Mental Health Settings Research Articles

Risk factors for deep vein thrombosis and pulmonary embolism: a comparative study between acute hospital care and mental health inpatient settings for older people

Purpose This study aims to establish if risk factors for venous thromboembolism (VTE) in older hospitalized psychiatric patients differ from geriatric inpatients and if the current risk assessment tools being used are suitable. Design/methodology/approach The authors undertook a single centre retrospective review of 75 records for presence of predetermined risk factors. In total, 55 discharged patients with thrombotic events within geriatric settings were compared with 20 from mental health settings. Differences in risk factors were determined using t-test and Fisher’s exact test. Findings VTE patients in geriatric units were older and had reduced mobility. Psychiatric patients were more likely to be dehydrated and treated with psychotropics. Whilst rates of VTE screening were comparable in both settings, geriatric inpatients were more frequently prescribed thromboprophylaxis. Research limitations/implications Older psychiatric inpatients differ from those in medical/surgical settings in their profiles and risk factors for VTE. Approaches for VTE risk management also differed. Practical implications The study suggests the need for VTE screening tools and treatment protocols specific to older psychiatric settings. Social implications Targeted approaches may improve outcomes specific to each group. Originality/value To the best of the authors’ knowledge, this is the first attempt in comparing VTE risk factors across acute physical health care and mental health settings.

A Scoping Review of Australian New Graduate Nurse Preparation to Work in Mental Health Settings

A Scoping Review of Australian New Graduate Nurse Preparation to Work in Mental Health Settings

Implementation of peer specialists in Veterans Health Administration primary care: Improving program fidelity through enhanced preimplementation support.

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC. Using a mixed-methods, formative program evaluation approach, we examined the effects of implementation facilitation across two cohorts of 15 sites. Due to startup timing, Cohort 1 received minimal implementation facilitation during preimplementation compared with Cohort 2. Outcome measures included qualitative evaluation of facilitator notes, time to attain implementation milestones, and PS productivity and program fidelity (percent of total PS encounters in PC). Results suggested that overall productivity was similar across cohorts, but Cohort 2 demonstrated high program fidelity in Month 1 of implementation, while Cohort 1 required 12 months to attain similar fidelity. Qualitative findings indicated implementation facilitation that fostered team cohesion, clarified roles, supported supervisor training, and encouraged sites to guard against competing demands smoothed transitions for PS into PC. During preimplementation, implementation facilitation that focused on these findings resulted in the rapid attainment of program fidelity. Policymakers should consider the value of investing in preimplementation support for speeding the attainment of high-fidelity implementation of novel and complex practices such as PS in PC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent Client and Clinician Predictors of Measurement-Based Care Fidelity in Community Mental Health Settings

ABSTRACT Objective Regularly administering outcome measures, measurement-based care (MBC), informs clinical decision-making and improves youth mental health. Understanding predictors of high-fidelity MBC delivery helps ensure all youth can benefit from this evidence-based practice. Research on client and clinician predictors of MBC fidelity has mixed findings. Method Participants included 53 clinicians and 115 adolescents from a randomized controlled effectiveness trial with MBC only and MBC + Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UPA) conditions. Clients and clinicians reported demographic information. Clinicians completed broad- and narrow-band attitude measures. MBC fidelity was operationalized using the implementation index, combining rates of administering and viewing questionnaires, using objective MBC data. Results and Discussion The average MBC fidelity was 56.75% (SD = 30.36) and was significantly higher in the MBC only condition (M = 67.46%, SD = 27.63%) than in MBC + UPA condition (M = 46.58%, SD = 29.52%; p = .012). Clients identifying as White received significantly higher MBC fidelity than youth not identifying as White. Youth ethnicity, family income, age, severity, and number of sessions did not significantly predict MBC fidelity. Clinicians with less experience at their agency, less confidence, and who found manualized treatments less appealing, had significantly higher MBC fidelity than other clinicians. These results can inform future efforts to increase fidelity and equity in MBC delivery.

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives.

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Do Therapeutic Recreation Mental Health Clinical Placements Provide Educational Experiences to Pre-Registration Student Nurses?: A Mixed Methods Systematic Review.

