Psychoeducation group facilitation training for nurses: A quality improvement project.

BACKGROUND: According to the 2020-2021 National Survey of Children's Health, 23.3% of children and adolescents met criteria for one or more mental, emotional, developmental, or behavioral problems. However, the prevalence of depression, anxiety, and post traumatic stress disorder have risen dramatically since the COVID-19 pandemic, leading to an increase in suicidal ideations, completed suicides, and pediatric psychiatric hospitalizations. There is a critical need for high quality mental healthcare treatments, including psychoeducation. Inpatient psychiatric nurses are well positioned to lead psychoeducation groups, but few receive training. LOCAL PROBLEM: Nurses at a designated inpatient pediatric psychiatric unit expressed discomfort in facilitating psychoeducation groups. METHODS: This is a one-group prepost and follow-up quality improvement study designed to improve the quality of psychoeducation group facilitation skills provided by nurses at a child and adolescent inpatient psychiatric unit. A convenience sample of nurses (N = 16) participated. Baseline (T1), post-test (T2), and follow-up (T3) data were collected regarding nurses' self-efficacy, evidence based-practice attitudes, and knowledge of psychoeducation group facilitation. INTERVENTIONS: Nurses received 45 min of psychoeducation group facilitation education and 15 min of skills simulation. RESULTS: The nurses' knowledge, self-efficacy, and attitudes toward evidence-based practice when facilitating psychoeducation groups increased significantly from the baseline to the post-test, which was sustained from the post-test to the follow-up period. CONCLUSION: Study findings indicate the importance of supporting nurses in their role of psychoeducation group facilitation through education and program structure. Further research is needed to assess longer term sustainability and efficacy in leading psychoeducation groups.

Design of a nursing psychoeducation program to reduce preoperative anxiety in adults.

Introduction: Preoperative anxiety, with its multifactorial origins, affects a wide range of surgical patients, leading to adverse physiological and psychological effects in the perioperative period. Customized, autonomous nursing interventions are needed to address individual person needs. The shift toward outpatient surgery emphasizes the need for restructured nursing approaches. Existing literature suggests that preoperative nursing consultations offer opportunities for assessing needs, providing information, and prescribing anxiety-reduction strategies. Psychoeducation, a specialized skill within mental health and psychiatric nursing, has proven effective in alleviating preoperative anxiety and reducing postoperative complications. The aim is to obtain and analyze the information reflecting nurses' understanding of the design, structure, and operationalization of a psychoeducation program to reduce preoperative anxiety in adults. Methods: A qualitative, exploratory, descriptive study was conducted. Data were collected through a 90-min focus group session held online via Zoom Meetings videoconferencing platform. Inclusion criteria for the participant's selection were established. The focus group was guided to deliberate on potential strategies for crafting effective psychoeducational interventions. Data collection ceased upon reaching theoretical saturation and gathered information was submitted for content analysis. Ethical procedures were ensured. Results: Of the participants, 10 were specialist nurses (7 working in mental health and psychiatric nursing and the remaining in medical-surgical nursing), with an average age of 41 and an average of 15 years working in surgical services. The nurses selected the target population, the structure and content of the psychoeducation sessions, and the resources and addressed the perceived importance, effectiveness, and feasibility of the designed psychoeducation program. Discussion: The study revealed the nurses' understanding of the design of a psychoeducation program potentially effective in reducing preoperative anxiety in adults, in an outpatient surgery context. This result will allow the transfer of the produced knowledge to nurses' professional practice reflecting lower levels of anxiety and promoting a better surgical recovery. This is an unprecedented study conducted in Portugal, adding substantial knowledge to the nursing discipline. However, further research into implementing psychoeducation in a surgical context is suggested aiming to consolidate the results of research already carried out internationally.

[The contribution of a mental health patient trainer to carers]. / L'apport d'une patiente-formatrice en santé mentale auprès des soignants.

As peer support becomes more professional, it is becoming increasingly recognised and diversified. When a mental health patient-trainer works with psychiatric carers, the latter gain a better understanding of the patient's point of view. In addition, valuing their experiential knowledge can support peer helpers in their recovery. However, we mustn't forget that these are fragile people and that their past can come back to haunt them if they are not careful. Testimonial.

