How do expert mental health nurses make on‐the‐spot clinical decisions? A review of the literature

An increasing number of writers have studied the work of Benner (1984) and Schon (1983) and have explored the concepts of expertise and 'intuitive' or 'tacit' knowledge. Efforts have been made to address the phenomenon of the theory--practice gap. Reborn interest in the craft of the professions is evident. A number of studies about the clinical decision-making process have suggested that clinicians are actually using a form of deductive reasoning known as hypothetico-abductivism whilst reflecting in action. Exploration of expert decision-making by psychiatric nurses requires first that the nature of psychiatric expertise be clearly described. However, literature shows that this is not an easy task. In order to facilitate the development of expertise in novice practitioners, further research is required into the nature of expertise and expert decision-making. Cultivating and recording reflection in action around expert decision-making has revealed greater insights into the gap between theory and practice. It is evident that there is a need for a model that makes sense of the informal theory that is generated through practice.     

Is self‐directed mental health recovery relevant for children and young people?

Consumer‐directed, personal recovery‐oriented mental health services are now the focus of mental health policies around the globe. However, there has been minimal debate about how the approach applies to young people. This study sought to address this gap through a Delphi approach, using three rounds of surveys, to gain a convergence of opinion from Australian Child and Adolescent Mental Health Service (CAMHS) practitioners regarding the relevance of personal recovery for children and adolescents. The findings suggest that concepts of personal recovery are appropriate for a young population. However, parents and carers are integral to the mental health recovery journeys of young people, either directly as guardian/decision‐maker and/or indirectly through the impact of caring for a young person with mental health problems. Further exploration of the relevance and application of personal recovery in the context of young people is warranted, particularly from the perspectives of adolescents, younger children and carers of young people with mental health problems.     

What is a comprehensive mental health nursing assessment? A review of the literature

Assessment is the foundation on which nursing care is delivered. The aim of this paper is to better understand the content (what information nurses seek about consumers) and the process (how they go about gathering that information) of a comprehensive mental health nursing assessment in practice. Using terms, such as 'nursing', 'mental health', and 'assessment', the CINAHL, Medline, and PsycINFO databases were searched for studies that describe the content and process of a comprehensive mental health nursing assessment. Although studies of aspects of mental health nursing assessment, such as the assessment of risk or carer burden, were found, no single study described both the content and process of a comprehensive mental health nursing assessment in practice. In Australia, a comprehensive assessment is codified as a competency to practice nursing; however, the standards of practice set for mental health nurses are less clear on what constitutes a comprehensive assessment or how this should be undertaken. The peer-reviewed literature describes assessment as both an independent and interdependent activity. It is described as informal, and there is evidence that comprehensive mental health nursing assessments are not well documented. The credibility of training and research into mental health nursing requires that the content and the process of a comprehensive mental health nursing assessment needs to be clearly defined.     

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.     

Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review

Viewing mental illness as an ‘illness like any other’ and promoting biogenetic causes have been explored as a stigma‐reduction strategy. The relationship between causal beliefs and mental illness stigma has been researched extensively in the general public, but has gained less attention in more clinically‐relevant populations (i.e. people with mental illness and mental health professionals). A systematic review examining whether endorsing biogenetic causes decreases mental illness stigma in people with mental illness and mental health professionals was undertaken using the preferred reporting items for systematic reviews and meta‐analyses guidelines. Multiple databases were searched, and studies that explored the relationship between biogenetic causal beliefs and mental illness stigma in people with mental illness or mental health professionals were considered. Studies were included if they focussed on depression, schizophrenia, or mental illness in general, were in English, and had adult participants. The search identified 11 journal articles reporting on 15 studies, which were included in this review. Of these, only two provided evidence that endorsing biogenetic causes was associated with less mental illness stigma in people with mental illness or mental health professionals. The majority of studies in the present review (n = 10) found that biogenetic causal beliefs were associated with increased stigma or negative attitudes towards mental illness. The present review highlights the lack of research exploring the impacts of endorsing biogenetic causes in people with mental illness and mental health professionals. Clinical implications associated with these results are discussed, and suggestions are made for further research that examines the relationship between causal beliefs and treatment variables.     

