Mental health nurse supplementary prescribing: experiences of mental health nurses, psychiatrists and patients

AIM: This paper is a report of a study to explore the views of patients, mental health nurses and psychiatrists involved in mental health nurse supplementary prescribing. BACKGROUND: Medication prescribing by mental health nurses in the United Kingdom is controversial. However, the experience of mental health patients suggests that increasing prescribing capacity could be one strategy to provide a person-centred prescribing approach. METHOD: A qualitative study was carried out in 2005. Semi-structured interviews were conducted with 12 psychiatrists, 11 mental health nurses with prescribing authority, and 12 patients who had been prescribed psychiatric medication by a mental health nurse. Participants were interviewed about positive aspects of supplementary prescribing including the extent of it being evidence-based, person-centred and clinically focussed. FINDINGS: Participants from all three groups had a positive reaction to nurse supplementary prescribing. Mental health nurse prescribing was viewed as evidence-based, person-centred and with an additional focus on physical health. Mental health nurses worked within their levels of competency. Barriers to the implementation of mental health nurse prescribing were nurses' lack of prescribing experience, shortfalls in supervision, insufficient focus on redesigning the service to support the role of the mental health nurse, and preparation for the role. CONCLUSION: Mental health nurse prescribing seems potentially beneficial. However, more rigorous audit and evaluation are needed to confirm its safety, patient satisfaction and health outcomes. Mental health nurse prescribing will require service redesign to ensure that is becomes embedded in the service organizational culture.     

Knowledge,attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey

ObjectivesTo explore the knowledge, attitude and practice of Chinese nurses regarding nursing interruptions and related factors.MethodsA total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge, Attitude and Practice (KAP) Questionnaire of Nursing Interruptions. The questionnaire consists of three dimensions, knowledge, attitude and practice, containing 10, 9 and 7 items, with full score of 50, 45 and 28, respectively.ResultsThe mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05 ± 16.65 (range: 26–123), with scores for the knowledge, attitude, and practice component being 21.74 ± 9.80, 34.83 ± 6.98, and 17.49 ± 4.97, respectively. Among the nurses, 70.8% of them experienced an average level of KAP toward nursing interruptions while 15.5% were at a poor level. The knowledge, attitude, and practice of nursing interruptions were better in chief nurses, managers, nurses with a master degree or above, nurses ever received training, and nurses with a strong agreement to leadership compared to nurses in other groups (P < 0.05). In addition, employment type, professional title, position, standardized training and leaders’ attention were predictors of KAP in nurses.ConclusionChinese nurses have a moderate level of KAP regarding nursing interruptions. Leaders’ attention, standardized training, position, professional title and employment type could predict nurses’ KAP state of nursing interruptions. Thus, a targeted training program should be implemented for clinical nurses by nursing leaders, with a particular focus on feasibility and professionalism.     

Attitudes towards mental illness among health care students at Swedish universities – A follow-up study after completed clinical placement

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.     

Attitudes toward Web-based distance learning among public health nurses in Taiwan: a questionnaire survey

BACKGROUND: Public health nurses (PHNs) often cannot receive in-service education due to limitations of time and space. Learning through the Internet has been a widely used technique in many professional and clinical nursing fields. The learner's attitude is the most important indicator that promotes learning. OBJECTIVES: The purpose of this study was to investigate PHNs' attitude toward web-based learning and its determinants. DESIGN: This study conducted a cross-sectional research design. SETTINGS: 369 health centers in Taiwan. PARTICIPANTS: The population involved this study was 2398 PHNs, and we used random sampling from this population. Finally, 329 PHNs completed the questionnaire, with a response rate of 84.0%. METHODS: Data were collected by mailing the questionnaire. RESULTS: Most PHNs revealed a positive attitude toward web-based learning (mean+/-SD=55.02+/-6.39). PHNs who worked at village health centers, a service population less than 10,000, PHNs who had access to computer facility and on-line hardware in health centers and with better computer competence revealed more positive attitudes (p<0.01). CONCLUSIONS: Web-based learning is an important new way of in-service education; however, its success and hindering factors require further investigation. Individual computer competence is the main target for improvement, and educators should also consider how to establish a user-friendly learning environment on the Internet.     