Under Prepared for Practice: A Qualitative Study of Mental Health Nurse Undergraduate Workforce Preparation in Australia.

Internationally there are both current and looming mental health workforce shortages. Mental health nurses who have received specialist education are a vital component to respond to these challenges. AIM: This qualitative study aimed to better understand the efficacy and product quality of mental health nurse workforce preparation through pre-registration nurse education in Australia. METHOD: To meet this aim 19 educators representing 13 different universities were qualitatively interviewed. RESULTS: Thematic analysis found four themes (1) Graduates are under-prepared for safe mental health nurse practice; (2) Essential mental health nurse capabilities are missing in graduates; (3) Barriers to graduate preparation, and (4) Negative impacts of inadequate graduate preparation. DISCUSSION: Findings from this study suggest future workforce shortages would be best addressed through direct undergraduate entry for mental health nursing Implications for Practice: All nurse undergraduate training needs significantly enhanced mental health theory and placement within the course.

Exploring Undergraduate Nursing Students' Preferences in Psychiatric Nursing Simulation Modalities.

BACKGROUND: The use of high-fidelity simulators (manikins) and standardized patients (SPs) in simulation has been incorporated into many nursing schools throughout the nation to augment the clinical rotation experience. There is little to no data available on comparing undergraduate students' preferences between SPs and manikins in psychiatric nursing. METHODS: A quantitative descriptive exploratory design was used to evaluate pre-licensure nursing students' preferences in both traditional 4-year Bachelor of Science in Nursing (BSN) and accelerated BSN programs (ABSN). RESULTS: Overall, students preferred having an SP over a manikin to learn how to properly perform a nursing assessment on a psychiatric patient. CONCLUSIONS: Standardized patients offer a more realistic experience when assessing various domains of the mental status examination and when practicing therapeutic communication techniques in psychiatric nursing. The growth of SP training programs should be fostered. Well-trained SPs are an asset to simulation, especially in psychiatric nursing.

Nursing students' experience of approaching risk for suicide behaviour through simulated environments: A content analysis study.

BACKGROUND: Suicide is a major public health problem, especially among the young population. Nurses are in a unique position to prevent it due to their constant contact with patients. However, addressing suicidal behaviour can be complicated by the emotional responses it elicits. Simulation has been shown to be an effective tool to increase the self-confidence of nursing students in dealing with these sensitive situations in a safe environment prior to dealing with real patients. AIM: To explore nursing students' perceptions, thoughts, and emotions about their performance in dealing with risk for suicidal behaviour through simulated scenarios. DESIGN: Qualitative descriptive study. METHODS: Students of Mental Health and Psychiatric II in the third year of the Nursing course at the University of Málaga were invited to explain their experience by answering a questionnaire of three open-ended questions following their participation in the simulated scenarios of the course. RESULTS: A total of 72 students participated. Content analysis of the written responses identified three main themes: (i) Emotions experienced during the simulation; (ii) Self-criticism of the performance/intervention; (iii) Student evaluation of the learning experience. Most of the students indicated at some point during the clinical scenario, they had felt anxiety, proposing possible improvements in their own performance. The clinical scenario that elicited the most negative emotions was that of a person diagnosed with borderline personality disorder. CONCLUSION: Clinical simulations contribute to a better understanding of nursing practice with mental health patients and the need for training in emotional and therapeutic communication skills among students.

Psychiatric nurse and educator perspectives on professional boundaries in nursing education: An interpretive description study.

BACKGROUND: Psychiatric nurses are responsible for maintaining professional boundaries. However, professional boundaries are as described as unclear and psychiatric nursing students are at risk of crossing these boundaries. Educational instruction regarding professional boundaries within psychiatric nursing often lacks foundational structure placing students at risk of transgressions. PURPOSE: The purpose of the study was to describe boundaries in psychiatric nursing practice, identify strategies effective in teaching professional boundaries, and inform curriculum development in psychiatric nursing education. METHOD: Interpretive description was utilized to answer: How do psychiatric nurse educators interpret and explain professional boundaries in psychiatric nursing undergraduate education? Psychiatric nurse educators and psychiatric nurses were recruited from an academic institution in western Canada. Twenty participants engaged in semi-structured interviews. Eight of those participants also attended a focus group. RESULT: Participants reported that 'textbook' definitions of boundaries were insufficient in illustrating the complexities of the construct. Rather, relational forms of learning such as educators sharing clinical stories, role play activities, clinical supervision, and clinical debriefing were described as helpful strategies. CONCLUSION: Foundational knowledge regarding professional boundaries in psychiatric nursing practice appears to be incorporated in the formal curriculum. However, learning is enhanced through the informal and hidden curriculum.

