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

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

Accessible summary: What is known on the subject: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases compared to the general population. Diabetes and cardiovascular diseases are preventable by improved lifestyle regarding smoking, alcohol consumption, physical activity and dietary behaviours.Forensic mental health service users are treated for longer periods of time compared to non‐forensic mental health service users, giving the opportunity to affect the lifestyle for a substantial period of time. What the paper adds to existing knowledge: This review gathers existing research on forensic mental health service users' lifestyle regarding smoking, alcohol consumption, physical activity, and dietary behaviours and factors influencing it. The lifestyle was found to be unfavourable with many patients being smokers, having problematic alcohol consumption, being physically inactive and eating a diet of poor nutritional value and rich in calories. Therefore, it seems likely that an unfavourable lifestyle is one reason for the excess mortality from diabetes and cardiovascular diseases.Smoking cessation and improving dietary habits was perceived difficult, but nicotine replacement and practical advice was suggested to support a change. What are the implications for practice: The treatment period gives an opportunity to improve the lifestyle of forensic mental health service users to prevent diabetes and cardiovascular diseases in this high‐risk group.We recommend a holistic approach, when planning the prevention activities, since activities that are perceived fun are more likely to succeed. Introduction: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases, both of which can be prevented by lifestyle. Aim: To review existing research, in order to investigate the characteristics of, and factors that influence forensic mental health service users' (FMU) health behaviours. Method: We searched PubMed, CINAHL, PsycInfo and Scopus for primary research on FMU's health behaviours regarding smoking, alcohol consumption, physical activity and dietary behaviours, and factors that influence them. Results: We found 13 eligible studies. The findings consistently indicated the presence of unfavourable health behaviours in FMU: Smoking, problematic alcohol consumption, physical inactivity and a high‐calorie diet of poor nutritional value. Changing smoking and dietary habits was perceived as difficult, but nicotine replacement and practical advice were suggested to support change. Discussion: The existing research on FMU's health behaviours is sparse. In particular, there is a lack of research on factors that influence health behaviours. From our findings, it seems likely that FMU's unfavourable health behaviours contribute to their increased risk of dying from diabetes and cardiovascular diseases. Implications for practice: FMU's health behaviours should be improved to prevent diabetes and cardiovascular diseases in this high‐risk group. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented studies show that the quality of the professional relationship plays an essential role in the recovery from mental illness. Within mental health care in general, previous studies show that helpful professional relationships are characterized by several reciprocal aspects, such as friendship resemblance and self‐disclosure.The literature is scarce on in‐depth explorations of professional relationships within the often long‐lasting and intimate help context of institutional supportive housing. Explorations of staff members' experiences are absent. The scientific rationale of this study was to expand the current knowledge about professional relationships in mental health care by exploring staff members' descriptions of helpful professional relationships in supportive housing institutions. What this paper adds to existing knowledge: The study shows that helpful relationships may involve staff experiences of reciprocity in terms of both a two‐way influence between staff and residents and a reciprocal gain from being part of the helpful relationships.A conceptualization of reciprocity that complements existing concepts is suggested and connected to a "good match" between staff and residents. What are the implications for practice?: When support and care are intended to be provided within a dyadic relationship, both parties' preferences should be considered when pairing service users and professionals.Practitioners should get involved in ways that open up for being influenced and inspired by the service user's characteristics, such as personality and attitude. Furthermore, they should dare to enjoy and make use of the company of the service user in ways that promote multifaceted reciprocity. Introduction: In the aftermath of the deinstitutionalization in western countries, new community‐based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community‐based institutional supportive housing. Aim: To explore how staff members describe their relationships with residents who have identified them as helpful. Methods: Qualitative interviews with nine staff members were analysed using thematic analysis. Results: "Reciprocity" was identified as the main theme, and two subthemes were developed: "Something influential about the resident" and "Value for the staff member." Discussion: The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested. Implications for practice: To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: A relevant number of restraint prevention programmes have been developed internationally.In Spain, there is no harmonized policy to prevent the use of restraint.More studies are necessary to establish which programmes and components are necessary to prevent restraint. What does the paper add to existing knowledge?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention.There was no significant decreasing trend in the number of mechanical restraint episodes. What are the implications for practice?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context.All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. Introduction: Mechanical restraint (MR) is used in many countries, including Spain, where non‐harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim: To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method: Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results: There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (−1.79%, p <.001), but not in the number of restraint episodes (−0.45%; p =.149). Discussion: The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice: Interventions at a regional level aimed at preventing MR are feasible in the Spanish context. [ABSTRACT FROM AUTHOR]

