Mental Health Nursing Research Articles

Exploring the Impact of Cognitive Dysfunction During Recurrent Depression in a Sample of Mid-to-Older Age British South Asians: A Qualitative Study.

Depression is a major public health issue, increasing the risk of comorbidities. Some people with depression experience cognitive dysfunction, which can persist even after symptomatic recovery. British South Asians are at greater risk of developing depression and are less likely to seek treatment. It is important to understand their experience of subjective cognitive dysfunction in depression and how best to support them. This study explored subjective experience of cognitive dysfunction during recurrent depression, in a sample of 12 British South Asians aged between 45 and 60 years. We conducted semi-structured interviews to explore cognitive dysfunction during recurrent depression. We analysed the data using thematic analysis. Difficulties in attention and concentration resulted in lower quality of social relationships, including not feeling present and social isolation. Learning new information was difficult, thus impacting productivity. Participants found it difficult to engage in enjoyable activities that promoted brain health. The emotional, physical and spiritual impact negatively impacted on quality of life. Cognitive strategies used in therapies could improve brain health and functional recovery in people living with depression. Mental health nurses play a pivotal role in providing culturally appropriate information and strategies for managing cognitive dysfunction in recurrent depression.

‘I Can't See Myself Seeking Help’: The Influence of Clinical Placements on Nursing Students' Stigmatising Beliefs and Intentions to Seek Help for Their Own Mental Health Issues: A Prospective Cohort Study

ABSTRACTMental health conditions such as anxiety, depression and psychosis represent a global health challenge. Stigma surrounding mental health continues to hinder help‐seeking behaviours for people with mental illness and as this study demonstrates, nursing students as well. However, if student nurses are reluctant to seek help for mental health issues, how can others be expected to do so? This reluctance poses challenges in mental health nursing, impacting both care provision and nursing education. The present study seeks to explore the influence of traditional versus non‐traditional mental health clinical placements on second‐year nursing students' stigmatising beliefs and intentions to seek help for mental health issues. Employing a prospective cohort design using the TREND checklist, the study sampled second‐year nursing students assigned to either traditional hospital‐based or non‐traditional recovery‐focused mental health clinical placements. Using validated scales, stigmatising beliefs and help‐seeking intentions were measured before and after the placements. Statistical analyses were conducted to assess changes in these variables over time and across placement settings. A significant impact of placement setting on help‐seeking intentions was observed, with students in non‐traditional placements showing an increased willingness to seek help. Additionally, non‐traditional placements were found to significantly reduce stigmatising beliefs in all measured domains, suggesting that these settings may provide a more conducive environment for fostering positive attitudes towards mental health. Recovery‐focused placements appear to offer experiences that can diminish stigma and encourage more positive perceptions and intentions related to mental health support.

Trauma-informed care and its use in psychiatric nursing: a review

Trauma-informed care and its use in psychiatric nursing: a review

Mental Health Nursing Care for Mrs. R with the Main Issue of Risk of Violent Behavior Due to Paranoid Schizophrenia in the Brotojoyo Ward, Dr. Amino Gondohutomo Psychiatric Hospital

Background: Paranoid schizophrenia is a mental disorder characterized by severe psychopathological symptoms, including delusions and hallucinations, which often lead to a risk of violent behavior. Purpose: This case study aims to provide nursing care for patients with paranoid schizophrenia at RSJD dr. Amino Gondohutomo, Central Java. The case discussed involves Mrs. R, who experiences a risk of violent behavior as a consequence of paranoid schizophrenia. Methods: The method used in this discussion is a case study with a mental health nursing care approach, including assessment, nursing diagnosis, intervention, implementation, and evaluation. Results: The results of the nursing care show that appropriate interventions, such as physical and verbal anger control exercises, as well as spiritual approaches, can reduce the intensity of violent behavior in the patient. Family support and patient compliance in undergoing pharmacological therapy also play a significant role in the recovery process. Conclusion: In conclusion, comprehensive and collaborative nursing care can improve the patient's psychological condition and reduce the risk of violent behavior.

Exploring Moderation Dynamics: Callous-Unemotional Traits, Parental Practices and Conduct Problems in JuvenileDelinquency.

