Inpatient Psychiatric Nurses Research Articles

Psychoeducation group facilitation training for nurses: A quality improvement project.

According to the 2020-2021 National Survey of Children's Health, 23.3% of children and adolescents met criteria for one or more mental, emotional, developmental, or behavioral problems. However, the prevalence of depression, anxiety, and post traumatic stress disorder have risen dramatically since the COVID-19 pandemic, leading to an increase in suicidal ideations, completed suicides, and pediatric psychiatric hospitalizations. There is a critical need for high quality mental healthcare treatments, including psychoeducation. Inpatient psychiatric nurses are well positioned to lead psychoeducation groups, but few receive training. Nurses at a designated inpatient pediatric psychiatric unit expressed discomfort in facilitating psychoeducation groups. This is a one-group prepost and follow-up quality improvement study designed to improve the quality of psychoeducation group facilitation skills provided by nurses at a child and adolescent inpatient psychiatric unit. A convenience sample of nurses (N = 16) participated. Baseline (T1), post-test (T2), and follow-up (T3) data were collected regarding nurses' self-efficacy, evidence based-practice attitudes, and knowledge of psychoeducation group facilitation. Nurses received 45 min of psychoeducation group facilitation education and 15 min of skills simulation. The nurses' knowledge, self-efficacy, and attitudes toward evidence-based practice when facilitating psychoeducation groups increased significantly from the baseline to the post-test, which was sustained from the post-test to the follow-up period. Study findings indicate the importance of supporting nurses in their role of psychoeducation group facilitation through education and program structure. Further research is needed to assess longer term sustainability and efficacy in leading psychoeducation groups.

Saudi Arabian Nurses' Motivations and Barriers to Employment in Inpatient Mental Health Facilities: A Qualitative Investigation.

The shortage of inpatient psychiatric mental health care nurses in Saudi Arabia represents an important health care challenge. The aim of this study was to illuminate perspectives of psychiatric mental health nurses employed in psychiatric inpatient settings about their employment experiences. This study adopted an exploratory qualitative approach using thematic content analysis. Ten professional nurses with psychiatric inpatient caring experience participated in two focus groups composed of Master of Nursing students. Four main themes emerged: inadequate professional skills and knowledge for psychiatric mental health care practice, negative public attitudes toward psychiatric/mental health nurses, concerns for personal safety, and alternatives and advantages. The findings of this study suggest that nurses' lack of interest in working in psychiatric units is not merely personal but also social and organizational. The study findings may encourage managers and authorities to develop measures to attract more mental health nurses to work in psychiatric units. Such strategies may include modification of nurses' skills, training, and professional knowledge, collegial supervision, mentoring, and working conditions and environment.

Experiences of Inpatient Psychiatric Nursing Care among People Who Have Survived a Suicide Attempt

ABSTRACT Nurses are front line providers for people who have been hospitalized following a suicide attempt, yet few studies have explored this population’s experiences specifically with nursing care in inpatient psychiatric units. The purpose of this study was to hear directly from people who have survived a suicide attempt about their experiences with inpatient psychiatric nursing care following a suicide attempt in order to identify strengths and weaknesses of current practices and elicit suggested improvements. Qualitative in-depth interviews were conducted with people who were previously psychiatrically hospitalized following a suicide attempt (N = 9; M age=42). Applied thematic analysis was used to identify themes related to positive and negative experiences with nursing care during hospitalization and advice for nurses. Findings demonstrated that positive experiences with nurses related to empathy, friendliness, feeling supported, flexibility, and active listening, while negative experiences centered around feeling stigmatized, invalidated, degraded, and coerced. Advice for nurses included being self-aware of preconceived or stigmatized notions, practicing empathy, listening, and humanity. The results of this study indicate the need for compassionate care, training to reduce nurse stigma, and adequate resources for nurses to mitigate emotional strain and burnout.

