"Recovery" in mental health services, now and then: A poststructuralist examination of the despotic State machine's effects.

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient-centered approaches. But as we argue in this paper, the recovery-oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as "recovery" nursing practices became more established, more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health-including forensic mental health-institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change.

Standards of proficiency for registered nurses-To what end? A critical analysis of contemporary mental health nursing within the United Kingdom context.

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of 'proficiency' in nurse education-prescribed by the regulator-impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self-determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain.

Is epistemic injustice a worthy application to mental health nurse education?

This paper explores the philosophical concept of epistemic injustice and contends its significance and relevance to mental health nurse education and clinical practice. The term epistemic injustice may be unfamiliar to mental health nurses, yet the effects are readily visible in the dismissing, silencing, and doubting of service users' knowledge, testimony, and interpretation. Existing professional values and clinical standards lack depth and critical exploration pertaining to epistemology and associated ethical concerns. Despite central tenets of person-centred care and valuing the service users' voice, epistemic injustice continues to occur. Epistemic injustice cannot be summed up merely by asking nurses to listen to service users. This represents an oversimplification of epistemology, ignoring the complexities of social influence and knowledge exchanges. Epistemic injustice brings something new and innovative to the nursing curriculum and fits within the principles of heutagogy. It encourages deep reflexivity surrounding the ethical issues of power inequalities and intersectionality. Inclusion in mental health nursing education allows for the social and political powers of psychiatric diagnosis as a form of silencing and stigma to be examined. Practical application is made to mental health nursing education and practice with epistemological values and ethical reflexive prompts. These can be utilised by educators and lecturers for pre-registration mental health nurse education, post-registration, and continued professional development.

Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit.

AIMS AND DESIGN: This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service. METHOD: Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. RESULTS: Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. CONCLUSION: The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced. IMPACT: In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.

Relationship between anxiety and quality of life among older adults with self-reported polypharmacy in long-term care: A cross-sectional study.

AIMS: To investigate the relationship between anxiety and quality of life among older adults with self-reported polypharmacy living in the long-term care setting. DESIGN: A cross-sectional design was used. METHODS: Between July 2021 and August 2022, 92 older adults living in long-term care completed an anonymous one-time questionnaire packet. Polypharmacy was measured as self-reported five or more medications daily. Anxiety was measured using the Geriatric Anxiety Scale-Long Term Care tool. Quality of life was measured as health-related quality of life using two global questions from the RAND-36 and as medication-related quality of life using the Medication-Related Quality of Life Scale. RESULTS: The prevalence of polypharmacy was 89%. Among participants with polypharmacy, average age was 80.1 ± 7.9 years. The majority were female (70%) and white (85%). There was a moderate-to-strong correlation between anxiety and quality of life. Specifically, anxiety was negatively related to current health-related quality of life, perceived change in health-related quality of life and medication-related quality of life. Overall, anxiety explained 27-31% of the variance in both health-related and medication-related quality of life. CONCLUSION: The results of this study indicate that as anxiety increases, health-related and medication-related quality of life decreases in older adults living in long-term care who report consuming five or more medications daily. Advanced practice nurses can use these findings to guide practice, tailor interventions and improve care for these long-term care residents. IMPLICATIONS: Multiple medications are increasingly prescribed to treat multiple comorbidities in older adults. As a result, the prevalence of polypharmacy (≥5 medications per day) is rising and problematic. The main findings of this study highlight the negative relationship between anxiety and quality of life in this population and the need for adequate assessment of anxiety by advanced practice nurses in order to personalize care. REPORTING METHOD: In preparing the manuscript, the authors have adhered to relevant EQUATOR guidelines and the STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution outside of participation in the actual study for purposes of data collection.

Developing nurse-sensitive outcomes in acute inpatient mental health settings-A systematic review.

BACKGROUND: While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. AIM: To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. METHODS: Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. RESULTS: A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes-aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm-were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. CONCLUSION: All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. PATIENT AND PUBLIC CONTRIBUTION: Patient or public contribution was not possible because of the type of the variables being explored.

