Mental Health Nursing Research Articles

Impact Of Work Environment Factors On The Mental Health Of Nurses In Psychiatric Settings

Background: The mental health of nurses in psychiatric settings is profoundly influenced by specific work environment factors, including the health profession's culture, excessive workload, and workplace violence (Ugwu, 2020; Neves, 2021). This study explores the impact of workload, bullying, and support mechanisms, uniquely focusing on their effects within mental health nursing. Objective: To identify and analyze how distinct environmental stressors such as workload, role ambiguity, and lack of support affect mental health outcomes among nurses in psychiatric care facilities, aiming to propose targeted interventions. Methods: Employing a mixed-methods approach, the study surveyed 382 mental health nurses using both quantitative Likert-scale questionnaires and qualitative interviews. The methodology, supported by the postpositivist paradigm, was selected for its appropriateness in addressing the complex dynamics of psychiatric nursing settings (Ugwu, 2020). Results: The study found that high workload, frequent exposure to workplace bullying, and insufficient support systems are critical stressors significantly compromising mental health nurses' well-being and job satisfaction. Particularly, nurses with less than two years of experience in mental health settings were most vulnerable to these negative impacts. Conclusion: Addressing these key environmental factors is crucial for improving mental health nurses' working conditions and, consequently, the quality of care provided in psychiatric settings. The study suggests implementing structured support systems and policy reforms aimed at reducing workplace stressors

Knowledge and stigma of depression among adolescents in Indonesia: a cross-sectional study

<span lang="EN-US">Depression is a prevalent mental health issue among Indonesian adolescents. Adolescents grappling with depression face various challenges, including exclusion, discrimination, educational difficulties, and violations of human rights. Limited knowledge about depression contributes to stigma, which impacts teenagers' reluctance to seek professional help. This study aimed to examine the correlation between adolescents' knowledge and the stigma of depression. Using a cross-sectional framework, this study involved 240 high school students from grades 10, 11, and 12. All participants completed and returned the requisite instruments. Knowledge about depression was assessed using the adolescent depression knowledge questionnaire (ADKQ), while the depression stigma scale (DSS) was used to gauge levels of stigma. The relationship between knowledge and stigma was analysed using the Spearman rank test. The findings indicate that the mean score for adolescents' knowledge about depression was 7.00 (SD=2.72), while the mean score for stigmatisation of depression was 42.02 (SD=8.43). A significant relationship between knowledge and stigma was observed (p<0.0001), characterised by moderate strength and a negative direction (r=-0.45). The study concludes that more excellent knowledge about depression among adolescents is inversely related to the level of the stigma they harbour. It is therefore recommended that mental health nurses in Community Health Centers enhance educational and counselling programs to inform adolescents about depression better. Collaboration between academic institutions and healthcare facilities, along with the development of school-based mental health programs, is imperative for reducing the stigma associated with depression among students.</span>

How Mental Health Nurses Perceive the Implementation of Batho Pele Principles in a Selected Mental Health Hospital in Limpopo Province, South Africa

Background: Batho Pele is a South African legislative framework initiative introduced to improve the overall delivery of public services. The framework was introduced in 1997 and aimed at bringing a comprehensive transformation of the work ethics of all public servants, including health workers, at all levels of health hospitals. The study aims to investigate nurses’ perceptions of implementing Batho Pele principles in selected mental health hospitals. Methods: A quantitative descriptive survey design using a self-administered questionnaire was used to collect data. Probability-stratified random sampling was used to select the sample of 230 from the population of nurses. Statistical Package for the Social Sciences (SPSS) version 23 was used to analyze descriptive data. Results: The study showed that lack of knowledge, communication and practical skills, and human and material resources negatively affect the effective implementation of Batho Pele principles in the care of mental health service users. Conclusions: The Batho Pele principles are insufficiently implemented in mental health hospitals due to a shortage of staff to facilitate the implementation of Batho Pele principles. The researcher recommended an in-service program to train nurses in implementing Batho Pele principles to enhance the provision of exemplary mental health services.

Conceptualising maternal mental health in rural Ghana: A realist qualitative analysis.

In low-and-middle income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social, and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women's interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n= 6) and 18 focus group discussions (n= 121) with pregnant and postnatal women, their relatives and health care providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the Context-Mechanism-Outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther's ecology of birth theory to unpack how context shapes women's interactions with public and alternative health care providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women's wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women's expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, support the role of private providers in offering women a feeling of protection from uncertainty. Co-production of context specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women's perspectives on spirituality and mental health, which can subsequently help to make health system responsive to maternal mental health conditions.

