Work engagement of psychiatric nurses: a scoping review.

OBJECTIVES: Work engagement is an essential factor in improving employee performance. However, no reviews on the work engagement of psychiatric nurses have been conducted to date. This study aimed to examine the current status of research on the work engagement of psychiatric nurses and identify salient factors. DESIGN: A scoping review. METHODS: This review adhered to the established scoping review methodological guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist. The inclusion criteria were based on nurses, work engagement and psychiatric settings without language or date restrictions. Regardless of the methodology or study design, research studies related to the work engagement of psychiatric nurses have been included. A systematic search was conducted in MEDLINE, CINAHL and PsycINFO from the inception of each database, with the search strategies being set by an information specialist. The deadline for the search was 15 February 2023. RESULTS: The study included 12 studies. All studies have been published since 2013. The study designs included cross-sectional (n=10), longitudinal (n=1) and intervention (n=1) studies. The impacts of work engagement were classified into (1) attitudes towards patients, (2) attitudes towards work, (3) mental health and (4) quality of care. Factors influencing work engagement were classified into (1) demographics, (2) workplace factors, (3) individual factors and (4) patient factors. CONCLUSION: Work engagement of psychiatric nurses has lately gained attention, although data are limited because most studies used a cross-sectional design. Psychiatric nurses with higher work engagement showed positive outcomes. Workplace and individual factors can potentially improve their work engagement. The findings can assist nursing managers in enhancing psychiatric nurses' work engagement and, consequently, their performance.

Exploring Psychiatric Home-Visit Nursing Practices for Patients with Schizophrenia and Hikikomori with a Thematic Analysis.

The phenomenon of some patients with schizophrenia withdrawing and becoming hikikomori needs to be resolved. In some countries, outreach methods are being employed. In Japan, psychiatric home-visit nursing for patients with schizophrenia and hikikomori is being implemented. However, it is not based on sufficient evidence and relies on the experience and intuition of individual nurses. This study explored the underlying themes in the nursing practices of psychiatric home-visit nurses via semi-structured interviews with 10 nurses and a thematic analysis. Nine key themes emerged. Four themes-(i) understanding the patient's world, (ii) supporting the patients as they are, (iii) providing a sense of relief, and (iv) having equal relationships-highlighted the nurses' commitment to respecting patients' individuality while building and sustaining relationships. Two themes-(v) exploring the right timing and (vi) waiting for the appropriate timing-illustrated the nurses' anticipation of proactive patient engagement. Finally, three themes-(vii) working together on things, (viii) continuing care for expanding the patient's world, and (ix) nursing care for the patient's future-underscored the nurses' gradual and methodical approach to working alongside patients. Nursing practices based on these nine themes cultivated meaningful relationships and secured a sense of relief for the patients. Additionally, they awaited patients' proactive engagement and delivered timely support to facilitate positive daily life changes. These findings contribute to the establishment of evidence-based nursing practices for patients with schizophrenia and hikikomori.

Individual Nurse-Led Active Listening Intervention for Spouses of Individuals With Depression: A Pre-/Posttest Pilot Study.

The current pre-/posttest pilot study investigated the impact of an individual nurse-led active listening intervention for spouses of individuals with depression (herein referred to as patients) on spouses' psychological states and patients' depressive symptoms. Sixteen couples participated in the study. Individual sessions were conducted over 10 weeks to help spouses express their thoughts and feelings. Psychological measurement scale scores did not change markedly postintervention for spouses; however, their subjective evaluations of the intervention were positive. In the qualitative analysis, spouses stated that they were able to express their thoughts and feelings and that the sessions were meaningful. Moreover, postintervention depressive scores of patients improved significantly. Findings suggest that the nurse-led intervention of active listening for spouses may provide a better environment for improving the depressive symptoms of patients. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 19-25.].

Work engagement of psychiatric nurses: a scoping review protocol.

