Search

Backgrounds: Most countries are facing increased pressure on healthcare resources. A better understanding of how healthcare providers respond to new demands is relevant for future pandemics and other crises. Objectives: This study aimed to explore what nurses and doctors in Norway reported as their main ethical challenges during two periods of the COVID-19 pandemic: February 2021 and February 2022. Research design: A longitudinal repeated cross-sectional study was conducted in the Western health region of Norway. The survey included an open-ended question about ethical challenges among doctors and nurses in hospital departments. Free-text comments were analysed using Systematic Text Condensation and also presented in a frequency table. Ethical considerations: Ethical approval was granted by the Regional Research Ethics Committee in Western Norway (131,421). All participants provided consent when participating in the study. Results: In 2021, 249 and in 2022, 163 healthcare professionals responded to the open-ended question. Nurses and doctors reported three main categories of ethical challenges related to the COVID-19 pandemic: (1) barriers that hindered them in acting as they ethically would have wanted to do; (2) priority-setting dilemmas linked to overtreatment, transfer of resources and ranking patient needs; and (3) workload expansion threatening work–life balance and employees' health. Category one comprised of resource barriers, regulatory barriers, system barriers, and personal barriers. Regulatory barriers, especially visitor restrictions for next-of-kin, were the most frequently reported in 2021. Resource barriers, related to the increased scarcity of qualified staff, were most frequently reported in 2022. Clinicians stretched themselves thin to avoid compromising on care, diagnostics, or treatment. Conclusions: Developing clinicians' ability to handle and cope with limited healthcare resources is necessary. To foster resilience and sustainability, healthcare leaders, in collaboration with their staff, should ensure fair priority-setting and initiate reflections among doctors and nurses on what it implies to provide 'good enough' care. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question: What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design: A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context: Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies. [ABSTRACT FROM AUTHOR]

Background: Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. Aim: The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context: We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations: Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings: We identified an overarching theme—nursing home nurses struggling on multiple fronts, "just do it"—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions: Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize. [ABSTRACT FROM AUTHOR]

Intellectual functioning impacts defendants' competence to stand trial, though research on this population remains limited. This study replicated and advanced prior work, focusing on defendants' demographic, clinical, cognitive, and criminal justice variables and their association with length of hospitalization and restoration determinations. Participants were 74 male and female criminal defendants in a midwestern state who were adjudicated incompetent to stand trial, had a diagnosis related to intellectual deficits, and completed competency restoration. Most defendants (83.7%) were restored to competency. Demographic factors were unrelated to restoration outcomes; violence of alleged offense predicted shorter hospitalization. Receiver Operating Characteristic Curve analyses determined an IQ score cut-off of 63.5 for which participants were of greater likelihood to be determined restored, providing guidance on the likelihood of restoration for defendants with intellectual disability related diagnoses. Specifically, this score can be used with clinical data to inform competency determinations for defendants with cognitive deficits. [ABSTRACT FROM AUTHOR]

The current study aims to identify Jordanian mothers' perspectives on their intellectually disabled daughters receiving hysterectomies. A qualitative methodology was employed; for the study sample, twelve mothers were chosen using a snowballing technique. Semi-structured interviews were carried out, and thematic analysis was utilized. Two main themes arose from the data analysis process: the reasons why mothers made the decision for their daughters to have hysterectomies – which included fears about unwanted pregnancy and keeping family honor – despite this conflicting with their religious and cultural values, and their concerns about their daughters having hysterectomies. Based on these findings, some implications and suggestions for future research were provided. [ABSTRACT FROM AUTHOR]

This study investigates the predictors of consistent condom use among male construction workers in South Africa who reported concurrent sexual relationships with regular partners, casual partners, and sex workers over a 3-month period. A cross-sectional survey was used to collect data from a convenience sample of 450 male workers across 18 construction work sites in the Western Cape province. Of these, 245 (54%) indicated that they had engaged in sex with all three partner types during the 3-month study period. Hierarchical multiple linear regression was then used to assess consistent condom use as a function of demographic, experiential, behavioural and cognitive characteristics. Three statistically significant predictors of consistent condom use were identified: perceived control over condom use (β = 0.252, p < 0.001), positive attitude toward condom use (β = 0.154, p < 0.05) and fear of HIV infection (β = 0.121, p < 0.05). These findings highlight the high prevalence of sexual concurrency among study participants. It also suggests that amid declining condom use, interventions which focus on enhancing an individuals' condom application skills and efficacy, that foster positive attitudes toward condom use and that strategically incorporate fear-based messaging within a multilevel framework may potentially increase condom use among individuals in concurrent sexual relationships. [ABSTRACT FROM AUTHOR]

Our paper explores in a large Romanian sample (2168 adolescents) the relational costs and benefits of the number of friends at school. Using the MEDCURVE procedure to test the non-linear mediation effects, our results show that psychological safety, bullying and negative relations mediate the association between the number of friends and depression and anxiety, while social acceptance and bullying mediate the association between the number of friends and academic self-efficacy. In general, our results show that the relational benefits of friendship tend to diminish as the number of friends increase, in general over 9 friends (depending on the relational state) and parents, teachers and school counselors should help adolescents manage their number of friends in order to prevent the relational costs associated with engaging in too many (superficial) friendships. [ABSTRACT FROM AUTHOR]