"My Body Changed a Lot After Taking Medication. I'm Trying to Hide It but…" A Qualitative Exploration of Body Image Experiences of Women Living With Schizophrenia.

Although body image is one of the essential concepts that should be addressed in comprehensive care, the question of how body image affects women with schizophrenia remains unanswered. This study aimed to explore the body image experiences of women living with schizophrenia. This study employed a qualitative approach and participants were recruited from a community mental health center in Türkiye. Semi-structured interviews were conducted with 18 women with schizophrenia. Data were analysed via content analysis. The data were categorised into five themes: (i) body image evaluation, (ii) factors affecting body image, (iii) effects of body image distortion, (iv) coping with body image challenges and (v) protective factors. Schizophrenia affects body functionality, appearance and the self. Women living with schizophrenia experience feelings of shame, sadness, worthlessness and anger related to their body appearance. Body image distortion leads to social distancing and treatment compliance problems. Mental health nurses should support patients to express their feelings and thoughts about the body and recognise their beliefs about ideal body image. Patients should be supported with psychoeducational interventions in the management of symptoms associated with body image disturbance such as weight gain, galactorrhea, sedation and hypersalivation.

Addressing Tobacco Use Disorder in Individuals With Mental Health Disorders: The Critical Role of Nurses.

Individuals with mental health disorders tend to smoke more frequently and intensely than the general population; however, smoking cessation efforts are still often neglected in mental health care. This position paper advocates for creating a more prominent role for mental health nurses in assisting individuals with severe psychiatric disorders to quit smoking. Given their extensive patient contact and holistic care approach, mental health nurses are uniquely positioned to lead smoking cessation initiatives. Consequently, there is an urgent need for increased awareness, mandatory professional training and policy support to empower nurses in this critical role. Strengthening the involvement of mental health nurses in smoking cessation programs could lead to reduced premature mortality and improved overall health for individuals with severe mental illnesses.

A scoping review of rural mental health and substance use nursing.

Globally, nearly 50% of the population live in rural areas, while just 36% of nurses serve in these locations. Rural nurses face distinct challenges such as limited resources and geographical isolation, and often work with an expanded scope of practice that includes mental health and substance use (MHSU) care. The extent to which rural nurses engage in MHSU care, care barriers, and facilitators has not been previously well described. Thus, this scoping review explored the international research on rural MHSU nursing. The aim was to synthesize the rural MHSU nursing evidence and consider it in relation to Knowing the Rural Community: A Framework for Nursing Practice in Rural and Remote Canada. The research question for this review was, 'What is known about rural nursing related to mental health and/or substance use considerations?' A scoping review approach was used to guide a systematic exploration of the literature. CINAHL, Medline, and PsycINFO databases were searched for international qualitative, quantitative, and mixed-methods scholarly articles with rural MHSU nursing considerations, with no date limiters. Extracted data were mapped to the framework's categories: rural people, community, rural context, and larger society. Forty-seven articles were selected for this critical review of the literature, with most of the articles from Australia (n=15), the US (n=8), Canada (n=7), and South Africa (n=5), and representing rural nurses who worked in hospital (n=16), primary care (n=11), community mental health (n=7), and emergency department (n=6) practice settings. Rural MHSU nursing was described as a generalist and multifaceted role, with challenges such as workplace violence, practice setting and community isolation, and resource inadequacies. Results also indicated that rural MHSU nursing is influenced by a nurse's preparedness for their role, with a lack of preparedness complicated by multilayered resource deficits. Social determinants of health, mental health stigma, and health inequities also affected rural MHSU nursing practice. Despite facing significant barriers, rural nurses demonstrated resilience and commitment to providing quality MHSU care for their communities. Overall, there was congruence between the included studies and the framework. The framework provided a comprehensive foundation for this scoping review. However, based on the findings of this scoping review, minor amendments to the framework are recommended, such as including the rural nurse as an explicit part of the framework. Further, a rural-centric approach that is local, context-sensitive, and developed in collaboration with rural people, was identified as crucial for addressing the unique challenges faced by rural MHSU nurses and their communities. Future rural research should address nursing shortages, practice support, and under-researched areas such as child and youth MHSU nursing and Indigenous health. This scoping review highlighted some of the challenges rural MHSU nurses encounter and provided valuable insights into the complexities of rural MHSU nursing internationally. By using the framework to organize and synthesize the literature, this study contributed to a deeper understanding of the role of rural nurses in addressing MHSU challenges and the context in which rural MHSU nursing care may be situated.

Registered Nurses' Knowledge and Attitudes Towards Psychedelics in Healthcare: Statewide Survey Results.

