Advocacy in mental health nursing: an integrative review of the literature

The term 'advocacy' has taken on a meaning beyond its legal origins and is now of importance as a concept in health and social care. Within nursing, the role of advocate has been accepted as an important one, although there are arguments against nurses taking on such a role. The majority of papers on this topic relate to nursing generically rather than being specifically mental health oriented. Nurses need to be made aware of the legal framework within which they practice, in terms of duty of care within their role of nurse advocate, maintaining standards of advocacy acceptable to their professional body, accountability relating to action and omission of actions, guidance on guarding against stepping beyond the boundaries of their professional practice of advocacy, and to have adequate knowledge of the law. This paper offers a critique of nursing advocacy models, raising a number of mental health nursing issues and identifying some areas for further research.     

Perspectives of mindfulness

The idea and practice of mindfulness has a long history in some of the world's religions and is also articulated in a number of secular discourses. The therapeutic potential of mindfulness is now being recognized and is being researched in a diverse range of healthcare settings including mental health. Being mindful presupposes that individuals whose awareness is not impaired do have a choice in what phenomena they attend to and how they act. For the psychiatric nurse, understanding the idea and practice of mindfulness is useful for developing both trans-cultural awareness and to recognize that personal inattention could compromise care. In terms of mental health promotion, mindfulness is worthy of consideration as an important life skill. This paper explores the notion of mindfulness from a number of perspectives. The paper does not claim to have explored all the options. The Buddhist understanding of mindfulness provides the perspective for continuity within the paper and is used to illuminate any similarities and differences with the secular discourses being considered.     

Mental health education programmes for generalist health professionals: An integrative review

Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. The lack of adequate mental health educational preparation of general health professionals (GHP) has been identified as a major barrier to meeting the health-care needs of mental health patients. This study aimed to review and synthesize research evidence on mental health education programmes (MHEP) that have been designed to develop the knowledge, skills, and attitudes of GHP. An integrative literature review was conducted following a search of key electronic databases and hand searching of references of relevant papers, and 25 papers met the study inclusion criteria. Knowledge, skill, and attitudinal improvements in GHP post MHEP were shown in most studies. MHEP that included supervised clinical experience, role play, and case scenarios were reported as being more effective. Issues such as patient participation in education, interprofessional education models, and the willingness, interest and, motivation for GHP to be involved in MHEP warrant further research.     

Participative mental health consumer research for improving physical health care: An integrative review

People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co‐investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness.     

Case report: The use of medical yoga for adolescent mental health

Mental health issues are epidemic among youth in the United States today. Recent studies suggest that up to 50% of all teenagers have complaints related to stress, anxiety, and/or depression. This problem is accompanied by an unprecedented rise in the rates of child and teen suicide in the United States. In response to this epidemic, the American Academy of Pediatrics is recommending universal depression screening for all teens. Medications are available to ameliorate mental health disorders, and many can be safely used in the primary care setting. However, many of these medications have unwanted side effects or may not be familiar to the primary care physician. For these reasons and others, primary care physicians require additional approaches to respond to the challenges imposed by a growing number of patients requiring mental health support. Medical Yoga Therapy, prescribed by a physician with special yoga therapy training, offers a safe and effective way to serve the patient with physical or mental challenges disabilities. Medical Yoga therapy is an individualized and personal approach to the patient, and it may be integrated with any current therapy or medical regimen. Here, evidence for medical yoga is reviewed in the context of an adolescent patient with a common disorder. Yoga practices, with particular focus on mindfulness, offer a safe and effective intervention for a growing number of pediatric patients.     

Mothers with mental health problems: a systematic review

Mothers with mental health problems meet challenges in coping with their condition, the responsibility of child rearing, and fulfilling their role as a mother. The aim of this study was to create a synthesis of the previous research on mothers with mental health problems and the challenges they face. A systematic literature search of international databases was undertaken, covering the period between January 1998 and April 2009. Nineteen articles met the inclusion criteria. The analysis process involved skimming, comprehending, analyzing, and synthesizing. Three themes emerged: the vulnerability of mothers with mental health problems, the fear of being perceived as not good enough as a mother, and concern that the children might develop mental health problems. In conclusion, the focus of the research field is shifting from viewing the mother's mental health problems from an individualistic perspective to considering them in a broader context of relational, economic, and environmental factors and on the basis of the mother-child relationship being characterized by interdependence.     

