Choosing to use compared to taking medication: the meaning of medication as described by people who experience schizophrenia.

PURPOSE: The use of medication is an important aspect within the experience of schizophrenia. DESIGN AND METHODS: Interviews with 14 people with schizophrenia were analyzed using van Kaam's psychophenomenological method, and findings revealed two opposing and important attitudes toward medication. FINDINGS: Adopting an attitude of choosing to use prescribed medication means autonomously self-managing medication and taking prescribed medication means feeling challenged and being under external pressure through being told or forced by others and therefore having no personal connection to the details or purpose of medication. PRACTICE IMPLICATIONS: Nurses need to actively work in partnership to support consumers to take an active stance toward choosing to use medication rather than ensuring consumers take medication.

The perceptions of the ward atmosphere in four Jordanian psychiatric hospitals from the perspective of patients' relatives.

PURPOSE: To describes the perceptions of the ward atmosphere of psychiatric hospitals from the perspective of the relatives of people who were inpatients in those hospitals. DESIGN AND METHODS: A nonexperimental descriptive survey was used. Data were collected using the Arabic version of Moos Ward Atmosphere Scale Ideal and Real forms. FINDINGS: Data indicate that even though relatives of Jordanian mental health patients were generally positive about the ward atmosphere, they would like to see changes. PRACTICE IMPLICATIONS: By describing their current and ideal treatment environments, participants have provided information that can guide interventions to change the ward atmosphere and thus help foster better patient treatment outcomes.

An examination of barriers to nurse practitioner endorsement in senior rural drug and alcohol nurses in New South Wales.

INTRODUCTION AND AIMS: To examine barriers senior rural nurses in New South Wales drug and alcohol clinical settings perceive when considering endorsement to Nurse Practitioner (NP). DESIGN AND METHODS: A survey was designed to record views of senior alcohol and drug nurses in rural New South Wales about becoming a NP. Participants were identified by Area Health Service Directors of Drug and Alcohol Services for each Area Health Service in NSW excluding metropolitan Sydney. Forty eight surveys were distributed, with 17 (35%) completed surveys included in the results. RESULTS: Of the 17 participants, 12 (70.6%) expressed interest in becoming a NP. The majority (12, 70.6%) were unaware or unsure of endorsement processes. Lack of clarity about the NP role and processes and benefits to becoming a NP was found to be of most concern to all participants. Only 6 participants (35%) indicated they would consider seeking endorsement to NP. DISCUSSION AND CONCLUSION: Despite agreeing that NP positions in alcohol and drug settings would improve patient access to treatment and care, senior nurses working in these settings in regional areas are unfamiliar with pathways to becoming endorsed. Barriers, such as a lack of internal support from management and colleagues, as well as the fact that respondents reported no foreseeable financial gain in endorsement, also need to be addressed, before more nurses will consider endorsement. Further evaluation of the views of senior nurses in metropolitan alcohol and other drug settings in the process to NP endorsement is needed before clients will benefit from the expertise and enhanced care that NP's may provide.

Factors involved in recovery from schizophrenia: a qualitative study of Thai mental health nurses.

Recovery-oriented services increasingly are being called for around the world. These services do not just consider recovery from mental illness as symptom remission, but as individuals' ability to redefine their self and to "live well", even with enduring symptoms. However, little is known about the views of Thai nurses regarding the conceptualization of recovery. This article presents the findings of a qualitative study that explored the perspectives of 24 Thai nurses regarding schizophrenia and recovery. Semistructured interviews were conducted with nurses who were providing care for persons who were living with schizophrenia in both hospital and community settings. A thematic analysis identified the personal and environmental factors that were related to recovery. Illness acceptance, hope, and adherence to treatment were viewed as the facilitators of recovery, while a low level of self-responsibility and illness-related factors were barriers. Environmental factors, such as the presence of a supportive environment and accessibility to mental health services, were described as facilitators, while stigma towards mental health illness and fragmented health services were barriers. The implications of these results in promoting recovery-oriented mental health services in Thailand are discussed.

What is a comprehensive mental health nursing assessment? A review of the literature.

Assessment is the foundation on which nursing care is delivered. The aim of this paper is to better understand the content (what information nurses seek about consumers) and the process (how they go about gathering that information) of a comprehensive mental health nursing assessment in practice. Using terms, such as 'nursing', 'mental health', and 'assessment', the CINAHL, Medline, and PsycINFO databases were searched for studies that describe the content and process of a comprehensive mental health nursing assessment. Although studies of aspects of mental health nursing assessment, such as the assessment of risk or carer burden, were found, no single study described both the content and process of a comprehensive mental health nursing assessment in practice. In Australia, a comprehensive assessment is codified as a competency to practice nursing; however, the standards of practice set for mental health nurses are less clear on what constitutes a comprehensive assessment or how this should be undertaken. The peer-reviewed literature describes assessment as both an independent and interdependent activity. It is described as informal, and there is evidence that comprehensive mental health nursing assessments are not well documented. The credibility of training and research into mental health nursing requires that the content and the process of a comprehensive mental health nursing assessment needs to be clearly defined.

