This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a (...) transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments. (shrink)

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view from (...) this position, although not without challenge and internal discipline dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an “othered” identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out (...) of its identity‐based understanding and recontextualized as an inferior category of “the human,” circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes‐contradictory nature of the discipline's grappling with identity‐based mental health concepts. We close with several implications for nursing policy, education, and practice. (shrink)

Background Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. Aim This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. Research design This study had a cross-sectional, (...) descriptive-correlational survey design. Participants and method Nurses ( N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. Ethical considerations Ethical approval for the study was obtained from the relevant ethics committee. Findings Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = −0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (β = −0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18). Discussion and conclusion Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected. (shrink)

This discussion paper offers a critical provocation to my mental health nursing colleagues. Drawing upon David Graeber's account of bullshit work, work that is increasingly meaningless for workers, I pose the question: Is mental health nursing a bullshit job? Ever‐increasing time spent on record keeping as opposed to direct care appears to represent a Graeberian bullshitisation of mental health nurses' work. In addition, core aspects of the role are not immune from bullshit. (...) Professional rhetoric would have us believe that mental health nursing is a therapeutically beneficent occupation organised around ideals of care and compassion and providing fulfilling work for practitioners. Yet, there are some key characteristics of the experience of mental health nursing work that afford alternative judgements on its value and meaningfulness. Not least of these is the fact that many mental health nurses feel quite existentially unsettled in the practise of their work and many service users do not recognise the professional ideal, especially when compelled into increasingly coercive and restrictive services. In this context, Graeber's thesis is explored for its applicability to mental health nursing with a conclusion that many aspects of mental health nursing work are commensurate with bullshit but that mental health care can possibly be redeemed from bullshitisation by authentically democratising reforms. Engaging with posthumanist ideas, this exploration involves a flexing of aspects of Graeber's theory. (shrink)

The following dialogue takes up recent calls within nursing scholarship to critically imagine alternative nursing futures through the relational process of call and response. Towards this end, the dialogue builds on letters which we, the authors, exchanged as part of the 25th International Nursing Philosophy Conference in 2022. In these letters, we asked of ourselves and each other: If we were to think about a new philosophy of mental health nursing, what are some of (...) the critical questions that we would need to ask? What warrants exploration? In thinking through these questions, our letters facilitated a collaborative enquiry in which philosophy and theory were generative tools for thinking beyond what is and towards what is yet to come. In this paper, we expand the dialogue within these letters—in a ‘dialogue‐on‐dialogue’—and take up one thread of our discussion to argue that a new philosophy of mental health nursing must rethink the relationships between ‘practitioner’/‘self’ and ‘self’/‘other’ if it is to create a radically different future. Further, we posit solidarity and public love as possible alternatives to foregrounding the ‘work’ of mental health nursing. The possibilities we present here should be received as partial, contingent and unfinished. Indeed, our purpose in this paper is to provoke discussion and, in so doing, to model what we believe is a necessary shift towards criticality in our communities of nursing scholarship. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe (...) the experience of moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

Managing aggression in mental health hospitals is an important and challenging task for clinical nursing staff. A majority of studies focus on the perspective of clinicians, and research mainly depicts aggression by referring to patient-related factors. This qualitative study investigates how aggression is communicated in forensic mental health nursing records. The aim of the study was to gain insight into the discursive practices used by forensic mental health nursing staff when they (...) record observed aggressive incidents. Textual accounts were extracted from the Staff Observation Aggression Scale-Revised (SOAS-R), and Fairclough’s Critical Discourse Analysis was used to identify short narrative entries depicting patients and staffs in typical ways. The narratives contained descriptions of complex interactions between patient and staff that were linked to specific circumstances surrounding the patient. These antecedents, combined with the aggression incident itself, created stereotyping representations of forensic psychiatric patients as deviant, unpredictable and dangerous. Patient and staff identities were continually (re)produced by an automatic response from the staff that was solely focused on the patient’s behavior. Such response might impede implementation of new strategies for managing aggression. (shrink)

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is (...) the ethical‐legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self‐determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain. (shrink)

The metaphor of mapping is used in this paper to examine the discursive construction of women whose nudity in public places (making a spectacle of herself) provides dilemmas for community mental health nurses required to make assessments of these women's ability to function in die community. Excerpts from stories provided by die nurses are used to demonstrate the complexity of die decision‐making processes and the limits to die choices they perceive they can make.

