Issues in Mental Health Nursing

Championing the "Me" in Treatment: Quality Improvement to Increase Individual Patient Participation in Treatment Planning in an Inpatient Behavioral Health Facility
Liebman EE and Peterson K
The Effect of COVID-19 Public Health Measures on Mental Health in California
Mehrabadi MA, Nurmi EL, Borelli JL, Lambert N, Rahmani AM, Downs CA, Chakraborty R and Pinto MD
The goal of this study was to examine the influence of the COVID-19 pandemic, including public health measures (mitigation and containment efforts), on new onset mental health diagnoses by age group. This study was a longitudinal retrospective cohort study. Data on new mental health diagnoses were extracted from the University of California Health System Electronic Health Records (EHR) that contained five academic health centers in California. Data were examined for identical timeframes before the COVID-19 pandemic (historical control cohort) and following the start of the pandemic (case cohort). Paired t-tests were used to test for differences in the number of new mental health diagnoses by age group. A two-way ANOVA was used to test for between group differences. The largest increase in mental health diagnoses (overall) was observed in the 26-35-year-old age group ( < 0.001) and for the following mental health diagnoses: anxiety, bipolar, depression, mood disturbance, and psychosis. Study findings may inform post-pandemic recovery efforts and pandemic preparedness strategies for future public health emergencies. Specifically, findings may guide the deployment of mental health screening, universal mental health interventions, and resource allocation for mental health to best support at risk groups during times of high vulnerability.
The Impact of a Mental Health Community Symposium on Nursing Students' Knowledge and Attitudes Toward Mental Illness
Bush J, Blackburn A, King E and Van Der Like J
Sources of Distress for Secure Mental Healthcare Staff: A Cross-Sectional Study of the Impact of Personal and Occupational Problems on Psychological Wellbeing and Functioning
Webb EL, Morris DJ, Khan M and Al-Refai N
Despite a global drive to improve staff well-being in healthcare, distress and absenteeism continue to persist, posing consequences for patient care and organisational functioning. Current research and subsequent strategies implemented to remediate such problems have primarily focused on occupational experiences, disregarding the contribution of problems occurring outside of the workplace. The current study sought to establish the prevalence of work and non-work problems, and their respective impacts on several well-being outcomes, in this occupational group. Secondary analysis of data from a cross-sectional survey of 323 staff in a secure UK mental healthcare organisation was conducted. Exposure to non-work problems was pervasive across the sample (79.3%). Demographic discrepancies in exposure to types of problems were apparent, though number of problems reported was comparable across the sample. Number of non-work problems was a significant predictor of depression, anxiety, functional impairment, and complex post-traumatic stress disorder symptoms, when controlling for exposure to work problems. The findings implicate the need for a broader conceptualisation of distress in secure mental healthcare staff, who typically report exposure to several non-work problems, in the context of occupational challenges. Policy, practice and service implications are discussed, with consideration for the availability and modality of support offered to staff.
The Latent or Covert Signs and Symptoms of Cyber Victimization and Risky Online Behaviors: An Integrative Review
Antisdel JL
The purpose of this integrative review is to describe latent or covert signals of cyber victimization and risky online behaviors in teens. This review was guided by Whittemore and Knafl's integrative review method. A literature search of peer-reviewed, primary source studies published between January 2010 and February 2022 was conducted using the following databases: Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (CINAHL), APA Social Work Abstracts, ERIC, PsycInfo, and APA PsycArticles. Initially, the search string was (cyber victimization OR cyberbullying) AND (risky) AND (internet OR online) AND (signs OR symptoms) AND (latent OR covert OR hidden OR cryptic) AND (lived experience OR perceived OR perception). Additional terms were added, including social engineering. A total of 20 articles were included in this review. Four themes emerged from the literature: (1) the reciprocal nature of cyber victimization and risky online behaviors, (2) latent or covert signs and symptoms, (3) new language surrounding teens' online experiences, and (4) barriers to disclosing experiences. Latent or covert signs and symptoms were categorized into two sub-themes: (1) mood dysregulation and (2) online interaction and expression. Barriers to disclosing experiences were categorized into two subthemes: (1) reluctance to disclose and (2) minimization or disconnection of experience. Qualitative studies yielded richer information concerning the experiences of teens who experienced cyber victimization. Future research using qualitative methodologies and direct analysis of public social media posts are needed to effectively detect the latent or covert signs and symptoms of cyber victimization and risky online behaviors.