An investigation of knowledge,attitude and practice towards simulation among clinical nursing teachers in China: A cross-sectional study

AimThis study aimed to investigate the knowledge, attitude and practice towards simulation among CNTs in China and analyze the influencing factors.BackgroundIn China, simulation is now increasingly used by Clinical Nursing Teachers (CNTs) who are mainly responsible for nurses’ continuing education, novice nurses training and nursing students practice in clinical settings. Over the past 20 years, enrolment scale of nursing education was expanded greatly, and the number of registered nurses increased from 1.22 to 4.10 million in China. To contribute to nurses’ or nursing students’ professional development and successful transition to competent practitioners, CNTs are now being challenged to use simulation to develop more learner-centered educational programs, which could better facilitate learner engagement. As faculty preparation is a prerequisite for conducting quality simulation, it is critical that CNTs have the requisite knowledge and skills to use simulation to its full potential. However, data on CNTs’ knowledge, attitude and practice towards simulation is limited.DesignA cross-sectional study.MethodsA total of 342 CNTs from six tertiary affiliated teaching hospitals of a medical university in Beijing, China, participated in the study. Electronic questionnaire of Nurse Educators’ Knowledge, Attitude and Practice towards Simulation (NEKAPS) was delivered to CNTs. Analysis of variance, t-test were used to analyze data.ResultsThe mean score of knowledge and attitude for all participants was 60.01 ± 13.42 and 81.40 ± 19.99, respectively. The mean practice score was 70.65 ± 22.05 for 162 participants (47.4 %) who had conducted simulation in their hospitals. Participants with higher educational level (F=3.476, p = 0.032) and nursing career length≤ 15 years (t = 2.676, p = 0.008) had higher knowledge scores. However, there were no significant differences among different groups for attitudes. Participants with age ≤ 35 years old (t = 3.355, p = 0.001), nursing teaching length ≤ 10 years (t = 2.073, p = 0.041) and advanced beginner nurses (t = 3.212, p = 0.002) presented higher practice scores.ConclusionsCNTs had a low level of knowledge on simulation. Their attitudes towards simulation were positive, whereas their practices were still lacking. It is highlighted an urgent need for standardized training of CNTs to improve their knowledge and practice towards simulation, so that they can optimize the simulation programs they provide for nurses or nursing students.     

Knowledge,attitude, and practice regarding COVID-19 among COVID-19 patients and their correlation with the outcomes: A cross-sectional study

Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes.Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76％) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63％; the mean attitude scores were 2.42, with an overall correct rate of 60.50％; the mean practice scores were 5.12, with an overall correct rate of 64.00％. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.     

Perception of nurse prescribing among nurses and psychiatrists in a developing country: A cross‐sectional survey

Nurse prescribing has the potential to improve patients’ access to, and experiences of, treatment. The aim of the present study was to examine nurse and psychiatrist attitudes about this extended role in a developing country. We conducted a cross‐sectional survey using a previously‐used, 65‐item, seven subscale measure of attitudes to nurse prescribing in mental health. We achieved a 79% response rate. The majority of participants had trained in developing countries where nurse prescribing has yet to be implemented. Across five subscales (general beliefs, impact, uses, training, and supervision), both groups reported positive attitudes about nurse prescribing. Both groups scored the training subscale particularly highly. Compared with psychiatrists, nurses were more confident about the range of clinical settings where nurse prescribing could be applied (e.g. acute inpatient and substance use). Although both groups had less favourable attitudes on the two subscales relating to clinical and legal responsibility, compared to nurses, psychiatrists were more undesirable. Although, overall, clinician attitudes do not seem to represent a barrier towards the potential implementation of nurse prescribing in the study setting, clarity about clinical and legal responsibility needs to be addressed.     

