Community Psychiatric Nurses Research Articles

Developing guidelines for nursing management of epilepsy in Ghanaian schools

BackgroundThe absence of guidelines for the nursing management of individuals living with epilepsy, who are students in Ghana, has resulted in the high dropout rates of such students. It is our hope, that in the near future, these individuals living with epilepsy will receive the needed attention, experience less stigmatization and discrimination. This, we expect, will result in better retention of such students in schools, improved academic performance and successful graduation. To achieve this, there is the need to develop appropriate guidelines and implement same for their benefit. In line with this, the study aims to develop guidelines for nurses to manage individuals living with epilepsy in Ghanaian schools.MethodologyQualitative approach will be adopted to conduct this study in two phases. In the first phase, a case study design will be deployed in the Twifo Atti-Morkwa District of the Central Region of Ghana. The case is the nursing management of individuals living with epilepsy within the school context, and the sources of information will be the general nurses, psychiatric, or community psychiatric nurses working at the schools. Within the context of the case, parents or guardians of individuals living with epilepsy in the schools as well as their teachers will be included in the study. Data will be collected through individual interviews for nurses and parents while focus group discussions will be used for the teachers. Thematic analysis will be used to analyze the data. In the second phase, guidelines will be developed using the modified e-Delphi Technique. The study will be piloted in the Komenda-Edina-Eguafo-Abrem Municipality of the Central Region of Ghana. Ethics approval for this study has been obtained from the Ethical Review Committee of the University of Pretoria in South Africa. Additionally, Administrative approvals have been obtained from the Ghana Education Service.DiscussionThe guidelines developed will form the basis for nursing management of individuals living with epilepsy in Ghanaian schools. This will help to improve educational outcomes for the individuals living with epilepsy.

The development and effects of an online-based community psychiatric nursing practice program with the ARCS model

Purpose: This study aimed to identify whether there is a difference between an online-based community psychiatric nursing practice program with the ARCS model and a conventional community psychiatric nursing practice program in promoting nursing students’ learning motivation, knowledge of community psychiatric nursing, communication skills, and learning self-efficacy.Methods: This study used a quasi-experimental design with a non-equivalent control group. The participants were 44 nursing students at three nursing colleges in Gyeongsangbuk-do. The experimental group was provided the online-based community psychiatric nursing practice program with ARCS model, while the control group was provided the conventional community psychiatric nursing practice program from July 9, to September 3, 2022. Both groups received practice training 8 hours a day, 5 days two weeks. The collected data were analyzed using the exact χ<sup>2</sup>, Mann-Whitney U-test, and Quade’s two-way ANCOVA with the IBM SPSS Statistics 28.0 program.Results: The results of the comparison of an experimental group training with the online-based community psychiatric nursing practice program with ARCS model and a control group training with the conventional community psychiatric nursing practice program showed that, there was no statistically significant difference between the two groups in learning motivation knowledge of community psychiatric nursing, and learning self-efficacy. However, communication skills were statistically significantly higher in the experimental group (F=6.23, p=.017).Conclusion: The online-based community psychiatric nursing practice program with ARCS model can be used as a substitute learning to improve community psychiatric nursing capabilities in situations when clinical practice is suspended due to infectious diseases such as coronavirus disease 2019 or when is a shortage of community psychiatric nursing practice institutions.

Community Psychiatric Mental Health Nursing: Practice and Challenges

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.

Evaluating the efficacy of the Thai Health Improvement Profile intervention for preventing weight gain in people with early stage psychosis: A randomized controlled trial

