Mental health nurses' empathy towards consumers with dual diagnosis: A descriptive study.

AIM: This study aimed to assess mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. The research question was What is mental health nurses' empathy towards consumers with co-existing mental health and drug and alcohol problems? DESIGN AND METHODS: A cross-sectional survey was carried out to understand mental health nurses' empathy. The convenience sample included 96 mental health nurses from various mental health settings with experience working with consumers with dual diagnosis. We assessed empathy using the Toronto Empathy Questionnaire. We utilised SPSS™ software to analyse both the descriptive data and multiple-regression. RESULTS: The mean empathy score was 47.71 (SD 8.28). The analysis of the association between demographic variables and individual subscales showed an association between the clinical setting and empathy (p = .031) and sympathetic physiological arousal (p = .049). The work sector was associated with sympathetic physiological arousal (p = .045) and conspecific altruism (p = .008). Emotional contagion (ß = .98, p < .001), emotional comprehension (ß = 1.02, p < .001), sympathetic physiological arousal (ß = 1.01, p < .001) and conspecific altruism (ß = 10.23, p < .001) predicted mental health nurses' empathy. CONCLUSIONS: This study found that most mental health nurses showed empathy towards consumers with dual diagnosis. Mental health nurses who are more empathetic towards their consumers experience emotional contagion. They understand emotions better, show sympathetic physiological responses and exhibit kind behaviour towards consumers. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Further research is required to understand how mental health nurses adapt to consumers' emotional states in different mental health settings. This information can help clinicians make better decisions about care quality for consumers with dual diagnosis. IMPACT: This study addressed mental health nurses' empathy towards consumers with dual diagnosis. Mental health nurses showed increased empathy towards consumers with dual diagnosis. The empathy levels vary based on age, clinical setting, work sector and work experience. Mental health nurses' empathy levels were predicted by emotional contagion, emotion comprehension, sympathetic physiological arousal and conspecific altruism. Empathy enhancement among mental health nurses, particularly towards consumers with dual diagnosis, is crucial and should be regarded as a top priority by healthcare leaders and educators. REPORTING METHOD: Outlined by the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

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.

Mental Health Nurses' Attitudes towards Consumers with co-Existing Mental Health and Drug and Alcohol Problems: A Scoping Review.

Consumers with co-existing mental health and drug/alcohol problems are exposed to more stigma than those with any other health problems. This scoping review aimed to systematically map the available literature regarding mental health nurses' attitudes, empathy, and caring efficacy towards consumers with a dual diagnosis. Twenty studies reported outcomes regarding nurse attitudes; however, none reported nurses' empathy or caring efficacy towards consumers with a dual diagnosis. Further research is required to advance the evidence on the impact of mental health nurses' attitudes, empathy and caring effectiveness, and the outcomes should lead to improved service delivery for consumers with a dual diagnosis.

Strategies for Implementing Consumer Involvement in Nursing Handover on Acute Mental Health In-Patient Units.

Consumer participation in the process of care delivery is crucial to recovery-oriented care. Nursing handover is an important process during the delivery of care on acute in-patient units. Despite the importance of involving consumers in this process, it remains a relatively new concept within mental health. This is due to the complexities involved in the provision of care within the mental health setting. There is a paucity of research on how to successfully implement consumer involvement in nursing handover within mental health settings even though this practice has been occurring within generalist settings for some time now. This paper reports on the findings on the implementation of consumer involvement on an acute in-patient unit. The views of consumers and mental health nurses about the process have already being reported. This current paper describes how a new handover system was implemented using a modified version of the model for successful change to bedside handover by McMurray et al. which was based on Lewin's force-field model of unfreezing, moving and refreezing and Kotter's model of change. The key elements of successful implementation are discussed. There is a need to carefully design and implement consumer involvement in nursing handover within acute in-patient units. There are lessons to be learnt in the process adopted and described in this paper.

A Journey of Discovery: Experiences of Carers of People with Mental Illness Seeking Diagnosis and Treatment for Their Relative.

This study explores the experiences of informal carers of people with mental illness in an Australian mental health service. A qualitative descriptive approach was used with data collected via focus group interviews with a purposive sample of 19 carers. Data analysis revealed two major themes: (a) "Something is not right" and (b) "Now we have a diagnosis." The carers noticed that there was something wrong with their relative before they received a diagnosis but were often hesitant to engage Mental Health services. Carers have trouble understanding if the problems they are witnessing are part of normal development, contemporary culture, or are symptoms of mental illness. Fear of stigma remains a barrier to accessing services and early diagnosis. Findings suggest a need to target support for informal carers in the period prior to and leading to the establishment of a mental health diagnosis.

