Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental / Perception of the use of humour by nurses and patients at Mental Health Units

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial. (AU)

Objective: based on the literature available, to understand the meaning of sense of humour between nurses and patients in the setting of Mental Health Units, as well as to determine the factors that facilitate its use, o make it difficult. Methods: a narrative review was conducted during the 2022-2023 period. Searches were conducted in Pubmed, PsycINFO, LILACS and CINAHL, using the descriptors: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, “psychiatric nursing”. All type of documents addressing this matter according to the objectives were included, published from 2012 until November 2022 in English, Spanish or Portuguese. An article translated from Korean was added due to its relevance. Results: ten (10) manuscripts were included in the review. Findings suggested that sense of humour was perceived as an essential tool in order to strengthen the relations between nurses and patients in psychiatric settings. However, it was highlighted that there are factors which could induce an inadequate use of humour, leading to dehumanization in care and a potential breach in the therapeutic link. Conclusions: it is important to carefully consider the use of humour in the mental health setting, in order to guarantee its effectiveness without compromising the quality of care. (AU)

Characterizing the direct care health workforce in the United States, 2010-2019.

BACKGROUND: To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS: Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS: From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION: From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.

The significance of the nursing actions in psychiatric hospitalization of female adolescent users of psychoactive substances / El significado de las acciones de enfermería en la internación psiquiátrica de mujeres adolescentes usuarias de sustancias psicoactivas / O significado das ações de enfermagem na internação de adolescentes usuárias de substâncias psicoativas

ABSTRACT Objective To understand the significance of the actions developed by the nursing team in a Psychiatric Inpatient Unit for adolescent female users of psychoactive substances in the light of Alfred Schutz's phenomenological sociology framework. Method Qualitative study with Alfred Schutz's Phenomenological Sociology approach. Four nurses and 17 nursing assistants and technicians from a General Hospital in the city of Porto Alegre participated in the study. Results Three concrete categories emerged: nursing actions as being-with-the-other; collective nursing actions as a potential for shared act and nursing actions as expectations and challenges. Final considerations The actions developed by the nursing team are established through intersubjective relationships, based on bonding and dialogue, but there is still a need for nursing to enhance its actions by expanding the offer of collective therapeutic activities aligned with the psychosocial care model.

RESUMEN Objetivo Comprender el significado de las acciones desarrolladas por el equipo de enfermería en Unidad de Internación Psiquiátrica para mujeres adolescentes usuarias de sustancias psicoactivas, considerando el referencial de la sociología fenomenológica de Alfred Schutz. Método Estudio cualitativo basado en la Sociología Fenomenológica de Alfred Schutz. Participaron cuatro enfermeros y 17 auxiliares de enfermería y técnicos de una unidad de hospitalización psiquiátrica en hospital general de la ciudad de Porto Alegre. Resultados Surgieron tres categorías concretas: acciones de enfermería sobre estar-con-el-otro; operaciones colectivas de enfermería como potencial de acción compartida y las acciones de enfermería como expectativas y desafíos. Consideraciones finales Las acciones desarrolladas por el equipo de enfermería se establecen a través de relaciones intersubjetivas, guiadas por el vínculo y el diálogo, pero aún se demarca la necesidad de la enfermería de potencializar sus acciones ampliando la oferta de actividades terapéuticas colectivas alineadas con el modelo de atención psicosocial.

RESUMO Objetivo Compreender o significado das ações desenvolvidas pela equipe de enfermagem em uma Unidade de Internação Psiquiátrica de adolescentes usuárias de substâncias psicoativas à luz do referencial da sociologia fenomenológica de Alfred Schutz. Método Estudo qualitativo com abordagem da Sociologia Fenomenológica de Alfred Schutz. Participaram do estudo quatro enfermeiros e 17 auxiliares e técnicos de enfermagem de um Hospital Geral do município de Porto Alegre. Resultados Emergiram três categorias concretas: ações de enfermagem enquanto ser-com-o-outro; ações coletivas de enfermagem enquanto potencial do agir compartilhado e ações de enfermagem enquanto expectativas e desafios. Considerações finais As ações desenvolvidas pela equipe de enfermagem são estabelecidas por meio de relações intersubjetivas, pautadas pelo vínculo e diálogo, porém ainda há a necessidade de a enfermagem potencializar suas ações mediante a ampliação de oferta de atividades terapêuticas coletivas consoantes com o modelo de atenção psicossocial.

