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Copyright of Nursing Care & Research / Nosileia kai Ereuna is the property of Greek Nursing Studies Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Although the majority of Mental Health Services nowadays is provided in community settings worldwide, there is only scant data regarding the lived experience of Community Mental Health Nurses (CMHNs) of their role, and the particular stressors faced by them within work context. AIM: Investigation of the perceptions and feelings of CMHNs of their professional role, with special focus on satisfying and dissatisfying factors. MATERIALS AND METHODS: A phenomenological design based on Munhall's approach was applied. Following purposeful sampling, along with informed consent, 5 CMHNs participated in the study. The rule of thematic saturation was also achieved. RESULTS: The emotions described by the participants were mainly grouped in two categories: a) feelings of distress and subsequent professional dissatisfaction and b) feelings of job satisfaction deriving from joy and enthusiasm. Overall a) effectiveness and quality of provided care, b) quality of therapeutic relationships between CMHNs and the patients and their family, and c) quality of relationships among colleagues were the main topics described by the participants, related to their work-related emotions. Moreover, the participants described limited autonomy, primarily stemming from administrative and institutional factors, as one of the main factors associated with adverse feelings related to their work environment. CONCLUSIONS: Positive feedback from patients and their families, as well as nursing managers and administrators, in relation to clinical outcomes, may be of immense importance for the development of constructive interventions aiming to empower MHNs, i.e. enhancement of clinical autonomy. [ABSTRACT FROM AUTHOR]

A trusted source of information, the Baby Buddy webapp was co-created with parents and professionals to support the educational role of maternal healthcare providers. However, providers in Cyprus and elsewhere may not actively engage in antenatal education (AE) to make "every contact count". Description of Problem: The impact of Public Health digital interventions can be maximized when adopted in care pathways. To define barriers and enablers in behavioural terms complimentary methods were used guided by the COM-B model and related Theoretical Domains Framework: questionnaire survey (N = 49), focus group (N = 11) and round-table workshops (N = 40) among in-training and registered midwives. Results: Beliefs about the benefits of AE are strong and viewed as a core function of the professional role, yet not supported nor prioritized by current practice. Many problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. Medicalization of birth and socio-cultural norms are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but the phenomenon is complex and also pertains to perceptions and behaviours of service users. There are also issues with procedural knowledge and the need for skill development was identified. Lessons: As a digital tool, Baby Buddy can enrich the user-provider exchange. However, AE beyond the formal setting of the antenatal class is perceived to be a 'bad fit' with current practice. Training (e.g. skills strengthening), persuasion (e.g. reflection on professional identity), enablement (e.g. protocols) were identified as promising intervention functions. Modelling was identified as the most promising both in terms of "credible models" for the role itself as well as re-framing the concept of AE not as preparation for childbirth but in the context of shared decision-making. Key messages: Barriers to being an effective antenatal educator are several, originating from an unsupportive system and wider sociocultural norms of users and providers. In addition to designing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection. [ABSTRACT FROM AUTHOR]

The experiences of people with severe and persistent mental illness (SMI) are neglected by the multidisciplinary therapeutic team or are not included in the treatment plan. Thus a systematic literature review and critical assessment of selected papers was undertaken in relation to qualitative studies of the lived experiences of severe mentally ill persons. The riger of the included studies was assessed by the standardized tool Critical Appraisal Skills Programme (CASP). The literature review was made between May and July 2014. The search took place in the databases CINAHL, Medline, PubMed, PsycInfo and Psychology and Behavioral Science Collection. This review, which integrated the findings from 13 papers, revealed that severely mentally ill persons experience conflict between their self-identity prior to illness and the limitations pased by their illness, loss of their personal and social role identity, diminished self-esteem and insecurity. These experiences may be conceptualized as an ongoing and painful struggle to regain selfidentity and integration into society. Recognition of the significance of personal identity in the continuum of SMI could lead to the development of targeted psychosocial interventions. In addition, the review highlights the need for the empowerment of the mentally ill persons in order to enhance their engagement into the therapeutic process. [ABSTRACT FROM AUTHOR]

