Impact of clinical supervision on the mental health nursing workforce: a scoping review protocol.

INTRODUCTION: Mental health nurses work in potentially unpredictable, stressful and complex environments that can lead to burn-out and high staff turnover. Clinical supervision is a formal and professional agreement between two or more people that aims to strengthen individuals' competencies and organisational strengths. Effective clinical supervision has been noted as a method of reducing workplace issues within mental health nursing, but there is not currently a synthesis of evidence in this area. The key objective of this scoping review is to identify, map and analyse the available evidence reporting on the impact of clinical supervision on workforce outcomes for mental health nurses. METHODS: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension method will be conducted exploring clinical supervision for mental health nurses. A search for academic literature from Medline, CINAHL, Embase and PsycINFO will be combined with grey literature sourced through Google to identify potentially relevant studies. Studies identified by the search strategy will be managed using Covidence, and two authors will screen all identified articles. Reference lists of included studies will be handsearched to identify any potentially relevant studies missed by the search strategy. ANALYSIS: A summary tool including predefined categories (such as author, date published, workforce outcome measured) will be used to summarise the included studies in this scoping review. Additionally, a narrative synthesis approach will be used to report the outcomes of included studies and provide further analysis. ETHICS AND DISSEMINATION: This scoping review protocol described research that will use secondary analysis of publicly available information, and therefore, does not require ethics approval. The findings of this research will be disseminated through publication in a peer-reviewed academic journal and relevant conference presentations.

Providing Gender Sensitive and Responsive Trauma-Informed Psychiatric Nursing Care. How Hard Can It Be?

This paper addresses the challenge of providing gender sensitive and responsive trauma-informed care (TIC) in psychiatric nursing practice. Gender identity, gender subordination, and gender-related trauma history are examined as three key individual-level factors that affect nurses' capacity to engage therapeutically to provide gender sensitive and responsive TIC. Using Peplau's Interpersonal Theory and building on a shared trauma and resilience model, gender-sensitive and responsive TIC is situated within interpersonal science and the ability of the psychiatric nurse to attune to her own and her patient's gender ideologies. Strategies for transforming practice including self-reflection, self-compassion, and peer and supervisor support are reviewed. Noting the import of the practice environment, several observations of changes needed at the level of the unit, organization, and society to effect gender equitable policies that enable the implementation of gender-sensitive and responsive TIC are made.

The Core Elements of Psychiatric and Mental Health Nursing: Time, Honest Engagement, Therapeutic Relations, Professional Nursing and Lifetime-Perspective.

Defining psychiatric and mental health nursing has been a challenge for decades, and it is still difficult to find a comprehensive definition. We have identified a possibility to clarify psychiatric and mental health nursing based on humanistic philosophy in a general psychiatric care context. The aim was therefore to identify and synthesize the theoretical frameworks from which psychiatric and mental health nursing models are developed. We systematically collected and evaluated articles based on Grounded Theory (GT) methodology regarding psychiatric or mental health nursing. The PRISMA statement for systematic reviews was used and the formal process of synthesis, as a three-step process of identifying first -, second - and third-order themes following the examples of Howell Major and Savin-Baden. The synthesis resulted in a model describing five core elements of psychiatric and mental health nursing: 'professional nursing', 'therapeutic relationships' and 'honest engagement', with time as the all-encompassing theme, including the patients' 'lifetime perspective'. Psychiatric and mental health nursing is a caring support towards recovery, where the patient's lifetime perspective must be in focus during the caring process with a relationship built on an honest engagement. Time is therefore essential for psychiatric and mental health nursing.