Holism in nursing and health promotion: distinct or related perspectives? – A literature review

Scand J Caring Sci; 2011; 25; 798–805
Holism in nursing and health promotion: distinct or related perspectives? – A literature review Background: The concept of holism is central in health promotion as well as in nursing. Holism or a holistic view on health was identified as one of the key principles of the Ottawa Charter for Health Promotion and is linked to social ecology and the determinants of health. Aims: To explore how the term holism was defined and/or described in Nordic articles with a health‐promotion approach, and how holism aspects were related to nursing and health promotion, and to the other key principles of the Ottawa Charter. Methods: Abstracts were first identified by the search word ‘health promotion’ as a keyword. The search was limited to 1986–2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for this study were subsequently selected from these abstracts using the search words ‘holism’ and ‘holistic’ and analysed by quantitative and manifest qualitative content analysis. Findings: The sample included 23 articles: one theoretical, two reviews and 20 empirical studies. Sixteen articles included a hospital setting or nursing perspective. A holistic perspective could be extracted from most articles. No larger but several minor differences were identified in the way holism aspects were related to nursing and health promotion respectively. Conclusion: There is a risk that the individual patient perspective of holism in nursing may result in less chance of reaching larger groups of patients with chronic diseases and mental health problems, not least the most vulnerable ones.     

Do adult mental health services identify child abuse and neglect? A systematic review

Child abuse and neglect play a causal role in many mental health problems. Knowing whether users of mental health services were abused or neglected as children could be considered essential for developing comprehensive formulations and effective treatment plans. In the present study we report the findings of a systematic review, using independent searches of three databases designed to discover how often mental health staff find out whether their clients were abused or neglected as children. Twenty‐one relevant studies were identified. Most people who use mental health services are never asked about child abuse or neglect. The majority of cases of child abuse or neglect are not identified by mental health services. Only 28% of abuse or neglect cases identified by researchers are found in the clients’ files: emotional abuse, 44%; physical abuse, 33%; sexual abuse, 30%; emotional neglect, 17%; and physical neglect, 10%. Between 0% and 22% of mental health service users report being asked about child abuse. Men and people diagnosed with psychotic disorders are asked less than other people. Male staff ask less often than female staff. Some improvement over time was found. Policies compelling routine enquiry, training, and trauma‐informed services are required.     

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

Objectives

The purpose of this review was to determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia. The aim was to identify approaches that could be delivered within community practice to reduce burden and increase knowledge, mental health and coping.

Questions addressed

What effect did support have on carer burden and other needs? What were the key elements of effective support? What effective supports could mental health nurses deliver within practice?

Design

This review covers the international scientific literature published between 1980 and 2008.

Data sources

Searches were made of electronic databases relevant to nursing. All papers, published in English, were assessed. Hand searches of review papers and references were also carried out. Sixty-eight studies were included.

Study appraisal and synthesis

Only comparative studies providing a quantitative assessment of carer outcomes were included. Findings were synthesised in narrative format and grouped by intervention type.

Results

Of the 68 emerging studies, 12 (18%) directly included nurses in delivering the intervention and 16 (24%) included nurses as part of a multidisciplinary team. There is fairly robust evidence that education improves carer knowledge of schizophrenia. There is, however, little evidence that it addresses more substantive areas such as burden, coping or mental health. Supportive family education moves beyond information giving by developing coping. As might be expected these approaches can reduce burden. More intensive programmes such as behavioural family therapy aim to address stressful relationships which commonly occur in families of people diagnosed with schizophrenia. These programmes are particularly effective in reducing burden and can also improve mental health. Community support such as intensive outreach is also effective in reducing burden. Finally, there is some evidence that mutual support groups reduce burden and improve coping.

Conclusions

Research on effective support for carers of people diagnosed with schizophrenia is emerging. Although findings were mixed, there was some evidence supporting a range of approaches that mental health nurses could offer to carers. There is, however, still a need for pragmatic studies to determine the extent that these approaches can be delivered within nursing practice.     

