The Hummingbird Project year 2: decreasing distress and fostering flourishing in a pragmatic pre-post study.

Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored. The current study, therefore, was designed to replicate the effects of the Hummingbird Project mPPI on positive mental health and to also explore the effects on symptoms of mental distress. Secondary school-aged children (N = 614; mean age = 11.46 years) from a sample of secondary schools located across the North West of England (N = 7) participated in the study; the majority of children were in Year 7 (94%). The PP concepts explored included happiness, hope, resilience, mindfulness, character strengths, growth mindset, and gratitude. The results showed significant improvements associated with the mPPI in well-being (as measured by the World Health Organization Well-Being Index; WHO-5), hope (as measured by the Children's Hope Scale; CHS), and symptoms of mental distress (as measured by the Young Person's Clinical Outcomes in Routine Evaluation; YP-CORE) from pre- to post-intervention. While acknowledging the limits due to pragmatic concerns regarding the implementation of a control group, the effectiveness of the Hummingbird Project mPPI on well-being was replicated alongside reducing the symptoms of mental distress. Future evaluation, however, will need to implement more robust designs and consider follow-up duration to assess the longer-term effects of the Hummingbird Project mPPI.

Flourishing, psychological distress and internalized stigma among parents of an adult son or daughter with schizophrenia.

BACKGROUND: Parents of adults diagnosed with schizophrenia, have been reported to have higher levels of psychological distress than the general population, and parents whose offspring have other mental or physical illnesses. AIM: This study examines the comparatively new construct of flourishing, and its relationship to internalized stigma and psychological distress. METHOD: A cross-sectional survey was conducted between July 2021 and March 2022, with an international sample of 200 parents of adult sons or daughters diagnosed with schizophrenia. Participants completed a demographic questionnaire and three standardized inventories. These were the PERMA Profiler, which measures flourishing, the CORE-10, which measures psychological distress, and a new parental Internalized Stigma Scale. Sample characteristics of individuals of schizophrenia and their parents were examined using descriptive statistics, and the contributing factors affecting stigma were assessed through regression analysis. RESULTS: The initial hypothesis that parents scoring high on internalized stigma, would have significantly higher levels of psychological distress and lower levels of flourishing, than parents with low-level internalized stigma, was confirmed. Overall, the flourishing levels were lower and psychological distress higher in these parents, than those of the general population. Regression analysis identified psychological distress and hopefulness as the two major predictors of flourishing, though in different directions. Interestingly, stigma did not determine flourishing, in spite of their close relationship. CONCLUSIONS: Researchers have long been aware of internalized stigma in persons with schizophrenia. Yet this study is one of the few that linked it with parents of adults with schizophrenia and flourishing and psychological distress. Implications were discussed in the light of the findings.

The Use of Chatbots as Supportive Agents for People Seeking Help with Substance Use Disorder: A Systematic Review.

INTRODUCTION: The use of chatbots in healthcare is an area of study receiving increased academic interest. As the knowledge base grows, the granularity in the level of research is being refined. There is now more targeted work in specific areas of healthcare, for example, chatbots for anxiety and depression, cancer care, and pregnancy support. The aim of this paper is to systematically review and summarize the research conducted on the use of chatbots in the field of addiction, specifically the use of chatbots as supportive agents for those who suffer from a substance use disorder (SUD). METHODS: A systematic search of scholarly databases using the broad search criteria of ("drug" OR "alcohol" OR "substance") AND ("addiction" OR "dependence" OR "misuse" OR "disorder" OR "abuse" OR harm*) AND ("chatbot" OR "bot" OR "conversational agent") with an additional clause applied of "publication date" ≥ January 01, 2016 AND "publication date" ≤ March 27, 2022, identified papers for screening. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to evaluate eligibility for inclusion in the study, and the Mixed Methods Appraisal Tool was employed to assess the quality of the papers. RESULTS: The search and screening process identified six papers for full review, two quantitative studies, three qualitative, and one mixed methods. The two quantitative papers considered an adaptation to an existing mental health chatbot to increase its scope to provide support for SUD. The mixed methods study looked at the efficacy of employing a bespoke chatbot as an intervention for harmful alcohol use. Of the qualitative studies, one used thematic analysis to gauge inputs from potential users, and service professionals, on the use of chatbots in the field of addiction, based on existing knowledge, and envisaged solutions. The remaining two were useability studies, one of which focussed on how prominent chatbots, such as Amazon Alexa, Apple Siri, and Google Assistant can support people with an SUD and the other on the possibility of delivering a chatbot for opioid-addicted patients that is driven by existing big data. DISCUSSION/CONCLUSION: The corpus of research in this field is limited, and given the quality of the papers reviewed, it is suggested more research is needed to report on the usefulness of chatbots in this area with greater confidence. Two of the papers reported a reduction in substance use in those who participated in the study. While this is a favourable finding in support of using chatbots in this field, a strong message of caution must be conveyed insofar as expert input is needed to safely leverage existing data, such as big data from social media, or that which is accessed by prevalent market leading chatbots. Without this, serious failings like those highlighted within this review mean chatbots can do more harm than good to their intended audience.