Background: Previous findings demonstrated that healthcare workers with a high level of social support are likely to engage in their work. Healthcare workers are not only engaged in the physical problems of their patients but also in their emotional difficulties. Pediatric professionals must express and regulate their own emotions during their interactions with young patients and their families. Purpose: The purpose of this study was to explore the impact of coworkers' emotional support on healthcare workers' work engagement in pediatric healthcare settings and the emotional regulation mechanisms by which emotional coworker support leads to work engagement. Method: A cross-sectional study was distributed in a Belgian pediatric hospital between October 2021 and December 2021. The sample consisted of 274 healthcare workers who were in direct contact with patients. Participants completed a questionnaire consisting of measures of coworker emotional support, work engagement, emotional suppression, and cognitive reevaluation. Results: Emotional suppression partially mediated the effects of perceived emotional coworker support on work engagement. Coworkers' emotional support fosters work engagement by reducing the negative effects of emotional suppression. Moreover, cognitive evaluation was positively associated with work engagement. Conclusions: These results provide insight into the influence of perceived emotional coworkers, emotional suppression, and cognitive reevaluation on work engagement. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the psychosocial adjustment of enterostomy patients on a national scale. Design: Based on a national cross‐sectional survey. Methods: From December 2021 and February 2023, a total of 22,040 enterostomy patients were assessed using the ostomy adjustment inventory‐20. Initial analysis involved employing the chi‐square test or Kruskal‐Wallis H test to identify factors influencing the psychosocial adjustment of these patients. Subsequently, multinomial logistic regression was used to determine the factors affecting the classification of psychosocial adjustment levels of enterostomy patients. The reporting of this study adhered to the STROBE checklist. Results: Eventually 21,124 patients with enterostomy were included in this study, out of which 7788 (36.9%) patients with low level of psychosocial adjustment, 11,803 (55.8%) patients with medium level of psychosocial adjustment and 1533 (7.3%) patients with high level of psychosocial adjustment. The factors influencing the classification of psychosocial adjustment levels of enterostomy patients were gender, educational background, carer, enterostomy self‐care knowledge score and medical payment method. Conclusions: The overall psychosocial adjustment level of enterostomy patients is not optimistic, and the factors that may affect the classification of their psychosocial adjustment level are analysed. Individualised intervention should be given according to different psychosocial adjustment levels of enterostomy patients. Relevance to Clinical Practice: The number of enterostomy patients with a high level of psychosocial adjustment is small in relation to the total number of enterostomy patients, and caregivers can provide health education to enterostomy patients by analysing the factors affecting the level of psychosocial adjustment of enterostomy patients. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Objectives: To explore the postoperative kinesophobia of patients after percutaneous coronary intervention (PCI) and its related factors. Background: Percutaneous coronary intervention is an effective method to treat coronary heart disease (CHD), and cardiac rehabilitation is an important auxiliary method after PCI. However, the compliance of patients with cardiac rehabilitation after PCI is not good, among which kinesophobia is an important influencing factor. Design: A descriptive cross‐sectional design was implemented, and the high‐quality reporting of the study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Methods: In total, 351 inpatients who underwent PCI in three tertiary grade‐A hospitals in China were selected by convenient sampling method. We use one‐way ANOVA and multiple linear regression analysis to determine the relevant related factors. Results: The kinesophobia of patients after PCI was negatively correlated with chronic illness resource utilization and sense of personal mastery, and positively correlated with illness perception. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery entered the regression equation, which could explain 78.1% of the total variation. Conclusion: The level of kinesiophobia of patients after PCI is high. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery are the related factors of kinesiophobia of patients after PCI. Relevance to Clinical Practice: By reducing the level of exercise fear of patients after PCI, patients are more likely to accept and adhere to the cardiac rehabilitation plan, thus improving their prognosis and improving their quality of life. Patient or Public Contribution: The patient underwent PCI in the research hospital. Researchers screen them according to the inclusion criteria and invite them to participate in this study. If they meet the requirements, participants will answer the research questionnaire face to face after signing the informed consent form. [ABSTRACT FROM AUTHOR]

In this study, we examined the mediating role of self-compassion in the relationship between insight and altruism and flourishing among mental health professional candidates. We adopted a cross-sectional atemporal design to examine how mental health professional candidates' insight and altruism affect their flourishing via self-compassion. The model was tested using structural equation modeling (SEM). Four hundred one participants (Male = 76, Female = 324; Mage = 20.5, SD = 1.8) took part in the study via a web-based survey and completed the Psychological Well-Being Scale, Altruism Scale, Self-compassion Scale, and Insight Scale. The study results showed that insight, altruism, and self-compassion were meaningful psychological dynamics supporting flourishing. The results revealed that self-compassion played a mediating role in the effect of insight on flourishing. On the other hand, the results showed that self-compassion did not mediate the effect of altruism on flourishing. [ABSTRACT FROM AUTHOR]

Aim: To understand the themes for Māori subjected to compulsory community treatment orders. Background: The Mental Health (Compulsory Assessment and Treatment) Act 1992 has been utilised in Aotearoa New Zealand for more than three decades. Despite Māori having higher rates of being subject to community treatment orders, there is little research examining their perspectives of its benefits and harms. Methods: Thematic analysis of a purposive sample of Māori in Hawke's Bay, New Zealand. Results: Five themes were developed. Māori described community treatment orders as restrictive and stigmatising. Some Māori described being poorly informed of the structures surrounding the use of community treatment orders and saw it as a mechanism to circumvent information-giving regarding treatment. Counterbalancing these, Māori described community treatment orders as mandating support and saw them as a mechanism to access care. Finally, some described their compulsory treatment status as unimportant and irrelevant. Conclusions: Thematic analysis identified five clear themes from interview participants. Conceptualisation of community treatment orders was largely negative, although Māori acknowledged that being subject to community treatment orders demanded more support from services. Themes of stigma and restriction are common in the literature, however, conception of the use of community treatment orders to bypass consent is novel. The literature describes community treatment orders as providing support, however, in this study, the interpretation suggests a need to lose personal autonomy to receive care, a potentially 'slippery slope' towards a two-tier type service. These findings remind services of the importance of attending to cultural elements of care, being clear around the process of consent. In terms of policy, weaving in cultural understanding appears to be important from an Indigenous perspective. [ABSTRACT FROM AUTHOR]

