An exploration of organizational climate in community-based opiate prescribing services; a mixed methods study.

INTRODUCTION: Assessing the internal dynamics of organizations has been shown to provide information that can help planners and policymakers improve service delivery. A good organizational climate, which in this study incorporates mission clarity, team cohesion, staff autonomy, communication, levels of stress, and openness to change has been shown to be of particular importance. Still, there is a dearth of evidence in this area, and while relationships between organizational factors have been identified, little is known about the mechanisms that might underpin these relationships, and there is little understanding of how to address deficits once they are identified. The objective of this study was to identify relationships between program factors that influence organizational climate and to explore which mechanisms might underpin these relationships. METHODS: This paper reports on a cross-sectional, concurrent, mixed-methods study design, across twelve discrete community-based prescribing service providers (organizations) in Ireland. Data was obtained using a staff survey [n = 132] which utilized measurements of organizational readiness to change and one-to-one interviews [n = 12]. Quantitative data was analyzed using multivariate linear regression modeling which assessed relationships between variables, while interviews were analyzed using an abductive approach, both types of data were synthesized at the interpretation stage. RESULTS: A range of interdependent factors were considered to affect the climate of organizations. Surveys identified that specific types of resources, such as physical infrastructure, training, and staffing resources were important for supporting a good organizational climate, while programs with greater needs had a poorer climate. Opportunities for professional growth, the skill sets of staff, and having access to e-communication were also significant. Interviewees reported that rigid organizational hierarchies and bureaucracy, philosophical views of addiction, stress, and staff turnover were influenced by the provision of fewer resources. Interdependent factors such as leadership, supervision, staff relationships, and collective training, also thought to be influenced by resources, were considered to positively influence programs. Resources were not the only challenge identified, and practices within programs and how existing resources are used were also thought to contribute both positively and negatively to the internal dynamics of services. CONCLUSION: Key findings in this study identified that the organization of effective services is influenced by a range of specific factors, some of which can be addressed without additional resources. Overall, staff views of organizations can provide us with valuable information to support service improvement. Using a mixed methods approach can not only identify where relationships between organizational variables exist but can also help us to understand the mechanisms that underpin these relationships and, importantly, how to address deficits once they are identified. In order to improve how substance misuse services work, the need for a long-term systemic approach to program development, which incorporates some of the findings from this study, is required.

"People want better": a qualitative exploration of stakeholders' views on introducing well-being coordinators in the screen industry.

PURPOSE: There are several factors that negatively impact the well-being of those working in the screen industry. Consequently, the need to introduce Well-being Coordinators has been identified. This study explored the experiences of participants who undertook a Well-being Coordination course tailored for the screen sector. Additionally, it sought to delve into perspectives regarding well-being within the screen industry. METHODS: Semi-structured interviews were conducted. The study was guided by an interpretive descriptive approach. Reflexive thematic analysis was used to analyse data. FINDINGS: Five themes were identified: Opportunities and challenges working in the screen industry, co-existing with harassment, the need for change: importance of wellbeing, becoming a well-being co-ordinator: learning from the course, and the future of the well-being co-ordinator role: opportunities and challenges. The reality that cast and crew co-exist with several forms of harassment within the industry was noted. Despite this, there is hope for the future of the screen sector, particularly the positive impact the role of the Well-being Coordinator could have. CONCLUSIONS: The experiences of professionals across the screen industry vary; however, a pervasive culture of bullying and harassment is commonplace. Through the introduction of Well-being Coordinators, there is the potential to enact positive change.

Barriers to using physical exercise as an intervention within inpatient mental health settings: A systematic review.

