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Background:  Medication non-compliance is a significant healthcare issue that is widespread. Extensive research has identified factors that contribute to medication non-compliance in different healthcare settings. As a result, there was a need to develop a conceptual framework to facilitate medication compliance among adults living with depression., Objectives:  The purpose of this study was to develop a conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression., Method:  A qualitative, exploratory, descriptive and contextual research design was utilised to investigate the experiences of adults living with depression who are non-compliant with medication. The study consisted of three phases: an empirical phase, a classification of concepts and a development phase. Following the empirical phase, a conceptual framework was developed based on the classified concepts., Results:  Three sets of results were merged for the cross-validation analysis, combining findings from the systematic review, the researcher's previously conducted and published minor dissertation and the current study., Conclusion:  A conceptual framework was developed to assist psychiatric nurses in effectively promoting an internal locus of control among adults living with depression. The resulting conceptual framework provides valuable insights and serves as a valuable tool for future research endeavours aimed at enhancing medication compliance among adults living with depression.Contribution: This framework serves as a valuable guide for future studies that aim to explore medication compliance among adults living with depression, specifically by focussing on the concept of internal locus of control.

WHAT IS KNOWN ON THE SUBJECT?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer-reviewed evidence examining recent trends. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service-provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: English mental health services report greater levels of patient-related factors such as self-harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic., Abstract: INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain., Aim: Comparison of English national data for incidents and nursing workforce to examine recent trends., Method: Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022., Results: A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals., Discussion: Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports., Implications for Practice: Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes., (© 2024 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Objective: An American Psychiatric Nurses Association (APNA) task force reviewed current staffing research to revise and update the 2011 APNA "Staffing inpatient psychiatric units" position paper and provide recommendations to the APNA Board of Directors on how psychiatric mental health (PMH) nurses might champion the staffing needs of inpatient psychiatric units., Methods: Current research on staffing and nursing practice in inpatient psychiatric units was reviewed as well as variables believed to influence staffing and nursing practice, such as consumer needs and workplace culture. Since current nurse staffing principles emphasize nursing value and how that value is connected to outcomes, the literature search included a focus on staffing and related patient outcomes., Results: PMH nurses are critical to the safety and quality of care in inpatient psychiatric units. However, there are little existing data on the relationship between staffing levels and even common adverse events such as staff injury and restraint of patients. Furthermore, there is scant research conducted on inpatient psychiatric units that informs optimal staffing models or establishes links between staffing and patient outcomes., Conclusions: Consistent with current evidence, the universal use of a single method or model of determining staffing needs (e.g., nursing hours per, case mix index, or mandatory ratios) is not recommended. PMH nurses should champion systematic evaluation of staffing on their inpatient units against select patient, nurse, and system outcomes. A data repository of PMH nurse-sensitive outcomes is necessary to benchmark unit performance and staffing., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics., Methods: An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce., Results: Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance., Conclusions: Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: The purpose of this study was to investigate the association between mental health (posttraumatic stress disorder, depression, anxiety disorder, and burnout) and intention to resign, and influencing factors regarding nurses involved with COVID-19 patients in A Prefecture as subjects.The design is a cross-sectional questionnaire-based study.Methods are conducted between August 4 and October 26, 2020. Basic attributes (gender, age, years of experience, etc.) were examined. Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, Impact of Event Scale-Revised, Maslach Burnout Inventory, "intent to resign," were used to collect data from nurses working at hospitals treating patients with COVID-19 in Japan.As a result, between 20% and 30% of nurses involved with patients with COVID-19 are in a state of high mental distress. Regarding the associations between psychiatric symptoms and intention to resign, "I want to quit being a nurse" was affected by "cynicism" and "professional efficacy"; "I want to change hospitals/wards" was affected by "cynicism"; and "subthreshold depression," "anxiety disorder," and "burnout" affected "I want to continue working as a nurse." The increase in the number of patients with COVID-19 was a factor affecting mental health and intention to resign. When the number of patients increased, anxiety disorders and intention to resign also increased. Damage from harmful rumors increased the severity of every psychiatric symptom. To prepare for a pandemic such as COVID-19, it is necessary in normal times to construct psychological support systems and community systems to prevent damage from harmful rumors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

WHAT IS KNOWN ON THE SUBJECT?: Nursing skill mix research has primarily focused on medical and surgical patients. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been adequately explored. No systematic reviews have been reported that have examined the association between the ratio of mental health to registered nurses and patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our protocol sets out, in detail, the methods we intend to follow to ensure that this review is conducted and reported to the highest possible standards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review will summarize evidence about safe staffing in mental health inpatient units internationally. The review will inform health policy and planning of health services. ABSTRACT: Aim To assess the association between mental health nurse to comprehensive/general nurse ratio and relapse-determined by hospital admission-in adult psychiatric inpatients. Background information There is considerable variation in psychiatric inpatient nursing skill mix internationally. In most countries, wards are typically staffed by a mix of mental health and comprehensive/general nurses. To date, there have been no systematic reviews that have examined the association between the ratio of mental health to registered nurses and patient outcomes. Method We will systematically search five databases. Risk of bias will be determined using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis will be undertaken if there are at least two similar studies. Results For included studies, we will produce table summarizing risk of bias and extracted data. If we are able to undertake a meta-analysis, this will be reported as a forest plot. Discussion This paper sets out a detailed plan for a systematic review of mental health nurse skill mix research. Implications for practice High-quality evidence about the association between nursing skill mix and patient outcomes is important to inform the planning of mental health services internationally., (© 2020 John Wiley & Sons Ltd.)