Background: We have previously analysed outcomes for all community treatment orders commenced during a 10-year period in New Zealand. Given Te Tiriti O Waitangi obligations to scrutinise health and consider equity for Māori, we completed this analysis to consider community treatment-order outcomes according to ethnicity. Methods: Ministry of Health databases provided demographic, service use and medication dispensing data for community treatment-order recipients between 2009 and 2018. As non-Māori on community treatment orders are older, less deprived and less likely to be diagnosed with a Psychotic Disorder, data were categorised according to age (<35/⩾35 years), level of deprivation (New Zealand Dep levels ⩽3, 4–6 and ⩾7) and diagnosis (Psychotic Disorder/non-Psychotic Disorder). The incidences of key outcome measures (admissions, community care, medication dispensing) were calculated for periods on/off community treatment orders for Māori and non-Māori to consider the differential impact of community treatment orders according to ethnicity. Results: Māori have high rates of community treatment order utilisation and are younger, more likely to be diagnosed with a Psychotic Disorder and spend longer receiving compulsory treatment than non-Māori. Non-Māori are more likely to receive more additional depot antipsychotic medication on–community treatment orders compared with periods off-community treatment order than Māori but other clear patterns of response distinguishing between Māori and non-Māori were not present. Conclusion: The differences between Māori and non-Māori for community treatment-order utilisation suggest the presence of structural inequity in underlying mental illness distribution and treatment provision. Māori cultural expertise at all levels of healthcare including healthcare planning and delivery is required to make advances and reduce disparity. [ABSTRACT FROM AUTHOR]

Objectives: Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. Methods: Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy–General Population]) and self-rated health (SRH) was assessed with a single-item question. Results: When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. Conclusions: The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect. [ABSTRACT FROM AUTHOR]

Objective: To explore psychological factors influencing decision-making regarding COVID-19 vaccination among pregnant women. Design: Cross-sectional mixed-methods online survey comprising sociodemographic factors, health beliefs, trust and anticipated regret, and open-ended qualitative questions. Pregnant respondents living in the UK or Ireland (n = 191) completed the online survey during June and July 2021. Main outcome measures: Intention to vaccinate against COVID-19 during pregnancy, with response options yes (vaccine accepting), no (vaccine resistant), unsure (vaccine hesitant). Qualitative questions about perceived benefits and risks of COVID-19 vaccination during pregnancy. Results: Multivariate analysis of correlates of vaccine hesitancy and resistance revealed independent associations for perceived barriers to the COVID-19 vaccine, anticipated regret, and social influences. Most respondents described making a decision regarding COVID-19 vaccination in the absence of satisfactory information or guidance from a health care professional. Vaccine hesitant and resistant respondents reported significantly greater barriers to the COVID-19 vaccination than vaccine accepting respondents. Concerns about the vaccine focussed on the speed of its development and roll-out and lack of evidence regarding its safe use in pregnancy. Conclusion: Participants who did not intend to be vaccinated against COVID-19 in pregnancy focused on vaccine fears as opposed to virus fears. Results indicate that pregnant women need balanced vaccine information and unequivocal health care provider recommendation to aid maternal vaccination decision-making. [ABSTRACT FROM AUTHOR]

Over a decade ago, in the 100th issue of Health Communication (Volume 25, issues 6–7); 2010), 30 "impact" articles addressed how our collective research findings had been translated to make a positive difference for persons across diverse communities. It is laudable to develop projects helping others to enhance their awareness about healthy living, refine practical communication skills to promote behavioral change, and rely on findings to enact important practices and policies giving priority to how well and long we live in contemporary society. As a preview, however, an article entitled "Why is it so difficult to talk about impact?" raised a series of inherent challenges faced whenever we conduct our research to advance basic knowledge by pursuing meaningful translation opportunities. These efforts are constrained in various ways: A lack of motivation, ability, and training to envision and implement protocols beneficial for the public good; the need to procure adequate resources (e.g., time and money) for sustaining longitudinal investigations; dealing with misconceptions that "applied" communication research has less value than "basic" studies; and creating and managing cross-disciplinary collaborations necessary to achieve project goals. When designing interventions to change others' lives in meaningful ways, attention must also be given to balancing community outreach while avoiding unnecessary self-promotion and imposition of social scientific priorities. [ABSTRACT FROM AUTHOR]

When celebrities, political figures, influencers, or anyone with a large following publicly disclose an illness or die, the news becomes a de facto public health campaign. Until health communicators began studying such disclosures and the effects of the following waves of media coverage, however, it was not known to what extent these events impacted the public. A growing body of research has empirically documented these events and examined the factors that predict which types of audiences are most affected and why. Beyond motivating research opportunities, celebrity and influencer health disclosures or deaths can impact calls to hotlines, views on health-related websites, discussions of related topics on social media, behavioral changes relevant to the disclosure, increased news coverage of celebrity health research, integration of celebrity health narratives into strategic health campaigns, and even policy changes. We provide an overview of research conducted in this area and detail examples of the impact that celebrity health disclosures and studies about those disclosures have had on public discourse and public health. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing debate regarding the value and applicability of brain-based understandings of addiction. This study examines how professionals in the Finnish addiction service system view this matter. Methods: The study participants (n = 997) were recruited at different levels of policy-making, treatment, prevention work, education, administration and research. We created an online questionnaire containing both multiple-choice and open-ended questions. Quantitative and qualitative analyses were performed. Results: There was a broad agreement among survey participants regarding the relevance and importance of brain-based understandings, per se. The support seemed to have increased a great deal in the past decades. On a closer view, a dichotomous attitude prevailed among the respondents: They expressed robust support for etiologies and ontologies of brain-based addiction, but simultaneously acknowledged some greater risks with neurocentrism and with wider implementations of neuroscientifically based interventions. New divisions of responsibility and the weakening of rights among concerned parties were presented as risk scenarios. The respondents feared that a medicalization of addiction would sideline social approaches. Conclusion: The Finnish addiction service professionals were not prepared to let brain-based ideas of addiction guide the country's addiction services but saw them as a useful supplementary hermeneutic and pedagogic tool. [ABSTRACT FROM AUTHOR]