Service providers find it difficult to implement Physical Exercise (PE) strategies in routine care within inpatient mental health settings even though they perceive it to be an effective therapy, with a robust evidence base. Identifying barriers that exist can assist with the development of future interventions and support PE services being introduced into mental health inpatient settings. The aim of this systematic review was to synthesise the evidence on the barriers or perceived barriers that exist amongst service users and providers when incorporating PE as an intervention within inpatient mental health settings. Using a narrative synthesis approach, four main themes were identified: (i) Barriers relating to service users' mental and physical health, (ii) Factors relating to service providers, (iii) Environmental factors and (iv) Cultural factors. Both service users and providers need more knowledge on implementing PE in inpatient mental health settings. Tailored programmes for service users are warranted, with specialist roles for staff developed.

"The third wing of the plane": Fathers' perceptions of their role in the treatment process for daughters with eating disorders.

Eating disorders are complex mental health conditions exacerbated by high mortality rates. International and national guidelines recommend family involvement in the treatment process, recognising the family as an important source of support to young people. Research suggests fathers engage less in the process compared to mothers. In studies exploring parental perspectives, most samples consisted of mothers, with fathers minimally represented. Few studies explore family involvement from the perspective of fathers. This study aimed to explore the experiences of fathers regarding their involvement in the treatment process. Qualitative descriptive methods were used, involving focus group interviews of seven fathers. Interviews were assisted by a semi-structured interview guide. A qualitative content analysis approach was used to analyse the data regarding paternal experiences of engagement in the treatment process. Fathers understood the importance of the whole family working together but viewed mothers as taking a more central role in the treatment process, with fathers more at the periphery. Gender emerged as an influencing factor in paternal involvement, with mothers primarily taking on responsibility for the child with the eating disorder and fathers providing secondary support. Healthcare providers need to be aware of the contribution of gendered roles within the family system and consider this when working with families within the treatment process. Consequently, mental health nurses have an important role in encouraging fathers to become actively involved in the treatment process.

An evaluation of a trauma-informed educational intervention to enhance therapeutic engagement and reduce coercive practices in a child and adolescent inpatient mental health unit.

High-risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re-traumatisation of young people and deteriorating therapeutic relationships. Trauma-informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma-informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma-informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma-informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma-informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma-informed practice is crucial to recovery-focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people.

Transgender and gender diverse youths' experiences of healthcare: A systematic review of qualitative studies.

Transgender and gender-diverse (TGD) populations are identified as high-risk for negative healthcare outcomes. Limited data exists on experiences of TGD youths in healthcare. The review aim is to systematically review literature on healthcare experiences of TGD youths. Seven electronic databases were systematically searched for relevant studies. Pre-determined eligibility criteria were used for inclusion with a double-screening approach. Sixteen studies were included. Studies included were quality appraised, data were extracted, and findings were synthesized narratively. Four narratives were identified including experiences of: accessing care, healthcare settings and services, healthcare providers, and healthcare interventions. Long waiting times, lack of competent providers, and fear were reported as challenges to accessing gender-affirming care. Negative experiences occurred in mental health services and primary care, while school counseling and gender clinics were affirming. Puberty blockers and hormone-replacement therapy were identified as protective factors. TGD youths are at risk of negative health outcomes due to an under resourced healthcare system. Further research is needed to assess interventions implemented to improve TGD youth's experiences.

"We're not educated on that enough, and we really should be": adolescents' views of mental health service education.

PURPOSE: Despite the susceptibility to the experience of mental distress during adolescence, this population often demonstrate poor help-seeking behaviours. Efforts have been made by schools to address adolescents' knowledge around mental health; less focus has been given to addressing their knowledge of mental health services and avenues for help-seeking. This study aimed to explore adolescents' views of mental health services education. METHODS: An interpretive descriptive design was adopted. Thirty adolescents from Ireland participated in individual interviews. Data were analysed using content analysis. TWO THEMES WERE IDENTIFIED: Recognizing Gaps in Knowledge about Mental Health Service Education, and Enhancing Mental Health Service Education for Young People. Participants reported gaps in their knowledge about mental health services and were uncertain how to access help. Current strategies (e.g., print media) were considered tokenistic and ineffective; instead, multimedia (film/TV) approaches were recommended. RESULTS: Two themes were identified: Recognizing Gaps in Knowledge about Mental HealthService Education, and Enhancing Mental Health Service Education for YoungPeople. Participants reported gaps in their knowledge about mental healthservices and were uncertain how to access help. Current strategies (e.g., print media) were considered tokenistic and ineffective; instead, multimedia (film/TV) approaches were recommended. CONCLUSIONS: Current mental health education programmes need to expand their focus beyond social/emotional well-being, providing adolescents with the knowledge they need to access appropriate supports. Considering traditional print media was viewed as ineffective, while film/TV had an influence on perceptions of mental health services, a multimedia approach to education may be an effective way of engaging this population.

