Prevalence of problematic psychological symptoms in samples of Canadian postsecondary students.

OBJECTIVES: To estimate the one-month prevalence of problematic psychological symptoms among Canadian postsecondary students, and to compare the prevalence by student characteristics. PARTICIPANTS: Three samples of students from two postsecondary institutions. METHODS: In a cross-sectional study conducted in 2017, we measured self-reported problems related to symptoms of depression, anxiety, and stress using questions from the functioning module of the WHO Model Disability Survey. We used modified Poisson regression modeling to compute prevalence ratios (95%CI) to compare the prevalence by student characteristics. RESULTS: Our study included 1392 students (participation rate 35%-77%). Across samples, the one-month prevalence of moderate-extreme problems ranged from 50.8%-64.7% for anxiety, 41.2%-60.8% for stress, and 29.4%-43.6% for depression. Such problems were consistently more prevalent among females, poor-quality sleepers, students with food insecurity and those with insufficient social support. CONCLUSIONS: Significant burden of problems related to psychological symptoms exists within the postsecondary student population and varies by student characteristics.

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence.

BACKGROUND: Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. AIMS: To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. METHOD: Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. RESULTS: Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. CONCLUSIONS: Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.

The one-week prevalence of neck pain and low back pain in post-secondary students at two Canadian institutions.

BACKGROUND: Low back and neck pain are common in the general population, but the prevalence among Canadian post-secondary students is not well known. We aimed to determine the one-week prevalence of neck pain (NP) and low back pain (LBP) among postsecondary students in Canada. METHODS: We conducted a cross-sectional study of students enrolled in the Faculty of Health Sciences and Faculty of Education at Ontario Tech University, and the Canadian Memorial Chiropractic College (CMCC) in the Fall of 2017. Neck and low back pain intensity in the past week were measured with the 11-point numerical rating scale. We report the cumulative, gender- and institution-specific one-week prevalence (95% CI) of any pain (1-10/10) and moderate to severe pain (≥ 3/10). RESULTS: The one-week prevalence of any neck pain ranged from 45.4% (95% CI: 38.4, 52.4) in the Faculty of Education to 76.9% (95% CI: 72.9, 80.4) at CMCC. The one-week prevalence of neck pain ≥3/10 ranged from 44.4% (95% CI: 37.5, 51.4) in the Faculty of Education to 58.4% (95% CI: 54.0, 62.7) at CMCC. The one-week prevalence of any low back pain ranged from 60.9% (95% CI: 53.8, 67.5) in the Faculty of Education to 69.0% (95% CI: 64.8, 73.0) at CMCC, and the one-week prevalence of low back pain ≥ 3/10 ranged from 47.8% (95% CI: 43.4, 52.2) at CMCC to 55.1% (95% CI: 51.2, 58.9) in the Faculty of Health Sciences. The prevalence of any back or neck pain and pain ≥ 3/10 was consistently higher in females than males, with the largest difference seen for neck pain at CMCC. CONCLUSION: Most post-secondary students in our samples experienced LBP and NP in the past week. Overall, the one-week prevalence of NP and LBP was higher among chiropractic students and among females. This study should draw attention to school administrators about the burden of NP and LBP in post-secondary students.

Exploration of note writing by mental health nurses using a video scenario.

AIMS AND OBJECTIONS: We aimed to explore the content and language of nursing documentation and gain insight into the internal processes of nurses while notetaking. BACKGROUND: Documentation is a core competency of mental health nursing, has clinical and ethical importance and is the integral to the efficient and effective care provided to patients. However, issues related to the content and quality of nursing notes continues to be a concern and there remains gaps in our understanding about the internal processes that nurses engage in when writing notes. DESIGN: We used a mixed method design that included a content analysis with note review and interviews. METHODS: After watching a video, psychiatric nurses (n = 27) wrote a note and then were interviewed about their note taking process. We used the COREQ guidelines for reporting our data. RESULTS: Participants relied on four main themes when determining what to include in their notes-what happened and what the patient said or did, plus anything different than baseline, and safety concerns. Analyses revealed the presence of bias in the notetaking and participants were not familiar with effective strategies to mitigate these during the documentation process. Lastly, we found that notes are typically consistent in using some of the SOAPE format with notes focused on direct observations and the use of 'facts', while assessment and construction of treatment plans are used to a lesser extent. CONCLUSIONS: Our results provide insight into the decision-making process of nursing staff regarding their documentation practices: overall they appear unaware of the importance of their notes, and believe that capturing the facts about their patients is important, while devaluing their own input and interpretations. RELEVANCE TO CLINICAL PRACTICE: Our results provide evidence that mental health nurses may need additional training regarding documentation, more specifically about what to include, word choice and bias.