[Initiation to patient partnership in mental health and psychiatry from initial training onwards]. / Initiation dès la formation initiale au partenariat patient en santé mentale et psychiatrie.

Introducing patient partnership in mental health and psychiatry to initial training is an innovative way of promoting recovery, while at the same time highlighting the undeniable contribution of peer support within healthcare teams, in order to accompany the people concerned. This is why Croix-Rouge Compétence Auvergne-Rhône-Alpes is developing a specific training program for trainees.

Decreasing Prejudicial Attitudes of Fear and Avoidance Toward Those Who Live with a Mental Illness-A Quasi-Experimental Controlled Study.

The undergraduate mental health nursing course is an optimal time to address stigma and prejudice, while developing positive student attitudes toward those who live with mental health conditions. A quasi-experimental, pretest-posttest, nonequivalent-group study with a sample of undergraduate nursing students in New York City (N = 126) was conducted to determine the impact of an undergraduate mental health nursing course on attitudes toward people living with a general mental illness, depression, or schizophrenia. The intervention resulted in a significant reduction in total prejudice scores toward those with a general mental illness when compared to the control (p = 0.033, partial η2 = 0.062). The intervention had no significant impact on total prejudice scores regarding those with depression, or schizophrenia. Subscale analysis revealed the intervention significantly reduced attitudes of fear/avoidance regarding general mental illness (p = 0.040, partial η2 = 0.058) and schizophrenia (p < 0.001, partial η2 = 0.164). There was no impact on authoritarian or malevolent attitudes. Though some attitudes were not amenable to change, this study provides evidence that positive attitudes can be cultivated through undergraduate nursing education. Curricular reform is needed to reduce all facets of prejudice and best prepare future nurses to care for those with mental health conditions.

Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study.

PURPOSE: Virtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students. METHODS: A quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions. RESULTS: The self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = -2.62, p = 0.011), violence risk management (t = -3.42, p = 0.001), and nurse-patient interaction (t = -3.12, p = 0.003). CONCLUSIONS: The findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

Consumers' Experiences of Comprehensive-Prepared Graduate Nurses and Their Nursing Care in Acute Mental Health Settings.

Pre-registration nursing education has long moved away from preparing nurses with mental health specialisation to nurses with comprehensive knowledge and skills. However, the consumers' experiences of comprehensive-prepared nurses and their nursing care has not been widely explored. This paper reports on a study with consumers to explore their experiences with comprehensive-prepared graduate nurses and the nursing care that they provide in acute mental health settings. An exploratory qualitative study using semi-structured interviews was chosen as the research method. Purposeful sampling recruited 12 consumers and data saturation was achieved. Braun and Clarke's method of thematic analysis was used to analyse the collected data and three themes emerged. The themes are: (i) You got what it takes to be a mental health nurse, (ii) Slow down and spend quality time with us, and (iii) Read in between the lines when we share our negative lived experiences. The findings are useful for identifying strategies to develop evidence-based nursing education for comprehensive-prepared graduate nurses to improve the consumers' experiences of their nursing care.

Identifying Competencies of the ACT Program Nurse Using the DACUM Method.

The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.

Academic Electronic Health Record in Mental Health Clinical: A Quality Review.

