Community mental health nurses in Wales: self-reported stressors and coping strategies

There is evidence to suggest that community mental health nurses experience stress and burnout related to their work. Previous research has been limited by a number of methodological problems. One of the problems is that studies have tended to have small or unrepresentative samples, and many researchers have only examined mental health nurses as a subset within their research, which limits the generalizability of the findings. The All-Wales Community Mental Health Nurse (CMHN) Stress Study was set up in order to address this issue. The total population of CMHNs in Wales was surveyed (N = 614) and 301 (49%) responded. The questionnaire booklet contained a number of validated instruments to measure stress, burnout, and coping, together with a demographic questionnaire. The demographic questionnaire included three open ended-questions. These questions were asked in order in determine the CMHNs' own views of the sources of stress in the workplace, and to investigate which methods they use to cope. This paper reports the findings from the content analysis of the three questions. The results from the other measures are reported in the companion paper (Edwards et al. 2000). The most frequently cited stressors included perceived workload, excessive paperwork and administration, and a broad spectrum of client-related issues. Coping strategies that CMHNs reported using included peer support, a range of personal strategies such as relaxation, and belief in self and supervision. It appears from the findings that a range of factors such as organizational pressures and factors related to working with patients are important in determining stress levels, and that informal rather than formal support networks are the preferred methods of coping.     

Differences in job stress experienced by female and male Japanese psychiatric nurses

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job‐related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health‐care interventions for psychiatric nurses.     

A qualitative study of coping in the early stage of acute traumatic hand injury

Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.     

Strategies for success: a toolbox of coping strategies used by breastfeeding women

Aims. The purpose of this paper is to present the findings of two qualitative studies which identified strategies used by breastfeeding women to assist them to continue breastfeeding. Background. While breastfeeding initiation rates are high in Australia, the majority of women wean before the recommended time. The identification of interventions which may increase breastfeeding duration is therefore a research priority. Design. The Against All Odds study used a case‐controlled design to investigate the characteristics of women who continued to breastfeed in the face of extraordinary difficulties. Phase One of the I Think I Can study employed the Nominal Group Technique to investigate the views of subject matter experts regarding which psychological factors may influence the duration of breastfeeding. Method. Against All Odds study participants (n = 40) undertook a one‐ to two‐hour interview and the transcribed data were analysed using thematic analysis. Stratified purposeful sampling was employed in the I Think I Can study (n = 21), with participants assigned group membership according to their most recent breastfeeding experience. A fourth group was composed of experienced breastfeeding clinicians. The nominal group technique was used to generate group data and segments of the discussion were audiotaped and transcribed for thematic analysis. Results. Participants in both the studies raised strategies used to assist them in their efforts to cope with the challenges of breastfeeding and early motherhood. These strategies included increasing breastfeeding knowledge, staying relaxed and ‘looking after yourself’, the use of positive self‐talk, challenging unhelpful beliefs, problem solving, goal setting and the practice of mindfulness. Conclusions. Employment of these simple behavioural and cognitive strategies may assist women to cope with the pressures inherent in the experience of early mothering, thereby increasing the duration of breastfeeding. Relevance to clinical practice. These results may represent a ‘tool box’ of coping strategies which can be provided to women for use in the postnatal period.     

Juvenile Mental Health Courts for Adjudicated Youth: Role Implications for Child and Adolescent Psychiatric Mental Health Nurses

TOPIC: Juvenile mental health courts for adjudicated youth. PURPOSE: To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. SOURCES: ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000–2010. CONCLUSIONS: Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.     

Charting the future today: Psychiatric and mental health nurses in cyberspace

The development of the Internet is happening at a staggering pace and promises to have a dramatic impact on human relations. If nursing is to adapt to and benefit from these changes, consideration ought to be given to the experiences and opinions of nurses who have adapted to and use the technology. This paper provides an outline of the findings of an Email survey of psychiatric and mental health nurses who are experienced in using the Internet. Questions focused on what psychiatric and mental health nurses use the Internet for, how their use has changed, work‐related benefits, and what impact they see the Internet having in the future.     

Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.     

《精神科护理学》纳入护理课程体系的必要性

为满足现代护理发展的需要，顺应培养适应21世纪高素质实用型人才的要求，我院将(精神科护理学)纳入护理教学体系。实践证明，为护理专业学生开设《精神科护理学》课程是必要的和可行的。     

儿童孤独症家长心理反应的调查及对策

目的了解儿童孤独症家长的心理反应,并提出相应的护理对策,以促进儿童孤独症家长及患儿的健康状态。方法采用自行设计的调查问卷,调查180名儿童孤独症家长的心理反应。结果儿童孤独症家长的心理反应依次为紧张和焦虑（92.7%）,急于求成和期望过高（86.6%）,压抑沉闷和缺乏信心（76.7%）,过于依赖和过分顺从（57.2%）。结论儿童孤独症家长存在较为复杂的心理反应。针对家长的心理问题给予相应的心理护理,对家长维持良好的心理状态具有积极的意义。     

A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community

AIMS: The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales. BACKGROUND: Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England. METHODS: A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self-Esteem Scale and General Health Questionnaire GHQ-12. The study was the largest of its kind conducted in the UK. RESULTS: Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption. CONCLUSIONS: These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.     