Investigating the impact of cognitive bias in nursing documentation on decision-making and judgement.

The clinical documentation of patients' mental status, behaviour and functioning is a fundamental aspect of inpatient mental health care. It is an important source of information-sharing with the interprofessional team and used by other clinicians within the circle of care to guide their decision-making process. Given the body of evidence highlighting concerns about the quality of nursing documentation and the growing literature demonstrating the presence of bias in healthcare, it is critically important that we examine the impact of this bias in nursing practice. The primary objective of this study was to determine whether clinical decisions and judgements change when nurses read documentation that is either biased or neutral. Using a quantitative, observational study that used surveys to collect data, participants were exposed to two patient vignettes and six clinical notes associated with each patient (notes were written with either biased or neutral language) and asked to make clinical decisions and judgements. Results from 199 nurse participants from a tertiary mental health hospital revealed a notable relationship between the type of notes read (biased vs. neutral) and clinical practice, namely, participants reading biased notes were less likely to offer health teaching when administering pro re nata (PRN) medication for sleep. We also found differences in decision-making and judgements based on the type of note read depending on years of experience and type of education. The results indicate that biased language in nursing documentation can influence other clinicians' decisions and judgements about patients, thereby indicating a cascade of bias.

Silver linings: Observed reductions in aggression and use of restraints and seclusion in psychiatric inpatient care during COVID-19.

WHAT IS KNOWN ABOUT THE SUBJECT?: In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services. Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid-19 pandemic restrictions being implemented. The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation-specific and less so a factor of mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well-being; our co-design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced. Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services. ABSTRACT: The global COVID-19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to "normal".

A Qualitative Review of What Forensic Mental Health Nurses Include in Their Documentation.

BACKGROUND: Documentation of mental health care is a critical component of nursing practice. Despite being identified as playing a critical role, researchers continue to question the quality of nursing documentation and missing and/or inaccurate information. PURPOSE: Our aim is to explore the content of nursing documentation among mental health nurses providing care to forensic inpatients. METHODS: Using a constructed semi-grounded emergent theme approach for data analysis, we reviewed the types of activities, subjects, and interactions described within nursing notes and identified themes of the content. RESULTS: Our results demonstrate that nursing documentation could be categorized into one of seven themes: interactions, food, activities, sleep, mental health, physical health and hygiene. These areas were not consistent with the recommendations from nursing bodies in Canada, specifically the areas of assessment, planning, implementation, and evaluation. Furthermore, missing in the nursing notes is context. CONCLUSIONS: The discussion highlights the importance of nursing documentation within the context of best practice, bias, and the impact on patient care. We also discuss missing information (context, clinical relevance, and case conceptualization), and suggest that nurses are not injecting this expertise in patient notes. Clinical implications for documentation practices are presented in relation to education and reflective practice.

An analysis of documentation language and word choice among forensic mental health nurses.

