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Accessible Summary: What is known on the subject?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt.Definitions of recovery from high‐income and English‐speaking countries should be carefully adapted to other settings.Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. What the paper adds to existing knowledge?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low‐middle‐income country were clear in the findings of this paper.There are differences in the definition of family and service user engagement in the current study and in high‐income countries.Seeking faith healers as a barrier to mental health recovery is culturally unique.Functional recovery prevails as a model in Egypt as there is limited service user involvement.Nursing values and code of ethics are consistent with enablers of mental health recovery. What are the implications for practice?: Changing the pre‐registration nursing education to prepare specialized graduates in mental health nursing.Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. Introduction: Recovery‐oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim: To explore perspectives of Egyptian mental health professionals on recovery. Method: Semi‐structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results: The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self‐awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion: The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice: There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues. [ABSTRACT FROM AUTHOR]

Introduction: The challenging work environments mental health nurses (MHNs) encounter can negatively impact their mental health, psychological well‐being and physical health. While these impacts have been investigated in quantitative research, little is known about work‐related stress from the perspective of MHNs. Aim: To explore the stresses faced by nurses working in mental health settings and to gain an understanding of the underlying workplace context. Method: A descriptive qualitative study with data collected via semi‐structured individual telephone interviews conducted with n = 21 Western Australian MHNs. Data were analysed using reflexive thematic analysis. Results: A total of 85 codes were generated that led to the identification of 13 subthemes and 4 main themes: (1) mental health nursing context, (2) work environment stressors, (3) factors that alleviate stress and (4) the impact of workplace stress. Discussion: Many of the stressors MHNs were exposed to are modifiable, such as understaffing and poor skill mix. Modifiable stressors increased risk for MHNs, impeded patient care and exacerbated inherent stressors such as patient acuity and complexity. Implications for Practice: This study collected data that provide rich descriptions of the experiences of MHNs and identify modifiable work‐related stressors that could be alleviated through effective leadership and management. [ABSTRACT FROM AUTHOR]

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

Accessible summary?: What is known on the subject: Analysis of co‐production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co‐production as a concept is open to multiple interpretations. Core components of co‐produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. What this paper adds to existing knowledge?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co‐production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co‐trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co‐trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. What are the implications for practice?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues’ mental health needs should be established and refined during co‐produced working. Negotiating personal disclosure and professional role identity must be explored further in both co‐production research and practice. Abstract: Introduction: Co‐production between service users and clinicians is a desirable element of recovery‐oriented practice in mental health, but the effect of co‐production on clinicians has not been explored thoroughly. Aim: To explore the meaning of co‐production for clinicians based on their experience of co‐production in a Recovery College. Method: Thematic analysis of eight semi‐structured interviews with clinicians who have co‐produced and co‐delivered workshops with a Recovery College Peer Trainer. Results: The “meaning of co‐production” had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians’ experience of co‐production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion: Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co‐produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice: Engaging in co‐produced educational workshops can alter clinicians’ perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges. [ABSTRACT FROM AUTHOR]

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

Accessible summary: What is known on the subject?: User involvement, when people who have accessed services become actively involved in aspects of mental health care, can sometimes be “tokenistic” and not well thought through. Users are often involved in their own care, and asked for feedback, but are less likely to be meaningfully involved in developing services and training staff. What this paper adds to existing knowledge?: To implement meaningful involvement, it is important to know why some users choose to devote time to such activities. User representatives in this study, involved in a UK mental health service, wanted to help people in a similar position and give something back to those that helped them. As people started involvement activities, such as interviewing staff, they gained confidence and felt part of something that was making a difference. After being supported by staff to explore opportunities, representatives become more independent and some moved to different, sometimes salaried, roles. Some representatives did not feel valued or supported. Staff often controlled opportunities, and many users missed out on being involved. What are the implications for practice?: Staff need to understand and receive training on involvement. The definition of involvement should be agreed by users and staff together, and outcomes of involvement activities must be fed‐back to users on a regular basis. There should be dedicated involvement workers in services, to support individuals and integrate involvement into the system. It is important to consider how to make involvement accessible to more mental health service users. Abstract: Introduction: Despite guidance promoting user involvement, meaningful involvement continues to be debated within services. To effectively implement involvement, it is important to acknowledge why users devote time to such activities. Aim: This study explores user representatives' experiences of involvement, including motivations and personal benefits. Method: Thirteen user representatives involved in activities such as staff training and interviews were recruited from a UK National Health Service mental health Trust during 2015. Themes within semi‐structured interviews were developed using constructivist grounded theory analysis. Memo‐writing, process and focused coding, and core categories supported development of the conceptual framework of being a user representative. Findings: Being a user representative was inextricably linked to wellness, yet staff governed opportunities. Making a difference to others and giving back were initial motivating factors. Experiences depended on feeling valued, and the theme of transition captured shifts in identity. Discussion: User representatives reported increased confidence and well‐being when supported by staff. However, involvement triggered mental health difficulties and identified the need for regular monitoring and reflection of involvement activities and practice. Implications for practice: Services should consider coproduction, where users and staff agree together on involvement definitions. Dedicated involvement workers are crucial to supporting individual well‐being and monitoring involvement. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: People with dementia can experience symptoms that upset them and upset the people who care for them To cope, care homes sometimes use strong medicines called antipsychotics but these can make people with dementia become more ill We do not know just why doctors and nurses caring for people with dementia still use these strong medicines more than they need to What the paper adds to existing knowledge: Giving antipsychotics can make it easier to care for residents within busy care homes, so people tend to see and remember the benefits of antipsychotics The harm of antipsychotics is noticed less, meaning carers will use them again, in a “vicious circle” What are the implications for practice: If these medicines worked before it does not make them the right choice again It might help to show carers very clearly the harms from using these medicines, to stress the dangers Abstract: Introduction: Treating the behavioural and psychological symptoms of dementia with antipsychotics can cause detrimental side‐effects but their use in care homes remains problematic with the views of professionals not fully explored. Aim/question: To develop an in‐depth explanatory model about inappropriate prescribing of antipsychotics in dementia within care homes. Methods: Twenty‐eight participants from eight different professional groups with a role in shaping treatment decisions in dementia care were recruited and interviewed. The audio‐recorded interviews were transcribed and analyzed using constructivist grounded theory. Results: When patients with dementia present with behavioural and psychological symptoms, the prescribing of antipsychotics allows the multitude of work in a care home to be managed; the effectiveness of antipsychotics is more perceptible than their side‐effects. This perceived usefulness strengthens beliefs that these medications ought to be prescribed again in future situations, generating a self‐fulfilling prophecy. Discussion: Our findings may partly explain why the launch of the national dementia strategy in England has been found not to have reduced antipsychotic prescribing in care homes. Implications for practice: Positive perceptions based on past experiences with antipsychotics should be challenged through future interventions that tackle inappropriate prescribing, for example using behaviour change techniques to better highlight adverse consequences of prescribing. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Individuals with mental illness have significantly higher mortality and morbidity than the general population due to physical illnesses. Mental health nurses play a key role in providing care for common physical problems and protecting and promoting healthy lifestyles. Little is known from previous studies in the international literature about the attitudes, behaviours and thoughts of mental health nurses on providing physical health care. What this paper adds to the existing knowledge: Mental health nurses mostly focus on the existing physical health problems of individuals with mental illness. However, mental health nurses do not include practices of disease prevention and physical health promotion for individuals with mental illness. The desire to see positive changes in individuals with mental illness, receiving positive feedback, feeling useful and happy, and feeling satisfied with their profession motivate mental health nurses in terms of providing physical health care. What are the implications for practice: The knowledge and skill required of mental health nurses to provide physical health care need to be increased. Institutions should employ expert nurses who are able to guide mental health nurses to provide physical health care. It is important to provide adequate physical infrastructure and human resources to provide better physical health care in mental health services. Abstract: Background: Mental health nurses play an important role in improving the physical health of individuals with mental illnesses. However, there are limited studies of their attitudes and practices about physical health. Therefore, there is a need for qualitative studies to clarify the issue. Aim: The aim of this study was to determine mental health nurses’ opinions about physical health care for individuals with mental illness. Methods: This study was carried out in Turkey. A qualitative descriptive approach was taken in the study. The sample consisted of twelve mental health nurses selected by purposeful sampling. In‐depth interviews were conducted using a semi‐structured interview format. A thematic analysis was used to evaluate the interviews. Results: Four main themes were determined. (1) The barriers to physical healthcare theme included barriers related to patients, illness and treatment, barriers related to patients’ caregivers, barriers related to health professionals and barriers related to the healthcare system. (2) The physical healthcare practices theme included common physical health problems and current nursing practices. (3) Motivators theme included the desire to see positive changes in a patient, receiving positive feedback, feeling useful and happy, having a sense of conscience and feeling satisfied with their profession. (4) The needs for better physical healthcare theme included the nurses’ recommendations for better physical health care. Conclusion: Mental health nurses believe that the physical health care provided to individuals with mental illness is not adequate. Many barriers to providing care for physical health, such as having psychiatric symptoms that are not seen as a priority by patients and health personnel, were determined. Implications for practice: Mental health nurses should integrate physical healthcare practices into their routine care. In addition, mental health nurses’ knowledge and skills about physical health care should be improved. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the topic?: Bipolar disorder is a long‐term condition which causes ongoing disruptions to the individual's life. Current evidence suggests that a combination of medication in combination with psychotherapy is more effective than medication alone. What the paper adds to existing knowledge?: There are few published reports of the effects of interventions (pharmacological or psychotherapeutic) for treatment in bipolar disorder. While both psychotherapies provided a framework for understanding bipolar disorder each had specific strategies that participants identified as effective. What are the implications for practice?: Because bipolar disorder is a long‐term condition, its treatment needs to incorporate psychotherapeutic approaches that address the unique nature of its impact on each individual and provide individualized strategies for managing the disorder. Both Interpersonal and Social Rhythm Therapy and Specialist Supportive Care provide strategies that promote personal recovery. Abstract: Introduction: The primary outcomes from this study of psychotherapy for young people with bipolar disorder identified that most participants had continued to remain well. Given that up to 80% of people relapse within 2 years, it was important to establish how these participants described the process of staying well. Aim: To examine how participants in a psychotherapy for young people with bipolar disorder study at 5‐year follow‐up described their experiences of the intervention and its impact on living with the disorder. Methods: This qualitative study was conducted 5 years after participants had completed a psychotherapy intervention in a randomized controlled trial for young people with bipolar disorder. Thirty people were recruited into this qualitative study and interviewed regarding their experiences. The data were analysed using an inductive thematic analysis. Findings: Three themes were identified from the data: self‐awareness in the context of bipolar disorder; understanding my bipolar disorder; and learning to stay well with bipolar disorder. Conclusions: Mental health nurses can promote the factors that participants found helpful in learning to stay well self‐awareness, understanding the unique characteristics of their disorder, learning to take care of the self and stabilization of social rhythms. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many nursing students have inadequate preparation for practice in mental health nursing in the United States and China. The concept of mental illness has different connotations in different cultures. Studies differ from country to country concerning the influence of nursing education on students’ knowledge about and attitudes towards mental disorders. There is a lack of cross‐cultural research that takes a broad perspective to explore how nursing students’ knowledge and beliefs about mental disorders are influenced by the culture within education and healthcare systems. What this paper adds to existing knowledge?: Nursing students in the United States and China shared similar views on a broad range of intervention options including professional help, psychotropic medications and activity interventions for managing depression and schizophrenia. The major difference between the two nursing student groups was that the Chinese students showed more preference to occasional alcohol consumption and specialized therapies including cognitive‐behavioural therapy and electroconvulsive therapy and the US students held less skepticism towards traditional and religious practices as possible treatment options for depression and schizophrenia. What are the implications for practice?: The Chinese nursing students need to be educated about safe alcohol consumption guidelines adopted by the National Health and Family Planning Commission. The US nursing students need to increase their awareness of national practice guidelines for managing mental disorders, particularly with respect to the use of specialized therapies such as cognitive‐behavioural therapy and electroconvulsive therapy. We support professional and psychosocial interventions in caring for patients with mental disorders. Abstract: INTRODUCTION: Nursing students in the United States and China have reported inadequate preparedness for practice in mental health nursing. It is important to investigate nursing students’ mental health literacy levels for a better understanding of their practice readiness in mental health field upon completion of their education. Aim: This study was aimed at developing an understanding of American and Chinese nursing students’ mental health literacy regarding the effectiveness of specific interventions for managing depression and schizophrenia. Method: The “Australian National Mental Health Literacy Survey” was completed by a group of 310 nursing students including 152 Americans and 158 Chinese between April 2016 and April 2017 to compare students’ rated intervention options on two provided vignettes. Results: The two student groups reached consensus on many intervention options. However, the Chinese students showed more preference to occasional alcohol consumption and specialized therapies and the US students held less skepticism towards traditional practices as treatment options for depression and schizophrenia. Discussion and implications for practice: The findings support professional and psychosocial interventions in caring for patients with mental disorders. There is a significant need for specific education on safe alcohol consumption guidelines for Chinese nursing students and clinical practice guidelines for managing mental disorders for American nursing students. [ABSTRACT FROM AUTHOR]