Trauma Informed Interventions to Reduce Seclusion, Restraint and Restrictive Practices Amongst Staff Caring for Children and Adolescents with Challenging Behaviours: A Systematic Review.

Engaging with children and adolescents in mental health settings who are exhibiting behaviours that challenge can often result in the use of seclusion, restraint and coercive practices. It is recognised that more therapeutic ways to engage this population are needed, adopting trauma informed interventions may provide a solution. The aim of this systematic review is to synthesize the evidence in relation to the effect of trauma-informed interventions on coercive practices in child and adolescent residential settings. The review is guided by elements of the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Results were synthesized and reported narratively. Nine studies met the eligibility criteria for this review. There was a lack of homogeneity amongst the studies. The trauma-informed interventions used were typically multi-faceted, underpinned by a variety of approaches and sought to bring about changes to clinical practice. Most studies (n = 8) reported significant reductions in the use of restrictive practices following the implementation of a trauma informed approach. The use of a trauma-informed approach, underpinned by an organisational change or implementation strategy, have the potential to reduce coercive practices with children and adolescents. However, the included interventions were insufficiently described to draw strong conclusions.

"I thought it would just be, like, older men in white coats": A qualitative exploration of first encounters with mental health services.

Individuals whose mental health is becoming a concern may not receive the care they require. Although efforts have been made to reduce barriers to accessing services, including stigma reduction campaigns and healthcare practitioner training, there remains a lack of understanding of individual perspectives regarding help-seeking behaviour. The aim of this study was to explore people's first experiences accessing mental health services. A qualitative descriptive approach was adopted. Interviews were conducted with eight service users. Data were analysed using reflexive thematic analysis. The COREQ checklist guided this study (Tong et al., 2007, International Journal for Quality in Health Care, 19, 349). Three themes were identified: learning to navigate an unfamiliar system, making sense of mental health services, and promoting a positive image for those in need of care. Uncertainty about mental health services and stigmatizing images could be mitigated by developing positive media-based interventions. Systemic barriers need to be addressed and services need to be better resourced to ensure the benefits of early intervention are available to those experiencing mental health challenges. To encourage people to access services earlier, services need to be promoted in a positive way.

Benefits of Hearing Voices Groups & Other Self-Help Groups for Voice Hearers: A Systematic Review.

People who hear voices that others do not often rely on mainstream mental health services. Several alternatives to treatment have grown in popularity including "Hearing Voices Groups" and other self-help groups for voice hearers. The aim of this systematic review is to evaluate the current evidence relating to the use of Hearing Voices Groups (HVGs) and other self-help groups for voice hearers, and identify the benefits felt by those attending such groups. The following databases were searched for relevant academic articles: CINAHL; APA PsycArticles; APA PsycInfo; Social Sciences; SocINDEX; UK & Ireland Reference Centre and Medline, with 13 papers identified for inclusion. Participants reported several benefits of attending a HVG/self-help group, which reduced isolation, improved social and coping skills, and gave them a better understanding of the meaning and context of their voices. The groups also provide hope for the future and act as a catalyst for recovery. These study findings suggest that voice hearers find some benefits from attending HVGs/self-help groups. Evidence indicates that voice hearers can live meaningful lives and continue to hear voices once context and meaning to their voices become clear. HVGs/self-help groups provide a vital service to voice hearers, which they felt was not available within mainstream mental health services. If mental health providers gained a better understanding of the HVN, they may be able to integrate the values and ethos of the HVN into groups for voice hearers within mainstream mental health services or signpost voice hearers to these groups.