Documenting patient care is an important part of mental health services. The documentation is expected to be accurate, relevant, and informative for all future readers as it provides details about patients and the care they are receiving. Language can produce positive or negative emotions in individuals, and these emotions can influence their thoughts and actions. Considering this, nursing documentation can impact the future care of patients. In this study, our aim was to analyse the language and words nurses use when documenting about their patients. Through a qualitative review of notes transcribed by mental health nurses in a forensic setting (n = 55), we explored the adjectives and verbs used across a subsection of their documentation over a three-month period. More specifically, we identified the most common words used, looked for patterns in use, and examined the emotional weight - or valence - of word choice. Examination of valence scores of the adjectives and verbs in the notes indicates that while nurses describe their patients in a rather neutral manner overall, some words and phrases are ambiguous and/or repetitive, and have the potential to negatively influence the perceptions of the reader regarding the patient. Clinical implications of patient care are discussed in the context of bias management. Nurses need to consider how word choice is linked to negative prosody and the need to provide additional information to avoid ambiguity. Without such care, notes can be subject to misinterpretation by readers leading to undue labels, stigma, and bias.

How forensic mental health nurses' perspectives of their patients can bias healthcare: A qualitative review of nursing documentation.

AIMS AND OBJECTIVES: Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. BACKGROUND: Clinicians are responsible to document and record accurately. However, nurses' attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients' care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. DESIGN: This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. METHODS: We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. RESULTS: The results highlight some evidence of nurses' empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. CONCLUSIONS: When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. RELEVANCE TO CLINICAL PRACTICE: Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation.

Staff and patient accounts of PRN medication administration and non-pharmacological interventions for anxiety.

Most psychiatric inpatients will receive psychotropic PRN medication during their hospital stay for agitation, anxiety, and/or insomnia. While helpful in some cases, caution is warranted with regard to PRN use due to inherent risks of additional medication; therefore, experts advise that non-pharmacological interventions should be attempted first where indicated. However, research to date highlights that, in practice, non-pharmaceutical approaches are attempted in a minority of cases. While some information is known about the practice of PRN administration and the use of and barriers to implementing non-pharmacological interventions for treating acute psychiatric symptoms, full understanding of this practice is hampered by poor or altogether missing documentation of the process. This study used interviews with patients and staff from two psychiatric hospitals to collect first-person accounts of administering PRN medication for anxiety, thereby addressing the limitations of relying on documented notation found in previous research. Our results indicate that nurses are engaging in non-pharmacological interventions more often than had previously been captured in research. However, the types of strategies suggested are not typically evidence based and further, only happening approximately half the time. The barriers to providing such care are centred on two main beliefs about client choice and efficacy of these non-medical strategies. Implications for research and practice are discussed.

Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health records compared with paper charts and verbal reports.

AIMS AND OBJECTIVES: To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. BACKGROUND: The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552) and considerable information missing (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker et al., 2008, J Clin Nurs, 17, 1122-1131). DESIGN: The project was a mixed-method, two-phase study that collected data from two sites. METHODS: In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. RESULTS: Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. CONCLUSIONS: We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. RELEVANCE TO CLINICAL PRACTICE: Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases.

Analysis of non-pharmacological interventions attempted prior to pro re nata medication use.

The aim of the present study was to elucidate what non-pharmacological interventions are applied by nursing staff prior to the administration of psychotropic pro re nata (PRN) medication. Best practices would instruct clinical staff to provide non-pharmacological strategies, such as de-escalation and skills coaching, as the first response to patient distress, anxiety, or agitation. Non-pharmacological strategies might be safer for patients, promote more collaborative relationships, and facilitate greater skills development for managing symptoms. The literature has highlighted that poor documentation of pre-PRN administration interventions has limited our understanding of this practice, but evidence suggests that when this information is available, non-pharmaceutical approaches are not being attempted in the majority of cases. This is troubling given that, while clinically appropriate in some instances, PRN have been subject to criticism and lack critical evidence to support their use. The current study is a continuation of our previous work, which examined the reason, frequency, documentation, and outcome (e.g. effectiveness, side-effects) of PRN medication use at our facility. A chart review was conducted to understand what happens prior to the administration of PRN medication at our facility across all inpatient units over the course of 3 months. Results support previous findings that non-pharmacological interventions are poorly documented by front-line staff and are seemingly used infrequently. The use of these interventions differs by patient presentation (e.g. agitation, insomnia), and most often include supportive measures. The findings suggest that both documentation and intervention practices of nursing staff require further investigation and adjustment to align with best practices.

