcomes are different in T2DM patients with and without SMI. We found significant differences in systolic blood pressure and HbA1c between the two groups.Fifty‐five percent and twenty‐nine percent of T2DM patients with comorbid SMI are at increased risk of adverse clinical outcomes due to sub‐optimal HbA1c and systolic blood pressure levels, respectively. What are the implications for practice?: Many patients with T2DM and SMI have higher levels of cardiovascular risk compared to patients with T2DM only, and good management of risk factors is therefore particularly important in patients with both conditions.Achieving better control of HbA1c levels is likely to be central to addressing inequalities in outcomes for patients with both SMI and T2DM. Introduction: Patients with both severe mental illness (SMI) and type II diabetes (T2DM) have lower life expectancy than patients with T2DM alone, partly due to poor control of cardiovascular risk factors in comorbid patients. Aim: To compare levels of cholesterol, HbA1c and blood pressure in T2DM patients with and without SMI. Method: We analysed longitudinal clinical records of 30,353 people with T2DM (657 with SMI; 29,696 controls without SMI) between 2001 and 2013 using the Clinical Practice Research Datalink (CPRD). We used mixed‐effects regression models to compare cardiovascular risk factors between SMI and controls. Results: Patients with SMI had lower mean systolic blood pressure (SBP; β: −2.49; SE = .45 p = <.01) and were more likely to have extreme (high and low) values of HbA1c and SBP (OR: 1.38, 95% CI: 1.16, 1.64 and 1.76:1.40, 2.21, respectively). Discussion: People with T2DM and SMI have similar average values of cardiovascular risk factors to people with T2DM alone but are more likely to have values of HbA1c and SBP indicating increased risk of adverse clinical outcomes. Implications for Practice: Improved management of cardiovascular risk factors in general, glycaemic control in particular, is central to addressing the increased risk of adverse outcomes in people with both SMI and T2DM. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurse prescribing allows nurses, after specific training, to prescribe medications under certain conditions. This article describes the third in a series of surveys of mental health services in England to understand how nurse prescribing is being used across the country., While there is research evidence that shows nurse prescribing to be as safe as prescribing by doctors and that service users typically find it at least as acceptable, there is a lack of detailed evidence about current forms of nurse prescribing practice specifically in mental health services., What this paper adds to existing knowledge? The survey found that the number of nurse prescribers has increased over the last few years. Nurse prescribers are increasingly prescribing in a form ('independent prescribing') that makes them independently responsible for prescribing decisions without working to a plan laid out by a doctor. Mental health organisations are increasingly planning in a systematic way how to identify, train and ensure good practice in nurse prescribing., This study demonstrates that growth in numbers of nurse prescribers can take place over an extended time period. The study demonstrates that the exact model of nurse prescribing will influence its applicability in different types of service., What are the implications for practice? Nurse prescribing is becoming increasingly common in mental health services, changing roles for nurses and the experience of services for service users. However, there is great variation between organisations in this regard., Research is needed regarding the outcomes and any risks of independent nurse prescribing specifically in mental health compared to medical prescribing., Abstract Introduction This paper reports the latest in a series of national surveys of nurse prescribing in mental health organizations in England. Aim To describe and understand changes and trends in the use of nurse prescribing nationally. Methods Postal survey to all 53 National Health Service Mental Health Trusts (publicly funded provider organizations); 75% responded ( n = 40). Results Numbers of nurse prescribers (NPs) have grown significantly in the last 6 years, although remain a small percentage of the total Mental Health Nursing workforce. Most NPs are in community services, particularly community mental health teams and drug/alcohol services. Independent prescribing has now become the most common form of NP, replacing supplementary prescribing. Discussion Overall growth in numbers of NPs has continued, but remains marked by large variance in numbers between organizations. The study evidences that the particular form of nurse prescribing will influence its applicability in different clinical settings and that sustained increase over time in NP numbers is feasible at a national level, even with local variation in uptake. Implications for practice Nurse prescribing has become well embedded in many organizations although large-scale adoption may be hindered by the lack of a definitive evidence base as to outcomes compared with those from medical prescribing. [ABSTRACT FROM AUTHOR]