Transcultural adaptation and psychometric properties of the spanish version of the therapeutic relationship Assessment Scale-Nurse.

BACKGROUND: The nurse-patient therapeutic relationship is considered a pillar of mental health nursing, contributing to improved person-centered care and shared decision making with the patient. Given the importance of the nurse-patient therapeutic relationship, appropriate evaluation instruments are required to assess its quality. The aim of this study was to adapt and validate the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse. METHODS: A translation and back-translation of the scale was carried out. To analyze the psychometric properties, the scale was administered to 213 nurses working in the field of mental health care. Temporal stability or test-retest was examined by means of the intraclass correlation coefficient (ICC) in a sample of 100 nurses. RESULTS: Confirmatory Factor Analysis revealed a four-factor structure identical to the original version, with some poor model fit indices. The ordinal alpha values for the total scale and the four factors were 0.939, 0.654, 0.798, 0.801, and 0.866, respectively. The intraclass correlation coefficient was 0.928 (95% CI: 0.893-0.952). CONCLUSIONS: The results show that the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse is reliable for determining the quality of the therapeutic relationship that mental health nurses can establish with their patients. However, more studies are needed to analyse the model fit of the instrument's factor structure in the Spanish population.

Assessing perceptions about critical thinking, motivation learning strategies in online psychiatric and mental health nursing education among Egyptian and Saudi undergraduate nursing students.

BACKGROUND: The pandemic context prompts nursing students to be involved in online learning. Researchers indicated that critical thinking develops through the learning process, but the link between critical thinking and online learning in nursing does not have sufficient evidence. AIM OF STUDY: This research examines student perceptions about critical thinking, motivation, and learning strategies in online psychiatric nursing education among nursing students at Imam Abdulrahman bin Faisal University in Saudi Arabia and Alexandria University in Egypt. SUBJECT AND METHODS: An online survey was designed to collect data anonymously. A total of 75 Saudi undergraduates and 105 Egyptian nursing students who met the inclusion criteria participated. The online survey assessed three parts: socio-demographic data, critical thinking motivational, and cognitive processing strategy scales. RESULTS: The current study found that using a motivating method for online learning inspired students to engage in critical thinking and cognitive processing strategies in a psychiatric and mental health nursing course, even in two different contexts. CONCLUSION: This study demonstrates that using motivational methods for online learning encourages students to engage in critical thinking and cognitive processing strategies in psychiatry and mental health care courses, even in two different settings.

Towards a new (or rearticulated) philosophy of mental health nursing: A dialogue-on-dialogue.

The following dialogue takes up recent calls within nursing scholarship to critically imagine alternative nursing futures through the relational process of call and response. Towards this end, the dialogue builds on letters which we, the authors, exchanged as part of the 25th International Nursing Philosophy Conference in 2022. In these letters, we asked of ourselves and each other: If we were to think about a new philosophy of mental health nursing, what are some of the critical questions that we would need to ask? What warrants exploration? In thinking through these questions, our letters facilitated a collaborative enquiry in which philosophy and theory were generative tools for thinking beyond what is and towards what is yet to come. In this paper, we expand the dialogue within these letters-in a 'dialogue-on-dialogue'-and take up one thread of our discussion to argue that a new philosophy of mental health nursing must rethink the relationships between 'practitioner'/'self' and 'self'/'other' if it is to create a radically different future. Further, we posit solidarity and public love as possible alternatives to foregrounding the 'work' of mental health nursing. The possibilities we present here should be received as partial, contingent and unfinished. Indeed, our purpose in this paper is to provoke discussion and, in so doing, to model what we believe is a necessary shift towards criticality in our communities of nursing scholarship.

[Practice and Niches of Advanced Practice Nurses (APNs) in Psychiatric and Mental Health Care].

