Clinicians' power in the inpatient care of anorexia nervosa: A qualitative investigation of consumer perspectives.

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi-structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life-saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person-centred care and trauma-informed care principles.

Undergraduate nursing students challenge misconceptions towards men in nursing: A mixed-method study.

AIMS: To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing. DESIGN: A convergent parallel mixed-method study. METHODS: A national survey was conducted (July-September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting. RESULTS: Undergraduate nursing students (n = 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) 'This is a very misandristic viewpoint'; (2) 'Compassion and intelligence are distributed in men and women equally'; (3) 'Men bring a different quality to nursing' (4) 'Anyone can be whatever they want to be'. CONCLUSION: Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society. IMPACT: Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The focus on weight in the inpatient care of anorexia nervosa: A qualitative investigation of consumer perspectives.

Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well-being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person-centred care, therapeutic relationships and trauma-informed principles.

How to Use Microhistory Methodology in Mental Health Research.

Incorporating anthropological principles, microhistory is a research methodology useful for exploring the interplay between ordinary people and social abstractions such as, the market, social systems, and governments. In this paper, the background and characteristics of microhistory are described, and a novel six-stage approach for conducting microhistories in mental healthcare is introduced. Each stage of the process is illustrated using sections from a microhistory focussed on the earliest recorded case comparison between British colonial mental healthcare and Aboriginal Australian traditional healing. Microhistory provides a way to uncover new insights about past mental healthcare, which may contribute to re-conceptualisations of modern-day beliefs and practices.

The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review.

BACKGROUND: The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood. AIMS: To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period. METHOD: A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form. RESULTS: Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support. LIMITATIONS: Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible. CONCLUSION: Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.

Development and psychometric testing of the gender misconceptions of men in nursing (GEMINI) scale among nursing students.

BACKGROUND: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. OBJECTIVE: To develop and evaluate the psychometric properties of the 'Gender Misconceptions of meN in nursIng (GEMINI) Scale. DESIGN: Cross-sectional survey. METHODS: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The 17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. RESULTS: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%) were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach's alpha of 0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. CONCLUSION: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. IMPACT STATEMENT: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society.

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review.

Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses' experiences: Absence of less coercive alternatives; and consumers' experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery-oriented, trauma-informed and consumer-centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers' experiences with coercive practices.

Dynamics of nurses' authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives.

Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well-being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend-like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.

The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study.

AIMS AND OBJECTIVES: To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). BACKGROUND: Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. DESIGN: This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. METHODS: Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. RESULTS: The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. CONCLUSIONS: The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. RELEVANCE TO CLINICAL PRACTICE: By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therapeutic alliances with consumers. A maternalistic nursing style emerged as a viable approach.

Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study.

AIMS: The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers. BACKGROUND: The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood. DESIGN: A two-phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis. METHODS: A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 - February 2015. RESULTS: Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses' intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance. CONCLUSION: Nurses' capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses' ability to develop therapeutic alliances.

Therapeutic alliance in mental health nursing: an evolutionary concept analysis.

The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.

Effective nursing care of adolescents with anorexia nervosa: a consumer perspective.

AIMS AND OBJECTIVES: To establish how nurses ensure weight gain and a positive inpatient experience for the treatment of adolescents with anorexia nervosa by considering consumer perspectives. BACKGROUND: Consumer perspective literature indicates approval and dissatisfaction with certain aspects of the inpatient experience, and there is a limited understanding of what consumers perceive to be effective nursing practice. DESIGN: The design of this study was qualitative, the data being interpreted with a thematic analysis. METHODS: This study sought the perspectives of eight (n = 8) recovered consumers through semi-structured interviews. RESULTS: Nurses were considered highly influential over the inpatient experience. The findings of this study are characterised by three overall themes regarding nursing practice: (1) ensuring weight gain, (2) maintaining a therapeutic milieu, and (3) the nursing relationship. CONCLUSIONS: Consumers have clear perspectives of how nurses effectively ensure weight gain and how nurses ensure a positive inpatient experience. The quality of relationships between consumers and nurses had implications for both weight gain and the perceived quality of the inpatient experience. By relying on the strength of positive, thoughtful and well-timed interactions, nurses may contribute to productive physical outcomes and a positive inpatient experience. Consumers indicated that motivation to adhere to care was derived from strong relationships with nurses. Ensuring both weight gain and a positive experience involves achieving a productive 'balance of restrictions'. Consumers also valued nurses that created a comfortable and productive environment. RELEVANCE TO CLINICAL PRACTICE: This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment and possibly enhance outcomes for consumers.