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.

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study.

INTRODUCTION: Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. AIM: This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. METHOD: An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. RESULTS: The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. DISCUSSION: MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. IMPLICATIONS FOR MENTAL HEALTH NURSING: According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

"It Is OK Not to Be OK": Nursing Students' Backgrounds and Perceptions of Mental Health Stigma and Implications for Mental Health Nursing Education.

There has been a notable increase in reported mental illnesses in recent years. Although mental illness is being discussed more openly, stigma toward mental illness still exists. Stigma can result in inadequate care for people with mental illnesses. Students come into nursing from a variety of backgrounds and these backgrounds influence their nursing clinical judgments, especially related to caring for people with mental illnesses. A qualitative descriptive analysis was conducted using 60 undergraduate nursing student reflections on their backgrounds and perceptions of mental health stigma. Students wrote about their Previously Held Beliefs and the Influence of Culture, Overcoming Stigma through their Experiences with Friends and Family, Influence of Popular Culture, and Personal Experiences, and their New Understanding of mental illness and what that means for their future nursing practice. These findings have important implications for nursing education including providing more opportunities for nursing students to care for people with mental illnesses, reframing how mental health content is delivered in undergraduate nursing programs, and providing additional support for students with personal mental illnesses.

Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India.

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

The role of mental health nurses in planetary health.

This article will critically explore the concept of planetary health and locate the role and identity of the mental health nurse (MHN) within it. Like humans, our planet thrives in optimum conditions, finding the delicate balance between health and ill-health. Human activity is now negatively impacting the homeostasis of the planet and this imbalance creates external stressors that adversely impact upon human physical and mental health at the cellular level. The value and understanding of this intrinsic relationship between human health and the planet is in danger of being lost within a society that views itself as being separate and superior to nature. The Period of Enlightenment witnessed some human groups viewing the natural world and its resources as something to exploit. White colonialism and industrialization destroyed the innate symbiotic relationship between humans and the planet beyond recognition and in particular, overlooking the essential therapeutic role nature and the land facilitated within the well-being of individuals and communities. This prolonged loss of respect for the natural world continues to breed human disconnection on a global scale. The healing properties of nature have effectively been abandoned within healthcare planning and infrastructure, which continue to be driven principally by the medical model. Under the theory of holism, mental health nursing values the restorative capabilities of connection and belonging, employing skills to support the healing of suffering, trauma and distress, through relationships and education. This suggests MHNs are well situated to provide the advocacy the planet requires, through the active promotion of connecting communities to the natural world around them, both healing the other.

How patients with severe mental illness experience care provided by psychiatric mental health nurse practitioners.

BACKGROUND: Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). PURPOSE: To explore what meaning people with SMI associate with the care provided by a PMHNP. METHODOLOGY: A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). RESULTS: Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. CONCLUSIONS: The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. IMPLICATIONS: For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

Attitudes towards family involvement in nursing care among psychiatric nurses in Hong Kong: A cross-sectional descriptive study.

WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders. ABSTRACT: INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings. AIMS: This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors. METHODS: This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument. RESULTS: Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care. DISCUSSION: The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades. IMPLICATIONS FOR PRACTICE: Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.

[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.

Artificial intelligence: An eye cast towards the mental health nursing horizon.

There has been an international surge towards online, digital, and telehealth mental health services, further amplified during COVID-19. Implementation and integration of technological innovations, including artificial intelligence (AI), have increased with the intention to improve clinical, governance, and administrative decision-making. Mental health nurses (MHN) should consider the ramifications of these changes and reflect on their engagement with AI. It is time for mental health nurses to demonstrate leadership in the AI mental health discourse and to meaningfully advocate that safety and inclusion of end users' of mental health service interests are prioritized. To date, very little literature exists about this topic, revealing limited engagement by MHNs overall. The aim of this article is to provide an overview of AI in the mental health context and to stimulate discussion about the rapidity and trustworthiness of AI related to the MHN profession. Despite the pace of progress, and personal life experiences with AI, a lack of MHN leadership about AI exists. MHNs have a professional obligation to advocate for access and equity in health service distribution and provision, and this applies to digital and physical domains. Trustworthiness of AI supports access and equity, and for this reason, it is of concern to MHNs. MHN advocacy and leadership are required to ensure that misogynist, racist, discriminatory biases are not favoured in the development of decisional support systems and training sets that strengthens AI algorithms. The absence of MHNs in designing technological innovation is a risk related to the adequacy of the generation of services that are beneficial for vulnerable people such as tailored, precise, and streamlined mental healthcare provision. AI developers are interested to focus on person-like solutions; however, collaborations with MHNs are required to ensure a person-centred approach for future mental healthcare is not overlooked.

Leveraging Innovation to Design a Psychiatric Mental Health Simulation for Undergraduate Nursing Students During the COVID-19 Global Pandemic.