Callous-unemotional (CU) traits, parental practices and conduct problems (CP) have been consistently identified across numerous studies as significant predictors of the severity and persistence of juvenile delinquency. This study seeks to investigate the moderation dynamics underlying the relationships between these variables among Arab incarcerated youth. Specifically, the study aims to (1) explore whether parental practices moderate the relationship between CU traits and CP among incarcerated youth in Jordan and (2) examine the bidirectional moderating influence of CU traits in shaping the dynamic relationship between parental practices and CP within the context of Arab juvenile delinquency. An observational survey design was employed, gathering data from 184 incarcerated youth across 11 rehabilitation centres in Jordan. Latent profile analysis identified three parental practice classes: more positive, balanced and more negative. Moderation analyses indicated significant associations between CU traits, parental practices and CP. Parental practices, especially positive ones, moderated the relationship between CU traits and CP, highlighting the protective influence of balanced parenting. Furthermore, bidirectional moderation effects were observed: CU traits moderated the link between parental practices and CP, while CP influenced parenting practices, particularly in the presence of elevated CU traits. The findings of this study underscore the vital role mental health nurses can play in addressing the behavioural and psychological challenges faced by youth involved in the justice system and their families. Specifically, mental health nurses can aid in ameliorating mental distress by supporting parents in understanding and managing CU traits and CP. Nurses can provide targeted educational programmes that empower parents with strategies to reinforce positive parenting practices and reduce negative interactions. Furthermore, nurses can facilitate access to community resources and therapy options, helping families build a supportive environment conducive to the mental well-being of the youth. These interventions are crucial not only for the direct treatment of juveniles but also in providing holistic support to their families, thereby enhancing the overall efficacy of mental health care in juvenile delinquency. This study highlights the essential role that mental health nurses play in managing behavioural issues among youth, emphasising the significance of implementing culturally sensitive interventions. Mental health nurses possess a pivotal position in early detection and intervention, which enables them to guide families in fostering positive parenting practices, essential for preventing delinquent behaviours. Their efforts to promote understanding and responsiveness within family dynamics make a significant contribution to the mental well-being of individuals, highlighting the necessity of their role in global mental health.

From self-reflection to shared recognition: Reconceptualising mental health nursing as an intersubjective phenomenon.

Existing challenges to the legitimacy of mental health nursing in the United Kingdom and beyond have stimulated a critical self-reflection and discourse around the mental health nursing role, forcing the profession to question its identity and critically re-evaluate its position within the wider healthcare arena. In this discussion paper, I suggest that the current difficulties in conceptualising mental health nurse identity arise from our role being inherently interwoven with distinctive challenges and unique needs of our service users. Emerging from this idea is that the 'being' (and the 'doing') of mental health nursing is firmly situated within the sphere of intersubjective relations. Drawing upon Hegel's ideas of reciprocal recognitive relations, to support the notion that our profession's role and purpose are better understood when defined in relation to the work that we do with our service users, I argue that it is in the understanding (and even embracing) of intersubjectivity as a core principle of mental health nursing, where we might not just better understand ourselves but also know how to shift asymmetric relations with our service users towards those which are more commensurate and mutually beneficial.

Work-Related Strain, Sense of Coherence and Intercultural Sensitivity Among Mental Health Nurses in Qatar: ACross-Sectional Study.

Migrant nurses face many challenges as they adapt and assimilate into their new working environments. The aim of this cross-sectional study was to investigate the perceptions of work-related strain, sense of coherenceand intercultural sensitivity among nurses who were employed at a public mental health facility in Qatar. We used three self-report questionnaires: the work-related strain inventory, sense of coherence scale and an intercultural sensitivity scale. A cohort of 136 nurses voluntarily engaged in the study. The majority of participants were male, migrated from South Asia and were in their mid-30s. The study found that both sense of coherence and intercultural sensitivity were inversely proportional to work-related strain. Work-related strain was found to be lower than expected; the factors that appear to protect against work-related strain include longer clinical experience, a high sense of coherence, and intercultural sensitivity. Additionally, greater age and extended clinical experience, combined with a history of work in three or more countries, associated with higher scores on the sense of coherence scale. Lastly, being female, having a postgraduate degree and holding a senior-level position were associated with increased intercultural sensitivity. As nurses' migration across national and international borders increases in response to global demand, this study has important implications for nursing administrators, educators and policymakers in relation to the development and implementation of strategies to enhance nurses' sense of coherence and intercultural sensitivity and prevent work-related strain. Trial Registration number: NCT04196751.

