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Purpose People who identify as transgender face stigma, isolation and harassment while often struggling to come to terms with their gender identity. They also disproportionately experience mental health difficulties. The purpose of this paper is to present the voices of transgender people in the Republic of Ireland (RoI) in regard to the issues they are facing, improvements they would like to see made to schools, workplaces, services and society in general and whether mental health supports fulfil their needs. Design/methodology/approach Ten open questions were embedded within a quantitative online survey (LGBTIreland study) on factors impacting social inclusion, mental health and care. These open questions were re-analysed with exclusive focus on the transgender participants (n = 279) using content/thematic analysis. Findings The participants in this study reported significant signs of mental distress. The following themes emerged: impact of stigma, deficiencies in mental health services, need for education on transgender identity, importance of peer support, achieving self-acceptance and societal inclusion questioned. Research limitations/implications Efforts to recruit young participants have led to a possible over-representation in this study. Practical implications The findings suggest the need for improvement in mental health support services, including further education in how to meet the needs of transgender individuals. Social implications Transgender people in Ireland experience social exclusion. The need for more inclusivity was emphasised most in secondary schools. Education on transgender identities in all contexts of society is recommended by the participants. Originality/value This study reports on the largest group of transgender participants to date in RoI. Their voices will affect perceptions on social inclusion and mental health care.

Anorexia nervosa presents as an international public health concern as it is the mental health problem with the greatest risk of mortality, and the average age of onset is decreasing. For those experiencing anorexia nervosa, mealtimes have long been recognized as a difficult and distressing time when young people need additional support. However, the post mealtime period can be associated with even greater distress, yet there is little research on interventions to support young people in this vulnerable time, and even less on how young people experience these interventions. This study, therefore, explores young peoples' perceptions of mealtimes and a post mealtime support group. Using a qualitative descriptive design, telephone interviews were conducted with a purposive sample of six young people who participated in a post-meal support group while an inpatient in a Child and Adolescent Mental Health Unit. Using a semi-structured interview guide, participants were asked about their experiences of this support group and their perceptions of how to improve this intervention. Content analysis resulted in the development of three themes: 'The Challenges of Mealtimes and Post Mealtimes', 'The Benefits of Post-meal Support Groups', and 'Improving Unhelpful Aspects of Post-meal Support Groups'. Findings are reported in accordance with COREQ guidelines and suggest that for young people experiencing anorexia nervosa, post mealtimes are often more distressing than the meal itself and that participants found post-meal support groups to be a helpful intervention in reducing post-mealtime distress. Post-meal support groups can be improved by ensuring a consistent approach from staff and providing staff with the training and knowledge required to support those affected by eating disorders.

Irish Travellers are a small indigenous minority group with a distinctive lifestyle and culture which sets them apart from the general population. Travellers are vulnerable to significant mental distress which is exacerbated by the social disadvantage that they experience. A Traveller Mental Health Liaison Nurse (TMHLN) was introduced in one health care region in Ireland to provide support for Travellers and increase their access to mental health services. The aim of this paper is to present the findings from an evaluation which explored Travellers access to and reasons for accessing the TMHLN, the interventions provided and their experiences of and perceptions of the role of the TMHLN. A descriptive qualitative approach was used. Ten Travellers who used the service were interviewed. Following data analysis, three themes emerged: factors affecting Traveller mental health; accessing the TMHLN and the Travellers experiences and perceptions of the TMHLN. The participants were extremely positive about the TMHLN and valued the support provided. The findings highlight how the interpersonal skills associated with mental health nursing set against recovery orientated and culturally congruent practices are suitable approaches when working with Travellers.

