The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment

This study investigated changes in the ‘atmosphere’ of an acute adult mental health setting following relocation to a new purpose‐built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital‐based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose‐built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less ‘staff control’ in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer ‘involvement’ in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the ‘atmosphere’ of a health facility, for both staff and consumers.     

Tough Transitions: Mental Health Care Professionals' Perception of the Psychiatric Hospital to School Transition

Psychiatric reasons are among the most common causes of hospitalization for adolescents. A Consensual Qualitative Research approach was used to explore mental health professionals' perceptions of the needs of adolescents as they transition from psychiatric hospital to school. Academic, social, and emotional domains emerged as important areas of attention prior to and during the psychiatric hospital to school transition. Implications from interviews with 14 mental health professionals working in inpatient, outpatient, and school settings are reported.     

Re-Arrest Among Juvenile Justice-Involved Youth: An Examination of the Static and Dynamic Risk Factors

The purpose of this study is to investigate the static and dynamic risk factors for re-arrest among detained youth by examining gender, race/ethnicity, age, special education, and mental health variables (i.e., anger/irritability, depression/anxiety, somatic complaints, suicide ideation, thought disturbances, and traumatic experiences). The demographic profiles of detained youth with one admit were also compared with those with multiple admits to the juvenile detention center. With regard to static risk factors, older, White, and special education were significantly at risk of re-arrest. Concerning dynamic risk factors, only anger/irritability predicted re-arrest. Practice implications are also discussed.     

The developing role of transition to practice programs for newly graduated mental health nurses

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.     

Users' attitudes towards home and hospital treatment: a comparative study between South Asian and white residents of the British Isles

This study examines attitudes, of adult users of mental health services, towards hospital and home treatment in a crisis or emergency. A comparison was made between South Asian clients (n = 35) and white residents of the British Isles (n = 26) with a diagnosis of schizophrenia as defined by the International Classification of Diseases (ICD 10). The aim was to broaden the knowledge base of the psychiatric service providers in an under-researched area. Data were collected using a structured 15-item questionnaire, measured on a five-point Likert scale. Although both groups of respondents expressed preference for home treatment, the reasons stated differed. There were statistical differences (P = 0.05) in five of the 15 items, including diet, stigma, treatment concordance, religious practices and faith healing, which form the bulk of the discussion. Greater client satisfaction is conditional upon a quality of care responsive to individual needs. These needs may vary according to ethnicity, religious beliefs, diet, language and family life, among other factors. As the cultural constitution of Britain continues to alter, it is increasingly important that healthcare professionals are sensitive, knowledgeable and skilled in caring for such a culturally diverse population. In turn, this may avoid stereotyping or mislabelling.     

Predicting Residential Treatment Outcomes for Emotionally and Behaviorally Disordered Youth: The Role of Pretreatment Factors

This study examined outcomes with 170 children and youth admitted to residential treatment with complex mental health problems. Overall, outcomes at 2 years post-treatment was predicted by children and youth's behavioral pretreatment status reflected in lower internalizing and externalizing behavior at admission. These findings recognize a cluster of variables upon admission that are differentially predictive of specific outcomes. Higher school participation/achievement and an absence of witnessing interparental abuse predicted educational status. Family status was predicted at admission by higher family functioning, being younger in the family, and children and youth who had poor community behavior. The results are discussed as they relate to pretreatment screening and the need to evaluate service outcomes.     

Rebuilding the foundations: Major renovations to the mental health component of an undergraduate nursing curriculum

Concerns relating to the adequacy of nurses' preparation for the care of people with mental illness prompted significant revision of the mental health component in a Bachelor of Health Science nursing programme in New Zealand that prepares approximately 200 students per year. Working collaboratively with clinical providers, university staff developed and introduced three courses (equivalent to 450 hours of learning) specifically focused on mental health science, inpatient practice, and primary community mental health practice. This paper provides an overview of the new courses and reports the findings of an appreciative inquiry evaluation of this curriculum innovation.     