Nosocomial infections in psychiatric hospitals during the new coronavirus pneumonia outbreak

No disponible

The experiences of people with borderline personality disorder admitted to acute psychiatric inpatient wards: a meta-synthesis.

Background: Acute psychiatric inpatient care is recommended for people with borderline personality disorder (BPD) to manage a crisis. Qualitative research exploring service user experience is valuable for the development of evidence-based treatment guidelines. Aim: To conduct a meta-synthesis of qualitative research exploring the experiences of people with BPD on acute psychiatric inpatient wards. Methods: Literatures searches of five electronic databases. Data were analysed using a three-stage theme identification process. Results: Eight primary studies and three first-hand accounts met the inclusion criteria. Four overarching themes were found to explain the data: contact with staff and fellow inpatients; staff attitudes and knowledge; admission as a refuge; and the admission and discharge journey. Conclusions: Similar experiences of acute psychiatric inpatient care were reported by people with BPD across the studies. Opportunities to be listened to and to talk to staff and fellow inpatients, time-out from daily life and feelings of safety and control were perceived as positive elements of inpatient care. Negative experiences were attributed to: a lack of contact with staff, negative staff attitudes, staff's lack of knowledge about BPD, coercive involuntary admission and poor discharge planning.

Understanding clinician attitudes towards implementation of guided self-help cognitive behaviour therapy for those who hear distressing voices: using factor analysis to test normalisation process theory.

BACKGROUND: The Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. The current study aims to apply the NPT model to a secondary mental health context, and test the model using exploratory factor analysis. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention. METHODS: Mental health clinicians were asked to complete a NPT-based questionnaire on the implementation of a brief CBTp intervention. All clinicians had experience of either working with the target client group or were able to deliver psychological therapies. In total, 201 clinicians completed the questionnaire. RESULTS: The results of the exploratory factor analysis found partial support for the NPT model, as three of the NPT factors were extracted: (1) coherence, (2) cognitive participation, and (3) reflexive monitoring. We did not find support for the fourth NPT factor (collective action). All scales showed strong internal consistency. Secondary analysis of these factors showed clinicians to generally support the implementation of the brief CBTp intervention. CONCLUSIONS: This study provides strong evidence for the validity of the three NPT factors extracted. Further research is needed to determine whether participants' level of seniority moderates factor extraction, whether this factor structure can be generalised to other healthcare settings, and whether pre-implementation attitudes predict actual implementation outcomes.

A Balancing Act-How Mental Health Professionals Experience Being Personal in Their Relationships with Service Users.

BACKGROUND: Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. AIMS: This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. METHOD: Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. RESULTS: Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their "experience-based knowledge" to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. CONCLUSIONS: Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.

Understanding Outcomes in a Randomized Controlled Trial of a Ward-based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences.

OBJECTIVE: Team formulation is advocated to improve quality of care in mental health care and evidence from a recent U.K.-based trial supports its use in inpatient settings. This study aimed to identify the effects of formulation on practice from the perspectives of staff and patient participating in the trial, including barriers and enhancers to implementing the intervention. METHOD: We carried out semistructured interviews with 57 staff and 20 patients. Data were analyzed using thematic analysis. RESULTS: Main outcomes were: improved staff understanding of patients, better team collaboration and increased staff awareness of their own feelings. Key contextual factors were as follows: overcoming both staff and patient anxiety, unwelcome expert versus collaborative stance, competing demands, and management support. CONCLUSION: Team formulation should be implemented to improve quality of care in inpatient settings and larger definitive trials should be carried out to assess the effect of this intervention on patient outcomes.

Training peer specialists with mental illness in motivational interviewing: A pilot study.

OBJECTIVE: The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. METHODS: Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. RESULTS: Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

"Just be a light": Experiences of peers working on acute inpatient psychiatric units.