Fear of COVID-19 among Frontline Nurses in a National University Hospital in the Philippines: A Mixed-Methods Study.

Nurses are at the forefront of caring for patients during the height of the COVID-19 pandemic. Nurses themselves are exposed to serious risk and even death while providing care for these patients. Among other healthcare professionals, nurses are mostly exposed to psychologically distressing situations during this time of crisis. Fear of COVID-19 can affect nurses' overall well-being, which in turn may affect their job performance and lead to a decline in the quality of patient care. To determine the level of fear of COVID-19, and to explore the experiences of COVID-19-related fear of frontline nurses in a national university hospital in the Philippines. To achieve the study objectives, the study utilized a convergent mixed methodology approach. In the quantitative phase, a random sample of participants completed the Fear of COVID-19 scale (FCV-19S) in order to assess their level of fear of COVID-19. Semi-structured interviews were conducted in the qualitative strand. Participants in the qualitative phase was selected using maximum variation sampling. Integration of data was done through a narrative contiguous approach. Quantitative data was obtained from 206 frontline registered nurses. The mean age of the participants was 35.5 years (SD =8.17). Overall, the composite score of the fear of COVID-19 scale was 21.76 (SD = 4.92), indicating an elevated level of fear. Having friends and relatives who tested positive predicted fear of COVID-19 (β = -3.658; p = 0.005; CI: -6.213 to -1.104). Three major themes categories emerged from qualitative data analysis: (1) balancing feelings of fear and moral obligation, (2) challenges experienced while providing frontline work, and (3) resilience amidst challenges. For the reporting and integration of our mixed-method results, a narrative contiguous approach was implemented. Frontline nurses reported an elevated level of fear during the height of the COVID-19 pandemic. This study was also able to capture the impact of COVID-19 on the mental health of nurses, specifically on their fear experiences. Understanding the underlying causes of fear, such as uncertainties surrounding guidelines and protocols, shortage of personal protective equipment, and moral distress, offers invaluable insights for shaping proactive strategies and policies aimed at mitigating these concerns in subsequent pandemics.

Effect of a Logotherapy-Based Empowerment Program for Achieving Self-Reliance Among Persons Living Houseless

The lives of houseless individuals are characterized by powerlessness, meaninglessness, hopelessness, and despair, yet they have a desire to escape homelessness. While the economic aspect is essential for escaping homelessness, psychological resources are crucial, as they form the basis of the strength needed to achieve independence. The study aimed to examine the effectiveness of a logotherapy-based empowerment program developed to strengthen the capabilities of persons living houseless and ultimately develop competencies that serve as a foundation for self-reliance. The study was performed in a homeless support center for men living houseless in South Korea using a repeated-measures design with a control group. The experimental group received an eight-session empowerment program over 8 weeks. The participants were assessed at three intervals: pretest, posttest immediately after the program, and follow-up test 4 weeks after the posttest. The follow-up tests were completed by 22 and 16 participants in the experimental and control groups, respectively. We found that the empowerment program significantly enhanced the meaning of life, hope, and empowerment of houseless individuals. Community mental health nurses, who are in a position to interact with persons living houseless, must empower them to escape homelessness and achieve self-reliance, an important goal for this population.

Effort–reward imbalance and well-being among psychiatric nurses: the mediating role of burnout and decent work

BackgroundPsychiatric nurses face additional challenges due to negative perceptions, workplace violence, and a lack of respect, impacting their well-being and job satisfaction, which are crucial for improving psychiatric care and patient outcomes.ObjectivesThis study aims to examine the relationship between effort-reward imbalance, well-being, burnout, and decent work among psychiatric nurses.MethodsThis study used a cross-sectional design. Data were collected using a convenience sampling method in February 2024 from 397 psychiatric nurses at two psychiatric hospitals in Hangzhou and Huzhou, Zhejiang Province. The Effort-Reward Imbalance Scale, Decent Work Perception Scale, Maslach Burnout Inventory-General Survey, and General Well-Being Schedule Scale were used for data collection. Data analysis was conducted using SPSS 26.0 and the PROCESS macro.ResultsThe study found that effort-reward imbalance among psychiatric nurses was negatively correlated with decent work (r = -0.564, p < 0.001) and well-being (r = -0.541, p < 0.001), and positively correlated with burnout (r = 0.603, p < 0.001). Burnout mediated the relationship between effort-reward imbalance and well-being (95% CI [-0.386, -0.257]), while decent work also served as a mediator (95% CI [-0.100, -0.012]). Additionally, burnout and decent work were found to mediate the relationship between effort-reward imbalance and well-being (95% CI [-0.050, -0.006]).ConclusionThis study highlights the impact of effort-reward imbalance on well-being, confirming that burnout and decent work serve as mediators. Enhancing support, fair compensation, reasonable work schedules, and professional development can promote psychiatric nurses’ perception of decent work and improve their well-being.