Descriptive analysis of pro re nata medication use at a Canadian psychiatric hospital.

Pro re nata (PRN), a Latin phrase meaning 'as needed', is used to describe medications that might be used in specific situations, in addition to regularly-scheduled medications, such as when a patient is particularly anxious, experiencing insomnia, or suffering pain. While helpful in some circumstances, PRN are associated with an increased risk of morbidity, overuse, dependence, and polypharmacy. There is also a dearth of medical literature describing current practices and trends of PRN administration in mental health facilities, especially in Canada, and the literature that does exist is limited by poor documentation practices. Therefore, the primary objective of the current study was to understand the reason (purpose), frequency, use, documentation practices, and outcome (i.e. effectiveness, side-effects) of PRN medication use on inpatient units. Data were pulled to capture a snapshot of PRN administrations over a 3-month period, and included information related to the administration of the PRN medication, such as time of administration, type and dose of PRN medication, and prescribed indication, as well as patient-specific information. Results indicated that approximately 8200 psychotropic PRN medications were administered during the designated 3-month time period, and over 90% of patients received at least one PRN. Most of these were benzodiazepines, followed by antipsychotics. Further analyses were conducted to determine other characteristics of PRN use patterns and to provide a baseline of understanding that will inform future research to investigate the practice of PRN administration to psychiatric inpatients.

Factors influencing treatment team recommendations to review tribunals for forensic psychiatric patients.

It is the responsibility of forensic psychiatric hospitals to detain and treat patients, gradually reintegrating them into society; decisions to release patients must balance risk to the public with maintaining the least restrictive environment for patients. Little is known about the factors considered when making such decisions and whether these factors have been empirically linked to future risk of violence. The current study explores the factors predictive of forensic treatment teams' recommendations for patients under the care of the Ontario Review Board (ORB). Factors differ depending on level of security; decisions on medium secure units were influenced by the presence of active symptoms and patients' overall violence risk level and decisions made on minimum secure units were influenced by the number of critical incidents that occurred within the recommendation year. Understanding the factors used to make recommendations to the ORB tribunal helps treatment teams to reflect on their own decision-making practices. Furthermore, the results serve to inform us about factors that influence length of stay for forensic psychiatric patients. Copyright © 2016 John Wiley & Sons, Ltd.

Psychopathy and deception detection.

Researchers have found that most people have difficulty detecting deception; however, certain individuals are able to consistently detect deception above the level of chance. This study examined whether psychopathic traits are related to deception detection. Undergraduate participants (n = 117) indicated whether individuals in video clips were lying or telling the truth and completed a measure of psychopathy. Overall, participants' performance was significantly greater than chance. Scores on the psychopathy measure were unrelated to participants' performance and their confidence on the lie detection task. Possible explanations for the findings are briefly discussed.

Measuring hope: is hope related to criminal behaviour in offenders?

In contrast to growing regard for the psychological construct of hope in medical and psychological arenas, hope has not yet found a permanent place in the field of criminology. Traditionally, treatment programs and risk assessment tools have focused on the deficits that criminal offenders possess. However, the orientation of our approach to corrections has recently shifted to embrace more strengths-based, offender-focused programming designed to rehabilitate offenders. The assessment for risk for recidivism has been slower to make this transition and use research supporting the use of more dynamic risk factors for reducing reoffending. This study investigates the nature of hope in offenders in relation to their risk for future criminal behaviour. The results indicate that hope is indeed related to the risk for reoffending. The information obtained through this research will inform researchers and clinicians about the nature of hope in a correctional population and its relation with risk for future criminal behaviour.

Long-term cognitive outcome in moderate to severe traumatic brain injury: a meta-analysis examining timed and untimed tests at 1 and 4.5 or more years after injury.