Medication management: an exploratory study into the role of community mental health nurses

The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation.     

Assessment of knowledge,attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study

BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable. RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group. CONCLUSION: This study demonstrates that there is a gap in EHCWs’ KAP, particularly regarding when to provide OT to a patient. This gap can affect patients’ safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.     

A comparative cross-sectional questionnaire survey of the work of UK and US mental health nurses

BACKGROUND: Comparative inter-country research which identifies similarities and differences in the work of mental health nurses in different social and political contexts is an important means of determining how changes in health care systems could lead to better outcomes for patients. OBJECTIVE: This study sought to compare aspects of the work of nurses in US and UK mental health care settings. Nurses were invited to reflect on aspects of their role including identifying the most and least satisfying elements of their work and suggesting ways in which it could be improved. METHODS AND PARTICIPANTS: A 12-item questionnaire, comprising closed and open-ended questions, based on the literature and the authors' own experiences of mental health nursing practice, was piloted and subsequently distributed to respondents in both countries. RESULTS: The US nurses tended to be more willing to accept a wider range of clients than their UK counterparts, although they had lower expectations of their clients' likelihood of recovery. Both groups of nurses felt that being part of a team and having direct contact with clients were the most satisfying aspects of their work, while administration was the least. Although both US and UK nurses utilised a variety of intervention models, it would appear that Cognitive Behavioural Therapy was the favoured model for the majority of nurses. CONCLUSIONS: The implications of these findings for the work of nurses and mental health care services in the UK and US, and the purpose, nature and need for future international comparative research are discussed.     

Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey

BackgroundIncreasing prevalence of overweight and obesity represents a global pandemic. As the largest occupational group in international healthcare systems nurses are at the forefront of health promotion to address this pandemic. However, nurses own health behaviours are known to influence the extent to which they engage in health promotion and the public's confidence in advice offered. Estimating the prevalence of overweight and obesity among nurses is therefore important. However, to date, prevalence estimates have been based on non-representative samples and internationally no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals using representative data.ObjectivesTo estimate overweight and obesity prevalence among nurses in Scotland, and compare to other healthcare professionals and those working in non-heath related occupations.DesignCross-sectional study using a nationally representative sample of five aggregated annual rounds (2008–2012) of the Scottish Health Survey.SettingScotland.Participants13,483 adults aged 17–65 indicating they had worked in the past 4 weeks, classified in four occupational groups: nurses (n = 411), other healthcare professionals (n = 320), unqualified care staff (n = 685), and individuals employed in non-health related occupations (n = 12,067).Main outcome measuresPrevalence of overweight and obesity defined as Body Mass Index ≥ 25.0.MethodsEstimates of overweight and obesity prevalence in each occupational group were calculated with 95% confidence intervals (CI). A logistic regression model was then built to compare the odds of being overweight or obese with not being overweight or obese for nurses in comparison to the other occupational categories. Data were analysed using SAS 9.1.3.Results69.1% (95% CI 64.6, 73.6) of Scottish nurses were overweight or obese. Prevalence of overweight and obesity was higher in nurses than other healthcare professionals (51.3%, CI 45.8, 56.7), unqualified care staff (68.5%, CI 65.0, 72.0) and those in non-health related occupations (68.9%, CI 68.1, 69.7). A logistic regression model adjusted for socio-demographic composition indicated that, compared to nurses, the odds of being overweight or obese was statistically significantly lower for other healthcare professionals (Odds Ratio [OR] 0.45, CI 0.33, 0.61) and those in non-health related occupations (OR 0.78, CI 0.62, 0.97).ConclusionsPrevalence of overweight and obesity among Scottish nurses is worryingly high, and significantly higher than those in other healthcare professionals and non-health related occupations. High prevalence of overweight and obesity potentially harms nurses’ own health and hampers the effectiveness of nurses’ health promotion role. Interventions are therefore urgently required to address overweight and obesity among the Scottish nursing workforce.     