The workforce was examined using the 2018 National Sample Survey of Registered Nurses to determine supply characteristics and perspectives of psychiatric-mental health nurses. The study looked at the success in achieving some of the workforce related recommendations of the Future of Nursing. A strong foundation exists for increasing the contributions of psychiatric-mental health nursing to overcoming shortages of mental health professionals and to improving access to mental health care. More work needs to be done to remove regulatory barriers to promote practicing to the extent of knowledge, education and training. Overall, the psychiatric-mental health nursing workforce is primed for the future., Competing Interests: Declaration of competing interest The author has no competing financial or personal interests to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

WHAT IS KNOWN ON THE SUBJECT?: Research findings indicate the percentage of knowledge-related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. WHAT THE PAPER ADDS TO THE EXISTING KNOWLEDGE?: This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A recent study has found that almost three-quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients. The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. ABSTRACT: Introduction Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim To assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple-Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results A total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge., (© 2020 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Acute psychiatric nurses experience workplace stressors related to organizational factors including staffing shortages, along with interpersonal conflict with patients and colleagues. The pilot study examined the experience of burnout among acute care psychiatric nurses and the usefulness of a social work lead mindfulness-based intervention for reducing burnout elements. Findings indicated participants experienced emotional exhaustion associated with their work, but also a significant degree of personal accomplishment. Nurses identified the intervention as having the potential to promote better emotional regulation in the workplace and beyond. Social worker education on mindfulness techniques may represent an untapped resource for improving the emotional wellness and effective patient care.

Background: Nurses are exposed to stress when working in the mental health care environment. This may be because of nurses being frontline health care providers. They develop close interpersonal relationships with mental health care users (MHCUs), which is inherent in the type of care that is provided. Mental health nursing may therefore be demanding and stressful, which could render mental health nurses susceptible to burnout., Objectives: To determine the prevalence of burnout among nurses working at a selected psychiatric hospital in the Western Cape., Methods: A quantitative, descriptive, survey design, by using simple random sampling was used to select 198 nurses employed at a psychiatric hospital in the Western Cape, South Africa. Maslach Burnout Inventory-Human Services Survey measuring emotional exhaustion, depersonalisation and personal accomplishment was used to collect the data. Domain scores were calculated, and the influence of the demographic variables on the domains was tested with independent samples Kruskal-Wallis tests and Mann-Whitney U tests., Results: The study had a 100% response rate. Most of the respondents experienced low emotional exhaustion, low depersonalisation and high personal accomplishment. Enrolled nursing assistants reported significantly higher emotional exhaustion than did the advanced psychiatric nurses and professional registered nurses. Respondents with more than 5 years of experience scored significantly higher in depersonalisation. No respondents met the criteria for burnout on all three domains., Conclusion: Maintaining a safe working environment with adequate nursing staff is recommended. Strategies to prevent burnout in the future include the provision of resources and the promotion of open communication between staff and management.

A descriptive correlational design was applied to explore association among self-assessed depressive symptoms, job satisfaction and self-assessed empathy in 206 Greek Psychiatric-Mental Health Nursing Personnel (PMHNP). Depressive symptom intensity was associated with satisfaction from performed tasks (r = -0.157, p = 0.033), professional prestige (r = -0.255, p < 0.0001), relations with colleagues (r = -0.263, p < 0.0001) and empathy (r = -0.183, p = 0.013). In a regression model, only satisfaction from relations and workload remained significant depressive symptom predictors after controlling for important covariates. The quality of relations with colleagues and workload are important predictors of PMHNPs self-perceived mental health well-being, independently of clinicians' self-assessed empathy or overall professional satisfaction., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Globally, people with mental illness are highly vulnerable to various forms of abuse. Yet, research on routine screening of violence by mental health professionals is limited., Aim: The aim of this study was to evaluate the impact of training on nurses' attitudes towards routine screening and confidence in implementing routine screening of violence among women with mental illness., Methods: A randomized controlled trial design was adopted for the present study. The participants of this study were 68 nurses randomly assigned to either experimental or control group (34 in each group). The experimental group was provided eight interactive sessions based on a Nursing Module on abuse among women with mental illness. The assessments were done in both groups at baseline, after the intervention, at three months and at six months. All assessments were self-rated questionnaires to assess nurses' attitudes and confidence in implementing routine screening of violence attitudes., Results: The experimental group showed a statistically significant improvement in the attitudes and confidence in implementing routine screening of abuse in women with mental illness (p < 0.05) than the control group. Repeated measures of analysis also revealed statistically significant differences related to attitude and confidence in implementing routine screening of abuse between the groups and within the experimental group at different time points of assessment (p < 0.001)., Conclusion: This study concluded that training based on a nursing module improved nurses' attitudes and confidence to conduct routine screening of violence among women with mental illness. However, further studies are necessary to clarify whether the training is effective in implementing in nursing practice., Competing Interests: Declaration of competing interest None. This article was prepared as a part of PhD thesis., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: The study aimed to assess the effectiveness of an assertiveness training program on psychological wellbeing and work engagement among novice psychiatric nurses., Design: A quasi-experimental design was utilized (one group pre/post assessment)., Setting: The study was conducted at The Abbasia hospital for mental health in Cairo, Egypt., Subjects: The subjects of the study were 36 novice nurses who were starting their careers the hospital during 2017/2018., Tools: The current study used four tools for collecting the data: socio-demographic data sheet, Rathus Assertiveness Schedule, Riff's Psychological Well-Being Scale, and Utrecht Work Engagement Scale., Results: The study results revealed a statistically significant difference between measure one and measure two intervention program regarding assertiveness skills, psychological well-being, and work engagement. Also, there was a significant positive correlation between the total mean scores of assertiveness skills and total mean scores of psychological well-being., Conclusions: This single-group feasibility study demonstrated that assertiveness training for novice nurses seems feasible. It may achieve a favorable outcome in developing assertiveness skills and improving psychological wellbeing., Recommendations: Further randomized controlled trials with more extended follow-up periods are required., (© 2020 Wiley Periodicals, Inc.)

