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.     

Supervision of the mental health lived experience workforce in Australia: A scoping review

The mental health Lived Experience workforce (also referred to as peer workforce) is growing rapidly internationally and within Australia. Peer workers are increasingly employed within multi- and inter-disciplinary teams, often directly supervised by mental health professionals such as nurses. Professional supervision has been identified as fundamental for implementing a sustainable peer workforce, but significant gaps in the literature remain, in particular, an understanding of appropriate supervision practices. This scoping review synthesized academic and grey literature on Lived Experience supervision in Australia, exploring current thoughts on best practices. Four electronic databases were searched, and grey literature was located via Google Advanced searches, contacting Lived Experience experts and conducting web-based desktop searches of key mental health organization websites. Thematic analysis identified and described key characteristics in relation to how supervision is conceptualized and operationalized. Eight peer-reviewed and 46 grey literature documents describing supervision and supervisory practices were analysed. Of these studies, 26 were Lived Experience-led. Analysis revealed four key themes: (i) defining peer supervision, (ii) variability in understanding the purpose of supervision, (iii) approaches to supervision and the need for choice and flexibility, and (iv) qualities and skills of the supervisor. Additionally, the establishment of a national professional organization for peer workers was highlighted to protect the authenticity of Lived Experience roles and develop an effective workforce. Clearly, a sustainable Lived Experience workforce cannot develop in isolation, and mental health nurses, as important allies in mental healthcare, need to work alongside, plan and advocate for appropriate supervision practices for this emerging workforce.     

Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision‐making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer‐reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

防治非自愿移民心理健康问题干预措施的系统评价

目的全面系统地回顾不同国家和地区为防治非自愿移民心理健康问题所采取的干预措施,并评价不同干预措施的效果。方法检索ISI Web of Science等10个电子数据库和3个灰色文献数据库,检索时间截止至2008年11月。同时检索相关机构网站和Google搜索引擎,以弥补数据库的遗漏。纳入描述和评价已实施的防治非自愿移民心理健康问题的干预研究。由两名研究者独立进行文献筛选、质量评价及资料提取,而后交叉核对,讨论达成一致意见。鉴于各纳入研究的干预类型、干预措施、研究设计及结局指标存在异质性,不能进行Meta分析,采用定性方法系统归纳纳入文献的信息和结果。结果最终纳入35篇文献,其中16篇描述干预措施,19篇评价干预效果。研究对象主要是战争、暴力及其它酷刑引起的难民和寻求庇护者,水库移民仅1篇。所有心理干预分为预防干预和治疗干预两类,其主要干预措施有：心理综合干预、团体疗法、认知行为疗法、证言疗法、叙事暴露疗法、支持性咨询服务、家庭支持及疗法等,其中综合干预是最常用的干预方法。评价心理干预效果的研究大部分为观察性研究,仅6个研究为对照试验,且存在较多方法学局限。绝大多数研究结果显示,已开展的心理干预对非自愿移民心理健康有积极的促进作用。结论目前针对非自愿移民开展的心理健康干预研究有限,尚缺乏设计严谨的评价性研究。应对非自愿移民心理健康干预,尤其是预防性干预开展更多研究,并开展大样本、设计严格的高质量试验,以评价适用于不同非自愿移民群体的最有效的心理干预方式。     

Nursing considerations for dual diagnosis in mental health

It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.     

Community mental health nursing: Keeping pace with care delivery?

The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.     

Emotional problems in primary care: what is the potential for increasing the role of nurses?

It has been suggested that the role of primary care and community nurses should be expanded in relation to mental health in order to assist in the prevention and management of prevalent emotional disorders such as depression and anxiety. However, relatively little is known about the mental health work presently undertaken by these nurses. Furthermore, nurses'training needs, attitudes and organizational barriers to role expansion in this area have not been systematically explored. This article seeks to review the literature on nurses' potential and current mental health work, current and future training needs, the views of patients and nurses concerning an expanded nursing role, and organizational issues of relevance. Educational interventions which have been systematically evaluated are also reviewed. The results suggest that nurses are already involved in emotional health care with a variety of patient groups, although this is not always acknowledged as mental health work. While clear potential for an expanded role exists, there is little consensus as to what role would be most effective for each nursing group, and few educational interventions have been demonstrated to be of proven effectiveness.     

What Is the Impact of Targeted Health Education for Mental Health Nurses in the Provision of Physical Health Care? An Integrated Literature Review

Individuals with a severe mental illness have a gap in life expectancy of up to 20 years in comparison to the general population. Nurses who work in mental health services have been identified as best placed to improve the physical health outcomes of individuals with mental illness. The literature identifies a lack of nursing knowledge related to physical health care and the presence of metabolic syndrome which is impeding nurses in providing essential physical health care to patients. An integrated literature review was carried out due to the dearth of research evidence pertaining to the impact of targeted education specifically with psychiatric/mental health nurses in the provision of physical healthcare. A search for literature included the following databases: CINAHL, Medline, PsycINFO, Embase and Web of Science revealed nine studies: seven quantitative, one qualitative and one mixed method. Qualitative synthesis has shed light on the value of targeted education on improving knowledge and skills in providing physical health care that can then be translated into clinical practice. Targeted education in physical healthcare grows psychiatric/mental health nurse's confidence and develops the skills necessary to enable them to screen and monitor and offer range of physical health interventions to individuals with severe mental illness.