Do nurses’ personal health behaviours impact on their health promotion practice? A systematic review

BackgroundThere is a growing expectation in national and international policy and from professional bodies that nurses be role models for healthy behaviours, the rationale being that there is a relationship between nurses’ personal health and the adoption of healthier behaviours by patients. This may be from patients being motivated by, and modelling, the visible healthy lifestyle of the nurse or that nurses are more willing to promote the health of their patients by offering public health or health promotion advice and referring the patient to support services.MethodsAn integrated systematic review was conducted to determine if nurses’ personal health behaviour impacted on (1) their health promotion practices, and (2) patient responses to a health promotion message. Medline, CINAHL, SCOPUS, and PsycINFO databases were searched. A narrative synthesis was conducted.Results31 studies were included in the review. No consistent associations were noted between nurses’ weight, alcohol use, or physical activity level and their health promotion practice, although smoking appeared to negatively impact on the likelihood of discussing and engaging in cessation counselling. Nurses who reported confidence and skills around health promotion practice were more likely to raise lifestyle issues with patients, irrespective of their own personal health behaviours. The two studies included in the review that examined patient responses noted that the perceived credibility of a public health message was not enhanced by being delivered by a nurse who reported adopting healthy behaviours.ConclusionsAlthough it is assumed that nurses’ personal health behaviour influences their health promotion practice, there is little evidence to support this. The assertion in health care policy that nurses should be role models for healthy behaviours assumes a causal relationship between their health behaviours and the patient response and adoption of public health messages that is not borne out by the research evidence.     

Do mental health consumers want to improve their long‐term disease risk behaviours? A survey of over 2000 psychiatric inpatients

Policies and clinical guidelines acknowledge the role mental health services have in addressing the physical health of individuals with a mental illness; however, little research has explored interest in reducing health risk behaviours or the acceptability of receiving support to reduce such risks among psychiatric inpatients. This study estimated the prevalence of four long‐term disease risk behaviours (tobacco smoking, hazardous alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity); patient interest in reducing these risks; and acceptability of being provided care to do so during a psychiatric inpatient stay. A cross‐sectional survey was undertaken with 2075 inpatients from four inpatient psychiatric facilities in one health district in Australia (October 2012–April 2014). Prevalence of risk behaviours ranged from 50.2% (inadequate physical activity) to 94.8% (inadequate fruit and/or vegetable consumption). The majority of respondents (88.4%) had more than one risk behaviour, and most were seriously considering improving their risk behaviours (47.6% to 65.3%). The majority (80.4%) agreed that it would be acceptable to be provided support and advice to change such behaviours during their psychiatric inpatient stay. Some diagnoses were associated with smoking and hazardous alcohol consumption, interest in reducing alcohol consumption and increasing fruit and/or vegetable consumption, and acceptability of receiving advice and support. The findings reinforce the need and opportunity for psychiatric inpatient facilities to address the long‐term disease risk behaviours of their patients.     

Do trait anxiety and age predict state anxiety of school‐age children?

Aim. The aim of this study was to determine whether the trait anxiety scores and age of children could predict their state anxiety scores under stressful and relaxing situations. Background. Surgery can cause considerable stress and anxiety that can have a profound effect on children. It is crucial for nurses to differentiate preoperative anxiety levels in children and to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery before any intervention can be appropriately planned, provided and evaluated. Methods. A test‐retest within subjects design was used. Five hundred and nineteen primary school‐age children were invited to participate in the study. Participants were asked to respond to the Chinese version of the State‐Trait Anxiety Inventory for Children under stressful (pre‐academic examination) and relaxing (post‐academic examination) situations. Result. Multiple regression analysis showed that the trait anxiety of children was a strong predictor of their state anxiety in a stressful situation but not in a relaxed one. Compared to trait anxiety, age was found to be a weak predictor of the state anxiety of children in either situation. Conclusion. This study confirmed that trait anxiety of children could be predicted from their state anxiety under a stressful situation. Relevance to clinical practice. The trait anxiety scale could be a useful screening tool for nurses to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery. Understanding the trait anxiety of children in advance could help nurses implement appropriate preoperative psychological intervention that can meet the individual needs of the child and thus promote better recovery.     

