Emergency department care for patients with mental health problems,a longitudinal registry study and a before and after intervention study

ObjectiveTo describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow.MethodsA longitudinal design was used to assess number of MH presentations and LOS during a 3-year period (2014–2016). In 2017, we introduced a PIT during ED peak hours, to reduce LOS for patients with MH problems. We evaluate the effects of the PIT on patients’ LOS with an 18-month before and after intervention study (2017–2018).ResultsTotal number of ED presentations increased with 4%. Total number of MH presentations increased with 23% from 2014 to 2016. LOS increased by 28 min (95 min vs. 123 min) for all presentations, while not changing for MH presentations (2014: 195 min, interquartile range (IQR) 120–293 and 2016: 190 min, IQR 116–296). In the before and after intervention study, number of MH presentations increased with 36% while LOS decreased with 46 min (p < 0.001).ConclusionsThe number of MH presentations increased over the three years while LOS remained similar. In the before and after intervention study, number of presentations increased even more while LOS decreased significantly. Specialist psychiatric input reduces ED LOS.     

某医院急救中心7年间自杀未遂者特征分析

目的 了解自杀未遂者的一般特征,如年龄、性别、自杀方式、时间分布及其他相关特征,以更好的理解自杀现象,为制定自杀预防策略提供借鉴.方法 采用回顾性调查方法,从某综合医院急救中心2002年至2008年的抢救记录中按序贯抽样方法抽取自杀未遂者907例,其中有效样本895例.结果 在895例自杀未遂中,男性191例,女性704例,男女之比为1∶3.69;15～34岁是自杀的高发年龄段,24岁为自杀未遂人数的最高值,47岁后自杀未遂人数明显下降;自杀方式以口服毒物为主;7年间,急救中心抢救成功的自杀患者经历了先减少后增加的过程;春(3-5月份)、夏(6-8月份)两季是自杀高发的季节,秋(9-11月份)、冬(12 -2月份)两季相对较低.结论 自杀行为与年龄、性别、季节有一定关系,预防工作应该有针对性地进行;加强对药品和农药的管理;医院急救中心应该加强对自杀未遂患者的心理干预和治疗.     

消化内科护士住院患者自杀预防系统化培训措施与成效

目的探讨预防消化内科住院患者自杀的培训方法。方法设计了"教学做合一"的系统化培训方法。做中教:培训者为主导者,以自杀风险管理的实际工作过程确定培训内容和方法,将培训计划与工作任务合一;做中学:以学习者为中心,在工作中实践自杀预防管理知识和技能,做到知行合一;做中评:根据"做"的内涵决定评价方式的多样性。结果经过1年的培训后,护士对自杀风险管理综合能力得分、消化内科自杀风险管理质量达标率、患者对护理工作满意度均较培训前显著提高(P0.01);医生对护理工作满意度较培训前提高(P0.05);患者自杀率从2.14‰下降到0.93‰。结论自杀预防系统化培训能提高护士的自杀风险管理能力和科室的风险管理质量以及患者和医生对护理工作的满意度,有效预防患者自杀。     

A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management

Background

Hospital-acquired pressure injuries are a quality indicator in healthcare, including nursing care. Successful implementation of interventions to prevent pressure injuries can be impeded by factors beyond the control of nursing staff. Limited research exists on nurses’ experiences of providing pressure injury prevention and management in a hospital setting.

Views and experiences of mental health nurses working with undergraduate assistants in nursing in an acute mental health setting

Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.     

Exposure to bullying behaviors as a predictor of mental health problems among Norwegian nurses: Results from the prospective SUSSH-survey

Background

The relationship between workplace bullying and mental health problems are well documented in previous cross-sectional studies, but knowledge on how this relationship develops over time is still scarce.

Objectives

The aim of this study was to explore the prospective relationship between exposure to bullying behaviors at baseline, and increased symptoms of mental health problems (anxiety, depression, fatigue) one year later. Furthermore, the reverse relationship was investigated.

Design

This is a prospective longitudinal study, where members of the Norwegian Nurses Organization answered identical questions regarding workplace bullying and mental health problems, at baseline (2008–2009) and follow-up (2010).

Participants

Altogether, 1582 nurses completed both questionnaires.

Results

Hierarchical regression analyses indicated that exposure to bullying behaviors at baseline predicted subsequent increased symptoms of anxiety and fatigue, after adjusting for baseline symptoms of anxiety and fatigue respectively, age, gender, night work and job demands. Moreover, symptoms of anxiety, depression and fatigue at baseline predicted increased exposure to bullying behaviors one year later, after adjusting for exposure to bullying behaviors at baseline, age, gender, night work and job demands.

Conclusion

In this study we find support for a reciprocal relationship between exposure to bullying behaviors and symptoms of anxiety and fatigue, respectively. Thus, the results may indicate a vicious circle where workplace bullying and mental health problems mutually affect each other negatively.     