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

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

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

Accessible Summary What is known on the subject? UK health policy is clear that researchers should involve the public throughout the research process., The public, including patients, carers and/or local citizens can bring a different and valuable perspective to the research process and improve the quality of research undertaken., Conducting health research is demanding with tight deadlines and scarce resources. This can make involving the public in research very challenging., What this paper adds to existing knowledge? This is the first time the attitudes of researchers working in mental health and learning disability services towards PPI have been investigated., The principles of service user involvement in mental health and learning disability services may support PPI in research as a tool of collaboration and empowerment., This article extends our understanding of the cultural and attitudinal barriers to implementing PPI guidelines in mental health and learning disability services., What are the implications for practice? Researchers in mental health and learning disability services need to champion, share and publish effective involvement work., Structural barriers to PPI work should be addressed locally and successful strategies shared nationally and internationally., Where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win 'hearts and minds' and support the effective integration of PPI across the whole research process., Abstract Introduction Patient and public involvement ( PPI) is integral to UK health research guidance; however, implementation is inconsistent. There is little research into the attitudes of NHS health researchers towards PPI. Aim This study explored the attitude of researchers working in mental health and learning disability services in the UK towards PPI in health research. Method Using a qualitative methodology, semi-structured interviews were conducted with a purposive sample of eight researchers. A framework approach was used in the analysis to generate themes and core concepts. Results Participants valued the perspective PPI could bring to research, but frustration with tokenistic approaches to involvement work was also evident. Some cultural and attitudinal barriers to integrating PPI across the whole research process were identified. Discussion Despite clear guidelines and established service user involvement, challenges still exist in the integration of PPI in mental health and learning disability research in the UK. Implications for practice Guidelines on PPI may not be enough to prompt changes in research practice. Leaders and researchers need to support attitudinal and cultural changes where required, to ensure the full potential of PPI in mental health and learning disability services research is realized. Relevance statement Findings suggest that despite clear guidelines and a history of service user involvement, there are still challenges to the integration of PPI in mental health and learning disability research in the UK. For countries where PPI guidelines are being developed, attention needs to be paid to cultural factors in the research community to win 'hearts and minds' and support the effective integration of PPI across the whole research process. [ABSTRACT FROM AUTHOR]