Enhanced supported living for people with severe and persistent mental health problems: A qualitative investigation.

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi-structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on-site activities; and (3) the experience of supported living as a stepping-stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer-relations, autonomy and fostering hope in empowering individuals in their ongoing recovery.

Effectiveness of an online short compassion strengths course on nursing students compassion: A mixed methods non-randomised pilot study.

BACKGROUND: Although student nurses are expected to demonstrate and show understanding of compassion in their learning and practice, literature suggests that this is not always the case. To address this, nursing students need to be introduced to the value and behaviours of compassion during their education. OBJECTIVES: To evaluate the effectiveness of an online course to help nursing students develop their strengths and further validate the Bolton Compassion Strengths Indicators. DESIGN: A pre-and post-mixed methods non-randomised pilot study. SETTING: A university in the north west of England. PARTICIPANTS: A sample of first year undergraduate nursing students (67), in two groups, with 33 in the online control and 34 in the on-site group. METHODS: Both groups took part in the Short Compassion Strengths Course (SCSC). The online group took the course in their own time over a 3-week period, while the on-site group completed the course during their time at University. In both groups baseline assessments were carried out using the Bolton Compassion Strengths Indicator (BCSI). Post-test data were collected 3 weeks after in the online group and immediately after in the on-site group, for the BCSI and reflective accounts. Data were analysed using ANOVA in SPSS27. RESULTS: The online group did not complete the course but filled out the questionnaires. The on-site group had significantly higher scores on all indicators but self-care and engagement. CONCLUSIONS: The SCSC is an effective course for teaching and developing compassion strengths when delivered on-site. This paper adds further validity for the BCSI.

An international validation of the Bolton Unistride Scale (BUSS) of tenacity.

Academic success at University is increasingly believed to be a combination of personal characteristics like grit, resilience, strength-use, self-control, mind-set and wellbeing. The authors have developed a short 12-item measure of tenacity, the Bolton Uni-Stride Scale (BUSS) which incorporates these elements. Previous work in the UK had established the reliability and validity of the BUSS. The present paper reports the findings of an International validation of BUSS across 30 countries (n = 1043). Participants completed the BUSS alongside other recognised scales. Factor analysis revealed an almost identical two-factor solution to previous work and the reliability and validity of the scale were supported using an international sample. The authors recommend however that the scale be used as a single score combining all 12 items. In the light of this, the authors suggest that the BUSS will be a useful measure to incorporate in studies of academic attainment.

European university students' mental health during Covid-19: Exploring attitudes towards Covid-19 and governmental response.

The effects of Covid-19 have been felt worldwide and one population that are of increasing concern are university students. University students have endured unique and drastic changes to their everyday and academic lives. It is important to understand how university students in different parts of the world have been affected by the Covid-19 pandemic and how it has affected their mental health? A cross-sectional study was conducted during the first wave of Covid-19, in May 2020 with 2,006 university students from the UK, Italy, Germany and Spain. Participants were recruited online and were asked to complete a series of standardised measures of psychological distress, anxiety, flourishing and wellbeing. Attitudes towards Covid-19 were measured using a new scale. The factor structure and reliability of this new scale was confirmed using this European sample. Results indicated that all university students were suffering from poor mental health, considerably below pre-pandemic norms. There were many geographical differences in the way that university students perceived the Covid19 pandemic, in terms of their fears, anxieties, loneliness and positivity. There were also significant mental health comparisons between students from the UK, Italy, Germany and Spain. Student beliefs that their government had provided effective leadership during the Covid-19 pandemic were strongly related to numerous mental health outcomes. A picture of university students' mental health is provided and discussed. Geographical comparisons are discussed, as are the implications for practice and future directions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02854-0.

Does Post-Traumatic Growth Follow Parental Death in Adulthood? An Empirical Investigation.