Background: According to the World Health Organization (WHO), up to 25% of people worldwide will develop mental health disorders during their lifetime. Patients admitted to acute inpatient units for mood disorders experience emotional distress. Group therapy has the potential to foster the therapeutic change through specific therapeutic mechanisms. Psychiatric nurses working in inpatient units are in a unique position to offer group therapy., Objectives: Explore and describe stabilised acute psychiatric patients with mood disorders' lived experiences of group therapy facilitated by psychiatric nurses. Make specific recommendations for psychiatric nurses to facilitate constructive group therapy for stabilised acute psychiatric patients with mood disorders in an inpatient unit., Method: A qualitative, exploratory, descriptive and contextual design was used in the study. A purposive sample of all patients with mood disorders older than 18 years admitted to inpatient units who participated in group therapy was made. Data were collected through conducting phenomenological interviews, observation and field notes. Interviews focussed on the following open question: 'How did you experience group therapy facilitated by the psychiatric nurses?' An independent coder analysed the data by using thematic coding. Measures to ensure trustworthiness were applied. The following four ethical principles were adhered to: autonomy, non-maleficence, beneficence and justice., Results: Three themes emerged from this study. Theme 1 entailed the psychological experiences of patients attending group therapy. Theme 2 highlighted the interpersonal experiences of patients. Theme 3 evolved around patients' experiences outside group therapy. Patients initially experienced attending group therapy as anxiety provoking. However, negative psychological experiences soon transformed into positive psychological experiences., Conclusion: The findings of this study were used to make specific recommendations to facilitate constructive group therapy for patients with mood disorders.

In Japan, Community-based integrated care systems are being built in response to a super-aged society and policies of de-institutionalization. In this paper, we present findings and discussion of our review about Japanese psychiatric home visit nursing services provided by Home Visit Nursing Stations (HVNS). We have examined documents, investigated the implementation rate and summarized findings of the surveys of home visiting services from 2006 to 2016. The number of users of psychiatric home visiting services during 2007 to 2015 increased from 13,532 to 52,203. From 2013 to 2015 there was a large increase in user numbers, from 31,248 to 52,208. The implementation rate of psychiatric home visiting also increased steadily from 35.5% in 2006 to 58.3% in 2016. These changes reflected the impact of policy on psychiatric service usage in Japan. We should be able to detect the outcome of psychiatric home visiting nursing in influencing patient's quality of daily life and their recovery.

Objective: To consider the changing profile of Australia's mental health workforce and the implications, particularly for specialist psychiatry services., Method: We analyse data from a national collection that describes changes in the workforce over a decade, to 2017-2018., Results: While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia's response to complex mental illness, are under enormous pressure., Conclusion: The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.

Nurses have the most contact with patients and therefore play vital roles in their satisfaction with health care services. The current study aimed to assess patient satisfaction with nursing care in Calabar, Nigeria using the Newcastle Satisfaction with Nursing Scale. One hundred eighty-five patients were surveyed, with a mean age of 33.5 (SD = 9.4 years). Mean percentage satisfaction score was 60.4% (SD = 19.2%). Eighty-two (44.3%) patients were dissatisfied with nursing care. Common areas of dissatisfaction were type of information nurses provided (54.6%), privacy nurses provided (52.4%), time spent with patient (51.4%), and nurses' helpfulness to patient (51.4%). Prevalence of dissatisfaction was more common among respondents who were 40 or younger, as well as among males (p < 0.05). There was a high prevalence of dissatisfaction with psychiatric nursing care in the current study setting. Areas of dissatisfaction and their implications for improvement in nursing care in developing countries are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 50-55.]., (Copyright 2020, SLACK Incorporated.)

Aims: This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods., Background: Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods., Methods: This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n = 90) completed the Attitudes to Containment Measures Questionnaire (ACMQ). The results were described with statistics, and the associations between attitudes and background variables were analysed using parametric tests., Results: Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards as necessary medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees., Conclusions: In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed., Implications for Nursing Management: This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff., (© 2020 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Background: This paper reports on a qualitative study utilising in-depth interviews of sixteen Australian mental health nurses (MHNs) working in general practice. On 1st July 2015, the commonwealth government of Australia established 31 primary health networks (PHN) to increase the efficiency and effectiveness of medical services for people, particularly those at risk of poor health outcomes, and to improve coordination of care. Aim: This study explores the experiences of Australian MHNs working in general practice. Design: Data were analysed using thematic analysis. Four themes emerged through the data analysis: (1) autonomy and flexibility , (2) opportunity for more clinically focused work , (3) health promotion and preventative health and (4) excited to work in general practice . Findings: Study Participants identified many clinical opportunities working in primary practice and noted that the autonomy and flexibility of their role was quite different from other areas they had previously worked. They reported having more time to spend with the patients and being able to engage in health promotion. Conclusions: In order to make mental health care more accessible it is important to have a well-qualified workforce within primary health care (PHC) settings such as general practice. The participants of this study have identified ways they have been best utilised in the Primary Care workforce. They embrace the autonomy of the role and the ability to engage with consumers by providing clinical interventions that can assess and intervene with people experiencing mental illness.

Background: The objective of this study was to investigate the impact on patient care quality of a positive, high-quality environment that is tailored to the practice of nursing. This study enabled nurses to show their professional skills and knowledge, which may help enhance job satisfaction. To date, little research has been done to assess the relationship between the nursing work environment and the job satisfaction of psychiatric nurses employed in acute wards of general hospitals., Purpose: This study was designed to explain the relationship between job satisfaction and the perceived indicators of a quality nursing work environment (QNWE) after adjusting for demographic characteristics and work characteristics., Methods: A cross-sectional correlational design was employed, and a stratified random sample of 185 psychiatric nurses (99% response rate) working in acute wards in Taiwan was surveyed in 2013. Nurses were asked to complete a self-administered questionnaire that included measures of perceived QNWE and job satisfaction and demographic variables., Results: A statistically significant, positive relationship was found between perceived indicators of QNWE and job satisfaction (r = .813, p < .001). In the hierarchical multiple linear regression model, for the subdimensions of QNWE, the variables "perceived indicators of professional specialization and teamwork" and "support and caring" showed a significant and positive association with job satisfaction, after adjusting for personal demographic characteristics., Conclusions/implications for Practice: Job satisfaction is related to the perception of nurses regarding their work environment. Therefore, nursing managers should improve workplace satisfaction by supporting and caring for nurses and creating better career development and teamwork opportunities for nurses through job training and planning.