Psychedelic science is re-emerging to address mental health conditions, of which certain populations in the United States experience disparities. However, the perspectives of registered nurses (RNs), who have important roles within mental health care, towards psychedelics are largely unknown. To assess attitudes, knowledge, and beliefs of a large, state-wide sample of RNs towards psychedelics in healthcare settings. RNs were randomly selected from a statewide directory to participate in a cross-sectional, multi-method online survey. 793 RNs completed all items, with generally positive attitudes towards psychedelics but mixed opinions regarding the legal landscape, including decriminalisation. Few (12.7%) reported psychedelic content in their training, and most expressed low confidence in their knowledge. Findings generally align with previous research regarding provider attitudes towards psychedelics. Participants in this study had slightly more favourable attitudes and higher knowledge scores. The study has potential selection bias, lacks a priori power analysis, and is limited to one state. As psychedelic science emerges as a potential treatment option for several mental health conditions, RNs must be prepared to support individuals and communities. Additional education in this emerging area of mental health nursing is warranted to ensure RN competence and confidence.

Barriers Experienced by Psychiatric Nurses to Facilitate Therapeutic Relationships With Mental Healthcare Users With Dual Diagnosis in a Psychiatric Hospital in South Africa

ABSTRACTBackgroundPsychiatric nurses are in a unique position to build therapeutic relationships with mental healthcare users with dual diagnoses to foster trust and recovery. However, a dual diagnosis poses barriers to establishing and maintaining a therapeutic nurse–patient relationship.AimThe overall aim of this study was to explore and describe barriers experienced by psychiatric nurses to facilitate therapeutic relationships with mental healthcare users with dual diagnosis in a psychiatric hospital in Limpopo province, South Africa.DesignA qualitative, explorative, descriptive and contextual design was followed.MethodSemi‐structured interviews were conducted with 12 purposively selected participants who cared for mental healthcare users with dual diagnoses. Tech's method of open coding was used to analyse the data.FindingsDisruptive and disrespectful behaviour and mental healthcare users' substance use during hospitalisation resulted in nurses harbouring ambivalent feelings that impaired therapeutic nurse–patient relationships.ConclusionThe barriers affecting therapeutic relationships with mental healthcare users with dual diagnosis should be addressed to enhance recovery and treatment compliance.RecommendationsAn integrated approach with the involvement of the interprofessional team, debriefing and training for nurses may help to foster therapeutic nurse–patient relationships, empower nurses and enhance the recovery of mental healthcare users with dual diagnosis.

Generalized anxiety disorder and job performance can predict job stress among nurses: A latent profile analysis

BackgroundNursing is a stressful profession that can impact the physical and mental health of nurses as well as the safety of patients. Furthermore, various factors may affect the job stress of nurses. However, recent studies mainly focused on the overall level of job stress and its related factors, ignoring the population heterogeneity of nurses’ job stress.MethodsA total of 440 nurses participated in the questionnaire survey between March 2023 and April 2023. Data were collected using the Demographic Characteristics Questionnaire, the Nursing Job Stressor Inventory, the Generalized Anxiety Disorder 7-item Scale, and the Nurse Job Performance Scale. A latent profile analysis was used to identify the latent profiles of job stress. Kruskal-Wallis H test and ordinal logistic regression were used to explore the predictors of different profiles.ResultsThe job stress of nurses could be classified into four profiles: relatively low job stress, relatively high job stress, high job stress, and the highest job stress. Generalized anxiety disorder, job performance, health status, and dislike of nursing as a career were predictors of different profiles.ConclusionsThe majority of nurses were classified into profile 2, and their job stress was relatively high. Lowering anxiety levels, enhancing job performance, improving nurses’ health status, and changing professional attitudes toward nursing may be effective ways to reduce nurses’ job stress.

Factors Influencing Person-Centered Care Among Psychiatric Nurses in Hospitals.

This study aimed to examine the association between psychiatric nurses' empathy, teamwork, nursing work environment, and the degree of person-centered care, as well as to identify factors influencing person-centered care (PCC). An online cross-sectional survey was conducted from 11 January to 19 January 2024, using four validated questionnaires. Participants included 167 psychiatric nurses with more than one year of clinical experience working in South Korea. Person-centered care was positively correlated (p < 0.001) with empathy, teamwork, and the nursing work environment. Hierarchical regression analysis was used to identify factors influencing person-centered care among psychiatric nurses. The analysis revealed that the nursing work environment (p < 0.001), teamwork (p < 0.001), empathy (p < 0.001), type of hospital (general hospital) (p = 0.002), and age (p = 0.037) significantly influenced person-centered care, explaining 78.7%. Enhancing PCC among psychiatric nurses requires the development of training and educational programs that bolster empathy and teamwork. Additionally, improvements and strategic enhancements to the nursing work environment are essential.