This study looked at the loss of a parent in adulthood and whether this was followed by post-traumatic growth? Participants, 100 bereaved adults, from Pakistan and England, lost parents in the last 10 years. They completed three questionnaires. The study hypotheses were, first, that participants whose bereavement occurred more than five years ago would show significantly higher levels of post-traumatic growth. Second, participants with higher levels of post-traumatic growth would experience significantly higher grief scores. Thirdly, participants with higher levels of post-traumatic growth would show significantly higher levels of coping skills. Two hypotheses were rejected, only one received partial support. Yet, levels of post-traumatic growth were high in this sample. Post-traumatic growth does not follow every bereavement. The authors provide autoethnographic material to challenge this. Circumstances surrounding bereavement during the Covid-19 pandemic, are more likely to lead to increases in complicated grief reactions, rather than post-traumatic growth.

Loneliness and mental health at the early stages of the Covid-19 pandemic in England.

The current researchers carried out a large online survey on 18 March 2020 and unintentionally provided a 'snap shot' of how the British population was responding in the early stages of the Covid-19 pandemic. This paper aims to investigate the relationship between loneliness and mental health at the early stages of the global crisis. This cross-sectional study was carried out using Prolific, an online participant recruitment platform that allowed 1608 responses in just 2 hr. Participants completed measures of Personal Well-being, Psychological Distress, Flourishing and Loneliness. Numerous associations between loneliness and mental health were found. A multiple regression found that 43% of the variance in loneliness can be accounted for by age, psychological distress and flourishing. Responses were also categorised into three groups: the non-lonely (n = 311), averagely lonely (n = 1054) and the severely lonely (n = 243), with analysis indicating that poorer well-being was associated with increased loneliness. Due to the cross sectional nature of this research, determining the direction of causality is not possible. It remains uncertain whether increased loneliness negatively impacted on mental health, whether poor mental health lead to increased loneliness, or both in fact. Current findings suggest that severely lonely individuals may be particularly vulnerable to psychological distress and that individuals with poor mental health may be especially prone to loneliness. Individuals experiencing loneliness and/or poor mental health will almost certainly need additional support during and beyond the pandemic.

Losing a Loved One During the Covid-19 Pandemic: An On-Line Survey Looking at the Effects on Traumatic Stress, Coping and Post-Traumatic Growth.

The Covid-19 pandemic has had a devastating effect across the world. In the UK alone, the death toll is 132,742, with 207 people dying the previous day and a total of 6,825,074 cases of Covid-19 thus far (September 1st, 2021). The aim of this study was to look at post-traumatic stress, coping skills and post-traumatic growth in relatives, who lost a loved one during the pandemic. Some 185 individuals took part in a Qualtrics survey. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised, the Coping Assessment for Bereavement and Loss (CABLE) and the Post-Traumatic Growth Questionnaire. There were two major findings. First, there were very high levels of post-traumatic stress, with 94.6% of the sample scoring above the threshold of 33 for a diagnosis of post-traumatic stress disorder (PTSD). Second, levels of post-traumatic growth were very low. Losing a relative during the Covid-19 pandemic may lead to more PTSD. The circumstances surrounding many Covid deaths, may have long term negative consequences for the bereaved relatives.

Development and validation of a new instrument to measure nursing students compassion strengths: The Bolton Compassion Strengths Indicators.

Despite considerable research and rhetoric on the importance of compassion in nursing, progress has been hindered by the lack of an adequate psychometric instrument to measure its multidimensional nature. This paper reports several studies conducted over three stages, to develop and validate a new instrument to measure nurses' compassion strengths. A purposive sample of UK pre-registered nursing students studying at a University took part in this study. The eight indicators highlight the multidimensional nature of compassion. The Bolton Compassion Strengths Indicators (BCSIs) demonstrated robust psychometric properties and could provide the means by which nursing students can empower themselves, as they strive to develop their professional identity as compassionate practitioners. This new measure will also help other researchers and educators who wish to study the development of compassion strengths in nursing.

The Hummingbird Project: A Positive Psychology Intervention for Secondary School Students.

Mental health in schools has attracted a lot of attention in recent years. Positive Psychology Interventions (PPIs) in secondary schools have been shown to improve mental health outcomes for students. Previous PPIs have tended to be delivered by trained Psychology specialists or have tended to focus on a single aspect of Positive Psychology such as Mindfulness. The current study involved 2 phases. Phase 1 was a pilot PPI, delivered by current university students in Psychology, which educated secondary school students (N = 90) in a variety of Positive Psychology concepts. Phase 2 involved delivering the PPI to secondary school students (N = 1,054). This PPI, the Hummingbird Project, led to improvements in student well-being, as measured by the World Health Organization Well-Being Index (WHO-5). The intervention also led to improvements in student resilience, as measured by the Bolton Uni-Stride Scale (BUSS), and hope, as measured by the Children's Hope Scale (CHS). Results are discussed in the context of their implications for the future of psychological intervention in secondary school settings.