Introduction: Various factors of socio-demographic characteristics can affect outcomes of substance abuse such as age, gender, employment history, marital status, education level, or previous history of other neurobiological disorders. Objectives: Exploration of demographic and clinical profile in people involuntary admitted at Cyprus Psychiatric Hospital, with positive substance use history. Methods: A descriptive correlational design was performed with cross-sectional comparisons in a sample of 172 individuals. Data collection following informed consent (12/2012-02/2018) was achieved through individual interviews, using a structured questionnaire. Results: 74.4% of the sample were Greek-Cypriots, 152 male and 20 female, at the age of 25-34. The most frequent clinical diagnosis was schizophrenia or a relevant thought disorder. 1 out of 2 reported a daily use of psychoactive agents, while 68% of the sample met the criteria for a dual diagnosis. Thought disturbances were strongly associated with dual diagnosis (p<0.001), while dual diagnosis was statistically significantly associated with non-adherence to pharmacotherapy and subsequent lack of insight (p=0.003) Cannabis was the most frequently substance used in people 25-34 years (p<0.001), unmarried, (p=0.034), who daily used substances (p=0.006), having a positive history of multiuse (p>0.001) and a clinical diagnosis of though (psychotic) disorders (p=0.001). Conclusions: These data may be relevant for the formation of preventive interventions and education in substance use among people with severe mental illness, and vice versa. Also, re-appraisal of the effectiveness of dual diagnosis treatment programs is also recommended. Furthermore, an acute involuntary short-term residential treatment program is suggested among individuals with substance abuse and dual diagnosis in Cyprus. [ABSTRACT FROM AUTHOR]

Background: The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000-2019., Aims: To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods., Method: Suicide deaths (ICD-10 taxonomy, including 'undetermined' code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods., Results: There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as 'violent' for both genders. The male suicide rate doubled from 4-5 to 9-10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across all age groups; rates in males aged 45-64 years continued to rise, surpassing the previously high rate in males aged 25-44 years. Rates in females declined from 4-5 per 100 000 to 2-3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020, compared with 2.73 (1.88, 3.95) in 2004-2008., Conclusion: Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.

Introduction: Educational strategies for preventive screening and effective interventions in midwives are needed to improve clinical practice and outcomes for abused women and their families. This scoping review aimed to describe available educational training programs on intimate partner violence (IPV) in pregnancy for midwives/student midwives., Methods: A scoping review of the literature, which was published in English from January 2010 to March 2023, in PUBMED, EBSCO, and CINAHAL databases, was applied. The following keywords were used in the search: 'evaluation', 'educational training', 'course', 'midwives', 'student midwife', 'intimate partner violence', 'pregnancy', combined with AND and OR Boolean operators. The included studies focused on training programs/courses for midwives/student midwives regarding intimate partner violence., Results: A total of 9 studies were eligible for inclusion, describing six programs for midwives and 3 for student midwives. Educational interventions varied in length (e.g. a few hours to weeks) and educational approaches such as multidisciplinary sessions, lectures, theory, role-playing, practice in screening, group activities, watching videos, and case reports discussion. The programs had similar content, including raising awareness of violence, defining it, discussing gender roles, the impact of IPV on women's health, referral agencies, and the laws regarding violence in each country., Conclusions: This scoping review highlighted a lack of educational programs on intimate partner violence during pregnancy, suggesting that new programs need to be developed based on contemporary clinical practices and recommendations for midwifery education., Competing Interests: The authors have each completed and submitted an ICMJE form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. N. Middleton reports that he is an unpaid Member of Board of the Scientific Society of the Cyprus Epidemiology and Public Health Association., (© 2024 Manoli E. et al.)

Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for emergency department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek Cypriot ED healthcare professionals' (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, twenty-eight assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. A total of 255 nurses (response rate (RR): 74.1%) and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among emergency department nurses and physicians in the Republic of Cyprus revealed significant deficits. This study stresses targeted interventions, including education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.

Gender-disaggregated data are continuously needed in all aspects of the coronavirus disease 2019 (COVID-19) pandemic, including cerebrovascular disease in patients infected with SARS-CoV-2. This brief review was conducted to summarize available evidence and highlight potential sex differences regarding the incidence, applied therapies, and outcomes of stroke in patients with COVID-19. Local and global registries of such patients were included, where comparisons with historical (pre-pandemic era) and contemporary (stroke patients negative for SARS-CoV-2) cohorts formed the basis of the analysis. According to the herein reported evidence, the frequency of stroke under COVID-19 does not seem to vary according to gender, although a tendency toward male predominance cannot be excluded. In terms of management and outcomes, more advanced therapies are used in men. Follow-up data on gender differences are needed, as the pandemic is evolving (no lockdowns; new strains; vaccinated or naturally immune populations)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mpouzika et al.)