OBJECTIVE The objectives of this review are: to explore the lived experiences of individuals with a diagnosis of borderline personality disorder (BPD) and to present recommendations for policy, practice, education and research. INTRODUCTION Borderline personality disorder is a mental disorder characterized by poor capacity to engage in effective relationships, intense and sudden mood changes, poor self-image and emotion regulation, significant impulsivity and severe functional impairment. Studies estimate the prevalence of BPD at 15% to 22% and identify a predominantly negative attitude among health professionals towards individuals with BPD. This review will examine the lived experiences of people with a diagnosis of BPD in order to better understand this condition. INCLUSION CRITERIA This review will include peer-reviewed qualitative studies on adults with a diagnosis of BPD in all settings and from any geographical location. METHODS A three-step search strategy will be used. A search strategy has been developed for MEDLINE. A second search using all identified keywords and index terms will be conducted across MEDLINE, CINAHL, PsycINFO and Embase. Studies will be screened by title and abstract by two independent reviewers against the review inclusion criteria. The full text of selected citations will be assessed against the inclusion criteria and for methodological quality. Qualitative data will be extracted from included papers using a standardized data extraction tool. Qualitative research findings will be pooled using the meta-aggregation approach. The final synthesized findings will be graded according to the ConQual approach and presented in a Summary of Findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019141098.

Higher Education Institutions (HEIs) have the potential to impact positively on the health and wellbeing of their staff and students. Using and expanding on the 'health promoting university' (HPU) platform within HEIs, this article provides a description of 'Healthy Trinity', which is an initiative underway in Trinity College Dublin, the University of Dublin. First, Healthy Trinity is contextualized in background literature including international and national policy and practice. Second, an overview of Healthy Trinity is provided including its vision and goals. Third, the article describes the steps taken relating to the identification of stakeholders and use of a network and a co-lead model. Within this approach, the article describes a partnership approach whereby responsibilities regarding health and wellbeing are shared by individuals and the institution. Fourth, the design and implementation of Healthy Trinity is discussed by taking a 'settings approach', in which the emphasis for change is placed on individual behaviours, environment, policy and organizational culture. Consideration is given to the interplay between intervention, implementation strategy and context for successful systemic implementation. The fifth element presented is the early-stage challenges encountered during implementation, such as the need to secure recurrent funding and the importance of having a direct input to the governance of the University to enable systemic change. The sixth and final component of the article is an outline of Healthy Trinity's intention to utilize a process evaluation of the early implementation phases of this complex intervention within a settings approach. Potential deliverables and impacts of this HPU initiative are presented and discussed.Universities, such as Trinity College Dublin, the University of Dublin, can be looked at as a community of staff and students. The university community has needs in terms of health and wellbeing. ‘Healthy Trinity’ attempted to build strategies and practices to meet these needs for its community. The approach taken was from multiple angles and involved students and staff, focusing on both individual and organizational responsibility to promote and encourage healthy behaviours. Healthy Trinity achieved some successes as well as encountering some challenges. This article explores how the university might build upon the successes of Healthy Trinity in order to embed a culture which prioritizes health and wellbeing for the entire university community. The article also looks at the broader impact of achieving this goal, namely the University’s contribution to a healthier community beyond the university setting.

Background Qualitative descriptive designs are common in nursing and healthcare research due to their inherent simplicity, flexibility and utility in diverse healthcare contexts. However, the application of descriptive research is sometimes critiqued in terms of scientific rigor. Inconsistency in decision making within the research process coupled with a lack of transparency has created issues of credibility for this type of approach. It can be difficult to clearly differentiate what constitutes a descriptive research design from the range of other methodologies at the disposal of qualitative researchers. Aims This paper provides an overview of qualitative descriptive research, orientates to the underlying philosophical perspectives and key characteristics that define this approach and identifies the implications for healthcare practice and policy. Methods and results Using real-world examples from healthcare research, the paper provides insight to the practical application of descriptive research at all stages of the design process and identifies the critical elements that should be explicit when applying this approach. Conclusions By adding to the existing knowledge base, this paper enhances the information available to researchers who wish to use the qualitative descriptive approach, influencing the standard of how this approach is employed in healthcare research.

Irish Travellers are a minority ethnic group within the Irish state with a distinct culture and set of traditions. Travellers experience mental health inequalities, high rates of mental ill health, and structural and individual barriers to mental health supports. A Traveller Mental Health Liaison Nurse (TMHLN) was introduced in a healthcare region in Ireland to provide greater mental health-related support to Travellers. This paper presents a description of the TMHLN role following a multi-stakeholder evaluation. The research design was descriptive qualitative and the findings are reported using COREQ criteria. Thirty-four key stakeholders were interviewed individually or as part of focus groups. Thematic analysis generated two broad themes: the role context, and the specific activities of the role. Mental health nursing experience and understanding of local issues and services were key, as was use of language, building trusting relations, creating the metaphorical, and having the physical, space for working. Specific activities involved in-reach and outreach work, including one-to-one mental health support provision, delivery of education/training sessions to Travellers and service providers, (re)establishing links to specialist services, integrated and interagency working, and promoting cultural competency. The findings set out a role with a greater emphasis on the use of recovery technologies, having an emphasis on psychosocial interventions and self-care, and less focus on biomedical technologies, signs and symptoms, and clinical outcomes. This study contributes to knowledge on the role of a MHLN as this relates to working with marginalized minority groups.