Onwards and upwards: The development, piloting and validation of a new measure of academic tenacity- The Bolton Uni-Stride Scale (BUSS).

What factors determine success at University? For many years the construct of intelligence was felt to be critical. More recently, the construct of grit, has attracted the attention of many researchers, along with related concepts such as self-control, growth mind-sets and resilience. The authors of this paper have developed a specific measure of tenacity and self-composure, two constructs crucial to academic achievement. This measure comprises of 12 items drawn from the above constructs, but also including mental well-being and strengths use. In the first study, the authors report on the psychometric properties of the Bolton Uni-Stride Scale (BUSS). The new scale was administered to 1117 university students. Exploratory factor analysis (EFA) revealed two underlying factors, one labelled "tenacity" had seven items and accounted for 30% of the variance. The second was labelled "self-composure," and accounted for 14% of the variance. In the second study the BUSS was given to 340 undergraduate students along with the Grit Scale, the Self-Control Scale, the Mind-sets Quiz, the Connor Davidson Resilience Scale (CD-RISC 10) and the short Warwick Edinburgh Mental Well-being Scale (WEMWBS). This study presented evidence for good internal consistency reliability (.74) and test-retest reliability over three weeks was .70 for Tenacity and .77 for Self-composure. BUSS Academic Tenacity correlated highly with grit (.63), self-control (.59), resilience (.52), mind-sets (.35) and mental well-being (.54). The study also evidences good discriminative validity of the BUSS. A second study conducted confirmatory factor analysis (CFA), explaining a total of 44% of the variance. The authors have shown good support for the reliability and validity of the BUSS scale. It now needs to be tested in other universities and in different countries. It is the contention of the authors that academic tenacity will be a better measure of academic success than other competing measures, such as grit, on their own. Further research is needed to test this assertion.

Stakeholder perspectives of compassion in nursing: The development of the compassion strengths model.

AIMS: To explore stakeholder perspectives of compassion in nursing. BACKGROUND: Studies show that nurses' compassion can be characterized by 11 characteristics. A growing body of research illustrates how courses aimed at teaching nursing students about compassion can be effective. Including the views of key stakeholders in the design of these programmes is recommended, yet the number of studies that have explored this are limited. DESIGN: This study used a qualitative exploratory design, applying a directed content and thematic analysis to the data. METHODS: Key stakeholders (N = 34), including nurse educators, nursing students, registered nurses and service user/patients, were recruited between September 2016 - July 2017. Focus groups and semi-structured one-to-one interviews were conducted. Data were transcribed verbatim. Directed content analysis and thematic analysis were applied to transcripts to address two separate research questions. RESULTS: In relation to question 1, 'What are the characteristics of a compassionate nurse'? eight themes: (a) character; (b) self-care; (c) connection; (d) empathy; (e) interpersonal skills; (f) communication; (g) competence; and (h) engagement, emerged from the content analysis. For question 2, 'How can compassion be taught to nursing students'? there were five separate themes that emerged from the thematic analysis: (a) beliefs about teaching compassion; (b) motivation; (c) the 5 W's needed to teach compassion to nursing students; (d) barriers to compassion in practice;  and (e) compassion requires strength CONCLUSION: The findings of this research support previous research into compassion in nursing. The Compassion Strengths model may serve as a framework for nursing students and nurses' compassionate practice. This may also assist nurses internationally to develop further research in this vital area.

Stigma towards non-suicidal self-harm: evaluating a brief educational intervention.

BACKGROUND:: health professionals' attitudes towards self-harming behaviour are predominantly negative. Research examining educational interventions to change negative attitudes is limited. AIMS:: this study aimed to provide an educational intervention for student nurses to change negative attitudes around self-harm. METHODS:: attitudes around self-harm and mental health in general were assessed through the Self-Harm Antipathy Scale and the Mental Health Attitude Scale. Fifty-five adult nursing students took part in the 45-minute intervention. This included facts and figures, celebrity stories and personal stories regarding self-harm, all intended to increase understanding. FINDINGS:: after the intervention, attitudes measured by the Self-Harm Antipathy Scale had improved significantly. CONCLUSION:: patients who self-harm will without doubt continue to experience negative attitudes from health professionals. This study shows an educational intervention can change attitudes towards those who self-harm.