Purpose: Studies on suicide-bereaved parents are scarce in South European and Eastern Mediterranean countries. We explored the experiences of Greek-speaking suicide-bereaved parents in Cyprus, with emphasis on the interpretations of their child's suicide, its aftereffects and their coping strategies., Methods: A qualitative methodology based on inductive content analysis of the interviews of ten mothers and two fathers was applied., Results: The participants described their efforts to make sense of the senseless, reporting numerous interpretations of their child's suicide. Some participants had achieved to move on by trying to keep the remaining family together. Others felt detached from their social network. The different coping strategies and support systems described, reflected participants' efforts to escape from obsessive, enduring and deeply traumatizing thoughts about their child's suicide. The analysis mirrored participants' ultimate desire to find existential relief and serenity through the management of distressing reminders of their child's suicide, and alleviate the burden of their own negative self-judgement and the criticism of others. They sought physical and emotional comfort in the inner realm of their psyche, through spiritual and psychological coping processes., Conclusion: Further exploration is suggested about intervention planning aiming to strengthen effective coping strategies and external supportive resources in mourning parents.

Introduction: Relevant and accurate information during the transition to parenthood is vital for active participation in decision-making. The aim of the study was to gain an in-depth understanding of informational support and information-seeking practices among women in Cyprus during the transition to parenthood with a focus on the use of the internet and informed decision making., Methods: Qualitative descriptive exploratory design of 12 focus groups with 64 participants representing different language-cultural groups served by the Baby Buddy Cyprus app. A topic guide covering expectations, experiences and practices guided the discussions. Data were analyzed using inductive content analysis., Results: Seven themes and several subthemes emerged. In an 'unsupportive system', 'void' of informational support, pregnant women strive to have a 'confident voice'. They find themselves 'self-navigating in parallel worlds' of formal and informal information, where the internet holds a prominent place. 'Supplementing and filtering', instinctively and selectively, results in a state of 'doubt and faith' towards the trustworthiness of the information but also healthcare providers. Effective communication with providers is needed to break the cycle, but seems dependent on the self-efficacy of the women themselves ('art of communication'). Women 'deconstruct and reimagine' their experiences, often assigning responsibility on themselves for not having been better prepared., Conclusions: Women want control over decisions affecting their pregnancy. While the internet is a prevalent source of information, they value communication with healthcare providers and want direction. A shift is needed from current practices of unguided information-searching. Maternity healthcare professionals need to recognize this phenomenon, offer appropriate guidance, and support active participation in informed decision-making., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2023 Koliandri I. et al.)

Background: Despite prior evidence supporting the association between stressful life events and mental health status, there are limited data on the number and severity of stressful life events and their effects on university students' mental health status. Therefore, the present study aimed to: (a) examine mental health status and subsequent predictors of clinically significant mental distress symptoms, (b) estimate the number and severity of stressful life events, and (c) explore the associations between mental health status, stressful life events (number and severity) and sociodemographic characteristics., Methods: This study was descriptive, cross-sectional, and correlational with internal comparisons. A convenience sample of 90 Master of Science in nursing and midwifery students, participated in the study. Participants with a General Health Questionnaire-28 (GHQ-28) total score ≥ 24 were considered to have clinically significant mental distress symptoms. Descriptive and inferential statistics were evaluated, and Pearson's chi-square test for group differences was used to analyse the data. Analysis of variance and t-tests were used for comparisons between two or more groups, and regression analyses were employed to identify the predictors of GHQ-28 scores and clinical mental distress symptoms., Results: The final sample comprised 90 students (response rate: 97.8%), 33 (36.7%) of whom reported clinically significant symptoms of mental distress. Students with divorced parents [29.92 (± 10.62), p < .05] scored high on the GHQ-28. Participants who had low/no satisfaction with the education system posted higher scores than participants who had high/very high satisfaction [24.82 (± 11.68) vs. 17.93 (± 9.78), p < .05]. In the subscale measuring depressive symptoms, there was a statistically significant gender difference, with men reporting higher scores than females. [3.0± (3.69) vs. 1.60 (± 2.42), p = .034]. In multiple analyses of sociodemographic characteristics and those who scored higher on the Life Events Scale for Students (LESS) scale (≥ 340), the loss of parent/s was associated with the total GHQ-28 score (B=-17.046, p < .001). In multiple analyses, chronic physical disorders or disabilities and numerous stressful life events among students (≥ 8 events) were correlated with higher overall GHQ-28 scores (B = 15.232, p < .005)., Conclusion: The high frequency of clinical symptoms of mental distress among postgraduate university nursing students and their correlation with stressful life events highlights the need for university counselling services to provide psychological support strategies to students., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.