Professional Quality of Life Among Mental Health Nurses: A Systematic Review and Meta-Analysis.

The professional quality of life (ProQOL) is increasingly applied to nurses and is a measure of the positive and negative aspects of their work. This systematic review and meta-analysis evaluated the level of compassion satisfaction, burnout and secondary traumatic stress (STS) in empirical studies. Electronic databases Scopus, PubMed and Web of Science were searched on 7th February 2024, and the review followed PRISMA guidelines. The pooled estimate of compassion satisfaction, burnout and secondary traumatic stress mean scores using a random-effects model for meta-analyses was undertaken. R statistical software and the dmetar program were used to execute the analysis. Heterogeneity was evaluated with the I2 statistics, while publication bias was evaluated using Egger's regression test. Twenty-four studies (sample size = 4274) were systematically reviewed and 18 studies (n = 3163) were incorporated into the meta-analysis. Burnout, secondary traumatic stress and compassion satisfaction are found to be at moderate levels in this research. The qualitative analysis informs that variables such as healthy lifestyle, work environment and psychological resilience contribute towards optimum ProQOL scores. The pooled mean estimate was 32.79 (95% CI = 29.57-36) for compassion satisfaction, 24.99 (95% CI = 23.75-26.23) for burnout and 21.99 (95% CI = 18.93-25.06) for secondary traumatic stress, respectively. Mental health nurse managers need to address the factors in the work environment and promote interventions to enhance coping with burnout and STS. Subgroup analyses of country-based economies & regions and years revealed significant results.

Knowledge, Attitude, and Practice of Nursing Staff Toward Patients Who Attempted Suicide at Tertiary Care Hospital of Central Gujarat, India

Background: Looking at the alarming increase in the incidence of attempted suicide worldwide, having adequate expertise in managing people with attempted suicide is imperative. Therefore, healthcare professionals, specifically nurses, must be provided training exclusively on managing patients with attempted suicide and preventing suicide in the near and distant future. Nursing staff play a major role as a point of first contact for suicide survivors, and therefore, it is of utmost importance that they are adequately trained and knowledgeable in this area. To understand their knowledge, the authors decided to do this study to measure knowledge, attitude, and practice (KAP) among nurses in suicide survivors. Aim: The aim of this article was to study the KAP of nursing staff toward patients with suicide attempts. Methods: A hospital-based cross-sectional, quantitative study was conducted among nursing staff. All nurses ( n = 300) were approached in small groups between July and November 2023 via a convenient sampling. Written informed consent from participants was taken. The semi-structured questionnaire included sociodemographic details, their professional experience, their training and experience in managing suicidal patients, and KAP questions. The KAP questions were on patients with suicide attempts and were derived from the suicide knowledge and skill questionnaire (SKSQ), suicide attitude questionnaire, and practice guidelines of the American Psychiatric Nurses Association. Data was analyzed by using MS Excel version 6.2.14. Result: In this study, a total of 200 nursing staff participated. The majority were female (80%), with a mean age of 37 years and a mean professional experience of 12 years. Out of all participants, 68% had experience managing patients with suicide attempts, but only 27% of them were trained in suicide prevention. The mean score of knowledge and attitude among study participants were 65.25/100 and 3.24/5, respectively. Nursing staff had higher scores in questions of suicide risk assessment and statements related to attitudes like “they deserve respect in society.” In practice assessment, more than 80 % of nurses were keenly observant, empathetic, and nonstigmatized for hospitalized patients of suicide attempts. The nurses took measures like restricting access to harmful objects (medicines, sharp objects) and giving medicines under supervision. Conclusion: The nursing staff had adequate knowledge, a nonstigmatized attitude, and appropriate clinical practices toward patients with suicide attempts, but they lacked formal training. So, hands-on training for suicide management at regular intervals is the need of the hour.