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

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

Accessible summary This paper compares two post-modern methodological approaches, post-structuralist and narrative, and considers their usefulness in relation to emancipatory research in mental health., The paper finds that post-structural analyses can be useful in deconstructing oppressive practices and in indicating emerging forms of resistance., Narrative approaches potentially offer greater emancipatory scope than post-structuralism as they enable people with mental health problems to restore their lives and enact their own subjective transformation., However, narrative templates may perpetuate injustice if they erase the complexity of people's stories. This raises ethical issues in relation to narrative interpretation., Abstract Concerns with social justice have been traditionally associated with a modernist concept of the individual whose actions express an underlying, essential and unified self. This paper compares the usefulness of two methodologies (post-structuralist and narrative) that are based on a rejection of identity of a unified self and compares their usefulness in relation to the development of a social justice paradigm within mental health. It considers how professional forms of knowledge may be deconstructed by post-structural analyses, arguing that these have also been used by service users to articulate more enabling discursive alternatives. The notion of agency is central to our understanding of social justice. We question the commonly held assumption that although post-structuralism deconstructs power and challenges its legitimacy, it is nevertheless unsuited to facilitating the necessary agency to put forward viable alternatives. The second half of the paper considers how narrative research offers greater emancipatory potential by enabling the research subject to author their stories and thereby brings about their own subjective transformation. Nevertheless, the interpretation of people's stories by researchers may result in the imposition of narrative templates that erase complexities and contribute to the perpetuation of oppression. This raises ethical implications in relation to how people's stories are interpreted. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS).Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. What does the paper add to existing knowledge?: Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge.This study found that with "timely support" and "family presence," people who had received the services of ICMHS continued to engage in more social activities ("expanding social networks"), had "better family relationships," were "letting go" of thinking too much and more able to relax, and had "better self‐efficacy and self‐caring" in the community.Professional contact after ICMHS through continuous conversations (e.g. home visits and follow‐up calls) and social activities are essential for both clients and their families to carry on living with the illness.Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. What are the implications for practice?: Although the ICMHS' resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients.Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost‐effectiveness of services and relapse rates over time should also be evaluated for future practice development.Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. Introduction: More comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. Aim: To explore the community life experiences of people after their discharge from the ICMHS. Method: A qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi‐structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. Results: Six themes emerged from the analysis: "timely support," "family presence," "better family relationships," "expanding social networks," "letting go" and "better self‐efficacy and self‐care," under the main theme of "walking with the illness and life." Discussion: Over and after the ICHMS, with timely support and family presence, there was a positive trend in the experiences of clients in expanding social networks, having better family relationships, letting go of thinking too much and being more able to relax, and improving self‐efficacy and self‐caring. Implications for practice: The study provides a more comprehensive understanding of the experiences of clients, family and staff about the community life of people post‐ICMHS, providing insights and clearer directions for research and practice development. [ABSTRACT FROM AUTHOR]

What is known on the subject: Healthcare assistants are untrained and unregistered frontline staff but are expected to be proactive in preventing and responding to 'untoward' incidents quickly and efficiently when working within adult acute inpatient psychiatric settings.Healthcare assistants should be trained to provide enhanced care to service users residing in acute psychiatric settings. To date, a training programme in Psychological First Aid has not been expended in such a setting with nonregistered staff. What the paper adds to existing knowledge: The study demonstrates that training healthcare assistants in Psychological First Aid is useful in improving their confidence in caring for service users, therapeutic engagement with service users and ward culture in general. What are the implications for practice: A training programme in Psychological First Aid for healthcare assistants to enhance ward culture can be implemented in different practice environments.Psychological First Aid is harmonious with nursing values and provides healthcare assistants with a relevant, useful and easily understood toolkit to apply in acute psychiatric settings. Introduction: Healthcare assistants working within adult acute inpatient psychiatric settings are untrained and unregistered, however, they can contribute to quality service if they receive some training. Psychological First Aid training has never been expended in these settings, so this study intends to fill this gap in the existing evidence with this category of healthcare personnel. Aim: The aim of this study was to introduce and evaluate first aid training for healthcare assistants. Method: A pre/post design was adopted to gather data using questionnaires and interviews. The groups of participants included 16 healthcare assistants trained in Psychological First Aid, a sample of service users and four ward managers. Results: Post‐training, (a) healthcare assistants and service users ranked the therapeutic milieu of the ward more favourably, (b) the self‐efficacy of the healthcare assistants increased, and the number of 'untoward' incidents decreased, and (c) health care assistants' confidence in their skills was high. The ward manager interviews post‐training revealed four themes: (a) staff utilization of new skills and renewed enthusiasm, (b) calmer atmosphere on the ward and staff togetherness, (c) confidence and reflection on practice and (d) therapeutic engagement. Discussion: Training healthcare assistants is useful in improving staff confidence, therapeutic engagement with service users and ward culture in general. Implications for practice: Techniques and skills learnt are relevant and useful to healthcare assistants and provide an easily understood toolkit that is harmonious with nursing values. If executed correctly, the training can enhance practice and care outcomes and the overall service user experience. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences.AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities.However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice.Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process.More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation.The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Introduction: Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim: To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method: We cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results: Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. Discussion: Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice: The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented. [ABSTRACT FROM AUTHOR]

