Nurses' In-service Education Program Content for Psychiatric Nurses: An Integrative Review

Introduction: One of the strategies that can be used to improve the quality of psychiatric care is the development and dissemination of a new in-service education program based on the use of technologies for both psychiatric nurse managers and nurses. Objective: This discussion paper aimed to report on in-service education for improving the quality of psychiatric nursing care based on the Technological Competency as Caring in Nursing (TCCN) theory for psychiatric nurse managers and staff nurses. Method: Relevant articles related to psychiatric nursing care, in-service education, technologies in nursing, and caring in nursing were retrieved, analyzed, discussed, and developed. Result: The use of in-service education programs based on the TCCN is expected to become a practical approach to incorporating new technologies into quality psychiatric care. Conclusion: Use of in-service education programs based on the TCCN theory is expected to become a practical approach to incorporating new technologies into quality psychiatric nursing care in the future.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

This study aims to identify and contrast key stakeholder perspectives about the core competencies of mental health nurses. Mental health nurses provide much of the direct care and treatment to patients with mental disorders. The perspectives of users of mental health services, mental health nurses, mental health nurse clinical leaders, psychiatrists, and mental health nurse academics regarding the core competencies of a mental health nurse are informative to improve the quality of care given to patients. We will use concept mapping to compare and contrast the views of different stakeholder groups (n = 50, 10 per group) about the core competencies (knowledge, skills, and attitudes) of mental health nurses. There are six stages in concept mapping: preparation, generation of statements, structuring of statements, representation of statements, interpretation of maps, and utilisation of maps. The Good Reporting of A Mixed Methods Study (GRAMMS) checklist will guide this study. The final output is a “concept map” that can be used and interpreted to understand core mental health nursing competencies. This study will provide insight into the perceived core competencies of mental health nurses from a variety of perspectives.

Associative Stigma Related to Psychiatric Nursing Within the Nursing Profession

WHAT IS KNOWN ON THE SUBJECT?: Evidence indicates a strong relationship between patient activation (i.e. confidence, knowledge and skills to self-manage health) and positive health behaviours and outcomes in a variety of clinical populations. Because persons with mental health disorders experience significant disease burden but often underutilize mental health treatment or experience poor treatment outcomes, they would likely benefit from increases in activation. No systematic reviews have been conducted to summarize and synthesize research on patient activation in persons with mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, this is the first comprehensive review to identify factors associated with activation and interventions that have shown to be effective in persons with mental health disorders. This integrative review indicates that better health status, less depression, positive health attitudes and behaviours, and higher quality therapeutic relationships may be associated with higher levels of activation in persons with mental health disorders. This review also indicates that a variety of interventions, most notably educational programs, are effective in increasing levels of patient activation in persons with mental health disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric mental health nurses and other clinicians should consider routine assessment of patient activation to inform individualized treatment plans for their clients. Clinicians should aim to form high-quality therapeutic relationships with clients as a way to promote higher levels of activation. Interventions that have been found to be effective in improving activation could be offered in a variety of mental health settings. ABSTRACT: Introduction Patient activation is understanding one's role in the healthcare process and having confidence, knowledge, and skills to self-manage one's health and health care. Researchers have begun to investigate patient activation in persons with mental health disorders, but no systematic reviews have been conducted to summarize and synthesize this research. For psychiatric mental health nurses and other clinicians to develop strategies to increase patient activation in this population, more information is needed about factors associated with activation and interventions that increase activation. Review Questions (1) What factors are associated with levels of activation in persons diagnosed with mental health disorders? (2) What interventions have shown to be effective at increasing levels of activation in persons diagnosed with mental health disorders? Method A 5-stage integrative review as described by Whittemore & Knafl. Results Twenty-nine articles were included in the review. Ten provided correlations between activation and other factors, and 20 examined the effects of interventions on activation. Some studies revealed significant correlations between a variety of health and treatment-related factors, and others revealed that some interventions, most notably educational programs, were shown to increase activation. Discussion The findings of this comprehensive review can inform psychiatric mental health nurses and other clinicians in developing strategies to increase activation in the patients with whom they work. More research is needed to provide a deeper understanding of the role of activation in the recovery and treatment of persons with mental health disorders. Implications for Practice Psychiatric nurses and other clinicians should assess for patient activation and incorporate strategies to increase levels of activation in patients in their practice. Positive therapeutic relationships likely enhance activation in persons with mental health disorders.

The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.

County-Level Estimates of Need for Mental Health Professionals in the United States