Introduction: The reason for this study was void of a data‐driven imminent risk assessment instrument for aggression in psychiatry clinics in Estonia. The predictive accuracy of the observer‐rated Dynamic Assessment of Situational Aggression (DASA) has been repeatedly demonstrated. However, the research gap remains regarding a deeper conceptual understanding of the underlying latent structure of the DASA. Aim: Comprehensively evaluate the psychometric properties of the Estonian DASA version for cross‐cultural clinical use. Method: We used a prospective repeated measure design and collected 6097 risk evaluations from 381 adult inpatients, 151 of whom committed 1013 aggressive incidents during the study. Results: The Estonian DASA version has acceptable inter‐rater reliability (Kendall's τ = 0.74) and is a useful instrument with excellent predictive validity (AUC = 0.86) for identifying potentially aggressive inpatients. In our sample, the DASA has a bi‐factorial structure which explains 83% of the total variance. Discussion: The adapted DASA has acceptable validity and reliability indices for measuring imminent aggression risk in adult inpatient units. Implications for Practice: Evidence‐based risk assessment of aggression in psychiatric clinics enhances recognition of the signs of potentially aggressive behaviour in order to apply preventive actions and reduce aggression, thereby improving the quality of the care provided. [ABSTRACT FROM AUTHOR]

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

Accessible summary: 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? Various expert opinions reported relational benefits and tranquilizing effects of therapeutic body wraps ( TBW) in adults experiencing high anxiety in the context of psychosis. Yet, this tranquilizing effect was never investigated in larger samples and in the context of modern psychopharmacology., What this paper adds to existing knowledge? This is the first study to establish descriptive statistics of this mind-body therapy in French-speaking Switzerland where TBWs are routinely used in two public psychiatric hospitals. It brings knowledge on patients nowadays treated with TBW. Moreover, it opens a new area of investigation on the potential of this nursing technique, which may contribute to reduce anxiolytic medication in severely ill patients., What are the implications for practice? This study sheds light on a clinical practice in mental health nursing and upon nurses' specific contribution to psychiatric clinic. It investigates a potential for TBWs to reduce the use of anxiolytic medications by patients who agreed to have TBW as part of their treatment. It may help to inform the mental health nursing practice., Abstract Introduction Many patients suffering from serious mental illness experience severe anxiety and those with psychosis often report the feeling of their bodies falling apart. While it is believed that these patients benefit from therapeutic body wraps ( TBWs), the use of this adjunct therapy has rarely been studied in adult patients. Aims The aim of this study was to obtain descriptive statistics on the clinical, social-demographic and institutional reality of TBW therapy in Swiss public adult inpatient wards. Methods Retrospective data related to a cohort of 172 adult inpatients were retrieved from records of two public hospitals. Correlations between TBW and the prescriptions of lorazepam were explored. Results TBWs were primarily used for patients diagnosed with either schizophrenia, schizotypal, delusional and other non-mood psychotic disorders or mood disorders. Patients had, on average, four psychiatric hospitalizations, and in 30% of the cases, TBWs were offered during the first hospitalization. Moreover, TBWs were mostly practiced by nurses. Body wraps were potentially associated with a reduction in both anxiolytic and neuroleptic drugs. Discussion/Implication for practice Based on our results, TBW might contribute to the clinical management of anxiety by nurses. The efficacy of TWB regarding anxiety has yet to be investigated in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Accessible summary While there is emerging evidence for family sensitive practice, few practitioners employ this approach., Over 2 years, practitioners were invited to identify the problems and the successful strategies experienced when working with families where a parent, with dependent children, has a substance and/or mental illness disorder., Problems were found related to working with multiple agencies, multiple family problems and high staff turnover., Practitioners found several strategies to be effective; working in a strength-based manner, establishing clearly defined and negotiated goals, and balancing the sometimes competing needs of children and parents., Abstract Even though employing a family-sensitive approach has been shown to be beneficial for parents and children, there is sporadic uptake of this approach. This paper focuses on practitioners' perspectives when working with families where a parent, with dependent children, has a mental illness and/or substance abuse disorder. The aim of this research is twofold: (1) identify the issues practitioners face when working with families with complex needs; and (2) present the strategies they find to be effective in addressing family needs. Within the context of an organization that supported a family-sensitive approach, this study reports on 21 semi-structured interviews conducted over 15 months with 10 practitioners, as well as three focus group interviews with the same staff. Employing a qualitative framework, data highlighted the multifaceted nature of family problems, issues working with multiple agencies and problems associated with staff turnover. Successful strategies included working with the family on clearly defined and negotiated goals, focusing on family strengths and employing specific skills such as managing the sometimes competing needs of children and parents. [ABSTRACT FROM AUTHOR]