Refining the model for an emergency department‐based mental health nurse practitioner outpatient service The mental health nurse practitioner (MHNP) role based in the emergency department (ED) has emerged in response to an increase in mental health‐related presentations and subsequent concerns over waiting times, co‐ordination of care and therapeutic intervention. The MHNP role also provides scope for the delivery of specialised primary care. Nursing authors are reporting on nurse‐led outpatient clinics as a method of (...) healthcare delivery that allows for enhanced access to health‐care, particularly following hospital discharge. However, due to a lack of in‐depth substantiation, this mode of service delivery requires more thorough investigation. This study describes the refinement phase undertaken before the implementation and pilot evaluation of a formalised and structured MHNP outpatient service in the ED of a large inner‐city hospital in Sydney, Australia. An expert advisory panel (EAP) consisting of key local informants was convened to provide feedback on and refinement to the proposed model. This related to issues such as target population, structure and process considerations, outcome measures and interface within the overall health service. Findings from the EAP meeting are presented and discussed. The importance of linking methods with the appropriate methodology in evaluating a healthcare program is highlighted. (shrink)

This study focuses on nursing in an inpatient mental health setting. Its analytic structure follows from a previous review of nursing studies by Allen, which did not include studies of mental health nursing. Allen's review concluded that the nurses’ role could be understood as that of healthcare intermediary and that nurses’ work could be analysed as eight interrelated bundles of activity. These bundles include such matters as managing the work of others. This study (...) aims to assess the fit of this model to mental health nursing and to add to the body of work concerning the social organisation of nursing. The research materials discussed are derived from an ethnography of a psychiatric unit. The analytic framework employed leads us to conclude that the work of mental health nurses can be understood, too, as that of the healthcare intermediary. However, one bundle is found to fit less well and this is attributed to the fragile uncertainty of knowledge in psychiatry. The use of an additional bundle to describe in‐context nursing interventions is suggested. It is argued that getting to grips with the reflexive relationship between individual patient care and the social organisation in which this is practised is essential for any practice development efforts. (shrink)

Since the era of deinstitutionalisation, many clinical approaches have emerged to enable the care and treatment of people suffering from mental illness. In recent years, the use of coercive approaches in the community (e.g., outpatient commitment or community treatment orders) has also increased internationally. Although nurses' role regarding these coercive approaches is central and significant, few empirical and theoretical writings have tackled this controversial nursing practice. The purpose of this paper is to analyse coercive nursing care through (...) the lens of French philosopher Gilles Deleuze's concept of ‘societies of control’. Taking up Michel Foucault's work on disciplinary power, Deleuze explores how the move from the striated spaces of closed institutions to the smooth spaces of societies of control took place since the middle of the 20th century. According to Deleuze, the overall objective of ‘societies of control’ is no longer simply to govern deviant behaviour in closed environments (e.g., psychiatric hospitals and prisons) but to ensure a regime of unrelentless surveillance in the open spaces of our communities. (shrink)

The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub‐Saharan Africa. They were interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep‐rooted discrimination and marginalisation. Aside from that, (...) because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential. (shrink)

This article explores how the intersections of gendered, racialized and neoliberal dynamics reproduce social inequality and shape the violence that nurses face. Grounded in the interviews and focus groups conducted with a purposeful sample of 17 registered nurses (RNs) and registered practical nurses (RPNs) currently working in Ontario's mental health sector, our analysis underscores the need to move beyond reductionist notions of violence as simply individual physical or psychological events. While acknowledging that violence is a very real and (...) disturbing experience for individual nurses, our article casts light on the importance of a broader, power structure analysis of violence experienced by nurses in this sector, arguing that effective redress lies beyond blame shifting between clients/patients and nurses. Our analysis illustrates how assumptions about gender, race and care operate in the context of global, neoliberal forces to reinforce, intensify and create, as well as obscure, structural violence through mechanisms of individualization and normalization. (shrink)