Resilience and mental health nursing: An integrative review of updated evidence

Mental health nursing work is challenging, and workplace stress can have negative impacts on nurses' well-being and practice. Resilience is a dynamic process of positive adaptation and recovery from adversity. The aims of this integrative review were to examine and update understandings and perspectives on resilience in mental health nursing research, and to explore and synthesize the state of empirical knowledge on mental health nurse resilience. This is an update of evidence from a previous review published in 2019. Using integrative review methodology, 15 articles were identified from a systematic search (July 2018–June 2022). Data were extracted, analysed with constant comparison method, synthesized narratively and then compared with the findings from the original review. As an update of evidence, mental health nurse resilience was moderate to high across studies, was positively associated with psychological well-being, post-traumatic growth, compassion satisfaction and negatively associated with burnout, mental distress and emotional labour. Lack of support and resources from organizations could negatively impact nurses' ability to maintain resilience and manage workplace challenges through internal self-regulatory processes. A resilience programme improved mental health nurses' awareness of personal resilience levels, self-confidence, capacity to develop coping skills and professional relationships. Some studies continue to lack contemporary conceptualizations of resilience, and methodological quality varied from high to low. Further qualitative and interventional research is needed to investigate the role of resilience in mental health nursing practice, personal well-being, workforce sustainability and the ongoing impacts of the COVID-19 pandemic.     

Effects of yoga on physical and psychological health among community-dwelling older adults: A systematic review and meta-analysis

Objectives

To synthesise and critically appraise the quality of existing evidence about the effects of yoga on physical and psychological outcomes among older adults.

Design

A systematic review and meta-analysis.

Participants

Participants aged 60 and above.

Measurements

Nine English and two Chinese electronic bibliographic databases, including MEDLINE OvidSP, PsycINFO, AMED, EMBASE, Global Health, PubMed, Scopus, CINAHL, Cochrane Library, Hyread and WanFang databases, were searched. Randomised controlled trials (RCT) of yoga on physical and psychological outcomes among older adults were included. Meta-analysis was conducted for outcomes studied in three or more studies, otherwise narrative synthesis was performed.

Results

Fifteen studies were included for review. The results of meta-analysis after sensitivity analysis showed that yoga significantly improved balance (SMD = 0.81, 95% CI: 0.48–1.14, p < .001, II² = 59%), flexibility (SMD = 0.38, 95% CI: 0.07–0.68, p = .020, II² 34%), muscle strength (SMD = 0.49, 95% CI: 0.18–0.79, p = .002, I² 43%) and depressive symptoms (SMD = 0.50, 95% CI = 0.09–0.91, p = .01, I² 0%). There was insufficient data for meta-analysis on gait and other psychological outcomes. Narrative synthesis suggested that yoga has positive effects on reducing anxiety, but its effects on improving gait and reducing stress among older adults were inconclusive.

Conclusion

The results of this review supported the beneficial effects of yoga on physical outcomes among older adults, but the heterogeneity across studies was relatively high. Evidence related to the effect on psychological outcomes was limited.     

Enhancing oral health for better mental health: Exploring the views of mental health professionals

The association between oral health, self‐esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants’ ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes.     

Resilience and mental health nursing: An integrative review of international literature

Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses’ resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person–environment process. Resilience was most often reported as low‐moderate, with positive correlations with hardiness, self‐esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses’ coping self‐efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience‐building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.     

Emotional labour in mental health nursing: An integrative systematic review

Emotional labour is the effort consumed by suppressing one's own emotions to care for others effectively while also caring for oneself. Mental health nurses are required to engage in effective therapeutic interactions in emotionally‐intense situations. The aim of the present integrative systematic review was to investigate the emotional labour of mental health work and how this manifested, the impacts, and the ways to mitigate these impacts. In June 2016, using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methodology, a systematic search of the bibliographic databases was undertaken to identify relevant literature. Screening, data extraction, and synthesis were performed by three reviewers. The inclusion criteria included any original research that investigated the emotional work of mental health nurses. We identified a total of 20 papers to be included in this review. Thematic synthesis of the findings revealed three emergent themes: emotional labour and caring, emotional exhaustion, and self‐protection (expressed as emotional intelligence). Emotional labour, emotional exhaustion, and emotional intelligence were considered to be intrinsically linked, where they were both the influencing factor for burnout and a contributor to attrition. The results highlighted that emotional labour could inspire the development and personal growth of emotional intelligence in mental health nurses. In light of these findings, recommendations for clinical practice were considered; they included supportive work environments, involving nurses in shared decision‐making, and the provision of ongoing professional development opportunities that facilitate the development of emotional intelligence and resilience.     

Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.