Accessible summary What Is Known on the Subject? Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care., No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs., What This Paper Adds To Existing Knowledge? This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as 'bridge' between these intensive services and purely outpatient treatment., Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access)., What Are the Implications for Practice? This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings., In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings., Abstract Introduction Despite the benefits of psychiatric day hospitals ( DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care. Method Twenty-five DH staff members completed semi-structured qualitative interviews. Two independent coders applied content analysis to achieve data saturation. Results Four major themes emerged: (1) program purpose and function, (2) what is in a name, (3) perceived patient motivation, and (4) room for improvement. Discussion Findings highlighted the importance of a multidisciplinary team delivering education and skill-focused interventions. Services were cited as 'bridging' different mental health settings. Challenges included barriers to treatment access and inadequate length of treatment. Implications for Practice Understanding the function and purpose of this treatment service may enhance service delivery by enabling programs to integrate identified key ingredients. Providers can also note treatment duration and consider how to best use that time. Finally, language used within a DH setting appears to impact staff delivering services, and may also alter patients' understanding of the services they will receive and purpose of the program. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? Implementation of user participation is described as a change from a paternalistic healthcare system to ideals of democratization where users' voices are heard in relational interplays with health professionals., The ideological shift involves a transition from welfare dependency and professional control towards more active service-user roles with associated rights and responsibilities., A collaborative relationship between users and professionals in mental health services is seen as important by both parties. Nevertheless, the health professionals find it challenging in practice to reorient their roles and to find productive ways to cooperate., What this paper adds to existing knowledge? This study illuminates how user participation is negotiated and involves multiple and shifting subject positions in the collaboration between users and professionals in community mental health care., By taking different positions, the relationship between users and professionals develops through dynamic interaction., This study challenges understandings of equality and implicit 'truths' in user participation by illuminating subtle forms of power and dilemmas that arise in user-professional negotiations., What are the implications for practice? Instead of denying the appearance of power, it is important to question the execution of power in the interplay between users and professionals., Focusing on the negotiation processes between users and professionals is important for increasing reflection on and improving understanding of the dynamic in collaboration and speech., By focusing on negotiations, power can be used in productive ways in user-professional relationships., Abstract Introduction Implementation of user participation is considered important in today's mental health care. Research shows, however, that user participation lacks clarity and provokes uncertainty regarding shifting roles. Aim To investigate negotiation of user participation in a microstudy of interplay between users and health professionals in community mental health care. Method This qualitative study is based on semi-structured in-depth interviews, involving ten service users and ten professionals in community mental health care in Norway. The analysis is inspired by Willig's model for Foucauldian discourse analysis. Results The study illuminates the dynamic nature of user participation that arises through negotiation between users' and professionals' positions as change enablers, dependents, resisters, persuaders and knowledge holders. Discussion Discourses of user participation allow for different subject positions in mental health care. User participation also involves government and questions of power, as well as ambitions of change and control. Professionals act in different ways to make and keep users active, participating, enterprising and self-governing, and users respond and take part within the same discursive framework. Implications for practice Awareness of subjects' positions in discourses is important to increase reflection on the dynamic interplay in user-professional collaboration. [ABSTRACT FROM AUTHOR]

Introduction: Sexual health is essential to the overall health. People suffering from severe mental illness (SMI) experience a deterioration in their sexual health. These patients and their caregivers seem unwilling to engage in a dialogue concerning sexual health within the context of mental health care. Aim: The study investigated nurses' and care assistants' beliefs and attitudes regarding the sexual health of people with SMI on the psychiatric care pathway. Methods: Twenty semi‐structured interviews were conducted with nurses and care assistants. Data were subject to a thematic analysis. Results: Three main themes emerged: (1) The formalization of the care approach towards people with a SMI in hospitals; (2) the place given to sexual health in psychiatry units; (3) nurses and care assistants are not equipped to deal with patients' sexual health. Discussion: Caregivers consider that sexual health is a fundamental right and an indicator of good health. They nevertheless believe that the psychiatric hospital remains a place of acute care where sexual health is not considered. Implication for Practice: This research justifies that it is necessary to question the representations of nurses and care assistants before implementing a tailored intervention that integrates the consideration of sexual health into the holistic care of the patient on the psychiatric care pathway. [ABSTRACT FROM AUTHOR]

Introduction: Previous research has indicated that community‐based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. Aim: This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. Method: An explanatory mixed‐methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi‐structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. Results: The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper‐vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. Discussion: MHNs employ a hyper‐vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. Implications for mental health nursing: According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards. [ABSTRACT FROM AUTHOR]

Accessible summary The pervasive impact of mental illness on identity is generally held as negative. Contemporary Models of involvement within statutory services pay little regard to the identity of individuals beyond the 'service user' label and in doing so unwittingly perpetuate and sustain the negative impact of mental illness., This aim of this paper is to discuss the process of working alongside people who use statutory mental health services as co-researchers. It highlights the perspective of those involved as researchers on both the process and the impact of this type of involvement on them considering a move beyond the illness identity., This three year participatory action research study was facilitated within community mental health services. 6 people, currently using statutory mental health services were recruited as co-researchers. The study required that they undertook a series of interviews with service users in relation to their life stories. The transcripts were mapped and analysed by the researchers using interpretative phenomenological analysis (IPA). In order that the people were enabled to undertake these roles the study included a process of interviewing and appointing service user researchers followed by a programme of training workshops, supervision and discussion group/peer support throughout., The study reveals the importance of key aspects within the process of user involvement emphasizing the potential for transformation: connection, creditable definitions of self and reciprocity. It discusses implications for service user involvement within the statutory mental health service, acknowledging potential for transformation at both an individual and collective level., Abstract Contemporary models of involvement within statutory services pay little regard to the identity of individuals beyond the 'service user' label and in doing so unwittingly perpetuate and sustain the negative impact of mental illness. The aim of this paper is to discuss the process of a 3-year participatory action research study facilitated by a mental health nurse. It highlights the perspective of those involved as co-researchers, all having experience of accessing statutory mental health services. It identifies both the process and the impact of this type of involvement on them illustrating their move beyond an illness identity. The study involved them undertaking a series of interviews with other service users in relation to their life stories. They subsequently mapped and analysed the transcripts. In order that the people were enabled to undertake these roles the study included a process of interviewing and appointing service user researchers followed by a programme of training workshops, supervision and discussion group/peer support. The accounts provided reflect the six researchers' attempts to make sense of their experience and reveal the path of transformation through collaboration. [ABSTRACT FROM AUTHOR]

Accessible summary Although not as historically dominant as it once was, acute admission units remain a place of care for people experiencing an acute mental illness and who cannot be cared for in a community setting., In line with global developments, Irish mental healthcare policy has focused on greater levels of collaboration between service providers and users., In admission unit care enhanced levels of service user involvement happens though nurses involving them in care planning and through interacting with them on a regular basis., Abstract Mental health care in Ireland has been in the midst of a modernization of services since the mid 1980s. Embellished in this change agenda has been the need for better care and services with a particular emphasis on greater levels of user involvement. Acute admission units provide a setting for mental health care to be delivered to people who are unable to be cared for in a community setting. Through discussion of findings from semi-structured telephone interviews with 18 acute admission unit staff nurses, the aim of this paper is to explore the level of involvement service users have in acute unit care in Ireland. Reporting on one qualitative component of a larger mixed method study, findings will show that acute admission unit staff nurses generally involve service users in their care by facilitating their involvement in the nursing process, interacting with them regularly and using different communication approaches. However, participants identified barriers to service user involvement, such as growing administrative duties. It can tentatively be claimed that, within an Irish context, acute admission unit service users are involved in their care and are communicated with in an open and transparent way. [ABSTRACT FROM AUTHOR]

Accessible summary This paper reports on a study that was conducted in an acute psychiatric unit investigating how and what information is communicated at nursing handovers that relates to a patients risk status., Nursing handovers are conducted in an ad hoc manner and may not effectively communicate information required for management of patient risks., A consistent and evidenced-based approach to mental health nursing handovers is required, in order to promote best nursing practice., Abstract Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14-item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported. [ABSTRACT FROM AUTHOR]

Accessible summary The purpose of this study was to describe the role of inclusiveness in lessening the pain of parents death in adolescents orphaned by AIDS., Data were derived from 15 AIDS orphans between the ages of 14 and 18 years., The method used was focus groups with discourse analysis using four themes: grieving patterns, coping strategies, experience with loss and expectations., The participants believed that including them in the illnesses, dying and funeral preparations of their parents would have facilitated their healing., Abstract The purpose of this paper is to raise an argument that inclusiveness will lessen the pain of losing a parent among adolescents orphaned by AIDS and as a result, prevent future mental health problems that may occur because of inappropriate grieving and maladaptive coping strategies. Participation of adolescents orphaned by AIDS in decisions pertaining to their parents' illnesses and funeral arrangements, for example, may shorten the grieving process and allow for closure. The paper draws data from focus group discussions that were held with 15 adolescents orphaned by AIDS in urban South Africa. The focus group discussions that were structured around four themes: grieving patterns; coping strategies; experience with loss; and expectations. The results of the study demonstrate inclusiveness as an overarching factor in the healing process. The concept is thus a strong recommendation for mental health practice and further study. [ABSTRACT FROM AUTHOR]