Revisiting Therapeutic Communication as an Evidence-Based Intervention to Decrease Violence by Patients Against Staff on Psychiatric Wards-A Quality Improvement Project
Amara SS, Hansen B and Torres J
Violence against healthcare workers continues to be a widespread problem and adversely impacts both healthcare providers and consumers.
A Scoping Review of Australian New Graduate Nurse Preparation to Work in Mental Health Settings
Hazelton M, Lakeman R, Happell B, Moxham L, Foster K and Hurley J
: The review explores current evidence on Australian pre-registration nurse education in preparing graduates to work in mental health settings, from the perspectives of the graduates. : A scoping review using the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was undertaken. : There were 31 eligible publications, reporting 12 qualitative studies, eight surveys and 11 quasi-experimental studies. All were in English language peer reviewed journals, published between 2000 and July 2023. Five themes emerged: 1. Well-organised and supported clinical placements can reduce stigma; 2. Student concerns regarding mental health clinical placements can be lessened when placements are well-designed; 3. Well-organised and resourced clinical placements can increase interest in mental health nursing; 4. Simulation learning can increase confidence during clinical placements; 5. Teaching by Experts By Experience (EBE) can reduce stigma and improved student attitudes. : Evidence from 31 eligible publications indicated that properly resourced, purpose-designed theoretical and clinical learning experiences can be effective in reducing stigmatising attitudes and behaviours in pre-registration nursing students. Involving EBEs in mental health teaching is an important, but so far under-utilised, development in pre-registration nursing programmes in Australia.
Call for manuscripts-Special issue on Caregiver Suicide and Promotion of Well-Being
A New Antipsychotic for Schizophenia: Xanomeline and Trospium (Cobenfy)
Mills J
"It Feels like You're Just Clawing Your Way Through": Young Adults' Experiences of Transitioning from Child and Adolescent to Adult Mental Health Services in Ireland
O'Leary C, Ryan E and MacNeela P
Transitioning from child to adult services is a significant event for young adults. The study aimed to explore the experiences of young adults who transitioned from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in Ireland. Semi-structured interviews were conducted with six young adults and analysed according to interpretative phenomenological analysis. Interpretations were subsequently viewed through the lens of transition theory. Findings indicate that the transition presents major challenges for young adults and can cause a deterioration in mental health, in the context of multiple concurrent life transitions, discontinuity of care, a dramatic culture shift in AMHS, and experiences of impersonal care. Participants expressed their view that AMHS clinicians did not know how to approach their treatment due to a lack of available options or diagnosis-specific expertise, leading these individuals to question the validity of their suffering; this is a novel finding in the context of previous transition research. The utility of transition theory in developing a CAMHS-AMHS transition framework is demonstrated.
Determining the Acceptability of Targeted Apps for High-Risk Alcohol Consumption in Nurses: A Qualitative Study
Searby A and Burr D
To determine the acceptability of targeted apps and provide recommendations for the implementation of and app addressing high risk alcohol use to nurses.
Music Matters - A Qualitative Evaluation of a Nurse-Led, Group-Based Music Program Complementary to Early Intervention for First-Episode Psychosis
Abild SM, Schuster S and Midtgaard J
First-episode psychosis is a significant mental health condition that can have a profound and lasting effect on an individual's functional abilities and overall quality of life. While music therapy has shown promise in improving these areas, there is a lack of research exploring the impact of music groups led by mental health professionals without formal music therapy training in the context of early intervention in psychosis. This study aimed to conduct a qualitative evaluation of a once-weekly, 12-week, nurse-led music group, offered as an adjunct to early intervention in young people with first-episode psychosis. The specific objectives were to explore social interaction and experiences of participants and instructors in relation to the music group and provide focus points for implementation in clinical practice. The study utilized Interpretive Description, collecting data through participant observation (6 sessions × 1.5 hrs; 9 hrs in total), key informant interviews ( = 1), and group ( = 4) and email-based ( = 2) interviews. The data was transcribed, thematized, and analyzed using NVivo12 and Interpretive Description inductive analysis resulting in three main themes: Practicalities of the music group, Restored identity, and Music as medicine reflecting the potential of the music group to contribute to a sense of non-patient identity, decreasing symptoms related to mental illness, foster social relationships and a feeling of belonging to a musical community. This study highligts how participation in music groups can be a possible promoter of recovery. However, sustainability appears contingent on the skills and resources of the facilitator (i.e., nurse). Suggestions for a program theory and clinical implications are presented and discussed.
