Staff's Experiences of a Person-Centered Health Education Group Intervention for People with a Persistent Mental Illness

Patient education in mental health care is a conventional intervention to increase patients’ knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large.     

An evaluation of a collaborative course for child and adolescent mental health professionals

There is a considerable gap between the offer and the demand for mental health treatment of children and adolescents, especially in low- and middle-income countries (LMICs). Permanent education in these countries is a promising and needed strategy to reduce this gap. This study was designed to evaluate the perceived impact of an educational intervention for child and adolescent mental health professionals in Brazil, the Child and Adolescent Mental Health Specialization Course (CESMIA). The intervention consisted of a 360-hour interprofessional postgraduation course. The CESMIA offered lectures and small-group case discussions for exchanging their experiences in dealing with the patients. The students were placed in these groups according to their professions in order to ensure a proportional distribution of healthcare professionals in each group. The evaluation employed a quasi-experimental design by the use of a knowledge, attitude, and practice (KAP) survey. The 39 participants reported significant improvement in all KAP dimensions. More specifically, the data indicated a 17% improvement for attitudes, a 9.4% increase for knowledge, and a 14% improvement for the practice dimensions. The CESMIA appeared to improve the level of knowledge of participants and their attitudes and actions towards patients, which reinforces the relevance of similar courses.     

A survey of the education of nurses working in mental health settings in 12 European countries

Background

Recent European policies emphasise that the training and education of health professionals are a major means of improving mental health services. Little comparative research has been undertaken to ascertain the degree of homogeneity in the training of nurses working in mental health settings across Europe.

Objective

The aim of this study was to investigate the training of nurses working in mental health settings in a range of European countries. Specifically, information regarding criteria for entry into training, type of qualification awarded and further training opportunities was to be explored.

Methods and participants

A specially designed questionnaire was designed to gather data from senior mental health nurses working in the mental health field in a sample of 12 countries from across Europe.

Results

Findings disclosed considerable disparity between countries in respect to nurse training, with few countries requiring a specialist nursing qualification to practice in the mental health field. There appears to be little homogeneity in terms of educational provision pre and post-qualification.

Conclusions

More research is needed into how European states deliver nurse training and education, how students are prepared for various practice settings and the effect on outcomes for service users of different models of training.     

Nurses' knowledge and learning experiences in relation to the effects of domestic abuse on the mental health of children and adolescents

Nurse researchers are yet to direct substantial attention towards addressing and understanding nurses' experiences of learning about and caring for child and adolescent victims of domestic abuse. This lack of recognition has resulted in the marginalisation of this issue. This paper seeks to explore nurses' present understanding and experiences of learning about the effects of domestic abuse on the mental health of children and adolescents. The research utilised an interpretive case study approach within a naturalistic paradigm. Snowball sampling of nursing staff within two mental health units was used. Data were collected using semi-structured in-depth interviews with each participant. Using a constant comparative method and hermeneutic dialectical process both the commonalities and differences regarding participants' multiple realities were identified. Three major categories emerged within the data. These were education, resources and nurses' role. It was apparent that nurses' knowledge and education about the effects of domestic abuse on the mental health of children and adolescents negatively impacted on nurses' ability to provide appropriate care. The research has clear implications for mental health nursing education, practice and future research.     

Clinical Placements in Mental Health: A Literature Review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students’ skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.     

Undergraduate nursing students’ views of mental health nursing in the forensic environment

The literature clearly demonstrates that mental health nursing tends to be viewed negatively by undergraduate nursing students. While positive clinical experiences have been found to encourage more favourable attitudes towards mental health nursing, suitable placements are becoming scarce. An evaluation of clinical placements at the Victorian Institute of Forensic Mental Health (VIFMH) was undertaken to determine whether appropriate learning opportunities were offered, and identify the impact of the placement on students’ attitudes to mental health nursing. The results suggest that VIFMH provides valuable learning experiences to increase students’ understanding of mental health nursing and is effective in producing more positive attitudes towards this area of practice.     