OBJECTIVES: To examine long-term outcome of moderate to severe traumatic brain injury (TBI) on timed and untimed cognitive tests using meta-analysis. DESIGN: Meta-analysis examining outcome at 2 epochs, 6 to 18 months postinjury (epoch 1) and 4.5 to 11 years postinjury (epoch 2). SETTING: Data source was published articles (1966-2007) identified through electronic and manual search. PARTICIPANTS: A total of 1380 subjects with moderate to severe TBI participated in the 16 studies meeting inclusion criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Timed and untimed neuropsychologic tests with quantitative results (means, SDs, t, and df tests) from studies containing a healthy comparison group and a mean time since injury falling within 1 of the 2 epochs. RESULTS: Patient versus control weighted effect sizes were medium to large at epoch 1 for both untimed tasks (r=-.46; confidence interval [CI], -.32 to -.65) and timed tasks (r=-.46; CI, -.35 to -.59). At epoch 2, effect sizes were slightly smaller for untimed tasks (r=-.38; CI, -.25 to -.60) and timed tasks (r=-.40; CI, -.32 to -.62). CONCLUSIONS: Patients showed robust, persisting impairments on both timed and untimed tests at recovery plateau (ie, 6-18mo postinjury) and many years later. These findings converge with previous studies, though using an alternative approach that obviates some of the methodologic problems of longitudinal studies, such as selective attrition.

Serotonin2A receptor binding potential in people with aggressive and violent behaviour.

OBJECTIVE: Indexes of brain serotonin2A (5-HT2A) density have never been investigated in a sample of humans with violent aggressive behaviour unbiased by medication use or current axis I psychiatric disorders. The objective of this study was to investigate prefrontal cortex 5-HT2A binding potential (BPND), an index of 5-HT2A density, in an unbiased sample of people with violent aggressive behaviour. METHODS: We used [18F] setoperone positron emission tomography to measure 5-HT2A BPND in the dorsolateral prefrontal cortex (primarily sampling Brodmann area 9) in 16 participants with violent aggressive behaviour and 16 healthy control participants. RESULTS: In people with violent aggressive behaviours, the slope of 5-HT2A BPND decline in the dorsolateral prefrontal cortex is 44% less than in healthy control participants (analysis of variance group by age interaction, p = 0.004). Prefrontal cortex 5-HT2A BPND was significantly lower in participants with more severe impulsivity and aggression (multiple linear regression with age and Barratt Impulsivity Scale [BIS] as predictor variables and regional 5-HT2A BPND as dependent variable; effect of BIS, dorsolateral prefrontal cortex: F1,13 = 7.95, p = 0.014). CONCLUSION: Lower prefrontal 5-HT2A BPND is related to violent aggression. Lower 5-HT2A BPND occurs at a younger age, when violent behaviour is more frequent, and is more prominent when impulsivity and aggression are more severe.

Elevated putamen D(2) receptor binding potential in major depression with motor retardation: an [11C]raclopride positron emission tomography study.

OBJECTIVE: Several antidepressants raise striatal dopamine, but the role of striatal dopamine during major depressive episodes is unclear. Striatal [(11)C]raclopride binding potential measured with positron emission tomography is an index of D(2) type receptors and is sensitive to extracellular dopamine levels (higher D(2) binding potential occurs when dopamine is lower). It was hypothesized that putamen D(2) binding potential would be higher during major depressive episodes featuring motor retardation. METHOD: Drug-free, nonsmoking subjects experiencing a major depressive episode (N=21) underwent [(11)C]raclopride PET imaging as did 21 healthy age-matched comparison subjects. Motor retardation was measured with the finger tapping test. RESULTS: The depressed subjects exhibiting motor retardation had significantly higher D(2) binding potential in both the left and right putamen than did healthy subjects, and putamen D(2) binding potential correlated significantly with motor speed in the depressed subjects. CONCLUSIONS: The results argue that extracellular dopamine is lower in subjects experiencing a major depressive episode that features motor retardation. This depression subtype should preferentially benefit from dopamine-increasing medications and should be targeted in future clinical trials of dopamine reuptake inhibitors.