This paper explores factors which contribute to happiness among lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals as part of the largest study to date of mental health in the LGBTI community in the Republic of Ireland (LGBTIreland study). This mixed methods study informed by minority stress theory, contained an online survey (n = 2,264) which explored various aspects of mental health and distress, but also the extent and experience of happiness and concomitant factors. The survey included ratings of happiness and life-satisfaction and an open-ended question on LGBTI related happiness. Quantitative findings showed a mean happiness rating of 6.58 out of 10 (11-point scale), which is lower than the general population in Ireland. Those identifying as gay men or lesbian women rated their happiness significantly higher than bisexual, transgender, or intersex participants. There was also an effect for age: teenage LGBTI participants had significantly lower ratings than other age groups. Happiness ratings very highly correlated with life-satisfaction (.88). A multiple linear regression showed happiness was predicted most significantly by self-esteem and being in a relationship. Qualitative findings emphasized the importance of self-acceptance and peer support for happiness. Findings are discussed using the minority stress perspective and cognitive dissonance theory.

Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient's symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication; however, many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings; however, this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people's experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short-term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision-making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.

PurposeThis study explores how individual, dyad and team levels of learning interact in public healthcare medical teams.Design/methodology/approachA single interpretive case study is carried out in the public Health Service Executive (HSE) in Ireland, involving three rounds of semi-structured interviews with non-consultant hospital doctors (NCHDs), supported by relevant professional documentation and researcher log entries.FindingsAn experience hierarchy, interpersonal relationships and social dynamics form the backdrop to learning interactions within public healthcare medical teams. Individual and team learning primarily occur in informal settings where interpreting and developing understanding takes place either in dyads, small groups or with the whole team. NCHD learning may vary depending on how effectively they build interpersonal relationships, take advantage of informal learning opportunities and manage the social dynamics within their team. Willingness and confidence to share insights and asking questions are triggers for individual and team learning.Research limitations/implicationsAs a single case study focused on the HSE NCHD individual and team learning experience, this research study represents a relatively small exploration of individual and team learning interplay in the public healthcare medical team environment. The development of learning theory in this domain presents an intriguing avenue of further research, including observation of interactions within a team.Practical implicationsThe findings have practical relevance to those who are interested in the effectiveness of post-graduate/ NCHD learning in the public healthcare system. Interpersonal relationships and social norms play strong roles in how interaction and learning occurs in a team. These findings highlight the challenge of ensuring consistent quality across individual NCHDs or across hospital sites when training is heavily influenced by the approach of senior colleagues/ consultants to their more junior colleagues and the degree to which they take an active interest in NCHD learning.Originality/valueThe proposed learning framework is a key theoretical contribution, which draws upon the multi-levels of learning and provides greater insight into how individual, dyad and team learning interact in public healthcare medical teams when managing patient care. The findings have practical relevance in how to facilitate effective teamwork and learning interactions and for those who are interested in the consistency and quality of the training experience for NCHDs.

Mental health nursing in the forensic services is perceived as stressful as there is often a tension between therapeutic and custodial processes. Clinical supervision has been discussed as a support strategy for nurses. The aim of this paper is to explore forensic mental health nurses understanding of clinical supervision and their perception of its utility within their practice. A qualitative descriptive method was used and 10 mental health nurses were interviewed with the aid of an interview guide. Qualitative data was analysed using a thematic approach culminating in the emergence of three themes.Participants talked about the tension between caring and custodial roles within the forensic services which was stressful and created difficulties in the maintenance of a therapeutic relationship. Clinical supervision was seen as a necessary support to assist nurses working in the forensic services. The findings support the premise that there is a tension between therapeutic and custodial practices. Acknowledgement of the complexities of working within the forensic services and the provision of clinical supervision within a confidential, non-judgemental relationship may assist nurses in the provision of care and the maintenance of therapeutic relationships.

Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention’s implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. Conclusion Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

Background: Psychoeducation provides a range of benefits to service users with severe mental health illness and their family members. A lack of engagement with mental health services may lead to poorer outcomes and increased healthcare costs. Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. Methods: The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n=75) involved with the programme within 14 mental health sites in the Republic of Ireland. Results: Enablers and barriers to engagement were identified at participant, provider and programme level. Motivated participants and clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included a lack of motivation and readiness among participants, concerns related to stigma and confidentiality, a lack of support for programme participation within families, group discomfort, issues with accessing transport, the time and length of the programme being unsuitable for some participants and a lack of capacity among clinicians.Conclusion: Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.

Involving and supporting the family members and caregivers of people with mental illness is essential to high-quality mental health services. However, literature suggests that there is a lack of engagement between family members and mental health nurses (MHNs). Lack of knowledge among MHNs is often cited as one of the main reasons for this lack of engagement. The aim of this review was to explore the knowledge, skills and attitudes that are required by MHNs to enable to them to work more effectively with families affected by mental illness. A literature based critical review was used to access and review 35 papers in order to extract concepts that could inform the design of eLearning materials to assist MHNs advance their knowledge in this area. Two overarching themes were identified; 'Mental health problems and the family' and 'Working with the family'. From these themes, the knowledge, skills and attitudes required to work more effectively with families are described. The findings from this review provide a descriptive account of the knowledge skills and attitudes that are required for effective family work. In addition, the review provides an empirical foundation for education programmes in the area.

In this study, we address the kind of knowledge that is required for Master’s level nurse education for lifespan mental health promotion and prevention. Data were collected through structured inter...

There is an increased interest in the experiences of youth who identify as trans* to promote individual human rights and provide socially inclusive health and social care. This scoping review aimed to explore the experiences of youth who identify as trans*. A full search of relevant electronic databases was undertaken from the years 2006 to 2016. The search resulted in 1,656 hits and following the application of rigorous criteria, 20 papers were included in the final review. Date extraction was executed by two of the authors and a quality assessment tool was used to review the papers. The data were analyzed, and the key themes that emerged included the following: stigma, discrimination, and mental health; family relationships and supports; educational concerns; health care experiences; and vulnerability and health risks. The findings from the review are discussed, and the implications for policy, research, education, and practice are highlighted.

Schools are a key setting for mental health promotion and the provision of emotional support to students. As teachers and school counsellors are adults with whom adolescents have regular contact, it is likely they would be used as a help source by distressed students however there are few studies on this from an Irish context. A mixed methods design was used to identify the extent of adolescent help-seeking in addition to exploring what influences a young person’s decision to seek help in school. Findings generated through surveys (N = 856) and four focus group interviews (N = 35) with adolescents indicate that young people do not regard teachers and school counsellors as a potential help source. Barriers to seeking help include dislike of the dual role of counsellor/teacher and concerns about confidentiality. The provision of independent school counselling and increased mental health education were identified as factors that might increase help-seeking in school.

Mixed methods have become increasingly popular in health-related research, allowing a broader and deeper understanding of complex human phenomena. This growth in popularity has increased the range of usage and complexity in design approaches, producing greater need for understanding of logistical and practical application in this field. This paper aims to provide an overview of mixed methods research and orientate readers to the critical issues that arise for researchers. It provides an introduction to mixed methods design and the rationale and philosophical underpinnings for this methodological approach. It navigates the reader through some real world or ‘hot’ topics within mixed methods, including data analysis, integration and quality appraisal criteria.