Aim: To understand the meaning of surviving out of hospital cardiac arrest and its aftereffects among Greek-speaking survivors., Design: Hermeneutical phenomenological method based on Martin Heidegger's philosophy., Methods: Eight Greek-speaking out of hospital cardiac arrest survivors were recruited using purposive sampling method. Data collection and analysis using the seven stages of hermeneutic analysis described by Diekelman. Data were collected through semi-structured personal interviews with open-ended questions., Results: Analysis revealed five themes: 'The unexpected attack', 'Experiencing a different world: Transformation of Body, Time, Emotion and Sensation', 'Restoration of the re-embodied self', 'Life transformation' and 'Personal transformation'. The themes are commensurate with transcultural components of Near-Death Experiences. Surviving out of hospital cardiac arrest was perceived as a 'divine gift' and a chance to continue 'living in a more conscious and meaningful way'. Despite participants' physical and psychosocial challenges, the narratives highlighted a newly acquired deep appreciation for the joy of life, living and others. Construction of meaning and a heightened spirituality seem central in reconstructing life after out of hospital cardiac arrest survivors., Patient or Public Contribution: Out of hospital cardiac arrest survivors reflected and described in-depth on their lived experiences of out of hospital cardiac arrest through a 60- to 90-min interview. In addition, the participants provided their feedback on the interpretation of the findings, confirmed the study findings, and ensured that the analysis reflected aspects of their individual experiences and were true to them., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Although international research-based literature from the last 2 decades seems to favor the use of medical cannabis (MC), there is a lack of evidence concerning healthcare students' education on MC in the Republic of Cyprus and across the world. Therefore, this study explores healthcare students' attitudes, beliefs, and knowledge regarding the use of MC. We paid special attention to differences across specific sociodemographic (gender, age, and religion status) and educational (level of study and study field) characteristics., Methods: A descriptive cross-sectional study was conducted between November 2019 and March 2020. All active undergraduate and postgraduate healthcare students (nurses, physiotherapists, speech therapists, pharmacists, and occupational therapists; N  = 900) studying in public and private universities in the Republic of Cyprus were eligible to participate (final sample: N  = 819, response rate = 91%). To collect data on the attitudes, beliefs and knowledge of the participants, we used the Medical Cannabis Questionnaire (MCQ). To analyze the data, we employed the Pearson's chi-square test for group differences, in addition to assessing the descriptive and inferential statistics., Results: Approximately 82.2% believed that MC education should be integrated into the clinical practice requirements. Statistically significant differences were observed between genders in terms of beliefs/risk associated with the use of MC, with males being more likely to believe that there are significant mental-health benefits associated with using ΜC compared to females (84.9% vs. 76.2%, p <0.05). Females were more likely than males to believe that using MC poses serious physical (76.8% vs. 60.6%, p <0.001) and mental-health (77.9% vs. 66%, p <0.001) risks. Moreover, participants who received formal education about MC during their study/training were more prepared to answer patient/client questions about ΜC ( p  < 0.001). In addition, participants who received formal education had more frequently friends ( p  < 0.001) or family members who used MC ( p  < 0.005)., Conclusion: This study provides useful information for curriculum development, educational changes, and policy decisions related to cannabis use for medical purposes in the Republic of Cyprus. The results showed that the majority of the healthcare students who participated in the study favored MC use. However, the participants reported a lack of knowledge and recommended additional evidence-based research and education to enhance their knowledge about MC use. Therefore, we recommend the implementation of formal education on MC among healthcare students in the Republic of Cyprus during their study and clinical training. Furthermore, it is important to include MC-related theoretical and clinical/laboratory courses during studies and clinical practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sokratous, Mpouzika, Kaikoushi, Alexandrou and Karanikola.)

