Perceptions and educational needs of social and healthcare professionals in the prevention of domestic violence - A focus group study.

OBJECTIVE: To explore and describe social and healthcare professionals' perceptions and educational needs in relation to domestic violence and its prevention. METHODS: A qualitative research was conducted in three European countries. Two multidisciplinary focus group interviews were conducted (in each country) among professionals and higher education teachers in the field of social and health care. Total number of participants were 32 (Finland n=12, Greece n=12, Portugal n=8). The transcribed data were analyzed by thematic analysis. RESULTS: Participants' perceptions of domestic violence and its prevention included: multidimensional phenomenon, consequences, and addressing concern. Domestic violence was seen as a multidimensional phenomenon, which has various consequences for several aspects of life. Professionals have difficulties addressing their concern due to lack of knowledge and tools. Solutions to prevent domestic violence that the participants shared were: education, intervention, and strategies. Education was seen as the key aspect for the prevention of domestic violence. Also, professionals' communication and situation management skills, as well as national and international strategies, were seen as valuable solutions. Educational needs for prevention of domestic violence were expressed based on content, methods, and practices, such as services system and legislation. CONCLUSION: The findings of the current study highlight the social- and healthcare professionals' need for education about domestic violence. It is essential that these professionals receive appropriate training to effectively identify and address domestic violence. The current study provides useful information for the development of relevant training/education for this group of professionals.

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.

Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study.

WHAT IS KNOWN ON THE SUBJECT?: Communication between nurses and patients is essential in mental health nursing. Lack of communication during seclusion causes dissatisfaction among patients. Coercive practices can cause psychological discomfort for patients and staff members. Research related to nurses' perceptions of nurse-patient communication during seclusion events is scant. In Finland, the use of coercive practices has been high despite efforts to reduce the need for coercive practices through the National Mental Health Policy since 2009. Nurse-patient communication is referred to in the Safewards model as one issue of delivering high-quality care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses aim to achieve high-quality communication while treating patients in seclusion. Nurses aim to communicate in a way that is more patient-centred. Various issues affect the quality of communication, such as nurses' professional behaviour and patients' state of health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improved communication between nurses and patients will support therapeutic relationships and could lead to a better quality of care. Nurses' enhanced communication may promote the use of noncoercive practices more frequently in psychiatric settings. Improving nurses' communication skills may help support the dignity and autonomy of secluded patients, resulting in patient experiences that are more positive in relation to care offered in seclusion. Nurses should be offered opportunities to take part in further training after education to enhance communication skills for demanding care situations. Further research that incorporates the perspectives of patients and those with lived experience of mental health problems is needed. Components of evidence-based Safewards practices, such as using respectful and individual communication (Soft Words), could be relevant when developing nurse-patient communication in seclusion events. ABSTRACT: INTRODUCTION: Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM: The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD: A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS: Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION: Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION: Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT: This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.

Mental health services in the school environment-Future visions using a phenomenographic approach.

AIMS AND OBJECTIVES: First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state. BACKGROUND: The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment. DESIGN: The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents. METHOD: The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist. RESULT: Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level. CONCLUSION: The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems. RELEVANCE TO CLINICAL PRACTICE: This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.

Mental health literacy among primary healthcare workers in South Africa and Zambia.

BACKGROUND: In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. METHODS: The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. RESULTS: Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. CONCLUSION: The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Development of a Mobile Application for Detection of Adolescent Mental Health Problems and Feasibility Assessment with Primary Health Care Workers.

Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods: Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results: The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion: HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.

Non-European immigrants' self-described strategies for mental health promotion and perceptions of Finnish mental health services: A qualitative descriptive analysis.

PURPOSE: This study aims to describe non-European immigrants' perceptions toward mental health care in Finland and the factors that support their mental health. DESIGN AND METHODS: Participants (N = 17) were interviewed through semistructured interviews, after which interview transcripts were analyzed using a six-phase thematic analysis process. FINDINGS: The participants reported that developing self-help strategies benefitted their mental health. The participants primarily preferred unprofessional help over professional mental health care. Several structural and cultural barriers to help-seeking were identified. PRACTICAL IMPLICATION: Health care staff working with immigrants need proper education and knowledge to provide sufficient, holistic care; for this reason, information about the cultural differences among immigrants and cultural sensitivity should be included in basic as well as post-graduate nursing education.

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.

Safety hazards in patient seclusion events in psychiatric care: A video observation study.

WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.

Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts.

AIM: The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia. DESIGN: This cross-sectional study was conducted between October 2018 and December 2019. METHODS: The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS. RESULTS: Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.

Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students.

Expert by Experience involvement in mental health nursing education is increasing in popularity as a teaching technique. The emerging literature attests to its benefits in enriching the educational experience for students. Much less attention has been devoted to the experience from the perspective of the Experts themselves. To address this gap and ensure this important perspective is captured and considered, the aim of this paper is to present the perceptions and experiences of Experts by Experience in delivering an educational module to mental health nursing students. A qualitative exploratory approach was adopted, involving in-depth individual interviews with Experts by Experience who delivered a learning module to nursing students in Australia and Europe. Data were analysed thematically. Analysis produced two overarching themes: Empowerment, and Challenges. Challenges included six sub-themes: Being constructive, not just critical; Time to unpack and reflect; Need for co-production and support from nursing academics; Emotional and practical support; maintaining personal boundaries; and adapting to the audience. These findings make a significant contribution to a broader understanding of Expert by Experience involvement in mental health education. The use of standards to maintain integrity and avoid tokenism is recommended.