The Mental Health Nurse Incentive Programme (MHNIP) provides funding to organizations to enable mental health nurses (MHNs) to provide care to people with complex needs in primary care settings in Australia. The programme is based on a 'for and on-behalf of' practice nursing model whereby the MHN is presumed to have no specialist knowledge, skills or professional autonomy, and rather extends the reach of medicine. This paper provides a profile of MHNs working in the MHNIP derived from an online survey. A content analysis of responses establishes that nurses who work within MHNIP are highly experienced, and have extensive postgraduate qualifications particularly in psychotherapy. Nurses have negotiated a range of complex employment and contractual arrangements with organizations and pushed the boundaries of the programme to realize good outcomes. The 'practice nurse model' of employment and the underpinning assumptions about MHNs and their skill set relative to other professions is critically examined. Changes to the programme funding mechanism and programme specifications are recommended. [ABSTRACT FROM AUTHOR]

Accessible summary Recovery Education is a series of innovative lessons used by nurses to teach groups of patients in an inpatient Behavioral Health Unit., The programme is based on a recovery model promoting hope, security, support/managing symptoms, empowerment, relationships, coping and finding meaning., Recovery Education aims to help patients move forward step-by-step on their recovery journey and become healthier and more able to prevent relapse., Making the group process for psychoeducation more consistently therapeutic was an example of research in action on our unit., Abstract Patient teaching is vital for nursing care of psychiatric patients. This paper describes the process of developing Recovery Education as a tool for nurses who lead daily patient education groups. Gundersen Lutheran's Recovery Model developed for the Inpatient Psychiatric Unit includes seven Elements of Recovery - Hope, Security, Support/ Managing Symptoms, Empowerment, Relationships, Coping and Finding Meaning. Concepts of cognitive behavioural therapy, mindfulness and case-based education were woven through recovery lessons in ready-to-use folders. Statistics on patient satisfaction and patient outcome data were positive. Education for self-management can move patients forward to improve health and healing on their recovery journey. [ABSTRACT FROM AUTHOR]

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

The aim of this paper is to describe the first 2 years of operation of an electronic system for reporting medication events in psychiatry (Medi-Event system). We have carried out a descriptive analysis of all medication events (errors, near misses and adverse drug reactions) reported between 1 March 2008 and 28 February 2010 at a large, specialist UK psychiatric hospital. A total of 406 medication errors, 40 near misses and no adverse drug reactions were reported in the study period, representing a very large increase in reporting frequency with respect to the previous paper system. The majority (88.8%) of incidents were medication administration errors. The most common error types were failure to sign for a drug and omission of a drug without valid clinical reason. Although most errors were of minor severity, 6.3% were rated as moderate or serious. Distraction was cited as the most common contributory factor, also poor communication and being unfamiliar with the ward. In conclusion, use of the Medi-Event system increased the reporting of medication errors. Analysis of the pattern of errors, as well as of contributory factors and suggestions for error prevention, may help reduce the frequency of medication events and hence improve patient care. [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Accessible summary A combination of individual cognitive behavioural therapy and of psychiatric rehabilitation is more effective in reducing hopelessness than group cognitive behavioural therapy combined with psychiatric rehabilitation or psychiatric rehabilitation only., Hopelessness is a cardinal symptom of depression and one of the main risk factors for suicide. Reduction of hopelessness under nine on the Beck Hopelessness Scale reduces the risk of suicide in depressed patients. In this study, the mean scores on the Beck Hopelessness Scale decreased in all groups under nine., Psychiatric rehabilitation with individual cognitive behavioural therapy for depressed patients suffering from hopelessness can be delivered effectively by an interdisciplinary team including advanced psychiatric nurses., Abstract The aim of this study is to evaluate the effects of individual and group cognitive behavioural therapy ( CBT) and of psychiatric rehabilitation ( PR) on hopelessness for depressed patients in a rehabilitation setting. Three groups of patients who underwent PR were allocated to individual CBT combined with PR ( n = 43), group CBT combined with PR ( n = 52) or PR only ( n = 22). Hopelessness was assessed by the Beck Hopelessness Scale ( BHS). The majority of the patients (68.4%) suffered from moderate to severe hopelessness before treatment (score ≥ 9-20). Results showed that the pretest mean score on the BHS decreased from 11. 57 ( SD = 5.58) to 7.46 ( SD = 5.20) at posttest. The mean scores on the BHS decreased in all groups under nine. The combination of individual CBT and PR was significantly more effective in reducing hopelessness than group CBT with PR or PR only. Group CBT combined with PR was not significantly more effective than PR only. It is concluded that individual CBT combined with PR is more effective in alleviating hopelessness among depressed patients than group CBT with PR or PR only. CBT can be delivered by an interdisciplinary team including advanced psychiatric nurses. [ABSTRACT FROM AUTHOR]