Aim The aim of this study is to explore mental health student nurses’ perceptions and application of a CBT-orientated training programme – the Decider Life Skills programme. Background The undergraduate nursing degree programme is a challenging one and places high demands both professionally and personally on students. Mental health nursing students are faced with particular stressors including working with people in significant psychological distress, which can result in students feeling overwhelmed and emotionally burdened. There is a requirement for student nurses to be supported to cope with professional and personal difficulties while on practice placement. The Decider Life Skills is a one-day training programme that aims to build resilience and increase effective coping skills. This programme was offered to internship mental health nursing students with the aim of providing them with a toolbox of skills to maintain their wellbeing while on clinical placement. Methods A qualitative descriptive design was used, and data were collected through two 45-min focus group interviews with mental health students (n = 10) on their internship placement. These students had received a one-day training in Decider Life Skills prior to their clinical placements. Full ethical approval was achieved for this study. Results Participants reported that they found the skills imparted in the training easy to understand and apply in both their professional and their personal lives. Conclusions The findings from this study that the Decider Life Skills helped students cope in stressful situations and become more mindful of protecting their own mental health is important, as there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners.

Caring for people who self-harm is an everyday experience for mental health nurses and an important part of their role. How mental health nurses respond to and support those who self-harm can have a significant impact on the outcomes for service users and their intentions to seek help in the future. Repeated self-harm can be a particularly challenging phenomenon as it is often misunderstood and can have a negative impact on the therapeutic relationship. This qualitative descriptive study aims to explore how mental health nurses understand and work with repeated self-harm. Nine nurses working in a range of mental health settings within one service participated in semi-structured interviews which were analysed thematically. Findings are presented in two themes exploring participants' perceptions and understanding of repeated self-harm, and the process of learning to work with repeated self-harm, and are reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Participants reported that nursing practice relating to repeated self-harm remains largely focused on maintenance of safety and prevention of self-harm despite the identification that this often does not work. It was accepted that there is sometimes a lack of understanding about the function of self-harm; however, participants reported understanding increased following specific education about self-harm. Participants also identified the potential for more empowering and recovery-orientated responses, including the utilization of harm reduction approaches, to the care of those who repeatedly self-harm.

Objectives: This study evaluated the impact of a one-day mental health Wellness Workshop on participants’ mental health and attitudes towards mental health. Design: Convergent, longitudinal mixed-methods approach. Setting: The study evaluated Wellness Workshops which took place throughout the Republic of Ireland. Method: Questionnaires measuring hope, mental health self-efficacy, attitudes towards mental health and perceived impact on wellbeing were administered to participants before the workshop ( n = 415), 1 week after ( n = 221) and 3 months after ( n = 110). Semi-structured interviews were carried out with 24 participants to generate a more in-depth understanding of the impact of the workshop. Results: Quantitative findings relating to hope, mental health self-efficacy and attitudes towards mental health did not identify statistically significant changes; however, participants’ perceptions of the effect of the workshop on wellbeing suggested a positive impact which was maintained over time. Qualitative findings, however, suggested that hope and self-efficacy were improved and the simplicity and utility of the wellness strategies disseminated in the workshop, in addition to the warmth and openness of the narrative approach used by the facilitators, were central to the perceived positive impact. Conclusion: This evaluation demonstrates the potential for wellness interventions to have a subjective improvement in wellbeing in members of the general public.

School-based studies identify that while 1 in 10 young people engages in self-harm, only a small minority seek professional help. School counsellors and teachers are potentially the only professionals who may be aware of a young person’s self-harm; however, little is known about how this impacts on them and how they might be best supported to respond to distressed students. This study employed a qualitative descriptive design to explore post-primary school teachers’ and guidance counsellors’ (n = 6) experiences of and responses to self-harm in Ireland. Findings indicated that participants react to self-harm in a highly emotional way with less experienced staff expressing more anxiety. Guidance counsellors and teachers identified the need for additional time, training, and professional support to help them respond to what is a commonly occurring phenomenon. Implications for the provision of support to students who self-harm are discussed.

Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery.

The aim of this paper is to review the relevant literature on organisational learning and offer a preliminary conceptual framework as a basis to explore how the multi-levels of individual learning and team learning interact in a public healthcare organisation. The organisational learning literature highlights a need for further understanding of how the multi-levels of organisational learning interact and a broadly accepted theory of organisational learning has not yet emerged. Organisational learning is a multi-level concept and while there has been some multi-level research, more is required to understand the mechanisms that facilitate the flow of learning between the levels. This paper explores multi-level learning, using action learning as a basis through which we consider how individual learning and team learning interact. The preliminary conceptual framework seeks to contribute to our understanding of the interaction between the individual and team levels of learning and the processes and con...

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.