Nurses' Perspectives on the Proposed Seclusion Elimination in Mental Health Wards.

Managing consumers with challenging behaviours by way of secluding them has been practiced for centuries. Many countries have attempted to eliminate seclusion but with very limited success. The Victorian government in Australia has embarked on a plan to stop seclusion within the coming 10 years. A qualitative research design using a purposive cluster sampling technique was utilised to understand nurses' perceptions on attempts to eliminate seclusions in acute wards. Semi-structured interviews and a thematic analysis were used to reveal participants' perceptions. Analysis revealed six themes: personal views, staff skills/resources, safety concerns, stakeholders' influence, doubt about elimination and participants' recommendations. Participants were doubtful of seclusion elimination success if there were no major improvements in nurse security, infrastructure, funding and staffing. Further research is required to establish and develop effective alternatives to seclusion.

Mental health nurses' empathy experiences towards consumers with dual diagnosis: A thematic analysis.

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is one of the leading causes of disability globally. Consumers with dual diagnosis have complex needs and are at risk of relapse of their psychiatric symptoms. Mental health nurses require essential skills, including empathy, to manage consumers with dual diagnosis. No studies have explored mental health nurses' empathy towards consumers with dual diagnosis. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Developing empathy towards consumers with dual diagnosis is complex. Mental health nurses' unemotional empathy experiences with consumers with dual diagnosis are related to their lack of ability to connect to their consumers' choices and feelings. Negative attitudes towards consumers with dual diagnosis contributed to nurses' poor empathy experiences. The unemotional responses of mental health nurses can be caused by factors such as novelty, insufficient information, and neutral evaluation of a consumer's situation. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study results benefit researchers, teachers, clinicians, and administrators when designing, developing, and delivering empathy training packages for mental health nurses. Improving the empathy of mental health nurses towards consumers with dual diagnosis should be a top priority for healthcare leaders and educators. A core curriculum containing holistic awareness of the biopsychosocial components of dual diagnosis makes it easier for mental health nurses to understand and develop empathy towards consumers with dual diagnosis. Future studies must address the relationship between attitude, stress, burnout, compassion fatigue and empathy among mental health nurses in relation to consumers with dual diagnosis. ABSTRACT: INTRODUCTION: There is a lack of evidence regarding mental health nurses' empathy towards consumers with dual diagnosis. AIMS: This qualitative study aimed to describe mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. METHOD: Through purposeful sampling, interviews were conducted with 17 mental health nurses who have experience in caring for consumers with dual diagnosis. Thematic analysis, as an inductive approach was used, to generate codes and themes from participant data. To report on this qualitative study, we adhered to the ENTREQ guidelines. RESULTS: Four themes emerged: challenges to develop empathy with consumers, lack of conducive attitude of nurses towards consumers, appraising consumers' emotions accurately and holistically responding to the appraised emotions. The findings indicated that developing empathy towards consumers with dual diagnosis is a complex task. DISCUSSION: Mental health nurses may struggle to empathize with consumers when encountering confrontational situations. Interventional studies are required to address the relationship between mental health nurses' attitudes, stress, burnout, compassion fatigue and empathy in relation to consumers with dual diagnosis. IMPLICATIONS FOR PRACTICE: Understanding why mental health nurses emotional experiences differ about a similar challenging situation experienced by their consumers is vital. Further research on strategies to address empathy issues among mental health nurses could enhance nursing practice and consumer care.

Mental health nurses' attitudes towards consumers with co-existing mental health and drug and alcohol problems: Adescriptive study.