Accessible summary Many people with mental health disorders experience fatigue, pain and poor sleep. In other patient groups, physical exercise has been shown to have positive effects on these symptoms., It is unknown whether day-to-day physical activity (not necessarily exercise) affects sleep quality or severity of pain or fatigue in those with mental illness., This study observed physical activity, sleep quality, pain and fatigue in four people hospitalized with severe mental illness., Significant associations were found between pain and fatigue severity in the morning, but not in the evening. A significant association was found between physical activity and morning and evening pain severity. No association was found between activity and fatigue., This is a preliminary study that may guide future investigations of the effect of physical activity and exercise on symptoms commonly experienced in people with mental illness., Abstract Good mental health is imperative to well-being. Symptoms of fatigue, chronic pain and poor sleep are common in people with mental illness and contribute to substantial loss of functioning. Physical exercise interventions have shown to decrease these symptoms in a range of populations; however, their possible association with physical activity related to day-to-day functioning have not been explored in people hospitalized with severe mental illness. Inpatients ( n = 4) of a metropolitan mental health facility were fitted with an Actiwatch, which collected physical activity and sleep measures for an anticipated 14-day data collection period. During this time, morning and evening pain and fatigue scores were collected on an 11-point numerical rating scale. Significant associations were found between morning pain and morning fatigue scores ( β = −0.44, P = 0.023), morning pain and physical activity ( β = 12.34, P = 0.042), and physical activity and evening pain scores ( β = 0.20, P = 0.017). Fatigue tended towards interfering more with quality of life than did pain, but this was not significant ( P = 0.07). This study provided preliminary data suggesting associations between pain and fatigue, and intensity of pain and physical activity levels. This information can be used to generate hypotheses for future clinical trials. [ABSTRACT FROM AUTHOR]

Accessible summary In the past decade UK government policy has been to develop alternative care for women detained in secure psychiatric hospital., This study evaluated the relative benefits of supportive accommodation, comparing female patients in community step-down housing and a control group in secure hospital who were on the waiting list for a place in the houses., The study provides evidence in favour of the further development of high-support step-down community housing for women in secure psychiatric care. This may provide greater personal freedom and enhanced relational security for the women concerned while also facilitating improvements in their psychological well-being, with no increased risk to the women themselves or to the wider community., We conclude that community reintegration rates could be improved further by the expanded development of step-down community services for women in forensic psychiatric care., Abstract In the past decade UK government policy has been to develop alternative care for women detained in secure psychiatric hospital. This study evaluated the relative benefits of community-based step-down housing. Comparisons were made between female patients in community step-down housing and a control group in secure hospital who were on the waiting list for the houses. For each woman in the sample, a range of assessments was conducted on three separate occasions over a 12-month period. We noted a gradual improvement over time in women in both settings. However, by the final assessment psychological well-being and security needs were significantly better in the community group ( P < 0.05). Although risks for violence and social functioning were also somewhat better in this group throughout the study, no statistically significant differences between the groups were found in these areas at any assessment time. This study has generated evidence in support of the further development of high-support step-down community housing for women in secure psychiatric care. This initiative may provide greater personal freedom and enhanced relational security for the women concerned while also facilitating improvements in their psychological well-being, with no increased risk to the women themselves or to the wider community. [ABSTRACT FROM AUTHOR]