How is ‘shortage’ defined? Exploring Nursing Workforce Data across Canada 2015-2022: An Ecological Study

RationaleDetermining the ability of a country’s nursing workforce to meet the health care needs of the population is essential for optimal health outcomes. ‘Nursing shortage’ is frequently heralded as an issue, yet it is unclear how ‘shortage’ is defined and calculated. The purpose of this study was to collect and link publicly available Canadian data to describe and compare trends in nursing workforce capacity. MethodsPrimary data sources included linking Statistics Canada and Canadian Institutes of Health Information (CIHI) data from 2015 to 2022. Statistics Canada tracks provincial population data and job vacancy rates. CIHI receives data from provincial nursing organizations on demographics, roles, and employment status. To estimate a sufficient workforce, job vacancy rates (a proxy for provincial need) were cross tabulated with the number of registered nurses (RNs) and registered psychiatric nurses (RPNs) per year. ResultsThe number of RNs and RPNs in Canada has increased by 8.6% between 2015 and 2022, to a total of 322,226. Job vacancies, as a percent of total nursing supply, shows a rising trend (2.3% to 8.7%) between 2015 and 2022 across Canada. In 2022, 84.9% of Canadian RNs and RPNs in direct patient care across Canada and 86.1% were in urban settings. Conclusion &amp; LimitationsThis project examines Canadian nursing workforce data encompassing potential effects of the COVID-19 pandemic. The trends are limited to annual due to aggregated data. Data on a country’s nursing workforce measured monthly and consistently across provinces would yield clearer information.

Experiences of Mental Health Nurses in Providing Care to Patients Receiving Electroconvulsive Therapy in South Korea.

In recent years, the demand for electroconvulsive therapy has been increasing in South Korea. However, there are problems due to mental health nurses' lack of understanding about electroconvulsive therapy and the absence of systematic education. This study aimed to explore mental health nurses' experiences of providing care to patients receiving electroconvulsive therapy in South Korea. We used content analysis to analyse the data collected from focus group interviews with 22 mental health nurses working in mental health hospitals. The results revealed four themes and 10 subthemes. More specifically, the results showed that mental health nurses consider themselves helpers in recovery. They pursue the physical and emotional well-being of patients receiving electroconvulsive therapy and strive to ensure that patients receive electroconvulsive therapy comfortably and safely. However, contentious issues such as concerns about patient dignity and autonomy lead to differing perceptions and attitudes towards electroconvulsive therapy and cause internal conflict during therapeutic interactions. Furthermore, insufficient education on electroconvulsive therapy leads to a lack of knowledge and difficulties in fulfilling the role of an information provider. The shortage of coping measures and support systems for issues such as extensive adverse effects and restricted medication increases the work burden immensely. These findings can serve as foundational data for the development of standardised nursing practices and systematic education for electroconvulsive therapy.

O le Fau Gagana: A Samoan Mental Health Nurse in Aotearoa-New Zealand.

This article explores my journey as a Samoan woman who migrated as a young mother to Aotearoa-New Zealand, completed nursing qualifications, later specialising in mental health nursing, and eventually completed doctoral studies. Since July 2023 I have been a Lecturer in the Department of Nursing, Faculty of Health and Environmental Studies, Auckland University of Technology. This article uses autoethnographic and narrative methods to collect data from my own life, to explore the experiences of Samoan people in the mental health system of Aotearoa-New Zealand. Criteria for reporting qualitative research was used to prepare the paper. My story showcases the benefits of having both clinical and cultural understandings in the context of mental health care in Aotearoa-New Zealand. The gap between the rhetoric and the reality of the 'New Zealand dream' for Samoan people mirrors the gap between policy and practice in relation to Pacific strategy plans for mental health care. By writing about my experiences, I aim to support better understanding of core concerns for Samoan people when they are engaging with mental healthcare services.

Relationships Among Secondary Traumatic Stress, Mindfulness, Compassion Satisfaction, and Compassion Fatigue in Psychiatric Nurses.