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is one of the leading causes of disability globally. There is limited evidence on mental health nurses' attitudes towards consumers with dual diagnosis. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Mental health nurses have positive attitudes towards consumers with dual diagnosis. A positive attitude at work is influenced by various factors, including feeling that one's role is appropriate and legitimate. This also includes receiving support in that role, being motivated to work, having confidence in completing tasks and feeling satisfied with one's job. ABSTRACT: BACKGROUND: Dual diagnosis is a global health concern. This descriptive research assessed mental health nurses' attitudes towards consumers with dual diagnosis in Australian mental health settings. The research question was: What is the attitude of mental health nurses towards consumers with co-existing mental health and drug and alcohol problems? MATERIALS AND METHODS: This cross-sectional survey included 103 mental health nurses who work with consumers with dual diagnosis. Participants were recruited from various mental health settings through convenience sampling. The Comorbidity Problems Perceptions Questionnaire was used to assess attitudes. Descriptive data and multiple regression analyses were conducted. We utilized the consensus-based checklist for reporting results of this study. RESULTS: Mental health nurses positively perceived consumers with dual diagnosis. Factors associated with a positive attitude were a higher level of work experience, feeling that one's role is adequate, perceiving one's role as legitimate, receiving increased support in one's position, having high work motivation, possessing high task-specific self-esteem and experiencing higher levels of work satisfaction. Work experience predicted role adequacy. Position predicted role support. The work sector predicted role-related self-esteem. CONCLUSIONS: As mental health nurses gain work experience; they develop positive attitudes that boost their self-esteem and sense of importance towards consumers with dual diagnosis. This constructive mindset also positively affects their work motivation and job satisfaction towards consumers with dual diagnosis. Conducting interventional studies is necessary to examine how clinical experiences, work environments, and job positions can impact attitudes, aiming to improve mental health nursing interventions towards consumers with dual diagnosis. IMPLICATIONS TO PRACTICE: The study found that mental health nurses' positive attitudes towards consumers with dual-diagnosis are influenced by their experience and knowledge. Moreover, mental health nurses who feel supported, motivated and confident in their roles are more likely to provide high-quality care to consumers with dual diagnosis. Mental health nurses could provide better care and support if they took a proactive approach and addressed the challenges associated with this consumer population. To be successful in their roles, mental health nurses require access to resources and support from healthcare organizations. As a result, their job satisfaction and attitudes towards consumers with dual diagnosis will be enhanced. In this way, consumers as well as healthcare organizations will benefit.

Views of Mental Health Nurses on Responding to Clinical Aggression on General Wards.

The overall aim of this study was to explore the views of mental health nurses (MHNs) about their experience of responding to workplace violence (WPV) and aggression (code greys and blacks) within acute general wards. WPV continues to pose a significant source of challenge within healthcare settings despite several initiatives that have been trialled over the years. It has the potential to impact patient care and overall staff health and well-being. Nurses play a significant role in the management of WPV; hence, it is important to understand how they respond to and manage incidents of WPV. The study design was an explorative descriptive qualitative design. Data were collected through semi-structured interviews involving n = 10 MHNs working within a mental health consultation liaison team that responds to incidents of violence and aggression (codes grey and black) in acute general wards. Participants were recruited using a convenient sampling method. Data were analysed using thematic analysis. The findings of this study highlighted the following themes: (1) Patient care (subthemes: patient frustration with hospital processes, lack of time and resources); (2) Staffing skills and confidence (subthemes: lack of adequate training, inability to intervene early and communication skills); (3) Understanding patient behaviours (subthemes: it's a psychiatry problem and zero tolerance approach). The management of WPV within acute hospital settings needs to be given due attention by healthcare services. Although a number of organisations are developing measures and guidelines to manage WPV, there is still a gap in the ability of general nursing staff to properly manage such incidences. Proper attention needs to be taken to the training of staff.

Perspectives of Mental Health Nurses About Sexual Safety in Acute Inpatient Mental Health Units.

The overall aim of this study is to explore the views of mental health nurses (MHNs) about the sexual safety of consumers receiving care in acute inpatient units. In Australia, people accessing mental health inpatient units have reported feeling unsafe while receiving care including experiences of sexual harassment and abuse from other patients. There has been no study to date that has explored the views of the MHNs providing care. An explorative descriptive qualitative study. Data were collected through semi-structured interviews involving n = 8 MHNs working on a metropolitan acute inpatient unit recruited using purposive convenience sampling. Data were analysed using thematic analysis. The findings of this study highlighted the themes of 'It's everyone's job to keep the patient safe', 'Going over expectations', 'Impact on patients' and 'Built environment'. Participants in this study believed that the sexual safety of patients in the inpatient unit is everyone's responsibility and that it was important during the admission process to ensure patients are aware of how to both seek help if needed and ensure that their actions or behaviours do not pose sexual safety concerns in others. Ensuring sexual safety in the mental health inpatient units is a complex issue that requires evidence-based multipronged interventions involving all key stakeholders within the units.

Nurses' perspectives on medication errors and prevention strategies in residential aged care facilities through a national survey.