Intervenções de enfermagem na prevenção da violência em contexto Forense: uma Scoping Review / Nursing interventions to prevent violence in forensic settings: a scoping review

Introdução: Atualmente, a violência, por ser um fenómeno complexo e dinâmico, exige, dos enfermeiros em geral e em particular daqueles que trabalham em serviços de psiquiatria forense, uma compreensão multidimensional e intervenções sistémicas e resilientes. Objetivo: Mapear as intervenções implementadas pelos enfermeiros, para prevenção da violência por parte das pessoas internadas, em serviços de psiquiatria forense. Metodologia: Protocolo de Scoping Review com base nos princípios preconizados pelo Joanna Briggs Institute, considerando os materiais bibliográficos publicados de janeiro de 2018 a julho de 2023, nas bases de dados CINAHL e MEDLINE e selecionados com recurso à plataforma Rayyan. Esta revisão considerou a inclusão de estudos, independentemente da área geográfica ou do desenho, nos idiomas português, inglês e espanhol, disponíveis sem custos para os revisores. Esta pesquisa procura responder à questão norteadora, fundamentada pela estratégia PopulaçãoConceito-Contexto (PCC): Que intervenções são implementadas pelos enfermeiros, para prevenção da violência por parte das pessoas internadas, em contexto de psiquiatria forense? Resultados: Foram incluídos quatro artigos na revisão e identificadas intervenções e programas de treino para a prevenção/redução da violência, pelos enfermeiros, em serviços de psiquiatria forense. Espera-se que os resultados possam contribuir para melhorar a prática de cuidados à pessoa com doença mental nestes contextos. Conclusão: Esta pesquisa identificou intervenções e programas de treino sustentados, dois deles baseados na Terapia Cognitivo-Comportamental, para prevenção da violência por parte das pessoas internadas, em serviços de psiquiatria forense. Mais estudos devem ser realizados para identificar intervenções inovadoras com foco na prevenção/redução do comportamento violento das pessoas internadas em serviços de psiquiatria forense.

Critical review of self-diagnosis of mental health conditions using artificial intelligence.

The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.

Exploring Psychiatric Home-Visit Nursing Practices for Patients with Schizophrenia and Hikikomori with a Thematic Analysis.

The phenomenon of some patients with schizophrenia withdrawing and becoming hikikomori needs to be resolved. In some countries, outreach methods are being employed. In Japan, psychiatric home-visit nursing for patients with schizophrenia and hikikomori is being implemented. However, it is not based on sufficient evidence and relies on the experience and intuition of individual nurses. This study explored the underlying themes in the nursing practices of psychiatric home-visit nurses via semi-structured interviews with 10 nurses and a thematic analysis. Nine key themes emerged. Four themes-(i) understanding the patient's world, (ii) supporting the patients as they are, (iii) providing a sense of relief, and (iv) having equal relationships-highlighted the nurses' commitment to respecting patients' individuality while building and sustaining relationships. Two themes-(v) exploring the right timing and (vi) waiting for the appropriate timing-illustrated the nurses' anticipation of proactive patient engagement. Finally, three themes-(vii) working together on things, (viii) continuing care for expanding the patient's world, and (ix) nursing care for the patient's future-underscored the nurses' gradual and methodical approach to working alongside patients. Nursing practices based on these nine themes cultivated meaningful relationships and secured a sense of relief for the patients. Additionally, they awaited patients' proactive engagement and delivered timely support to facilitate positive daily life changes. These findings contribute to the establishment of evidence-based nursing practices for patients with schizophrenia and hikikomori.

Psychometric evaluation of the Chinese version of the attitudes, subjective norms, perceived behavioural control and intention to pursue a career in mental health nursing scale.