Background: There is limited evidence on the association between cognitive function, psychotic symptoms and doses of antipsychotics in adults under compulsory psychiatric care., Aims: We assessed (a) the degree of cognitive impairment in adults involuntarily hospitalised for compulsory psychiatric care and (b) correlation of Montreal Cognitive Assessment (MoCA) score with psychotic symptoms, polypharmacy and prescription of high-dose antipsychotics., Method: This was a nationwide, cross-sectional study, conducted at the only referral state hospital for compulsory psychiatric care in Cyprus (December 2016-February 2018). Τhe MoCA was applied for the assessment of cognitive functioning. The Positive and Negative Syndrome Scale (PANSS) was applied for the assessment of psychotic symptoms., Results: The sample comprised 187 men and 116 women. The mean MoCA score was 22.09 (reported scale range (RSR): 3-30); the mean PANSS general symptoms subscale score was 49.60 (RSR = 41-162). The participants who reported positive psychiatric history (mean 21.71, s.d. 5.37), non-adherence to pharmacotherapy (mean 21.32, s.d. 5.56) and prescription of high-dose antipsychotics (with medication prescribed as needed: mean 21.31, s.d. 5.70; without medication prescribed as needed: mean 20.71, s.d. 5.78) had lower mean MoCA scores compared with those who reported negative psychiatric history (mean 23.42, s.d. 4.51; P = 0.017), adherence to pharmacotherapy (mean 23.10, s.d. 6.61; P = 0.003) and no prescription of high-dose antipsychotics (with medication prescribed as needed: mean 22.56, s.d. 4.90; without medication prescribed as needed: mean 22.60 s.d. 4.94; P = 0.045-0.005), respectively. Mean MoCA score was mildly and inversely associated with total PANSS score ( r = -0.15, P = 0.03), PANSS general ( r = -0.18, P = 0.002) and PANSS negative ( r = -0.16, P = 0.005) symptoms subscales, respectively., Conclusions: Our findings support the evaluation of cognitive functioning in adults under compulsory psychiatric care via the MoCA tool, with focus on those prescribed high-dose antipsychotics, with positive mental health history and non-adherence to pharmacotherapy.

WHAT IS KNOWN ON THE SUBJECT?: Losing a family member due to suicide has been described as a traumatic experience, as suicide-bereaved relatives grapple to accept the particular character of death and the core elements of guilt, self-criticism and stigma it inflicts. There are long-term consequences for those who bereave due to the suicide of their beloved on, a high risk for mental and physical health problems included. Feelings of guilt and self-stigma influence help-seeking behaviour among suicide-bereaved individuals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Coping mechanisms adopted by suicide-bereaved individuals mediate the impact of suicide on their family, and especially on the quality of relationships among them. Supporting others in need can help alleviate guilt and self-blame for the suicide while it enables the bereaved to fulfil their need to keep a non-traumatizing, or even positive bond with the deceased. WHAT THE IMPLICATIONS FOR PRACTICE ARE?: Nursing interventions to facilitate suicide-bereaved family members' participation in self-help support groups and promote their engagement in supporting others in need are important. Mental health nurses need to facilitate the replacement of dysfunctional coping strategies, such as substance use or self-blame with more adaptive ones focused on the personal needs of the bereaved, in order to help them embrace a non-traumatizing memory of the deceased while being in peace with the social environment. Screening for mental health problems and management of shame, self-stigma and guilt during the grieving period needs to be a priority in nursing interventions., Abstract: INTRODUCTION: Losing a family member to suicide is a traumatic experience which includes guilt and self-stigma. Yet, there is lack of data synthesis on the survivors' experience., Aim: A meta-synthesis of qualitative data on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on family., Method: A meta-ethnographic synthesis following a systematic literature search and evaluation of the methodological quality of the selected studies was applied., Results: The narratives of 326 individuals (parents/siblings/children/spouses) reported in sixteen studies were analysed. Trying to achieve a balance between keeping alive a non-traumatizing memory of the deceased, destigmatizing and liberating themselves from self-blame, self-criticism and guilt while being able to transform this experience into support towards others in need, was identified as the essence of the experience of the bereaved., Discussion: Although suicide within a family is a traumatic experience, spiritual and existential implications among the bereaved have been reported; their coping mechanisms mediate the impact of suicide on family sustainability., Implications for Practice: Nursing interventions to facilitate adoption of coping strategies centred on keeping a non-traumatizing memory of the deceased among the bereaved and promote their participation in self-help groups and activities to support others in need are important., (© 2022 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Background: Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. While using Baby Buddy in routine consultations can support the educational role of mother-child healthcare providers (HP), antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of influences on midwives engaging in an educational role during routine appointments and identify potential interventions using the Behaviour Change Wheel (BCW) framework., Methods: This is a formative mixed-methods research study, with a convergent parallel design, guided by the COM-B model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis shaped the behaviour diagnosis along the 6 COM-B and 14 TDF domains, and informed the selection of relevant intervention functions and related Behaviour Change Techniques from the BCW taxonomy., Results: AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there might be issues with procedural knowledge and the need for skill development was identified. Several intervention functions were identified as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing "credible models" for the role itself as well as re-framing AE through the concept of "making every contact count"., Conclusions: AE is currently perceived to be a 'bad fit' with routine practice. The study identified several barriers to the educational role of midwives, influencing Capacity, Opportunity and Motivation. While digital tools, such as Baby Buddy, can facilitate aspects of the process, a much wider behaviour and system change intervention is needed to enhance midwives' educational role and professional identity. In addition to proposing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection., (© 2022. The Author(s).)