In England and Wales, Approved Mental Health Professionals (AMHPs) have the ultimate responsibility, based on doctors' medical recommendations, for deciding to detain a person, without consent, under the Mental Health Act (1983). The work can be traumatic, yet its emotional impacts are often unacknowledged. Consistent themes include erratic levels of supervision and an overdependence on peer support, despite the longstanding recruitment and retention difficulties arising from high levels of stress and burnout. This article draws on findings from two research projects with AMHP services: one a national study using questionnaires and focus groups, and the other a doctoral research study using ethnography. Findings suggest that a lack of peer support, teamwork and debrief opportunities, exacerbated during the COVID-19 pandemic, intensified stress and burnout ('buckling under') as well as undermining socialising opportunities for trainees. AMHPs used metaphoric language to articulate their difficult experiences. Workplace environments including hot-desking and lone working may undermine casework discussions, social relations, informal peer support and supervision. Overall, AMHPs perceive their teammates as an essential source of support (a 'safety net') without which there are negative implications for practice. Ultimately, stress is exacerbated when there is no space to reflect and no team to do this with. [ABSTRACT FROM AUTHOR]

For the past years, Ecuador has been transitioning away from a hospital-based model of mental healthcare to one that is community-centred. However, challenges associated with hospital-based models endure, notably financial burden faced by those with severe mental health problems (SMHPs) due to labour market discrimination. Employment access for this group is often disregarded in policy planning, despite evidence of its benefits on mental health. Huertomanías, an urban garden initiative in Ecuador founded in 2015, works with individuals with SMHPs, providing work, income, and social inclusion. A case study using a participatory approach was carried out to explore factors that impact the recovery of people with SMHPs. Twelve participants engaged in diverse stages of the research, where several participatory activities were conducted including cognitive mapping, a photovoice project, and interviews. The analysis employed a thematic approach leading to four categories of impact within the urban garden: autonomy (financial and personal), interpersonal relations and relation with the environment, mental health, and family dynamics. A final category of impact was established encompassing external factors (family support and public policy and healthcare services) that influence recovery. Findings suggest that the urban garden promotes autonomy and active participation within society, improves mental health, and transforms family dynamics. Further, this study highlights the importance of community-based mental healthcare (CBMHC), emphasising the need of public policies and healthcare in promoting autonomy through employment and community-centred services. Lastly, the study contributes insights into recovery experiences and CBMHC benefits, informing programme development and similar initiatives in Latin America. [ABSTRACT FROM AUTHOR]

The article discusses informal coercion in psychiatric contexts, particularly focusing on the lack of consideration for the perspectives of individuals subjected to involuntary psychiatric treatment. It critiques existing models and approaches that overlook the lived experiences of psychiatric patients, calling for greater epistemic responsibility and the inclusion of first-person accounts in debates about coercion.

Mental illnesses are the leading causes of disability worldwide. Psychotic disorders occur in about 3% of people in the general population during their lifetimes. Patients experiencing acute psychosis need a medical provider who is capable of differentiating among medical, drug-induced, and psychiatric causes of the presentation to initiate the most appropriate management plan. This article focuses on the role of the acute care NP in medical clearance evaluations and initial management of adult patients experiencing acute psychosis in acute care settings. [ABSTRACT FROM AUTHOR]

Interracial and interethnic marriages have been increasing in the United States, growing from 7.4 percent in 2000 to 10.2 percent by 2016. Given the growing number of such marriages, more research is needed to inform social work practice, policy, and programming to effectively serve these couples, and their multiracial families. The current research reports on findings from a 2022 survey of 413 partners in interracial or interethnic marriages. Respondents were asked whether over the past five years they felt things have been getting better, about the same, or worse for intermarried couples in our society. Predictive of feeling things had been getting better included reporting support from extended family, living in a community with a number of multiracial and/or multiethnic families, intentionally seeking out social groups or settings with other interracial/interethnic couples, and having children. A few variables predicted feeling things have been about the same or getting worse. These included being male, the couple discussing recent racially related traumatic events such as the murder of George Floyd, and reporting being more frequently consciously aware of the interracial or interethnic nature of their marriage. Implications for practice with interracial and interethnic couples are discussed. [ABSTRACT FROM AUTHOR]

Despite efforts to maintain a satisfactory quality of life, a significant proportion of American workers face substantial material hardship. However, studies of material hardship have paid scant attention to lower-wage workers; hospital service, clerical, and technical workers represent a crucial yet understudied subset of this population. Using survey data from hospital workers employed by a large hospital in Pennsylvania, this research identified prevailing patterns of material hardship among these workers and investigated contributing factors, including hourly wages, utilization of public benefits, and demographics. The findings revealed the presence of two distinct material hardship groups: the high-hardship group (those with a high risk of experiencing multiple hardships concurrently) and the low-hardship group (those with a low risk). Notably, higher wages, better health, and being White were associated with a reduced likelihood of belonging to the high-hardship group. Conversely, an increased number of children in a household and utilization of a utility bill assistance program were associated with an elevated risk of belonging to the high-hardship group. The results hold several policy implications, including the need to increase hourly wages, enlarge antipoverty policy initiatives, enhance access to preventive health services, and offer more comprehensive childcare support. [ABSTRACT FROM AUTHOR]

Summary: The association of renal function with fracture incidence during teriparatide or alendronate treatment in elderly Japanese women was examined. Fracture incidence differed by fracture type, renal function, and treatment protocol. The results provide important information on pharmacotherapy in clinical practice for osteoporosis. Purpose: Incidence rate of morphometric vertebral fracture was lower under treatment with once-weekly teriparatide (TPTD) followed by alendronate (ALN) than under treatment with ALN throughout the study among elderly Japanese women at high fracture risk in JOINT-05. This is an exploratory subgroup analysis according to chronic kidney disease (CKD) status at baseline. Methods: Participants received sequential therapy with TPTD for 72 weeks, followed by ALN for 48 weeks (TPTD-ALN group, N = 483) or ALN monotherapy for 120 weeks (ALN group, N = 496). Baseline CKD status was classified by the estimated glomerular filtration rate (eGFR) and categorized as: CKD 1/2 (eGFR ≥ 60 mL/min/1.73 m2), CKD 3a (eGFR 45–59 mL/min/1.73 m2), or CKD 3b/4 (eGFR < 45 mL/min/1.73 m2). Incidences of vertebral fractures including morphometric fractures, non-vertebral fractures, and all fractures were evaluated during follow-up. Results: Baseline characteristics were not different between treatment groups. Higher stages of CKD were associated with age and number of prevalent vertebral fracture. In CKD 1/2 patients (N = 556 with 90 incidents of morphometric vertebral fracture), the incidence of vertebral fractures was lower in the TPTD-ALN group than in the ALN group (p = 0.01). In CKD 3b/4 patients (N = 112 with 10 incidents of non-vertebral fracture), the incidence of non-vertebral fractures was lower in the ALN group than in the TPTD-ALN group, although the number of fractures was small. In the ALN group, the incidences of vertebral fractures, non-vertebral fractures, and all fractures remained constant across CKD stages. Conclusion: This exploratory analysis showed that fracture incidence on ALN was constant regardless of renal function. It also suggested that the incidence of vertebral fractures on TPTD-ALN was lower than ALN monotherapy in CKD 1/2 patients. These results provide important information for drug selection in the clinical practice of osteoporosis. [ABSTRACT FROM AUTHOR]