Purpose: Addressing psychosocial distress is an essential part of cancer care. Therefore, nurses at the University Hospital Zurich have been screening all cancer inpatients with the Distress Thermometer (DT) since 2012. Screening is ineffective without any form of psychosocial intervention. We aimed to identify adherence to the screening protocol and how the reported problems influenced the nursing process. We compared changes in the documentation before and after screening implementation., Methods: This retrospective descriptive study used screening data and documentation of psychosocial items in the nursing process of inpatients at an oncologic ward. These data were compared with data obtained before screening implementation and were collected from electronic health records. All data were analyzed descriptively., Results: 65% (N = 1111) of the 2166 inpatients were screened. With the implementation, more psycho-oncological referrals were made (4.5% vs. 11.7%) and more psychosocial issues were described in the nursing process (24.6% vs. 51.2%). Inpatients mentioned emotional problems in 37.5% (N = 353) and physical problems in 47.4% (N = 504) of cases. 15.7% (147) had a psychosocial nursing diagnosis. Only 10.7% (N = 26) of patients who noted anxiety, also had a nursing diagnosis of "anxiety". In contrast, 71.1% (N = 202) of patients who noted pain, had a nursing diagnosis of "pain"., Conclusions: Although nurses are more sensitised to psychosocial issues after DT implementation, they do not use screening results to adapt nursing documentation to the psychosocial needs of the patients. Further studies are needed to investigate how distress screening and psychosocial issues can be integrated into nurses' daily work., Competing Interests: Declaration of competing interest The authors have no conflicts of interests that are directly or indirectly related to the research., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Post deinstitutionalisation, mental health mainstreaming has led to substantial increases in presentations to Emergency Departments (EDs). The assessment process requires the ED triage nurse to undertake a rapid client assessment, assign a clinically appropriate triage score, and then refer the client to a mental health clinician. The initial assessment is important, and a number of factors influence the process of triage, referral and response including an understanding of mental health presentation acuity. Aim: To understand the factors that influence the ED triage assessment, referral and clinical response of clients with a mental illness. Methods: An ethnographic methodology underpinned the research design. ED triage nurses and mental health triage nurses who worked in a regional hospital provided insights through interviews and observations. The study was also informed by institutional policies and procedures regarding triage. Transcribed in-depth interviews, field notes and memos were analysed using an inductive thematic process. Findings: Mental health triage nurses and ED triage nurses concur that triage is an important part of the assessing process for a person who presents to the ED with a mental health problem. Timely and clinically accurate assessment, followed by referral and response is strongly influenced by the user knowledge of the mental health triage scale, and comprehension of mental health acuity. The conflicting understandings between the two professional nursing groups, called professionally cultured orientations, further impact this process. Conclusion: Professionally cultured orientation to mental health triage and acuity comprehension influence the process of emergency mental health triage and therefore may affect optimal client outcomes. Further research into ED triage design, ED triage education, and a shared understanding of acuity is called for.

Background: The global health care system has applied case management (CM) as a care delivery service provided by nurses. Nurses require continuing education in CM to enhance their professional knowledge and competence. Mobile communities have been used to promote continuing education for medical professionals. However, limited studies have examined the effectiveness of such learning programmes in CM for psychiatric nurses., Objective: To evaluate the effectiveness of a mobile community learning (MCL) programme in CM for psychiatric nurses., Design: This study used an experimental two-group pre- and post-test design., Settings and Participants: Psychiatric nurses employed in a psychiatric teaching hospital situated in northern Taiwan were recruited., Methods: Nurses were randomly allocated to the experimental or comparison group. The former participated in the learning intervention in CM. The CM knowledge index and a competence scale were used to determine outcomes. Pre-tests and 2-month post-tests were conducted. The MCL programme comprised five simulated learning modules, self-assessment questions, learning cases, learning resources and experience sharing. A two-way repeated-measures analysis of variance was performed to evaluate the effect of the intervention on target outcomes., Results: The questionnaires were completed by 48 participants. The two groups possessed high homogeneity with regard to characteristics and pre-test outcomes. Differences between the two groups regarding CM knowledge (F = 22.99, p < .01) and competence (F = 6.33, p = .015) were significant. The programme had a positive benefit on the learning experience in the experimental group; the mean satisfaction score for the programme reached 4.27 (range, 1-5)., Conclusions: MCL programmes for psychiatric nurses can effectively enhance CM knowledge and competence. However, these methods cannot completely replace the continuing education approach for achieving CM competence., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The well-being of psychological practitioners is a key factor in the effective delivery of psychological therapies and the effectiveness of mental health services. Despite this, there are no measures of well-being for this professional group. The 26-item psychological practitioner workplace well-being measure (PPWWM) measures psychological well-being for psychological practitioners and was informed by a qualitative study. Items were generated and then verified by groups of practitioners using sorting tasks. The items reflect a broad range of issues relevant to the workplace well-being of psychological practitioners. The PPWWM was validated with a sample of 400 psychological practitioners recruited through professional networks. Internal consistency (α = .92) and test-retest reliability (r = .94) were high. Construct validity was indicated by positive correlations with the Health and Safety Executive Management Standards Indicator Tool and Satisfaction with Life Scale and negative correlation with the General Health Questionnaire. Exploratory factor analysis produced six factors, explaining 61.2% of the variance: professional and organizational; support and flexibility; professional role; physical environment; clinical supervision; and external personal. PPWWM scores were not significantly associated with a range of demographic variables (gender, health/disability, profession, and type of organization), but it did correlate significantly and negatively with age. The PPWWM has potential application as a brief measure, suitable for large-scale surveys that specifically measures workplace well-being in psychological practitioners. Future research could include cross validation with new samples and validation with subgroups of psychological practitioners., (© 2019 John Wiley & Sons, Ltd.)