Accessible summary It is stressful to be ill. People need nurses who help them emotionally while caring for their physical problems. The undergraduate psychiatric course is a good place to begin this learning. A pre and post survey asked 67 baccalaureate student nurses what they learned from their first clinical psychiatric nursing course. Specifically, the authors wanted to know whether working with people with mental illness would help students learn how to help people with emotional stress., The students developed skills in listening and communication and progressed through steps essential to the development of empathy: breaking down stigma and prejudicial judgments, developing skills of self-reflection, allowing people to impact them and feeling what it would be like if they were the patient, and recognizing what they had learned thereby making the learning conscious. With these new skills, students remarked on the life-changing experiences they had with these patients. Many commented on their intention to integrate these skills and understandings into their nursing practice with all patients., These study findings are important for three reasons: (1) recognition of the importance of the first psychiatric course in helping students develop empathy; (2) encouraging research to focus on faculty efforts to help students integrate these practices into other areas of nursing; and (3) recognition that empathy is a learned process., Abstract Psychiatric nursing teaches students how to engage and communicate with patients who have severe emotional distress. Nurses need this knowledge as the majority of patients encountered in hospitals are distressed. This study explores the impact of a psychiatric clinical course in helping students learn to relate to distressed patients. The study used a mixed research methodology to survey 67 baccalaureate students about their experiences in the placement portion of the psychiatric nursing course. The pre-clinical questions focused on students' anticipation regarding individuals with mental illness and how the clinical experience would affect them as nurses and as individuals. The post-clinical questions asked how the clinical experience affected them. The students stated that their time with patients had changed them. Ninety-nine per cent were no longer frightened of the patients. Students realized the patients were distressed and were glad to help them. This work sensitized them to the individual rather than the generic patient. It initiated a process in self-awareness, in sensitivity to the feelings of another person and in communication skills. These are steps in the development of an empathetic presence. The students recognized the need for these skills in all nursing. The authors recommend strategies to assist students in developing an empathetic presence. [ABSTRACT FROM AUTHOR]

Accessible summary This article explores the evidence to support an education programme for psychosis and introduces a new assessment tool designed to measure knowledge gain., A description of the programme entitled 'Coping With Mental Illness' - designed for people in forensic services - is offered., Results of the measures taken to review the programme show an improvement in knowledge, mental health and self awareness., Abstract A psycho-education programme is provided for patients suffering from psychosis in Scotland's only high secure hospital. An 18-month pilot study was carried out with consecutive case sample (treatment group) and 'treatment as usual' comparison group (control group). Pre, post and 6-month follow-up assessments were carried out. A range of outcome measures were used, including two measures of knowledge: a self-report assessment tool - Forensic Assessment of Knowledge Tool and the Understanding Medication Questionnaire. Other measures were used to establish level of insight, Schedule for the Assessment of Insight and assess mental state [Positive and Negative Syndrome Scale (PANSS)]. Results from ( n= 48) participants indicate no statistical difference between the treatment and control group scores on any assessment prior to commencement of the intervention, indicating a well-matched sample group. However, all four assessments showed statistically significant changes post group. Treatment group showed an ability to improve knowledge and retain information about psychosis, which may account for their improved mental state and level of insight. Despite methodological limitations and a small sample group, this project has given an early indication of the positive value of this psycho-education programme in a forensic setting. [ABSTRACT FROM AUTHOR]

Accessible summary There is currently no standard provision of care for younger people with dementia and their families in the UK and there is little involvement of families in care provision and care planning., Specialist services for young-onset dementia are consistently recommended in published and grey literature but continue to be overlooked in UK healthcare policy and service development., Staff experience difficulty working with family relationships because they are complex and family members often have different views and opinions about the best approach to care., Recommendations are made for the implementation of family-centred working in dementia care to increase the effectiveness of care for families living with a diagnosis of young-onset dementia., Abstract There is no standard model of specialist care for younger people with dementia (onset before the age of 65 years) and specialist service provision varies widely throughout the UK. In order to gain a clearer picture about ways in which clinical staff work with younger people with dementia, semi-structured interviews were conducted with dementia care staff working in the north-west of England. Interviews focused on exploring daily working practices and the meaning placed on clinical decision making when involving family/carers in routine practice. Content analysis generated three core themes: (1) Maintaining Separation: how clinical staff conceptualize the meaning of 'family' in the provision of dementia care services; (2) Providing Practical Help: the focus in care provision on assisting families with aspects of daily life such as finances, education and physical care; and (3) Acknowledging the Family Context: how staff understand and interact with family members in an attempt to initiate care, utilizing biographically informed practice. By understanding how staff view their role in providing younger people with dementia with effective, high-quality dementia care, it is anticipated that a more family-centred approach can be integrated into already established patterns of working that more holistically meet the needs of this group. [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

The treatment and risk management programmes in a women's medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research. [ABSTRACT FROM AUTHOR]

Accessible summary • Fear of violence from patients may affect the quality of care mental health nurses provide. • The Brøset Violence Checklist (BVC), a six-item instrument, has the potential to assist health-care providers in identifying patients who may become aggressive. • A trial of the BVC on a secure psychiatric intensive care unit suggested that the tool was well accepted by staff and may have contributed to reduced seclusion rates. • Five-year follow-up has revealed an incorporation of the BVC into routine practice on the psychiatric intensive care unit. Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented. [ABSTRACT FROM AUTHOR]