Purpose: Orthopedic surgeons can assess bone status intraoperatively and recommend skeletal health evaluation for patients with poor bone quality. Intraoperative physician assessment (IPA) at the time of total knee arthroplasty correlates with preoperative DXA-measured bone mineral density (BMD). This study evaluated IPA during total hip arthroplasty (THA) as a quantitative measure of bone status based on tactile assessment. Methods: This retrospective analysis identified 60 patients (64 hips) undergoing primary THA who had IPA recorded in the operative report and a DXA within 2 years before surgery. Intraoperatively, two surgeons assessed bone quality on a 5-point scale (1 = excellent; 5 = poor). IPA score was compared to DXA BMD and T-score, 3D Shaper measurements, WHO classification, FRAX scores, radiographic Dorr classification, and cortical index. Results: There was a strong correlation between the IPA score and lowest T-score, WHO classification, and FRAX major and hip fracture scores (r = ± 0.485–0.622, all p < 0.001). There was a moderate correlation between IPA score and total hip BMD and 3D Shaper measurements, including trabecular volumetric BMD, cortical surface BMD, and cortical thickness (r = ± 0.326–0.386, all p < 0.01). All patients with below-average IPA scores had osteopenia or osteoporosis by DXA. Conclusion: IPA during THA is a simple, valuable tool for quantifying bone status based on tactile feedback. This information can be used to identify patients with poor bone quality that may benefit from skeletal status evaluation and treatment and provide intraoperative guidance for implant selection. Summary: Orthopedic surgeons can assess bone health at the time of surgery. Intraoperative physician assessment (IPA) is a bone quality score based on surgeons' tactile assessment that correlates strongly with the lowest T-score, WHO classification, and FRAX fracture risk. IPA can guide surgical decision-making and future bone health treatment. [ABSTRACT FROM AUTHOR]

This study explored the factor structures, partial correlational, unique and indirect associations of meaning and purpose with depressive symptoms and suicide ideation in college students (n = 956) and adults with chronic illness (n = 346). Results showed that correlated two-factor models better captured (both absence and presence of) meaning and purpose, compared to the unidimensional models. Although meaning and purpose were strongly associated, they were differentially correlated with and predictive of mental health outcomes. On one hand, while absence of meaning was positively and moderately correlated with and predictive of depressive symptoms and suicide ideation, the associations of absence of purpose were, albeit similar, weak. On the other hand, presence of meaning was negatively and moderately correlated with and predictive of depressive symptoms and suicide ideation, and the presence of purpose only predicted suicide ideation in negligible amounts among students but not adults with chronic illness. In both samples, absence of meaning and purpose were indirectly and positively related to suicide ideation through their positive associations with depressive symptoms; whereas presence of meaning, but not presence of purpose, was indirectly and negatively associated with suicide ideation through its negative associations with depressive symptoms. Conceptual and counseling implications are discussed. [ABSTRACT FROM AUTHOR]

Male veterans are vastly over-represented in suicide rates relative to non-veterans. A critical avenue for improving male veterans' mental health outcomes is improving their engagement with mental health services. This study presents a qualitative investigation of mental health practitioners' perspectives on enhancers of engagement in, and drivers of dropout from therapy among male veterans. Participants were 138 mental health practitioners across Australia, the USA, Canada, New Zealand and the UK (44.9% male; age M = 47.5 years, SD = 12 years). Participants responded to qualitative survey items inquiring about their perspectives on what works to engage male veterans in therapy, alongside common drivers of therapy dropout. Under an overarching theme contextualising the therapeutic alliance between veterans and mental health practitioners, interpretive description analyses led to eight distinct subthemes. Results highlight the range of areas in which mental health practitioners can thoughtfully adapt their practice to engage male veterans and align with military masculinities. In addition, findings underscore the range of barriers facing veterans when they seek help, which can precipitate dropout if not overcome by the right balance between practitioner engagement and veteran persistence. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is the most common anxiety disorder and has serious negative effects on multiple areas of life. The possibility of comorbidity with other disorders and malfunction in different domains of life exists in both full-blown and subclinical social anxiety. This study aimed to compare the schema modes and self-beliefs related to social anxiety in individuals with subclinical social anxiety disorder and without social anxiety disorder. Multistage cluster random and purposive sampling methods were used to select 100 students, 50 with and 50 without symptoms of social anxiety disorder. Participants were evaluated in regard to schema modes, self-beliefs related to social anxiety, social anxiety, depression, and generalized anxiety disorder. They were then evaluated clinically through Structured Clinical Interview for DSM-5 (SCID-5). Data analysis was performed by Multivariate Analysis of Variance (MANOVA) which showed that there was a significant difference between the groups of individuals with and without symptoms of social anxiety in schema modes and self-beliefs related to social anxiety (p < 0.001). The obtained results can contribute to a deeper understanding of the dimensions of vulnerability underlying subclinical social anxiety disorder in the relationship between symptoms of subclinical social anxiety disorder and schema modes. [ABSTRACT FROM AUTHOR]