Using practice development to recruit and retain forensic mental health nurses: a preceptorship support project

Using practice development to recruit and retain forensic mental health nurses: a preceptorship support project

Perceived Stress and Coping Strategies for Frontline Nurses Caring for COVID-19 Patients: A Path Analysis.

This cross-sectional study explored the relationships among perceived stress, social support, positive coping, and mental health in frontline nurses caring for patients with COVID-19 in China. A quantitative cross-sectional study. A convenience sample of 339 eligible frontline nurses was identified from a designated hospital for COVID-19 in Shanghai, China, between May 2022 and August 2022. Data from nurses were collected through an online survey that contained 4 measurement domains: perceived stress, social support, coping strategies, and mental health. Path analysis was used to analyze the data in SPSS 24.0 and AMOS 23.0. The model tested in the path analysis fit the data well. The results demonstrated relationships among perceived stress, social support, positive coping, and mental health among frontline nurses caring for patients with COVID-19. Social support had a positive effect on positive coping strategies and a negative effect on perceived stress and mental health. In addition, path analysis indicated that social support moderated the relationship between perceived stress and mental health in nurses. Nurses experienced work-related mental stress while providing COVID-19-related care. Based on study findings, social support is expected to play a key role in stress management in nurses. Expanding opportunities for social support is an essential step for nurses to improve their mental health and quality of life.

The Influence of Emotional Intelligence on Psychiatric Nurses' Care Behavior, and the Chain Mediating Role of Compassion Fatigue and Perception of Management.

To investigate psychiatric nurses' emotional intelligence and its effect on care behavior, while also examining the mediating effect of compassion fatigue and perception of management. This cross-sectional study was conducted in several specialized psychiatric hospitals with 360 psychiatric nurses. Self-report surveys were administered, which included the Caring Factor Survey-Caring of Manager, Caring Behaviors Inventory, Compassion Fatigue Short Scale, and Wong Law Emotional Intelligence Scale. Data were analyzed using descriptive, correlation, and path analyses. Mean score for care behavior was 4.78 (SD = 0.83), which was at a moderate level. Compassion fatigue exhibited negative correlations with other variables. Results of mediation effect analysis showed that emotional intelligence directly predicted care behavior (p < 0.001). Emotional intelligence also indirectly affected care behavior through the mediating roles of perception of management and compassion fatigue, and affected care behavior through the chain mediation effect of perception of management and compassion fatigue. Nurse managers should pay attention to the influence of emotional intelligence on care behavior and improve care behavior by strengthening leadership and alleviating compassion fatigue. [Journal of Psychiatric Nursing and Mental Health Services, xx(xx), xx-xx.].

Understanding the Process of Acceptance Within the Nurse-Patient Therapeutic Relationship in Mental Health Care: A Grounded Theory.

Background/Objective: Deepening knowledge about the meaning of acceptance in the context of the nurse-patient relationship will help us to understand the importance and value that people with mental health challenges attach to this attribute in the process of the therapeutic relationship. The objective of this study was to understand the process of acceptance as part of the therapeutic relationship between nurses and patients in the field of mental health. Methods: This study employed a qualitative research design using Strauss and Corbin's grounded theory approach. Using theoretical sampling, data were collected through unstructured interviews with mental health nurses and with people with mental health challenges. Results: Acceptance is a complex and dynamic process that takes place when both patients and nurses feel and make the other feel like an individual human being. Acceptance is not an automatic process; rather, it requires awareness on behalf of both parties involved in the therapeutic relationship. The creation of a non-hierarchical caring environment is fundamental for fostering mutual acceptance and engagement in the therapeutic process. Conclusions: Nurses must develop self-awareness and reflect on their attitudes and biases to provide person-centered care. Nurse training and personal development are essential requirements for achieving an effective therapeutic relationship and empowering patients in their recovery process.

Mental health nursing students and generic proficiencies: how educators can support assessment.

Recent shifts in nursing education towards generic proficiencies pose challenges to the unique demands of mental health nursing education. Student mental health nurses at the authors' higher education institution (HEI) have provided service feedback that has expressed the difficulties they have encountered. This article examines the issues faced by students, assessors and educators in interpreting and applying the proficiency standards set by the Nursing and Midwifery Council. Addressing the complexities of mental health nursing education, as well as the barriers to learning and attainment, requires a collaborative effort and innovative solutions if HEIs are to successfully prepare future mental health nurses to meet the evolving demands of their role. The proposed solution is a 'Proficiency Directory', which provides structured resources for mental health nursing students to align learning experiences with assessment criteria, facilitating a more comprehensive and meaningful learning journey.