OBJECTIVE: The study aimed to clarify the potential role and impact of behavioral health peer support providers on community hospital acute inpatient psychiatric units. METHOD: Qualitative interviews were conducted to examine perspectives of peer support providers (peers) and individuals who initially received peer services (recipients) during an inpatient stay on a community hospital psychiatric unit. Interviews elicited perspectives on interactions between peers and recipients, the role of peers vis-à-vis the clinical treatment team, and involvement of peers in discharge planning and transitions to community-based care. Fourteen interviews were completed (6 peers and 8 recipients of peer services); all were recorded, transcribed, and coded using a thematic analysis approach. RESULTS: Emergent themes were grouped into 3 domains: (a) initial impressions and client engagement, (b) peer interventions to support discharge planning, and (c) shared or sharing experiences in an inpatient setting. Recipients described inpatient experiences as disempowering and humiliating and reported powerful positive initial reactions to peers who had had similar experiences but who also displayed competence and professionalism. Peers and recipients described strong emotional connections that differed from traditional attitudes and relationships with clinical staff. Peers described challenges and obstacles related to interactions with the clinical treatment team, and both peers and recipients strongly endorsed the role of peers in facilitating successful care transitions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Behavioral health peers can play important roles in acute inpatient psychiatric care, supplementing clinical treatment team activities and filling important gaps related to engagement, discharge planning, and care transitions. (PsycINFO Database Record

Los pacientes del manicomio La Castañeda y sus diagnósticos. Una propuesta desde la historia cuantitativa (México, 1910-1968) / The patients and their diagnosis at La Castañeda General Asylum. An approach from quantitative history (México, 1910-1968)

El Manicomio General La Castañeda, fundado en la Ciudad de México, albergó a 61.480 pacientes entre 1910 y 1968. El objetivo de este artículo es presentar un panorama general de la población que ingresó a esta institución y los diagnósticos que recibieron los internos, análisis realizado a partir de una base de datos construida con una muestra de 20% de la población total. El artículo se divide en tres partes: en la primera, proponemos tres etapas para comprender la historia de La Castañeda cuya periodización es definida por cambios demográficos que coinciden con reformas administrativas; en la segunda, exponemos las características generales de la población psiquiátrica de La Castañeda; y finalmente, describimos los principales cambios demográficos, los cuales obedecieron a factores socio-políticos, innovaciones tecnológicas y transformaciones en la clínica. Como características principales de la población de La Castañeda tenemos la brevedad del encierro (18 meses en promedio) y la reducida mortalidad (23.8%) en comparación con otras instituciones del mismo tipo. En dicha circulación poblacional encontramos que las familias desempeñaron un papel determinante al asumir el cuidado de sus parientes locos. Así, el encierro prolongado de pacientes crónicos no fue un problema que aquejara al Manicomio General de forma tan severa como se ha creído (AU)

During its 58 years in operation (1910-1968), the Manicomio General La Castañeda housed 61,480 people. In this paper, we present an overview of the general characteristic of the patients based on a 20% sample of the overall population. We divided the text in three sections: in the first part we argue that the history of the institution comprises three distinctive periods characterized by demographic changes that coincide with administrative reforms. In the second, we present the general characteristics of La Castañeda's psychiatric population. Finally, we describe the most salient demographic changes, which stemmed either from socio-political events, technological innovations or clinical transformations. Some of the most salient results of the analysis of the sample show that the inmate population had short periods of hospitalization in the asylum (an average of 18 month), as well as a lower mortality rate (24.2%) in comparison to contemporary mental institutions. Families played a fundamental role in the care of their mad relatives, which accounts for the relatively short periods of hospitalization as well as the low death rates. Consequently, for this particular institution, chronic patients weren't such a serious problem as believed (AU)

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

BACKGROUND: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. METHOD: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. RESULTS: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. CONCLUSIONS: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

Influences of the psychiatric reform in nursing care at the casa de saúde esperança, in Juiz de Fora, Minas Gerais, Brazil (1994-1998) / Influencias de la reforma siquiátrica en el cuidado de enfermeía en la casa de salud esperanza en Juiz de Fora/Minas Gerais/Brasil (1994-1998) / Influências da reforma psiquiátrica no cuidado de enfermagem na casa de saúde esperança em Juiz de Fora, Minas Gerais, Brasil (1994-1998)

ABSTRACT The aim of this socio-historical study was to describe the insertion process of nurses and to analyze the reformulation strategies of nursing care at the Casa de Saúde Esperança from 1994 to 1998. Historical sources, written and oral documents, were analyzed based on Michel Foucault's concept of power/knowledge. The results showed that, after nearly three decades of working in the absence of or with only one nurse, the Casa de Saúde Esperança hired four nurses, in order to meet the legal requirements of operation. To expand their power/knowledge in nursing, the nurses promoted meetings and trainings with the team. It was concluded that the strategies used produced effects such as: greater recognition of the power/knowledge in nursing; practical knowledge giving way to scientific knowledge; development of a more humanized care; and accreditation of the institution in psychiatry IV, which, by psychiatric hospitals' classification, allowed its operation in partnership with the Unified Health System.