The prevalence of mental health problems in sub-Saharan adolescents: A systematic review.

BACKGROUND AND PURPOSE: Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. METHODS: A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer's manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10-19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. RESULTS: The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.

Mental Health and Wellbeing at Schools: Health Promotion in Primary Schools with the Use of Digital Methods.

Mental health disorders among primary school children remain a crucial issue. Early health promotion interventions can positively affect and prevent the onset of mental disorders. Promising digital mental health methods have been implemented for adolescents and youths with scarce evidence among younger ages. Therefore, the aim of the current systematic review was to identify health promotion interventions on mental health and wellbeing, with the use of digital methods, delivered in primary school settings. Six digital interventions have been identified, three of which were targeting teachers and the others students. Regardless of the limited number of studies, the effectiveness of the web-based interventions upon teachers' knowledge and attitudes and the positive impact on children's behavioral improvements has been documented. The lack of adequate evidence highlights the need for further research in the field. The current review provides information for professionals working in primary schools useful for the design and implementation of effective mental health and wellbeing interventions.

Good interaction skills are not enough - competency in mental health issues in child health clinics and school health services.

BACKGROUND: Mental health problems among children and adolescents are a worldwide issue of concern. Health professionals who have sufficient competency in mental health issues are crucial for responding to this situation. AIM: The aim of the study was to describe the competency in mental health issues required by the work of public health nurses in child health clinics and school health services. METHODS: This qualitative, descriptive study was conducted with focus group interviews in March 2018. The sample consisted of public health nurses (n = 24) who were working in child health clinics or school health services in Finland. The data were analysed using inductive and deductive content analysis. RESULTS: The competency in mental health issues required by the work of public health nurses was formulated from the identified strengths and topics required in continuing education. In total, 18 competencies were identified as covering mental health promotion, as well as the alleviation and treatment of symptoms and disorders. Intuitive and interpersonal competency was identified as the main strength of public health nurses. The theoretical and evidence-based competency regarding mental health issues was identified as a main topic needed in continuing education. CONCLUSION: Public health nurses in child health clinics and school health services need competency in mental health issues for the promotion of mental health, the alleviation of symptoms and treatment of disorders. The results indicate that good interactional skills are not enough: the current competency of public health nurses in mental health issues is insufficient and does not meet the requirements of the work. The results were consistent with existing knowledge, but also provide a more comprehensive and precise insight into the current situation. In the future, the results should be verified with more studies. There is also a need for intervention studies aiming to improve competency in mental health issues.

Improving Service User Involvement in Mental Health Nursing Education: Suggestions from Those with Lived Experience.

Service user involvement in mental health nursing education is increasing and a developing evidence base is demonstrating more positive attitudes towards people labelled with a mental illness. To date, most research on this approach has focussed on the perspectives of nursing students, with very limited research drawing on the expertise and opinions of service users. The aim of this study was to explore potential improvements in mental health nursing education, and ways service user involvement can be enhanced as defined by service users themselves. An international qualitative research project was undertaken involving focus groups with service users (n = 50) from Australia and five European countries. The research was coproduced between Experts by Experience (service users) and mental health nurse academics. Data were analysed thematically. Findings reflected two broad themes: (1) improvements to content, including: further emphasis on developing emotional intelligence, understanding mental distress and broader context of care; (2) Improvements to service user involvement, including: support, format, and teaching and learning techniques. These findings provide direction for maximising the benefits of service user involvement and show the value of the expertise of service users.

"But I'm not going to be a mental health nurse": nursing students' perceptions of the influence of experts by experience on their attitudes to mental health nursing.

BACKGROUND: Mental health nursing skills and knowledge are vital for the provision of high-quality healthcare across all settings. Negative attitudes of nurses, towards both mental illness and mental health nursing as a profession, limit recognition of the value of these skills and knowledge. Experts by Experience have a significant role in enhancing mental health nursing education. The impact of this involvement on attitudes to mental health nursing has not been well researched. AIM: To explore the impact of Expert by Experience-led teaching on students' perceptions of mental health nursing. METHODS: Qualitative exploratory study involving focus groups with nursing students from five European countries and Australia. RESULTS: Following Expert by Experience-led teaching, participants described more positive views towards mental health nursing skills and knowledge in three main ways: learning that mental health is everywhere, becoming better practitioners, and better appreciation of mental health nursing. CONCLUSIONS: Experts by experience contribute to promoting positive attitudinal change in nursing students towards mental health nursing skills and knowledge. Attitudinal change is essential for the provision of high-quality mental health care in specialist mental health services and throughout the healthcare sector.

'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse.

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.