Effects of a Competency-Based Education Program for Inpatient Psychiatric Nurses: A Pre-Post Intervention Study

Purpose: This study aimed to develop a competency-based educational program for strengthening the competency of psychiatric nurses and evaluate its effects.Methods: The study used a quasi-experimental design. Participants included 64 psychiatric nurses in South Korea: 33 nurses (32 females, 1 male) in the experimental group and 31 nurses (26 females, 5 males) in the control group. A competency-based education program for psychiatric nurses was developed through a literature review and discussion with 12 experts. The program addressed eight topics and provided 24 hours of education over 4 days, for 6 hours each day. The collected data via questionnaires were analyzed statistically.Results: The education program enhanced overall clinical nursing competence and strengthened professional self-growth competence. The management and teaching competencies of both the experimental and the control groups also increased significantly.Conclusion: The findings of this study presented an educational program to strengthen the clinical competency of psychiatric nurses and it was proven that the education had a capacity-building effect.

Training inpatient psychiatric nurses and staff to utilize CBTp informed skills in an acute inpatient psychiatric setting

ABSTRACT Background The aim of this study was to investigate the impact of a novel, brief CBTp-informed skills training, called Positive Practices for working with Psychosis (PPP), on recovery-orientation of frontline inpatient psychiatric staff, and on staff knowledge of and confidence using skills informed by Cognitive Behavior Therapy for psychosis. Methods Twenty five providers participated in 12 hours of PPP training. We examined changes in providers’ skills in delivering recovery-oriented care (focusing on skills advocacy, evidence based practice, stigma, optimism, and client preference), and providers’ knowledge of, and confidence in using CBTp informed skills, using the Competency Assessment Instrument (CAI) and the Knowledge and Confidence Using CBTp Skills Scale (KC-CBTp). Results were analyzed using paired-sample t-tests. Results: Significant gains (p < .001) in self-rated knowledge and confidence using CBTp skills were seen on 8 of 9 domains measured. On the CAI, significant gain in optimism was seen (p = .004). Discussion Brief CBTp informed PPP training is a potential intervention for frontline staff, associated with significant gains in knowledge of, and confidence in using, evidence based CBTp-informed skills, and increased optimism in attitudes towards recovery. Limited change on recovery based competencies of staff was seen in other domains and requires further investigation.

Resilience and burnout in healthcare students and inpatient psychiatric nurses: A between-groups study of two populations

BackgroundStressful environments can have significant effects on an individual and lead to burnout. Psychological consequences of burnout include trauma reactions, depression, anxiety and substance use disorders. Resilience, a protective mechanism can mitigate the negative impact of burnout. MethodThis study utilizes an exploratory correlational design to determine whether or not there is 1) a similar correlation between resilience and burnout between psychiatric nurses working in a high stress environment and students who are naive to the high stress academic environment and 2) a higher level of resilience in the psychiatric nurses compared to the healthcare students. ResultsA significant inverse relationship was observed with respect to resilience and burnout in both the professional nurse and student groups. However, the inpatient psychiatric nurse group was not found to have a higher level of resilience than the student group, when controlling for age.Conclusion: This suggests that resilience to burnout is not related to the work environment but life experience (age) was found to be a factor related resilience in this sample.

Exploring a social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: a pilot study

ABSTRACT Acute psychiatric nurses experience workplace stressors related to organizational factors including staffing shortages, along with interpersonal conflict with patients and colleagues. The pilot study examined the experience of burnout among acute care psychiatric nurses and the usefulness of a social work lead mindfulness-based intervention for reducing burnout elements. Findings indicated participants experienced emotional exhaustion associated with their work, but also a significant degree of personal accomplishment. Nurses identified the intervention as having the potential to promote better emotional regulation in the workplace and beyond. Social worker education on mindfulness techniques may represent an untapped resource for improving the emotional wellness and effective patient care.

Let's Talk About Benzodiazepine Use: Inpatient Psychiatric Nurses Initiating the Conversation.

Inpatient psychiatric nurses regularly dispense pro re nata (PRN) medication to individuals during their psychiatric hospitalization. International studies indicate that 66% to 90% of patients receive PRN medications during hospitalization, a large percentage of which are benzodiazepines (BZDs). Although clear opportunities exist for nursing intervention to reduce BZD use, there is little recent U.S. literature on inpatient psychiatric nurses' proactive approach to the issue. The current article examines the factors that support BZD use during inpatient hospitalization, including nurses' attitudes around BZD use, the perceived effectiveness of the medication to address difficult situations, and the barriers to using alternative nonpharmacological methods. Suggestions are presented for how nurses might begin dialogues with patients around BZD use and alternative strategies to manage distress. It is recommended that the specialty initiate a research agenda for reducing BZD use during inpatient psychiatric treatment and champion the issue as a focus for systematic improvement efforts. [Journal of Psychosocial Nursing and Mental Health Services, 58(1), 33-38.].

Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review.

WHAT IS KNOWN ON THE SUBJECT?: In many countries, the majority of psychiatric care is being delivered in an outpatient setting and the proportion of outpatients is increasing on a global level. Nurses are the largest workforce in psychiatric care, but their role has been said to be difficult to define. According to our knowledge, there are no previous reviews focusing on nurse-delivered interventions in the adult psychiatric outpatient setting. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review summarizes nurse-delivered interventions identified in the research literature and describes these systematically. Analysing all the identified interventions using the Nursing Interventions Classification, we conclude that the emphasis of nurse-delivered interventions in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from those presented in a review on inpatient psychiatric nursing. There are several clinical trials describing nurse-delivered evidence-based treatments, such as psychoeducation for patients and their family members in the case of patients diagnosed with schizophrenia and bipolar disorder. The quality of randomized controlled trials was higher than in earlier reviews describing psychiatric nursing interventions in general or in connection with a specific patient group. Further clinical trials are needed to describe the role of nurses in the care of patients diagnosed with depression and in the use of web-based interventions. Additionally, it would be important to study what supports, and on the other hand hinders, the role of nurses in delivering evidence-based treatments at the clinical level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can play a central role in responding to the growing demand for evidence-based practices in adult outpatient psychiatry, by delivering treatments for patients and family members. It is important that both nursing education and clinical practices recognize and support this role. Abstract Introduction According to our knowledge, there are no previous reviews on nurse-delivered interventions in the adult psychiatric outpatient setting. Aim To identify and systematically describe and analyse nurse-delivered interventions based on research literature. Method An integrative review. Results This review included 60 studies, of which 46 were intervention studies, including 40 clinical trials. The most common patient groups were patients diagnosed with schizophrenia and bipolar disorder. The nursing interventions described in the studies resembled a total of 68 interventions from the Nursing Interventions Classification. The treatment delivery methods varied and treatments often lacked a clear theoretical background. Implications for practice The core of nurse-delivered interventions identified in research literature in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from the interventions identified in a review describing nursing in the inpatient setting. There are high-quality clinical trials describing nurse-delivered treatments for patients diagnosed with schizophrenia and bipolar disorder. These include evidence-based treatments such as psychoeducation. Understanding of how these treatments are transferred in clinical practice is missing. Clinical trials describing nurse-delivered web-based interventions and interventions for patients diagnosed with depression are needed.

Exploring strategies for promoting trauma-informed care and reducing burnout in acute care psychiatric nursing

Psychiatric nurses in inpatient settings provide person-centered and relationship-based care to persons in acute distress from behavioral health and substance use problems. The emotional labor of this highly interpersonal care is further complicated by the high rates of historical trauma among this population. This article summarizes the impact of trauma on patients in acute psychiatric settings, the impact of challenging organizational contexts and patient distress on nurse burnout, and proposes four strategies for promoting trauma-informed care by inpatient psychiatric nurses including a) promoting education of nurses on the impacts of trauma, b) building support among nurse colleagues, c) emphasizing clinical skills in coping with patient distress, and d) implementing mindfulness skills as a core coping strategy for nurses for managing their reactions to patient distress. Trauma-inforced care holds patient safety as primary to clinical effectiveness and is also crucial for promoting supportive patient-nurse relationships. As such, trauma-informed care has the potential to combat nurse burnout and improve outcomes for patients.

How do inpatient psychiatric nurses make sense of and respond to behaviours in dementia? An Interpretative Phenomenological Analysis.

