"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings.

WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.

Effects of a Mindfulness Activity on Nursing Service Staff Perceptions of Caring Behaviors in the Workplace.

Research on caring in nurse-to-nurse relationships is not extensive, but studies have shown that health care workers can experience incivility in the workplace and unhealthy relationships can increase stress and influence nurse retention. The current study examined nurse perceptions of caring in the workplace and the effect of a mindfulness activity. A mixed method design was used, and data were collected on 164 nursing staff members after a 1-minute mindfulness activity. Pre- and post-survey growth in caring behavior indicated a statistically significant positive effect for the treatment group. Qualitative reports showed that after completing a mindfulness activity, staff members were more focused, and willing to set a good example, off er help to others, and encourage a positive overall work environment. Mindfulness activities can improve nurse-to-nurse caring and reduce incivility in the workplace. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 28-36.].

Concerns most important to parents after their child's suicide attempt: A pilot study and collaboration with a rural mental health facility.

PROBLEM: Little is known of the needs of parents after their child has made a suicide attempt. The goal of this research was to create and pilot an acceptable and effective survey for parents whose child has made a suicide attempt so that their needs and concerns are known. METHOD: The Social-Ecological Model was used as a framework to better understand the problem of adolescent suicide from the parent perspective. Collaboration with interdisciplinary staff at a rural mental health facility in the United States occurred to create and pilot the survey tool with content and practice experts validating the survey questions. FINDINGS: Five parents completed the pilot survey. Results showed that parents have unmet needs after their child's suicide attempt; reporting the need to ensure safety for their child and the need for understanding how to help their child. Parents stated interest in attending a focus group to discuss their needs and noted transportation and childcare being primary barriers to attending a focus group. CONCLUSION: Results from this research will inform the planning focus groups of parents whose child has made suicide attempt.

The Home Healthcare Universal Best Practice Protocol.

To address rehospitalization rates and emergency department rates that were above the state and national averages, a quality improvement project was implemented at a midsized home healthcare agency. In order to address these escalating rates, the Home Health Universal Best Practice Protocol was developed and implemented by a home healthcare consultant. The protocol is evidence-based, time-specific, comprehensive, and includes interventions that are linked to reducing avoidable hospital visits. Interventions include risk assessment for rehospitalization, initiation of telehealth, utilization of teach-back method, and timely documentation. The Home Health Universal Best Practice Protocol was effective in not only exceeding objectives regarding decreasing rehospitalization and emergency department rates within a 6-month period but also in improving home healthcare agency referral rates.

Decreasing the Stigma of Mental Illness Through a Student-Nurse Mentoring Program: A Qualitative Study.

Stigma is defined as endorsing prejudicial attitudes about mental illness leading to discriminatory behaviors. It undermines the quality of medical care received by people with mental illness. Research suggests contact based interventions are effective in reducing stigma and increasing positive attitudes towards people with mental illness. This paper describes the development of a consumer led student-nurse mentoring program as part of nursing student education. People with lived mental health experience would mentor student nurses regarding the harmful effects of stigma and the beneficial outcomes of affirming attitudes. Seventy members of stakeholder groups (people with lived mental health experience and student nurses) participated in focus groups. Qualitative analyses revealed themes across stakeholder groups regarding: perceived mental health stigma from nurses, ways to reduce stigma, target message for the mentorship program, characteristics of mentors and logistics in developing such a program within the student nurse curricula.

Moving Nursing Program Portfolio Assessment From Midterm to End of Program: Lessons Learned.

Portfolio assessment promotes a culture of evidence, evaluates program outcomes, and provides an opportunity to assess the acquisition of knowledge and skills that are not easily assessed by examinations and other traditional assessment methods in nursing curricula. The portfolio program of 1 Midwestern school of nursing recently moved portfolio assessment to the end of program. The process of this change including logistics, rubric development, and lessons learned is highlighted.

Management of Relocation in Cognitively Intact Older Adults.