Crossing cultural boundaries: flexible approaches and nurse education: a case study

Computer-mediated conferencing commonly is used to promote collaborative learning, including student learning across distance. This article presents the outcomes and experiences of Master of Nursing students in three countries using flexible learning approaches facilitated by the use of computer-mediated conferencing. It examines issues relating to support for global nursing education, presents an evaluation of one particular unit, and presents themes in the feedback from students about their experience. The authors report the findings in three categories: broadened perspectives, tackling the technology, and adaptive learning. Furthermore, the article offers suggestions for enhancing student-learning experiences when computer-mediated conferencing facilities are used.     

护生三维立体式心理健康教育模式的研究

目的探索“三维立体式”心理健康教育模式对护生心理健康的影响。方法从8个护士班中随机抽取4个班为实验班,4个班为对照班。对实验班采取建立监测-保健-教育三个系统、运用课堂教学-心理辅导-心理咨询三种方式、达到矫治-预防-发展三个目的的立体教育模式进行为期1年的干预,对照班为常规模式。以症状自评量表(SCL-90)为工具.在实验前后对两班被试进行测查。结果干预前实验班SCL-90总均分及各因子分明显高于全国常模(P<0.01),差异有显著性意义。与对照班比,除敌对因子外其余差异无显著性意义。筛查阳性率为33.8%。主要心理问题为强迫、焦虑、人际敏感、抑郁、敌对等。干预后实验班与干预前及与对照班干预后比较,除躯体化、恐怖两因子外,其余项目差异有显著或非常显著意义(P<0.05,P<0.01)。结论本模式对护生的心理健康产生了良好影响。     

Level of positive mental health in the European Union: Results from the Eurobarometer 2002 survey

Background

Few epidemiological studies have focused on the occurrence of positive mental health, and those comparing several countries practically non-existent. This study presents comparative findings of positive mental health in 11 EU countries or regions, based on the Eurobarometer 2002 (autumn) survey.

Method

The sample (n = 10,878) represents the general population, aged 15 or over, of 11 European countries or regions (all old EU Member States except Denmark, Greece, Ireland, Finland and Great Britain which had to be excluded because of poor response rate, less than 45%). The method of opinion survey was applied using face-to-face interviews. The Energy and Vitality Index (EVI) from the SF-36 questionnaire was use as measure of positive mental health.

Results

Overall, there were between-country differences in the gender- and age-adjusted EVI mean scores. In general, poorer mental health was found in women, older age groups, those in poor economic position and those experiencing weak social support.

Conclusion

Methodological biases cannot be fully excluded, and thus, one has to take the presented results with certain caution, especially when comparing the results from the different countries. On the other hand, the results on the determinants of positive mental health are in concordance with most previous studies.

     

Preceptors’ perspectives of an integrated clinical learning model in a mental health environment

Supervised clinical practice is an essential component of undergraduate nursing students’ learning and development. In the mental health setting, nursing students traditionally undertake four‐week block placements. An integrated clinical learning model, where preceptors mentor students on an individual basis, has been used successfully in the clinical learning environment. This flexible model provides the opportunity for students to work across morning, afternoon, night and weekend shifts. There is a need to improve the evidence base for a flexible model for students undertaking a mental health placement. The aim of this study was to understand preceptors’ experience of, and satisfaction with, a mental health integrated clinical learning model. Focus groups were used to elicit the views of preceptors from a mental health service. Findings highlight the advantages and disadvantages of an integrated clinical learning model in the mental health setting. Participants suggested that students may benefit from flexible work arrangements, a variety of experiences and a more realistic experience of working in a mental health service. However, they found it challenging to mentor and evaluate students under this model. Most also agreed that the model impeded students’ ability to engage with consumers and develop rapport with staff. The findings indicate the need to develop a placement model that meets the unique needs of the mental health setting.     

‘It is meant to be heart rather than head’; International perspectives of teaching from lived experience in mental health nursing programs

Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co‐produced between ‘Experts by Experience’ (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: ‘there wasn't a barrier’ described how personal narratives enhanced relationships between Experts by Experience and students; and ‘made the human being visible’, described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio‐political, humanistic focus in mental health nursing, congruent with rights‐based reform agendas.     