All That Glitters Is Not Grit: Three Studies of Grit in University Students.

The present research looked at the importance of the concept of grit in University students based on a mixed-method approach. Study 1 comprised 440 University students. All were given the Grit Scale, the Perceived Stress Scale, the short Warwick-Edinburgh Mental Well-being Scale, the Office of National Statistics Well-being items and the Self-Control Scale. Levels of grit were significantly higher in female students, older students and postgraduates. Grit correlated highest with self-control. Study 2 looked at 340 University students. In addition to measuring self-control, mental well-being and grit, measures of resilience and mindsets were also added. A construct validity test of the Grit Scale showed that high grit scorers had significantly higher levels of self-control and mental well-being, were more resilient and were more likely to have a more growth oriented mindset. Grit varies with age and is most closely associated with the concept of self-control. The third study was a qualitative investigation with 10 successful graduates. Semi-structured interviews were coded using thematic analysis. Three broad themes emerged. The first, Passion and Perseverance, included themes of having short and long terms goals, resilience, dedication, and endurance. The second, Self-Control, included time management, self-awareness, prioritizing tasks and knowing strengths and weaknesses. The third theme identified was Positive Mindsets. This included having a positive attitude toward learning, the importance of feedback and constructive criticism and that success is not materialistic. The qualitative research has helped "unpack" concepts from the grit research and may enable University tutors to guide students better. Though these studies were only conducted in one English University, they have been stepping stones in our quest to discover what are the most important factors in determining student academic success? The development and piloting of our new Uni-Stride Scale, is the next step in this process.

Qualities, teaching, and measurement of compassion in nursing: A systematic review.

BACKGROUND: Compassion has global implications for nursing care. However, failure to provide compassionate care is reported by patients. Nursing and nurse education have been scrutinized about the impact training can have on student's compassion. Furthermore, there is a paucity of standardised measures to assess levels of nurses' compassion. OBJECTIVES: To identify (1) the qualities of a compassionate nurse, (2) how compassion is taught to nursing students, and (3) the instruments used to measure compassion in nursing. DESIGN: Systematic literature review. DATA SOURCES: CINHAL, EBSCO, SCOPUS, PubMed, Ovid Nursing. SEARCH METHODS: A systematic review of published research was conducted with. No limitations in the search timeframe were used. Articles were included if they were (1) nurses (2) nursing students (3) educators and (4) patient groups, (5) written in English. Articles that were, peer reviewed, research articles, or articles grounded in evidence based practice were also included. RESULTS: Fourteen studies (6 UK, 3 USA, 2 Canada, 1 Korea, 1 Thailand, and 1 Netherlands) identified eleven characteristics of a compassionate nurse. Two UK and one Australian study investigated teaching compassion to nursing students. Four articles reported on instruments used to measure compassion in nursing. Three were American, and one Korean. CONCLUSION: This review identified only 21 papers overall. Several qualities of a compassionate nurse were found. In addition, few studies have explored how compassion is taught to nursing students. Also, there are a limited number of instruments for measuring compassion in nursing. More research is needed in nurse education to develop a teaching approach and psychometric measure for nurses' compassion.

A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses.

BACKGROUND: Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses. AIM: To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses. METHOD: Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout. PARTICIPANTS: A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study. RESULTS: Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout. CONCLUSION: High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.

Compassion for others, self-compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives: A quantitative survey.

BACKGROUND: compassion fatigue and burnout can impact on the performance of midwives, with this quantitative paper exploring the relationship between self-compassion, burnout, compassion fatigue, self-judgement, self-kindness, compassion for others, professional quality of life and well-being of student midwives. METHOD: a quantitative survey measured relationships using questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) Short Warwick and Edinburgh Mental Well-being Scale; (4) Compassion For Others Scale. PARTICIPANTS: a purposive and convenience sample of student midwives (n=103) studying at university participated in the study. RESULTS: just over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgement sub-scale are less compassionate towards both themselves and others, have reduced well-being, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout. CONCLUSION: student midwives may find benefit from 'being kinder to self' in times of suffering, which could potentially help them to prepare for the emotional demands of practice and study. IMPLICATIONS: developing, creating and cultivating environments that foster compassionate care for self and others may play a significant role in helping midwives face the rigours of education and clinical practice during their degree programme.