ABSTRACT: Undergraduate nursing students experience challenges integrating didactic knowledge into the clinical care of clients living with psychiatric mental illness. Simulation can be a successful teaching strategy to mitigate some of these challenges. The aim of this pilot simulation experience was to understand how academic technology and telehealth competencies could be leveraged to support the success of standardized patient simulations for nursing students during the COVID-19 pandemic. Data from debriefings found that students had greater confidence in their technical skills than their ability to manage their emotional responses to simulation scenarios.

From Subjective Opinion to Medical Fact: A Critical Discourse Analysis of Mental Health Nursing Education.

Using various methods and strategies of Critical Discourse Analysis, this article demonstrates how certain influential nursing texts generate a certain biomedical framing of the mental health nursing assessment. Accordingly, the mental health assessment in undergraduate nursing education becomes imbricated in processes of governance that legitimate psychiatric discourse by 1. Presenting the opinions and judgements of mental health professionals as objective scientific facts; 2. Utilizing grammatical mood and modality to convey a matter-of-fact urgency and necessity for psychiatric intervention that is made to appear largely through conjecture and passive logical leaps; and 3. Through hybrid fusion with other scientific and medical disciplines that lend credibility to psychiatry through association. While we largely focus on critique of the mental health assessment, we buttress this critique using two other institutional texts that draw on a psychiatric framing of mental health, to demonstrate how these texts reinforce and work in discursive cohesion with the mental health assessment. We conclude by discussing the implications of these consequences to nursing education and nursing students and educators alike.

Holding Hope: Co-producing eating disorders education that integrates the lived experience voice to inform best practice.

WHAT IS KNOWN ON THE SUBJECT?: Eating Disorder (ED) education is predominating taught through a DSM-V diagnostic criteria and clinically focused lens devoid of lived experience expertise. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Current clinically focused ED education may be shaping health professional misunderstandings of EDs, influencing the therapeutic relationships between health professional and consumer which is key to the recovery process. Integrating the lived experience voice through co-produced, humanities-based ED education deepens understandings and honours the complexities of EDs by bringing a much-needed, alternate perspective to health professional learning, practice and research. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Reframing mental health education towards a more strengths-based, trauma-informed and recovery focused lens has the potential to upskill the health workforce in how to hold hope, space and learn to walk the fight with people living and recovering with an ED.

Mental health nursing capability development: Perspectives of consumers and supporters.

Mental health nursing requires a specialist range of capabilities and values. In Australian contexts, the preparation of nurses to work in mental health settings has attracted criticism from government reviews, academics, and graduate nurses. Insufficient mental health content and clinical placement experience in undergraduate nursing courses have been central to this criticism. The study aim was to identify the areas and modalities of capability development of graduate mental health nurses, from the perspectives of end point users. In order to meet the aim, a four-item cross-sectional online survey with three additional and open-ended questions was developed. The questions were co-designed with consumer academics and reviewed by consumer and carer organizations. The survey was widely distributed across Australian consumer and carer organizations, with 95 useable responses. Findings indicated strong support for lived experience being integrated into teaching teams for nurses, as well as support for undergraduate direct entry for mental health nursing. Themed content from open-ended responses reflected the survey outcomes as well as prioritizing skill development to support better therapeutic relating and nurse self-care. Key findings included strong support for greater lived experience input into mental health nurse education, specialist undergraduate preparation and a focus on developing relational capabilities in the mental health nurse workforce.

Key stakeholder perspectives on expert-by-experience involvement in the values-based recruitment of student mental health nurses: A co-produced qualitative study.

BACKGROUND: Values-based recruitment is a mandatory process for nursing programmes within UK higher education, with the Nursing Midwifery Council expecting that experts-by-experience are engaged in these recruitment and selection processes. The wider involvement of experts-by-experience in healthcare education is gaining momentum internationally with calls for engagement in all aspects of design and delivery; however, the impact of such involvement in recruitment of nursing students has received little attention, particularly in mental health nursing. AIM: To understand the impact of expert-by-experience involvement in the values-based recruitment of mental health nursing students from the perspective of candidates, experts-by-experience, and academic staff. DESIGN AND METHODS: This qualitative approach was co-designed and implemented by a research team comprised of academics, experts-by-experience, and student mental health nurses. Focus groups and an on-line survey were used to collect data, with Burnard's thematic analysis providing a framework for data analysis. SETTING/PARTICIPANTS: This study took place at one UK university. Participants included nurse academics, experts-by-experience, and student nurses with experience of a values-based recruitment process. RESULTS: Thematic analysis identified four themes: starting out, collaboration, rich assessment, and stakeholder gains. Whilst not without its challenges, the involvement of experts-by-experience in the recruitment of mental health nursing students was identified as delivering a robust recruitment process, encompassing academic abilities alongside the personal qualities required to make a 'good nurse'. Personal benefits for experts-by-experience, candidates, and academics were also reported. CONCLUSION: This study provides insights into the impact of experts-by-experience in supporting values-based recruitment. The approach is identified as enhancing the selection process by drawing from academic and lived experience perspectives and highlights to potential candidates, at the outset of their career, the value of meaningful engagement. These findings support the Nursing Midwifery Council's position that experts-by-experience should be engaged in the recruitment and selection of student nurses.

