A Mixed-Methods Study of Nurse Managers' Managerial and Clinical Challenges in Mental Health Centers During the COVID-19 Pandemic.

PURPOSE: The worldwide outbreak of the COVID-19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID-19 pandemic. DESIGN: A mixed-methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel. METHODS: The quantitative phase was conducted prior to the group sessions using a structured self-administered questionnaire that examined the nurse managers' (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses' functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic. FINDINGS: The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care. CONCLUSIONS: Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility. CLINICAL RELEVANCE: In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.

Personal and organizational factors related to initiative behavior among psychiatric nurses.

PURPOSE: To identify the degree of personal initiative (PI) among psychiatric nurses and to examine the influence of personal and organizational characteristics on their PI. DESIGN AND METHODS: Ninety-seven nurses completed a questionnaire on PI, work climate, self-efficacy toward initiatives and innovations, nursing work environment, and actual initiative at work. FINDINGS: Differences in actual initiative at work according to the level of education, and negative association between PI and age were found. Self-efficacy and work climate explained 56% of PI; self-efficacy, work climate, and age explained 30% of initiative behavior. PRACTICE IMPLICATIONS: Investing in young nurses, fostering higher education, and creating supportive work environment can help in conversion of innovative vision into actual initiatives.

Nurses Teaching Prison Officers: A Workshop to Reduce the Stigmatization of Prison Inmates With Mental Illness.

PURPOSE: This report describes and evaluates the effectiveness of a nurse-led workshop designed to improve correctional officers' stigmatizing attitude toward inmates with mental illness. DESIGN AND METHODS: Eighty-three prison officers attended a 6-day workshop targeting the cognitive, psychoeducational, and behavioral components of publicly expressed stigma, and combining theoretical learning, observational experience on psychiatric wards, frontal lectures, case reviews, discussions, peer supervision, and simulations. The workshop's impact was measured systematically using a structured self-administered questionnaire examining cognitive, affective, and behavioral components of stigmatization. FINDINGS: The workshop significantly increased perceived knowledge and decreased stigmatizing attitudes. IMPLICATIONS FOR NURSING PRACTICE: The evaluation presented here demonstrates a less-known aspect of the possible contribution of expert psychiatric nurses to mental health education in a wider context.

Between a Rock and a Hard Place: Ethical and Professional Dilemmas in a Psychiatric Hospital Under Missile Attacks.

BACKGROUND: Israeli hospitals must continuously develop various mechanisms to protect both patients and staff against the physical threat of missile attacks during war situations. OBJECTIVES: To examine the difficulties and dilemmas with which the staff of a psychiatric hospital had to deal during missile attacks. DESIGN: A quality improvement project consisting of three stages (1) establishment of a steering committee; (2) execution of a staff nurses' focus group; and (3) categorization of issues raised and suggestions for care improvement in future emergencies. RESULTS: The project stressed the challenges of dealing with restrained patients during missile alarms, waking up patients or dealing with those who refuse to enter the protected area, mismatching of the security needs in protected areas, and institutionalized emotional support for staff members. CONCLUSION: Suitable policies for clinical and management behavior and for information transfer between management and wards are essential during a continuous emergency.

Closing an open psychiatric ward: organizational change and its effect on staff uncertainty, self-efficacy, and professional functioning.

PURPOSE: Converting an open psychiatric ward to a closed one can be threatening and stressful for the medical and nursing staff involved. This study describes the effects of this change, in particular the before-after correlation among self-efficacy, professional functioning, and uncertainty. DESIGN AND METHODS: Forty-four staff participated, completing pre-/poststructured questionnaires. FINDINGS: Uncertainty was higher before the conversion than after the conversion. Professional functioning declined after the conversion. Self-efficacy was positively correlated with pre- and postconversion functioning, but negatively correlated with postconversion uncertainty. PRACTICE IMPLICATIONS: It is important to prepare staff for this significant organizational change. Suggestions for prechange interventions are offered.

'Let me tell you what I really think about you'--evaluating nursing managers using anonymous staff feedback.

The evaluation of employees by their superiors is standard managerial practice but the value of the evaluation of superiors by their employees is much less recognized. This study describes a project where for 3 years (2000-02), in an Israeli mental health center, the Director of Nursing, clinical supervisors, ward head nurses and their deputies were evaluated by nurses and nursing aides. Feedback was gathered through anonymous questionnaires under conditions of confidentiality. Based on the findings, steps were taken to improve managers' performance. Evaluators were also requested to evaluate the project's contribution to themselves and the hospital in a second, open questionnaire. All parties, evaluators and evaluated, expressed satisfaction and recommended that the project continue on a regular basis. Nurses felt empowered and respected and that manager-subordinate relations were improved. Other results and recommendations are discussed.

Patient rights and law: tobacco smoking in psychiatric wards and the Israeli Prevention of Smoking Act.

In August 2001, the Israeli Ministry of Health issued its Limitation of Smoking in Public Places Order, categorically forbidding smoking in hospitals. This forced the mental health system to cope with the issue of smoking inside psychiatric hospitals. The main problem was smoking by compulsorily hospitalized psychiatric patients in closed wards. An attempt by a psychiatric hospital to implement the tobacco smoking restraint instruction by banning the sale of cigarettes inside the hospital led to the development of a black market and cases of patient exploitation in return for cigarettes. This article surveys the literature dealing with smoking among psychiatric patients, the role of smoking in patients and the moral dilemmas of taking steps to prevent smoking in psychiatric hospitals. It addresses the need for public discussion on professional caregivers' dilemmas between their commitment to uphold the law and their duty to act as advocates for their patients' rights and welfare.

Reactions of staff members to the relocation of a psychiatric department to a new building.

This study, which was conducted in Israel, examined staff members' reactions to the relocation of three closed psychiatric wards to a new building. Participants' (N=61) levels of uncertainty were significantly higher before the relocation than they were after the relocation. In addition, a significant positive correlation was found between anxiety levels before the relocation and anxiety levels after the relocation. A significant positive correlation was also found between anxiety levels before the relocation and uncertainty levels before and after the relocation. No significant correlation was found between the perceived success of the relocation and the other study variables.