AIM: To adapt culturally and assess the reliability and validity of the Attitudes, Subjective Norms, Perceived Behavioural Control and Intention to Pursue a Career in Mental Health Nursing (ASPIRE) scale among Chinese nursing students. BACKGROUND: Mental health nurses make up a substantial proportion of the mental health workforce and are pivotal for improving access to professional mental health care. However, a shortage of mental health nurses persists across various countries. Although new nursing graduates have the potential to alleviate the labor shortages, there is currently no standardized tool specifically designed to measure nursing students' intentions to pursue a career in mental health nursing in China. DESIGN: A quantitative and cross-sectional design. METHODS: Following email authorization from the author, the Chinese version of the ASPIRE scale was translated following the cross-cultural adaptation process guidelines established by the American Association of Orthopedic Surgeons (AAOS). A questionnaire survey was conducted among 540 nursing students from three universities in Hunan Province from April 2023 to October 2023. Nine experts were invited to evaluate the content equivalence of each item. Item analysis, exploratory factor analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability were used to test reliability and validity. RESULTS: The Chinese version of the ASPIRE scale retained 14 items and it has high content validity. Pearson correlation analysis revealed a statistically significant difference in the correlation between the total scores of the items (P < 0.001). Exploratory factor analysis indicated that the one-factor solution explained 65.82% of the total variance and confirmatory factor analysis results indicated a good fit (CMIN/DF = 2.64, RMSEA = 0.079, GFI = 0.908, IFI = 0.964, SRMR = 0.0326). The Cronbach's alpha coefficient for the scale was 0.958 and the test-retest coefficient was 0.783. CONCLUSION: The Chinese version of the ASPIRE scale has great reliability and validity and can be used for assessing Chinese nursing students' intention to pursue a career in mental health nursing.

A equipe de enfermagem e o atendimento às emergências psiquiátricas: uma revisão integrativa / The nursing team and care for psychiatric emergencies: an integrative review

Analisar o atendimento da equipe de enfermagem nas emergências psiquiátricas. Método: Estudo de revisão integrativa da literatura, considerando como estratégia PICo: (P) Equipe de enfermagem, (I) Atendimento, (Co) Emergências psiquiátricas, os critérios de inclusão são artigos publicados em português, entre 2013 e 2023, disponíveis na Biblioteca Virtual em Saúde. Resultados: Foi elaborado uma tabela para coleta dos dados. Emergiram três categorias: Fragilidades no atendimento de enfermagem às emergências psiquiátricas; Fortalezas no atendimento de enfermagem às emergências psiquiátricas; Educação continuada e permanente como recurso de melhoria da qualidade no atendimento às emergências psiquiátricas. Considerações finais: É evidente a necessidade de ações de educação continuada, a importância dos recursos humanos e físicos adequados para assistência, capacitações profissionais que contemplem a atenção à saúde mental, promoção da desconstrução social, dos estigmas e estereótipos vinculados à loucura e à figura do doente mental.(AU)

To analyze the care provided by the nursing team in psychiatric emergencies. Method: Integrative literature review study, considering the PICo strategy: (P) Nursing team, (I) Care, (Co) Psychiatric emergencies, the inclusion criteria are articles published in Portuguese, between 2013 and 2023, available in the Library Virtual Health. Results: A table was created to collect data. Three categories emerged: Weaknesses in nursing care for psychiatric emergencies; Strengths in nursing care for psychiatric emergencies; Continuing and permanent education as a resource for improving the quality of care for psychiatric emergencies. Final considerations: The need for continuing education actions is evident, the importance of adequate human and physical resources for assistance, professional training that includes mental health care, promotion of social deconstruction, stigmas and stereotypes linked to madness and the figure of brain sick.(AU)

Analizar la atención brindada por el equipo de enfermería en emergencias psiquiátricas. Método: Estudio de revisión integradora de la literatura, considerando la estrategia PICo: (P) Equipo de enfermería, (I) Atención, (Co) Emergencias psiquiátricas, los criterios de inclusión son artículos publicados en portugués, entre 2013 y 2023, disponibles en la Biblioteca Virtual de Salud. Resultados: Se creó una tabla para recolectar datos. Surgieron tres categorías: Debilidades en la atención de enfermería en emergencias psiquiátricas; Fortalezas en la atención de enfermería para emergencias psiquiátricas; La educación continua y permanente como recurso para mejorar la calidad de la atención de las urgencias psiquiátricas. Considerações finais: É evidente a necessidade de ações de educação continuada, a importância dos recursos humanos e físicos adequados para assistência, capacitações profissionais que contemplem a atenção à saúde mental, promoção da desconstrução social, dos estigmas e estereótipos vinculados à loucura e à figura do enfermo mental.(AU)

Mental Health Nurses' Attitudes on Consumers with Dual Diagnosis: A Thematic Analysis.