Relocation, a major life transition that can affect health positively and negatively, is moving from one permanent home to another. Many older adults will relocate at some time during their life. Relocation is also a complex process that requires careful consideration and planning before the move (i.e., pre-location) and adjustment to the new home after the move (i.e., post-relocation). The current article is a summary of content based on a comprehensive evidence-based practice guideline focused on management of relocation in cognitively intact older adults. The guideline was designed to be used across diverse settings by nurses and other providers. Pre-relocation guidelines include assessment for the need for relocation, interventions prior to moving, and outcomes for evaluation of the pre-relocation process. For post-relocation, content focuses on assessment of risks for not adjusting after the move as well as intervention guidelines to promote adjustment and outcomes for evaluation. Implications include advocacy for older adults by using the guideline, disseminating it, and conducting future research. [Journal of Gerontological Nursing, 42(11), 14-23.].

Issues Most Important to Parents After Their Children's Suicide Attempt: A Pilot Delphi Study.

PROBLEM: Suicide is the third leading cause of death for people aged 15-24 and results in 4,600 lives lost each year. One important risk factor for completed suicide is a nonlethal suicide attempt. To date, little research has been conducted on the needs of parents of adolescents who have made a nonlethal suicide attempt. METHODS: The goal of this pilot study was to describe the most important concerns of parents whose children have made a nonlethal suicide attempt from the perspective of adolescent mental health professionals. A two-round Delphi technique was utilized with an interdisciplinary panel of adolescent mental health experts to gain consensus on what issues are most important to parents after their children's suicide attempt. FINDINGS: Panelists described the following as most important to parents after their children's nonlethal suicide attempt: keeping their children safe; identifying what caused or triggered the suicide attempt; strategies to prevent another suicide attempt; and communication and building trust for the future. CONCLUSIONS: An advanced understanding of the issues most important to parents whose children have made a nonlethal suicide attempt has implications for clinicians in creating acceptable and useful interventions aimed at preventing youth suicide.

Creating a simulated Mental Health Ward: lessons learned.

The future of psychiatric-mental health nursing depends on the preparation of nurses who will meet the mental health care needs of society. The current article discusses the development of the "Mental Health Ward," a simulated mental health experience that was offered for the first time to undergraduate baccalaureate nursing students at a Midwestern university in the United States. The Mental Health Ward is an innovative simulated hospital environment that includes the use of standardized patients and role play scenarios, resulting in a full mission simulation whereby students learn various psychiatric diagnoses and practice various pertinent skills, including nursing assessments, admission and discharge processes, medication administration, and therapeutic communication. Lessons learned by faculty and students in formulating the Mental Health Ward are presented.

Using Findings From the Human Rights Authority Reports to Inform Psychiatric Nursing Practice.

BACKGROUND: In Illinois, the Human Rights Authority (HRA) exists to conduct investigations of complaints of violations of the rights of persons with disabilities. PURPOSE OF STUDY: The purpose of this study is to describe the findings from the HRA investigations and to determine significant implications for psychiatric nursing practice. METHOD: A descriptive cross-sectional design was used, and the sample was composed of reports from the Illinois Guardianship & Advocacy Commission HRA (N = 129) for 2008. RESULTS: Allegations of restriction/notification of rights were significantly more likely to be substantiated than other allegation types. State hospitals were less likely to have allegations against them, whereas medical hospitals were less likely to have inadequate treatment allegations and more likely to have restriction/notification of rights allegations. CONCLUSIONS: The HRA findings will inform psychiatric nursing practice by expanding the nurses' knowledge of patient rights issues.

Creating a culture of evidence in nursing education using student portfolios.

There has been a growing interest in the use of portfolios to assess nursing student progress in areas such as critical thinking, problem solving, and communication. The data obtained from student portfolios can be used to improve undergraduate nursing curricula; however in order for change to occur, closing the assessment feedback loop is essential. The portfolio program of one Midwestern school of nursing has successfully used portfolio evidence to effect undergraduate curricular change. This portfolio program, under the direction of the school's Portfolio Subcommittee, involves active participation by students, faculty and administration. Examples of curricular improvements based on portfolio findings included increasing rigor in course assignments, improving student self reflection, promoting students' ability to write in the discipline, and maintaining writing assignments in larger classes.