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient (...) relationship using an interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships. (shrink)

The required role of the psychiatric‐mental health nurse in primary health‐care: an augmented Delphi study An augmented Delphi study was employed to elicit the perceptions of CPNs, GPs, social workers, managers of psychiatric nursing services and health service purchasers in England, on the role required of a psychiatric (mental health) nurse in primary health care. In the final stage of the study, users of mental health service were enlisted in a (...) verification study of the emergent findings. A broad consensus emerged that a gap existed in mental health services in primary care. This was perceived as placing a large burden on GPs, which might be reduced by the appropriate development of community psychiatric‐mental health nursing. The study suggested the possibilities for development of a ‘mental health nurse consultant’ role, which might augment the current CPN role, within which the nurse might offer not only direct patient care, but also support to members of the primary care team. (shrink)

The aim of this study was to explore and reflect upon mental health nursing and first-episode psychosis. Seven multidisciplinary focus group interviews were conducted, and data analysis was influenced by a grounded theory approach. The core category was found to be a process named ‘working behind the scenes’. It is presented along with three subcategories: ‘keeping the patient in mind’, ‘invisible care’ and ‘invisible network contact’. Findings are illuminated with the ethical principles of respect for autonomy and (...) paternalism. Nursing care is dynamic, and clinical work moves along continuums between autonomy and paternalism and between ethical reflective and non-reflective practice. ‘Working behind the scenes’ is considered to be in a paternalistic area, containing an ethical reflection. Treating and caring for individuals experiencing first-episode psychosis demands an ethical awareness and great vigilance by nurses. The study is a contribution to reflection upon everyday nursing practice, and the conclusion concerns the importance of making invisible work visible. (shrink)

The health crisis caused by COVID-19 has resulted in the physical and emotional deterioration of health personnel, especially nurses, whose emotional state is affected by the high risk of contagion, the high demands of health services, and the exhausting working hours. The objective of this research was to determine the relationship between fear, anxiety, and fatigue of nurses caring for patients with COVID-19 in a second level public hospital in Peru. This study presents a quantitative approach and (...) correlational level, cross-sectional, and non-experimental design. The sample consisted of 145 nurses who attended patients with COVID-19 in health care areas. The results show a significant relationship between fear of contagion and physical-cognitive fatigue and a significant relationship between generalized anxiety and physical-cognitive fatigue. It is concluded that in this context, both fear of contagion and generalized anxiety are related to physical-cognitive fatigue. (shrink)

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this (...) paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of “Breaking Point,” in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. (shrink)

Clinical decision-making within an ethical context -- The ethical self -- Ethical reasoning : a pragmatic approach -- Recognising ethical issues -- Gathering facts and values -- Ethical rules and frameworks -- Ethical theories -- Managing the outcome -- Future development.

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum (...) Theory presents a single‐system intuitive‐analytical approach to examining and understanding nurse cognition, analogous to the recommended single‐system approach to decision‐making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a ‘common sense’ blending of intuitive and analytical cognition, whereby cues presented to a decision‐maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition. (shrink)

Nurses die by suicide at a higher rate than the general population. Previous studies have observed mental health problems, including substance use, as a prominent antecedent before death. The purpose of this study was to explore the characteristics of nurses who died by suicide documented in the death investigation narratives from the National Violent Death Reporting System from 2003 to 2017 using thematic analysis and natural language processing. One thousand three hundred and fifty‐eight subjects met these inclusion criteria. (...) Narratives from 601 subjects were thematically analyzed and 2544 individual narratives were analyzed using natural language processing. The analyses revealed five themes: “mental health treatment,” “poor general health and chronic pain,” “substance use,” “worsening mental health after bereavement,” and “repeating a family member's suicide.” Mental health/substance use, chronic illness, and chronic pain were seen to coexist in a complex, interdependent manner that appeared to be entangled in the nurses' narratives before death. These findings echo the need for reducing the stigmatization of mental health problems in nursing and removing barriers to help‐seeking behaviors as early preventative interventions. Future research is needed to determine if a comprehensive healthcare integration approach to address these entangled problems would reduce suicide vulnerability in nurses and improve their quality of life. (shrink)