Objectives: Existing literature demonstrates that nurses’ understanding of behaviours in dementia influences their responses to persons with dementia. However, there is limited research on the psychological processes involved in how nurses make sense of the behaviours and how these impact on responding, and a dearth of such literature from inpatient acute dementia settings. This study explored how inpatient psychiatric nurses make sense of and respond to behaviours in dementia.Method: This study employed Interpretative Phenomenological Analysis (IPA), a qualitative method that explores in detail how participants make sense of their experiences. Eight inpatient psychiatric nurses were recruited from two inpatient services within a National Health Service Mental Health Trust. Semi-structured interviews were conducted to gain an in depth understanding of their experience. Transcripts of the interviews were then analysed using IPA.Results: Four interrelated themes were identified: ‘Effort to sense make’, ‘Pressures of the organisation’, ‘Balancing personal and professional selves: The underlying emotional connection’; and ‘”Looking back on it…”’.Conclusions: The study highlighted that sense making is a dynamic process, which occurs through a range of psychological processes and can change moment by moment dependent on the influences on the nurse. It demonstrated that nurses need to be supported to move flexibly through a range of emotional connections, which were found to underlie the negotiations made at work and influence sense making and responding. Nurses may benefit from space to reflect and formulate their understanding of clients, but further research is required to determine the effectiveness of this.

Psychiatric Inpatient Nurses' Perceptions of Using Motivational Interviewing

ABSTRACTBackground: Motivational interviewing (MI) is an evidence-based intervention that may help inpatient psychiatric nurses understand patient beliefs about medication while simultaneously strengthening the therapeutic alliance.Objective: Investigate nurses' perceptions regarding use of motivational interviewing after an educational program.Design: A prospective intervention project.Results: Agreement with consistent use of MI skills declined at one month. Nurses listened and connected with patients and gained self-awareness of their interactions with other providers.Conclusions: Consistent use of MI was used less often than initially believed but having MI focused conversations were useful. When planning MI training for inpatient psychiatric staff nurses, activities must be timely, realistic, and achievable. Work environment is important to making and sustaining the use of MI.

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran

ABSTRACTBackground: The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards. Design: A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data. Results: Four themes were developed based on the analysed data: “experiencing psycho-social challenges,” “experiencing psychological challenges,” “encountering catalysts causing challenges,” and “employing various strategies for coping with challenges.” Conclusions: Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.

Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

Medical Emergency Team Response Processes for Behavioral Health Inpatient Units: Implications for Nursing Education

Following a literature review of nurses’ attitudes and perceived barriers regarding the utilization of medical emergency teams (METs) and completing key informant interviews with psychiatric nurses, a questionnaire developed by the researcher was administered to inpatient psychiatric nurses to further examine their attitudes and perceived barriers about MET utilization. Using a 23-item questionnaire, the psychiatric nurses were asked to rate each item using a 5-point Likert scale. Results indicated that nurses did not have a clear understanding of the criteria for calling a MET and also tended to seek out other staff personnel and/or a physician consultation prior to initiating a MET call. Results of this descriptive, quality improvement project were then used to revise and refine nursing education and practice regarding MET utilization.

Metasynthesis of Research on the Role of Psychiatric Inpatient Nurses

Inpatient psychiatric nurses are a large workforce, but their work is poorly articulated and thus poorly understood outside of the professional inpatient community. To learn how inpatient psychiatric nurses depict their work, define important aspects of their role, and view the impact of the unit environment on their clinical practice. Metasynthesis of research that has focused on the ideas and perceptions of inpatient psychiatric nurses around their role and practice on inpatient psychiatric units. Three themes emerged from the analysis; the first was an umbrella for three important aspects of nursing work: the nurses' efforts to forge engagement with patients; their activities which maintained the safety of the unit and interventions nurses viewed as educating/empowering patients. The second theme captures the conditions that enabled nurses to do this work such as a cohesive nursing team and their sense of self-direction in their role. The final theme centers on difficulties nurses encountered in enacting their role which included multiple responsibilities for patient care and management of the milieu; intense work often with low visibility and scant support within the organization. Nurses need to articulate their practice so they can assert for the staffing and resources needed to keep units safe and promote patients' well-being, strive toward quality, and promote the development of the specialty.