Adolescent self-harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help-seeking for self-harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self-harm in an urban region in Ireland, and to investigate help-seeking behaviours for self-harm. This was a cross-sectional study of 856 school-going adolescents, employing an anonymous self-report questionnaire. A lifetime history of self-harm was reported by 12.1% of adolescents. Factors independently associated with self-harm included exposure to self-harm of a friend/family member. Professional help-seeking was uncommon prior to (9%) and after (12%) self-harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self-harm act. These findings indicate that self-harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the 'tip of the iceberg' of adolescent self-harm. Identifying the prevalence of self-harm and associated factors, in addition to help-seeking behaviours, in young people is important to determine the preventative programmes to target 'at-risk' groups. Mental health nurses have an important and increasing role to play in such school-based initiatives.

Problem Adolescent self-harm is a common phenomenon; however, little is known about young peoples' attitudes toward self-harm and what they believe can be done to prevent it. This study aimed to identify adolescents' attitudes about self-harm and their perspectives on preventing it. Methods A cross-sectional anonymous survey was administered to 856 post-primary school students across 11 schools in Dublin, Ireland. Attitudes toward self-harm were captured through a five-item scale and views on prevention of self-harm were captured through an open-ended survey question. Responses from those who self-harmed and those who did not were compared to identify differences. Findings Significant differences were identified between those who self-harmed and their peers. Those who self-harmed were less likely to believe that self-harm was carried out to get attention or was a result of loneliness or depression; they were more likely to believe that self-harm was impulsive. Findings demonstrated that a majority of young people believed that self-harm could be prevented and a number of preventative strategies were identified. Conclusions It is important that the views of adolescents are incorporated into the design and delivery of youth-friendly services and that there is a focus on increasing awareness of the youth-orientated services that currently exist.

Family and informal caregivers provide a substantial amount of care and support to people who experience mental health problems. The aim of this study was to explore mental health nurses', students' and service users' perceptions of the knowledge, skills and attitudes that are required by mental health nurses to work with families and carers using a qualitative methodology. Three themes emerged from the data: Knowledge of the family and how mental distress affects the family; working with the family - support and education; and valuing the role of the family. The three themes demonstrate the complexity of preparing mental health nurses to work with families and carers, and the article offers recommendations about how this might be achieved.

Mental health promotion remains an important component of mental health nursing practice. Supporting wellness at both the individual and societal levels has been identified as one of the key tenets of mental health promotion. However, the prevailing biomedical paradigm of mental health education and practice has meant that many nurses have not been equipped to incorporate a wellness perspective into their mental health practice. In the present study, we report on an exploratory study which details the knowledge, skills, and attitudes required by master-level mental health nurses to practice within a wellness paradigm from the perspective of three groups of key stakeholders: (i) service users and family members (n = 23); (ii) experienced mental health nurses (n = 49); and (iii) master-level mental health nursing students (n = 37). The findings, which were reported from individual and focus group interviews across five European countries, suggested a need to reorientate mental health nursing education to include a focus on wellness and resilience to equip mental health nurses with the skills to work within a strengths-based, rather than a deficits-based, model of mental health practice. Key challenges to working within a wellness paradigm were identified as the prevailing dominance of the biomedical model of cause and treatment of mental health problems, which focusses on symptoms, rather than the holistic functioning of the individual, and positions the person as passive in the nurse–service user relationship.

This account of practice outlines how action learning was used as the key component of a leadership development initiative for managers in an acute hospital setting. It explains how the initiative was conceived, why action learning was chosen and how action learning principles were incorporated. Insights into the outcomes and considerations for the future are also included.

