Nursing interventions for adults following a mental health crisis: A systematic review guided by trauma‐informed principles

There exists a growing need for health and service providers to respond to persons in a manner that recognizes the prevalence and impact of trauma in individuals and prevent inadvertent re‐traumatization in the routine process of care. The experience of mental health crisis in of itself can have traumatic and impactful effects on individuals. Trauma‐informed approaches to care offer a framework to provide crisis intervention responses that are based on the acknowledgement of the prevalence and impact of trauma and define trauma not by the event per se, but by the impact of an experience of trauma. The integration of trauma‐informed principles in the context of crisis intervention is a current practice gap. In order to inform a portion of a best‐practice guideline for registered nurses and the interprofessional team, a systematic literature review was conducted to primarily identify nursing interventions within four weeks of a mental health crisis, with a secondary focus on identifying particular interventions that included trauma‐informed principles. The systematic review yielded 21 quantitative and qualitative studies related to nursing interventions for mental health crisis, 10 of which referred to one or more principles of trauma‐informed approaches. There was a lack of studies on nursing interventions explicitly linked to implementation of trauma‐informed principles, highlighting future research needs and focused efforts to integrate trauma‐informed principles into crisis intervention practices.     

Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health‐care systems

There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health‐care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health‐care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health‐care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self‐preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self‐preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well‐being.     

Thinking differently: Re‐framing family violence responsiveness in the mental health and addictions health care context

Aotearoa New Zealand’s high rates of intimate partner violence (IPV) and child abuse and neglect point to a clear need to develop and resource equitable mental health and addiction practices that are responsive both to people experiencing and using violence, and to their families. Current responses to IPV in mental health and addiction settings in Aotearoa New Zealand require a critical re‐framing, from an individualistic autonomy and empowerment framework that constrains practitioners’ practice, to an understanding IPV as a form of social entrapment. Using a composite story constructed from 28 in‐depth New Zealand family violence death reviews, we highlight current problematic practice and discuss alternative responses that could create safer lives for people and families. Re‐framing IPV as a form of social entrapment acknowledges it as a complex social problem that requires collective steps to secure people’s safety and well‐being. Importantly, a social entrapment framework encompasses interpersonal and structural forms of violence, such as the historical and intergenerational trauma of colonization and links to ongoing structural inequities for Māori (the indigenous people of Aotearoa) in Aotearoa New Zealand.     

Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

Purpose: Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

Method: Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n?=?14), and focus groups with healthcare professionals (n?=?16).

Results: Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

Conclusions: The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found.

• Implications for Rehabilitation

• The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation.

• Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence.

• Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

     

Effectiveness of 1‐day trauma‐informed care training programme on attitudes in psychiatric hospitals: A pre–post study

Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma‐informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow‐up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre–post design with 3‐month follow‐up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1‐day programme consisting of a 3.5‐hour lecture and 1‐hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma‐Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma‐Informed Care scale scores increased significantly from 5.1 during pre‐training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3–0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2–0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3‐month follow‐up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.     

Smoking‐related violence in a mental health setting following the implementation of a comprehensive smoke‐free policy: A content analysis of incident reports

Smoke‐free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking‐related incidents of physical violence over a two‐year period, (12 months when an indoor‐only smoke‐free policy was in place, followed by 12 months after a new comprehensive smoke‐free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty‐one smoking‐related incidents occurred during the indoor‐only smoke‐free policy period; 32 smoking‐related incidents occurred during the comprehensive smoke‐free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient breach of the smoke‐free policy iv) asking for, trading or stealing smoking materials. The antecedent pattern changed across the two policy periods, with fewer incidents of denying a patient's request to smoke and a greater number of incidents involving staff responding to breaches occurring after the introduction of the comprehensive smoke‐free policy. The prohibition of smoking breaks removed this source of violence. Timeout and PRN medication were the most common containment interventions. Understanding the context of smoking‐related violence may inform clinical guidelines about its prevention and management.     

A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision

Aim. This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients. Background. Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services. Methods. A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in‐depth semi‐structured interviews were the instruments used to collect data. Findings. Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service‐related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities. Conclusion. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi‐professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals. Relevance to clinical practice. The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.     

In safe hands: a qualitative study on older adults’ experiences of a tailored primary health care unit

Objective: Today’s health care system faces challenges in meeting the needs of older people with multimorbidity. To better cope with these needs, tailored primary health care with geriatric competence and person-centred care has been suggested. The aim of this study was to explore older patients’ experiences of a tailored primary health care unit.Design: This was a qualitative study using semi-structured individual interviews and qualitative content analysis.Setting and patients: Nineteen patients were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden.Methods: The interview data were analysed using inductive category development.Results: In the analysis, the theme In safe hands when in need of primary health care emerged. The interviewees expressed a desire to participate in their own care. Easy access, enough consultation time and a calm environment, along with the PHC professionals’ welcoming and attentive approach enhanced their feeling of being in safe hands. PHC professionals were perceived as having geriatric knowledge and taking responsibility for the care of older patients. Although the interviewees experienced that they received attention for their health conditions, a need for a more preventive approach to care emerged.Conclusion: Older patients highly appreciated their tailored PHC unit and they emphasised that it was an improvement compared to the ordinary PHC centre. This study provides insights into older patients’ experiences, which may be helpful in the ongoing process of improving care for older patients in PHC.

KEY POINTS

• Older patients attending a tailored Primary health care (PHC) unit felt acknowledged, unlike in the ordinary PHC centre, which facilitated their participation in their care.
• The calm environment, specialist geriatric competence and ample patient contact time enabled them to feel secure and taken care of.
• Older patients expressed a need for an incorporation of social services and health promotion visits at the tailored PHC unit.