Support interventions for nurses working in acute psychiatric units: A systematic review

Diverse support interventions have been implemented to provide support for nurses working in acute psychiatric settings. These interventions aimed at modifying the psychological and social factors, as they either prevent stress responses or reduce its effects to improve the psychological well-being of staff. This study aimed to examine effective stress reduction interventions for nurses and to identify key elements of these successful interventions. Studies included in this review were conducted in acute psychiatric settings. A comprehensive search of electronic databases was conducted for support intervention studies between 2010 and 2021. The search yielded 315 studies that were reduced to seven studies after being reviewed by two independent reviewers. The studies were coded, and key elements were identified. Seven studies that were included consisted of a randomised controlled trial, quasi-experimental design and single-group design. Interventions included mindfulness-based stress reduction, burnout prevention programmes, communication skills, educational programme, group intervention, resilience training programme and stress management. Four key elements emerged from these interventions, namely, educational support, interpersonal skills, psychological support and adaptive coping. The findings highlighted the diverse interventions in supporting psychiatric nurses to cope with stress. However, there is a dearth of studies in acute psychiatric settings that were mostly done in emergency settings. Knowledge gained from this review may assist with practice improvement as managers can implement the identified interventions.

Experiences of psychiatric nurses caring for mental healthcare users with a comorbid disorder

Background: Caring for mental healthcare users (MHCUs) with a comorbid disorder of human immunodeficiency virus (HIV) and schizophrenia has always been challenging and requires expertise, skill, intuition and empathy. Objectives: The objective of this study was to explore and describe the experiences of psychiatric nurses caring for MHCUs with a comorbid disorder of HIV and schizophrenia. Method: A qualitative, exploratory, descriptive and contextual research design was used. Eight participants were selected through purposive sampling for individual in-depth interviews to collect data. Thematic analysis was used to analyse data. Results: Three themes emerged from this study. The first theme is that the psychiatric nurses experienced deep frustration because they were capable but unable to manage MHCUs with HIV and schizophrenia because of poor infrastructure and other contributing barriers. The second theme identified that the psychiatric nurses experienced discrimination against MHCUs compromising their holistic recovery. Lastly, the psychiatric nurses identified the need for health care workers in general hospitals and communities and families of MHCUs with a comorbid disorder to be educated in mental health issues to ensure continuous medical care. Conclusion: The results of this study showed that psychiatric nurses became exhausted when trying to cope with difficult nursing situations. The challenges they faced had negative consequences for the mental health of the psychiatric nurses and compromised patient care. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by implementing recommendations to mitigate the challenges of psychiatric nurses caring for MHCUs with HIV and schizophrenia.

Patients' opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare

Background: Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service. Aim: This study explored the opinions of patients receiving care at a tertiary psychiatric hospital's outpatient department (OPD) about referral to a primary healthcare clinic (PHCC). Setting: The study was conducted at Weskoppies Psychiatric Hospital OPD. Methods: This was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays. Results: From the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants' homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation. Conclusion: The perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed

A profile of adult acute admissions to Lentegeur psychiatric hospital, South Africa

Background: The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission.Aim: To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital.Setting: Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas.Methods: This retrospective study involved an audit of all patients (18­60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined.Results: The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis.Conclusion: Substance use and a history of violence contributed to admissions in this population

Barriers to care among people with schizophrenia attending a tertiary psychiatric hospital in Nigeria

Background: Individuals with schizophrenia in low- and middle-income countries and their caregivers face multiple barriers to care-seeking and continuous engagement with treatment services. Identifying specific barrier patterns would aid targeted interventions aimed at improving treatment access.Aim: The aim of this study was to determine stigma- and non-stigma-related barriers to care-seeking among persons with schizophrenia in Nigeria.Setting: This study was conducted at the Outpatient Clinics of the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria.Methods: A cross-sectional study of a dyad of persons with schizophrenia and caregivers (n = 161) attending outpatient services at a neuro-psychiatric hospital in Nigeria. Stigma- and non-stigma-related barriers were assessed using the 30-item Barriers to Access to Care Evaluation (BACE) scale.Results: Lack of insight, preference for alternative care, illness severity and financial constraints were common barriers to care-seeking among persons with schizophrenia. Females were significantly more likely to report greater overall treatment barrier (p < 0.01) and stigma-related barriers (p < 0.02).Conclusion: This study shows that attitudinal barriers impede care access and engagement among persons with schizophrenia in Nigeria

Oral health status and treatment needs of in-patients of a Nigerian psychiatric hospital

