Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review.

Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.

Limited changes in activities of daily life performance ability among people with schizophrenia at clinical settings and the factors moderating the changes.

BACKGROUND: Impaired community functioning and functional ability are common among people with schizophrenia spectrum disorders (SSD). However, changes occurring in activities of daily life (ADL) ability through interventions provided at clinical settings have not been systematically examined in this population. METHODS: We retrospectively collated and analysed changes in ADL ability between admissions and discharges, measured utilising the Assessment of Motor and Process Skills (AMPS), among 72 people with SSD at a public inpatient treatment and rehabilitation facility in Western Australia. Clinical and demographic factors moderating the changes were also determined. RESULTS: The standardised AMPS motor (p = 0.0088) and process scores (p < 0.0001) improved significantly between admission and discharge. However, overall, the improvements were of small to moderate magnitude, and >60% of participants did not experience significant or meaningful changes. Furthermore, mild to moderate impairment in the AMPS standardised motor (-1.3 SD), and process (-1.6 SD) ability was present at discharge. A logistic regression analysis revealed that low admission AMPS scores and duration of illness of more than five years predicted improvement of the AMPS motor score by discharge, but only the former predicted changes in the process scores. Other demographic, clinical, and treatment-related variables did not affect the outcome of the AMPS scores. CONCLUSIONS: Impairment of ADL ability is recalcitrant in schizophrenia. The improvement was modest and occurred only in a proportion of participants. However, promisingly, chronic illness, low baseline ADL ability, treatment with clozapine and presence of treatment-resistant schizophrenia did not have an adverse effect on the outcome.

Successful implementation of a cognitive remediation program in everyday clinical practice for individuals living with schizophrenia.

OBJECTIVE: This article evaluates the feasibility and benefits of implementing cognitive remediation interventions in everyday clinical practice among individuals living with schizophrenia. METHOD: We retrospectively assessed short-term cognitive and occupational outcomes of 89 consecutively admitted people with schizophrenia at a public mental health service. A computerized cognitive remediation program was offered at the facility as an integral component of psychosocial treatments. Data of service recipients who had completed the Brief Assessment of Cognition in Schizophrenia (BACS; Keefe et al., 2004) on admission and discharge were included for evaluating outcomes. RESULTS: Thirty-seven service recipients did not participate (nontrainee), 18 completed less than 20 hr (incomplete trainee), and 34 completed more than 20 hr of cognitive remediation (completed trainee). Whist a variety of factors affected involvement, lack of interest was the predominant reason voiced for nonparticipation. Repeated measures analysis of variance did not reveal significant Group × Time interaction. Exploratory contrasts showed statistically significant improvement within the completed trainee group from baseline to discharge on the BACS composite score, list learning, and token motor task. Logistic regression analysis indicated that although improved cognition predicted enhanced employment outcome, there was no significant difference among the 3 groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Cognitive remediation interventions were accepted by a sizable proportion of people with schizophrenia admitted to an inpatient clinical treatment and rehabilitation facility. Promising improvement in cognitive function among those who completed the training suggests the need for methodologically rigorous research exploring the feasibility and benefits of cognitive remediation programs at everyday clinical settings. (PsycINFO Database Record

Successful evaluation of cognitive function and the nature of cognitive deficits among people with schizophrenia in clinical rehabilitation settings.

OBJECTIVES: Despite possessing considerable relevance for planning and delivery of effective rehabilitation interventions, systematic evaluation of cognitive function is often ignored in clinical practice. This paper describes a successful method for measuring cognitive function and the nature of cognitive deficits (CD) in people with schizophrenia admitted to psychiatric rehabilitation services. METHODS: Data on the cognitive functioning of consecutive patients with schizophrenia / schizoaffective disorder admitted during a 5-year period to a public in-patient rehabilitation facility was collated retrospectively and analysed. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive function. RESULTS: It was possible to administer the BACS to 122 of 135 consecutive admissions. The mean composite score on the BACS was 1.8 standard deviations below the norm, and 43% had moderate or severe CD. The BACS sub-tests of list learning and symbol coding revealed more severe deficits. CONCLUSIONS: The study indicates that evaluation of cognitive function using brief instruments is feasible in psychiatric rehabilitation settings. Global and domain-specific CD were prevalent among people with schizophrenia. In view of the strong association of cognitive functioning with community functioning and rehabilitation outcomes, further studies exploring the feasibility and utility of routinely evaluating cognitive function are warranted.

The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia.

BACKGROUND: Functional impairments in schizophrenia are substantial, complex, and persistent. Objective measurement of ADL ability, functional capacity and performance is needed for effective intervention planning and outcome evaluation. OBJECTIVE: To evaluate ADL ability in people with schizophrenia using the Assessment of Motor and Process Skills (AMPS) and to determine the utility of using the AMPS to predict levels of assistance required for successful community living. METHOD: In a retrospective audit, AMPS ADL measures of a consecutive sample of 64 people with schizophrenia admitted to a mental health facility were compared with normative data and with recommended "cut-off" measures for competency to live independently in the community. RESULTS: Substantial difficulties were measured in both ADL motor (mean z = -1.5) and ADL process ability (mean z = -2.1). AMPS ability measures did not predict problems with independent living for 62.5% of the patients. CONCLUSION: People with schizophrenia admitted to an inpatient rehabilitation facility experienced significant difficulty performing ADL tasks. AMPS is a useful measure of ADL ability but should be used in conjunction with measures of functional performance in order to plan interventions and supports for people with schizophrenia that reflect the complexity of factors affecting community functioning.