Nurses' attitudes towards suicidal behaviour – a comparative study of community mental health nurses and nurses working in an accidents and emergency department

The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was desined using statements from Domino's 'Suicide Opinion Questionnaire'(SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of: acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t-test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area in nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.     

Violence in mental health care: the experiences of mental health nurses and psychiatrists

Violence against mental health service personnel is a serious workplace problem and one that appears to be increasing. This study aimed to ascertain the extent and nature of violence against mental health nurses and psychiatrists, and to identify what support, if any, they received following exposure to violence. Mental health staff working within five West Midlands Trusts in the United Kingdom were surveyed using a postal questionnaire to investigate the extent and nature of violence they encountered in their daily work. There was an overall response rate of 47%, which included a response rate for psychiatrists of 60% (n=74) and for mental health nurses of 45% (n=301). Though both groups experienced violence at work, nurses were found: to have been exposed to violence significantly more during their career; to have been a victim of violence within the previous 12 months of the survey; and to have suffered a violent incident involving physical contact. Whilst a higher proportion of nurses than psychiatrists received some support following a violent incident, a large proportion of both groups did not receive any, although most felt in need of it. The implications of this study for training and management are discussed.     

Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems

BACKGROUND: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration. OBJECTIVES: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms. DESIGN: A qualitative grounded theory approach guided the study in data collection and analysis. SETTINGS: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals. PARTICIPANTS: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages. METHODS: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons. RESULTS: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness. CONCLUSION: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.     

急诊科护士工作压力和心理健康状况的调查研究

目的了解急诊科护士工作压力、心理健康状况以及二者相互关系,为实施有针对性的护理干预措施提供依据。方法对梅州市4所医院共88名急诊科护士进行问卷调查,并对结果进行分析。结果急诊科护士压力源主要表现在工作量、工作时间和护理专业方面。护士的压力与心理健康水平成一定的正相关性。结论急诊科护士压力源主要来自专业及工作方面、工作量及时间分配、工作环境及资源、病人护理、管理及人际关系;SCL-90得分低于全国常模;压力源可对护士心理健康产生相应的影响。     

急诊科护士睡眠质量和心理健康状况的调查及分析

目的:调查分析急诊科护士的睡眠质量和心理健康状况.方法:采用匹兹堡睡眠质量指数量表(PSQI)和症状自评量表(SCL-90),对本市两所三级甲等医院68名急诊科护士和70名普通内科护士的睡眠质量和心理健康状况进行调查.结果:急诊科护士匹兹堡睡眠质量指数量表总分和各因子得分均高于普通内科护士,差异有显著性(P＜0.05,P＜0.01).症状自评量表中除敌对、偏执因子外,其余因子分及总分均高于普通内科护士,有显著性差异(P＜0.01).急诊科护士除睡眠时间这个成分外,其余匹兹堡睡眠质量指数量表各成分与症状自评量表各因子及总分间呈正相关关系.结论:急诊科护士睡眠质量和心理健康水平值得关注,需采取多种措施改善急诊科护士的睡眠质量和提高其心理健康水平,以保证护理安全和质量.     

Predictors of self-assessed physical and mental health of Icelandic nurses: results from a national survey

Background

Recent health care organizational changes have been associated with stress and musculoskeletal disorders in nurses. However, studies are lacking on what factors are the most important predictors of poor self-assessed health among nurses.

Objectives

To describe and identify the self-assessed predictors of physical and mental health of nurses.

Participants and design

A cross-sectional design was used with a sample of 394 nurses, drawn from the registry of the Icelandic Nurses’ Association, representing 17% of the workforce of Icelandic nurses.

Methods

Data were collected with a self-administered questionnaire, addressing symptoms, illness and treatment, lifestyle and sleep, work and working environment, family and quality of family life. Data were analysed according to nurses’ assessment of their physical and mental health (very good/good; poor/very poor) by use of analysis of variance, chi-square and stepwise multiple linear regression.

Results

21.7% of participants assessed their physical health as poor or very poor and 14.3% assessed their mental health as such. Those who assess their physical or mental health poor/very poor, as compared to the others, reported more symptoms in general, less regular exercise, as well as more use of medication, more visits to physicians, trouble with sleeping, conflicts between work and family life, work absence, and they experience their work as more strenuous. Experiencing symptoms is an important predictor of both physical and mental health of nurses.

Conclusion

Various factors, including work-, family- and socio-cultural environment, play a role in how nurses assesses their health. During our present time of nurse shortage it is imperative that the authorities take special measures in order to improve the work environment of nurses.     