INTRODUCTION: Psychiatric nurses face various stressors related to nurse-patient relationships, workplace interpersonal relationships and organisational problems, and are required to perform excellent work under stressful situations. As work engagement (a counterconcept of burnout) is a key factor that improves the performance of nurses, clarifying how to improve work engagement is an essential topic among researchers. Although some knowledge has been accumulated on the subject, no reviews have been conducted on the work engagement of psychiatric nurses. To fill the gap, this scoping review will examine the status of research activity on the work engagement of psychiatric nurses and identify related factors, consequently mapping the available research in this area. METHODS AND ANALYSIS: The review will be conducted according to established scoping review methodological guidelines. The inclusion criteria will be based on nurses (participants), work engagement (concept), and psychiatric settings (context) without language or date restrictions. Regardless of the methodology or study design, research related to the work engagement of psychiatric nurses will be included. A systematic search will be conducted for MEDLINE, CINAHL and PsycINFO, with the searches being arranged by an information specialist through discussion. The first author will screen all potentially relevant publications, and the second author will independently screen a random sample comprising 10% of the manuscripts. Any disagreement will be resolved by a review team. Data will be extracted using a standardised extraction form, subsequently summarised through quantitative (frequencies) and qualitative analyses (narrative synthesis), and reported in the results of the review. ETHICS AND DISSEMINATION: As the data will be collected from existing literature, ethical approval is not required. The findings will be disseminated through conference presentations and publication in a peer-reviewed journal. They are expected to help researchers enhance psychiatric nurses' work engagement, consequently contributing to improving their performance.

Associations between psychiatric home-visit nursing staff's exposure to violence and conditions of visit to community-living individuals with mental illness.

AIM: Psychiatric home-visit nursing is key for providing medical services to community-living individuals with mental illness in Japan. However, little is known about factors associated with encountering violent incidents among psychiatric home-visit nursing staff during visits. This cross-sectional study examined associations between staff's exposure to violence and their visit conditions reflecting characteristics of individuals with mental illness. METHODS: Psychiatric home-visit nursing staff members completed a questionnaire regarding their exposure to violence during the past 12 months and their visits to individuals with 23 characteristics, comprising static (13 items; e.g., psychiatric diagnosis) and dynamic factors (10 items; e.g., hostility/anger). RESULTS: Forty (16.3%) of the 246 participants had experienced violence. Visits to individuals with four static factors (psychiatric diagnoses, i.e., Disorders of Adult Personality and Behavior or Mental Retardation, alcohol/drug abuse with psychiatric diagnoses, and history of violent behavior), and nine dynamic factors were significantly and positively associated with participants' violent experiences. In addition, regarding the static factors of Disorders of Adult Personality and Behavior and history of violent behavior, it was found that overlapping of specific dynamic factors (e.g. hostility/anger) were significantly associated with violent experiences. CONCLUSIONS: For visits with limited information on individuals (e.g., initial visits), having information on their static factors could help prevent violence. Additionally, it is important to create educational programs for psychiatric home-visit nursing staff to detect the status of individuals' dynamic factors, and a system to share any related changes in timely fashion.

Testing the relationship between patient-related stressor, psychological distress, work engagement, job satisfaction and recovery attitude among psychiatric nurses in Japan.

