The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.     

The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health

Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants’ experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.     

Staff drug knowledge and attitudes towards drug use among the mentally ill within a medium secure psychiatric hospital

There is little research in the UK that focuses on medium secure psychiatric nursing staff attitudes, beliefs and knowledge about alcohol and illicit substances, substance use and mental illness. The current study presents data from 98 staff, working within a medium secure psychiatric hospital, and compares differences between staff groups in relation to general drug knowledge and attitudes towards both alcohol and illicit substances and the mentally ill patients who use them. Data suggest that, even for qualified staff, training in alcohol and illicit substances was inadequate in both length and depth. Qualified nursing staff had better knowledge of licit and illicit drug use than unqualified nursing staff and non-clinical staff, and also had different beliefs about why people with severe mental illnesses use licit and illicit drugs. However, no significant differences were found between groups for either level of punitive attitude towards people with severe mental illness who use drugs or the impact that certain factors have on severe mental health problems. These results identify the need for training in drug knowledge and drug use in mental illness, for those staff working in the field. The need for ongoing post-registration training in substance use and mental health is emphasized.     

Relocating elderly people and nursing staff from the NHS to the independent sector

Relocating elderly people and nursing staff from the NHS to the independent sector The results of the study reported here highlight the difficulties and potential problems facing re-provision programmes of mental health services. Relocation of services affects not only patients and staff, it also has implications for the education of staff and managers. Without appropriate preparation for relocation, the potential negative effects for older patients could be life threatening. For the staff, relocation could mean new ways of working for which they may not have been prepared. The current educational format does not appear to be sensitive enough to adapt to the pace of policy changes. The management process of re-provision programmes requires more than financial accounting. Preparation for relocation of patients and staff is of paramount importance to achieve the maximum benefits.     

Leadership, support and acknowledgement of registered nurses work in acute mental health units

In acute mental health inpatient units, it is not surprising that culture, peers, immediate management, and sources of support and acknowledgment all contribute to positive nursing outcomes. In this qualitative study, four questions targeting leadership, culture, support, and acknowledgement of work well done were asked of 40 registered nurses (RN) working in acute mental health units. Findings convey a mixed picture indicating variation across units. Three-quarters believe that senior nursing staff actively contribute to a positive working environment. Almost half of the RN nominated peers as the providers of counsel and support when required, and a similar percentage believed that senior nursing staff fulfil these roles. Of interviewees, 33% said their nursing achievements are never, or rarely, acknowledged. For these RN, management, peers, and nurse unit managers are the preferred personnel to provide appropriate positive feedback. Thus, there is a gap between the expectations and hopes that nurses have for senior management approaches and behaviours and the reality of their daily experience. Overall, the responses portray a culture that underpins and enables both subtle interpersonal interactions that might arise out of necessity given the perceived lack of support from non-hands-on RN and administrators.     

Early detection of mental health problems in older people

A survey of the mental health needs of older adults, conducted in 1996 by the Mental Health Services of Salford NHS Trust (Watts et al, 1996), confirmed earlier research findings that mental health problems in older adults are under-recognized and under-treated. This article reports on this survey, the aims of which were to identify within an inner city area in northwest England the extent and method by which primary care staff detect mild to moderate mental health problems in later life, and the best way to support the teams to detect and manage these issues effectively. As a result, this 11-week survey was conducted which sought to interview all attendees aged 65 years and above at a general practice. Given the high levels of psychological distress and low levels of identification, education/training was provided for practice staff, enabling them to develop the use of appropriate screening tools. The article concludes by discussing how the evaluation of the project by the primary healthcare teams involved has demonstrated that primary healthcare nurses can be trained in brief assessment tools and management techniques suitable for primary healthcare settings.     

The experience and views of mental health nurses regarding nursing care delivery in an integrated, inpatient setting

Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.     

Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration

Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits. Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks. A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness. An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits. The situation was less acute in a rural trust where a second audit was performed for comparative purposes. The motivation of clinical staff to improve hand hygiene precautions was high.     

新型冠状病毒肺炎疫情期间护理人员心理状况调查

目的 了解新型冠状病毒肺炎(COVID-19)期间我院护理人员的心理状况,以予以针对性心理干预。方法 采用症状自评量表（SCL-90）对我院护理人员进行调查,并将结果与非疫情期间进行比较,并分析影响护理人员心理状况的相关因素。结果 疫情期间我院护理人员心理健康水平较非疫情期间总体偏低,躯体化、焦虑、偏执三个因子有非常显著的差异（P＜0.01）,抑郁、敌对有显著差异（P＜0.05）。已婚、与配偶及子女同住、工作年限＞10年护理人员及门急诊护理人员较其他组护理人员各因子得分更高。结论 应当予以已婚、与家人同住、高年资护理人员和门急诊护理人员的心理健康状况更多关注,并予以针对性干预措施。     

Nursing attitudes towards acute mental health care: development of a measurement tool

AIM: This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. BACKGROUND: The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. METHODS: A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. RESULTS: Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant 'Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0.72. CONCLUSION: The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.     