ObjectivesTo investigate the efficacy of the Thai Health Improvement Profile intervention for preventing clinically significant weight gain in people with early stage psychosis. MethodsWe undertook a randomised controlled trial from 10/2018 to 05/2021. Participants with early stage psychosis (<5 year duration) were recruited using convenience sampling from the caseloads of community psychiatric nurses in Thailand and randomly allocated to either the Thai Health Improvement Profile intervention or treatment as usual group following baseline assessment. Outcome assessors were blind to group allocation, whereas participants were not. Participants in the intervention group received three monthly (five in total) systematic health checks using the Thai Health Improvement Profile tool, which was used to develop a personal health plan in collaboration with a family member/carer. Nurses supported participants to implement the health plan using behaviour change techniques derived from motivational interviewing. The treatment as usual group consisted of medication and psychosocial support, and no additional intervention was provided. The primary outcome was weight gain (defined as a greater or equal to 7 % increase in weight against baseline) within 1 year. ResultsFifty-three participants were allocated to the intervention and an equal number to the treatment as usual group. Primary outcome data were available for 30 participants in each group at the 12 month follow-up. We undertook an intention to treat analysis with multiple imputation (to handle the missing data) for the primary outcome. The treatment as usual group was found to have higher odds than the Thai Health Improvement Profile intervention group of gaining ≥7 % of baseline body weight (OR = 6.52; 95 % CI: 1.88–22.65, p = 0.004). ConclusionsThe Thai Health Improvement Profile intervention was effective at preventing weight gain in people with early stage psychosis at one year, though attrition was relatively high. The results highlight the need for community mental health nurses to adopt a holistic approach, the potential benefits of conducting regular comprehensive health checks and the importance of involving family members when aiming to improve the physical health of people diagnosed with early stage psychosis. A large definitive multi-site randomised controlled trial of the Thai Health Improvement Profile with a longer follow-up is now justified. Trial registrationProspectively registered with the Thai Clinical Trials Registry (reference: TCTR20180305002).

The interprofessional collaboration between police and crisis response team in managing suicide-related cases in Singapore

Introduction The Crisis Response Team (CRT) is an interprofessional collaboration between the Singapore Police Force (SPF) and the Mental Health Helpline (MHH) of the Institute of Mental Health (IMH). Supported by a multidisciplinary team comprising of the SPF, IMH psychiatrists, community psychiatric nurses and crisis counsellors, and community partners, this intervention aims to support suicidal individuals, depending on their risk severity, residing in the community. Objectives To present the CRT work process and to explore the characteristics and outcomes of suicide-related cases referred. Methods In this descriptive research study, a quantitative approach is adopted. An Excel file shared across the helpline counsellors is used to collate information of the referred cases. Data collected from October 2021 to August 2022 were evaluated using the IBM SPSS Statistics for Windows v28.0. Descriptive statistics were used to summarise the characteristics and outcomes of the cases. Results Figure 1 shows the CRT work process. To standardise the method of assessing both suicide ideation and behaviour, the Columbia-Suicide Severity Rating Scale (C-SSRS) is utilised. As compared to other suicide ideation and behaviour scales, the C-SSRS has demonstrated good convergent and divergent validity, high sensitivity and specificity for suicidal classifications, and moderate to strong internal consistency (Cronbach’s α: 0.73 - 0.95) (Posner et al. AJP 2011; 168(12) 1266-1277). A total of 3,386 suicide-related cases was referred. The age range of the suicide-related cases range from 8 – 97 years old (M = 36, SD = 17.33). Of these 3,386 cases, 627 cases were discharged back to their family members/employer/friend/partner and with follow-up check-in calls by the MHH counsellors, 416 cases were sent to the restructured hospitals for organic workup, 2,268 cases were brought back to IMH, 55 cases were discharged back to the SPF for further investigation, and 20 cases warranted CRT home visit activations. Figure 2 shows the total number of referred cases and outcome of these cases in each month. Image: Image 2: Conclusions The CRT intervention could mitigate suicide risk and pressure on the mental health system (i.e., reduce unnecessary emergency room visits and hospital admissions), create greater mental health awareness, and facilitate individuals’ connection to mental healthcare services (i.e., in hospitals and/or in the community) as evidenced by the increasing number of cases referred, and increased collaboration with the various stakeholders, ensuring timely intervention and necessary follow-ups thereafter. Disclosure of Interest None Declared

Coping with COVID-19: Strategies of Frontline Nurses

Nurses are the largest workforce within healthcare systems. They are integral to managing pandemics, but due to pandemics, Nurses encounter various traumatic situations, mainly due to distressing and stressful work life. Therefore, nurses must strengthen their resilience in coping with difficulties, adapting to new strategies, and protecting their work and daily life. If nurses have sufficient resilience strategies, burnout and the rate of leaving a job or resigning decrease, posttraumatic growth develops, and work satisfaction increases. The results showed that psychological resilience is an essential predictor of perceived stress in nurses. Protecting the mental health of nursing staff is essential for nurses to combat COVID-19 effectively. Community mental health and psychiatric nurses should develop, implement, and evaluate interventions designed to enhance psychological resilience in clinical nurses.