BACKGROUND: The issue of dual diagnosis continues to be a global health concern. There is a lack of empirical research on mental health nurses' attitudes toward consumers with dual diagnosis. OBJECTIVE: This study aimed to answer the following research question: How do mental health nurses describe their attitude toward consumers with co-existing mental health and drug and alcohol problems? DESIGN: This qualitative study employed purposive sampling to recruit participants. Semi-structured interviews were conducted to explore mental health nurses' attitudes toward consumers with dual diagnosis. SETTING: This study focused on mental health nurses employed in mental health settings. It placed a particular emphasis on mental health nurses who had experience in caring for consumers with dual diagnosis. Seventeen mental health nurses participated in the interview. METHODS: Interviews were transcribed verbatim and coded using NVivo™ 12 Plus software. Thematic analysis was used to generate codes and themes inductively. RESULTS: Three major themes with a total of eight sub-themes were identified: (1) satisfaction and connection, with three subthemes; (2) combating negativity in others, with two subthemes; and (3) working to improve outcomes, with three subthemes. CONCLUSIONS: Participants were concerned about their peers' sense of fear and frustration, stigmatized language, and lack of consistency in providing dual diagnosis training for mental health nurses. There is a need to investigate effective strategies to address mental health nurses' stigmatized attitudes, fear, and frustration toward consumers with dual diagnosis.

Staff Perceptions on the Effectiveness of GRiP-S, a New Approach to Clinical Supervision Incorporating Safewards: An Interpretive Phenomenological Analysis.

This study explored the impact of an innovative approach to clinical supervision for mental health nurses which integrates Safewards, named Group Reflective integrated Practice with Safewards - GRiP-S. Qualitative data was collected through 10 individual semi-structured interviews with nursing staff who had participated within the clinical supervision approach. Interviews provided insights into the nursing staff's perception and experience of the clinical supervision approach. Through interpretive phenomenological analysis six themes emerged (i) illuminating embodied practice of Safewards, (ii) building confidence through empowering connections, (iii) creating a culture of positive change, (iv) identifying internal motivation for and external barriers to supervision engagement, (v) navigating a global pandemic, and (vi) the transformative role of reflection. Findings demonstrated that the GRiP-S approach assisted mental health nurses' adoption of Safewards interventions in practice, while supporting the development of a cohesive staff team. The impact of COVID-19 within the study setting was addressed and nurses identified how the Safewards model assisted in navigating challenges during this time. Findings further supported prior research on the role of the supervisor and supervisee relationship. This study supports the integration of Safewards within reflective clinical supervision for mental health nursing staff to assist in Safewards fidelity and nursing staff personal and professional development.

On the bullshitisation of mental health nursing: A reluctant work rant.

This discussion paper offers a critical provocation to my mental health nursing colleagues. Drawing upon David Graeber's account of bullshit work, work that is increasingly meaningless for workers, I pose the question: Is mental health nursing a bullshit job? Ever-increasing time spent on record keeping as opposed to direct care appears to represent a Graeberian bullshitisation of mental health nurses' work. In addition, core aspects of the role are not immune from bullshit. Professional rhetoric would have us believe that mental health nursing is a therapeutically beneficent occupation organised around ideals of care and compassion and providing fulfilling work for practitioners. Yet, there are some key characteristics of the experience of mental health nursing work that afford alternative judgements on its value and meaningfulness. Not least of these is the fact that many mental health nurses feel quite existentially unsettled in the practise of their work and many service users do not recognise the professional ideal, especially when compelled into increasingly coercive and restrictive services. In this context, Graeber's thesis is explored for its applicability to mental health nursing with a conclusion that many aspects of mental health nursing work are commensurate with bullshit but that mental health care can possibly be redeemed from bullshitisation by authentically democratising reforms. Engaging with posthumanist ideas, this exploration involves a flexing of aspects of Graeber's theory.