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

Accessible summary What is known on the subject? 'Expertise by experience' has become an increasingly valued element of service design and delivery by mental health service providers., The extent and influence of mental health professionals' personal experience of mental ill health on clinical practice has seldom been interrogated in depth., What this paper adds to existing knowledge? We investigate how mental health nurses' own personal experience of mental ill health informs their mental health nursing practice with particular reference to direct work with service users., Participants said that personal experience could impact on work in three positive ways: to develop their relationship with service users, to enhance their understanding of service users and as a motivation for potential mental health nurses to join the profession., This study moves the discussion of the state of mental health nurses' mental health further towards the recovery and well-being focus of contemporary mental health care, where 'expertise by experience' is highly valued., What are the implications for practice? We must address the taboo of disclosure within clinical nursing practice and debate the extent to which personal and professional boundaries are negotiated during clinical encounters., Abstract Introduction 'Expertise by experience' is a highly valued element of service delivery in recovery-oriented mental health care, but is unacknowledged within the mental health nursing literature. Aim To explore the extent and influence of mental health professionals' personal experience of mental ill health on clinical practice. Method Twenty-seven mental health nurses with their own personal experience of mental ill health were interviewed about how their personal experience informed their mental health nursing practice, as part of a sequential mixed methods study. Results The influence of personal experience in nursing work was threefold: first, through overt disclosure; second, through the 'use of the self as a tool'; and third, through the formation of professional nursing identity. Discussion Mental health nurses' experience of mental illness was contextualized by other life experiences and by particular therapeutic relationships and clinical settings. In previous empirical studies, nurses have cited personal experience of mental illness as a motivator and an aspect of their identity. In this study, there was also an association between personal experience and enhanced nursing expertise. Implications for practice If drawing on personal experience is commonplace, then we must address the taboo of disclosure and debate the extent to which personal and professional boundaries are negotiated during clinical encounters. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation., However, little is known about consumer and carer desires at the earliest stages of development of new services., What this paper adds to existing knowledge? Consumers and carers desire changes to how mental health services are provided., Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings., Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery., Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness., What are the implications for practice? Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided., Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs., Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery., Abstract Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment and teaching facility in their region. Methods Two 2-hr focus groups were conducted, with separate groups held for mental health consumers ( n = 9) and carers ( n = 9), respectively. Discussions pertained to mental health literacy, gaps in current services, desires for an ideal facility (in terms of physical design and services offered) and what would help in recovery. Results Inductive thematic analysis was used to generate three themes: care outside of consultations, carer involvement in recovery and holistic approaches to mental health care. Consumers desired a facility that could cater to individual needs. Carers felt excluded in recovery and unable to provide effective support. Both groups preferred holistic approaches to mental health, expressing ambivalence towards medication and hospitalization. Discussion Consumers and carers have many needs that conventional practices may not meet. Implications for practice They have clear desires for equal partnership in recovery and for transformation of conventional treatment methods. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? UK NHS policy highlights the importance of user and carer involvement in health professional training., We know little about service user and carer motivations and experiences of accessing training courses for delivering training to health professionals and how well such courses prepare them for delivering training to healthcare professionals., 'Involvement' in training has often been tokenistic and too narrowly focused on preregistration courses., There is limited data on how best to prepare and support potential service user and carer trainers., What does this paper add to existing knowledge? This study adds to the international literature by highlighting service user and carer motivations for accessing a training course for delivering training to health professionals., Service users and carers wanted to gain new skills and confidence in presentation/facilitation as well as to make a difference to healthcare practice. We also learned that service users desired different levels of involvement in training facilitation - some wanted to take a more active role than others., A one-size-fits-all approach is not always appropriate. Encountering resistance from staff in training was a previously unidentified challenge to service user and carers' experience of delivering training in practice and is a key challenge for trainers to address in future., Professional training involvement can be enhanced via specialist training such as the EQUIP training the trainers programme evaluated here., What are the implications for practice? When training service users and carers to deliver training to mental health professionals, it is important that service users are equipped to deal with resistance from staff., It is important that service user and carer roles are negotiated and agreed prior to delivering training to healthcare professionals to accommodate individual preferences and allay anxieties., Training for service users and carers must be offered alongside ongoing support and supervision., Mental health nurses (and other health professionals) will be better able to involve service users and carers in care planning., Service users and carers may feel more involved in care planning in future., Abstract Introduction Limited evidence exists on service user and carer perceptions of undertaking a training course for delivering care planning training to qualified mental health professionals. We know little about trainee motivations for engaging with such train the trainers courses, experiences of attending courses and trainees' subsequent experiences of codelivering training to health professionals, hence the current study. Aim To obtain participants' views on the suitability and acceptability of a training programme that aimed to prepare service users and carers to codeliver training to health professionals. Method Semi-structured interviews with nine service users and carers attending the training programme. Transcripts were analysed using inductive thematic analysis. Results Participants' reasons for attending training included skill development and making a difference to mental health practice. Course content was generally rated highly but may benefit from review and/or extension to allow the range of topics and resulting professional training programme to be covered in more depth. Trainees who delivered the care planning training reported a mix of expectations, support experiences, preparedness and personal impacts. Implications for Practice Mental health nurses are increasingly coproducing and delivering training with service users and carers. This study identifies possibilities and pitfalls in this endeavour, highlighting areas where user and carer involvement and support structures might be improved in order to fully realize the potential for involvement in training. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings., Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings., Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care., What this paper adds to existing knowledge? Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care., Mental health staff face difficulties using electronic records alongside other systems of information sharing., Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care., What are the implications for practice? Frontline staff should be involved in designing new information systems including care plans., Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia., Practice-based mentors could be deployed to strengthen good practice in effective information sharing., Abstract Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service ( NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The GQ-6 is one of the most widely used self-report questionnaires to evaluate the level of gratitude among adults. The GQ-5 appears suitable for adolescents., What this paper adds to existing knowledge? We developed a Chinese version of the GQ-5 and examined evidence for its reliability and validity. Results demonstrated adequate reliability and validity, indicating that it is appropriate for the assessment of gratitude in Chinese adolescents., In addition, Chinese early adolescent females reported higher gratitude than adolescent males., What are the implications for practice? Screening adolescents who have lower levels of gratitude through the GQ-5 could help identify students who may benefit from empirically validated interventions to promote higher levels of gratitude in an effort to promote positive psychosocial and academic outcomes., Abstract Background This study was conducted to evaluate the psychometric properties of the Chinese version of the 5-item Gratitude Questionnaire ( GQ-5). Method The sample consisted of 2093 middle school students (46.8% males) in mainland China. Confirmatory factor analysis and multigroup confirmatory factor analysis were performed to examine the factor structure and the measurement equivalence across gender. The convergent validity, Cronbach's α and mean interitem correlations of the GQ-5 were also evaluated. Results The results provided evidence of internal consistency reliability through a Cronbach's α of 0.812 and a mean interitem correlation of 0.463 for the total sample. The results also supported a one-dimensional factor structure. In addition, convergent validity was assessed by statistically significant positive correlations between the GQ-5 and the two subscales of the Children's Hope Scale ( CHS) and the Brief Multidimensional Students' Life Satisfaction Scale ( BMSLSS) total score. Finally, multigroup confirmatory factor analysis also demonstrated measurement equivalence across gender. Subsequent analyses of latent mean revealed gender differences in early adolescent male and female students. Conclusions The Chinese version of the GQ-5 appears to be a reliable and valid measure of gratitude among Chinese early adolescents. Early adolescent female students reported higher gratitude than early adolescent male students. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery., At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members., What this paper adds to existing knowledge? This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland., In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy., What are the implications for practice? Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment., Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally., Abstract Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? In general, the current studies of positive mental health use questionnaires or parts thereof. However, while these questionnaires evaluate aspects of positive mental health, they fail to measure the construct itself., What does this paper add to existing knowledge? The widespread use and the lack of specific questionnaires for evaluating the positive mental health construct justify the need to measure the robustness of the Positive Mental Health Questionnaire. Also six factors are proposed to measure positive mental health., What are the implications for practice? The availability of a good questionnaire to measure positive mental health in university students is useful not only to promote mental health but also to strengthen the curricula of future professionals., Abstract Introduction Nursing has a relevant role in managing mental health. It is important to identify and thereafter to enhance positive aspects of mental health among university nursing students. Aim The aim of the present study was to analyse the psychometric properties of the Positive Mental Health Questionnaire ( PMHQ) in terms of reliability and validity using confirmatory factor analysis in a sample of university students. Method A cross-sectional study was carried out in a sample of 1091 students at 4 nursing schools in Catalonia, Spain. The reliability of the PMHQ was measured by means of Cronbach's alpha coefficient, and the test-retest stability was measured with the intraclass correlation coefficient ( ICC). Confirmatory factor analysis was used to determine the validity of the factorial structure. Results Cronbach's alpha coefficient was satisfactory (>0.70) for four of the six subscales or dimensions and ranged from 0.54 to 0.79. ICC analysis was satisfactory for the six subscales or dimensions. The hypothesis was confirmed in the analysis of the correlations between subclasses and the overall scale, with the strongest correlations being found between the majority of the subscales and the overall scale. Confirmatory factor analysis showed that the model proposed for the factors fit the data satisfactorily. Discussion This scale is a valid and reliable instrument for evaluating positive mental health in university students. Implications for Practice A good questionnaire to measure positive mental health in university students is useful not only to promote mental health but also to strengthen the curricula of future professionals. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? In the UK and internationally, the number of looked after children is increasing year on year., Mental health problems among looked after children are significantly higher than in the general population, and the uptake of mental health services for these children is low., There is a poor prognosis for children with untreated mental health problems; this is further compounded if the child is within the care system., What does this paper add to existing knowledge? This study adds to our understanding of foster carers' experiences of the mental health needs of looked after children and demonstrates some of the challenges associated with accessing appropriate and timely mental health services., New knowledge derived from this research is that the barriers to accessing Child and Adolescent Mental Health Services (CAMHS) are not at the time of initial referral as previously reported, but later, once within the mental health system with long waiting times experienced particularly for specialist services., This study provides new insights into the experience of being a foster carer and the levels of support and resources needed that directly relate to the viability of the placement., The majority of the foster carers interviewed were from a Black and Minority Ethnic (BME) background, previously under-represented in this research area., What are the implications for practice? A number of areas in current CAMHS provision need addressing with a focus on accessibility, consultation and support for foster carers. Waiting times need to be addressed, and improved communication with other agencies is also highlighted., CAMHS nurses are well placed to develop and deliver a comprehensive care package to foster carers, offering more tailored support to them whilst enabling the children and young people in their care to access and engage more effectively with mental health services., Abstract Introduction Despite well-documented vulnerabilities to mental health problems among the increasing population of looked after children, there continues to be poor uptake and utilization of Child and Adolescent Mental Health Services ( CAMHS). Aim To elicit views of foster carers regarding the mental health needs of children and adolescents in their care and their experiences of accessing mental health services. Methods A grounded theory approach and semistructured interviews with ten foster carers. Results The experience of being a foster carer was the core category, with three major themes: (1) foster carers' psychological understanding of challenging behaviour; (2) barriers to accessing CAMHS; (3) the importance of support. Discussion A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but once within the mental health system. The foster carers demonstrated a proactive approach to accessing services but expressed a need for more support structures related directly to the viability of the placement. Implications for practice Mental health nurses have a pivotal role in providing a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley ()., There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses., What this paper adds to existing knowledge? Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour., The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability., What are the implications for practice? Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care., Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes., Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence., Abstract Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Caregivers of adolescents with ADHD experience major difficulties as care providers and are in need of guidance and support., Adolescents with ADHD may develop oppositional and criminal behaviour. More than 50 % have the symptoms in adulthood, and up to one-fourth with severe emotional or antisocial difficulties., There is a lack of evidence of caregivers′ supporting intervention although caregiver groups have been found to contribute to better coping, decreased stress and improvements in ADHD symptoms., What does this paper add to existing knowledge? Primary caregivers of adolescents with ADHD experienced better quality of life after the Therapeutic Conversation Intervention., The intervention contributed to better social functioning among secondary caregivers., What are the implications for practice? The content of the Therapeutic Conversation Intervention is significant and highlights the utility of a combination of group and private sessions for caregivers of people with ADHD., The intervention can influence how services for families are organized, such that a Therapeutic Conversation Intervention could be offered on a regular basis., Abstract Introduction Caregivers of adolescents with Attention Deficit Hyperactivity Disorder are burdened with tasks and many suffer from distress. Adolescents with ADHD may develop antisocial behaviour and caregiver′s group can empower caregiver's supporting role. Aim/Question To evaluate the effectiveness of a Therapeutic Conversation Intervention on caregivers of adolescents with ADHD regarding strengthening the supportive role. Method The study utilized a quasi-experimental design. The participants ( n = 60) were caregivers of adolescents (13-17 years old) with ADHD. The intervention consisted in-group and parent sessions. The Calgary Family Model and the Family Illness Beliefs Model were used as theoretical frameworks. Results The study revealed significant differences in the improvement of quality of life; regarding primary caregiver ( PC) worry, daily activities, family relationships and collaboration post-intervention, as well emotional functioning at both post-intervention and follow-up. Secondary caregiver ( SC) social functioning was significantly improved at follow-up. Discussion The intervention proved to be beneficial to the caregivers and is filling a gap in much needed intervention. Implication for practice The results will expand health care professionals' knowledge of how to increase PC quality of life when supporting their adolescent with ADHD. This treatment information should improve service at health care centres/hospitals where adolescents with ADHD receive care. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Panic disorder patients display various panic-related physical symptoms and catastrophic misinterpretation of bodily sensations, which lower their quality of life by interfering with daily activities. Cognitive behavioural therapy (CBT) is a useful strategy for panic disorder patients to manage symptoms associated with inaccurate cognitive interpretation of situations resulting from the patient's cognitive vulnerability. In South Korea, however, despite the increasing prevalence of panic disorder, CBT is not a common element of nursing care plans for panic disorder patients. Moreover, few Korean researchers have attempted to assess the effects of CBT on such patients., What this paper add to existing knowledge? In a strategy combining CBT and routine treatments, patients with panic disorder can experience greater positive effects in the acute treatment phase than those they experience when receiving only routine treatment., What are the implications for practice? Mental health professionals, especially psychiatric nurses in local clinics who operate most special mental health programmes for panic disorder patients, should apply a panic disorder management programme that integrates CBT and routine treatments. The integrated approach is more effective for reducing the number of panic attacks and cognitive misinterpretation in patients than providing routine treatment alone., For patients with panic disorder, the objective of CBT is to understand the relationship between psychological panic disorder sensations, emotions, thoughts and behaviours. Therefore, nurses can help patients address and improve biological, social and psychological aspects of physical health problems as well as help them improve their coping skills in general., Abstract Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations by correcting these cognitive distortions by controlling negative thoughts and panic attacks. Aims This study verified whether group CBT is more effective than treatment as usual (TAU) in South Korean patients with panic disorder. Methods The study participants consisted of 76 panic disorder patients. Patients in the therapy condition attended sessions once a week for a total of 12 sessions in addition to drug treatment. Results In the therapy condition, there were significant decreases in panic-related bodily sensations and ranking and belief scores for catastrophic misinterpretation of external events. Discussion Group CBT, in comparison to TAU, decreases panic and agoraphobia symptom severity in South Korean patients with panic disorder. Our study provides evidence for the effectiveness of a panic disorder management programme that integrates group CBT and traditional pharmacotherapeutic treatment for patients with panic disorder. Implications for Practice The cognitive behavioural approach is needed to reduce panic and agoraphobia symptoms for hospitalized patients with panic disorder more than activity therapies, medications and supportive counselling by doctors and nurses. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? A lack of transitional care covering the period from psychiatric hospital discharge to community mental health care can increase the likelihood of illness recurrence or readmission of discharged patients., What this paper adds to existing knowledge? The participants expressed the view that discontinuity between inpatient and community life was a post-discharge challenge after being involuntarily admitted to a psychiatric emergency ward., These challenges arose from the dissatisfaction with inpatient treatment, inability to coordinate post-discharge life, What are the implications for practice? Patients should be able to disclose their feelings about their own experiences in inpatient care settings and the current challenges in community care settings in an open manner., An advocate should be appointed in acute psychiatric inpatient care settings to reflect patients' own feelings and individual needs to transitional care without bias to inpatient and community care providers., Abstract Introduction Psychiatric care in Japan usually comprises inpatient care provided during lengthy hospital stays. Recently, policies for shortening psychiatric hospital stays have been aggressively pursued. However, appropriate transitional care is not always provided for acute psychiatric inpatient care. Aim We elucidated patients' challenges immediately after hospital discharge following acute psychiatric inpatient care to clarify how to improve inpatient care and post-discharge follow-ups. Method This study utilized a qualitative descriptive study design and incorporated patient interviews. Participants comprised 18 patients who experienced involuntary admission following a diagnosis of schizophrenia spectrum disorder. Inductive qualitative content analysis was used to create codes and categories from interview transcripts. Findings The core category of post-discharge challenges that emerged was 'separating life as an inpatient from community life'. This comprised two subcategories: 'dissatisfaction with the inpatient care received' and 'lack of abilities to coordinate lifestyle following discharge'. Discussion Patients should be able to disclose their feelings about their experiences in inpatient care settings and the current challenges in community care settings openly. Implications for practice Advocate (e.g. peer staff) should be appointed in acute psychiatric inpatient care settings to reflect patients' feelings and individual needs to transitional care without bias to inpatient and community care providers. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Problematic parent-child relationships have been identified as one of the main predictors of adolescents' mental health problems, but there are few existing interventions that address this issue., The format and delivery method of existing interventions for parents are relatively inaccessible for parents with full-time jobs and families living in rural areas., What does this paper add to existing knowledge? The newly developed 'Stepping Stone' culturally specific web-based intervention, which is intended to help Korean parents of adolescents to acquire both knowledge and communication and conflict management skills, was found to be feasible and well-accepted by parents., This study enabled us to identify areas for improvement in the content and format of the intervention and strategies. This will potentially increase effect sizes for the outcome variables of parents' perception and behaviours., What are the implications for practice? This web-based intervention could be delivered across diverse settings, such as schools and community mental health centers, to increase parents' knowledge of adolescent's mental health and allow for early detection of mental health problems., Mental health nurses working in schools may spend a significant amount of time addressing students' mental health issues; thus, this web-based intervention could be a useful resource to share with parents and children. In this way, the mental health nurses could facilitate parental engagement in the intervention and then help them to continue to apply and practice the knowledge and skills obtained through the program., Abstract Introduction There is a need for accessible, culturally specific web-based interventions to address parent-child relationships and adolescents' mental health. Aims This study developed and conducted a preliminary evaluation of a 4-week web-based intervention for parents of adolescents aged 11 to 16 years in Korea. Methods We used a two-group, repeated measures, quasi-experimental study design to assess the feasibility of developing and implementing a web-based intervention for parents. Descriptive statistics, chi-square and t tests, and mixed effect modeling were used for data analysis. Results The intervention and 1-month follow-up survey were completed by 47 parents in the intervention group and 46 parents in the attention control (AC) group. The intervention was found to be feasible and well-accepted by parents. Discussion This culturally specific web-based intervention is a useful tool for knowledge dissemination among large numbers of parents. Areas for improvement in the content and format of the intervention and strategies to elicit significant parent-child interactions are provided. Implications for practice and conclusion The intervention could be disseminated in collaboration with mental health nurses working in schools to facilitate parents' participation. [ABSTRACT FROM AUTHOR]