OBJECTIVE: To describe the current rural mental health system crisis in the United States and how psychiatric mental health nurse practitioners (PMHNPs) can holistically mitigate this systemic issue. METHOD: Respective to the objective, relevant literature is reviewed. RESULTS: PMHNPs have successfully increased access to care in underserved rural communities by practicing at the fullest extent of their scope without mandated supervision, utilizing telepsychiatry practice, while expanding PMHNP rural mental health education and research to meet and absolve pressing rural mental health challenges. CONCLUSIONS: Current evidence supports that rural mental health care improves when PMHNPs have full scope of practice, utilize telepsychiatry, engage in related scholarly activity, and have formalized education and training for rural health care delivery, which collectively answer the professional and moral call serving the underserved rural population with mental illness.

Objectives: The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma., Design: Observational study-cross-sectional design., Setting: Tertiary psychiatry hospital in Singapore., Participants: The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital., Measures: Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness., Results: Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores., Conclusion: The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Most studies on workers' health are based on non-specific models of occupational stress, thereby limiting the understanding and research on efficient interventions. This qualitative approach aimed to explore the structure of resources and constraints in the working environment of nurses in a deliberately open approach. Semi-structured interviews were conducted with 37 nurses working in closed and open inpatient psychiatric wards in a French university hospital. The data were statistically analyzed using a hierarchical clustering method. Our model highlighted a systemic structure, describing the interactions, including patients, nurses, doctors, and managers in a specific material, communicational, and organizational environment. The results show a discursive structure organized around dimensions pertaining to "environment", "patients", "medical-care group", and "the individual". Our model showed interest in an interdisciplinary approach that encompasses occupational medicine and social psychology.

Background: Therapeutic engagement (TE) has been described as the crux of mental health nursing but despite its perceived importance, to date, there is no measurement tool that captures it. As a result, there is no way of determining the contribution of mental health nursing interaction to service user recovery, in acute inpatient mental health settings or the wider care quality agenda., Methods: To develop and validate a TE measurement tool in partnership with Service Users (SUs) and Registered Mental Health Nurses (RMHNs). The TEQ was developed in 3 stages: 1) item generation (and pre-testing), 2) item reduction using Principal Component Analysis (PCA), and 3) validation across Mental Health Trusts in England., Results: The final questionnaire has two versions, (SU and RMHN version), each scored within two contexts (1-1 SU-RMHN interactions and overall environment and atmosphere of the ward) and includes 20 items with two sub-scales (care interactions and care delivery). Psychometric evaluation of the TEQ shows high inter-scale correlations (0.66-0.95 SU; 0.57-0.90 RMHN), sound sub-scale internal consistency (> 0.95), concurrent validity (> 0.60) and adequate score variability for both versions of the TEQ. In summary, the TEQ behaves well as a measurement tool., Conclusions: The TEQ can determine the collaborative and empathic nature of RMHN-SU interactions, capture if SUs are treated with dignity and respect and recognise that the principles of the recovery approach are being respected. The TEQ can also provide robust monitoring of nursing activity, offer opportunity for transparency of activity, feed into healthcare organizations' key performance indicators and provide reassurance about the nature and quality of nurses' work.

Objective: To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile., Method: Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables., Results: A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health., Conclusions: Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

In the light of the increasing recognition of the relevance of spirituality in person-centred, holistic care, this study examines the attitudes of a convenience sample of mental health practitioners, including nurses, to the concepts of spirituality in general and in clinical practice. A series of 5-point Likert-style items assessed two key domains of spirituality in everyday life (SEDL) and spirituality in practice (SIP). The questionnaire was derived from one previously used with healthcare educators (including nurses). Each item was scored from 1 point (strongly disagree) to 5 points (strongly agree). Additional information about how far practitioners believed spirituality had been integrated in their education and how much they believed that spirituality related to religion was also ascertained. Three further items, not part of the main questionnaire, dealt with respondents' views of spirituality competent practice, in the light of a description provided as part of the questionnaire. Data were collected from 104 respondents. Standard statistical procedures, including reliability analyses, were applied to the data. Respondents who viewed spirituality to be distinct from religion, or a place of worship, were likely to place a higher value on spirituality in everyday life, while respondents who experienced the integration of spirituality within their preregistration training and/or clinical education were likely to place a higher value on the place of spirituality in practice. The possible reasons for these associations are discussed in the light of the importance of spiritual care as a part of person-centred, holistic practice., (© 2019 Australian College of Mental Health Nurses Inc.)

The aim of this study was to determine the prevalence of burnout in mental health nurses and to identify its predictors. A systematic review was conducted of studies published in the following databases: CINAHL, Dialnet, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus. The search equation used was "Nurs * AND Burnout AND mental health". Subsequently, three fixed-effects meta-analyses were performed, one for each dimension of burnout, to calculate its prevalence and the corresponding confidence intervals. The data were analysed using StatsDirect meta-analysis software. Eleven studies were finally included (n = 11). In most cases, the literature informs about moderate levels of emotional exhaustion, depersonalization, and personal accomplishment. The studies inform that variables such as work overload, work-related stress, professional seniority, male gender, being single, and aggression at work, among other factors, contribute to burnout development. The meta-analytic prevalence estimations of burnout with a sample of n = 868 mental health nurses are 25% for high emotional exhaustion, 15% for depersonalization, and 22% for low personal accomplishment. From a workforce development and safety perspective, it is important for managers to address the emotional exhaustion and low personal accomplishment aspects of burnout reported in the workplace by mental health nurses., (© 2019 Australian College of Mental Health Nurses Inc.)