The current expansion in role responsibilities of advanced practice nurses (APNs) stems from the current change in public health needs. Advanced nursing education enables APNs to respond promptly to current health needs while expanding the scope of nursing practice. As a result, APNs have obtained recognition and acceptance from the public. The "clinical nurse specialist" in psychiatric care was a pioneering example of APNs in the United States. These specialists not only led the vigorous development of contemporary psychiatric nursing but also advanced the nursing profession as a whole. This article aims to elucidate the role practice of and future opportunities for advanced psychiatric mental health nurses. Using examples of "applying evidence-based care to solve complex practice issues", this article demonstrates the role functions of advanced psychiatric mental health nursing and outlines potential niche opportunities for this field.

[Self-Preparation and Professional Development of Nurses: Psychiatric Mental Health Care Issues].

Today's mental health care needs are diverse. After the COVID-19 pandemic, factors related to individuals, the environment, and their interactions represent complex and cumulative risks. Physical and mental health problems rely on early detection, trust building, care engagement, and disease identification to provide complete psychiatric assessment, management, and continuum of care for affected people. Thus, early detection and intervention in nursing is beneficial for the discovery and treatment of psychological symptoms. However, the nursing profession is divided into multiple specialties, and the current education system lacks integrated interdisciplinary psychiatric mental healthcare training. In this article, the multifaceted aspects of mental health care services and interdisciplinary nursing professional development in mental health are explored, covering the roles and tasks of interdisciplinary nurses, the function and purpose of psychological care in hospitals, reflections on the role of school nursing in adolescent mental health issues, and novel developments in domestic and international psychiatric mental health care. It is hoped that this article can promote reflections on psychological health issues for nurses and help promote cross-disciplinary consensus on nursing strategies to facilitate cooperation among multidisciplinary nurses to promote more comprehensive quality of care, social participation, and professional innovation.

[Community Psychiatric Mental Health Nursing: Practice and Challenges].

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

[Incorporating Anti-Stigma Training Into Psychiatric Mental Health Nursing Education].

Anti-stigma interventions have become important worldwide in light of the negative consequences that the stigma of mental illness has on the recovery to health of individuals with mental illness as well as on general quality of care and public mental health. Thus, psychiatric mental health nursing courses are being targeted with early anti-stigma interventions to improve related awareness and skills among future nurses. This article firstly elaborates on the importance of the stigma issue in psychiatric care and assesses the empirical effectiveness of anti-stigma interventions in psychiatric mental health nursing education. Next, a pedagogical exemplar of integrating a "recovery patients as educators" and anti-stigma intervention into an innovative psychiatric mental health nursing course is demonstrated. Community psychiatric patients, who traditionally receive passive care from healthcare providers, were invited to attend psychiatric mental health courses with the goal of becoming educators in their communities. These courses offer nursing students and patients opportunities to interact as equals and helps these students become aware of their values, attitudes, and prejudices with regard to mental illness. This approach may help reframe their experience and learning, and guide them to clarify and integrate anti-stigma values and attitudes into their work and life. Through such experience sharing, nursing educators may be expected to brainstorm and implement the pedagogical value of anti-stigma.

Updates to American Psychiatric Nurses Association: Seclusion and Restraint Position Statement and Standards of Practice.

OBJECTIVE: The purpose of this discussion paper is to summarize the 2022 updates to the American Psychiatric Nurses Association's (APNA) Seclusion and Restraint Position Statement and Seclusion and Restraint Standards of Practice. METHOD: Both documents were the work of the APNA 2022 Seclusion and Restraint Task Force that consisted of APNA nurses with expertise in the use of Seclusion and Restraint, who practice across a wide range of clinical settings. RESULTS: The 2022 Updates to the APNA Position Statement and Standards were guided by evidence-based information found in the review of seclusion and restraint literature and clinical expertise from the 2022 Seclusion and Restraint Task Force. CONCLUSIONS: Updates were evidence-based and in line with APNA's core values and initiatives in diversity, equity, and inclusion.

Undergraduate Nursing Student Mental Health Clinical Experiences in Saudi Arabia: Findings From a Qualitative Study.