The development of supported mental health accommodation and community psychiatric nursing in Oxfordshire.

Overcrowding in British mental hospitals was a major service and political concern when the NHS was introduced in 1948. From 1959, a number of projects were initiated locally in Oxfordshire, based from Littlemore Hospital Oxford, to provide alternative accommodation, primarily for long-stay residents. Two NHS hostels were opened and a network of group homes was developed from 1963. These were administered through the hospital League of Friends and supported by the community psychiatric nursing service led by Helmut Leopoldt. From 1977 a separate local charity, Oxfordshire Mind, also provided supported housing for younger patients. These developments can be seen as an early local case study of the provision of non-hospital (supported) accommodation and other forms of support for people with long-term mental health problems.

Evaluating social drop-in facilities and their impact on social recovery in early intervention in psychosis services

Purpose“Social recovery” is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis.Design/methodology/approachAttendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved.FindingsInductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance.Originality/valueThis paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff.

The professed effect of stigma on community psychiatric nurses in the Greater Accra region of Ghana

BackgroundStigma is a major factor that inhibits Mental Health Nurses work, especially Community Psychiatric Nurses, in terms of productivity. Even though mental health services have improved drastically, because of decentralization of mental health care, a lot more people still have reservations when it comes to mental health nurses particularly Community Psychiatric Nurses. The purpose of the study was to explore the professed effects of stigma on CPNs in the Southern part of Ghana.MethodsThe study was carried out in three district hospitals (Ga South, Ga Central and Okaikoi) all in the Accra Metropolis. The aim of the study was to describe how stigma affects Community Psychiatric Nurses. A qualitative descriptive exploratory design was adopted for the study. The purposive sampling technique was used to recruit participants. Data was saturated with 12 participants, aged between 25 and 40 years. The audio-taped interviews were transcribed verbatim and afterwards analyzed using thematic and content analysis.ResultsThe findings gathered from participants revealed that Community Psychiatric Nurses experienced various effects of stigma, such as low productivity, depression, and anger. Most of the participants recounted how stigmatization had affected their work both in the hospital setting and in their communities.ConclusionThe study showed that Community Psychiatric Nurses carried out their activities with much difficulty, because of their poor image. They stressed the need for recognition and support from employers, stakeholders and the general community so as to boost confidence and morale with the resultant effect of better healthcare delivery.

COVID‐19 and CPN attendance on ward rounds

COVID‐19 and CPN attendance on ward rounds

Quality Improvement Project to Improve GP Referrals to a Rural Psychiatric Team

AimsWith increasing awareness and reduction of stigma associated with Mental Health issues, referrals to services are increased, pushing specificity of commissioning and therefore declining patients of services when referrals are inadequate. Standards would be improved by better inclusion of information necessary for the Single Point of Access process (SPOA) in the Bolsover Community Mental Health Team (CMHT) to make prompt, effective decisions on allocating care.A Quality Improvement project in a Mental Health Team was devised to improve standards, and acceptance rate, of appropriate referrals to the Bolsover CMHT from General Practitioners (GPs). This would encourage GPs to refer patients whose mental health difficulties do not meet CMHT thresholds to alternative services. A higher acceptance rate and lower rejection rate would indicate that the proportion of suitable referrals had increased.MethodsUsing the Plan, Do, Study, Act (PDSA) model, Driver diagrams were used to create a template with the crucial information necessary for GP referrals to psychiatry/SPOA. Data were collected to check aims of the referral, sufficient information of the presenting complaint, personal &amp; family history, safety concerns, protective factors, comorbidities, medication and substance misuse. The outcome of each referral was recorded and categorised as either Community Psychiatric Nurse Assessment, Outpatient Appointment, Referral Rejected, Referred Elsewhere or No Patient Response.All referrals in September and October 2021 were analysed to assess whether enough information had been included for each variable. The September and October data were compared to check if the template had been associated with improved quality of referrals.ResultsPre-template, 17.4% of referrals were accepted, 13.0% received a SPOA assessment, 17.4% were rejected, 39.1% were re-referred elsewhere and 21.8% did not respond to the CMHT. After the template was circulated, 28.0% were accepted, 36.0% received a SPOA assessment, 4% received joint Doctor-SPOA care, 8% had a medication review and 12% were waiting for an MDT decision when data were analysed. The results for SPOA assessment and rejection were statistically significant (p &lt; 0.05), while results for other outcomes were not.Information on presenting complaint (82.1% to 100%, p &lt; 0.05), personal history (39.3% to 92.3%, p &lt; 0.05) and aims (50% to 88%, p &lt; 0.05) increased, while other information did not change in a statistically significant manner.ConclusionThe template led to an increased proportion of accepted referrals and a decreased proportion of rejected referrals. However, information on variables did not necessarily improve in the same manner. The template is useful to improve decision-making in SPOA.