Changing attitudes about self-injury prevention management: lessons learned.

In the behavioral health environment, nurses often use continuous staff monitoring and, at times, physical restraints, to manage the severity of patients' self-injury. Both options put staff in control, are the most restrictive in nature, and can be financially draining on the hospital's budget. This can result in negative reactions by both patients and staff. It is important to develop a program that will empower patients to control their behavior and allow staff to be aware of their perceptions and attitudes toward patients who self-injure. This article describes the leadership initiative that drove the development, training, and implementation of a self-injury prevention project and the lessons learned by staff.

Use of animal-assisted therapy with psychiatric patients.

The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients' socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

Factors related to successful teaching by outstanding professors: an interpretive study.

The purpose of this study was to identify and describe factors associated with successful university teaching within the cultural norms of a public university in the midwestern United States. An interpretive analysis was conducted using the educational philosophy and goal statements of 35 university professors who received Presidential Teaching Awards from the university. The professors' diverse disciplines included nursing, curriculum and instruction, accountancy, music, and political science. The authors offer nursing educators the opportunity to increase their confidence and effectiveness by "learning" from faculty members who have been recognized as exceptionally successful in teaching. Four main relevant themes associated with successful university teaching were identified: Presence, Promotion of Learning, Teachers as Learners, and Enthusiasm. The narratives of the professors helped define the meaning of successful teaching across disciplines and offer nursing faculty additional perspectives and experiences.

Assessing students' learning needs and attitudes: considerations for gerontology curriculum planning.

The growing number of older adults with multiple healthcare needs underscores the importance of teaching gerontological content to students in healthcare fields. To effectively accomplish this educational goal, it is essential to consider students' attitudes and learning needs related to caring for elderly persons. The purpose of this study was to identify prelicensure undergraduate nursing students' (N=200) perceived learning needs and attitudes toward older adults. Current knowledge of gerontology and attitudes were correlated with multiple variables including comfort and confidence in caring for older persons. Students identified their desire for more information on selected topics such as supportive resources for elders and their caregivers. Students who intended to learn more about gerontological nursing chose more topics; the two most commonly chosen topics were end-of-life issues and specific disorders. The data from this study can be used to design courses and curricula related to the care of elderly persons. Similar approaches to obtain student input can be adopted in designing other gerontology curricula.

Behavioral health staff's perceptions of pet-assisted therapy: an exploratory study.

The purpose and objectives of this exploratory descriptive study were threefold: to assess the impact of pet-assisted therapy on the overall well-being of behavioral health staff, to document whether pet-assisted therapy affected the retention of behavioral health staff, and to explore and describe therapeutic measures behavioral health staff implemented in using pet-assisted therapy in the delivery of mental health patient care. The participants in this study were 10 behavioral health staff members who were involved with the pet-assisted therapy program at a private psychiatric hospital in a Chicago suburb. Themes that emerged from the study included Self-Awareness, Morale, Innovative Therapeutic Strategies, Challenges, and Future Directions. This article describes these themes in detail, provides quotations from participants to further highlight meaning, and discusses the powerful effect of pet-assisted therapy on both patients and staff in the therapeutic milieu.

Early identification of relocation risk in older adults with critical illness.

One aspect of an evidence-based practice (EBP) guideline on managing relocation in cognitively intact older adults is elaborated upon in this article. The older population is at particular risk for needing to relocate to a new permanent home following hospitalization for a critical illness, but planning for these moves is often done in crisis mode. The purpose of this article is to sensitize nurses to risks for relocation in critically ill older persons and to encourage application of the EBP guideline in practice. Recommendations for risk assessment are made including using existing and supplementary assessment methods and data. Implementing EBP guidelines such as this is one key element in providing quality care to critically ill older adults.