Skills, knowledge, and attitudes expected of a newly-graduated mental health nurse in an inpatient setting.

Mental health nurses (MHN) are at the forefront of care and treatment within acute inpatient settings. Research suggests that newly-graduated MHN are unsure about the skills and knowledge that they are expected to possess, and are expected to practice at a level that they are not prepared for in their undergraduate courses; however, research focusing on competencies for newly-graduated MHN is scarce. This study aimed to identify competencies expected of newly-graduated MHN working in a regional mental health facility in New South Wales, Australia. Eight registered nurses (with varying levels of experience) participated in individual semistructured interviews. Four themes were identified, and termed: communication, safety, self-awareness, and treatment. Within these four themes, 14 competencies were described that detail clear aims for new graduates, provide a better understanding of mental health nursing, and promote specialized and competent practice in mental health.

Exploration of therapeutic interventions that accompany the administration of p.r.n. ('as required') psychotropic medication within acute mental health settings: a retrospective study.

Within acute mental health settings, pro re nata (p.r.n.) 'as required' medication is a widely used adjunct to regular treatment plans, and is administered at the discretion of a registered nurse. However, there is concern that some orders may benefit staff more than patients by providing a 'quick fix' to compensate for inadequate therapeutic programmes. Previous authors assert that p.r.n. medication administration should not be the first line of action, but should be used when other less invasive interventions such as de-escalation, talking, or separation from the group are unsuccessful. This project explored the occurrence of p.r.n. medication administration and the type of alternative therapeutic interventions that are documented as accompanying its administration. A retrospective 1-month chart audit was undertaken for a cohort of inpatients in a 20-bed mental health facility attached to a regional hospital in New South Wales, Australia. Forty-seven patients (73.4%) received p.r.n. medication at least once, with a total of 309 doses of p.r.n. medication administered during this time. There were wide variations in the documented rationales, and for nearly three-quarters (73%) of p.r.n. medication administrations, no other therapeutic intervention was documented as occurring prior to administration.

You have no credibility: nursing students' experiences of horizontal violence.

Horizontal violence is a significant issue confronting the nursing profession both in Australia and internationally. The term horizontal violence is used to describe bullying and aggression involving inter-group conflict. Some evidence suggests that nursing students commonly experience this during clinical placement(s). Despite the current shortage of nurses and the fact that clinical placement experiences may influence whether students remain in the nursing profession, there has been little research undertaken on this topic. This study used a questionnaire to investigate 152 second and third year nursing student's experiences of horizontal violence (either directly experienced or witnessed). Analysis identified five major themes: humiliation and lack of respect; powerlessness and becoming invisible; hierarchical nature of horizontal violence; coping strategies; and future employment choices. More than half of the sample indicated that they had experienced or witnessed horizontal violence; importantly, most of these (51% of the total sample) also indicated that it would impact on their future career and/or their employment choices. Strategies are discussed that could be implemented to reduce the effect of horizontal violence, including giving a higher priority to debriefing within a supportive university environment, and teaching assertiveness and conflict resolution skills within the Bachelor of Nursing Degree.

Working together: a joint initiative between academics and clinicians to prepare undergraduate nursing students to work in mental health settings.

There is ongoing concern among mental health professionals regarding the recruitment of newly graduated nurses to this specialist nursing area. Many reasons for the problem have been identified, including the perceived inadequate preparation by the tertiary sector, students' prejudices and anxieties about mental illness, a perceived lack of support while undertaking clinical placement, and the quality of the clinical placement itself. This paper describes a collaborative response to these issues undertaken in the Illawarra region of New South Wales, Australia. The implementation of preclinical undergraduate workshops using problem-based learning and role plays were undertaken. Mental health nursing scenarios were developed in association with experienced clinicians to introduce core concepts in a supportive learning environment. Quantitative and qualitative evaluation data were collected immediately following the workshop and again after the students returned to the university following a mental health clinical placement. A further survey of one cohort was undertaken 12 months after initial state registration and the beginning of a career in mental health nursing. Results showed that both students' and clinicians' attitudes to the workshops were consistently positive and indicated that the workshops were beneficial in preparing students for their clinical placement. Importantly, since the implementation of the workshops and other collaborative initiatives, an increasing number of newly graduated nurses from the region are choosing to work in mental health.

Administration of 'as needed' psychotropic medication: a retrospective study.

Mental health nurses are increasingly encouraged to discuss and document the outcomes of their nursing practice in order to maximize the care that they offer clients. One frequent function performed by mental health nurses working in inpatient units is the administration of 'as required' (PRN) psychotropic medications. However, according to the literature, this important aspect of nursing practice has been poorly explored and studies that have been undertaken demonstrate that nursing documentation of PRN medication administration is often inadequate. This study presents the results of a descriptive study examining the administration of PRN psychotropic medication at a secure acute inpatient mental health unit attached to a regional hospital in Australia. Of major concern is the findings of inadequate or no documentation regarding PRN administration. In 41% of cases the results of the PRN administration was not documented in the nursing progress notes, in 38.6% of entries it was not possible to identify who initiated the request for medication and in 9.1% of cases no reason was given for the administration of PRN medication.