BACKGROUND: Medication errors are common in residential aged care facilities (RACFs) due to several factors. Effective medication management is essential to prevent medication errors among older people particularly due to the complexity of co-morbidities they can experience. OBJECTIVES: This study aimed to examine and quantify the contributing factors of medication errors from nurses' perspectives and the prevention strategies to reduce medication errors among older adults living in RACFs. METHODS: A survey with 140 completed responses from registered nurses (RNs) and endorsed enrolled nurses (EENs) working in RACFs across Australia were included in the study. The survey had 24 items, related to contributing factors of medication errors, and the prevention strategies. Descriptive statistics and exploratory factor analysis were used in the data analysis process. RESULTS: The study identified medication errors are caused by contributing factors such as use of agency staffing (70.4%) and delays in receipt of laboratory results (94.3%). However, it also identified suggestions to reduce medication errors in RACFs, for example use of electronic alerts (88.3%), and efficient laboratory communication (91.8%). Our results revealed three key factors for causes (workload, interprofessional involvement and interruptions) and suggestions (medication safety alerts, medication process improvement and effective reporting). CONCLUSION: Medication errors in RACFs are a global problem being one of the leading causes of morbidity and mortality. The knowledge and awareness of the factors associated with medication errors and the prevention strategies can guide potential quality improvement plans and contribute to minimisation of risk associated with medication safety in RACFs. IMPLICATIONS FOR PRACTICE: The study recommends strategies for best practices in medication management such as interprofessional collaboration, implementing standardised policies and electronic alerts to reduce medication errors in RACFs.

Perspectives of mental health clinicians on physical health of young people with early psychosis.

The aim of this study is to explore the views and understanding of youth mental health clinicians with regard to the physical health of young people with early psychosis and their perspectives on lifestyle interventions improving the health and well-being of young people with early psychosis. Physical health disparities leading to premature mortality among people with mental illness are well evident in the literature. Mental health and physical health are directly correlated. The risk of poor physical health often begins before the onset of mental ill health. Young people with early psychosis are highly susceptible to poor physical health. A co-designed integrated approach focusing on early prevention and intervention in overall well-being and health is imminent for this targeted population to prevent poor physical health trajectory across the lifespan. Ten clinicians were recruited and participated in this study through semi-structured interviews. Five themes were identified: (i) Impact of early psychosis, (ii) Focus of care, (iii) Conversations around physical health, (iv) Co-location of specialist roles and (v) Health literacy. The findings of this study confirm the dimensional impact of early psychosis on the well-being and health of young people through the vicious cycle of early psychosis. Promotion of health literacy along with social connectedness and elements of self-determination, as well as having a prime focus on the individuals' experience in the journey of health promotion through participation in lifestyle interventions, has been identified as critically prominent.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study.

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Modifying the clinical reasoning cycle to enhance forensic mental health nursing utility.

Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care.

Exploring adaptations to the clinical reasoning cycle for forensic mental health nursing: A qualitative enquiry.

Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to 'own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team.

Transition Experiences of Indian Nurses Into Australian Mental Health System.

INTRODUCTION: In the past decade, there has been an influx of migrant nurses from India to Australia. Migrant professionals have specific transition needs associated with working in Mental Health (MH). This study aimed to explore the transition experience of overseas trained nurses from India working in Australian MH settings. METHOD: Hermeneutic phenomenology was the methodological approach used in the study. The participants (N = 16) were overseas trained nurses from India. Data were collected through in-depth interview and analysed using thematic analysis. RESULTS: The findings resulted in the identification of the following themes: (1) Living in dual culture, (2) Loneliness, (3) Discrimination, and (4) Feeling incomplete. DISCUSSION: It is evident that the transition to work in MH in Australia was a journey of mixed experiences. While certain findings of this study are comparable with experiences of migrant nurses in other settings, it provides insight into those that are working in MH.

Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper.

The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions.

Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study.

Forensic mental health nursing (FMHN) is a specialized field, designed to meet the needs of people who have a serious mental illness across the criminal justice system, inpatient services and community. Frameworks can assist assessment, planning, intervention, documentation and evaluation of nursing care. However, there is no prior research investigating frameworks in FMHN. This study aimed to explore the Nursing Process (NP) and the Clinical Reasoning Cycle (CRC), with nurses, to determine a suitable framework for use service-wide. A Nominal Group Technique was used to facilitate exploration of the two frameworks, where open-ended verbal and written responses collected from a Nominal Group were thematically analysed, and the participants voted on their preferred framework. Seventeen nurses from a state-wide forensic mental health (FMH) service participated. The four main themes were as follows: challenges to current practice, limitations of the NP, perceived benefits of the CRC and addressing implementation. Consensus was reached with the nurses selecting the CRC as the framework of choice. This is the first study to explore frameworks to guide practice in FMHN. Nurses in this study considered the CRC to be a suitable framework for novice through to expert, offering a contemporary framework to guide nursing care in complex FMH settings. Some adjustments to the existing cycle were suggested to emphasize recovery-oriented practice, and inclusion of family and carers. Any changes to the cycle warrant exploration with the interdisciplinary team and consumer carer workforce.