Mental health nurses' perspectives of people who self‐harm

Self‐harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self‐harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self‐harm. Data were collected using semi‐structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self‐harm: (i) Nurses’ level of preparedness to work with people who self‐harm; and (ii) The healthcare system. Several sub‐categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self‐harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self‐harm and an accurate understanding of the functions of self‐harm focuses therapeutic interactions to manage psychological distress and reduce further self‐harm and lessen the risk of suicide.     

Mental health nurses' and psychiatrists' views on addressing parenthood issues among service users

Mental health professionals (MHPs) are in a central position to provide support for mental health service users (MHSUs) in regard to parental needs, from preconception to caring for children. This study aims to examine whether mental health nurses and psychiatrists regard the issue of having children and being a parent as relevant to be considered in a clinical setting, how they describe the MHPs' roles and responsibilities in this regard, and to what extent they feel willing and able to fulfil these demands. A qualitative approach was undertaken by conducting four focus groups with 30 MHPs (15 nurses and 15 psychiatrists) within an inpatient mental health service in south Germany. We found that MHPs generally acknowledged the importance of parenting issues for psychiatric treatment. However, they assessed the talks between MHPs and MHSUs about parenting as less relevant in routine practice; the issue of the desire for children in particular was seen as generally not important. Addressing parenthood issues was restricted to mainly two areas: clarifying children's situations during inpatient treatment and considering medication issues among (potentially) pregnant service users. MHPs' focus on the adult service user, privacy, and historical issues were the main arguments against addressing parenthood issues.     

Nurses' learning experience and expressed opinions regarding seclusion practice within one NHS trust

Brief face-to-face interviews took place with 64 mental health nurses working within one National Health Service Trust about their education and training regarding seclusion practice. Free comments were also recorded as to their opinions about seclusion practice. Seventy-three per cent claimed to have either implemented seclusion or supervised patients in seclusion. Only 28% recalled any training or education regarding seclusion practice with 34% recalling reading articles. Training experiences were perceived to be more appropriate to practice than reading articles. Sixty-six per cent claimed that they would like more information. Seventy-eight per cent disagreed with the statement that seclusion should no longer be used with 52% agreeing that seclusion was a valuable intervention. Brief comments made during interviews were sorted into six thematic categories. Nurses' comments involved issues concerning: (1) keeping safe; (2) seclusion abuse; (3) nurses' role conflict in implementing seclusion; (4) the value of seclusion in 'real world' practice; (5) the learning process; and (6) 'against the wall' decision-making. Nurses were more able to identify difficulties than define proper use of seclusion. Nurses most closely involved with seclusion were more likely to refuse to be interviewed about their experiences reflecting the fact that issues surrounding seclusion continue to be a sensitive area for research.     

Twelve possible strategies for enhancing interprofessional socialisation in higher education: Findings from an interpretive phenomenological study

The aim of this study was to investigate the interprofessional socialisation experiences of health professional educators (HPEs) across five health science faculties in Perth, Australia. Evidence supported the importance of educators teaching and learning together, although there was minimal evidence with regard to the type of support HPEs received or required in order to socialise interprofessionally within higher education. Interview participants comprised 26 HPEs from various health-related professions across Western Australia. An interpretive phenomenological framework was used to discover the phenomena of interprofessional socialisation. The examination of the data was undertaken via qualitative content analysis with the aid of NVivo 10 software. Content coding led to the development of categories, sub-categories, and then themes. Five themes were identified; however, only one of these themes, “interprofessional socialisation strategies within higher education,” is explored within this article. Based on the data within this theme, 12 possible socialisation strategies (formal and informal) were identified for HPEs, which could be implemented within health science faculties, taking into account the organisation’s culture and strategic intent towards interprofessional collaboration and education.     

Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person. Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person‐centred, integrated physical and mental health care. Thus, the aim of this study was to describe mental health nurses’ experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness. Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse’s experiences. Analysis of the interviews generated three categories: (i) to have a health promotion focus in every encounter, (ii) to support with each person’s unique prerequisites in mind and (iii) to take responsibility for health promotion in every level of the organization. The results show the importance of a health promotion focus that permeates the entire organization of mental health care. Shared responsibility for health and health promotion activities should exist at all levels: in the person‐centred care in the relation with the patient, embedded in a joint vision within the working unit, and in decisions at management level.     

Reporting about disability evaluation in European countries

Abstract

Purpose: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. Methods: Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. Results: Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant’s working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant’s health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. Conclusion: Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research.

• Implications for Rehabilitation

• Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability.

• Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured and scaled report forms of working capacity.

• The ICF could serve as a reference for describing work capacity, provided the ICF contains all necessary categories.

     

Priorities for mental health and learning disability nurse education in the UK: a case study

? The closure of psychiatric and mental handicap hospitals, the emphasis on community rather than hospital care and the distinction between health and social care for people in the community, with its funding implications, have demanded that mental health and learning disability nurses face the challenges of developing new skills and new ways of working. ? In this paper the findings of a study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB) are reported. This study explored the impact of these reforms on nurses and their practice, and identified the educational needs of mental health and learning disability nurses that have changed as a result. ? The study took a multiple-case study approach and involved interviews with 22 `key informants' and 88 mental health and 59 learning disability stakeholders in six sites, three in each nursing specialty. ? Inductive analysis of the interview data revealed 20 categories which summarize the major issues facing the two nursing specialties. ? These categories are discussed under seven themes and issues for nurse education are raised.     

Computer mediated conferencing - a hope or hype for healthcare education in higher learning?: A review of the literature

AIMS AND OBJECTIVES: In view of the increase use of computer mediated conferencing (CMC) by nurses with other health care professionals in health care education, this literature review provides insights into the experiences and issues surrounding the use of the technology by nursing students and their use with other health care students. It is an important initial step in designing and developing strategies in the use of CMC. This literature review also aims to structure the available research findings of needs and experiences of other health care students and students from disciplines other than health care to provide the best approximation of what nursing students will experience in diverse groups for inter-professional learning. METHOD: Literature review. RESULTS: The literature review indicates a substantial amount of students' experiences and expectations in CMC. The problems thus far, are more complex than access and use of the technology, and emerged as six different, but related issues associated with technology and reflective and collaborative online learning in a constructivist learning environment. RELEVANCE TO PRACTICE: Priority needs should be central in the preparation of student in the constructivist learning environment. Concerted efforts should not be just about increasing students' technological competence, but on addressing the socio-psychological dimensions in CMC.     

Information technology-based standardized patient education in psychiatric inpatient care

Title. Information technology‐based standardized patient education in psychiatric inpatient care Aim. This paper is a report of a study to describe nurses’ experiences of information technology‐based standardized patient education in inpatient psychiatric care. Background. Serious mental health problems are an increasing global concern. Emerging evidence supports the implementation of practices that are conducive to patient self‐management and improved patient outcomes among chronically ill patients with mental health problems. In contrast, the attitude of staff towards information technology has been reported to be contradictory in mental health care. Method. After 1 year of using an Internet‐based portal (Mieli.Net) developed for patients with schizophrenia spectrum psychosis, all 89 participating nurses were asked to complete questionnaires about their experiences. The data were collected in 2006. Fifty‐six participants (63%) returned completed questionnaires and the data were analysed using content analysis. Findings. Nurses’ experiences of the information technology‐based standardized patient education were categorized into two major categories describing the advantages and obstacles in using information technology. Nurses thought that it brought the patients and nurses closer to each other and helped nurses to provide individual support for their patients. However, the education was time‐consuming. Conclusion. Systematic patient education using information technology is a promising method of patient‐centred care which supports nurses in their daily work. However, it must fit in with clinical activities, and nurses need some guidance in understanding its benefits. The study data can be used in policy‐making when developing methods to improve the transparency of information provision in psychiatric nursing.