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Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub‐elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery‐oriented mental health services that allow meaningful family involvement. [ABSTRACT FROM AUTHOR]

Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi‐structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self‐maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self‐maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self‐maintenance and positively influence their self‐development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers' self‐development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare. [ABSTRACT FROM AUTHOR]

Abstract: In a mental healthcare that embraces a recovery‐oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role‐related competences in clinical practice. The aim of this study was to clarify and understand these self‐perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role‐related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role‐related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self‐assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training. [ABSTRACT FROM AUTHOR]

Abstract: There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health‐care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health‐care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health‐care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self‐preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self‐preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well‐being. [ABSTRACT FROM AUTHOR]

Objectives To identify peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services. Design Review of qualitative and quantitative studies. Data sources A comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch. Review methods All articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ statement. Results Eighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers’ perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals’ negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies. Conclusions This review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles. [ABSTRACT FROM AUTHOR]

Aim. To acquire insight into the onset and meaning of transgressive behaviour from the perspective of nurses. Background. Patient aggression towards healthcare providers occurs frequently. Nurses in particular are at risk of encountering aggressive or transgressive behaviour due to the nature, duration and intensity of relationships with patients. This study analysed nurse perspectives with regard to the onset and meaning of transgressive patient behaviour in a general hospital setting. Design. Qualitative research according to the grounded theory method. Methods. Data were collected in 2011 through individual interviews with 18 nurses who were selected using purposive and theoretical sampling. Findings. Findings revealed that various nurse-patient interactions can result in episodes of transgressive behaviour, depending on the interplay of determining and regulating factors which have been identified at the patient, nurse and ward level. Experiences of transgressive behaviour are influenced by degree of control nurses experience over the provision of care; the degree of patient acceptance of organizational and ward rules, the degree of gratitude and recognition expressed by the patient and the extent of patient regard for the nurse as a person. Factors affecting transgressive experiences were a trusting relationship between patient and nurse; the extent to which patient perspectives are understood; methods of managing transgressive behaviour; and the influence of the team, head nurse and ward culture and habits. Conclusions. The results of this study can support the development of nurses' coping ability and self-confidence to mitigate or prevent experiences of transgressive behaviour. [ABSTRACT FROM AUTHOR]

Aim. To gain insight in the onset and meaning of transgressive behaviour in care relationships with nurses, from the perspective of patients. Background. Aggression and transgressive behaviour in health care have been a focus of research over the last decades. Most studies describe staff experiences on patient aggression. Patient' perspectives on aggression and transgressive behaviour in interactions with nurses are rarely sought. Design. Qualitative interview study. Methods. Twenty patients were purposefully sampled from six wards of two general hospitals. Semi-structured interviews were carried out in 2011. Data were analysed using the constant comparative method influenced by the grounded theory approach. Findings. On elaborating on what constitutes experiences of transgressive behaviour, patients employ a framework of suppositions towards hospital care and nurse-patient relationships. This framework leads to implicit ideas on how competent professional caregivers will be and on how relationships with nurses will be characterized as normal human interactions. When these anticipated ideas are not met, patients feel obliged to address this discrepancy by adjusting their expectations or behaviour. Patients become more vigilant with regard to care given by nurses; search for own solutions; make excuses for nurses or reprioritize their expectations. Because of this adjustment, perceptions of transgressive behaviour are reinforced, mitigated or put into perspective. Conclusion. Patients adjust their behaviour based on what they experience in care relationships with nurses or the hospital care. It is crucial that patients feel free to discuss their assumptions or untoward needs and nurses learn to understand and reflect on those experiences. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to enhance the conceptual understanding of the working alliance in the context of nursing care for people experiencing suicidal ideation. Design: A qualitative study based on grounded theory was conducted. Methods: Two authors conducted individual semi‐structured interviews from September 2017–January 2019. Twenty‐eight nurses in 13 wards of four psychiatric hospitals participated. The Qualitative Analysis Guide of Leuven was used to support constant data comparisons and the cyclic processes of data collection and data analysis. Findings: The nurses' perspectives revealed that the working alliance can be understood as an interpersonal and collaborative relational process. This relational process highlighted the core variable 'seeking connectedness and attunement with the person at risk of suicide'. The core variable underpinned three clusters: investing in the foundations of the working alliance, nourishing the clinical dimension of the working alliance and realizing an impact with the working alliance. Conclusion: This study highlights the importance for nurses to assess, evaluate and respond to persons' suicidal ideation in harmony with a commitment to connect with them and attune to their perspective. Impact: The relational process uncovered through this study offers valuable insights to support advanced nursing practice, where nurses meaningfully integrate relational elements of care with their contributions to suicide prevention and treatment. [ABSTRACT FROM AUTHOR]

Aim: To uncover and understand the core elements of how nurses in psychiatric hospitals make contact with patients experiencing suicidal ideation. Design: A qualitative study based on the principles of grounded theory was performed. Methods: Nineteen nurses on wards of four psychiatric hospitals were interviewed between May 2017 – February 2018. The Qualitative Analysis Guide of Leuven was used to facilitate the constant comparison of data. Findings: Nurses make contact with patients experiencing suicidal ideation by "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients". These interconnected core elements represent nurses' attention to relational processes like building trust as well as their predominant focus on assessing suicide risk. Nurses put other emphases in their contacts with patients depending on whether their approach is guided more by checking and controlling suicide risk or by acknowledging and connecting (with) the person. Conclusion: The study enhances the conceptual understanding of how nurses on psychiatric wards can involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. These findings can be used to underpin the nurses' role in and contribution to suicide prevention. Impact: The core elements "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients" can inform policies for nursing practice and education that aim to preserve and improve the capacity of nurses to involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. [ABSTRACT FROM AUTHOR]

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses' actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element 'promoting and preserving safety and a life‐oriented perspective'. This core element represents the three interconnected elements 'managing the risk of suicide', 'guiding patients away from suicidal ideation', and 'searching for balance in the minefield'. The enhanced understanding of nurses' actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses' capacity and ability to connect and collaborate with patients experiencing suicidal ideation. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to gain insight into the influence of team members in how nurses perceive and address patients' transgressive behaviour. Background Aggression and transgressive behaviour in health care have been a focus of research over the past few decades. Most studies have focused on individual nurses' experiences with aggression and transgressive behaviour. Literature examining group dynamics in nursing teams and team members' interactions in handling patients' transgressive behaviour is scarce. Design Qualitative interview study. Methods Seven focus-group interviews and two individual interviews were carried out in 2014-2016. Twenty-four nurses were drawn from eight wards in three general hospitals. Interviews were analysed using the constant comparative method influenced by the grounded theory approach. Findings While elaborating how they perceived and addressed transgressive behaviour, nurses disclosed how interactions with team members occurred. Several patterns arose. Nurses talk to one another, excuse one another, fill in for one another, warn one another and protect and safeguard one another. In these patterns in reaction to patients' transgressive behaviour, implicit group norms transpire, causing nursing teams to acquire their specific identity 'as a group'. Consequently, these informal group norms in nursing teams impinge how nurses feel threatened by patients' potential transgressive behaviour; gain protection from the group of nurses and conform to informal ward rules. Conclusion The findings of this study can support intervention strategies aimed at supporting nurses and nursing teams in managing patient aggression and transgressive behaviour by identifying and explicating these group dynamics and team members' interactions. [ABSTRACT FROM AUTHOR]