AIMS: To test the relationship between patient-related stressor, psychological distress, work engagement and outcomes (job satisfaction and recovery attitude) among psychiatric nurses in Japan. Specifically, we tested the following hypotheses: psychological distress mediates the relationship between patient-related stressor and outcomes and work engagement moderates the direct and indirect effects of patient-related stressor on outcomes. DESIGN: Cross-sectional study. METHODS: In total, 446 psychiatric nurses in Japan responded to a self-reported questionnaire between August and October 2018. Data on demographics, patient-related stressor, job satisfaction, recovery attitude, psychological distress and work engagement were collected, followed by a moderated mediation analysis using hierarchical regression and structural equation modeling (SEM). RESULTS: Regression analysis indicated that psychological distress mediated the negative relationship between patient-related stressor and job satisfaction and that work engagement moderated the direct and indirect effects of patient-related stressor on job satisfaction. In particular, the higher the work engagement, the higher the indirect effect, but the lower the direct effect. Additionally, no mediation of psychological distress and moderation of work engagement was observed in the relationship between patient-related stressor and recovery attitude; however, work engagement directly increased recovery attitude. Results of the SEM test showed a satisfactory fit of the final model. CONCLUSIONS: Work engagement facilitates recovery attitude and increases the indirect effect of patient-related stressor on job satisfaction through psychological distress. However, work engagement decreases the direct effect not mediated by psychological distress. IMPACT: This study addresses an essential topic, that is, psychiatric nurse job outcomes (job satisfaction and recovery attitude) are negatively influenced by patient-related stressor. Work engagement has multiple beneficial effects on outcomes as both a facilitator and moderator; thus, programs that improve work engagement are useful for psychiatric nurses. Furthermore, programs may be enhanced considering that work engagement decreases the direct effect of patient-related stressor on job satisfaction.

Association between sleep, care burden, and related factors among family caregivers at home.

AIM: Several studies have reported a negative correlation between depressive symptoms and family caregivers' (FCs) subjective sleep status. However, there is a paucity of information on the association between objective/subjective sleep status, care burden, and related factors. METHODS: Participants were 23 pairs of care receivers (CRs; Mage = 82.7 ± 8.5 years; 69.6% women) receiving long-term care at home and their FCs (Mage = 66.9 ± 11.0 years; 69.6% women). At baseline, demographic data, subjective sleep status (Pittsburgh Sleep Quality Index; PSQI), WHO-5 well-being, depressive mood, and frequency of going outdoors were collected. FCs wore a small, wrist-worn device with an accelerometer to assess objective sleep status for a consecutive 24-h 2-week period, and they answered the Zarit Burden Interview short version (ZBI) every night before sleep. After 3 months, CR status was collected and analysed retrospectively. RESULTS: The mean total sleep time over 2 weeks was 349.5 ± 69.6 min. The mean ZBI score over 2 weeks was 8.8 ± 6.8, which was significantly correlated with total sleep time (r = -0.42; P < 0.05), total time in bed (r = -0.44; P < 0.05), PSQI (r = 0.62; P < 0.01), frequency of going outdoors by CRs (r = -0.42; P < 0.05), and WHO-5 well-being among CRs (r = -0.50; P < 0.05). Multiple regression analyses revealed that total sleep time (ß = -0.51; P < 0.05) was significantly associated with care burden (adjusted R2 = 0.45). At the 3-month follow-up, four CRs had been hospitalised or died, and their FCs displayed significantly severe care burden and slept less than at baseline. CONCLUSIONS: Reduced objective total sleep time is significantly associated with the severity of care burden among FCs. Home-based care is critical in Japan; therefore, it is meaningful to determine how to reduce care burden.

Effects of Home-visit Occupational Therapy Using a Management Tool for Daily Life Performance on Severe Mental Illness: A Multicenter Randomized Controlled Trial.