Exploring the Use of an Electronic Competency Assessment Document Using iPad Minis to Assess Clinical Practice Competency in a Preregistration Nursing Program: A Cross-sectional Feasibility Study.

The aim of this study was to explore the feasibility of using iPad minis as a method of completing competency assessment in clinical practice. Digital technology helps to revolutionize all aspects of our lives. The use of digital technologies in clinical practice can facilitate a move toward a more flexible learning environment and enable students to adapt in a rapidly changing, interconnected world. The introduction of electronic clinical booklets in practice placements could facilitate the sharing of clinical information through connected healthcare systems, thus improving the student experience. A cross-sectional design was used in this study. A sample of BSc nursing students (n = 53) and clinically based healthcare professionals (n = 27) (preceptors and clinical placement coordinators) participated in this study. Data were collected using a modified version of Garrett and colleagues' instrument, the System Usability Scale, a demographics questionnaire, and three open-ended questions. There was a significant difference between the students and preceptors/clinical placement coordinators across all items with higher proportions of students (ranging from 66% to 75.5%), indicating that they agreed or strongly agreed with the reliability, ease of use, and effectiveness of the device in assessing their clinical competency (ranging from 11.1% to 40.7%). In addition, the iPad minis were found to be smaller, lighter, and easier to carry than paper-based booklets and encouraged students to access timely online learning resources during placement to help augment their learning. The use of iPad mini to complete the electronic competency assessment document as a replacement for a paper-based system to assess clinical practice is feasible. The introduction of electronic assessment documents should incorporate a robust training plan and standard operating procedures.

DQA1*0102 DQB1*0602 haplotype distinguishes coeliac disease and its complications from gluten unrelated enteropathies.

BACKGROUND: Duodenal villous atrophy is due not only to coeliac disease and its complications but also to other rare enteropathies unrelated to gluten consumption, defined as noncoeliac enteropathies. The diagnosis of noncoeliac enteropathies remains challenging, and HLA typing has been widely used to exclude coeliac disease if DQ2 and DQ8 alleles are absent. However, the frequency of the various HLA alleles in noncoeliac enteropathies is still unknown. AIMS: To describe the HLA genetic profile of patients affected by noncoeliac enteropathies who have been evaluated at our centres between 2000 and 2021, and to investigate the diagnostic role of HLA typing. METHODS: Genomic DNA was collected from 44 Italian and 19 British adult patients with noncoeliac enteropathies. Patient genotypes were compared with those of healthy Italian and British populations obtained from HLA bone marrow donors' banks. In addition, genotypes were also compared with those of patients with coeliac disease and complicated coeliac disease. RESULTS: Both in the Italian and in the British group, the DQA1*0102 DQB1*0602 haplotype and related alleles occurred significantly more frequently in patients with noncoeliac enteropathies compared to coeliac disease and complicated coeliac disease. CONCLUSIONS: Together with negative HLA-DQ2 and DQ8 haplotypes, the DQA1*0102 DQB1*0602 haplotype can be used to guide the differential diagnosis between coeliac disease and noncoeliac enteropathies.

'As for dignity and respect . me bollix': A human rights-based exploration of service user narratives in Irish methadone maintenance treatment.