Effects of introducing MEWS on nursing staff in mental health inpatient settings

AbstractThe Modified Early Warning Score (MEWS) is now commonly used in the assessment of physically unwell patients in non‐acute hospital wards. The effect of the introduction of MEWS on the confidence of inpatient psychiatric nurses in identifying the severity of a physically deteriorating patient, and taking appropriate clinical action, has not been reported previously. The authors undertook a cross sectional survey looking at the level of confidence of qualified mental health nurses, and their ability to make correct clinical decisions, before and after introduction of the MEWS tool. Copyright © 2014 John Wiley &amp; Sons

The influence of staff training on the violence prevention and management climate in psychiatric inpatient units

Violence prevention and management is an important part of inpatient psychiatric nursing and specific staff training is regarded essential. The training should be based on primary, secondary and tertiary prevention. In Stockholm, Sweden, the Bergen model is a staff-training programme that combines this preventive approach with the theoretical nursing framework of the City model that includes three staff factors: positive appreciation of patients, emotional regulation and effective structure. We evaluated this combination of the Bergen and City models on the violence prevention and management climate in psychiatric inpatient wards. A 13-item questionnaire was developed and distributed to patients and staff in 41 wards before the staff was trained and subsequently to 19 of these wards after training. Data analyses included factor analysis, Fisher's exact test and Mann-Whitney U-test. The result showed that the staff on trained wards had a more positive perception of four of the items and the patients of one item. These items reflected causes of patient aggression, ward rules, the staff's emotional regulation and early interventions. The findings suggest that a focus on three levels of prevention within a theoretical nursing framework may promote a more positive violence prevention and management climate on wards.

Moving to a Recovery Framework of Care: Focusing Attention on Process

From the Rush College of Nursing, Chicago, IL. Corresponding Author: Kathleen R. Delaney, PhD, PMH-NP, FAAN, Professor, Rush College of Nursing, 600 S. Paulina Street, Chicago, IL 60612. E–mail address: Kathleen_R_Delaney@rush.edu © 2011 Published by Elsevier Inc. 0883-9417/1801-0005$34.00/0 doi:10.1016/j.apnu.2011.12.005 THE FEDERAL GOVERNMENT, professional organizations, and mental health service users have harnessed their collective visions to steer mental health services to a recovery framework of care. The Substance Abuse and Mental Health Services (SAMHSA) has thrown its considerable weight toward the change with the Recovery to Practice (RTP) initiative. The RTP program awarded grants to five national behavioral health care provider associations (psychiatry, psychology, nursing, social work, and peer specialists) to promote recovery-oriented practice within their respective professional groups (SAMHSA, 2010). As part of the RTP grants, professional groups will produce curriculums to educate their workforces in recovery principles and practice. Thus, training materials will soon be available that provide a structure for organizing psychiatric mental health nursing practice around recovery-oriented care. As the RTP task forces build the didactics for recovery services, a fundamental process element should also be considered—one that comes into play as traditional provider–patient roles transform. In the recovery framework, patient–professional dynamics will shift toward a relationship marked by the user's self-direction and the provider's patientcentered stance. This shift has particular impact in psychiatry, where the history of provider–patient power differential is deeply engrained in treatment (Cutcliffe & Happell, 2009). This shift has raised issues of risk and responsibility, decisional control, and the implied devaluation of professional intervention (Davidson, O'Connell, Tondora, Styron, & Kangas, 2006). The interpersonal dynamics of this shift hold another set of issues, particularly for inpatient psychiatric nursing staff and how their role plays out in action. Inpatient psychiatric nurses are often busy with both safety issues and the practical aspects of their role (Seed, Torkelson, & Alnatour, 2010). As Cleary and Edwards (1999) found in their study of psychiatric ward environments, although nurses would like more interaction with patients, “Some-

Examining the Efficacy of No-Suicide Contracts in Inpatient Psychiatric Settings: Implications for Psychiatric Nursing

Verbal and written no-suicide contracts are commonly practiced by psychiatric nurses in inpatient psychiatric facilities. However, evidence is sparse regarding whether no-suicide contracts are effective tools for maintaining patient safety. The purpose of this paper is to examine the use of the verbal and written no-suicide contracts, discuss the resulting implications for psychiatric nurses on inpatient units, and suggest alternative clinical practices for inpatient psychiatric nurses to utilize to increase patient safety.