Service evaluation of the South Wales police control room mental health triage model: outcomes achieved, lessons learned and next steps

PurposeSouth Wales Police Mental Health (MH) Triage service was initiated to meet the Welsh Government MH priority of early intervention to prevent MH crisis. Community Psychiatric Nurses, based in the control-room, provide advice to police and control room staff on the management of MH-related incidents. The purpose of this paper is to evaluate the first 12 months of operation (January-December 2019).Design/methodology/approachService evaluation of the first 12 months of operation (January–December 2019). Data were analysed in relation to: MH incidents; repeat callers; Section (S)136 use/assessment outcomes. Police, health staff and triage service users were interviewed and surveyed to capture their opinions of the service.FindingsPolicing areas with high engagement in triage saw reductions in S136 use and estimated opportunity costs saving. Triage was considered a valuable service that promoted cross agency collaborations. De-escalation in cases of mental distress was considered a strength. Access to follow-on services was identified as a challenge.Practical implicationsTriage enables a multi-agency response in the management of MH-related incidents. Improving trust between services, with skilled health professionals supporting police decision-making in real time.Originality/valueThere is a gap in the research on the impact of police-related MH triage models beyond the use of S136. This project evaluated the quality of the service, its design and the relationship between health, police and partner agencies during the triage process. Multi-agency assessment of follow-up is needed to measure the long-term impact on services and users.

A qualitative service evaluation of community psychiatric nurses’ experiences of conducting the Addenbrooke Cognitive Examination-lll via NHS Attend Anywhere

A qualitative service evaluation of community psychiatric nurses’ experiences of conducting the Addenbrooke Cognitive Examination-lll via NHS Attend Anywhere

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views.

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.

FAMILY PSYCHOEDUCATION TOWARDS ANXIETY CARING FAMILY WITH CHRONIC DISEASE AND MENTAL DISORDERS

Families who treat patients with chronic illnesses or mental disorders are felt as a financial and emotional burden, in addition to the lack of information to the family about the illness experienced by patients causing increased levels of family anxiety. The purpose of this study is to explain the influence of family psychoeducation on anxiety levels in caring for family members with chronic diseases and mental disorders. Research design used literature review. Journal search strategies are carried out at ProQuest, Google Scholar, Science Direct. The journal reviewed was a study of the effect of family psychoeducation on anxiety levels in caring for family members of chronic illness and mental disorders that were restricted to the past 10 years (2011-2020). A total of 516 journals that have been found are adjusted to the keywords which are then screened based on predetermined criteria. There were 11 journals that met the inclusion criteria that have been set and then conducted a review, consisting of 8 national journals and 3 international journals. From a review of journals that have been done, family psychoeducation has an effect in reducing family anxiety. Effective family psychoeducation to reduce anxiety is a psychoeducation carried out in 5 sessions, because the goals of each session can be achieved. it is expected that community psychiatric nurses are active in providing. psychoeducation therapy to families, especially with patients with chronic illnesses and mental disorders so that they can improve adaptive coping independently, and reduce anxiety in the care of sick family members.