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

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

Accessible Summary: What is known on the subject?: The experience of hearing distressing voices is commonly reported by service users with a diagnosis of first‐episode psychosis, but their access to formal conversations about voices in the form of psychological therapies can be limited.Service users within Early Intervention in Psychosis (EIP) services can benefit from informal opportunities to talk about their voice hearing experiences. However, they can be reluctant to engage with these conversations.Little is known about the experiences of EIP practitioners as they try to engage service users in conversations about their voices. What does the paper add to existing knowledge?: Despite EIP Services specializing in the treatment of the symptoms of psychosis such as voice hearing, practitioners can still be reluctant to initiate and continue informal conversations about voices. What are the implications for practice?: EIP practitioners may benefit from the introduction of interview guides and brief interventions to assist them with the initiation and continuation of conversations about voices. Introduction: Hearing voices is a common and distressing symptom of first‐episode psychosis. Formal and informal conversations about voices are helpful, but service users within Early Intervention in Psychosis (EIP) Services can be reluctant to discuss their voice hearing experiences. There is currently no literature that explores the experiences of EIP practitioners as they try to facilitate conversations about distressing voices. Aim/Question: A qualitative methodology was used to investigate how EIP practitioners work with service users who hear voices. Ten practitioners were interviewed, and interviews were analysed using template analysis. Results: Two themes that offer novel insights are presented: "starting a conversation about voices" and "continuing the conversation about voices." Discussion: Starting and continuing a conversation about voices was considered important but not all practitioners were confident in this respect. The initiation and continuation of these conversations may need to be systematically supported. Implications for practice: To support the initiation of informal conversations, a standardized interview guide for voice hearing could be introduced and systematically utilized. The continuation of these conversations could be supported by practitioners being given the opportunity to receive training in and the opportunity to deliver brief symptom‐specific therapies for distressing voices. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Families act not only as the primary support for people with a diagnosis of schizophrenia but also as partners in the healthcare system.Families who have members with mental disorders, particularly schizophrenia, experience challenges in family functioning.Research on families in relation to schizophrenia primarily focuses on the determinants that affect family functioning from primary family caregivers' perspectives. What does the paper add to existing knowledge?: This report provides evidence that there is a concordance between family functioning and inpatient psychiatric rehabilitation facilities for the patient–caregiver dyad; both care‐receivers and primary family caregivers considered family functioning as poor.Care‐receivers with lower education levels, increased number of previous hospitalizations and poor quality of family‐centred care experienced unhealthy family functioning.Primary family caregivers and care‐receivers with higher education levels, lower suicidality and greater quality of family‐centred care experienced healthier family functioning. What are the implications for practice?: Understanding the degree of family functioning, particularly its concordance and correlates as perceived by patients and primary family caregivers, may serve as a platform for inculcating assessment of family functioning to achieve holistic patient care.Open dialogue in family‐focused care planning is essential to facilitate collaborative partnerships and improve family functioning among people with a diagnosis of schizophrenia and their primary family caregivers.Further research on culturally relevant, evidence‐based family interventions to enhance the functioning of affected families is warranted, especially for families with members in inpatient psychiatric rehabilitation facilities. Introduction: Families provide frontline caregiving support for people with a diagnosis of schizophrenia. However, research primarily addresses correlates of family functioning from primary family caregivers' perspectives. Aim: To examine perceived family functioning, particularly its concordance within patient–caregiver dyads and associated factors in families of people living with schizophrenia. Methods: A cross‐sectional, descriptive correlational design was used. A total of 133 dyads of patients and primary family caregivers from inpatient psychiatric rehabilitation services participated. Descriptive statistics, independent‐sample t test, one‐way ANOVA, Pearson's correlation coefficients, intraclass correlation coefficient and stepwise multiple linear regression analyses were applied. Results: Family functioning was perceived as impaired by patient–caregiver dyads, and there existed a concordance in this regard. Patients' and family caregivers' education levels, patients' suicidality, number of previous hospitalizations and quality of family‐centred care correlated with patients' and primary family caregivers' family functioning. Discussion: Findings highlight the importance of patient‐ and family‐reported family functioning with implications to address individual and collective concerns. Implications for Practice: Evidence‐based family interventions are crucial for assisting vulnerable families in promoting family functioning. Mental health nurses should facilitate collaboration and open dialogue concerning perspectives of patients and families to improve delivery of comprehensive mental health care. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known about shared decision‐making?: There is increasing investigation of shared decision‐making in mental health services.Exploration of shared decision‐making and relevant instrument is scant in China. What this paper adds to existing knowledge?: In this study, the Clinical Decision‐making Involvement and Satisfaction (CDIS) was translated into Chinese and validated with patients and mental health professionals.The Chinese version of the CDIS is a reliable and valid instrument for measuring perception of involvement and satisfaction with treatment decision for schizophrenia What are the implications for practice?: Mental health nurses could use the CDIS patient‐rated and health professional‐rated versions to compare their perceptions of the decision‐making process. Introduction: There is growing interest in shared decision‐making in Chinese mental health services. However, few specific instruments are available to measure decision‐making satisfaction and involvement. Aim: To translate and validate Clinical Decision‐making Involvement and Satisfaction (CDIS) in a Chinese population. Methods: The translation process was completed based on the Brislin translation method. Convenience sampling of 505 participants including 212 people diagnosed with schizophrenia and 293 mental health professionals for psychometric testing (e.g., content and construct validity, and test‐retest reliability). Results: The CDIS Chinese version has good internal consistency and temporal stability. Factor analysis determined two factors including satisfaction and involvement subscales, explaining 60.08% of the total variance. The Cronbach's α was 0.70, and the intraclass correlation coefficient ranged from 0.83 to 0.89. The composite reliability value was 0.85, and the average variance extracted was 0.50. Critical Ratio values ranged from 5.28 to 17.95, and item‐total correlation values ranged from 0.48 to 0.75. Discussion: The CDIS Chinese version is a feasible and reliable instrument. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? Self-harm plays a function, commonly in the form of distress management., There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue., What this paper adds to existing knowledge This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress., It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm., What are the implications for practice? The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around., Abstract Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can lead to a continuation of distress and subsequent potentially harmful attempts to manage distress. Staff described experiencing a struggle for control in preventing self-harm, leading to increasingly harmful methods of self-harm. Alternatively some staff were able to support service-users with distress management. We discuss factors influencing which of these 'paths' service-users followed. Implications Considerations for care planning including understanding self-harm, using individualized care planning and attending to barriers are outlined with the ultimate aim of reducing distress and the impact of prevention of self-harm. [ABSTRACT FROM AUTHOR]

