Loneliness and the COVID-19 pandemic: implications for practice.

Loneliness is a complex universal human experience. A variety of evidence indicates that prolonged loneliness can have a negative effect on an individual's long-term physical and psychological outcomes. Empirical evidence and systematic reviews show strong links between loneliness and ill health, particularly cardiovascular disease and mental health. Loneliness is increasing in frequency and severity. The issue of loneliness has been part of UK Government mandates since 2018; however, evidence suggests that, due to the pandemic, the need to focus on the issue may be even more significant. Assessing for loneliness can be challenging and many people do not want to report their feelings of loneliness. Interventions should aim to be preventive and help people create meaningful interactions. Useful interventions include person-centred interventions, cognitive therapy and group intervention therapy. There is a need for more evidence-based loneliness interventions. A knowledge of local and voluntary sectors is vital so health professionals can effectively support their patients.

How does severe mental illness impact on cancer outcomes in individuals with severe mental illness and cancer? A scoping review of the literature.

INTRODUCTION: Individuals living with severe mental illness (SMI) have a reduced life expectancy of approximately 15-20 years compared to the general population1,2. Individuals with SMI and comorbid cancer have increased cancer related mortality rates compared to the non SMI population. This scoping review examines the current evidence in relation to the impact on cancer outcomes where individuals have a pre-existing SMI. METHODS: Scopus, PsychINFO, PubMed, PsycArticles and the Cochrane Library were searched for peer reviewed research articles, published in English language between 2001 and 2021. Initial title and abstract screening, followed by full text screening sourced articles reporting on the impact of SMI and cancer on: stage at diagnosis, survival, treatment access or quality of life. Articles were quality appraised, and data were extracted and summarised. RESULTS: The search yielded 1226 articles, 27 met the inclusion criteria. The search yielded no articles that met the inclusion criteria that were from the perspective of the service user or that were focused on the impact of SMI and cancer quality of life. Three themes were developed following analysis: Cancer related mortality, stage at diagnosis, and access to stage appropriate treatment. DISCUSSION: The collective study of populations with comorbid SMI and cancer is complex and challenging without a large-scale cohort study. The studies yielded through this scoping review were heterogenous and often study multiple diagnoses of SMI and cancer. Collectively these indicate that cancer related mortality is increased in the population of individuals with pre-existing SMI and the SMI population are more likely to have an increased likelihood of metastatic disease at diagnosis and less likely to receive stage appropriate treatment. CONCLUSIONS: Individuals with pre-existing SMI and cancer have increased cancer specific mortality. Comorbid SMI and cancer is complex, and individuals with SMI and cancer are less likely to receive optimal treatments, experience increased interruptions and delays to treatment.

Mental health pre-registration nursing students' experiences of group clinical supervision: a UK longitudinal qualitative study.

There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students' views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics.

Lecturers' accounts of facilitating clinical supervision groups within a pre-registration mental health nursing curriculum.

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. Since then a body of literature has emerged, largely focusing on students' experiences of a variety of training initiatives in supervision. There is however a paucity of literature exploring the experiences of nursing lecturers engaged in such initiatives. This paper reports the findings from one part of a three-year prospective longitudinal study examining mental health students' and lecturers' experiences of group clinical supervision undertaken as part of a pre-registration course. In this part of the study eight mental health nursing lecturers participated in semi-structured individual interviews in which they discussed their experiences of facilitating student supervision groups. Content analysis of the interview data produced eight major categories: 'attitudes to supervision'; 'perceptions of the student experience'; 'preparation and support'; 'approaches to supervision'; 'the "good" supervisor'; 'the lecturer as supervisor'; 'the structure and process of sessions; and 'the content of supervision'. The findings suggest that the idea of undertaking supervision for students is attractive to lecturers. However, several issues need to be addressed if this type of initiative is to be successful in preparing students for their future role as supervisee.

Medical response time to section 5(4) (nurses' holding power) of the Mental Health Act 1983 over a 24-year period.

This study examines the trends associated with medical response time (MRT) for all section 5(4)s of the Mental Health Act 1983 applied in one mental health trust over a 24-year period. Eight hundred and three section 5(4)s were applied during the study period of which 786 had a recorded medical response time. The mean MRT was 140 minutes and 647 (82.3%) patients were seen by a doctor within the four-hour period specified in the Mental Health Act Code of Practice (DoH, 1999). Analysis of MRT showed no significant difference with the day of the week or when the weekday mean MRT was compared to that for the weekend. A significant difference was observed for the mean MRT prior to, and following, the introduction of the four-hour period noted in the MHA Code of Practice. Significant differences were also observed for the MRT over the 24-hour period . The mean MRT for the 'working hours' period was significantly higher than that for the combined period Monday-Friday, 5pm-9am, and Saturday and Sunday. The findings suggest the need for mental health trusts to review their practices to ensure that patients receive a medical assessment in the shortest period of time following the application of section 5(4).

Group clinical supervision for mental health nursing students.

Clinical supervision is recognized as important for developing safe professional practice in nursing. Although attention has been given to the development of training and education in clinical supervision for registered nurses, less discussion exists regarding these issues for pre-registration mental health nursing student to the theory and practice of group clinical supervision. In particular, this article raises awareness and promotes discussion of the practical issues involved in such an initiative.

Group clinical supervision in pre-registration nurse training: the views of mental health nursing students.

In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. In response to this recommendation, the now defunct English National Board (ENB) stated that: "It will be a requirement that all students of pre-registration nursing programmes receive preparation in what to expect from clinical supervision" (ENB, 1995, p. 4). Despite the fact that no further guidance was issued there is an emerging body of literature exploring this area. This paper reports findings from the initial phase of a three-year prospective longitudinal study examining students' experiences of group clinical supervision undertaken as part of their pre-registration training. In this part of the study 32 mental health nursing students participated in focus groups in which they discussed their expectations of clinical supervision. Content analysis of the data produced five major categories: 'the nature of clinical supervision'; 'roles and responsibilities'; 'staying safe and doing no harm'; 'being in a group'; and 'being a student'. The findings suggest that the idea of supervision is attractive to students, although there are significant anxieties both about supervision in general and of group supervision in particular.