Nurses may be at a higher risk of experiencing work-related traumatic stress response during the COVID-19 pandemic compared to other clinicians. This study aimed to investigate the correlations between work-related trauma symptoms and demographic factors, psychosocial hazards and stress response in a census sample of nurses working in COVID-19 settings in Cyprus. In this nationwide descriptive and cross-sectional study, data were collected between April and May 2020 using a questionnaire that included sociodemographic, educational and employment and work-related variables, as well as a modified version of the Secondary Traumatic Stress Scale (STSS) for the assessment of work-related trauma symptoms during the pandemic. Overall, 233 nurses participated (with a response rate of 61.3%) and 25.7% of them reported clinical work-related trauma symptoms (STSS-M > 55; actual scale range: 17-85). The mean value for emotional exhaustion was 7.3 (SD: 2.29; visual scale range: 1-10), while the value for distress that was caused by being avoided due to work in COVID-19 units was 6.98 (SD: 2.69; visual scale range: 1-10). Positive associations were noted between trauma symptoms and both emotional exhaustion and distress from being avoided by others due to work in a COVID-19 setting and a negative association was also found between trauma symptoms and satisfaction from organizational support variables (all p < 0.002). Working in COVID-19 settings during the pandemic is a stressful experience that has been linked to psychologically traumatic symptoms Thus, supportive measures are proposed for healthcare personnel, even in countries with low COVID-19 burden.