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

Accessible summary What is known on the subject? Existing literature provides insight into the general experience of carers of people with a mental illness. Previous studies have found that carers experience a range of emotions when looking after their relatives with a mental illness. However, experiences of carers as they engage with the healthcare system is largely absent from the literature., What this paper adds to existing knowledge? This paper identified the experiences of carers when their relatives are experiencing a crisis or acutely unwell. Carers found themselves in the middle between mental health services and their relatives., Strategies employed by carers to ensure their relatives receive adequate care were identified from this study. This paper identified how carers needed to become more assertive in order to receive adequate care for their relatives, and this finding has implications for any future carer education., What are the implications for practice? The participants identified the need to work more collaboratively with carers of people with a mental illness as they seek treatment for their relatives in order to achieve better health outcomes for the patients. Improved health service engagement of carers was seen by participants to assist them to better care for their relative., The study also found that there needs to be a clearer definition as to what constitutes mental health crisis and how carers are able to intervene during this period. Services could provide clear information concerning crisis services and in particular triage., Abstract Aim The literature reporting experiences of relatives of people with mental illness regarding their interactions with mental health services identifies many commonalities. However, the actual experience of carers engaging the services and understanding healthcare systems remains a gap in the literature. The aim of this study was to explore the experiences of carers (of people with a severe mental illness) in a major area mental health service in Victoria Australia as they fulfil their caring role while negotiating support for their relative. A carer is defined as a family member or significant other who is the primary individual who provides informal care for a person with severe mental illness and may or may not be in receipt of income supplement for such a role. Specifically this study has a focus on the experience of the carer when negotiating care needs or admission with a mental health service. Method A qualitative descriptive approach was used with five focus groups as a means of data collection. Ethical approval for the study was obtained from both the hospital and universities ethics committees. Results Key themes identified using thematic analysis are presented in the words of the carers and include: 'Juggling' between services; We became assertive and If only they would listen. Often carers were advocating for their relative and needing to negotiate between services (police and crisis assessment teams) to gain any form of assessment or intervention. Carers often spent a great deal of time on the phone to services only to be told that their relative was 'not sick enough' to access care or that no response would occur without another service also being involved. Discussion Our research highlights the importance of working collaboratively with informal carers and acknowledging their valuable contribution to the care of their relatives with a severe mental illness. It is very important that adequate support is given to carers especially during the period when their relatives are experiencing a crisis. An understanding of their experiences ensures a more family focused approach towards care. The study findings should enable the healthcare team to focus attention on the issues which are most pertinent to carers. Nurses are advocates not only for the patient but also for their families. Relevance statement Carers supporting a person who experiences mental illness can often find themselves in difficult and emotionally challenging situations such as at times of crisis and admission to mental health services. The fourth and latest Australian National Mental Health Plan (2009-2014) acknowledged these concerns and highlighted the need to recognize the role of carers in promoting well-being and recovery of the relative with a mental illness. The plan acknowledges that families are often best placed to recognize signs of relapse in their family members with a mental illness and discharge planning should include the involvement of family members (Commonwealth of Australia, ). To achieve best care outcomes for consumers, mental health nurses need to recognize the role of the carer and collaborate in care planning. [ABSTRACT FROM AUTHOR]

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

Accessible summary What is known on the subject? The concept of compassion is well documented in the healthcare literature but has received limited attention in mental health nursing., What this paper adds to existing knowledge? Mental health nurses struggle with defining compassion. The study, with its limitations, brings greater clarity to the meaning of compassion for community mental health nurses and NHS organizations., Mental health nurses need time to reflect on their provision of compassionate care., What are the implications for practice? The study has shown that compassion is important for NHS healthcare management, frontline mental health nurses and policy-makers in UK, and there is potential for sharing practice and vision across NHS organisations., Mental health nurses could benefit from training to facilitate their understanding of compassionate practices., Emphasis should be placed on the importance of self-compassion and how this can be nurtured from the secure base of clinical supervision., Abstract Introduction There is increasing emphasis in policy, research and practice in the UK and internationally on the importance of caring in health care. Compassion needs to be at the core of all healthcare professionals' practice. Recently, health care has received negative attention through media and government reports which cite a lack of compassion in care. Rationale The concept of compassion has received limited attention in community mental health nursing. Aim Based on data taken from semi-structured interviews with community mental health nurses, this paper aims to describe interpretations and perspectives of compassion to gain insight and development of its meaning. Method A naturalistic, interpretive approach was taken to the study. Semi-structured interviews with nine mental health nurses were analysed using Burnard's 14-step model of thematic analysis. Findings The research illuminates the complexity of compassion and how its practice impacts on emotional responses and relationships with self, patients, colleagues and the employing organization. Participants identified difficulties engaging with compassionate practice whilst recognizing it as a driving force underpinning provision of care. Implications for practice Mental health nurses need to be supported to work towards a greater understanding of compassionate care for clinical practice and the need for self-compassion. [ABSTRACT FROM AUTHOR]