Mental health nurses' resilience in the context of emotional labour: An interpretive qualitative study.

Strengthening mental health nurses' (MHNs) resilience may help mitigate the negative effects of the emotional labour (EL) of their work. There is no prior evidence on MHNs' experiences of resilience in the context of EL. This interpretive qualitative study sought to explore how MHNs build and maintain their resilience in the face of high levels of EL. Semi-structured interviews were conducted with 11 MHNs. Reflexive thematic analysis was used to analyse the data. Four main themes were constructed. The first three; Being attuned to self and others, Having a positive mindset grounded in purpose, and Maintaining psychological equilibrium through proactive self-care, describe how MHNs build and maintain their resilience. The fourth theme, Running on emotionally empty, describes what impedes MHNs' resilience. MHNs engaged in internal self-regulatory processes to manage their mental and emotional state. They maintained intra- and inter-personal boundaries and proactively used self-care strategies to maintain their well-being. Through this, they were able to replenish and sustain the energy required to maintain a state of equilibrium between themselves, their interpersonal practice, and their working environment, and to positively adapt to EL. However, lack of organizational support and high workplace demands can negatively impact MHNs' equilibrium and adaptive ability. There is a need for organizations to proactively work to reduce workplace stressors, and support MHNs' professional well-being and practice. Education and support strategies focused on strengthening MHNs' resilience, well-being, and mental health practice capabilities, including the provision of clinical supervision, and clear role expectations within MHNs' scope of practice are recommended.

Evaluation of the implementation of an online psychiatric nurse practitioner program for primary care nurse practitioners: Use of a Participatory Evidence-Informed (PEPPA-Plus) framework.

To address a growing need for primary care nurse practitioners to provide mental health care, grant support was obtained to create an accelerated online post-master's psychiatric-mental health nurse practitioner (PMHNP) program. A participatory evidence-informed framework (PEPPA-Plus) was used to 1) evaluate the program structures and processes from the perspectives of program graduates, and within this context, to evaluate outcomes following graduation, and 2) to evaluate the impact of the program through the implementation of the dual nurse practitioner role. Approximately half (56%) of the graduates completed a 40-item web-based survey. Ninety-nine percent of those who had taken the PMHNP exam were certified as PMHNPs, 99% were dually certified as primary care NPs, 86% reported that their scope of practice had changed to include the delivery of more mental health care services, and 27% were providing both mental and physical health care in integrated care settings. The vast majority (90%) reported a moderate to very high level of confidence in their PMHNP competency, 60% were teaching psychiatric-mental health nursing as preceptors, educators, or new program directors and 29% were providing care in communities with <50,000 residents. Over half of the graduates were committed to staying in their current practice position for at least the next five years. These findings demonstrate the success of the online program in producing graduates who utilize dual NP competencies in practice, at least 25% of whom are treating populations in non-urban settings, in integrated care settings, and treating populations with high social and environmental risk factors.

What do psychiatric nurse practitioners need to know about trauma?

PURPOSE: The purpose of this article is to describe Trauma and Resilience Competencies for Psychiatric Nurse Practitioners and to propose a trauma and resilience informed framework for nursing practice. CONCLUSIONS: Trauma and Resilience Competencies for Nursing Education have been developed and validated, yet to date, these have not been widely disseminated. PRACTICE IMPLICATIONS: It is essential that all nurses have competency in trauma and resilience to provide care for their patients as well as for their own well-being. The Psychiatric Nurse Practitioner who practices from a trauma-informed framework ensures the delivery of safe, quality care for all patients.

Effectiveness of a Problem-Based Geropsychiatric Nursing Clinical Internship Program.

Clinical internships that effectively incorporate the care of older adults with mental health disorders are sparse in many countries, including Taiwan. This study investigated the effectiveness of a problem-based geropsychiatric clinical internship program for nursing students in Taiwan. We conducted a quasi-experimental study among 126 nursing students. Experimental and control groups received problem-based geropsychiatric and general psychiatric practice sessions, respectively. Knowledge, attitude, skills, and self-reflection were evaluated before (T1) and after (T2) measurements. There were no significant differences between the groups in knowledge, attitude, skills, and self-reflection at T1. At T2, knowledge was significantly higher in the experimental group (t = 2.39, p = 0.02). Attitude, skills, and self-reflection ability did not differ between the groups at T2. Our results showed that clinical problem-based approaches can be applied in geropsychiatric mental health nursing internship programs. The problem-based approach was helpful in improving nursing students' knowledge about psychiatric symptoms and the health problems of older adults with mental illness. However, it did not significantly enhance or change the attitudes, skills, or the ability to self-reflect among students.