Objective: Despite indications that patients with Acquired Brain Injury (ABI) as a result of deliberate self-harm have more complex presentations and lower rehabilitation outcomes (Brenner, 2009)1, there is nominal published literature that considers adjustments to care for these individuals. A multifaceted and emotionally triggering subject, laced with clinical and ethical considerations, the lack of published articles may indicate the complexities surrounding this topic. Method: This case study reflects on the care of a young man on a specialist brain injury unit who had devastating physical and cognitive disabilities after a significant drug overdose. Because the patient was unable to make informed treatment choices, all medical care was delivered in the patient's best interest amidst questions and doubts about the value of continuing life-saving treatments and escalation plans. Results: This article is not to defend or challenge the decisions made during this patient's care, but reflects on the complexity and impact of these situations on the patient, the family, and the care team. The patient's father gave permission for this case review publication. Conclusion: Further investigation is needed to better understand the challenges faced by this population and to determine if bespoke pathways and therapy considerations are necessary to address these specific circumstances. [ABSTRACT FROM AUTHOR]

One of the main contributing factors of antibiotic resistance is the dispensing of antibiotics without prescription. This study investigated community pharmacists' knowledge, attitudes, and practices in relation to antibiotic dispensing and resistance in United Arab Emirates (UAE). A cross-sectional survey was conducted using validated questionnaire. (40.1%) had an overall positive KAP score. A total of (88%) respondents were aware of the illegality of dispensing antibiotics without a prescription. Only (31%) had good knowledge regarding amoxicillin dosage for upper respiratory tract infection. The primary misconduct found numerous pharmacists prescribing antibiotics without a prescription, even though they were aware that this should never be done. Pharmacists who attended events focused on antibiotic use and resistance were more likely to have good knowledge about antibiotics (Adjusted Odd Ratio (AOR): 1.673; 95%CI: 1.029–2.719; p = 0.038), more likely to have positive attitude (AOR: 1.889; 95%CI: 1.133–3.149; p = 0.015), and more likely to have good practice (AOR: 3.182; 95%CI: 1.541–6.572; p = 0.002). [ABSTRACT FROM AUTHOR]

A longitudinal qualitative study was conducted to explore the experiences of church leaders (10 priests, pastors, and pastors' wives) who provided disaster spiritual/emotional care (DSEC) to the island of Puerto Rico during a period of intense and repeated crises from 2017 to 2022. Utilizing a narrative inquiry approach, 18 in-depth interviews were conducted and analyzed. Findings indicated that the participants engaged in psychological, social, and religious coping strategies to actively cope with the stress and trauma of being first responder rescuer/victims. Regional, cultural and contextual factors are considered in an effort to understand and enhance services to populations where disaster is the new normal. [ABSTRACT FROM AUTHOR]

Diversifying the chaplain workforce in hospital spiritual care departments and Clinical Pastoral Education (CPE) programs is essential for meeting the needs of a religiously diverse population in the USA. We interviewed seven total participants, including two Somali Muslim chaplain students and their Muslim and Christian chaplain educators in one CPE program. Participants described their personal journeys and motivations for pursuing careers in healthcare chaplaincy, their impact on hospitalized patients, and the role of expanding perspectives for those with little prior exposure to Somali Muslim faith leaders. Representation and linguistic diversity were viewed as positive attributes despite challenges of racial and religious discrimination. Recommendations include adjusting educational requirements for entry into the field to consider professional equivalencies; engaging community chaplains; and collaborating with local communities. These findings have important implications on creating pathways for spiritual care providers from underrepresented faith traditions to meet local community needs. [ABSTRACT FROM AUTHOR]

Spiritual healthcare providers (e.g., chaplains) working in healthcare settings across the United States were surveyed with the goals of (1) understanding their awareness of aphasia (a language disorder affecting reading, writing, verbal communication, and auditory comprehension); (2) determining whether they have received any training in aphasia and what type of training has been received; (3) whether they altered their approach to assessing the spiritual well-being of a person with aphasia; and, (4) what tools were used to augment communication. From a convenience sample of 203 respondents, the results indicated that 96% of respondents had previously heard of aphasia and 85% of respondents correctly identified the definition of aphasia. Seventy-three percent of respondents (N = 128) altered their approach to spiritual well-being assessment due to the aphasia diagnosis. Most respondents did not indicate receiving any formal training related to aphasia. [ABSTRACT FROM AUTHOR]

The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981–1995) and early COVID-19 (2020–2021) pandemics. A total of 11 hospital chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response. [ABSTRACT FROM AUTHOR]

Faith leaders are often called upon to provide mental health support to their congregants, yet there is limited research on how these leaders experience this aspect of their role. The objective of this study is to understand the experiences of faith leaders who are sought by individuals for mental health support. We report on the findings from a qualitative study based on interviews with faith leaders of different denominations in Ottawa, Canada. The results indicate that faith leaders are asked to provide support for a wide – but not comprehensive – range of mental health issues; that faith leaders experience various challenges in managing role boundaries; and that these leaders believe that training not only in mental health issues, but also on subjects of liability and self-care to maintain their own wellness would be valuable. We address implications for research and practice. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse is higher among adults experiencing homelessness (AEH) compared to housed adults. Greater expectancy that alcohol will improve mood, negative affect, and lower self-efficacy have been linked to alcohol misuse in AEH. However, little is known about the momentary relationships between affect, alcohol expectancies, and self-efficacy to avoid alcohol in AEH. To our knowledge, this is the first study to examine these constructs in a sample of AEH. Methods: AEH (n = 72; Mage= 47, 85% Male, 68% Nonwhite) completed smartphone-based ecological momentary assessments 5x/day for four weeks. Generalized multilevel modeling examined the association between concurrent momentary ratings of (1) expectancy that alcohol would improve mood and negative and positive affect and (2) self-efficacy to do something other than drink to improve mood and negative and positive affect. Results: Momentary reports of increased negative affect were associated with greater expectancy that alcohol would improve mood (b = 0.25, p < 0.01), whereas momentary reports of increased positive affect were associated with less expectancy that alcohol would improve mood (b = −0.11, p < 0.01). Increased momentary negative affect was associated with less self-efficacy to improve mood without alcohol (b = −0.09, p = 0.03), but momentary reports of increased positive affect were associated with greater self-efficacy to do something other than drink to improve mood (b = 0.18, p < 0.01). Conclusion: It may be important to deliver real-time treatment messages suggesting alternatives to drinking and/or ways to boost self-efficacy during moments when negative affect is high. [ABSTRACT FROM AUTHOR]