BACKGROUND: Clinical experience is an important way of resolving preregistration challenges. Negative feelings toward pursuing a career in mental health nursing may be modified by well-structured practicums. AIMS: To explore nursing student perspectives of clinical practicums in mental health in Saudi Arabia for the purpose of enhancement of nurse education in mental health care. METHODS: This qualitative study used thematic analysis from semistructured focus group interviews of 20 female undergraduate nursing students. Inductive outcomes and emergent conceptual data were reviewed by investigators, doctoral prepared faculty peers, and members of the sample. NVivo 10.1 software was used to suggest conceptual groupings into themes based on inductive codes. RESULTS: The core theme-enhancement of mental health care skills-comprised four emerging subthemes, including the application of theory for clinical improvement, positive feelings, and motivation toward removal of discrimination and stigmatization, experience with apprehension, anxiety, fear, and stress, and therapeutic communication skills. DISCUSSION: Clinical placement in mental health-related practice may assist undergraduate nursing students in addressing anxiety and stress related to contacting patients, confronting stigmatizing and negative emotions, applying theoretical knowledge to clinical practice, having therapeutic communication skills, and enhancing overall professional experiences of nursing students. It is hoped that undergraduate clinical mental health placement will contribute valuable skills and viewpoints to nursing students who aim to enter professional practice in all areas and especially mental health.

[Advanced Nursing Practice (ANP) in the practice of mental health nursing in Germany: A phenomenological study]. / Advanced Nursing Practice (ANP) in der psychiatrischen Pflege in Deutschland.

Advanced Nursing Practice (ANP) in the practice of mental health nursing in Germany: A phenomenological study Abstract. Background: The wide variety and constantly changing selection of offered psychiatric care services, in combination with the demand for high quality nursing practice supports the integration of Advanced Practice Nurses (APN). The literature presents a multifaceted picture of APNs working in psychiatric services. Individually chosen emphasis was especially prevalent in the field of care. Gaps in research persist concerning the clinical scope of responsibility. Aim: How does the ANP phenomenon find expression in German clinical psychiatric practice? Method: The dataset comprises problem-focused interviews with three expert APNs from different hospitals. The interviews took place between April and October 2019. Applied phenomenology was used to analyze and interpret the dataset. Results: Soft skills and clinical leadership are pivotal competencies for APNs to perform efficiently in clinical practice. Profound life and work experience are key factors in terms of impact. Conclusions: To perform efficiently, APNs require professional and methodological knowledge at a master's level, profound soft skills as well as clinical leadership expertise. Higher education and further curricular training are required. Establishing APNs in clinical psychiatric practice depends primarily on the decisions of managers in nursing. The management of nursing needs to adopt new care structures that allow APNs to implement their qualifications in the psychiatric care system.

Improving psychiatric nurses' competencies in spiritual care and integration of clients' religion/spirituality into mental healthcare: outcomes of an online spiritual care training program.

BACKGROUND: Religion/spirituality (R/S), which is associated with individuals' well-being and psychological health, plays a significant role in most clients' lives in healthcare systems. Although clients in mental healthcare settings prefer their R/S to be employed in nursing care, R/S has neither been adequately integrated into mental healthcare nor discussed in the assessment and nursing interventions of mental healthcare. Evidence shows that most psychiatric nurses receive little or no training in spiritual care (SC) and are unable to integrate clients' R/S into mental healthcare. To address this gap, the present study aimed to investigate the effects of an online SC training program on psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare. METHODS: This experimental study was conducted with nurses working in a psychiatric hospital affiliated with a large University of Medical Sciences in southeast Iran. Random sampling was performed and 95 nurses were assigned to the intervention (n = 50) and control (n = 45) groups. Online SC training was conducted for the intervention group in four sessions over four weeks. Data were collected using the Self-Assessment of Spiritual Care Competency and R/S Integrated Practice Assessment Scale before and one month after the training program. RESULTS: There were no significant differences between the two groups before training (p > 0.05). After the training, nurses in the intervention group obtained significantly higher scores in competencies in SC and integration of clients' R/S into mental healthcare compared to the control group, with a considerable effect size (P < 0.05). CONCLUSION: The online training program positively affected psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare. Since SC is a critical need for clients, specifically in mental healthcare settings, nurses must receive continuous education to provide SC to various clients.