RESUMEN Estudio socio histórico cuyo objetivos son describir el proceso de inserción de enfermeros y analizar las estrategias de reformulación del cuidado de enfermería en Casa de Saúde Esperança, entre los años 1994 y 1998. Fuentes históricas, documentos escritos y orales, analizados basándose en el concepto de saber/poder de Michel Foucault. Los resultados mostraron que después de casi tres décadas de funcionamento con ausencia o con solo una enfermera, la Casa de Saúde Esperança contrató cuatro enfermeros para atender exigencias legales de funcionamiento. Para ampliar el saber/poder de la enfermería, promovieron reuniones y capacitaciones junto al equipo. Las estrategias utilizadas produjeron efectos como: mayor reconocimiento del saber/poder de enfermería, en la que un saber práctico dio lugar a un saber científico; desarrollo de un modelo asistencial más humanizado; acreditación de la institución en siquiatría IV, por esa clasificación los hospitales siquiátricos tenían permiso para trabajar en convenio con el Sistema único de salud.

RESUMO Estudo sócio histórico cujos objetivos são o de descrever o processo de inserção de enfermeiros e analisar as estratégias de reformulação do cuidado de enfermagem na Casa de Saúde Esperança, no período de 1994 a 1998. Fontes históricas, documentos escritos e orais, forma analisados com base no conceito de saber/poder de Michel Foucault. Os resultados mostraram que, após quase três décadas funcionando com ausência ou com apenas uma enfermeira, a Casa de Saúde Esperança contratou quatro enfermeiros visando atender exigências legais de funcionamento. Para ampliar o saber/poder da enfermagem, os enfermeiros promoveram reuniões e capacitações junto à equipe. Concluímos que as estratégias utilizadas produziram efeitos como: maior reconhecimento do saber/poder da enfermagem, o saber prático deu lugar ao saber científico; desenvolvimento de uma assistência mais humanizada; credenciamento da instituição em psiquiatria IV, que pela classificação dos hospitais psiquiátricos permite seu funcionamento em convênio com o Sistema Único de Saúde.

Effect of Human Rights Sensitivity and Social Distance on Attitude toward Mental Illness in Psychiatric Hospital Orderlies / 정신간호학회지

PURPOSE: The purpose of this study was to examine the effects of human rights sensitivity and social distance in psychiatric hospital orderlies on attitudes toward mental illness, including authoritarianism, benevolence, social restrictiveness, and community mental health ideology. METHODS: Participants were 201 psychiatric hospital orderlies working in one national mental hospital or one of 10 private mental hospitals. Data were collected from May 9 to June 22, 2016. Data were analyzed with descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficients and hierarchical multiple regression using the SPSS/WIN 21.0 program. RESULTS: Human rights sensitivity and social distance were statistically significant predictors for the attitude toward mental illness in psychiatric hospital orderlies. Hierarchical multiple regression analysis revealed that human rights sensitivity and social distance explained an additional 23% of authoritarianism, 16% of benevolence, 35% of social restrictiveness and 29% of community mental health ideology. CONCLUSION: These findings suggest that education programs to increase levels of human rights sensitivity and reduce the levels of social distance among psychiatric hospital orderlies would improve their attitude toward patients with the mental illness.

Nursing care process for releasing psychiatric inpatients from long-term seclusion in Japan: modified grounded theory approach.

Based on a modified grounded theory approach, in this study, we sought to elucidate the nursing care process used to guide psychiatric inpatients in long-term seclusion towards release from seclusion. Participant observations and interviews were conducted with a total of 18 nurses from three long-term psychiatric wards at two institutions from September 2011 to November 2012, to collect data on the nursing care they provided for psychiatric patients in long-term seclusion. Consequently, four categories and 15 concepts were extracted. The nurses viewed "a mature therapeutic environment that utilizes flexible apportionment of care" as the foundation (i.e. the core category) in guiding psychiatric inpatients towards release from long-term seclusion. The results revealed a care structure in which nurses in such a treatment environment provided care by flexible apportionment of three types of care: care aimed at avoiding mental and physical exhaustion, standardized care that does not confer a disadvantage to patients, and immediately responding to prevent problematic behaviors.

Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development.

In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.