Social work programs are grappling with changing students' attitudes about working with older adults. Our study aimed to understand whether adding a guest speaker working in the field into weekly content would influence students' attitudes about working with older adults. We conducted an exploratory study using a cross-sectional design with a pre and posttest to answer our question. Eighteen MSW students were enrolled in the 'Social Work with Older Adults' course and 17 students completed the pre-posttests. Willingness to work with older adults was measured using the "Willingness to Work with Elderly People Scale (WEPS). Guest speakers were recruited from local area agencies on aging. A significant finding was a statistically significant (t= −3.31, p <.01) increase from pre- (M = 3.59, SD = 1.54) to posttest (M = 4.88, SD = 1.22) scores for item, 'My professors advise me to consider aged care career.' In addition, there were statistically significant pre to posttest differences for all items of 'Perceived Behavioral Control' and 'Intention toward working with older adults' reflecting competence, training, skills, and capabilities to work with older adults, suggesting guest speakers may play a crucial role as influential sources to positively shape students' attitudes and intentions toward working with older adults. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic affected individuals in different contexts (e.g. long-term care facilities, schools, communities), including psychiatric hospitals. Thus, the objective of this systematic review, duly registered and approved on PROSPERO (CRD42023427835), is to assess the frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals. Methods: A total of 4,922 articles were identified in the database searches, and 17 studies conducted in psychiatric hospitals from different regions of the world were selected. Results: The frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals ranged from 1.8% to 98.8%. Out of a total of 19,573 patients hospitalized in psychiatric hospitals, the pooled mean frequency of positive COVID-19 cases was 11.9%. The majority of patients presented COVID-19 symptoms (e.g. cough, fever and others). The COVID-19 diagnosis was primarily conducted through RT-PCR testing in 88.9% of the studies. Conclusion: In conclusion, there is discrepancy in the methodology of the studies assessing the frequency of positive COVID-19 cases in psychiatric hospitals. However, this review allowed us to understand how the COVID-19 pandemic has impacted the population hospitalized in psychiatric hospitals. [ABSTRACT FROM AUTHOR]

Background: In situations where a child's mental well‐being is threatened, the parents also need support. The available support has been perceived as insufficient by both parents and professionals. Aim: To explore the views of experts‐by‐experience of the support needed by parents when a child's mental well‐being is threatened. Methods: A qualitative study with a phenomenological approach was conducted in Finland. The data were collected in six focus group interviews during the autumn of 2022. The participants (n = 26) were adult experts‐by‐experience who had experienced either mental well‐being challenges in their own childhood (before the age of 18 years) or experienced the mental well‐being challenges of a child from the role of a parent. The data were analysed using inductive content analysis. Results: The support needed by parents in situations where the mental well‐being of their child is at risk consists of support for parenting, support for sharing and support for surviving. Conclusion: Parents whose child's mental well‐being is at risk, need support both for their own well‐being and for their ability to support their child's well‐being. Support is needed not only from professionals but also from peers. [ABSTRACT FROM AUTHOR]

Background: As family members affect patient outcomes following open‐heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. Aim: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open‐heart surgery in Sweden. Methodological Design and Justification: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. Ethical Issues and Approval: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. Research Methods: Individual interviews were conducted with 35 patients who underwent open‐heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. Results: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk‐taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. Conclusions: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open‐heart surgery. [ABSTRACT FROM AUTHOR]

Background: In the wake of an increasingly ageing population, Norway has a growing need for healthcare workers, especially in nursing homes. This study explored the employment experiences of migrant nursing assistants working in elderly care in Norway. Methods: A qualitative interview‐based study was carried out between March and August 2020. In‐depth, semi‐structured interviews were performed with 13 purposively selected immigrant nursing assistants working in a nursing home within Western Norway. Data were thematically analysed. Results: Migrant nursing assistants working in Norwegian elderly care faced mixed experiences. On the one hand, study participants experienced several barriers in their workplace, resulting from insufficient command of the Norwegian language, heavy workload and mistreatment and discrimination by both patients and colleagues. On the other hand, participants cited the financial compensation from work, the meaningfulness derived from helping others and the flexible day‐off requests as workplace facilitators. Participants also made continuous efforts to learn the Norwegian language and to build good relations with their co‐workers. Conclusion: There is a need to enhance migrant nursing assistants' positive experiences in the Norwegian eldercare sector by making targeted workplace reforms and fostering a supportive and inclusive environment. [ABSTRACT FROM AUTHOR]

Background: The increasing migration of internationally educated nurses (IENs) from developing to developed countries highlights the importance of implementing integration strategies that facilitate their workplace transition, leading to improved job satisfaction and professional competence. Aim: The mixed‐methods systematic review aimed to synthesise the current literature on factors influencing job satisfaction and professional competencies among IENs throughout their transition process, including the pre‐migration, migration, and post‐migration periods. Methods: This study conducted a mixed‐methods systematic review from 2013 to 2023, using the CINAHL, Scopus, and PubMed databases and employing a Population, Interventions, Comparisons, Outcomes (PICO) framework. Quality assessment employed the Mixed Methods Appraisal Tool (MMAT), and data analysis followed a convergent parallel design. Data synthesis was presented narratively, and the literature review adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Out of 565 articles, eleven studies (eight qualitative, two quantitative, and one mixed‐method) met the inclusion criteria. Three key themes that influenced job satisfaction and professional competencies among IENs were identified: pre‐migration and pre‐deployment demands, challenges in workplace integration, and post‐migration career challenges and retention strategies. Limitations: The study primarily focused on IENs recruited from developing countries, potentially limiting the generalisability of the findings to IENs from other regions or countries. Furthermore, the inclusion of nurses from developed countries who also migrated was limited in the available studies, which further restricts the applicability of the research findings. Conclusions: It is essential to reconsider the pre‐migration language requirements and evaluate the feasibility of completing them during the integration period to enhance the job satisfaction and professional competencies of IENs. Additionally, key factors for improving job satisfaction among IENs include providing personalised support, addressing managerial barriers, facilitating career advancement, efficiently managing workloads, and promoting effective communication within the healthcare team. [ABSTRACT FROM AUTHOR]