Accessible summaryWhat is known on the subject? Self-harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self-harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self-harm. What does this paper add to existing knowledge? This paper identifies the reasons for self-harm in a community sample of young people and finds that the functions of self-harm differ for different people and that there may be multiple reasons for self-harm. Findings provide support for the affect-regulation model of self-harm which states that young people self-harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self-harm is an attempt to influence how other people respond to them. What are the implications for practice? Self-harm for most young people serves at least one specific function and is an indication of distress. There is a requirement for a non-pathologizing response towards young people who self-harm; self-harm should be understood as a meaningful behaviour rather than a symptom of an illness. Mental health nurses need to understand the multiple functions of self-harm. A better understanding of the individualized meaning behind self-harm can positively impact on attitudes towards young people who self-harm and provide for improved mental health service provision. AbstractIntroduction Although self-harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self-harm contributes to negative perceptions about those who self-harm and a poor healthcare experience. Aim & Methods This study identifies motivations behind self-harm in school-based adolescents using a cross-sectional survey. Motivations behind self-harm were elicited using a scale and open-ended responses. Results Of the 856 adolescents who completed the survey across 11 postprimary schools, 103 reported a history of self-harm. The most commonly endorsed reason for self-harm was to ‘get relief from a terrible state of mind’ (79%). Open-ended responses were consistent with scale responses with most reporting that they self-harmed to relieve distressing emotions. Discussion Findings provide support for the affect-regulation model of self-harm with support also demonstrated for the self-punishment and antidissociation models. There was little support for the interpersonal influence model suggesting that the commonly held belief that self-harm is attention-seeking is one attributed by others to young people, and not widely reported by young people themselves. Implications for practice Mental health services need to be responsive to the needs of young people who self-harm which requires eliciting and understanding the individual and multiple meanings behind self-harm to best inform treatment options.

Activation of the basal ganglia has been shown during the preparation and execution of movement. However, the extent to which the activation during movement is related to efferent processes or feedback-related motor control remains unclear. We used motor imagery (MI), which eliminates peripheral feedback, to further investigate the role of the subthalamic area in the feedforward organization of movement. We recorded local field potential (LPF) activity from the region of the subthalamic nucleus (STN) in eight patients with Parkinson's disease off dopaminergic medication during performance of a warned reaction time task. Patients were instructed to either extend the wrist [motor execution (ME)], to imagine performing the same task without any overt movement (MI), or, in a subgroup, to perform a non-motor visual imagery (VI) task. MI led to event-related desynchronization (ERD) of oscillatory beta activity in the region of the STN in all patients that was similar in frequency, time course and degree to the ERD occurring during ME. The degree of ERD during MI correlated with the ERD in trials of ME and, like ME, was accompanied by a decrease in cortico-STN coherence, so that STN LFP activity during MI was similar to that in ME. The ERD in ME and MI were both significantly larger than the ERD in VI. In contrast, event-related synchronization (ERS) was significantly smaller in trials of MI, and even smaller in trials of VI, than during ME. The data suggest that the activity in the region of the human STN indexed by the ERD during movement is related to the feedforward organization of movement and is relatively independent of peripheral feedback. In contrast, sensorimotor feedback is an important factor in the ERS occurring in the STN area after completion of movement, consistent with a role for this region in trial-to-trial motor learning or the re-establishment of postural set following movements.

Objective Here, we investigate whether the event-related desynchronization (ERD) of spectral components of the cortical EEG in the beta (13–30 Hz) frequency range may, in part, index motor selection processes. Specifically, we sought evidence for a contralaterally dominant component of the beta ERD that is limited to trials in which motor selection is possible prior to any imperative cue to move, with attendant behavioural advantage. Methods We measured reaction time and assessed the lateralization of beta ERD in 12 healthy volunteers as they performed pre-cued choice reaction time tasks, in which warning S1 cues were either fully predictive about the laterality of a subsequent imperative S2 signal or provided no laterality information. We calculated ‘lateralized ERD index’ (LERDI), a parallel measure to the lateralized readiness potential in the time domain. Results Trials with 100% S1–S2 congruency produced significantly shorter reaction times than trials with 50% S1–S2 congruency, where laterality information was unreliable. Beta LERDI indicated significantly greater lateralisation of the ERD in the warning-go interval and of event-related synchronization (ERS) following movement in the 100% condition than in the 50% condition. The lateralization of the beta ERD with respect to hand persisted, even when subjects were instructed to make movements of opposite laterality to those prompted. Conclusions Lateralized EEG changes occur in the beta band in the S1–S2 interval prior to movement, but only when informative warning cues allow early motor selection, as suggested by the shortening of reaction time. Furthermore, the enhanced contralateral ERS with 100% S1–S2 congruency suggests that this phenomenon is at least partly independent of afferent feedback, as the same movement was made in the 100 and 50% conditions. Significance Lateralized suppression of beta power prior to externally generated movements is associated with motor selection.