AIM: Effective intervention is necessary for improving the social functioning of patients with severe mental illness (SMI). We examined the effects of home-visit occupational therapy (OT) using a Management Tool for Daily Life Performance (MTDLP) that was designed to support patients in completing their desired daily life activities. The control group were treated by home-visit OT without using MTDLP. METHOD: In this multicenter randomized controlled trial, 60 participants included adults aged 18-65 with an ICD-10 diagnosis of F2 (i.e., schizophrenia, schizotypal and delusional disorders) or F3 (i.e., mood [affective] disorders) and who utilized one of the 20 psychiatric outreach teams in Japan. Participants were randomly assigned into two groups: MTDLP (n = 29), control (n = 31). Home-visit OT was provided to both groups, once a week, for four months. A repeated-measures analysis of variance was conducted to compare changes in participants' social functioning using the Global Assessment of Functioning (GAF) and the Social Functioning Scale (SFS). RESULTS: The GAF scores of the MTDLP group improved significantly greater than those of the control group. No significant change in SFS total scores was found between the groups; however, the Employment/Occupation scores (an SFS subscale) of the MTDLP group significantly improved compared to the controls. CONCLUSION: These findings suggest that MTDLP can increase the social functioning of people with SMI more so than controls. Thus, home-visit OT using MTDLP that is intensively focused on the patient's desires and implemented in the real-world environment appears to contribute to improvements in social functioning.

Factors influencing work engagement among psychiatric nurses in Japan.

AIM: To identify the factors influencing work engagement among psychiatric nurses. BACKGROUND: Work engagement is an essential outcome that promotes nurses' performance, but studies investigating its influencing factors remain limited in psychiatric settings. We hypothesized that job resources and personal resources positively predict psychiatric nurses' work engagement and have a particularly positive impact on engagement when job demand is high. METHODS: This cross-sectional study included 425 Japanese psychiatric nurses. Data regarding demographics, job resources, personal resources (emotional intelligence), job demand (patients' attitude towards nurses) and work engagement were collected followed by data analysis using hierarchical multiple regression. RESULTS: Reward, supervisor support, nurse-physician collaboration, other-emotion appraisal and use of emotions were positively related to work engagement. Patients' unpleasant attitude towards nurses boosted the association of reward and supervisor support with work engagement. CONCLUSIONS: Certain job resources, empathic ability and self-motivation ability may enhance work engagement. Furthermore, reward and supervisor support may be particularly useful when psychiatric nurses face patients' unpleasant attitude. IMPLICATIONS FOR NURSING MANAGEMENT: For enhancing psychiatric nurses' work engagement, nursing leaders should educate nurses' skills related to empathy and self-motivation, consider whether nurses are confronted with patients' unpleasant attitude, and improve the job resources.

Experiences of Violence and Preventive Measures Among Nurses in Psychiatric and Non-Psychiatric Home Visit Nursing Services in Japan.

Home visit nurses (HVNs) are crucial in psychiatric home visit nursing (PHVN) in Japan. However, little is known about violence toward HVNs in PHVN and non-PHVN settings. The current study aimed to clarify nurses' experiences of violence in these settings, their implementation of preventive measures, and related associations. Questionnaires were distributed to HVNs who provided PHVN and non-PHVN services. Sixty-nine (38%) of 184 participants had experienced at least one form of violence during the past 12 months, and 87 (47%) had experienced violence during their PHVN career. In non-PHVN settings, violence was experienced by 94 (51%) participants in the past 12 months and 119 (65%) participants during their career. Low use of preventive measures was found. The management of visiting schedules and confirmation of HVNs' locations during visits were negatively associated with exposure to violence in PHVN settings. It is important to promote measures to prevent high exposure to violence, emphasize the monitoring of visits, and have nursing agencies clarify HVNs' concerns in PHVN settings. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 40-48.].

Text Messaging for Psychiatric Outpatients: Effect on Help-Seeking and Self-Harming Behaviors.

A mobile phone intervention was developed and tested with 30 psychiatric outpatients with mental illness, who had high ideation for suicide. The intervention involved promoting help-seeking behaviors by sending text messages, including information about social welfare services and reminders about medical appointments, for 6 months. After the intervention period, the number of participants who used social services significantly increased, and more than 80% of participants reported that the text messaging service was helpful and useful. Compared to baseline, participants' self-harming behaviors decreased and the attending psychiatrists rated their suicide ideation as weaker. This is the first intervention study to promote psychiatric patients' help-seeking using text messaging, and although it was not a randomized controlled trial, this intervention has practical value and may lead to the prevention of suicide.