Clinical placements are a critical component in any pre-registration student nurse's skill development and play an influential role in career specialisation upon registration. However, students are reporting to feel anxious and under prepared attending clinical placements, especially within mental health settings. Such a concern was highlighted in the Australian Government's Productivity Commission into Mental Health (2020). With recommendations for clinical placements to occur in therapeutic recreation environments, allowing increased interactions between students and individuals with a lived experience. Hence, this mixed methods systematic review aims to explore the experiences of pre-registration student nurses completing their mental health clinical placement within a therapeutic recreation environment. Six databases were searched for the review; CINHAL, Medline, PsycINFO, Web of Science, Scopus and the ProQuest Dissertation and Theses database, yielding 10 214 articles. Data were imported to COVIDENCE for management and screening processes. Risk of bias was undertaken by two authors utilising the Joanna Briggs Institute's Critical Appraisal Checklist for qualitative and quasi-experimental studies and McGill's Mixed Methods Appraisal Tool 2018 Version for mixed methods studies. Data were extracted manually for the 13 included articles which met the review inclusion criteria. Following a thematic analysis of the extracted data, three themes emerged: an optimal learning environment, impact on stigmatising beliefs and influence on future career. Findings identified that therapeutic recreation environments pose numerous education benefits for pre-registration student nurses. It is apparent through an immersive mental health clinical placement; student nurses are able to increase their mental health understanding through the lens of those with lived experiences. Such environments challenge stigmatising beliefs held by students prior to clinical placements and can lead to an increased desire to pursue a career within the mental health speciality. This review offers an insight into the many benefits for pre-registration student nurses who complete their mental health clinical placements in therapeutic recreation environments, including reduced stigmatising beliefs, increased mental health knowledge and improved clinical confidence. Trial Registration: PROSPERO: CRD42023476280.

Rapid review of facilitating reflective practice groups with staff in adult inpatient mental health settings

ABSTRACT Reflective practice is poorly defined and often lacks distinction from other practices, such as clinical supervision. In the UK, the National Health Service (NHS) faces unparalleled challenges within the context of chronic underfunding, high staff attrition, and the recent global pandemic. Frontline staff are desperately trying to meet the demands of their roles and services are struggling to prioritise their professional development and wellbeing, further exacerbating these problems. This rapid review of the evidence sought to identify barriers and facilitators of Reflective Practice Groups (RPGs) within adult inpatient mental health services, using three databases. Two-hundred and one unique references were retrieved, yielding eight papers meeting the inclusion criteria. Barriers to facilitating RPGs included: practicalities; individual and team expectations; needs and competencies of facilitators; and organisational issues. Studies suggested solutions including facilitating RPGs off-ward to reduce disruptions and protect the space; increasing psychological safety by incorporating clear guidelines and expectations for attendees; and organisational support. The review highlighted universal challenges faced by healthcare professionals and organisations in facilitating and accessing RPGs. The review illustrates the paucity of research in this area, which may be due to nebulous definition and inconsistencies between different organisations. Implications for practice are discussed.

Impact of Collaborative Nursing Care on Health Outcomes of Mental Health Day Hospital Users: A Mixed Methods Study.

Given that recovery-oriented care focuses on empowering individuals with mental health challenges, collaborative care can be an effective tool for nurses in mental health day hospitals. To deepen knowledge about the impact of collaborative nursing care for improving health outcomes of mental health day hospital users. A sequential and transformative mixed methods study was designed. In the first phase of this mixed methods study, quantitative data were collected from 144 users of mental health day hospitals. In phase two, a group of users underwent an intervention based on collaborative nursing care, through participatory action research, and qualitative data were collected. Finally, quantitative data were again collected from all users. The users who participated in the intervention group improved quantitatively in terms of the quality of the therapeutic relationship. They also improved at different stages of the recovery process, thus the qualitative results confirmed that collaborative nursing care was an essential component in their recovery process. The findings highlight the critical role of collaborative nursing care in health outcomes. The therapeutic relationship was identified as a key factor in facilitating patient empowerment. The study supports implementing collaborative nursing care models in mental health settings to enhance patient outcomes. ClinicalTrials.gov identifier: NCT04814576.

Barriers and facilitators to implement Assertive Community Treatment (ACT) in Japan: a qualitative study protocol using Consolidated Framework for Implementation Research (CFIR)

IntroductionAssertive Community Treatment (ACT), which was developed in the 1970s in the USA, is a programme that supports people with severe mental illness living in the community through a multidisciplinary...

A qualitative study exploring occupational therapist’s experiences of delivering interventions to patients in seclusion whilst working as part of a multi-disciplinary team

Introduction: Although occupational therapists work within mental health settings, there is limited research regarding their role in seclusion. This study aims to explore occupational therapists’ experiences of delivering occupational therapy in seclusion whilst working as part of a multi-disciplinary team. Method: An exploratory qualitative approach using a semi-structured virtual interview approach was adopted. A convenience sample of six participants with experience of working in inpatient mental health seclusions settings were recruited at a national level. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Findings: Four key themes were identified: (1) the perception of seclusion as a punitive approach, (2) the role of occupational therapy in improving the patient’s journey through seclusion, (3) grading and adapting occupations to manage risk and increase engagement, and (4) promoting the role of occupational therapy in seclusion. Conclusion: Occupational therapists can play an important role in improving the experience of patients in seclusion. They have unique skills that enable them to work in this challenging environment. It has also highlighted the lack of understanding about occupational therapy within the multi-disciplinary team and how important it is for occupational therapists to promote their role.