T rapidly changing health care system requires expert clinician leaders to assure that changes in service systems enhance, or at least maintain, quality patient care. The number of graduates from master’s-degree programs specializing in psychiatric nursing has decreased significantly over recent years; annually there are fewer graduates in psychiatric nursing than in any of the other core mental health professions (1). This decline implies a future shortage of psychiatric nurses to fill leadership, teaching, and clinical positions in the health care system. Data from the National League for Nursing (NLN) show that the number of graduates with a master’s degree in psychiatric nursing decreased dramatically from 781 in 1980 to 443 in 1996, a period during which graduations from all types of master’s programs in nursing soared from 4,778 to 9,953. About 74 percent of psychiatric nursing enrollees were part-time students in 1996, compared with 51 percent in 1980, increasing the overall length of time between enrollment and graduation. As Figure 1 shows, the percentage of graduates with a specialty in psychiatric and mental health nursing dropped from 16.3 percent in 1980 to an all-time low of 4.5 percent in 1996. Decreased federal support for traineeships was suggested as a primary cause of the decline in the mid-1980s (2), but more recent declines may also reflect the increase in nurse practitioners, from 18 percent of all master’s-level graduates in 1991 to 43 percent in 1995. The increasing use of nurse practitioners in health care delivery is also reflected in changes in the graduate education of psychiatric nursing specialists. NLN data show that the number of psychiatric nurse practitioner programs increased from ten in 1991– 1992 to 33 in 1994–1995. The number of psychiatric nurse practitioner graduates increased from 47 in 1991 to 100 in 1996, while the number of graduates of master’s level psychiatric nursing clinical specialty practice programs decreased from 492 to 324. The failure to educate an adequate number of graduate-level psychiatric nurses will reduce the quality of psychiatric nursing education in basic nursing preparation programs and the quality of care in practice settings. In 1994 a total of 82,620, or 14.3 percent, of full-timeequivalent positions in mental health organizations were filled by registered nurses (1), the vast majority of whom received their education and clinical experience in psychiatric nursing in their basic nursing program. The unique combination of physical health care and psychiatric knowledge and skills possessed by advanced-practice psychiatric nurses is essential for providing high-quality, cost-effective patient care. Incentives must be available to increase the number of nurses with graduate degrees in psychiatric and mental health nursing to assure an adequate supply of these well-prepared and cost-effective providers. ♦

National mental health policies accentuate the importance of having positive attitudes, skills, and knowledge among mental health professionals to facilitate recovery-oriented practices in all areas of mental health care. However, evidence suggests that mental health professionals' negative attitudes towards mental illness are still evident and that recovery-oriented practice in acute inpatient units may be poorly implemented. At the same time, there is also a paucity of research to understand Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice specifically. Therefore, this non-participant observation study aimed to explore Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient units by observing the interactions between the consumers and nurses. The Mental Illness Clinicians Attitudes Scale-v4 and The Recovery Attitudes Questionnaire inspired the development of a non-participant observation chart for this study and the observations were recorded on the chart. Six observations were conducted in three acute inpatient units. Observations focused on Mental Health Nurses' knowledge about mental illness, communication, dignity, respect, anxiety, fear, punishment, facilitation of real choices for consumers, physical care, cooperation with consumers' families and others and recovery orientation. Interpretive descriptive analysis was used to analyse the data. The results show that Mental Health Nurses generally have positive attitudes towards mental illness and recovery-oriented practice. Some deficits in the physical care of people with mental illness in the acute inpatient units were observed. Therefore, future research could address the adequate preparation of Mental Health Nurses to provide physical care to people with mental illnesses.

Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors. Mental health nurses often describe role confusion in relation to other health professionals. Opportunities for interdisciplinary communication with other professionals may benefit health care. The current large-scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities. Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so. The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needs Interdisciplinary teamwork could strengthen nurses' ability to address patient needs Finding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met. INTRODUCTION: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors. The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs. A cross-sectional web-based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded. The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs. Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services.

AIM: There was no qualitative study found in which individuals diagnosed with mental illness explained their views in detail about the use of medicinal plants. It is therefore thought that this study will fill this gap in the literature and guide mental health nurses in the field. The research was carried out to determine the use of medicinal plants by individuals diagnosed with mental illness. This research was a qualitative study conducted using the case study design. Ten individuals diagnosed with mental illness for at least 10 years, determined by the purposeful sampling method were interviewed. The data were collected between March and April 2022 with information form and semi-structured interview form and analysed with the content analysis method. Four of the participants had depression, four had anxiety and two had mood disorders. Themes were determined to be a source of healing (ointment for the soul, body tonic and organic and nature's miracles) and cultural accumulation (faith and inheritance, counselling helpline). Participants described medicinal plants as a source of healing, stating that medicinal plants are good for bodily and mental health and provide purification. Individuals stated that the information about medicinal plants represents cultural accumulation as an inheritance, they applied them as a counselling helpline in case of illness. The positive effects of medicinal plant use can be supported by mental health nurses. Considering that medicinal plants may interact with the drug treatment, the use of medicinal plants should be evaluated in detail by mental health nurses.

BackgroundAlthough providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses.MethodsThis prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] “big-five Mini-Markers” questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses.ResultsThe mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of “Conscientiousness” (p < 0.001), “Agreeableness” (p < 0.001), “Extraversion” (p = 0.03), and “Openness/Intellect” (p < 0.001).ConclusionsBoth personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

BackgroundThe urgent and emergency care review advocates new models of care to provide safer, faster and better care. Available evidence highlights scope for improvement in the delivery of care for...

Little attention outside the therapeutic setting has been given to specifying the aspects of social relationships that might be helpful for patients recovering from psychotic episodes. The authors studied 20 patients who had been hospitalized for a psychotic episode for 1 year following discharge to examine the role their social relationships played during this period. The data show that 12 functions of social relationships were important and that there were two phases of social needs--convalescence and rebuilding--over the recovery period. The authors discuss the theoretical and clinical implications of these findings.

Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well-being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018-June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well-being, post-traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self-regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self-confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well-being, workforce sustainability and the ongoing impacts of the COVID-19 pandemic.