Practice makes perfect, but the neural substrates of trial-to-trial learning in motor tasks remain unclear. There is some evidence that the basal ganglia process feedback-related information to modify learning in essentially cognitive tasks 1, 2, 3 and 4, but the evidence that these key motor structures are involved in offline feedback-related improvement of performance in motor tasks is paradoxically limited. Lesion studies in adult zebra finches suggest that the avian basal ganglia are involved in the transmission or production of an error signal during song 5, 6 and 7. However, patients with Huntington's disease, in which there is prominent basal ganglia dysfunction, are not impaired in error-dependent modulation of future trial performance [8]. By directly recording from the subthalamic nucleus in patients with Parkinson's disease, we demonstrate that this nucleus processes error in trial performance at short latency. Local evoked activity is greatest in response to smallest errors and influences the programming of subsequent movements. Accordingly, motor parameters are least likely to change after the greatest evoked responses so that accurately performed trials tend to precede other accurate trials. This relationship is disrupted by electrical stimulation of the nucleus at high frequency. Thus, the human subthalamic nucleus is involved in feedback-based learning.

Accessible summaryWhat is known on the subject? Risk assessment and safety planning are a core aspect of the role of the mental health nurse. Conflicting views exist on the value of risk assessment tools. Few studies have examined mental health nurses' attitudes towards risk, including use of tools and the role of positive risk in recovery. What the paper adds to existing knowledge? Mental health nurses view risk assessment as a core dimension of their role and not merely an exercise to fulfil organizational clinical safety and governance obligations. The majority of nurses hold positive attitudes towards therapeutic or positive risk, and consider creative risk taking as vital to people's recovery. The majority of nurses believe that risk assessment tools facilitate professional decision making, however, some are concerned that tools may negatively impact upon therapeutic relationships. What are the implications for practice? Ongoing education on the use of risk assessment tools is required to minimize views that their use is incompatible with therapeutic engagement, and to enable nurses to develop confidence to engage with positive risk and to allow service users make decisions and take responsibility. AbstractIntroduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional decision making; however, there is concern that the use of these tools may negatively impact upon therapeutic engagement with service users. The majority of participants have positive attitudes towards therapeutic risk, believing that service users have the right to take informed risks in the context of recovery-orientated care. Discussion The provision of education on the use of risk assessment tools within the context of engagement may help minimize views that the use of assessment tools are incompatible with therapeutic engagement.

Objectives This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master’s level in order to bring about significant and positive change to practice. Design This is a literature-based critical review incorporating a modified rapid review method. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). Data sources In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. Review methods We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. Results A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. Conclusions This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master’s level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

This article describes a European collaborative project that developed master’s degree level e-learning materials for mental health nurses. The e-learning materials are freely available online at w ...

The treatment of alcohol dependence syndrome (ADS) involves strategies to manage detoxification as well as strategies to promote recovery and relapse prevention. This article describes ADS and discusses the various pharmacological interventions that can be used as part of the overall management of ADS

Purpose: This discussion paper aims to explore the need of a clarified definition of master’s level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging. Methods: Master’s level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services. Results: The discussion show contents, values and utility of master’s level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master’s level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care. Conclusion: This discussion paper shapes implications for developments in master’s level mental health nursing education curricula.

Overview This module will give a brief overview of typical and atypical antipsychotic drugs and their modes of action. The pharmacological management of extrapyramidal side-effects will be discussed in detail. Nursing considerations when administering antipsychotic drugs will also be outlined. The module will conclude by summarizing the key points.

Abstract Mixed methods research is viewed as the third methodological movement and as an approach it has much to offer health and social science research. Its emergence was in response to the limitations of the sole use of quantitative or qualitative methods and is now considered by many a legitimate alternative to these two traditions. Purists’ view of the dichotomy between positivist and non-positivist philosophies is prevalent; however, mixed methods afford researchers an opportunity to overcome this ‘false dichotomy’. The philosophical underpinning of pragmatism allows and guides mixed methods researchers to use a variety of approaches to answer research questions that cannot be addressed using a singular method. In particular, healthcare researchers may benefit from the opportunity to use such a dynamic approach to address the complex and multi-faceted research problems often encountered in the health care sector.