WHAT IS KNOWN ABOUT THE SUBJECT?: Planning and implementation of care are based on the selection and application of nursing interventions, which correspond to a key element in the nursing process. No information was found in the literature about which major nursing interventions are documented by nurses working in psychiatric wards. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite the criteria applied to the intervention records' analysis may have led to the exclusion of certain important aspects of mental health nursing, this study provides information on some of the most relevant interventions in the field of psychiatric and mental health nursing documented in Portugal, placing them into the different steps of the nursing process. This study revealed the lack of standardized language used by nurses in intervention definitions, which results in the use of varied terminology to describe the same intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study constitutes an important contribution towards the standardization of language used by mental health nurses in intervention definitions, which may lead to the production of health indicators that will show policymakers the importance of nursing care towards population health. This study also contributes to the improvement of nursing informatics systems in use in psychiatric departments, particularly through the differentiation between different types of intervention, placing them into the proper steps of the nursing process. The problems identified in this study regarding nursing documentation may suggest that more training for professional nurses in the field of intervention formulation is needed. ABSTRACT: Introduction The nursing intervention corresponds to a key element in the nursing process. No information was found in the literature about which major interventions are documented by nurses working in psychiatric wards. Aims (a) To identify the interventions documented by nurses in Portugal that respond to nursing needs within the scope of psychiatric nursing; (b) to identify the main problems in identifying these interventions. Method A descriptive study combining: (a) quantitative content analysis of intervention records identified by mental health nurses in Portugal and (b) a focus group meeting with 14 nurses exploring the results of the first study phase. Results The 2,881 initial intervention records were systematized into 198 intervention categories. Some problems in the interventions' documentation by nurses were identified. Discussion Despite certain important aspects of mental health nursing may have been excluded, this study provides information on some of the most relevant interventions in the field of mental health nursing documented in Portugal. Implications for practice This study may offer an important contribution to the improvement of nursing informatics systems and the production of health indicators that reveal the contribution of nursing care towards population health., (© 2019 John Wiley & Sons Ltd.)

WHAT IS KNOWN ABOUT THIS SUBJECT?: Burnout is a prominent issue in psychiatric nursing and associated with significant adverse consequences for staff, service users and at an organizational level. Exploration of the extent and predictors of burnout in secure settings has received little research attention. It is not fully understood why prevalence rates of burnout in forensic settings are not elevated in comparison to other settings, despite the presence of known risk-related correlates. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: In contrast to previous research, findings suggest that clinical supervision may not be an effective, stand-alone intervention to support staff experiencing burnout. Thus, the current focus on clinical supervision to mitigate burnout may be insufficient in forensic services. The ward environment (specifically how safe staff feel, how therapeutic the ward feels and how well service users relate to one another) was found to be more important than clinical supervision in terms of burnout for forensic psychiatric nursing staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policies regarding staff health and well-being should be developed with due consideration given to the association between burnout and the working environment. It should not be assumed that clinical supervision is sufficient to mitigate burnout in practice. Further research assessing all types of support and the ward environment is needed to gain a better understanding of its relationship to burnout. ABSTRACT: Introduction Despite extensive research examining burnout in psychiatric nursing staff, literature exploring key predictors of burnout in secure psychiatric settings has been relatively neglected. Research has yet to explore burnout in these settings by adopting previously identified predictors such as support or the ward environment. Aim The current study aimed to reduce this gap by exploring burnout, the perceived effectiveness of clinical supervision and ward environment. Method In 2014, nursing staff working in a medium secure forensic psychiatric unit in the United Kingdom (N = 137) provided demographic information and completed the measures assessing: Burnout, clinical supervision and the ward environment. Results Approximately 10% of nursing staff could be classed as "burnt-out". The main predictors of burnout were age and ward environment. Clinical supervision had minimal association with burnout. Discussion The current study sheds doubt on clinical supervision as a potential intervention for burnout and results appear comparable to research within other settings. The implications of the ward environment, supervision and burnout are discussed herein. Implication for Practice Interventions may need to focus on a positive ward environment (including patient cohesion, experienced safety and enhancing the therapeutic atmosphere). Organizations should support younger nursing staff as they appear particularly vulnerable to burnout., (© 2019 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities. Studies of nurse consultants in the United Kingdom have largely been non-empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change. A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors. The continued absence of robust evidence as to the clinical/cost-effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint. Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Abstract Introduction The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross-sectional survey of post holder characteristics and semi-structured interviews with directors of nursing. Results Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0-12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work., (© 2019 John Wiley & Sons Ltd.)

We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size.

To evaluate and describe the physical and mental health of staff on acute psychiatric wards and examine whether violence exposure is linked with health status. We undertook a cross-sectional survey with 564 nursing staff and healthcare assistants from 31 psychiatric wards in nine NHS Trusts using the SF-36, a reliable and valid measure of health status and compared summary scores with national normative data. Additional violence exposure data were collated simultaneously and also compared with health status. The physical health of staff was worse, and their mental health was better than the general population. Physical health data were skewed and showed a small number of staff in relatively poor health while the majority were above average. Better physical health was associated with less time in the current post, a higher pay grade, and less exposure to mild physical violence in the past year. Better mental health was associated with being older and from an ethnic minority background. Violence exposure influenced physical health but not mental health when possible confounders were considered. Mental health was strongly influenced by ethnicity, and further research might highlight the impact on own-group ethnic density on the quality of care. The impact of staff whom are physically unwell or impaired in the workplace needs to be considered as the quality of care may be compromised despite this being an example of inclusiveness, equal opportunities employment, and positive staff motivation., (© 2018 Australian College of Mental Health Nurses Inc.)