Experiences of primary care among young adults with mental illness – A systematic literature review

Background

Mental illness, such as depression, anxiety disorders, attention deficit hyperactivity disorder and different addictive diseases, has increased among young adults over the last decade. Mental illness is associated with distress and problems functioning in social activities. Healthcare centres, that is, primary care, serve as the first point of contact with healthcare professionals for those young adults and provide outpatient medical and nursing care covering both physical and mental illness.

Objective

To explore experiences of primary care among young adults with mental illness.

Methods

A systematic literature review was conducted that followed the method of Bettany–Saltikov and McSherry. A keyword search was performed in various databases, and after a quality assessment 23 articles were included in the review.

Results

Young adults' experiences from primary care are described in four categories – Facing difficulties to accept help, relational preconditions, structural and organisational hindrances and satisfaction with youth-focused mental health interventions. Young adults with mental illness experience many difficulties in accessing and receiving proper help from primary care. Further, they did not believe in recovery from mental illness, and they also expressed a lack of mental health literacy.

Conclusion

While being the first contact with healthcare professionals, primary care needs to adjust its services to address the growing group of young adults suffering from mental illness. It is necessary to provide tailored guidelines and interventions in primary care for young adults with mental illness, and the Tidal Model may improve the contacts with young adults in primary care.     

Depot neuroleptics,schizophrenia and the role of the nurse: is practice evidence based? A review of the literature

Nurses are expected to justify their practice with research based evidence. Community psychiatric nurses (CPNs) are under pressure to concentrate more on the 'seriously mentally ill', particularly those with a diagnosis of schizophrenia. Neuroleptic medicines are a recommended therapy in schizophrenia. The administration and monitoring of these drugs is a central part of the CPN's role. The CPN also often assumes an important position as patient advocate in relation to prescribing practices. Neuroleptics are commonly given in depot form to promote compliance, prevent relapse and be of benefit to the patient. This literature review considers the research evidence that these aims are achieved through current practice and reflects on the implications for nursing. In the absence of definitive research work, it may be that important decisions are based on received wisdom rather than research evidence. Whilst the data supporting the use of depots are inconclusive, there is an increasing body of knowledge demonstrating the efficacy of nursing approaches to drug therapy which seek to empower the patient.     

“Is gestational age a factor in determining the health-related quality of life of children and young people born preterm?” A critical review of the literature

This review offers an in-depth critical exploration of 5 studies investigating the relationship between prematurity and health-related quality of life (HRQoL) in preschool children, adolescents and young adults. Innovations in neonatology have meant that children born preterm have a better chance of surviving than in previous decades, but less is known about the influence of prematurity on the subsequent HRQoL of survivors.In the papers reviewed, gestational age is negatively associated with cognitive and physical functioning, but the relationship between gestational age and HRQoL differs between groups. The review concludes that whilst these studies make a valuable contribution to understanding the HRQoL of children who were born preterm, standardisation between approaches would enable improved comparison between cohorts. Further research is needed to set the standards against which the HRQoL of children can be measured and conceptualised, and to take into account the wider concept of quality of life (QoL).     

Self‐harm: what's the problem? A literature review of the factors affecting attitudes towards self‐harm

People who have experienced self-harm report dissatisfaction with the care provided by statutory services. This review provides a critical exploration of the evidence examining the attitudes of healthcare professionals across both mental health and medical settings towards people who self-harm. It also explored in detail service users perceptions of care. A literature search conducted via electronic databases and cross-matching reference lists produced 19 papers that met the inclusion criteria. A thematic analysis of the literature indicated six key areas which contributed to the development of attitudes defined as positive or negative towards people who self-harm. Negative attitudes and experiences of care were associated with lack of education and training, the impact of differences in perceptions of health professionals' role and the influence of clinical culture as well as how self-harm was perceived as a health need. More positive attitudes were associated with a greater understanding of experiences of self-harm and improved training. However, the nature of care reported by service users indicates that there are still significant improvements needed to the attitudes in health settings to ensure they receive a high-quality service.     

Sexual health education for people with mental health problems: what can we learn from the literature?

Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness'severe mental illness'persistent mental illness'psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.     

What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review

Objective

The aim of this study was to examine prior studies relating to carers’ needs from mental health services for their own wellbeing.