INTRODUCTION: This paper explores the narratives of service users of contemporary methadone maintenance treatment services (MMT) in the Republic of Ireland to obtain their perspectives in the context of them negotiating their right to health METHODS: Participants were recruited and interviewed by a former service user of MMT services. In-depth qualitative interviews were conducted with 40 current and recent users of MMT services RESULTS: Participants overwhelmingly reported a reduced sense of personal agency because of their experiences in MMT treatment. Participants observed that their perceptions of treatment were forged by a sense of reduced autonomy, coercive and disrespectful approaches from healthcare workers. Within a system which the participants considered to be failing, the services that they accessed were predicated on a process of reward and punishment, where best practice was often ignored by practitioners, all of which resulted in adverse consequences for service users DISCUSSION: The findings indicate that there is a significant 'chasm' between human rights, policy and best practice and how these are operationalised within the structures and practices of Irish MMT services. The treatment of service users, based on human rights principles such as equality, respect, autonomy, empowerment and personal choice remains aspirational and is unlikely to be fulfilled without addressing more systemic challenges such as funding, training of staff, service culture, governance and independent oversight of MMT services.

'It's good to have the knowledge and the confidence': Mental health student nurses' views of a medication workshop.

The administration of medication in a safe manner is a key nursing role and nursing regulatory bodies mandate that it is part of undergraduate training. However, it has been noted that qualified nursing staff are dissatisfied with the knowledge demonstrated by students. As such, a 2-day evidence-based workshop on medication management for final-year nursing students was facilitated to address knowledge deficits. Content was delivered by academics and practicing nurses. The aims of this study were to evaluate internship mental health student nurses' experiences of a 2-day medication management workshop. A qualitative descriptive design was adopted. Three focus group interviews were held with student nurses who partook in the workshop. Data were analysed using reflexive thematic analysis. Three themes were identified: Developing Confidence around Medication Management, Reflections on Learning Gained from the Workshop, and Enhancing Awareness and Vigilance of Medication Errors. Overall, participation in the workshop was identified as having a positive impact on students' knowledge, competence, and confidence in relation to becoming a safe practitioner. Students reported that the timing of the workshop - during internship - was appropriate for their knowledge needs. Findings indicate that the right amount of information was delivered by the right people, at the right time, in the right way. This study has highlighted the positive impact of a 2-day workshop delivered in the final year of mental health student nurse training, on their confidence and competence in the area of medication management. It provides some insight into how a practical collaborative approach to this type of education between academics and clinicians can help students bridge the theory-practice gap.

Undergraduate student nurses' views of online learning.

Background: The COVID-19 pandemic and resultant public health restrictions saw the mass movement of higher education to online, remote delivery. There was wide variation in how this was implemented, and for many undergraduate programs, this was the first time teaching was conducted remotely. The aim of this study was to explore undergraduate student nurses' views of online learning. Methods: Reflexive thematic analysis was used to analyse focus group data from undergraduate nursing students. Findings: Two central themes described student preferences for learning environments and challenges associated with asynchronous learning. Participants reported a preference for face-to-face learning. Suggestions for optimising remote learning include an emphasis on synchronous live sessions rather than asynchronous learning, incentivised learning, and a focus on ongoing formative informal assessment to maintain engagement. Specific challenges related to poor retention, difficulty remaining motivated, and maintaining focus on content and learning outcomes. Conclusion: As more opportunities arise to engage with online pedagogies for undergraduate nursing students, educators need to ensure their approaches are evidence-based and learner-centric.

"Unless they bring it up, I won't go digging": Psychiatric nurses' experiences of developing therapeutic relationships with adult survivors of child sexual abuse.

PURPOSE: The purpose of this study is to explore psychiatric nurses' experiences of developing therapeutic relationships with adult survivors of child sexual abuse (CSA). DESIGN AND METHODS: A qualitative descriptive design was adopted. Semistructured interviews were conducted with six registered psychiatric nurses. Data were analyzed using reflexive thematic analysis. FINDINGS: Although participants were able to develop therapeutic relationships with survivors and cited the importance of interpersonal skills, they felt uncomfortable discussing CSA. PRACTICE IMPLICATIONS: Given the importance of developing trusting relationships, more support needs to be provided for nurses so they can build stronger alliances with survivors of CSA.

Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research.

OBJECTIVE: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.

Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution.

WHAT IS KNOWN ON THE SUBJECT: ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE: ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT: Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.