Burnout in nursing staff is a major cause for turnover and absenteeism. Identifying risk and protective factors may be helpful in decreasing burnout symptoms. Moreover, research indicates that ambulatory assessments of the autonomic nervous system might be helpful in detecting long-term stress and burnout symptoms. One hundred and ten forensic nursing staff members completed questionnaires measuring experiences with aggressive behaviour, emotional intelligence, personality, and job stress during four waves of data collection across a 2-year period. Multilevel analyses were used to test the predicted associations and moderation effects with (the development of) burnout symptoms. Burnout was predicted by a combination of emotional intelligence, job stress, aggression, personality factors, and skin conductance, but no moderation effects over time were found. Over a period of 2 years, the model approximately predicts a change in one burnout category on the Maslach Burnout Inventory. The amount of burnout symptoms in nurses might be used as an indicator to predict turnover and absenteeism considering the increase in symptoms over time. Nursing staff who experience severe aggression and who have relatively low levels of emotional intelligence and altruism and high levels of neuroticism and job stress should be monitored and supported to decrease the risk of burnout. Staff members can be trained to increase their emotional intelligence and relieve stress to decrease their burnout symptoms and turnover and absenteeism on the long term. Ambulatory assessment might be helpful as a nonintrusive way to detect increasing levels of burnout., (© 2018 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.)

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use., (© 2018 Australian College of Mental Health Nurses Inc.)

Aims: To characterize the future Psychiatric Mental Health (PMH) Advanced Practice Registered Nurse (APRN) workforce in light of the high demand for psychiatric providers in all aspects of mental health service delivery. Over the past 20 years, there has been significant growth of the PMH APRN workforce, a provider group capable of addressing mental health provider shortages. However, continued growth may be limited by anticipated retirements and traditional volume of graduations from PMH nurse practitioner (NP) programs. Optimum utilization of PMH APRNs in service delivery systems and State workforce planning may also be impeded by their frequent mischaracterized in federal reports and mental health workforce studies., Methods: Based on a review of the literature, this discussion paper evaluates trends related to PMH NP programs and graduates, anticipated retirements of current PMH ARPNs, facilitators and barriers to increasing the PMH APRN workforce, and opportunities and threats to workforce development., Results: The PMH APRN workforce faces significant challenges owing to barriers and facilitators to growth of the specialty. These factors conspire to limit the supply of PMH APRNs at a time when they are needed to compensate for declining numbers of providers in the United States, particularly practicing psychiatrists., Conclusion: Recommendations are forwarded as to how best shape the educational pipeline to meet the current and emerging needs of American citizens for quality mental health care.

Objective: To define and describe the current psychiatric mental health registered nursing (PMHN) workforce providing care for persons with mental health and substance use conditions, evaluate sources of data relevant to this workforce, identify additional data needs, and discuss areas for action and further investigation., Method: This article uses currently available data, much of it unpublished, to describe the current PMHN workforce., Results: The available data indicate that PMHNs represent the second largest group of behavioral health professionals in the United States. As is true of the overall nursing workforce, PMHNs are aging, overwhelming female, and largely Caucasian, although the PMHN workforce is becoming more diverse as younger nurses enter the field. PMHNs are largely employed in the mental health specialty sector, and specifically in institutional settings. Similar to other behavioral health professionals, a significant shortage of PMHNs exists in rural areas. Because of data limitations and difficulty accessing the best available data on the PMHN workforce, it is often overlooked or mischaracterized in published research and government reports on the behavioral health workforce., Conclusions: Although PMHNs are one of the largest groups in the behavioral health workforce, they are largely invisible in the psychiatric literature. Psychiatric nursing must correct misperceptions about the significance of the PMHN workforce and increase awareness of its importance among government agencies, large health care organizations, and within the broader nursing profession.

Objective: To describe the development of a data-driven policy platform for psychiatric nurses roles and outcomes to alleviate the current mental health crisis in the United States., Method: Drawing on census data, statistical reports, and analysis of the current psychiatric mental health nursing (PMHN) workforce, a data-driven policy platform is designed to recruit, train, and prepare psychiatric nurses for addressing the nation's mental health crises., Results: As noted by the Institute of Medicine's 2010 & 2016 reports on the future of nursing, the largest available health care workforce is not being used effectively, particularly to address the nation's mental health care needs. The development of a data-driven platform provides direction for psychiatric nurses in developing the workforce to meet the national mental health crisis., Conclusions: From education through practice and research, psychiatric-mental health nursing must build and share a data-driven, relationship-to-care platform emphasizing how PMHN care affects patient outcomes. Using a data-based platform to grow supportive public opinion, psychiatric mental health nursing can build a workforce to modify national accreditation standards and laws supporting data-driven PMHN care. The specialty profession must also seek to modify the nursing profession's attitude toward embracing data-driven platform of care relationships to psychiatric mental health outcomes.

Background: Written feedback assists students in refining their future academic work. However, students prefer having feed-forward instead of feedback by their instructors that are the comments provided to them on drafts prior to the actual assignment submission. The current literature describes two common ways to convey feed-forward: the foremost one is on outlines while the second is on drafts. However, no existing literature had been found yet for sufficient guidance on the ideal approach of feed-forward to facilitate students' subsequent learning., Design: A Quasi-experimental study design was employed to determine the effectiveness of feed-forward on outline versus drafts., Setting: Study was conducted in a private nursing institution in Karachi, Pakistan., Participants: 118 third-year undergraduate nursing students participated in the study., Methods: Using consecutive sampling, 118 students were enrolled and equally divided in to two groups, each comprising of 59 students in the control and intervention arm. Control group received feed-forward through standard practice i.e. on their assignment outline while the intervention group received feed-forward on the draft of their scholarly paper., Results: The performance of intervention arm had an upper hand over that of control wing as portrayed by their increased overall assignment and academic writing scores (of students on IELTs bands). The set outcomes also reflected better results in terms of the (reduced) frequency of visits to their instructors for clarification of written feedback. All in all, this research deduced that feed-forward on drafts is far more beneficial in contrast to that on an outline as it reinforces students' learning., Conclusion: The study findings affirmed that feed-forward is a useful strategy to enhance students' subsequent learning., (Copyright © 2018. Published by Elsevier Ltd.)

Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges., Materials and Methods: Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships., Results: Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome., Conclusions: Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.

The effects of mental health nurses' own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses' lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six-phase approach. The analysis revealed the broad context of nurses' experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses' lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses' mental illness could be much broader than the effect of workplace stress., (© 2018 Australian College of Mental Health Nurses Inc.)

Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross-sectional design was selected; 226 point-of-care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2-step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision-making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse-rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses., (© 2018 Australian College of Mental Health Nurses Inc.)

WHAT IS KNOWN ABOUT THE SUBJECT?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision-making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions., Abstract: Introduction Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods A cross-sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self-administered questionnaires were provided to mental health nurses. Results Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision-making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions., (© 2018 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: This paper addresses an identified gap in the international literatures related to physical health care of young people with first episode psychosis. Previous studies indicate that nurses' skills, knowledge and attitudes influence physical health outcomes for service users. The educational preparation of nurses influences their physical health care nursing practices. Nurses who have a high level of skills, knowledge and positive attitudes towards the provision of physical health care are more likely to initiate this care to young people experiencing first episode psychosis Young people experiencing first episode psychosis are more likely to have physical health comorbidities and less likely to receive treatment for them than young people in the general population. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: Psychiatric/mental health educated nurses are more likely to provide routine physical health care, for example checking that service users have a general practitioner for health care follow-ups, while comprehensive/generalist educated nurses also consider the young person's more complex physical health care needs such as smoking cessation and sexual health. The length of nurses' employment in mental health did not have any significant influence on their physical health care practices to young people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses working in the mental health setting provide physical health care to young people experiencing first episode psychosis, so it is important to determine if their educational preparation affects their physical health care practices. Provision of professional education opportunities and resources will enable nurses to improve their knowledge, skills and increase their awareness of the importance of providing comprehensive physical health care to young people experiencing first episode psychosis. Education providers need to emphasize the importance of providing physical health care to young people as part of mental health content in undergraduate nursing curricula., Abstract: Background Registered nurses working in the area of mental health complete either a psychiatric/mental health or comprehensive/generalist nursing program, and their education preparation influences their physical health care nursing practices. The differences in educational preparation may be a contributory factor to nurses' delivery of physical health care to young people experiencing first episode psychosis. This paper addresses an identified gap in nursing practices related to physical health care of young mental health service users. Aim To examine the relationship between the educational preparation of nurses and attitudes, confidence level, perceived barriers and physical health care nursing practices. Method A cross-sectional survey was conducted in 2015 with 207 nurses using the modified Physical Health Attitude Scale for Mental Health Nurses (PHASe). Results Comprehensive/generalist prepared nurses were more likely to provide education on heart disease prevention and sexual health and support young people to stop cigarette smoking than psychiatric/mental health nurses. However, as the length of service progresses, the propensity for psychiatric/mental health nurses to be involve in smoking cessation increases. Implication for practice It is important to identify how nurses' educational preparation affects their nursing practices so as to address the gaps in their physical health literacy., (© 2018 John Wiley & Sons Ltd.)

WHAT IS KNOWN ON THE SUBJECT?: There is a shortage of empirical research in the field of psychiatric and mental health nursing regarding how to calculate a safe staffing level in psychiatry inpatient units. Furthermore, the tools to assess nursing workload in this specialty are limited. No systematic reviews on measurement tools in adult psychiatric inpatient settings were found. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study confirms the scarcity and heterogeneity of instruments with which to evaluate nursing workload in this specific context. Likewise, the instruments identified do not capture the complexity of the psychiatric nursing setting, namely, the relational and psychotherapeutic strategies that must be implemented in the patient care approach. The findings of the study suggest that evidence-based tools for adult psychiatric inpatient settings require further development. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review shows the need to continue to develop tools that assess workload in psychiatric inpatient units that embrace activities related to patient (direct and indirect) and nonpatient activities. The great challenge is providing a sensitive understanding of the workload resulting from psychotherapeutic interventions, the primary treatment that many patients need. This review reinforces the need to add patient outcomes to workload assessment processes., Abstract: Introduction No systematic reviews on measurement tools in adult psychiatric inpatient settings exist in the literature, and thus, further research is required on ways to identify approaches to calculate safe nurse staffing levels based on patients' care needs in adult psychiatric inpatient units. Aim To identify instruments that enable an assessment of nursing workload in psychiatric settings. Method A scoping review was conducted. Results Four studies were identified, with five instruments used to support the calculation of staff needs and workload. All four studies present methodological limitations. Two instruments have already been adapted to this specific context, but validation studies are lacking. Discussion The findings indicate that the tools used to evaluate nursing workload in these settings require further development, with the concomitant need for more research to clarify the definition of nursing workload as well as to identify factors with the greatest impact on nursing workload. Implications for practice This review highlights the need to develop tools to assess workload in psychiatric inpatient units that embrace patient-related and non-patient-related activities. The great challenge is to enable a sensitive perception of workload resulting from nurses' psychotherapeutic interventions, an important component of treatment for many patients., (© 2018 John Wiley & Sons Ltd.)

Knowing professionals' attitudes is the basis for the development of skills for dealing with drug dependence. These attitudes may affect patients' clinical safety and the cost-benefit ratio of the interventions. The goal of this study was to assess emergency and mental health nurses' attitudes and perceptions towards alcoholics. A multicenter prospective descriptive study was conducted in six hospitals with 167 emergency and mental health nurses. Nurses classified alcoholics as sick individuals, although there was a tendency to feel uncomfortable working with them. Results indicated that these professionals had a rejecting attitude towards moderate alcohol consumption. It found that there was a significant association between the attitude of the nurse and gender, with the degree of rejection towards the alcoholic being higher in men than in women, and with less punitive attitudes in professionals with 0 to 11 years of professional experience.