综合医院接诊的自杀未遂者有无自杀意念特征比较

目的获得城市综合医院急诊室自杀未遂者自杀意念特征,为预防其再次发生自杀行为提供参考。方法以在沈阳市4所三级综合医院急诊室同一时段内接诊的自杀未遂患者为调查对象,使用自伤情况问卷、贝克自杀意念量表和美国精神障碍与统计手册第4版病人版(DSM-Ⅳ)轴Ⅰ障碍临床定式检查为调查和诊断工具,并比较分析调查资料完整的239例自杀未遂者有无自杀意念特征。结果 (1)两组在年龄、受教育年限等方面差异无统计学意义(均P>0.05);(2)与从无自杀意念组相比,有过自杀意念组有宗教信仰者多(11.45%vs.1.37%,P<0.01),近一个月曾因心理问题而难以从事日常活动或工作者多(57.23%vs.19.18%,P<0.01),本次最早出现伤害自己的想法到自伤所间隔时间超过2h的多(71.69%vs.27.40%,P<0.01),这次自伤最主要的目的是解脱痛苦者多(65.06%vs.26.03%,P<0.01),自杀当时想死程度超过80%者多(61.45%vs.13.70%,P<0.01),对这次自杀认真者多(72.29%vs.23.29%,P<0.01),后悔这次自杀失败者多(17.47%vs.9.59%,P<0.05),...     

护士工作压力源与心理健康状况的调查分析与对策

目的了解护士的工作压力源与心理健康状况,分析护士的工作压力与心理健康状况之间相关性。方法采用一般健康问卷(goldberg’s 12-itemgeneral health questionnaire,GHQ-12)及护士工作压力源量表,对190名护士的心理健康状况与工作压力源进行调查,并对两者之间的关系进行相关分析。结果护士心理健康状况不佳检出率为42.1%,其中抑郁、精神紧张、焦虑而失眠者发生率较高,分别为64.2%、56.8%和55.8%。临床护士工作压力源从高到低依次为工作环境及资源方面的问题、工作量及时间分配问题、护士专业及工作方面的问题、病人护理方面的问题、管理及人际关系方面的问题。Pearson相关分析表明,护士工作压力与心理健康状况关系密切。结论护士的心理健康状况不容忽视,应加强护士的心理健康保健,改善工作环境,提高福利,从工作量及工作时间分配方面减少护士工作压力,促进其身心健康。     

Perceptions of mental health nurses and patients about health promotion in mental health care: a literature review

The aim of this review was to examine the perceptions of patients with mental disorders and mental health nurses of health promotion targeting physical activity and eating habits in mental health care. An electronic search strategy was conducted. Furthermore, references were searched by hand-searching the reference lists of the retrieved articles from the electronic databases. The literature on perceptions of health promotion and lifestyle interventions in mental health care principally consist of qualitative studies using interviews and focus groups. Positive perceptions of both mental health nurses and patients towards health promotion targeting physical activity and eating habits in mental health care were identified. Contrary, several barriers for integrating healthy lifestyles into the daily life of patients were described. Patients usually want to learn more about healthy lifestyles, but see the ability to change their physical health as beyond their control. In this sense, support from mental health nurses is considered as important. Despite the awareness of the importance of health promotion in mental health care, it appears that visions and attitudes towards the potential of health promotion are in need of change.     

Mental health nurse supplementary prescribing: experiences of mental health nurses, psychiatrists and patients

AIM: This paper is a report of a study to explore the views of patients, mental health nurses and psychiatrists involved in mental health nurse supplementary prescribing. BACKGROUND: Medication prescribing by mental health nurses in the United Kingdom is controversial. However, the experience of mental health patients suggests that increasing prescribing capacity could be one strategy to provide a person-centred prescribing approach. METHOD: A qualitative study was carried out in 2005. Semi-structured interviews were conducted with 12 psychiatrists, 11 mental health nurses with prescribing authority, and 12 patients who had been prescribed psychiatric medication by a mental health nurse. Participants were interviewed about positive aspects of supplementary prescribing including the extent of it being evidence-based, person-centred and clinically focussed. FINDINGS: Participants from all three groups had a positive reaction to nurse supplementary prescribing. Mental health nurse prescribing was viewed as evidence-based, person-centred and with an additional focus on physical health. Mental health nurses worked within their levels of competency. Barriers to the implementation of mental health nurse prescribing were nurses' lack of prescribing experience, shortfalls in supervision, insufficient focus on redesigning the service to support the role of the mental health nurse, and preparation for the role. CONCLUSION: Mental health nurse prescribing seems potentially beneficial. However, more rigorous audit and evaluation are needed to confirm its safety, patient satisfaction and health outcomes. Mental health nurse prescribing will require service redesign to ensure that is becomes embedded in the service organizational culture.     

Exploring mental health nurses' expectations and experiences of working in the community

As mental health care is increasingly being provided in community settings, a variety of job opportunities are becoming available to mental health nurses. The extent to which nurses' views and experiences of working in community settings have been explored, however, is limited. This paper reports on newly qualified nurses' plans in relation to taking up work in the community and, for those who thought it likely that they would take up such work, their reasons for doing so. Reasons for working in the community were diverse, and suggested that a range of satisfactions could be expected. The extent to which such expectations become a reality is considered in the light of findings from interviews with 12 nurses who were working in community settings. Satisfactions and difficulties experienced by the 12 nurses are described, and suggestions for tackling some of the difficulties are made.