Objective: Mental disorders have been reported to increase the risk to neglect of oral care. The objective of this study was to determine the oral health and treatment needs of psychiatric in-patients and compare with non-psychiatric patients.Methods: This was a cross-sectional study conducted at the Federal Neuro-psychiatric Hospital, Yaba, Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos. A structured questionnaire was administered by investigators to the two groups of participants case group (psychiatric patient) and the control group (dental patient with no psychiatric history). This included mini international neuropsychiatry interview (M.IN.I)questionnaire to ascertain the diagnoses. Other information sought included missing teeth, retained teeth, carious teeth and tooth wear lesions were noted during oral examination. Results: A total of 167 participants were seen (81 were in the control group and 86 in the case group). Age range was from 18-90 years. The mean age was 41.44±14.98 years. All the participants (2.99%) with retained root were in case group. The majority (52.3%) of the participants in case group were dentate (p=0.001). The control group had the highest proportion of participants with good oral hygiene (p= 0.09). Carious teeth (p =0.33) and the number of teeth affected by tooth wear lesion were found to more in the case group (p= 0.02).Conclusion: Psychiatric patients had poor oral health compared to non-psychiatric patients. There was also a higher restorative and surgical treatment need in psychiatric patients

Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry; they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that; in some cases; MUS may be ascribed to Somatoform Disorders when; fact; they are ""organic"" syndromes that are misdiagnosed. In developing countries; with fewer resources; MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics; referral pathway; management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5of the total number of files reviewed. In only 38of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28of cases a new ''organic"" diagnosis was made and in 72of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with ""organic"" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA; a significant number of patients with MUS may have underlying ""organic"" illness; and most may have psychiatric disorders. Patients with MUS; especially older patients; should be more extensively investigated. Psychiatric referral of these patients is very appropriate."

Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals; researchers; policy makers; politicians; users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0; using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155. Most respondents were of the view that the state psychiatric hospitals were very congested; substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services; using psychiatric hospitals only as referral facilities; relapse prevention programmes; strengthening psychosocial services; adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana

Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward

Abstract Objectives: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward ­ within a general hospital, Helen Joseph Hospital (HJH). Method: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using "Generalized Linear Latent and Mixed Models" (GLLAMM). Results: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (p<0.001), gender (p<0.019), substance abuse (p<0.019) and follow-up referral (p<0.000) were significantly associated with LOS. Conclusion: The study contributed by identifying these predictive indicators for the acute in-patient treatment outcome of patients with schizophrenia. Future standard operational procedures for diagnostic and treatment processes in acute wards may have to include structured interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with schizophrenia

Profile of mortality of patients admitted to Weskoppies Psychiatric Hospital in South Africa over a 5-year period (2001-2005)

Objective: Mortality in the psychiatric population; both from natural and unnatural causes; is higher than in the general population and this is despite an improvement in the delivery of care and treatment of mental illness in recent years. The study was conducted to determine a profile of mortality and standardized mortality rates within our psychiatric hospital. Method: A retrospective clinical case audit was conducted of deaths that occurred at Weskoppies Hospital between 1st January 2001 and 31st December 2005. Direct standardised mortality rates were calculated (gender specific adjusted for age according to the South African population). Results: A total of 164 deaths were observed during this period. The gender-specific all cause mortality rates; standardised to the South African population; were 0.0177 (95CI 0.0141; 0.0213) and 0.0163 (95CI 0.0121; 0.0206) for males and females respectively. The all cause mortality rates for the South African male and female population were 0.0188 and 0.0170 respectively (not significantly different as it falls within the 95confidence interval of the standardised rates). The predominant natural cause of mortality was infection. Ten of the deaths were due to unnatural causes; of these 7 were suicides. The mortality ratio for unnatural causes was 0.47. Conclusion: Mortality studies are important tools for determining quality of health care provisions to patients. Studies of this nature assist in making recommendations for optimal clinical practice and aid in developing preventative measures

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Objective: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch/'s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of ≥10. The mean BPRS score was 23.6±22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). Conclusion: These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid­way facilities for their rehabilitation

Profil evolutif et comparatif des patients de l'hopital psychiatrique de Bingerville en 1985 et en 2004