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

Accessible Summary What is known on the subject? Loneliness in older adults has been identified as an important public health issue in many countries., Widowhood is a time when many older people experience loneliness., What this paper adds to existing knowledge? Little is known about strategies that are effective in mitigating experiences of loneliness and this paper explores this with older people who have been through the process., The narratives of the older people in this study described a trajectory in which loneliness was experienced as both a loss of spouse and a loss of routines that enabled them to maintain connections with others., This trajectory moved onto the establishment of new routines that enabled connections to be developed., What are the implications for practice? Loneliness is strongly associated with depression and anxiety in the elderly and mental health nurses should be encouraged to screen for loneliness when undertaking assessments., Interventions that facilitate the development of meaningful routines could be integrated into mental health nursing care of older people., Abstract Background Loneliness in older people is a public health concern in many Western countries. While not necessarily a symptom of mental disorder, it is often associated with depression and anxiety. Widowhood is a transition period during which many older people experience acute loneliness but over time develops strategies to manage it. Little is known about effective strategies that older people have used to manage the experience. The strategies older people used to manage this was the focus of this paper. Aim The aim was to examine older widows' experiences of loneliness. Design The design of this study was a qualitative narrative analysis with thematic analysis and the participants were 40 older widow/widowers aged between 70 and 97 years. Findings The study found that the participants negotiated the experience of loneliness following widowhood from an acute phase of experiencing an absence and the associated loss of routine connection to the establishment of new routines that provided new connections and a new sense of identity as an individual rather than a couple. Conclusions It is important for mental health nurses to screen for loneliness and be able to facilitate interventions that may alleviate the experience of loneliness. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known on the subject?: In clinical psychiatry and mental health nursing practice, family caregivers are known to provide the bulk of care and play an important role in facilitating recovery outcomes for their loved ones diagnosed with psychosis.Providing services and interventions to family caregivers is as important as to patients in the early stage of psychotic experience for having a beneficial impact on the patients' clinical and social outcomes.Limited qualitative research has focused on family caregivers' subjective views of what they need during the critical period to identify early warning signs and connect their loved ones to professional help as they have no prior experience in caring for persons with psychosis. What this paper adds to existing knowledge?: Using qualitative analysis of family caregiver focus groups, this manuscript provides readers in clinical nursing practice with an understanding of family caregivers' lived experiences of supporting their loved one diagnosed with early psychosis.Understanding family caregivers' caregiving unmet needs in supporting their loved one diagnosed with early psychosis could inform both the technology‐assisted intervention development and nursing practice in improving family‐centred care and facilitate self‐management practice. Implications for mental health nursing: Psychiatry and mental health nursing has long been engaged with the health and well‐being of individuals with psychosis and supporting their families in the development, evaluation and implementation of innovative approaches to patient and family education.Digital technologies designed to deliver tailored intervention for family caregivers are underdeveloped, and the present study identifies a number of potential features that could comprise technology to meet the needs of this population. Introduction: Caregivers play a critical role in detecting and managing psychotic symptoms before young people diagnosed with early psychosis present to care. Little is known about the specific needs of caregivers in navigating pathways to care for their loved one. Aim: The purpose of this study was to understand the needs of family caregivers and their ways of coping on the pathway to care for early psychosis. Method: Twenty family caregivers of individuals diagnosed with early psychosis participated in three focus groups that explored caregiving needs provision for early psychosis. Thematic analysis was conducted. Results: We identified four major themes: education and skill training; raising wider awareness, such as police offers and teachers; adopting technologies for coping; and effective coping strategies. Implications for practice: These findings provide important insights into caregiving needs and the ways for nurses to address those needs and better equip carers to recognize early symptoms, monitor behaviour changes and navigate care to support people with first‐episode psychosis. Nursing researchers can use the information to develop on‐demand and tailored family‐centred intervention in addressing caregivers' needs in education, increasing awareness of early psychosis and fostering effective coping strategies. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known on the subject?: Religion plays important role in recovery from mental illness.Religion can have both positive and negative effects on recovery. What does this paper add to existing knowledge?: It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms.BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery.The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services. What are the implications for practice?: There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey.There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes.Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings. Introduction: Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England. Aim: The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England. Method: Twelve Black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). Results: The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion: The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for practice: The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known on the subject?: People with dementia experience cognitive decline which can affect their ability to communicate with others and consequently getting their needs met.Loneliness and social isolation are associated with depression and anxiety, while difficulties communicating may magnify such difficulties. Enhancing meaningful interactions may support maintenance of valued relationships and positive wellbeing.Although previous research has examined communicative experiences, this has been from the perspectives of professionals or caregivers. Exploring meaningful communication from the perspectives of people with dementia is crucial in supporting relationships and wellbeing. What the paper adds to existing knowledge?: People with dementia can be active participants in research. They are aware of their cognitive impairments as well as social interactions and features constituting meaningful communications.People with dementia recognized carers' attempts to understand and empathize with them; allowing them to feel valued and heard, empowering them to maintain interactions. Alternatively, feeling dismissed, inferior or pressured to provide 'correct' responses deterred them from further conversations. What are the implications for practice?: People with dementia have an awareness of their relationships, communications and preferences. Thus, it is imperative to respect this population and make attempts to understand their communication as they sense this effort even when miscommunications occur.Embrace qualities that facilitate person‐centred care within communications is vital as this can preserve valued relationships, support one's needs and enhance wellbeing. Such features include active listening, empathizing, being physically and mentally present, spending time to know the individual and sharing experiences, thoughts and emotions. Introduction: Social isolation can be problematic for people with dementia; understanding what makes communication meaningful may reduce such risk. Scientific rationale: Previous research has examined caregivers' or professionals' experiences of meaningful communication. Understanding this from the perspectives of people with dementia could enhance their interactions and wellbeing. Aim: Exploring what makes communication meaningful from the perspective of people with dementia. Methods: Nine dyadic interactions between a person with dementia and a family carer were filmed. Individuals with dementia watched the footage and reflected on their communications in semi‐structured interviews. Results: Three superordinate themes emerged. Themes 'sharing moments of emotional connection' and 'empowering one's ability to communicate' related to the experience of feeling connected, understood, valued and heard, allowing further communication. Conversely, 'inhibitors to communication' related feeling disempowered and reduced interactions. Discussion: Even when carers could not understand what people with dementia attempted to communicate, their efforts to interact with them were valued and considered meaningful as they reinforce their sense of connectedness. Implications for practice: Embracing a person‐centred approach by actively attuning to the person and continuously attempting to empathize and understand persons with dementia can help preserve important relationships and allow the person to feel valued and interpersonally connected. [ABSTRACT FROM AUTHOR]