Preparing nurses with enhanced mental health knowledge and skill: A major in mental health

In Australia, since the early 1990s there has been a significant change to the way in which mental illness has been managed. Major government reforms resulted in the ‘mainstreaming’ of mental health care, with a significant reduction in the numbers of psychiatric hospitals. This significant policy change resulted in the demise of direct entry, specialist mental health nurse education that was the main provider of the mental health workforce. In theory, since that time, nurses have been prepared for practice through a comprehensive degree program; however, there is strong evidence to suggest that the mental health content in the comprehensive program is well below what is needed for nurses to have the knowledge and skill to provide effective mental health care. This article reports on the development of an innovative curriculum designed to prepare an appropriately qualified nursing workforce with enhanced mental health knowledge and skill to be responsive to the changing nature of health service delivery.     

A comparative study of the perceptions of British mental health nurses and psychiatrists of their work environment

This comparative study of the perceptions of mental health nurses and psychiatrists about aspects of their work environment was undertaken in the West Midlands in England. The aim of the study was to ascertain the extent to which the environment in which mental health professionals' work impacts on their own mental and physical well-being. Seventy-four psychiatrists and 301 mental health nurses responded to a postal questionnaire. Analysis of data indicated that significant differences exist between nurses and psychiatrists in their working conditions, their physical working environment, their sources of support with a work-related problem, and the effects of their work on their own mental and physical health. The main recommendation derived from this study was to improve communication between mental health professionals and their managers by giving more structured feedback and guidance about one's work performance. This may help to alleviate the mental strain many mental health professionals experience in their work.     

Engaging primary healthcare nurses in men's health education: A pilot study

Many countries have identified a need for targeted men's health promotion within primary health care as part of broader men's health policy. Primary health care nurses are well placed to deliver such services but may lack the requisite skills. The aim of this study was to pilot the delivery phase of an education program and evaluate a train-the-trainer approach for delivering men's health education to primary health care nurses. The 8-h train-the-trainer workshop was designed to equip nurses to deliver men's health education workshops to peers. Surveys of facilitators (n = 18) and peer workshop participants (n = 98) evaluated their level of confidence in men's health and knowledge and skills in men's health promotion.After completing the train-the-trainer workshop, most facilitators expressed confidence (92%), and all indicated sufficient knowledge and access to resources to deliver a peer workshop. All agreed that the module was sufficiently flexible to suit their local setting. Following the peer education workshop, facilitators and workshop participants reported high levels of confidence and knowledge in men's health promotion.This pilot evaluation suggests train-the-trainer is an effective model to deliver men's health education across a range of settings, with a flexible approach to raising awareness and improving the skills of primary health care nurses in men's health promotion.     

Caring behaviours and stress perception among student nurses in different nursing programmes: A cross-sectional study

Caring is central to providing high-quality nursing. Little research exists concerning the relationship between caring behaviours and stress perception among student nurses. This study aimed to explore this relationship among student nurses in different nursing programmes. A sample of 792 student nurses from three nursing education programmes in one academic institution completed Chinese versions of the Caring Behaviors Scale and the Nurse Stress Checklist to assess participants' caring behaviour and psychosocial responses to work-related stress, respectively. We found a statistically significant negative correlation between caring behaviour and stress perception among participants. The three most frequently reported caring behaviours were related to ‘knowing the patient’: (a) recognising that each patient holds unique values, (b) taking a patient's chief complaints seriously, and (c) stating that the family's best interests should be respected regarding health decisions. Completion of work, time limitations, and lack of personal interactions were sources of stress. Nursing education curricula involve the fundamentals of caring and the preparation of nursing students for clinical practice. The study recommends that nursing faculty and administrators should educate students in stress management in order to foster, support, and promote caring behaviours among nursing professionals.     