Could artificial intelligence write mental health nursing care plans?

WHAT IS KNOWN ON THE SUBJECT?: Artificial intelligence (AI) is freely available, responds to very basic text input (such as a question) and can now create a wide range of outputs, communicating in many languages or art forms. AI platforms like OpenAI's ChatGPT can now create passages of text that could be used to create plans of care for people with mental health needs. As such, AI output can be difficult to distinguish from human-output, and there is a risk that its use could go unnoticed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Whilst it is known that AI can produce text or pass pre-registration health-profession exams, it is not known if AI can produce meaningful results for care delivery. We asked ChatGPT basic questions about a fictitious person who presents with self-harm and then evaluated the quality of the output. We found that the output could look reasonable to laypersons but there were significant errors and ethical issues. There are potential harms to people in care if AI is used without an expert correcting or removing these errors. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We suggest that there is a risk that AI use could cause harm if it was used in direct care delivery. There is a lack of policy and research to safeguard people receiving care - and this needs to be in place before AI should be used in this way. Key aspects of the role of a mental health nurse are relational and AI use may diminish mental health nurses' ability to provide safe care in its current form. Many aspects of mental health recovery are linked to relationships and social engagement, however AI is not able to provide this and may push the people who are in most need of help further away from services that assist recovery. ABSTRACT: Background Artificial intelligence (AI) is being increasingly used and discussed in care contexts. ChatGPT has gained significant attention in popular and scientific literature although how ChatGPT can be used in care-delivery is not yet known. Aims To use artificial intelligence (ChatGPT) to create a mental health nursing care plan and evaluate the quality of the output against the authors' clinical experience and existing guidance. Materials & Methods Basic text commands were input into ChatGPT about a fictitious person called 'Emily' who presents with self-injurious behaviour. The output from ChatGPT was then evaluated against the authors' clinical experience and current (national) care guidance. Results ChatGPT was able to provide a care plan that incorporated some principles of dialectical behaviour therapy, but the output had significant errors and limitations and thus there is a reasonable likelihood of harm if used in this way. Discussion AI use is increasing in direct-care contexts through the use of chatbots or other means. However, AI can inhibit clinician to care-recipient engagement, 'recycle' existing stigma, and introduce error, which may thus diminish the ability for care to uphold personhood and therefore lead to significant avoidable harms. Conclusion Use of AI in this context should be avoided until a point where policy and guidance can safeguard the wellbeing of care recipients and the sophistication of AI output has increased. Given ChatGPT's ability to provide superficially reasonable outputs there is a risk that errors may go unnoticed and thus increase the likelihood of patient harms. Further research evaluating AI output is needed to consider how AI may be used safely in care delivery.

Solving the shortage of psychiatric - mental health nurses in acute inpatient care settings.

INTRODUCTION: This debate essay proposes possible remedies to the shortage of nurses in acute inpatient mental health settings and draws inspiration from a Journal of Psychiatric and Mental Health Nursing editorial, Glascott and McKeown (2022, 29, 767). AIM: The aim is to stimulate debate within the profession. The art and science of nursing continues to develop but staffing shortages in key areas undermine practice, leadership, academic and policy efforts to improve the quality of care for people attending services. METHOD: This is a debate essay which draws on the authors' experience and presents ideas based on extant literature. RESULTS: Organisational, professional and wider societal challenges are explored. Practice-based solutions as well as recommendations for improving the terms and conditions of employment of nurses are made. Opportunities which may empower the nursing profession are promulgated. DISCUSSION: It is intended that this paper will provoke further discourse and may reflect the 'call to action' advocated by Glascott and McKeown (Journal of Psychiatric and Mental Health Nursing, 2022, 29, 767). IMPLICATIONS FOR PRACTICE: While the focus is on acute inpatient mental health nursing, the ideas presented may have an application to wider nursing groups or a wider cadre of public sector workers.

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

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