Parental stress increased during the COVID-19 pandemic. Families with children with an intellectual or developmental disability (IDD) and extensive support needs—such as complex communication needs—experienced additional challenges, including service loss and difficulties accessing virtual learning. The purpose of this study was to understand the experiences of parents (N = 37) with children with IDD and complex communication needs related to parental stress and family resilience. Qualitative interview and quantitative survey data were collected within a convergent parallel mixed-methods design, with interviews occurring three times across the 2020–2021 school year. The two sets of data were analyzed separately and then integrated using back-and-forth exchanges and a joint display. Findings indicated that families showed resilience through family adaptation and cohesion—creating rhythms and routines that fostered togetherness—and by growing in advocacy and empowerment related to their child's learning. But, many parents worried that they were not able to do enough for their child. Social support predicted lowered parental stress and stronger family resilience; yet, perceived social support varied widely across families—particularly support from teachers and service providers. This study provides important insight into family experiences during a unique time with the COVID-19 pandemic while pointing to important ways to strengthen family resilience long into a postpandemic future. [ABSTRACT FROM AUTHOR]

The article discusses the importance of assessing suicidal mental imagery, which has been largely overlooked in clinical practice despite its potential impact on suicidal behavior. Topics include the underutilization of suicidal mental imagery in risk assessments, the role of cognitive behavioral therapy (CBT) in addressing these images, and the need for more comprehensive tools and techniques to incorporate imagery into routine suicide prevention strategies.

The article discusses the global issue of homelessness, particularly its impact on vulnerable groups like women, Indigenous Australians, and those with mental health challenges. Topics include homelessness as a complex social issue, the lived experiences of homelessness, and the role of mental health nurses in providing trauma-informed care and advocating for affordable housing.

This review aims to consolidate and appraise evidence exploring the caregiver burden of parents of children with mental disorders. A mixed‐studies review structure was adopted and six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until September 2023. Thomas & Harden's thematic analysis framework was utilised for data analysis. Twenty‐three studies were included in this review. The results‐based convergent integration method identified an overarching theme titled 'hiding behind the walls on fire, engulfed in chaos: dark and alone', three main themes named 'Invisible scars': role of psychological factors on caregiver burden, navigating through social and economic influences on caregiving burden, and influence of illness‐related variables and nine subthemes. This review highlighted that the parents perceived insufficient support from healthcare providers and a lack of insight regarding their children's medical condition as the primary contributors to the burden experienced. It is imperative for healthcare professionals to collaboratively engage with parental caregivers, offering accessible treatment options for their children with mental disorders and providing comprehensive educational resources to facilitate a profound understanding of their children's mental health conditions. In addition to addressing caregivers' informational needs, the establishment of an integrated support system is advocated, one involving active participation from healthcare professionals, healthcare institutions, community resources, social services and policymakers. This holistic approach could better meet the multifaceted needs of caregivers, encompassing psychosocial, emotional and financial aspects. Trial Registration: International Prospective Register of Systematic Reviews: PROSPERO ID: CRD42022363420 [ABSTRACT FROM AUTHOR]

Peer support specialists (PSSs) in mental healthcare services are individuals recovering from mental health conditions and providing formal peer support to clients with similar conditions. Despite evidence of the benefits of this modality and the increasing demand for it, little is known about the PSSs' experiences in mental healthcare services. This review systematically synthesises available qualitative data on the certified PSSs' experiences in providing formal peer support in mental healthcare services. A search was performed across six electronic databases and one grey literature database for all published and unpublished qualitative studies in English between 2014 and 2022. Mixed‐methods studies were included if their qualitative data were extractable. This review included PSSs who provided formal peer support to clients with similar mental health conditions. The included studies were appraised through the Critical Appraisal Skills Program Qualitative checklist, while data extraction was done through a customised tool. Our meta‐synthesis revealed an overarching theme on certified PSSs' journey in mental healthcare services, alongside four main themes: (i) emotional impacts of being PSSs, (ii) struggle to justify their roles, (iii) complex roles of PSSs and (iv) sources of support. The review has provided an insightful understanding of the PSSs' roles and needs, for which there is a need to cultivate a supportive working environment. Given the difficulties in adopting the PSSs' roles, as demonstrated by our findings, future research should explore how mental healthcare organisations can address their work‐related challenges and cultivate a supportive working environment. [ABSTRACT FROM AUTHOR]

Since 2002, National Outcomes and Casemix Collection of clinician‐rated and consumer‐rated outcome measures has become part of routine care within Australian clinical mental health services, aiming to ensure that services understand, improve and are accountable for effectiveness of treatment and care provision. Consumer‐rated outcome measures, implemented well, support basic human rights of consumers to be asked, heard and included equally in their own care. However, their use has lagged due to clinician inertia, uncertainty about their value to clinical care, assumptions about consumers' capacity to complete the measures and organisational cultural issues that have hampered more holistic assessment, consumer inclusion and care collaboration. Much is known about negative, largely tokenistic use of such measures, poor uptake and dominance of clinical approaches to measurement that privilege clinical expertise; however, little is known about consumers' positive experiences of using consumer‐rated measures, Therefore, our aims were as follows: to seek the views and experiences of mental health consumers of using consumer‐rated measures in their encounters with clinicians; to understand better whether there were benefits (and if so what) of consumer‐rated measures being used in routine mental health practice; to understand how feedback on the use of consumer‐rated measures can inform training for mental health staff; and to promote their wider use within mental health services. In‐depth interviews conducted with 10 Australian mental health consumers used interview questions co‐designed with lived experience and clinical advocates. Descriptive thematic analyses produced four themes emphasising consumers' preferences for completing the measures, the importance of explaining their purpose, how the process validated their feelings and was an opportunity for self‐reflection, sense‐making, trust‐building, and transparency in the encounter and empowerment. This research offers recommendations about the value of effective implementation of consumer‐rated measures. [ABSTRACT FROM AUTHOR]