Assessing oral health literacy of university nursing students: A cross-sectional exploratory study

AimResearch has proven a link between oral health and numerous chronic systemic diseases. To achieve better health outcomes, there is a need to involve interprofessional primary health care providers, such as nurses to raise awareness and promote oral health. Nurses have regular contact with patients which provides a unique opportunity to impart disease-specific information and technical skills for patients to self-manage their oral health conditions. However, the baseline oral health literacy of undergraduate nursing students at the University of Sydney is not known. Before creating a targeted curriculum to improve oral health literacy amongst nursing students, it is essential to assess the baseline oral health knowledge of these students. This study aimed to assess the oral health literacy level among undergraduate nursing students of the University of Sydney, Australia.DesignAn exploratory research approach was used.MethodsA cross-sectional survey study was conducted using the validated Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument. A univariate general linear model was used to explore the association of CMOHK total score with demographic and educational variables.ResultsA total number of 197 nursing students participated in the survey, with a mean CMOHK score of 15.48, SD 3.27. 72% were categorized as having good, 16% fair and 12% poor oral health knowledge. The analysis from the six individual knowledge domains of the CMOHK revealed lower percentages of correct responses in the periodontal disease and oral cancer knowledge domains. Students with English as their second language, on average, scored 2 fewer correct responses (p <.001) than students whose first language was English. Low socioeconomic status was not associated with a low level of oral health literacy.ConclusionThe baseline results show a good level of general oral health knowledge as measured by the CMOHK. However, periodontal disease and oral cancer were identified as the particular domains where a knowledge gap exists. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nursing students. Culturally responsive pedagogy may need to be considered for students with English as their second language. This baseline survey data may potentially facilitate integrating oral health in nursing education and practice.     

Toileting behaviours and lower urinary tract symptoms among female nurses: A cross-sectional questionnaire survey

BackgroundUnhealthy toileting behaviours exist among women, and lower urinary tract symptoms have a high prevalence and significant effects on quality of life. However, the relationship between toileting behaviours and lower urinary tract symptoms is unclear.ObjectivesThis study aimed to investigate the prevalence of lower urinary tract symptoms among female nurses, and the association between toileting behaviours and lower urinary tract symptoms.DesignA cross-sectional stratified cluster sampling study.ParticipantsA total of 636 female clinical nurses from tertiary hospitals in Jinan (the capital city of Shandong Province, China).MethodsThe Toileting Behaviour-Women’s Elimination Behaviours and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms scales were used to assess the participants’ toileting behaviours and lower urinary tract symptoms, respectively. Multiple linear regression analysis was used to evaluate the association between toileting behaviours and lower urinary tract symptoms.ResultsUnhealthy toileting behaviours were common among the female nurses, with delayed voiding being the unhealthiest toileting behaviour, which was followed by place and position preference for voiding. Nearly 68% of the female nurses had at least one lower urinary tract symptom, nearly 50% had incontinence symptoms, 40% had filling symptoms, and 18% had voiding symptoms. Unhealthy toileting behaviours (premature voiding, delayed voiding, and straining to void) were positively associated with lower urinary tract symptoms. However, lower urinary tract symptoms were not significantly associated with voiding place or position preference. Among the control variables, being married or having a history of a urinary tract infection was associated with lower urinary tract symptoms. Having a higher income and regular menstrual period were negatively associated with lower urinary tract symptoms. Compared with vaginal delivery, caesarean delivery had a protective association with lower urinary tract symptoms.ConclusionLower urinary tract symptoms among female nurses should not be overlooked, because their prevalence among female clinical nurses exceeded that among the general population of women. These findings highlight the importance of avoiding unhealthy toileting behaviours (especially premature voiding, delayed voiding, and straining to void), as these unhealthy toileting behaviours were significantly associated with susceptibility to lower urinary tract symptoms.