Mental health nursing students' relationships with the pharmaceutical industry.

INTRODUCTION: The medical profession's relationship with the pharmaceutical industry (PI) has come under increased scrutiny in recent years, however little is known on the subject in mental health nursing. AIMS: The study sought to investigate: (1) the frequency of contact between mental health nursing students and PI employees; (2) students' attitudes and beliefs about their relationship with the PI; (3) the range of 'gifts', promotional items and hospitality accepted or seen in clinical environments by students in a one year period; and (4) students' attitudes to 'gifts', promotional items and hospitality offered by the industry. METHOD: Employing a survey design, a 35-item questionnaire was distributed to 472 students at two universities in the UK. Data were analysed from 347 respondents by means of descriptive statistics and simple content analysis. RESULTS: The findings suggest that students have significant contact with the industry through one-to-one meetings with pharmaceutical representatives (PRs) and by attending events giving information on specific drugs or general mental health issues. Students also identified a number of benefits (e.g. receiving "up-to-date" information on new drugs) and problems (e.g. the potential influence exerted on practitioners to use their drugs) arising out of this contact. Most students (79.8%) had accepted some form of 'gift' from the industry but few (11.5%) believed it was unacceptable to do so. The presence of promotional items in the clinical environment was seen as advertising (84.4%) but few students (19.3%) believed clinical environment should be free of these items. Over half (57.1%) of the students believed that PRs did not always give unbiased information but thought that they and mental health nurses in general would be able to detect any bias. CONCLUSIONS: In parallel with medicine, the study has shown that the pharmaceutical industry has at least the potential to influence mental health nursing students. Within medicine this realisation has triggered a vigorous debate on how medical schools should respond to the promotional activities of the PI. We suggest this study goes some way to demonstrating there is a need for these issues to be debated in the education of mental health nurses.

Student nurses' use of their interpersonal skills within clinical role-plays.

Heron's six-category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. In addition, researchers have used six-category intervention analysis as a theoretical framework for exploring nurses' perceptions of their interpersonal skills. This study aimed to advance previous research by using Heron's framework to analyse student nurses' actual skills, as deployed in clinical role-plays, and then to compare them to earlier findings. Analysis of the data produced the following rank order of interventions based on Heron's framework: catalytic, prescriptive, supportive, informative, confronting and cathartic. The findings both challenge and support previous findings on nurses' perceptions of their interpersonal skills. The paper discusses these findings and their implications for clinical practice.

Mental health nursing students' rationales for self-disclosure: 2.

This is the second of two articles that consider the findings of a study exploring mental health nursing students' reasons for their use and non-use of self-disclosure in their relationships with patients. The first article (Vol 12(20): 1220-7) described the background to the deployment of this skill within therapeutic approaches, the paucity of literature discussing its use within nursing, the methods employed in this study and the findings for mental health nursing students' reasons for using the skill. This second article focuses on student's reasons for not deploying this skill, which are discussed in the following categories: 'crossing the line', 'unhelpful', 'name, rank and serial number' and 'students' vulnerability'. A discussion of the findings from both articles and their implications is offered.

Mental health nursing students' rationales for self-disclosure: 1.

This study explored mental health nursing students' rationales for choosing whether or not to self-disclose in therapeutic encounters with patients. Using a two-item questionnaire, data were collected from a convenience sample of 162 preregistered students recruited from two universities in the UK. Content analysis of the data produced three categories for using self-disclosure: "building a therapeutic relationship", "similar experiences" and "appropriate information". Reasons for not self-disclosing fell into four categories: "crossing the line", "unhelpful", "name, rank and serial number" and "students' vulnerability". The research findings suggest that both therapeutic and personal reasons are involved in the decision to use self-disclosure. This article, the first of a two-part series, outlines the background, research methods and nurses' reasons for using self-disclosure. The second article will present students' reasons for not using self-disclosure and a discussion of the findings and their implications.

An examination of the last 10 years of mental health nursing.

This article offers an examination of the mental health nursing articles published in the British Journal of Nursing during the last 10 years, and a commentary on how these reflect developments within this specialism. It identifies a number of clinical and professional issues, which have emerged over the last decade, including: community care; concerns over the quality of acute inpatient services; clinical supervision; and the integration of schools of nursing into higher education. Finally, the article identifies some clinical areas which it suggests warrant attention in the next decade such as child and adolescent mental health and mental health care for older people.

Self-disclosure in adult and mental health nursing students.

Self-disclosure, the process whereby people verbally reveal themselves to others, is an important interpersonal skill in initiating, developing, maintaining, and terminating therapeutic relationships. Studies of this interpersonal skill in nursing have, primarily, focused on adult nurses. They are dated, make no comparisons between this and other nursing specialisms, and have not considered the patient as a focus for nurses' self-disclosure. This study attempts to address these issues in relation to student nurses by: replicating a previous study of self-disclosure in adult nursing students (ANS) and offering a comparison of two nursing specialisms, reporting on the use of this skill in relation to the patient. A matched sample of 25 ANS and 25 mental health nursing students (MHNS) were asked to complete a modified version of Jourard's 25-item self-disclosure questionnaire. The findings suggest that: ANS were more self-disclosing than students sampled in an earlier study (Burnard and Morrison, 1992); both sets of students disclosed significantly less items to the patient as target-person than to other categories; and MHNS disclosed significantly more items than the ANS to the patient category.