Developing the emergency response for mental health patients.

Carly Lynch, Consultant Nurse for Mental Health, London Ambulance Service (carly.lynch@nhs.net), was the winner of the Gold Award in the Mental Health Nurse of the Year category of the BJN Awards 2024.

The mediating role of surface and deep acting and the moderating effect of occupational identity in workplace violence and sleep quality among psychiatric nurses: a cross-sectional study.

Psychiatric nurses often encounter patients with mental health disorders and consequently experience prolonged periods of high stress, increased workload, and frequent incidents of workplace violence. These aspects can lead to a higher incidence of poor sleep quality. This study examined the interplay between workplace violence and emotional labour (surface and deep acting) to suggest measures for enhancing sleep quality among psychiatric nurses. A total of 300 completed and valid online questionnaires were collected. The Pittsburgh Sleep Quality Index was used to measure sleep quality, Workplace Violence Scale (WVS) to measure the occurrence of workplace violence, and Emotional Labour Scale to measure surface and deep acting. The data were analysed using Hayes' PROCESS macro with SPSS. Independent samples t-tests and one-way ANOVA were used to compare differences in sleep quality and emotional labour (surface and deep acting) between psychiatric nurses with different demographics. The prevalence of poor sleep quality (PSQI > 5) was 55% among the nurses. Surface acting in emotional labour partially mediated the relationship between workplace violence and sleep quality(a1*b1=0.035,95%CI: 0.002, 0.079), whereas deep acting had a suppressive effect(a2*b2=-0.033,95%CI: -0.071, -0.003). Occupational identity had a positive moderating effect on the relationship between workplace violence and surface acting(Effect=0.091,95%CI: 0.004, 0.179). The relationship between workplace violence and poor sleep quality was partially mediated by surface acting and suppressed by deep acting. Moreover, nurses with higher occupational identity engaged in more surface acting after workplace violence. Workplace violence, surface acting, and deep acting emerged as significant factors influencing sleep quality among psychiatric nurses. Deep acting can reduce the impact of workplace violence on sleep quality. The results provide a new and expanded view of the interplay between workplace violence and emotional labour concerning sleep quality. Interprofessional collaboration with clinicians, administrators, educators, and spiritual leaders can contribute to the development of related education and training. Chinese Clinical Trial Registry ChiCTR2200062347. https://www.chictr.org.cn/showproj.html?proj=173264.

The Unsung Heroes: The Enduring Support of Mental Health Nurses

The Unsung Heroes: The Enduring Support of Mental Health Nurses

Unveiling Shadows: Challenges Encountered by Mental Health Nurses and Health Cadres in the Delivery of Care to Persons With Mental Illness in Indonesia.

Mental health nurses and health cadres in Indonesia who provide care to persons with mental illness (PWMI) report encountering several challenges and obstacles to the delivery of quality care. At present, there is a paucity of research on this topic. The objective of this study was to examine the challenges encountered by mental health nurses and health cadres in their interactions with the families of PWMI in the community. This descriptive qualitative study employed focus group discussions, conducted in three Indonesian cities: Banda Aceh, Surabaya and Yogyakarta. Thematic analysis was utilised to analyse the data. The study revealed that the theme of this research is nurses and health cadres experienced challenging family behaviours toward a PWMI. The initial subtheme of family behaviour is 'concealing the PWMI.' This subtheme encompasses instances where families attempted to hide the mental health condition of the PWMI. The second subtheme is 'unsupportive families'. This subtheme is characterised by reluctance to engage in treatment or outright rejection of hospital care. This is often due to factors such as familial busyness. The third subtheme is 'poor parenting styles'. This subtheme highlights how inadequate parenting practices, domestic violence and lack of family support contribute to stress and exacerbation of mental disorders in PWMI. The fourth subtheme is 'hidden motive related to wills and testaments', which reveals how families may attempt to manipulate treatment to remove the inheritance rights of PWMI. The fifth subtheme is 'abandonment by family', which describes scenarios where families completely neglect PWMI, leading to inadequate care and medication adherence. The final subtheme, 'removal of PWMI from family units', describes instances where families sent PWMI to mental health facilities for permanent separation, sometimes even relocating to another city. To address these issues, a comprehensive approach is required that considers both the affected individuals and their families. An understanding of the motivations behind these behaviours is essential for the development of targeted interventions that promote family support, reduce stigma and improve the overall mental health environment in communities.