Physical health monitoring in antipsychotic depot clinic

AimsA service evaluation project to look at if annual bloods, ECG, physical examination, and medical review was completed within the last year for patients attending anti-psychotic depot clinic at Bassetlaw mental health services in Nottinghamshire HealthCare NHS Foundation Trust.MethodElectronic notes were examined in October 2020 for 25 patients who attend anti-psychotic depot clinic to ascertain if medical review and physical examination had been completed along with annual bloods and ECG.ResultOut of 25 patients attending depot clinic in 2020 at Bassetlaw Hospital, 21 had all their blood tests done, 1 patient had refused bloods and 2 patients did not have blood tests done. ECG was completed for 3 patients at Bassetlaw hospital and 8 patients had it requested from primary care with 2 patients refusing to have ECG done. For 12 patients there was no evidence of ECG being requested or completed. 8 patients had physical examination completed and rest 17 patients did not have the physical examination completed including due to refusal. Out of 25, only 14 patients had a medical review conducted.ConclusionPatients who attend depot clinic may have an allocated community psychiatric nurse (CPN) or get reviewed by medics in outpatient clinics and would usually have their blood tests, physical health examination and ECGs requested and monitored by them. Patients who do not have any allocated CPN or medic tend to miss out on blood tests and ECG. General Practitioners are expected to complete physical health checks for patients who do not have CPN or regular outpatient review. The results of these investigations may not always be received in depot clinic, hence there is no documentation on electronic RIO system. When these patients disengage from the depot clinic, it is often very difficult to track them. As a follow-up from this service evaluation, all depot clinic patients will be allocated a key worker/CPN. This will ensure that they have a responsible person to facilitate annual checks. This will be reviewed in a years' time to evaluate the effectiveness of this intervention.

Standards for lithium monitoring. “Are we good at adhering to these standards in Lanarkshire”?

AimsThe National Institute for Health and Clinical Excellence (NICE) recommend that renal and thyroid function must be checked before lithium is prescribed and for all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. The aim of this audit is to ascertain whether or not routine blood monitoring for bipolar disorder patients, taking lithium is in keeping with the guidelines.BackgroundLithium has been a mainstay in the management of bipolar disorder since the 1970's; indeed, lithium carbonate was first used in the early 1880's for the treatment of mania. Despite its usefulness however, the drawback of lithium treatment remains its very narrow therapeutic index, toxic side effects and as such its need for close therapeutic monitoring.MethodA list of patients with a diagnosis of bipolar disorder being treated with lithium was collated from an electronic database of psychiatry patients in Cumbernauld Community and inpatients at Glencairn unit Coathill Hospital and Cleland Hospital. A retrospective analysis using Clinical Portal was conducted looking at blood results; Lithium levels checked 3 times a year and Kidney functions and Thyroid function checked twice a year, over the previous year. Our results were then compared to the NICE Guidelines for lithium monitoring to see if they complied with the expected routine monitoring schedule. We may have missed patients open to Community Psychiatric Nurses (CPN) but not open to Consultant psychiatrists. Other group that might have been missed could be open to General Practitioners but not to secondary care. We attempted to contact them but this was unsuccessful.ResultTotal of 690 patients were studied. Of 690 patients 51 patients had the diagnosis of Bipolar Affective Disorder. 49 percent of them were prescribed Lithium. 48percent had their Lithium bloods checked and 60 percent had their Kidney function and thyroid functions checked according to the guidelines. There were no data available for around 7 percent of patients but their Lithium levels were indicated only in Clinical notes.ConclusionThis audit has demonstrated that Lithium monitoring falls short of conforming to accepted standards. Data obtained by this audit have prompted an electronic alert system for patients on Lithium endorsing primary care, mental health and laboratory staff to work together to ensure supporting recommended Lithium monitoring.

Audit on prolactin monitoring for patients on oral risperidone, intramuscular risperidone, and intramuscular paliperidone