Developing competency in the use of EHRs is essential for entry-level professional nurses. Although nursing education has been encouraged to integrate this technology into nursing curriculum, many students still graduate feeling unprepared in this area. As a result, nursing graduates lack the skills necessary to effectively use EHRs, which may have negative consequences for safe patient care. Use of academic EMRs provides students the opportunity to integrate informatics education, develop critical thinking, and incorporate problem-solving skills in the clinical area. An academic EMR was introduced to students in the second semester of a baccalaureate degree nursing program. Students completed documentation on one patient from the mental health clinical rotation. A retrospective chart review was conducted, using a rubric to determine charting efficacy. Data analysis indicated that students struggled with documentation of the mental health assessment, care plan development, and nursing notes. Student documentation was strongest in vital signs and basic information. Students need practice documenting on the critical aspects of nursing care. Utilization of an academic EMR for clinical charting provides an opportunity for students to practice documentation and develop necessary skills for clinical practice.

A mixed-method evaluation of peer-led education about attitudes towards consumers' recovery among Mental Health Nurses working in acute inpatient psychiatric units.

Despite integrating the recovery model of care in mental health, mental health professionals still have pessimistic attitudes towards the recovery of people with mental illness. Positive attitudes towards recovery are essential components to integrate recovery-oriented practices in all areas of mental health. Evidence shows that education and training are effective while emphasising the importance of consumer-based interventions to enhance recovery attitudes. This study aimed to evaluate the effectiveness of peer-led education about recovery attitudes towards people with mental illness among Mental Health Nurses working in acute inpatient settings. The methodology used was a sequential explanatory mixed method with pre- and post-test design involving three phases. Phase 1: survey (n = 103), phase 2: post-test survey immediate (n = 17) and follow-up (n = 11) and phase 3: in-depth interviews (n = 12). The results show that Mental Health Nurses have positive recovery attitudes with some room for improvement. Most participants agreed with all items of the Recovery Attitudes Questionnaire. However, the participants had various views on the relationship between faith and recovery. The peer-led education significantly improved RAQ items 1, 2, 3, 4 and 6 statistically. Furthermore, peer-led education effectively enhanced recovery attitudes immediately after the intervention and helped to maintain sustainable attitudes 3 months later. A qualitative exploration of recovery attitudes revealed three main themes: participants' reflections, recovery hurdles and interpersonal relationships.

Advancing Behavioral Health Equity Through Telehealth and Remote Training of Newly Certified Psychiatric-Mental Health Nurse Practitioners.

PURPOSE: Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric-mental health nurse practitioners (PMHNPs). METHOD: The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. RESULTS: In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. CONCLUSION: Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 19-24.].

A model for the involvement of service users as instructors into the psychiatric nursing curriculum in Korea: A qualitative study on participation experience.

For many years, attempts have been made to incorporate service users into psychiatric nursing education, particularly in European countries and Australia. In Asian countries, however, concrete examples of this are notably scarce, and the limited instances of implementation lack the necessary systematic organisation and long-term sustainability. This study systematically planned and implemented a psychiatric nursing curriculum that integrated service users in Korea. It explored the experiences of 14 nursing students and four service users (who participated as instructors) who participated in these classes. Content analysis was performed on the results of focus group interviews with the participants. Owing to the participation of service users in the programme, students focused more on the patients as human beings, with the contexts of their individual lives, rather than on their diseases. The process facilitated a deeper grasp of person-centred psychiatric nursing and heightened student engagement in the learning process. The service users' experiences as instructors breathed new meaning into their psychiatric distress as an opportunity for new possibilities and helped them view themselves in a positive light, as members of society with self-esteem. They made great efforts to perform well in their role as instructors. These findings provide substantial evidence to support the expanded and sustained implementation of service user participation in future psychiatric nursing education. Establishing a national consortium to foster and support service user instructors could greatly improve psychiatric nursing education and related outcomes.

A job analysis of mental health nursing in a school for students with intellectual and developmental disabilities.

While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self-reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant-participator in a single-case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health.

An evaluation of a trauma-informed educational intervention to enhance therapeutic engagement and reduce coercive practices in a child and adolescent inpatient mental health unit.

High-risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re-traumatisation of young people and deteriorating therapeutic relationships. Trauma-informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma-informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma-informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma-informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma-informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma-informed practice is crucial to recovery-focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people.

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study.

INTRODUCTION: Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. AIM: This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. METHOD: An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. RESULTS: The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. DISCUSSION: MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. IMPLICATIONS FOR MENTAL HEALTH NURSING: According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia.

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.