Introduction: A culturally adaptive and easy‐to‐administer 12‐item Caregiving Rewarding Feelings (CRF) scale has been developed in China yet never published in English and validated in another population. Aim: The current study aimed to validate the CRF among a community sample of Chinese caregivers of those diagnosed with schizophrenia. Method: A sample of 449 family caregivers was recruited for scale validation that included factorial validity, construct validity, measurement invariance, item analysis, internal consistency reliability, test–retest reliability, known‐group validity, convergent validity and divergent validity. Results: Confirmatory factor analysis supported the a priori three‐factor structure. Construct validity was supported by high standard regression weight (SRW) and average variance extracted (AVE), measurement invariance across age and gender groups. The CRF showed good internal consistency and test–retest reliability. Known‐group validity was confirmed by the higher CRF scores among caregivers with certain socio‐demographics. The convergent validity of the CRF was supported by its positive correlations with social support, active coping and family functioning. The divergent validity of the CRF was supported by its negative associations with stigma, stress and depressive symptoms. Conclusions: This study confirmed the reliability and validity of the CRF specifically designed for caregivers in Chinese culture. Implications for Practice: The CRF may be further applied and validated in other populations and other countries. [ABSTRACT FROM AUTHOR]

Introduction: Self‐care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self‐care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self‐care practices is essential. There is currently a paucity of literature on this topic. Aim: To explore mental health nurses' views about what influences their ability to self‐care in relation to workplace stress and the impact on their practice and work environment. Methods: An Interpretative Phenomenological Analysis approach was utilized. In‐depth interviews explored how nurses perceived the influence of environment and relationships on self‐care practices in the workplace. Results: Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes—the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care. Conclusions: Stressful working environments pose major barriers to effective self‐care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally. Implications for Practice: Mental health nurses' self‐care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self‐care are therefore necessary. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Verbal de-escalation is an intervention aimed at calmly managing an agitated client to prevent violence. Effective de-escalation can help reduce the use of seclusion and restraint in psychiatric settings., Despite its importance in practice, there is little agreement on the necessary techniques of de-escalation and most of the research on the topic is based on expert opinion., To our knowledge, only one attempt at quantifying de-escalation skill has been pursued through the German-language De-Escalating Aggressive Behaviour Scale (DABS). While the DABS identified seven qualities necessary for de-escalation, it has not been validated in English and may lack important descriptors., What this paper adds to existing knowledge? The present study enhanced the original DABS with best, acceptable and least desirable staff de-escalation practice descriptions for each of the seven items., This enhancement of the DABS lead to the creation of the English modified DABS (EMDABS)., The EMDABS was psychometrically validated for use in research and practice: raters could use the EMDABS with a high level of agreement and consistency. Also, the scale appeared to measure a single cohesive construct - de-escalation., What are the implications for practice? With further validation, the EMDABS has potential to be the first English quantitative measure of de-escalation., The EMDABS offers seven items, with associated best practice descriptions, that may be used to inform de-escalation practice., The EMDABS can be used to evaluate training and education programmes and inform how these programmes and independent de-escalation practice may be improved., Abstract Introduction Verbal de-escalation is crucial to a non-coercive psychiatric environment. Despite its importance, the literature on de-escalation is sparse and mostly qualitative. To address this, Nau et al. (2009) quantified de-escalation by creating the German-language De-Escalating Aggressive Behaviour Scale (DABS). The DABS provides seven skills necessary for de-escalation, however it has not been validated in English and lacks the necessary anchor descriptions to make it useful. Aim To modify the DABS to include descriptions of best, acceptable and least desirable staff practice and to validate the English modified DABS (EMDABS). Method To develop item descriptions for the EMDABS, 50 conflictual staff-patient interactions were reviewed, summarized and cross-referenced with the literature ( n = 19). Three raters then used the EMDABS to evaluate 272 simulations depicting these interactions. Results The EMDABS demonstrated very good inter-rater reliability [ICC (3, 1) = 0.752] and strong internal consistency (α = 0.901). A factor analysis revealed that the seven items were best represented by a single factor. Discussion The EMDABS was validated for future use in research and practice. Additional validation and future research directions are discussed. Implications for practice The EMDABS holds promise as a quantitative measure of de-escalation. Its seven items and best practice guidelines have clinical implications for improving practice and training. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The only previous quantitative study that examined nurses' use of assessment tools to identify antipsychotic medication side effects found that about 25% of mental health nurses were using assessment tools., No previous studies have examined factors that influence the manner in which mental health nurses assess antipsychotic medication side effects., What this paper adds to existing knowledge? One-third of the respondents were not aware of any antipsychotic medication side-effect assessment tool, and only one-quarter were currently using an assessment tool., 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools, indicating that respondents with more positive attitudes to their service were more likely to continue using antipsychotic medication assessment tools., What are the implications for practice? The low level of awareness and use of antipsychotic medication side-effect assessment tools indicates that nursing educational institutions should incorporate more detail about these tools in course content, and emphasize in particular the benefits that result from the use of these tools in clinical practice., Service processes contributed significantly to the use of antipsychotic medication assessment tools, which indicates that managers need to foster workplace cultures that promote routine use of these tools., Abstract Introduction Limited evidence suggests that only a minority of mental health nurses regularly use standardized assessment tools to assess antipsychotic medication side effects, but the factors that contribute to the non-routine use of these tools remain unknown. Aim To examine Australian mental health nurses' awareness of, and attitudes towards, side-effect assessment tools, and also identify factors the influence the use of these tools. Methods A cross-sectional survey was undertaken through distributing an online questionnaire via email to members of the Australian College of Mental Health Nurses. Completed questionnaires were received from 171 respondents. Linear regression was used to examine the relationship between the 'service responsibility' and 'personal confidence' scale scores, and awareness, previous use and ongoing use of antipsychotic medication assessment tools. Results Only one-quarter of the respondents (26.5%) were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools ( Β = 3.26; 95% CI 0.83-5.69). 'Personal confidence' did not influence the ongoing use of assessment tools ( Β = −0.05; 95% CI −1.06-1.50). Implications for clinical practice Stakeholders can incorporate 'service responsibility' processes to foster increased use of assessment tools, which may enhance the identification antipsychotic medication side effects and improve the quality of care for service users. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Despite the increased interest in nursing students' happiness in South Korea, few studies have attempted to identify factors influencing their happiness. Therefore, nursing educators should consistently investigate the factors influencing happiness and develop strategies to improve happiness among Korean nursing students., What this paper adds to existing knowledge? This study confirmed that there were positive correlations between grateful disposition, social support and happiness. In addition, grateful disposition and support from intimate people were identified as predictors of happiness in Korean nursing students., What are the implications for practice? Development of intervention programmes to help nursing students increase grateful disposition and support from intimate people may be helpful for improving happiness. These programmes can include activity, such as writing a gratitude journal, and extracurricular programmes, such as mentoring programmes between seniors and juniors and/or professor and student., Abstract Introduction Happiness is very important in the training and development of nursing students as future nurses. However, nursing students experience a high level of stress and low level of happiness in South Korea. Aim This study aimed to investigate factors that affect happiness among nursing students in South Korea. Method Data were collected from a total of 241 nursing enrolled in two 4-year baccalaureate nursing programmes in South Korea, using a self-administrated questionnaire. To identify predictors of happiness, stepwise regression analysis was conducted. Results The results indicated that grateful disposition and support from intimate people significantly predict happiness among Korean nursing students. These two factors accounted for 38.0% of the variance in happiness. Discussion This study indicated grateful disposition and support from intimate people as factors promoting happiness in nursing students. The findings highlight grateful disposition and support from intimate people as important factors when developing effective interventions that foster nursing students' happiness. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? People diagnosed with schizophrenia or bipolar disorder have a life expectancy 10-15 years less than the general population., In rural and remote Australia, there is a shortage of health care professionals to provide physical health care for people living with a serious mental illness (SMI)., A large proportion of the care for people living with a SMI is provided by non-government organizations (NGOs), often employing workers without formal qualifications., There has been minimal research regarding the experiences of NGO workers who have been trained to complete health checks to help people living with SMI to access primary care services., What this paper adds to existing knowledge? This is the first study to examine the experiences of preparing NGO workers to use the health improvement profile (HIP) to support the physical health of people with SMI., It builds on previous studies that examined the use of the HIP by trained/qualified staff., What are the implications for practice? This study highlights that NGO employees may have an important role in helping people with a SMI to address their physical health., Engaging lay workers to use the HIP increases their awareness of the importance of providing good physical health care for people with SMI., The use of a tool, such as the HIP, prepares NGO workers to support the physical health needs and enables them to describe meaningful improvements in the health of people with a SMI., Abstract Background The life expectancy of people living with a serious mental illness (SMI) is up to 10-15 years less than the general population. They experience difficulties in accessing timely and appropriate physical health care. People with SMI living in regional Australia experience additional barriers to accessing services. This is in part due to the difficulties associated with recruiting and retaining health professionals in regional Australia. Aim To explore the regional non-government organization (NGO) workforce views of using a physical health care check list - the health improvement profile (HIP) - with people with a SMI. Gain insights into the workers' experiences of using the HIP., Understand which aspects of the HIP workers perceived as being most and least helpful., Learn how the HIP and the training program could be modified to better support its application in regional Australia., Method A focus group using a semi-structured interview was conducted with seven NGO employees who had been trained to use the HIP and subsequently used the HIP in their everyday work with patients. A mental health nurse (MHN) and a Psychology graduate working for the University of South Australia Department of Rural Health conducted the focus group. Results Using thematic analysis, the focus group discussion generated four main themes: taking control; accessing services; guiding my conversation; and working with others. The overall meta-theme was that lay workers can work effectively to address physical health problems in SMI patients. Conclusion Our observations highlight the important role lay workers in regional Australia have in helping people with SMI to address their physical health needs. They have an opportunity to extend their role in parts of the world where it is difficult to recruit MHNs. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Delusions are common experiences in psychosis and this is reflected in the number of studies focused on improving our understanding of their development, impact, and treatments. Many service users with psychosis are in informal caregiving relationships and carers can play an instrumental role in the recovery process., There remains a lack of knowledge and understanding about carer experiences and how they cope when their relative's delusions involve them or close others., What this paper adds to existing knowledge? Data drawn from five individual carer interviews, which were subject to interpretative phenomenological analysis, identified the importance of six key themes. In addition to a carer's exposure to their relative's illness symptoms and a reported lack of understanding about their relative's delusions, was a fear of delusion-driven behaviours, and the carer's attempt to conceal the true extent of their caregiving challenges to others. Carers' relationships were fractured and their coping was best described as an ongoing process, mainly developed through trial and error., It extends our understanding of important issues faced by a subgroup of carers and facilitates discussion beyond their levels of stress and burden., What are the implications for practice? The study, with its limitations, indicates some carers may live in fear of harm from their relatives but also be reluctant to disclose to others the full story of what they are coping with., Health professionals must routinely assess for risks that informal carers may be exposed to as part of their role, and offer tailored support and interventions., Abstract Background In recent years, there has been a gradual shift towards the study of individual symptom presentations in psychosis, this is particularly found in studies of delusional beliefs. However, the literature remains sparse on informal caregiver experiences of individual symptoms. Aim The study sought to investigate carer experiences of supporting a relative with delusional beliefs, which involve family members. Methods Semi-structured interviews were undertaken with five caregivers and subject to interpretative phenomenological analysis. Results Interviews yielded six superordinate themes highlighting issues concerning a carer's exposure to symptoms of illness; lack of understanding about their relatives' delusional beliefs; concerns over coming to harm from their relative: efforts made by the carer to conceal their relative's delusional beliefs and their consequences; fractured relationships, and a long process of learning how to best cope. Conclusion Caring for a relative with psychosis who experiences delusional beliefs about the carer and family members can be challenging. The results underscore the importance of providing a programme of support to meet the varied needs of informal carers with an explicit aim of assisting carers in their day-to-day problem solving. It should also help to address issues carers may have about causality, including beliefs about self-blame, and identifying effective coping strategies. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Community care has evolved beyond recognition since the closure of the asylums and the introduction of a socially inclusive concept of care. Through their gatekeeping role, Crisis Resolution Home Treatment Teams (CRHTT) aim to reduce inappropriate admissions, facilitate early discharge and maximize the ability of service users to live independently within their own communities. It is evident that there is a vast array of literature on CRHTT internationally, however, little evidence on nurses experiences of working within CRHTT and gatekeeping. In light of limited research, this study aims to expand the current evidence base by exploring nurse's experiences of working in CRHTT with its additional gatekeeping responsibilities., What the paper adds to existing knowledge? The findings from this study provide a valuable contribution to the existing international literature base, highlighting the experiences of nurses as gatekeepers within CRHTT. It also helps to identify further gaps in the literature that can be addressed through future research., What are the implications for practice? This research study has a number of academic and clinical implications. As gatekeeping is an integral aspect of the work conducted by CRHTT, a closer look at nurse's experiences of working in CRHTT with its additional gatekeeping responsibilities can help inform future developments within the service whilst identifying the necessary improvements to current working practices. It can also add to the existing evidence base on CRHTT and gatekeeping., Abstract Introduction Through their gatekeeping role, CRHTT aim to reduce inappropriate admissions, facilitate early discharge from hospital and maximize the ability of service users to live independently within their own communities. It is evident that there is a vast array of literature on CRHTT internationally, however, little evidence on nurses experiences of working within CRHTT and gatekeeping. Therefore, in the light of limited research, this study aims to expand the current evidence base by exploring nurse's experiences of working in CRHTT with its additional gatekeeping responsibilities. Methodology Six nurses working across two CRHTT's were interviewed using semi-structured interviews. Data were analysed through the use of thematic analysis. Results Four key themes emerged which were, 'CRHTT as a specialist role', 'core principles of the gatekeeping role', 'redefining risk management for gatekeepers in CRHTT' and 'the future of gatekeeping'. Discussion It is evident through nurse's experiences of working within CRHTT and gatekeeping that their roles were very dynamic and challenging. A positive risk-taking approach contributed towards the success of CRHTT as gatekeepers. Family members played a significant role in ensuring gatekeeping remained a priority consistent with Government targets. Clinical Implications and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? UK mental health policy dictates user involvement in mental health care planning., Service users report feeling marginalized in the care planning process., Ongoing dissatisfaction with care planning involvement suggests a failure to translate policy into practice over time., What this paper adds to existing knowledge? Service user involvement should no longer be regarded as a nebulous concept., Ten key criteria underpin service user satisfaction with care planning involvement., Five criteria characterizing the process of care planning involvement are prioritized by service users., What are the implications for practice? Service users can conceptualize and describe meaningful user involvement. Service user requests, summarized through a 10C framework of care planning involvement, provide a clear structure for practice improvement., Abstract Background Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. Question How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? Methods In 2013, we conducted five focus groups ( n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services ( n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. Discussion The process of care planning, centred on the user-clinician relationship, is key to user involvement. Implications for Practice Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? Citizenship is an important yet largely overlooked concept within psychiatric and mental health nursing practice, Many service users are subject to legally mandated restrictions that place conditions on their rights and responsibilities as citizens., What this paper adds to existing knowledge? Even though service users have legal status as citizens, they continue to experience many conditions on their rights and responsibilities., Concerns about services users' trustworthiness and doubts about their levels of insight impact on their status as full citizens., What are the implications for practice? Nurses' understandings of the conditions placed on the citizenship rights and responsibilities of service users will ensure inclusive and less restrictive care and treatment, Integration of the principles of therapeutic reciprocity and procedural justice within practice will help nurses balance both the rights of services users and legal restrictions on their liberty and autonomy, Abstract Introduction Service users have long been lobbying for equal participation as citizens, yet citizenship is an important and largely overlooked concept within nursing education and practice. Aims The study explored service users' understandings of their rights and responsibilities of citizenship and the conditions placed on these. Methods A total of 17 service users participated in semi-structured interviews. Isin's theory of the content of citizenship was used to analyze the data using a framework approach. Results Service users experience conditional citizenship that includes barriers to their participation and their rights and responsibilities that others in society enjoy. Discussion When the world of the service user is constructed through the language of the biomedical model, nurses may unwittingly reinforce psychiatric labels and thus perpetuate the stereotype that service users lack the competence to fully enact their rights and responsibilities. Implications for practice When providing care, nurses should incorporate the notion of therapeutic jurisprudence and the principles of reciprocity, procedural justice and the implementation of advanced directives to reduce conditions on service users' status as citizens. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Several studies have measured the general public's knowledge and attitudes towards Alzheimer's disease; however, much of this work is based on western samples. Due to cultural differences, the western findings may be difficult to generalize to the Chinese general public. In addition, the few studies conducted in China were often restricted to a relatively narrow range of knowledge and attitudes., What this paper adds to existing knowledge? The general public had little knowledge of Alzheimer's disease, especially on the causes, symptoms and risk factors. In terms of attitudes, although the general public held positive attitudes towards persons with Alzheimer's disease, most of them were not sure whether or not to share a diagnosis of Alzheimer's disease with the patient. In daily life, only a low proportion of people kept mentally active., What are the implications for practice? A popularization of a wide range of knowledge about Alzheimer's disease needs to be undertaken, especially focusing on persons with low educational level and emphasizing the causes, symptoms and risk factors. Besides, there is a significant need to draw up evidence-based dietary and lifestyle guidelines for Alzheimer's disease risk reduction. Moreover, health promotion agencies should identify priority groups for Alzheimer's disease risk reduction initiatives, especially those with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases., Abstract Aim The purpose of this descriptive correlational cross-sectional study was to assess the current level of knowledge, attitudes and health behaviours regarding Alzheimer's disease among community residents in Tianjin, China and to identify factors related to these attributes. Method A convenience sample of 140 community-dwelling adults aged 20-75 years was selected to complete a researcher-designed questionnaire about Alzheimer's disease-related knowledge, attitudes and health behaviours. Results The findings revealed that 15.7% of the participants knew the risk factors for Alzheimer's disease. With regard to attitude, 138 participants (98.6%) believed that people with Alzheimer's disease should not be discriminated against, and 55.7% were not sure whether to share a diagnosis of Alzheimer's disease with the patient. In daily life, 28.6% of the participants pursued their interests and hobbies. A lower level of health behaviours was associated with lower income, presence of chronic diseases and a lower level of knowledge about Alzheimer's disease. Discussion These findings provide a strong case for population-level risk reduction initiatives to be undertaken, especially among people with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge., Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service., What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital., While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision., What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices., The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms., Abstract Introduction Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. Aim The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. Method This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. Results The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. Implications for Practice This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? There is very minimal research available on mental health (MH) student nurse perceptions of cultural phenomenon - specifically, the ways in which they differentiate between 'normal' and 'psychopathological' beliefs related to culture and religion., Work in cultural psychiatry suggests that other MH professionals struggle with identifying whether beliefs or experiences indicate 'psychosis' or are 'typical' of a person's religious and cultural background., One research study with nurses suggests that they can sometimes also struggle to differentiate between religious and 'psychotic' beliefs and experiences., What this paper adds to existing knowledge: This research adds to the literature through analysing and demonstrating student nurses' experience with witnessing and accurately determining the clinical significance and relevance of people's religious beliefs and experiences., To our knowledge, this is the first study to use clinical practice to reflect on cultural issues in student MH nurses in this way, rather than using vignettes., These problems were attributed to a lack of religion-specific knowledge both in our study and within wider MH and anthropology research., What are the implications for practice? This study highlights the potential practice implications resulting from the risk of misinterpretation of beliefs and experiences., We propose ways in which this can be addressed through using different models of belief systems, and suggestions for approaching the issue in MH nurse education., Abstract There is limited research around how mental health ( MH) student nurses interpret and differentiate between people's religious and cultural beliefs and the existence of psychopathological symptomatology and experiences. Here we focus on one cultural issue that arose from research exploring how MH student nurses approach and interpret religion and culture in their practice - that is, the difficulties in determining the clinical significance of the religious beliefs and experiences expressed by the people they care for. While problems with establishing the cultural boundaries of normality in clinical assessments are an important area of debate in cultural psychiatry, it remains a peripheral issue in MH nurse education. An anthropologically informed qualitative research design underpinned 'critical incident' ( CI)-focused ethnographic interviews with 36 second and third-year MH nursing field students and seven undergraduate MH branch lecturers. Follow up focus groups were also carried out. Interview transcripts were subject to thematic analysis. Four subthemes were identified under the broad theme of the clinical significance of religious-type expression and experience: (1) identifying the difference between delusions and religious belief; (2) identifying whether an experience was hallucination or religious experience; (3) the clinical implications of such challenges; and (4) applying religion-specific knowledge. There are clinical implications that may result from the difficulties with assessing the clinical significance of religious beliefs and experiences, identified in both our research and within international cultural psychiatry literature and research. Misinterpretation and therefore wrongly assessing someone's experience as pathological is a significant concern. It is suggested that CI analysis could be adapted to help nurses, nursing students and nurse educators recognize the religious dimensions of mental distress, particularly those that then potentially impact upon the accuracy and person centeredness of clinical assessment. Further research is proposed to investigate the clinical assessment and training needs of nurses in the area of religion and mental distress. [ABSTRACT FROM AUTHOR]