Τhe severity and variation of depressive symptoms (DS), among psychotic individuals under involuntary hospitalization is unclear. We investigated the socio-demographic and clinical characteristics of psychotic adults with DS involuntarily hospitalized for compulsory treatment in Cyprus. We also evaluated the psychometric properties (internal consistency, known-group and discriminant validity) of the HDRS-17 and HAM-A for the assessment of depressive and anxiety symptoms, respectively. A descriptive correlational study with cross-sectional comparisons was applied. Data on demographics, cognitive functioning (MoCA scale), depressive (HDRS-17 scale), anxiety (HAM-A scale) and psychotic (PANSS scale) symptoms were collected (December 2016 -February 2018). Following informed consent, the sample included 406 patients. Among them, 21 males and 23 females reported DS (HDRS-17 total score ≥8). The latter were mainly Greek-Cypriots (61.4%), 45-65 years old (38.6%), single (77.3%), unemployed (72.7%), mainly admitted due to aggressiveness towards others (47.7%), most frequently diagnosed with a bipolar disorder (59.1%). The mean score (M) in the HDRS-17 was 30.72 (scale range: 8-50; Standard Deviation [SD]: 10.42). The highest mean score (M) per item was in the variables "Suicide behavior"'(M:3.09; SD:1.09) and "Depressive mood" (M=2.95; SD=1.07). The DS group (HDRS-17 score≥8) reported higher PANSS positive symptoms subscale score (t-test, p=0.003) and HAM-A total score (t-test, p=0.05) compared to the non-DS group (HDRS-17 score<8). In multivariable logistic regression analysis only female sex [OR (95%CI) = 3.28 (1.33.-8.04), p=0.01)] and a mood disorder diagnosis [OR95% CI: 15.22(4.13.-56.14), p<0.0001)] retained a statistically significant association with DS. Cronbach' s alpha was 0.827 for the HDRS, and 0.763 for the HAM-A. The present findings partially support the known-group validity of the HDRS-17 and the ΗΑΜ-Α, and the discriminant validity of the HDRS-17 in psychotic patients under involuntary hospitalization. Additionally, the most frequent diagnosis in the DS group was a bipolar disorder, and the most frequent admission cause was aggressiveness towards others; it is possible that the majority of the DS group participants were patients with a bipolar disorder in episodes with mixed features, presenting simultaneously depressive symptoms and aggressiveness. Further studies on relapse prevention regarding this clinical group are proposed, as well as studies on specificity and sensitivity of the HDRS-17 and HAM-A.

Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide., Objective: This protocol describes the study "Management of my Bipolarity" (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform., Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0)., Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors., Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life., Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210., International Registered Report Identifier (irrid): DERR1-10.2196/25168., (©Anna Hatzioannou, Andreas Hatzittofis, Virginia Sunday Koutroubas, Evridiki Papastavrou, Maria Karanikola. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.09.2021.)

Objectives: Patients' experience of psychological distress in the intensive care unit (ICU) is associated with adverse effects, reduced satisfaction, and delayed physical and psychological recovery. There are no specific guidelines for the assessment and management of acute psychological distress during hospitalisation in the ICU. We reviewed existing tools for the assessment of acute psychological distress in ICU patients, examined evidence on their metric properties, and identified potential gaps and methodological considerations., Method: A scoping review based on literature searches (Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted as per current scoping review guidelines., Findings: Overall, 14 assessment tools were identified having been developed in diverse ICU settings. The identified tools assess mainly anxiety and depressive symptoms and ICU stressors, and investigators have reported various validity and reliability metrics. It was unclear whether available tools can be used in specific groups, such as noncommunicative patients and patients with delirium, brain trauma, stroke, sedation, and cognitive impairments., Conclusion: Available tools have methodological limitations worth considering in future investigations. Given the high prevalence of psychiatric morbidity in ICU survivors, rigorously exploring the metric integrity of available tools used for anxiety, depressive, and psychological distress symptom assessment in the vulnerable ICU population is a practice and research priority., Relevance to Clinical Practice: These results have implications for the selection and implementation of psychological distress assessment methods as a means for promoting meaningful patient-centred clinical outcomes and humanising ICU care experiences., Competing Interests: Conflict of Interest There is no conflict of interest to disclose., (Copyright © 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients., Aims: We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns., Method: This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded., Results: Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included., Conclusions: A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [ Research in Gerontological Nursing, 14 (3), 150-159.].

Objective: To synthesize current evidence on nurses' attitudes and/or knowledge on the entire spectrum of patient rights., Method: A systematic search of the literature was performed in Web of Science, PubMed, Scopus and CINAHL. Studies were selected according to pre-defined inclusion/exclusion criteria. The Cochrane and PRISMA guidelines, including templates for systematic reviews, were applied. For rigor assessment, the Critical Appraisal Skills Program Qualitative Research Checklist, and the Center for Evidence-Based Management tool were employed., Results: Thirteen studies were included, that exhibited important methodological limitations, such as convenience sampling, mediocre response rates and inadequate instrument validity. Findings indicated: a) low level of awareness regarding patient rights among nurses, b) knowledge discrepancies on specific aspects of patient rights, c) low priority ascribed to a patient's right to access information, and d) insufficient evidence on formal educational sources of knowledge on the topic of patient rights., Conclusion: Narrow geographical localization, heterogeneity and methodological limitations render generalizability of the conclusions difficult. Further research based on robust methodology is proposed.