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

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

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

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

Accessible Summary: What is known on the subject?: Health systems in many low‐ to middle‐income countries (LMICs) are heavily underfunded, and staff training opportunities are limited.There is a lack of empirical data on the development and use of sustainable training programmes in aggression management skills in LMICs. What does this paper add to existing knowledge?: After RESPECT, participants showed greater agreement with statements about the role of environmental and relational factors as antecedents of aggression and described favouring the use of non‐physical techniques to manage aggressive behaviour.Attitudes towards management practices of seclusion, medication and restraint remained unchanged after RESPECT training. What are the implications for practice?: Training programmes like RESPECT may be useful to improve attitudes towards causes of aggression and its management in LMIC hospitals. However, further evidence is required to demonstrate whether these results can be sustained over time and whether these attitudinal changes are associated with reduction of workplace violence.Mental health nurses and other mental health professionals can play a key role in establishing hospital‐wide training and sharing skills across geographical boundaries. Introduction: Occupational violence has been demonstrated to impact negatively on the well‐being of nurses and patients. Staff attitudes towards causes and management of patients' aggression influence their practice. Training is likely to influence attitudes towards aggression; however, Uganda's health system lacks adequate resources to provide aggression management training for staff. Aim: To assess the impact of a training programme (RESPECT) on staff attitudes towards causes and management of patient's aggression in a Ugandan hospital. Methods: This study used a mixed‐methods convergent design. A convenience sample of nurses and support staff employed in the psychiatric ward and other services across the hospital (N = 90) completed the Management of Aggression and Violence Attitude Scale (MAVAS) pre‐ and post‐training. The views of a smaller sample (n = 35) were captured via interviews and focus groups and analysed using thematic analysis. Results: Participants reported greater agreement with patients' physical and social environment (external and situational causative models) as factors influencing patient's aggression. Qualitative findings substantiated the results identified in the survey. Attitudes towards seclusion, restraint and medication remained unchanged. Discussion and implications for practice: RESPECT has the potential to change staff attitudes towards aggression in the short term. Further research is needed to investigate long‐term effects and impact on incidents of aggression. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? There is evidence suggesting that exercise may be effective at reducing depression in adults and young people; however, there is no research exploring how adolescents with depression experience exercise interventions., What the paper adds to existing knowledge? This study presents the experiences of 26 adolescents with depression who undertook an innovative preferred intensity exercise programme. Important insights relating to benefits and aspects of the preferred intensity exercise emerged. Specifically, the adolescents experienced feelings of improved mood, achievement and enjoyment, alongside numerous benefits., What are the implications for practice? Given that mental health nurses are in key positions to promote physical exercise for this target group, this paper suggests that when promoting exercise they should consider that preferred intensity exercise may provide a series of valuable mental health benefits without the need for fixed intensity training., Abstract Introduction Despite systematic reviews demonstrating an association between exercise participation and reduced depressive symptoms in young people, there is no qualitative research exploring the experience of depressed adolescents who have engaged in an exercise intervention. Aims To explore the experience of depressed adolescents who had recently engaged in a preferred intensity exercise intervention. Method The participants ( n = 26) were recruited through health and social care services, were all in treatment for depression, and were purposefully sampled for interview following engagement in a preferred intensity exercise intervention, which was being evaluated via a pragmatic randomized controlled trial. A thematic approach was undertaken to analyse and organize the data. Results Numerous beneficial changes were reported by participants alongside specific aspects of the intervention that were valued. Discussion and implications The findings suggest that preferred intensity exercise can lead to feelings of improved mood, enjoyment and achievement, alongside benefits that transcend depressive symptom reduction. Considering mental health nurses are in key positions to promote exercise in this population, the current findings provide vital information for this purpose. [ABSTRACT FROM AUTHOR]