The Mental Health Literacy Scale is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin’s translation model and tested with a sample of 872 (...) clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-2 were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named “knowledge of mental disorder,” “ability to seek information and help,” “recognition of mental disorder,” and “acceptance of patients with mental illness,” with factor 1-3 were summarized into MHLS-Core and factor 4 as MHLS-SA. The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 and highly positively correlated with JSE-HP. The Cronbach’s α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50th percentile for the MHLS-C was 99, with 50th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended. (shrink)

Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses (...) found that their responsibility first and foremost was the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses’ support of relatives: seeing the relative in the shadow of the patient or as an individual person. (shrink)

Postdisciplinarity in mental health‐care: an Australian viewpointThis paper outlines some of the powerful forces progressively undermining the conceptual and practical foundations upon which the major disciplines have been established, and dissolving the boundaries which have traditionally distinguished them from each other, particularly those disciplines involved in the healthcare enterprise. It discusses some of the implications of these processes for mental health nursing, and champions a new cadre of ‘postdisciplinary’ staff, comprising a graduate generic mental (...) healthcare worker and a postgraduate clinical specialist. It is argued that such a specialist — a ‘Generic Mental Health Worker’— should be welcomed by all those who want to see improved quality of care in mental health services rather than defend a failing system. (shrink)

Recovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became (...) more established, more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change. (shrink)

BackgroundThe positive component of Mental Health Literacy refers to a person’s awareness of how to achieve and maintain good mental health. Although explored recently, the term still lacks a clear definition among healthcare practitioners.AimTo identify the attributes and characteristics of PMeHL, as well as its theoretical and practical applications.MethodsLiterature search and review, covering the last 21 years, followed by concept analysis according to the steps described by Walker and Avant approach.ResultsPositive component of Mental Health (...) Literacy is considered one component of MHL, integrating positive mental health. The concept’s attributes include: competence in problem-solving and self-actualization; personal satisfaction; autonomy; relatedness and interpersonal relationship skills; self-control; and prosocial attitude. Four case scenarios were used to clarify the antecedents and consequences of PMeHL.ConclusionPositive component of Mental Health Literacy is considered a component of MHL, which deserves attention throughout the lifespan, in different contexts and intervention levels. Considering PMeHL as a multi-faceted and dynamic construct will help understand the mechanisms that improve mental health and promote healthy behaviors. Priority should be given to robust primary research focused on nursing interventions that enhance and sustain PMeHL in people and families. (shrink)

Spirituality and spiritual care have long been kept separate from patient care in mental health, primarily because it has been associated with psycho-pathology. Nursing has provided limited spiritual care competency training for staff in mental health due to fears that psychoses may be activated or exacerbated if religion and spirituality are addressed. However, spirituality is broader than simply religion, including more existential issues such as providing non-judgmental presence, attentive listening, respect, and kindness. Unfortunately, healthcare personnel (...) working in mental health institutions are not well prepared to address spiritual concerns or resources of their patients. Therefore, a mixed-method pilot study was conducted using a self-assessment survey tool to examine spiritual care competencies of mental health staff in Norway and to understand the perspectives of mental health staff in the Scandinavian context. Five questions and comments related to survey items provided rich qualitative data. While only a small pilot with 24 participants, this study revealed a need for spiritual care educational materials targeted specifically for those who work in mental health, materials that address the approach of improving attitudes, enhancing skills, and increasing knowledge related to spirituality and spiritual care of patients. (shrink)