L'etude retrospective relative au profil evolutif et comparatif des patients de I'HPB en 1985 et en 2004 a permis de constater tant au niveau des donnees sociodemographiques que cliniques et therapeutiques les resultats suivants :La population des patients de I'HPB reste jeune. Les ages sont compris entre 22 et 44 ans. Le sex-ratio est en faveur des hommes.Le secteur informel domine toujours les categories professionnelles.Les musulmans majoritairement hospitalises en 1985 avec 34;88pour cent passent a 21;75pour cent au profit des catholiques avec 25pour cent.Les patients de nationalites etrangeres sont majoritairement du Burkina Faso (24;85pour cent) suivi du Mali (12;42pour cent). Cette donnee reste valable pour 2004. Il faut signaler cependant une forte regression dans les pourcentages qui passe de 24;85pour cent en 1985 a 16pour cent en 2004. Les maliens representent 12;42pour cent en 1985 et ont ete 6;32pour cent en 2004.Les urbains qui etaient de 53;11pour cent en 1985 sont passes a 77;92pour cent en 2004. Le celibat reste une donnee constante tant en 1985 qu'en 2004 avec 65;59pour cent et 74;67pour cent. Les patients maries representent 31;53pour cent de l'effectif en 1985 contre 14;77pour cent en 2004.52;27pour cent en 1985 et 43;18pour cent en 2004 n'ont pas d'enfants. 36;42pour cent en 1985 et 31;81pour cent en 2004 ont entre un et 5 enfants; 1;51pour cent en 1985 et 1;62pour cent en 2004 ont plus de 10 enfants.Les malades sont generalement des aines dans leur fratrie soit 44;52pour cent en 1985 et 47;07pour cent en 2004. Les readmissions oscillent entre 36 et 38pour cent.Les demandes d'hospitalisations emanaient en 1985 dans 57;67pour cent des cas de centres de sante; pour 27;65pour cent provenant des parents. Cette tendance s'est inversee en 2004.La majorite des malades sont admis pour trouble du comportement; pour agitation psychomotrice et pour agressivite aussi bien pour l'annee 1985 que pour 2004.Ces malades soufrent majoritairement de troubles de l'humeur; de troubles psychotiques brefs et de troubles schizophreniques pour les annees etudiees.En 2004 55;51pour cent des malades payaient leurs frais d'hospitalisation.La duree du sejour est interieur a 30 jours dans 50;75pour cent des cas en 1985 et 67;20pour cent en 2004. Les durees de sejour sont plus courtes en 2004 qu'en 1985. 2;19pour cent des malades ont beneficie des examens biologiques en 1985 contre 14;28pour cent en 2004. 0;33pour cent sont concernes par la serologie VIH en 1985 contre 7;62pour cent en 2004. Aucun malade de 1985 n'est seropositif alors qu'en 2004 34;04pour cent des malades sont seropositifs.Il n'y a pas de difference notoire entre les prescriptions de 1985 et celles de 2004. De nouvelles molecules (Olanzapine) ont fait leur apparition en 2004. Les deces sont tres peu significatifs avec 0;16pour cent de cas en 1985 et 0;81pour cent en 2004.13;15pour cent de nos malades sont sortis contre avis medical (SCAM) en 1985 contre 17;53pour cent en 2004

Pathologies psychiatriques en milieu hospitalier feminin. A propos de 146 cas colliges a l'hopital psychiatrique de Bingerville

"Les deux pavillons de femmes de l'H.P.B. ont ete baptises en septembre 1998 Pavillon ABHE ANTOINE du nom du premier psychiatre ivoirien qui y a exerce comme medecin chef. Cette etude retrospective a porte sur 146 nouveaux cas hospitalises en 1997. Ce sont des patients adultes jeune (76;07 pour cent); de religion chretienne (66;4 pour cent); sans emploi (67;8 pour cent) et residant generalement a Abidjan (65;8 pour cent). La demande de soins a ete surtout formulee par leur famille (74;7 pour cent) et pour les 3 principaux motifs suivant : l'agitation psychomotrice; l'incoherence des propos; I'agressivite. Les pathologies psychiatriques qui s'exprimaient ainsi ont ete identifiees selon les criteres de OMS (CIM 10) comme etant principalement : la schizophrenie et les troubles delirants (58;9 pour cent); les troubles affectifs (21;9 pour cent); les troubles mentaux organiques (8; 2 pour cent). Ainsi les troubles mentaux ""origine physiologique (psychose puerperale) specifiques a cette population feminine ne representent que 2; 1 pour cent. Les activites qui Sont menees dans ce pavillon sont les memes que celles de l'H.P.B dont il fait partie : consultations; soins hospitaliers; formation; recherche. Le volume hospitalier du pavillon a represente en 1997 33;6 pour cent du volume total de l'H.P.B. Les problemes que rencontre le Pavillon ABHE ANTOINE ne lui sont pas specifiques et meritent que les autorites competentes y portent un interet particulier."