How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study.

BACKGROUND: There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS: Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS: While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS: Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.

Collaborative identification and prioritisation of mental health nursing care process metrics and indicators: a Delphi consensus study.

BACKGROUND: The Irish Office of Nursing & Midwifery Services Director (ONMSD) commissioned the development an updated suite of mental health nursing metrics and indicators for implementation in Irish mental health clinical settings. While measuring care processes does offer the potential to improve care quality, the choice of which mental health nursing metrics to measure presents a significant challenge, both in Ireland and internationally. The provision of safe and high-quality mental health nursing care stems from nurses' expertise, skills and overall capacity to provide recovery focused care across a range of health care settings. Accordingly, efforts to measure what mental health nurses do depends on the identification of those care processes that contribute to mental health nursing practice. This paper reports on the identification, development and prioritisation of a national suite of Quality Care Metrics (QCM), along with their associated indicators, for mental health nursing care processes in Ireland. METHODS: The study was undertaken over four phases; i) a systematic literature review to identify mental health care process metrics and their associated indicators of measurement; ii) a two-round, online Delphi survey of mental health nurses to develop consensus on the suit of mental health nursing care process metrics; iii) a two-round online Delphi survey of mental health nurses to develop consensus on the indicators to be used to measure the agreed metrics; and iv) a face-to-face consensus meeting with mental health nurses and service user representatives to develop consensus on the final suite of metrics and indicators. RESULTS: Following these four phases 9 metrics and their 71 associated indicators were agreed for inclusion in the final suite of Mental Health Nursing QCM. These metrics are applicable across the life span and the range of mental health nursing health care settings. CONCLUSION: The development of this suite of Mental Health Nursing QCM and their indicators represents an opportunity for the measurement of safe and high-quality mental health nursing care for application in Ireland and internationally. This initial development of metrics and indicators should be followed by a rigorous baseline review of QCM uptake and implementation amongst mental health nurses as part of an ongoing evaluation.

Coping strategies among women exposed to Gender-Based violence in Turkey.

AIM: To understand coping strategies used by women experiencing gender-based violence and living in Turkey. Coping is a cognitive and behavioural strategy that individuals develop to manage stress, generally categorized as emotion-focused or problem-focused coping. Women exposed to gender-based violence develop various coping strategies to manage stress and its adverse mental and physical health effects. DESIGN: Qualitative study using the phenomenological approach. METHODS: Data were collected in Turkey by using the snowball technique (n = 17) between September 2019 and September 2020. The Clinical Ethnographic Narrative Interview is the source of the qualitative data for this study. Data were coded manually and utilized the RADAR technique. RESULTS: Seventeen women aged 25-40 were included in this analysis. Women stated that they were exposed to more than one type of gender-based violence according to their lived experiences. Analysis of the nature of coping strategies revealed five main themes. The themes were self-competence, separation from others/isolation, getting professional help, having faith and social support. CONCLUSION: Breaking the silence and listening to gender-based violence experiences from survivors' voices contribute significantly to literature. There was a dearth of research on Turkish women's gender-based violence survivors; the research intended to address that gap. The participants highlighted that they would like to receive more attention and felt relief in sharing their experiences. IMPACT: The Clinical Ethnographic Narrative Interview is a great tool to explore narratives of gender-based violence and coping skills of women. The study explored coping strategies of Turkish women's gender-based violence survivors. The participants indicated their emotion-focused and problem-solving coping strategies and shared their stories. This study will enhance efforts to concentrate on gender-based violence among Turkish women and inspire other researchers, practitioners and policymakers to change and provide more opportunities for the benefit and well-being of these women.