Role transition from student nurse to staff nurse: Facilitating the transition period

BackgroundUndergraduate nursing programmes are designed to equip student nurses with the skills and knowledge necessary for their future work as professional nurses. Influences on the role during the transition period from student to staff nurse are unclear.PurposeThis paper explores the experience of role transition for newly-qualified nurses from an Irish perspective.MethodsA Heideggerian Hermeneutic approach was the research method adopted. Ten newly qualified nurses from one of Dublin's Academic Teaching Hospitals were interviewed. Data were analysed using Van Manen's thematic analysis. Influences on the transition period were explored in the context of Chick and Meleis's Transition Concept.FindingsNewly-qualified nurses initially felt excited upon qualification. However, professional responsibility and accountability associated with the new role were overwhelming for participants. They felt frustrated when they didn't receive adequate support during transition.ConclusionNewly-qualified nurses need support while they incorporate their knowledge into clinical practice. Hidden influences should as education levels and scope of practice should be considered before nurse educators begin to develop education programmes for undergraduate nurses.     

Preparing master‐level mental health nurses to work within a wellness paradigm: Findings from the eMenthe project

Mental health promotion remains an important component of mental health nursing practice. Supporting wellness at both the individual and societal levels has been identified as one of the key tenets of mental health promotion. However, the prevailing biomedical paradigm of mental health education and practice has meant that many nurses have not been equipped to incorporate a wellness perspective into their mental health practice. In the present study, we report on an exploratory study which details the knowledge, skills, and attitudes required by master‐level mental health nurses to practice within a wellness paradigm from the perspective of three groups of key stakeholders: (i) service users and family members (n = 23); (ii) experienced mental health nurses (n = 49); and (iii) master‐level mental health nursing students (n = 37). The findings, which were reported from individual and focus group interviews across five European countries, suggested a need to reorientate mental health nursing education to include a focus on wellness and resilience to equip mental health nurses with the skills to work within a strengths‐based, rather than a deficits‐based, model of mental health practice. Key challenges to working within a wellness paradigm were identified as the prevailing dominance of the biomedical model of cause and treatment of mental health problems, which focusses on symptoms, rather than the holistic functioning of the individual, and positions the person as passive in the nurse–service user relationship.     

The effectiveness of adhering to clinical‐practice guidelines for anxiety disorders in secondary mental health care: the results of a cohort study in the Netherlands

Background While studies into the implementation of clinical practice guidelines for mental health care are scarce, studies on the effectiveness of implementing practice guidelines for anxiety disorders appear to be entirely non‐existent. Objective To examine whether adherence to anxiety disorder clinical practice guidelines in secondary mental health care yields superior treatment results than non‐adherence. Method A closed‐cohort study of 181 outpatients with an anxiety disorder or hypochondriasis who were treated in a routine mental health setting. Preceding the inclusion of these 181 patients, a start was made on the implementation of the Dutch national multidisciplinary practice guidelines for anxiety disorders. Patients were asked to complete several questionnaires before the start of treatment and again 1 year later. The medical records of these patients were reviewed to assess guideline adherence. Ultimately, adherence or non‐adherence to the different treatment algorithms described in the guidelines was related to changes in the severity of psychiatric symptomatology, psychiatric functioning, general well‐being and satisfaction with treatment. Results Compared with patients whose treatment did not adhere to the guidelines, those whose treatment adhered to the guidelines were found to have greater symptom reduction after 1 year (P < 0.01). The latter group of patients also rated their satisfaction with their treatment significantly higher (P = 0.01). No significant differences were found after 1 year with respect to changes in impairment of functioning and quality of life in the two groups of patients. Conclusions Adherence to anxiety disorder guidelines yields superior treatment results and increased patient satisfaction with treatment when compared with patients whose treatment did not adhere to the clinical guidelines. These results should encourage a more widespread implementation of such guidelines in mental health care facilities.     

Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit

Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20‐item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery‐oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.