"Sacred Space," Caring for Patients in the Hospital Dying from COVID-19: Part 2
Dodge LA, Johnson-Rodriguez H, Lesser J and Gill SL
"Sacred Space," Caring for Patients in the Hospital Dying from COVID-19: Part 3
Dodge LA, Johnson-Rodriguez H, Lesser J and Gill SL
Mental Health Risk Assessment and Safety Planning During UK Covid-19 Pandemic Lockdown: Mixed Methods Survey and Interview Study
Dickens GL, Watson F, Schoultz M, Kemp C, Ion R, Hallett N and Al Maqbali M
Risk assessment and safety planning are central to mental health nursing practice but were seriously affected by the Covid-19 pandemic and associated lockdowns. In this study, we aimed to explore how the UK pandemic lockdowns affected risk assessment and safety planning from the perspective of mental health practitioners. A sequential, mixed methods study design was used. A link to an online survey questionnaire was distributed and semi-structured interviews with a subset of respondents were conducted. Survey data were analysed to describe perceived changes in the frequency and nature of risk assessment and safety planning during the pandemic lockdowns. This was supplemented by thematic analysis of qualitative interview data. In total, 106 practitioners were surveyed and 10 participated in semi-structured interviews. More respondents increased than decreased risk assessment frequency but there was no significant overall change. Remote contact was more common in community settings and largely involved telephone appointments. Participants did not wish to continue with remote working following the pandemic. Risk assessment practice changed in UK mental health services as a result of COVID-19 lockdowns.
Suicide Mortality Among Nurses in the United States: Incidence, Factors Associated with Suicide, Circumstances Preceding Suicide, and Methods of Suicide
Kreuze E, York J and Merwin EI
The aim of this review was to identify and integrate evidence on suicide mortality among U.S. nurses. To the best of our knowledge, this represents the first review to focus exclusively on suicide among U.S. nurses. Electronic medical databases, reference lists, and supplementary files were searched to identify studies that examined suicide mortality among U.S. nurses. In total, n = 28 studies were included: n = 14 were cohort, n = 10 were epidemiological, and n = 4 utilized mixed methods. Many studies had unique aims, included different nurse groups and referent populations, and utilized a variety of statistical procedures. However, when taken together, four categories were assessed across these n = 28 cumulative studies: incidence of suicide, factors associated with suicide, circumstances preceding suicide, and methods of suicide among U.S. nurses. Taken together, continued surveillance of suicide incidence among U.S. nurses is important, as evidence largely suggests nurses experience elevated suicide incidence when compared to select referent groups. Additional research on factors associated with suicide and circumstances preceding suicide are also needed, particularly among male nurses. Finally, additional research regarding the leading method of suicide, leading substance implicated in self-poisoning, and sex-differentiated suicide methods are also important. Collectively, these data are needed to inform intervention and surveillance strategies.
Effect of a Logotherapy-Based Empowerment Program for Achieving Self-Reliance Among Persons Living Houseless
Hyun M, Kim S and Park E
The lives of houseless individuals are characterized by powerlessness, meaninglessness, hopelessness, and despair, yet they have a desire to escape homelessness. While the economic aspect is essential for escaping homelessness, psychological resources are crucial, as they form the basis of the strength needed to achieve independence. The study aimed to examine the effectiveness of a logotherapy-based empowerment program developed to strengthen the capabilities of persons living houseless and ultimately develop competencies that serve as a foundation for self-reliance. The study was performed in a homeless support center for men living houseless in South Korea using a repeated-measures design with a control group. The experimental group received an eight-session empowerment program over 8 weeks. The participants were assessed at three intervals: pretest, posttest immediately after the program, and follow-up test 4 weeks after the posttest. The follow-up tests were completed by 22 and 16 participants in the experimental and control groups, respectively. We found that the empowerment program significantly enhanced the meaning of life, hope, and empowerment of houseless individuals. Community mental health nurses, who are in a position to interact with persons living houseless, must empower them to escape homelessness and achieve self-reliance, an important goal for this population.