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

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?: Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context.The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable.No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers' knowledge and attitudes is warranted. What does the paper add to existing knowledge?: The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices.This study illuminates the prevailing paternalistic provider–user relationship as the main barrier surrounding AHD management in terms of decision‐making.Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. What are the implications for practice?: Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care.Obtaining up‐to‐date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement.The implementation of AHDs in the Spanish mental health system requires macro‐ and micro‐changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. Introduction: An advance healthcare directive (AHD) is a written document that contains a patient‐in‐care's will and preferences concerning the treatment options available to them, should they lack decision‐making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs. Aim: To explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health. Method: A qualitative study was conducted using semi‐structured interviews that were thematically analysed. Findings: Three main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient‐in‐care AHDs. Discussion: Professionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non‐technical skills through training is required. Such training should include users and families and allow for compliance with United Nations requirements. Implications for practice: Advance healthcare directives offer important information regarding user preferences, although they pose challenges for practices. Acquiring an up‐to‐date perspective on the attitudes of professionals towards AHDs allows organizations to attend to particular aspects that require reinforcement. Wider awareness, staff training and new ways of relating to users are necessary to implement AHDs in Spanish context. Relevance statement: A better understanding of the attitudes of Spanish mental health professionals towards AHDs was achieved. Despite the implementation of AHDs being an important and potentially beneficial initiative, mental health professionals find many pragmatic issues that need addressing before AHDs become a reality in their clinical practice. Wider awareness, staff training, personalized assistance and new ways of relating to users are required to implement AHDs in everyday practice. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is already known about the topic?: Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments.Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. What the paper adds to existing knowledge?: Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety.Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. What are the implications for practice?: Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses.Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not "go the wrong way" and decrease confidence levels. Introduction: Much has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities. Aim: To explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa. Method: Following a qualitative descriptive design, 11 newly qualified nurses in their first 6–18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed. Results: Four themes emerged from the analysis: fear related to the mental healthcare environment; self‐doubt upon meeting the expectations of the inter‐professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals. Discussion: During the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self‐confidence in both managerial and therapeutic realms. Implications for practice: Management of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nursing in the UK and other countries faces an acute workforce crisis.Safe staffing levels are called for, and in some jurisdictions have been legislated for.The evidence base linking staffing levels and patient outcomes is limited.Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this.Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. What does this paper add to existing knowledge?: Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project.Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face‐to‐face contact between nurses and service users.Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it.Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de‐escalation, were also attributed to staffing levels.There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. What are the implications for practice?: Efforts to reduce restrictive practices will be hampered without adequate staffing levels.Restrictive practices may justifyably be framed as an employment relations matter.Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. Introduction: Safe staffing and coercive practices are of pressing concern for mental health services. These are inter‐dependent, and the relationship is under‐researched. Aim: To explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. Methods: Thematic analysis of semi‐structured interviews with staff (n = 130) and service users (n = 32). Results: Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes—"insufficient staff to do the job"; "detriment to staff and service users"; "a paperwork exercise: the burden of non‐clinical tasks"; "false economies"; and, "you can't do these interventions." Discussion: Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff. Implications for practice: Restrictive practices are unlikely to be minimized unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals' distress. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: In the nursing perspective of Roy's adaptation model, to be adapted means to have positive interactions with one's environment.The ability to use effective coping strategies is an essential ingredient of mental health recovery. However, coping difficulties are often a problem for people with a diagnosis of schizophrenia spectrum disorder, especially those who have inadequate social support. What the paper adds to existing knowledge?: "Filters in the coping process" is a grounded theory of coping in people with a diagnosis of schizophrenia spectrum disorder. A filter effect impairs their ability and limits their opportunities to use effective coping strategies.These filters are as follows: to have been helped, to understand in one's own way, to act despite limited freedom and to modulate the process of self‐disclosure. "Surface coping" is the product of the effect of these filters on coping attempts and possibilities. It does not reflect the person's real potential. What are the implications for practice?: By offering an alternative, holistic nursing perspective, the filter model provides the nurse with factors to consider when assessing clients with a diagnosis of schizophrenia spectrum disorder, so as to plan interventions towards improving their coping capacity.By allowing for the presence of surface coping, the nurse will have less tendency to form negative judgments about clients with a diagnosis of schizophrenia spectrum disorder. Introduction: Numerous studies confirm the coping difficulties of people diagnosed with schizophrenia spectrum disorder, especially those with limited social support. Further, the coping process is itself poorly understood. Aim: Starting from a conceptualization of the adaptation of Roy's model, the aim of this study was to describe the coping process of people with schizophrenia spectrum disorder in the context of an inadequate social support. Method: A constructivist grounded theorization was performed with a sample of 30 persons with schizophrenia spectrum disorder. Results: The results are a model named: "Filters in the coping process of people with a diagnosis of schizophrenia spectrum disorder who have inadequate social support." The type of coping strategies used evolves over time and in accordance with the filters. The consequence of the process is "surface coping." Discussion: The coping potential of people with schizophrenia spectrum disorder is affected by environmental factors as well as factors inherent to the disorder itself. The filter model provides a holistic perspective, as opposed to merely focusing on behaviours. Implication for practice: The findings of this study could improve nursing interventions through a better understanding of impediments to coping: what they are, how they arise and the nature of their effects. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mindful yoga combines yoga techniques with the mindfulness‐based stress reduction approach.Previous studies on mindful yoga have reported improvements in depression for working‐age adults, but no studies have been conducted with older people. What the paper adds to existing knowledge?: Mindful yoga may be a safe and acceptable intervention to improve the mental and physical health of older adults with depression.The beneficial therapeutic ingredients of mindful yoga, included calmness, being non‐judgmental, letting go and seizing the day. What are the implications for practice?: Single‐sex mindful yoga groups may be more acceptable for some people.Well‐conducted feasibility studies comparing mindful yoga with an alternative group‐based approach are necessary. Introduction: Mindful yoga combines yoga techniques with the mindfulness‐based stress reduction approach. Previous studies on mindful yoga have reported improvements in depression for working‐age adults, but no studies have been conducted with older people. Aims: To explore the experiences of older adults with depression participating in a mindful yoga group to establish whether the approach has potential as a future intervention for this client group. Method: This study adopted a qualitative descriptive method and used inductive content analysis. Eighteen in‐depth individual interviews were conducted with nine participants (each participant had one interview following the programme and another four weeks later). Results: Six main themes emerged: "improved physical status," "actively involved in the community," "positive psychological effects," "perceived therapeutic ingredients," "facilitators of practising mindful yoga" and "barriers to practising mindful yoga.". Discussion: Most participants reported benefitting from the programme. Two male participants expressed that exercises were too challenging and more suited to women, suggesting single‐sex groups may be more acceptable. Implications for practice: Mindful yoga may be an acceptable/useful intervention for older adults with depression, but future studies are required to establish its feasibility and potential efficacy. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known on the subject?: Individuals with eating disorders (EDs) experience hopelessness, suicidal thoughts and behaviours at elevated rates compared to the general population.Current knowledge of recovery from EDs does not address nurse engendered hope.This study aimed to explore differences between patients' and nurses' perceptions of hope‐engendering nurse actions and the relationship actions have with patients' perception of hope. What the paper adds to existing knowledge?: This is the first study to explore differences between patients' and nurses' perceptions of hope‐engendering nurse actions in an inpatient ED facility and find significant differences; nurses' scores were higher than patients' scores.The study explored the relationship perceived self‐reported nurse hope‐engendering actions have with patients' and nurses' perception of hope. There were no significant relationships.This study provides additional evidence to support that there are common patient needs for nurse hope‐engendering practices such as caring and providing for patients; supporting and encouraging patients' connection to others; facilitating patients' adaptive belief systems; and helping to set goals and attain resources for patients. What are the implications for mental health nursing practice?: Nurses who work with patients who have EDs should be prepared to work with patients who are feeling hopeless about their future. Thus, nursing continuing education should focus on strategies that enable nurses to deliver care that reduces hopelessness, improves connection, and inspires hope in those who are recovering from EDs.The results revealed that nurses perceived that they offered patients with EDs hope‐engendering actions more often and effectively than patients believed; this finding pinpoints a future direction for research that may improve care for patients.Patient feedback identified ways nurses may improve care to engender hope: providing an open caring environment, nurse presence, comfort/pain relief, and involving patients in their care. Actions by nurses aimed to enhance interpersonal connection and nurse presence could facilitate hope in patients with ED. Introduction: Individuals with eating disorders (EDs) experience suicidal thoughts and behaviours at elevated rates compared to the general population. Hope‐engendering nursing actions may increase patients' levels of hope for the future, improve coping self‐efficacy, and possibly reduce suicidality. Although nursing staff are integral ED treatment team members, little is known about nursing actions targeting hopefulness. Aim: Explore differences between patients' and nurses' perceptions of hope‐engendering nurse actions and the relationship actions have with patients' perception of hope. Methods: Descriptive, cross‐sectional, comparative, correlational research design was used. Responses for 97 ED patients and 10 nurses were entered into analysis. Hope‐engendering nurse intervention and hope questionnaires were administered and analysed. Results: Nurses' total hope‐engendering nurse intervention and hope scores were higher than patients' scores. Discussion: Patients reported that the most effective nursing actions were providing an open caring environment, comfort/pain relief, and involving patients in their care and treatment. Nurses perceived that they offered patients hope‐engendering actions more often and effectively than the patients believed. Implications for Practice: Findings indicate that patients with EDs have low levels of hope. Nursing educators should further develop strategies that enable nurses to deliver care that inspires hope and improves connectedness in those who have EDs. [ABSTRACT FROM AUTHOR]