Mental health triage tools: A narrative review

Mental Health Triage (MHT) tools may be defined as any clinician administered scale that specifies psychiatric signs or symptoms, proposes a corresponding service response, and determines priority categories based on the level of perceived acuity. Multiple MHT tools are used across different jurisdictions and care settings. This article summarizes the literature on MHT tools, describes the available tools and the supportive evidence, evaluates the impact and clinical applications, and compares their strengths and weaknesses. This review utilized a systematic review process to identify articles examining MHT tools. Several benefits of using MHT tools are described; however, in general, the supportive evidence for their use is lacking. A modified Australasian Triage Scale has the strongest evidence base for use in emergency settings; however, further data are needed to establish improved outcomes. There is limited evidence for the use of MHT tools in ambulatory or primary care settings. No evidence was found supporting any one tool as effective in guiding service responses across the entire clinical spectrum. Future research could focus on developing and evaluating MHT tools that service all levels of illness presentation. Additionally, more robust studies are required to support the use of MHT tools in emergency settings. Finally, there is an impetus for the development and evaluation of MHT tools in ambulatory, community, and primary care settings.     

How effective are mental health nurses in A&E departments?

Background

A&E departments are key points of contact for many people with mental health problems. Various models of care have been developed in A&E departments for delivering mental health services, but few have been assessed for effectiveness. The present study aimed to assess the impact of a dedicated A&E psychiatric nurse service on several outcomes relevant to patients and clinicians.

Methods

A crossover design was used to introduce a dedicated psychiatric nurse service (comprising four experienced community psychiatric nurses) into two busy UK A&E departments. Standardised assessments were completed for each patient, and a random sample of these independently assessed for quality. Data were also collected on the number of patients assessed, psychiatric nurse time employed, waiting times, onward referrals, repeat attendances, patient satisfaction, and staff views.

Results

A&E staff referred about a third of patients judged to have mental health problems to the psychiatric nurse service; approximately half of those assessed had a psychiatric history. On average, assessments took 60 min and over 90% of the formulated management plans were judged appropriate by independent assessors. The psychiatric nurse intervention had little impact on waiting times or satisfaction levels for mental health patients, although there was evidence of a change in onward referral patterns.

Comment

Psychiatric nurse assessment services have been introduced in many A&E departments, although the evidence base for the effectiveness of this development is not well established. This study presents evidence that psychiatric nurses can provide an accurate assessment and referral service with advantages for patient care.     

Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study

The aim of this case study was to describe and analyse the basic pre-conditions for an intervention programme focusing upon mental health promotion and prevention of depression in an elderly community group and to discuss the psychiatric nurse's community-oriented health promotion work. The intervention programme, which was led by a psychiatric nurse, was built on intersectorial co-operation between public and voluntary organizations, development of social networks to promote social support, and target group participation. The nurse's function in the community-oriented work was to act at the individual, group and society level, as well as to mobilize resources among individuals and organizations, in order to create a favourable interaction, resulting in health and empowerment for the individual. Pre-conditions for leading this work were: knowledge of health and mental all health among the elderly, investigation methodology, knowledge about the local society, as well as pedagogical, supervisory and social competence.     

Quality and substance of educational strategies for mental health in undergraduate nursing curricula

In Australia, there is a workforce shortage of nurses in the mental health sector, and it is essential that universities play a part in the recruitment of nurses to work in this area. In this article, we present a literature review of educational strategies for mental health in undergraduate nursing curricula and how these align with the recommendations of the Mental Health Nurse Education Task Force. We reviewed quantitative and qualitative research from 2005 to 2012. Twelve studies from Australia and elsewhere of different types of educational courses and strategies were included for this review. The key topics identified were in relation to a general overview of programmes outlining the content and outcomes, clinical placement strategies, involvement of consumers and mental health nurses in curriculum delivery and oversight, e‐learning strategies, and implementation of mental health majors. Finally, limitations with considering the literature as a whole were highlighted, and recommendations made for future changes and research.     

临床实习护生应对方式与心理健康调查

[目的 ]了解不同层次实习护生在临床实习期间的应对方式与心理健康状况。 [方法 ]采用肖计划等编译的应付方式问卷和SCL -90症状自评量表对泸州医学院护理系、卫生学校本科、专科、中专共 2 61名实习护生进行测评。 [结果 ]不同层次的实习护生应付方式无明显差异 ,多采用成熟型的应付方式。使用成熟型应付方式的护生心理健康水平相对较高 ,使用不成熟型应付方式的护生心理健康水平较低。 [结论 ]使用不同类型应付方式的护生心理健康水平存在统计学意义。护理教育工作者应加强对护生应付方式的指导 ,预防心理疾患 ,保持心理健康。