AimsThe aim of this audit was to investigate whether sufficient Prolactin monitoring was completed in a patient sample in the Torfaen area of Aneurin Bevan University Health Board. This audit targetted patients an oral or intra-muscular formulation of Risperidone in the year 2018 with the hypothesis that Prolactin monitoring is done less frequently than recommended.BackgroundRisperidone is the anti-psychotic drug most frequently associated with hyperprolactinemia which is often asymptomatic but can present with symptoms of oligomenorrhea, amenorrhea, galactorrhea, decreased libido, infertility, and decreased bone mass in women. Men with hyperprolactinemia may present with erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, and rarely galactorrhea. The BNF advises monitoring of Prolactin at baseline, after 6 months, and then annually.MethodRetrospective review of 150 patients’ clinical letters to identify if they are on the above medications, using the local digital records system EPEX. Emails were also sent to community psychiatric nurses asking them if they could highlight any patients they were caseholding on the above medication. Depot clinic lists were also examined. Patients identified as being on the above medication had their blood tests reviewed on the online system Clinical Workstation (CWS) to determine whether they had their Prolactin level tested. A single spot sample of all patients on Talygarn ward in January 2019 was also included.Result1. 28 Risperidone2. 23 of 28 never had any Prolactin measurements3. 2 of 28 patients had the appropriate level of monitoring done for the year of 2018a. One patient complained of Galacotorrheab. Another patient had baseline done while on the ward and isn't due for any further monitoring at the time of writing.ConclusionThe above results identify that Prolactin monitoring is not being routinely completed for patients on the studied medication at an acceptable compliance level. Limitations around utitlity of prolactin monitoring may be the contributing factors; eg. Prolactin levels or medication dose may not be positively associated with adverse effects.. Further efforts were made to highlight the importance of baseline prolactin monitoring, as well as including a baseline Prolactin as an admission blood test for patients presenting with psychotic symptoms or on an anti-psychotic. A complete audit of metabolic monitoring and Prolactin levels for all patients on anti-psychotics would be an appropriate next step.

Creative Theory in Psychiatric & Mental Health Nursing, Alternative Teaching Model, and a New Breakthrough in Psychiatric Home Care Nursing

Although many resources have been explored and applied in our environment, personal internal and external resources have yet to be adequately exploited. A nursing theory and model for internal and external resources may be developed and discussed deeply (Zauszniewski, 2018) to provide newer vision and direction, while helping face the challenges of caring for patients with psychiatric disorders or mental obstacles. Recently, many breaking news stories have highlighted the hidden worries affecting our society due to patients with psychiatric disorders who live in the community. This has resulted in people, including student nurses, to retain their stigma toward mental illnesses and psychiatric patients and express negative perceptions and fear toward psychiatric patients (Choi et al., 2016). Therefore, it has been a challenge of psychiatric nursing education to develop and use a new and more-acceptable teaching model to help student nurses better understand and hold a more-correct perception toward psychiatric patients. The practice of clinical nursing profession still needs to be focused while we remain committed to psychiatric nursing education. The number of psychiatric patients who need more continuous care in community settings has increased significantly. The needs of psychiatric home care nursing should be particularly emphasized, as the manpower / capabilities necessary for psychiatric nursing are limited in community health nursing practice (Huang & Wang, 2015). More resources and psychiatric practice nursing professionals should be made available to communities for continuous psychiatric care (Wu et al., 2016). Strong and authentic partnerships are very important to acute care, education, evidence-based research, and practical policy development in psychiatric & mental health nursing (McInnis-Perry et al., 2015). In this column, resourcefulness theory is introduced as a new theory that may be applied in the psychiatric and mental health nursing practice; alternative teaching models are recommended for psychiatric nursing education; and finally, the importance of overcoming the difficulties and addressing the needs in community psychiatric home care nursing is also emphasized. It is hoped that this approach will help facilitate the further, positive advance of psychiatric and mental health nursing.

Qualitative process evaluation of a problem-solving and Story-bridge based mental health literacy program with community leaders in Ghana.

Improved knowledge about, and positive attitudes towards, people with mental illness could lead to improved support and decreased stigma for people with mental illness, including their families and carers. The aims of our study were to evaluate the perspectives of community leaders about the usefulness of a cluster randomized trial of a problem-solving and Story-bridge based mental health literacy (MHL) programme and to understand whether they utilized the knowledge acquired from the programme in their usual interactions with people with mental illness and their families. Twenty-five participants were sampled randomly from the intervention cluster of the trial to participate in a qualitative process evaluation, and individual interviews were used to collect data. A thematic analysis of the data was undertaken. Three themes were abstracted from the data, reflecting participants' perspectives about the usefulness of the programme: overcoming fear of perceived dangerousness, increasing willingness to engage, and becoming empathetic and non-judgemental. This qualitative process evaluation offers insights into how a problem-solving and Story-bridge based MHL programme to a targeted group could lead to real and supportive actions/attitudes to people with mental illness. The findings have clinical relevance for a collaboration among family members and caregivers, community leaders and community psychiatric nurses, and other primary healthcare workers to develop community MHL strategies to improve the quality of care, support and life of people with mental disorders.