Chest auscultation

The fundamentals series is a collection of articles that present key procedures and competencies, as outlined in the Nursing and Midwifery Council's Future nurse: standards of proficiency for registered nurses. In this article, David Collett outlines how to conduct a chest auscultation and interpret the results, as well as additional considerations in a mental health setting.

Increasing resuscitation status-related goals of care discussions for older adults with severe mental illness in a Canadian mental health setting: a retrospective study

BackgroundOlder adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked...

Clear universal clinical and ethical guidelines must be developed to prevent and reduce coercive interventions in various clinical mental health settings aiming at promoting evidenced-based and trauma-informed care.

Clear universal clinical and ethical guidelines must be developed to prevent and reduce coercive interventions in various clinical mental health settings aiming at promoting evidenced-based and trauma-informed care.

Using Virtual Reality in Mental Health Nursing to Improve Behavioral Health Equity.

Nursing students often experience anxiety, stress, and fear during a clinical rotation in a mental health setting due to stressors and biases toward the setting as well as lack experience in caring for patients with mental health conditions. One in four people worldwide suffers from a mental disorder; therefore, it is critical that nurses feel confident interacting with these patients to provide equitable care. Undergraduate training is a critical period for changing students' attitudes toward this population. This study's goal was twofold. First, we offered students' exposure to common behaviors and symptoms displayed by a patient with mental illness through an engaging and immersive virtual reality simulation experience before taking care of patients in a clinical setting. Second, we aimed to determine if a virtual reality simulation will change students' attitude and stigma, favorably, toward patients with mental health conditions. We used a mixed-method comparative analysis to collect information and identify themes on undergraduate students' attitudes and stigma toward patients with mental health conditions. Our findings demonstrate that virtual reality simulations enhance awareness and sensitivity to the situations of others (empathy) while improving their communication skills. The use of virtual reality in a baccalaureate curriculum deepens the understanding of health equity in behavioral health for nursing students.

Differences in Risk for Sexual Violence Protocol (RSVP) risk factors among older and adult men who have sexually offended

ABSTRACT Ageing has a protective impact on recidivism risk, including for those who offend sexually (Ambroziak, G., Kahn, R. E., Mundt, J. C., Keiser, K. L., & Thornton, D. (2020). Are civilly detained and committed sexually violent persons released after age 60 low risk? Criminal Justice and Behavior, 48(7), 981–998; Doren, D. M. (2006). What do we know about the effect of aging on recidivism risk for sexual offenders? Sexual Abuse: A Journal of Research and Treatment, 18; Harris, G. T., & Rice, M. E. (2007). Adjusting actuarial violence risk assessments based on aging or the passage of time. Criminal Justice and Behavior, 34(3), 297–313). Recent research of the Risk for Sexual Violence Protocol (RSVP) suggests increased age may affect the validity of this guideline, with good predictive performance in samples of men mostly aged under 50 (Davis, M. R., Woods, M., Raymond, B., Ogloff, J. R. P., & McEwan, T. E. (in submission). Does it work? Convergent and predictive validity of the Risk for Sexual Violence Protocol (RSVP) in an Australian Community Forensic Mental Health Setting. Manuscript submitted for publication; Vargen, L. M., Jackson, K. J., & Hart, S. D. (2020). Interrater reliability, concurrent validity, and predictive validity of the Risk for Sexual Violence Protocol. Law and Human Behavior, 44(1), 37–50), but poor predictive performance in a sample aged over 50 (Raymond, B. C., Davis, M. R., Ogloff, J. R. P., & McEwan, T. E. (in submission). Convergent and predictive validity of the sexual violence risk-20 and risk for sexual violence protocol with older sexual offenders. Manuscript submitted for publication). This study investigated possible reasons for these contrasting results by investigating age-related differences in risk factor endorsement and the relationships between risk factors. RSVP risk factors in two samples of men with prior sexual offending, older adults aged between 50 and 78 (n = 95) and adults aged between 18 and 46 (n = 139). Few differences were identified in risk factor endorsement or the relationship between risk factors. The younger adult sample were observed to have more risk factors present. PRACTICE IMPACT STATEMENT This research adds to the literature regarding older men who offend sexually. It is anticipated that further research into factors that are associated with this age group, may encourage future research of gerontological literature in a forensic arena. Until more reliable evidence is available, the current risk assessment tools may require a level of caution when used with older men.