IntroductionDuring the COVID-19 pandemic, healthcare workers in Italy have been exposed to an unprecedented pressure and traumatic events. However, no direct comparison with the general population is available so far. The aim of this study is to detail mental health outcomes in healthcare workers compared to the general population.Methods24050 respondents completed an on-line questionnaire during the contagion peak, 21342 general population, 1295 second-line healthcare workers, and 1411 front-line healthcare workers. Depressive, anxious, post-traumatic symptoms and insomnia were assessed. Specific (...) COVID-19 related potential risk factors were also considered in healthcare workers.ResultsDepressive symptoms were more frequent in the general population and front-line healthcare workers compared to the second-line healthcare workers groups. Anxiety symptoms showed a prevalence of 21.25% in the general population, 18.05% for second-line healthcare workers, and 20.55% for front-line healthcare workers. Insomnia showed a prevalence of 7.82, 6.58, and 9.92% for the general population, second-line healthcare workers, and front-line healthcare workers, respectively. Compared to the general population, front-line healthcare workers had higher odds of endorsing total trauma-related symptoms. Both second-line healthcare workers and front-line healthcare workers had higher odds of endorsing core post-traumatic symptoms compared to the general population, while second-line healthcare workers had lower odds of endorsing negative affect and dissociative symptoms. Higher total traumatic symptom score was associated with being a front-line healthcare worker, having a colleague infected, hospitalized, or deceased, being a nurse, female gender, and younger age.ConclusionThis study suggests a significant psychological impact of the COVID-19 pandemic on the Italian general population and healthcare workers. Front-line healthcare workers represent a specific at-risk population for post-traumatic symptoms. These findings underline the importance of monitoring and intervention strategies. (shrink)

When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular (...) challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. (shrink)

BackgroundThe literature shows the negative psychological impact of the coronavirus disease 2019 outbreak on frontline healthcare workers. However, few are known about the mental health of physicians and nurses working in general hospitals during the outbreak, caring for patients with COVID-19 or not.ObjectivesThis survey assessed differences in mental health in physicians and nurses working in COVID-19 or non-COVID-19 medical care units.DesignA cross-sectional mixed-mode survey was used to assess burnout, insomnia, depression, anxiety, and stress.SettingA total of 1,244 (...) physicians and nurses from five general hospitals in Belgium, working in COVID-19 care units, non-COVID-19 care units, or both were informed of the study.ParticipantsSix hundred forty-seven healthcare workers participated in the survey.MeasurementsValidated instruments were used to assess the outcomes: the PFI, the ISI, and the DASS-21.ResultsResults showed high prevalence of burnout, insomnia, depression, and anxiety among participants. After adjusting for confounders, multivariate analysis of variance showed no differences between CCU, NCCU, and CCU + NCCU workers. Univariate general linear models showed higher level of burnout, insomnia, and anxiety among nurses in comparison to physicians. Being a nurse, young, isolated, with an increased workload were risk factors for worse mental health outcomes.LimitationsThe mental health of the tested sample, before the outbreak, is unknown. Moreover, this cross-sectional design provides no information on the evolution of the mental health outcomes over time.ConclusionDirectly caring for patients with COVID-19 is not associated with worse mental health outcomes among healthcare workers in general hospitals. High prevalence of burnout, insomnia, depression, and anxiety among physicians and nurses requires special attention, and specific interventions need to be implemented.Protocol RegistrationClinicalTrials.gov, identifier NCT04344145. (shrink)

The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the ‘experimental’ nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even ‘willfully obstructive’. In an attempt to resist such impressions, this paper will seek to provide an (...) accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a ‘continuity’, rather than as a series of distinct ‘moments’ or ‘events’. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent ‘turn’ to ‘narrative’ as a psychotherapeutic approach and for contemporary mental health care's growing interest in ‘social constructionism’. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, by exploring (...) rather than ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

In order to be able to provide informed, effective and responsive mental health care and to do so in an evidence‐based, collaborative and recovery‐focused way with those who use mental health services, there is a recognition of the need for mental health professionals to possess sophisticated critical thinking capabilities. This article will therefore propose that such capabilities can be productively situated within the context of the work of the French philosopher Michel Foucault, one of (...) the most challenging, innovative and influential thinkers of the 20th century. However, rather than focusing exclusively upon the content of Foucault's work, it will be suggested that it is possible to discern a general methodological approach across that work, a methodological approach that he refers to as “the history of the present.” In doing so, Foucault's history of the present can be understood as a productive, albeit provisional, framework in which to orientate the purpose and process of critical thinking for mental health professionals by emphasizing the need to both historicize and politicize the theoretical perspectives and therapeutic practices that characterize contemporary mental health care. (shrink)