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

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

Accessible summary: What is known on the subject?: One‐to‐one observation uses continuous staff observation to safeguard patients judged likely to harm themselves or others.Policies increasingly mandate that staff engage therapeutically with patients during one‐to‐one observation. Yet not enough is known about factors facilitating or impeding such therapeutic engagement. What does this paper add to existing knowledge?: This study enriches existing literature on one‐to‐one observation through integrating the perspectives of staff of different levels of qualification, and patients of different diagnostic and risk profiles.Whilst previous research has highlighted the occurrence of counter‐therapeutic staff‐patient interactions, integration of patient and staff perspectives in the current study has demonstrated that patient and staff often attribute the causes differently, with each apportioning blame to the other, leading both parties to feel misunderstood, and staff lack confidence to overcome these challenges.A novel finding was that rapport‐building via simple demonstrations of compassion and conversations about everyday things, was viewed as an essential prerequisite to encouraging patients to open up about their experiences of emotional distress, whilst implementation of techniques drawn from psychological interventions was viewed as less important than staff's core relational skills. What are the implications for practice?: Therapeutic engagement during observation can enhance its risk management aims, providing thought is given to understanding and negotiating complex dynamics between staff and patients. Supervision for staff conducting observations should focus on building rapport in preference to emphasizing psychological intervention (e.g. DBT), and should enable staff to reflect on better understanding and managing their own emotions towards "hard‐to‐engage" patients. Introduction: Policies increasingly focus on staff‐patient interactions during one‐to‐one psychiatric nursing observations as an opportunity for therapeutic engagement – yet if and how this is feasible is unknown. Aim: This study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one‐to‐one observation. Method: Thematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles. Results: Negative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and 'normalizing' conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their experiences and work with them to find solutions. Implications for practice: Engagement during observation could be facilitated if staff receive more supervision in understanding difficult dynamics that impede rapport‐building and in managing their emotions towards patients they experience as "hard‐to‐engage". [ABSTRACT FROM AUTHOR]

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