Accessible summary ? The poor physical health outcomes and premature death of individuals with severe mental illness is of growing concern; a contributing factor is a lack of knowledge and confidence amongst psychiatric/mental health nurses to providing physical health screening and intervening in preventable diseases such as cardiovascular disease, stroke cancer, and type 2 diabetes mellitus.

? An integrated literature review was used to ascertain if targeted education on physical health care can improve the knowledge base of psychiatric/mental health nurses within physical health care.

? Nine studies were critically appraised, and the data reduced using a narrative synthesis that tells a story of the findings from these research studies.

? The review found that targeted education with psychiatric/mental health nurses does result in a statistical increase in knowledge This review finds that nurses have not been regularly supported with physical health education to alter existing practices. This lack of knowledge within physical healthcare is hindering psychiatric/mental health nurses to fully engaging in physical health care activities in practice.

     

Mental Health and Academic Achievement: Role of School Nurses

PURPOSE: This article discusses how school nurses promote mental health and subsequent academic achievement by screening and referral for children demonstrating mental health problems. Nursing interventions are discussed at the individual, systems, and community levels. CONCLUSION: Mental health problems can affect school performance and academic achievement. When mental health problems are not recognized, students may be unable to reach their academic potential. School nurses are in a key position to provide interventions to address mental health and academic achievement. PRACTICE IMPLICATIONS: The role of school nurses and examples of mental health collaborative activities are provided.     

A Pilot Study Exploring Nursing Knowledge of Depression and Suicidal Ideation in Kenya

Nurses play key roles in recognizing, diagnosing, managing, and referring persons with mental disorders. This cross-sectional study assessed mental health literacy (depression and suicidal ideation) among nurses in a private urban referral hospital in Kenya. Nurses read a vignette and answered questions regarding diagnosis, treatment/interventions, and related attitudes and beliefs. Thirty-seven nurses (12 males) completed the questionnaire. Three correctly identified the diagnosis and 23 identified depression only. Although 75% noted the symptoms were extremely distressing, fear, and stigma were common reactions. This highlights challenges in mental health promotion/prevention in Kenya, and suggests continuous nursing education and curriculum enhancement is needed.     

Community mental health nurses, caseloads, and practices: a literature review

Deinstitutionalization, and more recently, earlier discharges from psychiatric inpatient units, have created and intensified the need for case management in community mental health. Nurses have been at the forefront of providing this case management. This literature review provides a synthesis of research and policy on the contribution of mental health nurses to community case management. The focus of this review is on the proportion of case management that mental health nurses undertake, the caseloads of case managers, and the interventions that mental health nurses most frequently perform in the community. The professional compositions of mental health case management workforces have been associated with economic imperatives, professional priorities, and the choice of case management models. The influence of mental health nurses in the case management workforce is particularly strong in the U.K. and Australia, but less so in the U.S.A. where social workers and people without mental health qualifications perform similar roles. Although heavy caseloads seem to be common among case managers, the research in this area is quite weak. The interventions that mental health nurses perform most often include case management (e.g., coordinating care), counselling, and medication management. Caring for the physical health of consumers might often be overlooked.     

“I feel broken”: Chronicling burnout,mental health,and the limits of individual resilience in nursing

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of “Breaking Point,” in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.     

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.     

A systematic review of stress and stress management interventions for mental health nurses

BACKGROUND: Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained. AIM: The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies. METHOD: A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided. RESULTS: The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies. CONCLUSIONS: The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.     

Stress and burnout in forensic mental health nursing: a literature review

Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training.     

A systematic review of the effectiveness of in-home community nurse led interventions for the mental health of older persons

Aims and objectives. The aim was to systematically review evidence about the effectiveness of in‐home community nurse‐led interventions for older persons with, or at risk of, mental health disorders, to inform best practice nursing care with this focus. The primary review question was ‘How effective are in‐home community nurse‐led interventions for older persons with or at risk of mental health disorders for improving mental health?’ The outcome indices of interest were nursing actions to determine incidence or prevalence of mental health disorders, any change in a patient’s attitude towards their mental health condition, any change in objective measurement of mental health, or a change in diagnostic status. Background. The rising incidence of mental health disorders in older persons is a major concern for community nurses in developed countries. Effectively facilitating improved mental health for older persons is necessary in this era of ageing populations with increased demands on health funding. Disseminating systematically reviewed evidence for in‐home community nursing that positively impacts on the mental health of older persons is crucial to ensure effective care is provided to this vulnerable patient group. Results. This review reveals that there is evidence to support the superiority of applying validated screening tools for mental health disorders over relying on community nurses’ opinions and non‐validated tools about this matter. Design. Systematic review. Methods. Search of electronic databases. Conclusion. A clear need for replication and multi‐centre trials of reviewed pertinent studies is identified. Relevance to clinical practice. Community nurses should consider using validated screening tools for this focus. Until such time as higher quality evidence is available about other nursing interventions, the reviewers suggest that the prime nursing action should be the identification of whether older persons receiving community nursing care might have a mental health disorder and, if so, then collaborative referral is made to appropriate services.