Inpatient Suicides in Swedish Psychiatric Settings - A Retrospective Exploratory Study from a Nursing Perspective
Lindberg M, Sunnqvist C, Wangel AM, Probert-Lindström S, Fröding E, Bergqvist E, Stefenson A, Waern M and Westrin Å
In Sweden, approximately 1,200 individuals die by suicide annually. Inpatient suicide is considered rare, but death by suicide still occurs when admitted to a psychiatric hospital. This study was part of a national retrospective project covering data from all patients' medical records for the 2 years before death by suicide in 2015. In this study, 41 patients who died by suicide while being admitted to psychiatric care were identified. The aim was to retrospectively identify documentation of suicide risk, safety measures, and comparisons between those with and without suicide attempts for patients who died by suicide during psychiatric inpatient care. There was documentation of suicidal variables in 80% of the patients; 59% had a previous known suicide attempt, 63% were diagnosed with mood disorders, and 41% were assessed for elevated suicide risk. The most common suicide method was hanging, suffocation (68%), and 22% had died by suicide within 24 h after admission. Almost three-quarters were on voluntary care. No patients had constant professional supervision on a one-to-one basis, and 17% had 15-minute checks. One-third were on agreed leave at the time of the suicide. These results emphasise the lifesaving role of high-level supervision in the early stages of inpatient care.
Enhancing Mental Health Assessment for Non-Fatal Strangulation in Clients with a History of Intimate Partner Violence
Clements PT, Mitchell SA and Janson A
Intimate partner violence (IPV) against women is widely recognized as a significant global problem, a major public health issue in the United States, and one of the most widespread violations of human rights. Recent research has noted that non-fatal strangulation (NFS) has been a significantly overlooked indicator and by-product for victims of IPV and often may be undisclosed or can be confounded with other mental health symptoms; for example, those that are common with conditions seen in psychiatric facilities. Traumatic brain injury (TBI) and nonfatal strangulation are often unrecognized forms of IPV and can lead to significant short and long-term neurologic sequelae. It is possible that some mental health disturbances and anxiety symptoms may be better explained as a medical consequence of TBI and repeated NFS-or a signal of homeostatic disruption. In such cases, providing psychopharmacological treatment might help the patient with the symptoms, but will not address the underlying cause. This reinforces the critical need for mental health nurses to not only assess for IPV, but simultaneously screen for TBI-related neurological disorders and injuries, including recent and/or past unconsciousness, and facilitate linkage to IPV interventions and mental health treatment.
Geographic Access to Community Mental Healthcare and Adherence to Treatment Among Patients with Schizophrenia Spectrum Disorders
Smith-East M, Neff DF, Hawthorne T, Conner NE and Edwards J
Non-adherence to antipsychotic medications is a commonly recognized problem that can lead to lack of follow-up for patients with schizophrenia spectrum disorders, increasing risk for psychotic symptoms, hospitalizations, and decreased quality of life. We conducted a secondary data analysis of electronic health record data of patients with schizophrenia spectrum disorders ( = 1,341) in Central Florida to explore relationships between geographic access to mental healthcare facilities, socioeconomic factors, and follow-up visits, and whether these conditions contributed to adherence over 1 years' time. Using Geographic Information Systems among six mental health facilities, spatial analysis and logistic regression indicated that patients had 27.9% increased odds ( = 0.02) of adherence to treatment when travel time to facilities was 30 min or less. Spatial autocorrelation revealed significant positive clusters in areas with low travel time (15 min or less). Patients who had Medicaid, a case manager and/or a life skills coach, medication side effects, a substance use disorders history, and/or closer proximity to mental healthcare services, had an increased likelihood of attending four or more follow-up visits in 1 year. Identifying effects of spatial and non-spatial variables on non-adherence to treatment can provide useful insights for developing targeted interventions to improve treatment outcomes.
Call for Manuscripts-Special Issue on Caregiver Suicide and Promotion of Well-Being
Thomas S