Influence of aortitis on late outcomes after repair of ascending aortic aneurysms.

OBJECTIVE: To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. METHODS: We reviewed histopathologic findings and outcomes of elective repair of ascending aortic aneurysms between January 1, 1955, and December 31, 2012. Noninfectious aortitis was identified in 186 patients, and we compared outcomes for these patients with outcomes for others operated on at the same time with diagnoses of medial degeneration (n = 317) or atherosclerosis (n = 232). RESULTS: Early mortality (<30 days postoperatively) for patients with aortitis was 2%, and overall 10-year survival was 45%, compared with 66% for patients with medial degeneration, and 45% for patients with atherosclerosis (P < .001 vs medial degeneration). In addition to histopathologic diagnosis, overall mortality was influenced by older age at operation (hazard ratio [HR]: 1.060; 95% confidence interval [CI], 1.046-1.077; P < .001), chronic obstructive pulmonary disease (HR: 1.560; 95% CI: 1.136-2.136; P = .006); concomitant coronary artery bypass grafting (HR: 1.980; 95% CI: 1.520-2.600; P < .001); and use of circulatory arrest (HR: 1.500; 95% CI: 1.148-1.960; P = .003). Risk of aortic reoperation at 10 years was 21% for aortitis patients, compared with 11% for those with medial degeneration, and 19% for patients with atherosclerosis (P = .028). CONCLUSIONS: Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.

Interleukin 27 inhibits atherosclerosis via immunoregulation of macrophages in mice.

Chronic inflammation in arterial wall that is driven by immune cells and cytokines plays pivotal roles in the development of atherosclerosis. Interleukin 27 (IL-27) is a member of the IL-12 family of cytokines that consists of IL-27p28 and Epstein-Barr virus induced gene 3 (EBI3) and has anti-inflammatory properties that regulate T cell polarization and cytokine production. IL-27-deficient (Ldlr-/-Ebi3-/-) and IL-27 receptor-deficient (Ldlr-/-WSX-1-/-) Ldlr-/- mice were generated and fed with a high-cholesterol diet to induce atherosclerosis. Roles of bone marrow-derived cells in vivo and macrophages in vitro were studied using bone marrow reconstitution by transplantation and cultured peritoneal macrophages, respectively. We demonstrate that mice lacking IL-27 or IL-27 receptor are more susceptible to atherosclerosis compared with wild type due to enhanced accumulation and activation of macrophages in arterial walls. The number of circulating proinflammatory Ly6C(hi) monocytes showed no significant difference between wild-type mice and mice lacking IL-27 or IL-27 receptor. Administration of IL-27 suppressed the development of atherosclerosis in vivo and macrophage activation in vitro that was indicated by increased uptake of modified low-density lipoprotein and augmented production of proinflammatory cytokines. These findings define a novel inhibitory role for IL-27 in atherosclerosis that regulates macrophage activation in mice.

IL-27 inhibits hyperglycemia and pancreatic islet inflammation induced by streptozotocin in mice.

Inflammation driven by immune cells and pro-inflammatory cytokines is implicated in pancreatic ß-cell injury, leading to the development of diabetes mellitus. IL-27, a cytokine consisting of IL-27p28 and Epstein-Barr virus-induced gene 3 (EBI3), binds a membrane-bound heterodimeric receptor consisting of the IL-27 receptor α chain (WSX-1) and gp130. IL-27 has anti-inflammatory properties that regulate T-cell polarization and cytokine production. We evaluated blood glucose and islet proinsulin concentrations, inflammatory cell infiltration in islets, and expression of IL-1ß mRNA in pancreas in wild-type (WT), EBI3(-/-), and WSX-1(-/-) mice treated with streptozotocin (STZ). Hyperglycemia was augmented in EBI3(-/-) and WSX-1(-/-) mice compared with WT mice. Islet proinsulin levels after STZ treatment were lower in EBI3(-/-) and WSX-1(-/-) mice than in WT mice. The infiltration of islets by F4/80(+)CD11c(-)7/4(-) macrophages, CD4(+) T cells, and CD8(+) T cells was increased in EBI3(-/-) and WSX-1(-/-) mice compared with WT mice. The administration of recombinant IL-27, compared with control, decreased the blood glucose level, immune cell infiltration into islets, and IL-1ß mRNA expression in the pancreas and increased islet proinsulin levels in WT and EBI3(-/-) mice. Thus, IL-27 inhibits STZ-induced hyperglycemia and pancreatic islet inflammation in mice and represents a potential novel therapeutic approach for ß-cell protection in diabetes.