To examine relationships among secondary traumatic stress, mindfulness, compassion satisfaction, and compassion fatigue in psychiatric nurses. Participants comprised 142 nurses working in two psychiatric hospitals in the same province of Turkey. Data were collected using a personal information form, the Secondary Traumatic Stress Scale, Mindful Attention Awareness Scale, and Compassion Fatigue and Compassion Satisfaction subscales of the Professional Quality of Life Scale. A significant and negative correlation was found between secondary traumatic stress, mindfulness, and compassion satisfaction, and between mindfulness and compassion fatigue. A significant and positive correlation was found between secondary traumatic stress and compassion fatigue, as well as between mindfulness and compassion satisfaction (p < 0.05). Findings demonstrate that mindfulness may be a protective factor in preventing secondary traumatic stress and compassion fatigue in psychiatric nurses. It is recommended that in-service training be organized periodically to increase levels of conscious awareness among psychiatric nurses. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Training Nurses in Trauma-Informed Care to Address Workplace Violence in Inpatient Settings.

Frontline workers in psychiatric facilities are exposed to considerable risks of verbal and physical assaults, with 40% to 65% of mental health nurses experiencing violence in the workplace. The goal of this pilot study was to assess the readiness and motivation for adopting trauma-informed care (TIC) to address workplace violence in an acute care psychiatric hospital. A pre-post quality improvement study was conducted in two pilot units of a 274-bed acute care psychiatric hospital, involving a discussion-based seminar and a practical exercise. Surveys assessed participants' readiness and motivation posttraining. Sixty-eight staff members completed part 1 training, with 63 (92.6%) reporting being prepared to use TIC principles afterward. All 14 staff members (100%) who completed part 1 and part 2 training reported being motivated to apply the TIC model after the intervention. The results show that TIC training may impact self-reported strategies for reducing workplace violence. Education in trauma-informed care may prove to be beneficial in providing nurses with the necessary skills to effectively implement TIC principles in their daily practices. [J Contin Educ Nurs. 2024;55(10):472-478.].

The role of mental health in the relationship between nursing care satisfaction with nurse-patient relational care in Chinese emergency department nursing.

The relationship between a nurse and a patient is a key part of nursing that can impact how happy the patient is with the care they receive. It appears that the nurse's mental health can also affect this connection. However, there is little research on this topic. So, the aim of the present study was to determine the correlation of nurse's mental health with nurse-patient relational care and nursing care satisfaction. A total of 532 nurses and 532 patients from 13 Level-III hospitals of Hubei province (China) completed a China Mental Health Survey, general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale. Age, nurse working years, and night shift last month were correlated with mental health score (r = -0.142, r = -0.150, r = 0.164, p < 0.05). Nurse's mental health was correlated with relational care score and nursing care satisfaction score (r = -0.177, r = -0.325, p < 0.05). Also, relational care score, patients age and gender were correlated with nursing care satisfaction score (r = 0.584 and r = 0.143, x2 = 11.636, p < 0.05). Descriptive information of nurses had a direct impact on nurses' mental health (direct effect = 0.612, 0.419-0.713). Nurses' mental health had a direct effect on relational care score (direct effect = 0.493, 0.298-0.428) and an indirect effect on nursing care satisfaction score (indirect effect = 0.051, 0.032-0.074). Relational care score and patient's descriptive information had also a direct effect on nursing care satisfaction score (direct effect = 0.232, 0.057-0.172 and 0.057, 0.347-0.493). This study showed that the better the mental health of nurses, the more patients feel satisfied with nursing services.

Psychotherapy Skills for Psychiatric Mental Health Nurse Practitioner Students in the Age of Competency-Based Education.

As the field of nursing moves toward competency-based education, faculty need to adapt teaching and learning strategies to meet standards for assessing core behaviors of graduate psychiatric mental health nurse practitioner students. This article reviews a psychotherapy skills-based learning assignment at Frontier Nursing University that was adapted to meet developing competency-based learning standards. The assignment utilizes prerecorded video scenarios to provide students with opportunities to reinforce psychotherapy skills during didactic coursework. Assessment is conducted via an analytic rubric and specific feedback is given to each student in writing.

Associations between individual and social stigma perception and burnout levels in Italian mental health nurses: an exploratory study

Associations between individual and social stigma perception and burnout levels in Italian mental health nurses: an exploratory study