Engagement between adults in suicidal crises and nurses in mental health wards: a qualitative study of patients' perspectives.

OBJECTIVE: To understand how patients in suicidal crises perceive their engagement with nurses in mental hospitals. METHODS: A qualitative study based on grounded theory was conducted. Semi-structured interviews were used with 11 hospitalised adults living through suicidal crises. The data were analysed by multiple researchers, using the constant comparison method, coding, and memo writing. FINDINGS: The core process was: 'Feeling nurtured through an interpersonal engagement'. This process underpinned two categories: 'Feeling safe and cared for while struggling to trust' and 'Working toward alleviation and change of my suicidal ideation'. The patients valued nurses who integrated caring approaches of building trust, demonstrating compassion, and promoting safety, with healing approaches of helping them to express and explore their suicidal ideations, and develop new insights and ways of coping. This interpersonal engagement could nurture patients' feelings of being accepted and understood, and being hopeful and capable of overcoming their suicidal ideations. CONCLUSION: The conceptual insights can inform strategies to reframe overly instrumental approaches to prevent suicide and treat suicidal ideation, and instead promote an interpersonal orientation in nursing practice that integrates caring-healing approaches.

The working alliance with people experiencing suicidal ideation: A qualitative study of nurses' perspectives.

AIMS: This study aimed to enhance the conceptual understanding of the working alliance in the context of nursing care for people experiencing suicidal ideation. DESIGN: A qualitative study based on grounded theory was conducted. METHODS: Two authors conducted individual semi-structured interviews from September 2017-January 2019. Twenty-eight nurses in 13 wards of four psychiatric hospitals participated. The Qualitative Analysis Guide of Leuven was used to support constant data comparisons and the cyclic processes of data collection and data analysis. FINDINGS: The nurses' perspectives revealed that the working alliance can be understood as an interpersonal and collaborative relational process. This relational process highlighted the core variable 'seeking connectedness and attunement with the person at risk of suicide'. The core variable underpinned three clusters: investing in the foundations of the working alliance, nourishing the clinical dimension of the working alliance and realizing an impact with the working alliance. CONCLUSION: This study highlights the importance for nurses to assess, evaluate and respond to persons' suicidal ideation in harmony with a commitment to connect with them and attune to their perspective. IMPACT: The relational process uncovered through this study offers valuable insights to support advanced nursing practice, where nurses meaningfully integrate relational elements of care with their contributions to suicide prevention and treatment.

Contact and communication with patients experiencing suicidal ideation: A qualitative study of nurses' perspectives.

AIM: To uncover and understand the core elements of how nurses in psychiatric hospitals make contact with patients experiencing suicidal ideation. DESIGN: A qualitative study based on the principles of grounded theory was performed. METHODS: Nineteen nurses on wards of four psychiatric hospitals were interviewed between May 2017 - February 2018. The Qualitative Analysis Guide of Leuven was used to facilitate the constant comparison of data. FINDINGS: Nurses make contact with patients experiencing suicidal ideation by "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients". These interconnected core elements represent nurses' attention to relational processes like building trust as well as their predominant focus on assessing suicide risk. Nurses put other emphases in their contacts with patients depending on whether their approach is guided more by checking and controlling suicide risk or by acknowledging and connecting (with) the person. CONCLUSION: The study enhances the conceptual understanding of how nurses on psychiatric wards can involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. These findings can be used to underpin the nurses' role in and contribution to suicide prevention. IMPACT: The core elements "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients" can inform policies for nursing practice and education that aim to preserve and improve the capacity of nurses to involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation.

The Development and Validation of the Patient Participation Culture Tool for Inpatient Psychiatric Wards (PaCT-PSY).

Patient participation is an important topic in mental health and receives increased attention along with deinstitutionalization. No tool exists to measure healthcare worker-related factors that influence patient participation. A three-staged study was conducted to develop and validate the 'Patient Participation Culture Tool for inpatient PSYchiatric wards' (PaCT-PSY), and to analyse its psychometric properties (n=603). The 60-items tool, comprising thirteen components, showed content validity, strong psychometric properties, and a high internal consistency. The PaCT-PSY measures the patient participation culture on psychiatric wards by exploring healthcare worker's factors influencing patient participation. It enables researchers, practitioners and administrators to develop tailored actions.

Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study.

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems. ABSTRACT: INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. AIM/QUESTION: To measure nurse-sensitive patient outcomes of the nurse-patient relationship. METHOD: In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. RESULTS: Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). DISCUSSION: The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. IMPLICATIONS FOR PRACTICES: Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.

Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals.

WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.

Family expectations of inpatient mental health services for adults with suicidal ideation: a qualitative study.

Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub-elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery-oriented mental health services that allow meaningful family involvement.

Contact between patients with suicidal ideation and nurses in mental health wards: Development and psychometric evaluation of a questionnaire.

Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three-stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test-retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients' perceptions of contact experiences with nurses (CoNuPaS-experience) and what they find important in that contact (CoNuPaS-importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self-determining individual, encountering nurses' availability/information-sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78-1.00); test-retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient-nurse contact in mental health wards is central to improving understanding of nurses' contributions to suicide prevention and suicidal ideation treatment.

The development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings.