Modernizing the school health workforce. Staff perceptions of a rapid roll-out redesign programme

Aims To explore the perceptions of staff participating in an NHS school health workforce modernization rapid roll‐out redesign programme. Background The health and well‐being of children is central to national policy and focuses upon multi‐agency working. As part of the NHS modernization programme, a rapid roll‐out workforce redesign model was developed for the school health workforce and introduced in northern England. Methods An evaluation approach using electronic distributed questionnaires and telephone interviews was utilized. Results Respondents reported that the approach was a valuable and fast way of introducing change to the workforce. Benefits for participants in providing networking opportunities were reported. Limitations of the study Data were collected from one programme and local factors may have influenced the findings. Conclusion The rapid roll‐out approach appears to be a successful way of introducing change to the school health workforce. Implications for nursing management Workforce redesign using a rapid roll‐out approach is a fast and effective approach, additionally providing benefits for staff participating in the process.     

Involving NHS service users in teaching advanced clinical skills

With the development of advanced practice roles in nursing, innovative ways of delivering programmes are continually sought by academic staff working within higher education. This study explores the ways in which NHS service users can be included in education programmes to develop clinical examination skills for nurses. Although small scale and exploratory, this study concluded that NHS service users benefit from making a contribution towards the education of healthcare staff and feel empowered in the process.     

The mental health nurse: a valuable addition to the consultation-liaison team

Nurses, particularly those working in non-psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation-liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff. The impact of the introduction of a nursing position into an established consultation-liaison psychiatry service was evaluated using an activity audit, a staff attitude survey, and staff focus groups. The findings demonstrated that the addition of the nursing role to the consultation-liaison psychiatry service improved access of general hospital patients to specialist mental health care. It also provided valued expert assistance to staff in the provision of care to this patient group, particularly those with complex problems and significant psychiatric comorbidity. The study found that the nursing consultation was particularly helpful because of its focus on practical and care-orientated interventions. The model of practice that evolved out of this project is described and the findings support the use of both direct and indirect patient interventions as important psychiatric consultation-liaison nurse activities.     

Recruiting licensed staff in mental health.

This 4- to 6-month mental health internship program for new graduates vocational nurses (GVNs) involves a 4-month mental health course, a new graduate course, management of assaultive behavior course, and a 1:1 preceptorship in mental health. This successful program has recruited and trained 18 VNs to improve licensed staff/patient ratios in mental health. These new graduates are licensed at the end of 4 months and are working successfully as licensed staff on the psychiatric units. All of these licensed vocational nurses (LVNs) are now completing prerequisites or entering registered nurse (RN) programs to earn an advanced degree. They bring their medical skills, positive attitudes, and therapeutic strategies to contribute to the milieu on the nursing units. They have reduced the facility's licensed staff shortage in mental health.     

Iranian nursing staff's self-reported general and mental health related to working conditions and family situation

ARSALANI N., FALLAHI‐KHOSHKNAB M., JOSEPHSON M. & LAGERSTROM M. (2012) Iranian nursing staff's self‐reported general and mental health related to working conditions and family situation. International Nursing Review 59 , 416–423 Background: There is increasing global evidence that today's work environment results in higher risk of adverse health among nursing staff than among other professions. Aim: To investigate self‐reported general and mental health among Iranian nursing staff, and associations with organizational, physical and psychosocial working conditions and family situation. Methods: 520 nursing personnel from 10 university hospitals in Tehran participated in this cross‐sectional study. Data were collected using a validated questionnaire in the Persian language, containing the Copenhagen Psychosocial Questionnaire, physical items from the Nurse Early eXit Study and two scales relating to general health and mental health from the Short Form‐36. The Chi‐square test with P < 0.05 and logistic regression were used to analyse data. Results: Three out of four nursing staff reported overtime work. The self‐reported general and mental health rates of participants were poor/fair (38%, 41%), good (44%, 39%) and very good/excellent (18%, 20%), respectively. Family demands were associated with general health but were not associated with mental health. Adverse physical and psychosocial work conditions gave an elevated odds ratio for poor health. Conclusion: Poor general and mental health was associated with adverse working conditions and family demands. Physical and psychosocial working conditions of nursing personnel should be improved. Social facilities such as daycare for children and care for the elderly should be available during work shifts to help Iranian nurses play their family roles.     

Reflections on nursing as a career choice

Aim The study sought to explore (1) reasons for choosing nursing as a career; (2) expectations, if any, of nursing; (3) whether those expectations had been realized; (4) how such expectations had been met or could be met.
Background Nursing recruitment and retention are of central concern to health care. The Audit Commission have highlighted the costs of 'preventable' staff attrition and suggested that staff turnover may be minimized if staff policies reflected an understanding of the views and aspirations of staff.
Method A semi-structured interview survey was conducted with a quota sample of undergraduates attending one university ( n =40). Different course groups were represented.
Findings Satisfaction of caring for people together with long-term desire to nurse emerged as important factors influencing career choice. Expectations included working in a caring team and having a satisfying career. Conflict experienced in the clinical setting, disappointment over the treatment of nurses and changes within the NHS and nursing were considered among the factors detracting from nursing as a career.
Conclusion Health care management must recognize issues of concern to nurses and develop policies which make nurses feel valued.