Seminolipid and its precursor/degradative product, galactosylalkylacylglycerol, in the testis of saposin A- and prosaposin-deficient mice.

Sphingolipid activator proteins (saposins A, B, C, and D) are derived from a common precursor protein (prosaposin) and specifically activate in vivo degradation of glycolipids with short carbohydrate chains. A mouse model of prosaposin deficiency (prosaposin-/-) closely mimics the human disease with an elevation of multiple glycolipids. The recently developed saposin A-/- mice showed a chronic form of globoid cell leukodystrophy, establishing the essential in vivo role of saposin A as an activator for galactosylceramidase to degrade galactosylceramide. Seminolipid, the principal glycolipid in spermatozoa, and its precursor/degradative product, galactosylalkylacylglycerol (GalEAG), were analyzed in the testis of the two mouse mutants by electrospray ionization mass spectrometry. Saposin A-/- mice showed the normal seminolipid level, while that of prosaposin-/- mice was approximately 150% of the normal level at the terminal stage. In contrast, GalEAG increased up to 10 times in saposin A-/- mice, whereas it decreased with age in the wild-type as well as in prosaposin-/- mice. These analytical findings on the two saposin mutants may shed some light on the physiological function of seminolipid and GalEAG.

Studies on the asexual reproduction in the polystyelid ascidian, Polyzoa vesiculiphora Tokioka.

New blastozooids of Polyzoa vesiculiphora, the polysytelid ascidian are produced by pallial budding of three types depending on the method of "isolated bud" formation; stolonic, planktonic and intermediate types. Differences among each type of bud are attributed to behavior of test-vessels composing a part of the bud. Isolated buds produced by each type are essentially equal in terms of their internal structures and their subsequent fate, and develop independently of their parent zooids. New test-vessels originate directly from the epidermis of a "prefunctional zooid," while the test-vessels derived from the parent zooid finally disintegrate. The new test-vessels extended with branching under the ventral side of a "functional zooid," ascend to the lateral side of it and participate in bud formation. Budding regions exist in three dimensions on the lateral wall of the mantle of the functional zooid, especially the right posterior part. During the life cycle of one functional zooid, the stolonic type buds appear at early and/or aged stages. Appearances of the stolonic type buds in early stages tend to repress those of the planktonic types. The number of planktonic type buds formed on a functional zooid at the same time is many more than that of the stolonic type. Such budding features are discussed from the viewpoint of behavior of the test-vessel system.

The characterization of granular amoebocytes and their possible roles in the asexual reproduction of the polystyelid ascidian, Polyzoa vesiculiphora.

The blood cells in the bud and the zooid of the polystyelid ascidian, Polyzoa vesiculiphora, were examined by means of light and electron microscopy to identify the cells that have been named trophocytes. The large blood cells were abundant in the mesenchymal space of the bud, but not in that of the functional zooid. They contained glycogen particles, lipid droplets, large protein granules and autophagosomes in their cytoplasm and were identified as granular amoebocytes. The majority of these cells were specifically phagocytized by phagocytes during bud development and disappeared. These results indicate that the granular amoebocytes virtually represent trophocytes in Polyzoa and may participate in bud development via nutrient supply to the developing tissues.