Mental health nurses are struggling to describe their nursing identity as professional discipline in a changing mental health care. Measuring nurse-sensitive patient outcomes and demonstrating nursing's effect(s) experienced by patients contribute to (re)discover the specific nursing identity. However, a valid and reliable scale is currently lacking. The aim of this study was the development and psychometric evaluation of the Mental Health Nurse-Sensitive Patient Outcome Scale (MH-NURSE-POS) for inpatient psychiatric hospital settings. This three-staged study resulted in a scale capturing how inpatients experience the contribution of nurses in their treatment in psychiatric hospitals. First, a draft questionnaire was developed based on a literature review, an independent expert's advice, and an experts panel. Second, the content validity was tested in a two-round Delphi-procedure and focus groups with patients. A pilot test, based on cognitive interviews, confirmed the feasibility of the questionnaire. Third, the psychometric properties of the mental health nurse-sensitive patient outcomes were determined in a sample of 353 patients. The cross-sectional study included a convenience sample of five psychiatric hospitals (Belgium). The factor structure (Kaiser-Meyer-Olkin measure of sampling adequacy 0.924; Bartlett's test of sphericity χ2  = 4162.537; df = 231; P < 0.001), convergent validity by the Individualized Care Scale (Pearson correlation 0.660; P < 0.001), and reliability (Cronbach's Alpha 0.854) were evaluated. The factor analysis resulted in a four-factor solution representing growth, expression, control, and motivation. The Mental Health Nurse-Sensitive Patient Outcome Scale is a valid and reliable tool to measure the effectiveness of mental health nurses from the patient perspective.

The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review.

BACKGROUND: In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked. OBJECTIVE: To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. DESIGN: Review of qualitative and quantitative studies within a data-based convergent synthesis design. DATA SOURCES: A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists. REVIEW METHODS: The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes. RESULTS: In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality. CONCLUSIONS: This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.

'Promoting and preserving safety and a life-oriented perspective': A qualitative study of nurses' interactions with patients experiencing suicidal ideation.

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses' actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element 'promoting and preserving safety and a life-oriented perspective'. This core element represents the three interconnected elements 'managing the risk of suicide', 'guiding patients away from suicidal ideation', and 'searching for balance in the minefield'. The enhanced understanding of nurses' actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses' capacity and ability to connect and collaborate with patients experiencing suicidal ideation.

Mental health nurses and mental health peer workers: Self-perceptions of role-related clinical competences.

In a mental healthcare that embraces a recovery-oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role-related competences in clinical practice. The aim of this study was to clarify and understand these self-perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role-related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role-related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self-assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training.

Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health-care systems.

There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health-care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health-care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014-2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health-care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self-preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self-preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well-being.

Patient safety on psychiatric wards: A cross-sectional, multilevel study of factors influencing nurses' willingness to share power and responsibility with patients.

The World Health Organization highlights the need for more patient participation in patient safety. In mental health care, psychiatric nurses are in a frontline position to support this evolution. The aim of the present study was to investigate the demographic and contextual factors that influence the willingness of psychiatric nurses to share power and responsibility with patients concerning patient safety. The patient participation culture tool for inpatient psychiatric wards was completed by 705 nurses employed in 173 psychiatric wards within 37 hospitals. Multilevel modelling was used to analyse the self-reported data. The acceptance of a role wherein nurses share power and responsibility with patients concerning patient safety is influenced by the nurses' sex, age, perceived competence, perceived support, and type of ward. To support nurses in fulfilling their role in patient participation, patient participation-specific basic and continuing education should be provided. Managers and supervisors should recognize and fulfil their facilitating role in patient participation by offering support to nurses. Special attention is needed for young nurses and nurses on closed psychiatric wards, because these particular groups report being less willing to accept a new role. Ward characteristics that restrict patient participation should be challenged so that these become more patient participation stimulating. More research is needed to explore the willingness and ability of psychiatric nurses to engage in collaborative safety management with patients who have specific conditions, such as suicidal ideation and emotional harm.

Peer workers' perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review.

OBJECTIVES: To identify peer workers' perceptions and experiences of barriers to implementation of peer worker roles in mental health services. DESIGN: Review of qualitative and quantitative studies. DATA SOURCES: A comprehensive electronic database search was conducted between October 2014 and December 2015 in PubMed, CINAHL, Web of Science, The Cochrane Library, and PsycARTICLES. Additional articles were identified through handsearch. REVIEW METHODS: All articles were assessed on quality. A thematic analysis informed by a multi-level approach was adopted to identify and discuss the main themes in the individual studies. Reporting was in line with the 'Enhancing transparency in reporting the synthesis of qualitative research' statement. RESULTS: Eighteen articles met the inclusion criteria. All studies adopted qualitative research methods, of which three studies used additional quantitative methods. Peer workers' perceptions and experiences cover a range of themes including the lack of credibility of peer worker roles, professionals' negative attitudes, tensions with service users, struggles with identity construction, cultural impediments, poor organizational arrangements, and inadequate overarching social and mental health policies. CONCLUSIONS: This review can inform policy, practice and research from the unique perspective of peer workers. Mental health professionals and peer workers should enter into an alliance to address barriers in the integration of peer workers and to enhance quality of service delivery. Longitudinal research is needed to determine how to address barriers in the implementation of peer worker roles.