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WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base., Abstract: INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare., Aim: To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020., Method: A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias., Results: Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias., Discussion: Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery., Implications for Practice: Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery., (© 2022 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Accessible Summary: What is known on the subject?: Risk assessment and risk management are considered to be important practices carried out by mental health nurses.Risk assessment can help keep mental health service users' safe, but some nurses see it as a 'tick the box' exercise.Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. What the article adds to existing knowledge?: Mental health nurses' attitudes towards risk assessment are diverse with regard to its legitimacy, conduct and value.This study provides an organised framework to help understand the areas in which these different attitudes occur. What are the implications for practice?: Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. Introduction: Understanding nurses' attitudes towards risk assessment could inform education and practice improvements. Aim/Question: To explore mental health nurses' attitudes towards risk assessment. Method: An integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis; quantitative data were integrated with emerging themes. Results: Eighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation); use of structured approaches (technical orientation); value of intuition (intuitive orientation); and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses. Discussion: Mental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment. Implications for Practice: This review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes. [ABSTRACT FROM AUTHOR]

Seclusion is one of the extreme measures of managing violence and aggression. Despite the evidence base for the effectiveness and therapeutic value of seclusion being limited, there arguably remains a compelling case for its use. This qualitative study aimed to explore forensic nurse's experiences and perspective on the use of seclusion in clinical practice and establish: •What are the factors that influence and inhibit the use of seclusion? •What skills are required when caring for patients in seclusion? A purposive sample of 12 registered and non-registered nurses from a UK high-security hospital consented to engage in a focus group. Thematic analysis was used to interrogate the data. The results included two emerging themes: 'Keeping everyone safe' and 'The challenges', including the identification of binary oppositions. A rationale for the use of seclusion; it's a last resort. Evidence of challenges to the therapeutic relationship and communication barriers. Findings illustrate the need to critically examine the practise of seclusion, accuracy of risk assessment, also to balance safety and security proportionately and ensure therapeutic value. The use of a daily dynamic risk assessment and staff relational training is recommended to improve communication and reduce excessive and prolonged use of seclusion What is known on the subject Over the last decade, significant headway has been made across the globe in relation to reducing restrictive practices such as seclusion. Early intervention and staff confidence in managing violence and aggression have been identified as factors that influence the occurrence of seclusion. What the paper adds to the existing knowledge Findings support the necessity to utilise objective assessment routinely. The binary oppositions described within the presenting results are as relevant today as they were almost two decades ago when published by Mason (2002) This paper provides new knowledge on forensic nurses' perception use of seclusion and draws attention specifically to the impact of the therapeutic relationship and communication challenges during a seclusion event. What are the implications for practice The provision of a daily dynamic risk assessment within nursing practice will effectively identify patients who are imminently at risk of engaging in violence and aggression and reducing excessive and/or prolonged use of seclusion. Staff development and development that includes relational skills training in how to manage complex relationships to improve positive communication and reduce the need for seclusion being required. The findings suggest the need for future research and senior managers and health-care professional leaders to gain a better understanding of the factors that influence the clinicians' decisions in the use seclusion, in order to achieve long-term reductions in its use. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand that new preregistration nursing courses in the UK must still comprise four specialisms: adult, child, mental health, and learning disability • To familiarise yourself with the issues facing nurse educators preparing new mental health preregistration programmes • To understand how upskilling the mental health nursing workforce can improve the experiences of service users According to the Nursing and Midwifery Council (NMC), universities across the UK must develop and implement new preregistration nursing programmes by the end of 2020. Unlike the rest of the world, where initial nurse training is generic, preregistration education in the UK enables students to specialise in one of four fields of nursing practice: adult, child, mental health or learning disability. The recent NMC standards of proficiency for registered nurses confirmed the continuation of these specialist fields at undergraduate level. Considering these recent standards, nurse educators across the UK have an opportunity to review their existing educational provision. This article explores three issues facing nurse educators as they prepare new mental health nursing courses: how to respond to adverse life experiences or trauma; how to address the ethical tensions inherent in the use of coercive practices; and how to make a difference to people's physical health and to mortality statistics, which indicate that people with longstanding mental health issues die at a much younger age than their contemporaries. These areas need to be systematically addressed across mental health preregistration nursing programmes to improve the lives of service users and determine the future of the specialty. [ABSTRACT FROM AUTHOR]

Background: There has been a recent growth in research addressing mental health nurses' routine physical healthcare knowledge and attitudes. We aimed to systematically review the empirical evidence about i) mental health nurses' knowledge, attitudes, and experiences of physical healthcare for mental health patients, and ii) the effectiveness of any interventions to improve these aspects of their work. Methods: Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple electronic databases were searched using comprehensive terms. Inclusion criteria: English language papers recounting empirical studies about: i) mental health nurses' routine physical healthcare-related knowledge, skills, experience, attitudes, or training needs; and ii) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of routine physical health care for mental health patients. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative, narrative synthesis of study findings was conducted. Results: Fifty-one papers covering studies from 41 unique samples including 7549 mental health nurses in 14 countries met inclusion criteria. Forty-two (82.4%) papers were published since 2010. Eleven were intervention studies; 40 were cross-sectional. Observational and qualitative studies were generally of good quality and establish a baseline picture of the issue. Intervention studies were prone to bias due to lack of randomisation and control groups but produced some large effect sizes for targeted education innovations. Comparisons of international data from studies using the Physical Health Attitudes Scale for Mental Health Nursing revealed differences across the world which may have implications for different models of student nurse preparation. Conclusions: Mental health nurses' ability and increasing enthusiasm for routine physical healthcare has been highlighted in recent years. Contemporary literature provides a base for future research which must now concentrate on determining the effectiveness of nurse preparation for providing physical health care for people with mental disorder, determining the appropriate content for such preparation, and evaluating the effectiveness both in terms of nurse and patient- related outcomes. At the same time, developments are needed which are congruent with the needs and wants of patients. [ABSTRACT FROM AUTHOR]