Feasibility of a multifaceted nutrition-risk screening tool for mental health settings: the NutriMental screener.

People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.

A thematic analysis of the subjective experiences of mothers with borderline personality disorder who completed Mother-Infant Dialectical Behaviour Therapy: a 3-year follow-up

BackgroundPerinatal borderline personality disorder (BPD) is a common condition in perinatal mental health settings with few specialised treatment options, and little is known about the enduring effects of available treatment programs. This study explored the follow-up experiences of women with BPD after completing Mother-Infant Dialectical Behaviour Therapy (MI-DBT).MethodsSemi-structured interviews were conducted with eight women who had completed MI-DBT 3 years prior. Reflexive Thematic Analysis was used to analyse the interviews to gain a richer understanding of these mothers’ lived experience.ResultsA thematic analysis generated four main themes which indicated that participants found that MI-DBT improved their ability to hold their child in mind, be aware of their own internal state and behaviours, manage their own emotional reactions and stay calm, and manage interpersonal interactions within adult relationships. Mothers with perinatal borderline personality disorder also highlighted the need for ongoing support in the context of parenting.ConclusionsThis study is the first of its kind to explore the longer-term experiences of mothers following such an intervention, giving voice to this vulnerable group of women. The findings of this study provide a greater understanding of the complex challenges experienced as part of parenting for mothers with borderline personality disorder, and provides both insight into mothers’ experiences of life after MI-DBT and the impact of the program on their lives. The clinical and research implications of the study’s findings are discussed.Trial registrationThis research was retrospectively registered on 07/03/2024, ACTRN12624000225516.

Ensuring that psychological interventions are delivered as intended on mental health inpatient wards.

Talk, Understand and Listen for InPatient Settings (TULIPS) was a multi-centred randomized control trial of an intervention that aimed to increase patient access to psychological therapies on acute mental health wards. This paper aims to: (i) describe a strategy for designing a psychological intervention that is implementable in inpatient mental health settings; (ii) describe methods for assessing the fidelity of interventions within these settings; (iii) report on the extent to which fidelity was achieved in the TULIPS trial. The TULIPS intervention was designed using information from a systematic review, stakeholder interviews, pilot work and a consensus workshop. We assessed fidelity to the model in terms of the delivery and dose of essential elements of the intervention, quality of intervention delivery, engagement of participants with the intervention and differentiation between the intervention and usual care. Although the TULIPS intervention targeted known barriers to the delivery of psychological interventions on mental health wards, we found issues in implementing aspects of the intervention that were dependent upon the participation of members of the multidisciplinary team. Psychologists were able to overcome barriers to delivering individual therapy to patients as this provision was not reliant on the availability of other staff. The intervention period in the study was 6 months. A greater period of time with a critical mass of psychological practitioners is needed to embed psychological interventions on inpatient wards. Our fidelity framework and assessment methods can be used by other researchers implementing and testing psychological therapies within inpatient environments.

The negative impacts of secondary traumatic stress and mutual suffering: considerations in the hospital setting.

Nurses and other health professionals may be at an increased risk of experiencing emotional disturbance associated with caring for people who are experiencing distress, illness or disease or who are at the end stage of their life. This was a particular problem during the COVID-19 pandemic. This article seeks to explore how working closely with individuals who are experiencing ill health may impact negatively on the nurse as a care provider. This exposure to trauma, illness and death can result in a vicarious experience of trauma that may result in a sense of shared experience with the patient. The emotional burden this places on the nurse can lead to increased anxiety, stress and a need to detach from the patient. This can have a detrimental effect on patient care and nurses must remain vigilant to their susceptibility to, and experience of, mutual suffering through secondary trauma. Although nursing offers many positive experiences, this article is focused on highlighting the negative impacts of secondary traumatic stress. This article briefly outlines the literature relating to secondary traumatic stress and mutual suffering in the acute hospital setting and does not consider mental health settings or patients. The aim of the article is to close the theory-practice gap while also encouraging personal reflection on nurses' experiences of mutual suffering in practice. The author recognises the loaded nature of the term 'mutual suffering'; however, this is an established phrase used to explain the phenomena of interest. Although the term 'suffering' may imply a passive sick role for nurses, in this context the term should be seen as a shared sense of the experience of the patients and health staff.

Meta-analysis reveals low language capacity in childhood is associated with mental health problems in adulthood.

Children and adolescents with language problems have poorer mental health compared with their non-language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta-analysis that addresses this gap in the literature. Specifically, it summarisesthe results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development. Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta-analysis. Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054). This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well-being in the long term. What is already known on the subject Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalisingproblems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems. What this paper adds to the existing knowledge The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood. What are the practical and clinical implications of this work? First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech-language therapy in the adult mental health system.