Academic literature on the topic 'Psychiatric nurses' mental health'

OBJECTIVE: To examine the size and distribution of the advanced practice psychiatric nurse workforce relative to the total psychiatry workforce to determine whether nurses are predominantly working in areas with higher or lower levels of behavioral health specialists. METHODS: State-level data for psychiatric nurses were obtained from the American Nurses Credentialing Center, and included mental health psychiatric nurse practitioners, adult psychiatric nurse practitioners, child psychiatric clinical nurse specialists, and adult psychiatric clinical nurse specialists. Supply estimates of the full psychiatry workforce were calculated for comparison purposes. State population estimates were obtained from U.S. Census Bureau data. State workforce estimates were converted to a 1:100,000 provider-to-population ratio to analyze the density of providers across states. RESULTS: In 2018, the psychiatric workforce supply was estimated to be composed of 66,740 providers, including psychiatrists ( n = 47,046; 71%), psychiatric nurses ( n = 17,534; 26%), physician assistants ( n = 1,164; 2%), and psychiatric pharmacists ( n = 966; 1%). Overall, psychiatric providers appeared to be most densely concentrated in the northeast region of the United States. A dearth of providers was most pronounced within areas in the 12-state Midwest region, southern states, California, and Nevada. The average concentration of psychiatric workers was 22.61 per 100,000 population. CONCLUSIONS: The findings of this study find inconsistent pattern of how psychiatric nurses are distributed relative to the rest of the workforce, but reinforce the idea that they are essential in addressing care needs in areas with low concentrations of psychiatry specialists—especially if they are authorized to work to the full extent of their training/education.

A postal questionnaire was sent to a random sample of 300 fund-holding general practices. Respondents were asked to indicate if they had links with a psychiatrist, community psychiatric nurse or psychologist; 210 (70%) general practitioners returned completed questionnaires. Out of 210 practices 161 (77%) had links with at least one specialist mental health professional. Community psychiatric nurses had links with more practices than psychiatrists or psychologists. Problems with time or space made it difficult for practices to form links.

OBJECTIVE: To identify the competencies of nurses to health promotion in psychiatric and mental health context. METHODS: Integrative review of literature performed through search using the keywords: "mental health" and "professional competence", in the databases SciELO, LILACS, CINAHL, PubMed, Scopus and Cochrane, in the period of 2003 to 2011. 215 studies were identified, of these, six followed the inclusion criteria. RESULTS: Based on the National Panel for Psychiatric Mental Health NP Competencies, the competencies were identified on the evaluated studies: Monitoring and ensuring the quality of health care practice, management of patient health/illness status, cultural competence, managing and negotiating health care delivery systems, the nurse practitioner-patient relationship. CONCLUSION: The studies analysis evidenced the need for education and training so that nurses may develop the competencies of health promotion in diverse psychiatric care and mental health contexts, in order to broaden knowledge and skills.

OBJECTIVE: To describe the development of a data-driven policy platform for psychiatric nurses roles and outcomes to alleviate the current mental health crisis in the United States. METHOD: Drawing on census data, statistical reports, and analysis of the current psychiatric mental health nursing (PMHN) workforce, a data-driven policy platform is designed to recruit, train, and prepare psychiatric nurses for addressing the nation’s mental health crises. RESULTS: As noted by the Institute of Medicine’s 2010 & 2016 reports on the future of nursing, the largest available health care workforce is not being used effectively, particularly to address the nation’s mental health care needs. The development of a data-driven platform provides direction for psychiatric nurses in developing the workforce to meet the national mental health crisis. CONCLUSIONS: From education through practice and research, psychiatric-mental health nursing must build and share a data-driven, relationship-to-care platform emphasizing how PMHN care affects patient outcomes. Using a data-based platform to grow supportive public opinion, psychiatric mental health nursing can build a workforce to modify national accreditation standards and laws supporting data-driven PMHN care. The specialty profession must also seek to modify the nursing profession’s attitude toward embracing data-driven platform of care relationships to psychiatric mental health outcomes.

This interview is with Jane A. Ryan, RN, MN, CNAA, immediate past president of the American Psychiatric Nurses Association. She began her nursing career in 1959 and spent 27 years in psychiatric nursing at the University of California at Los Angeles (UCLA) Medical Center Neuropsychiatric Institute, and eventually was responsible for nursing systems. Now she consults with the U.S. Justice Department on psychiatric nursing in state psychiatrist hospitals. Lisa Legge, managing editor of Creative Nursing Journal, interviewed Ms. Ryan.

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing suicide, 100% of participants reported that they were comfortable asking direct and open-ended questions regarding suicide. Nine of the 10 respondents assessed their knowledge and skills as sufficient to engage effectively with patients contemplating suicide, which indicates that psychiatric nurse practitioners may overestimate their ability to identify and treat persons with suicidal ideation. Healthcare providers in all specialties can benefit from this project by improving competencies and guiding continuing education to bridge any gaps in knowledge for adequately assessing suicide. Further education is needed for psychiatric nurse practitioners to promote positive social change for suicidal persons, their families, and their communities.

Magister Curationis - MCur
Professional nurses, with additional training in mental health, report attitudes and perceptions of mental health nursing that are more positive, whilst those with less training report more negative attitudes and perceptions to mental health nursing. The primary aim of this research study was to describe the attitudes and perceptions of professional nurses towards the mentally ill in a psychiatric hospital in the Cape Metropole. The objectives of the study were: to explore the attitudes and perceptions of professional nurses towards the mentally ill; to identify common factors that influence the professional nurses’ attitudes and perceptions towards the mentally ill; to compare the attitudes and perceptions of professional nurses who have completed the Regulation 425, Regulation 808 and Regulation 212 training in mental health nursing towards the mentally ill. A quantitative, exploratory, descriptive design was employed and cross-sectional survey was carried out. Participants comprised all permanent professional nurses (n=60) at a governmental Associated Psychiatric Hospital in the Cape Metropole. Participants completed a demographic questionnaire and two self-report questionnaires, measuring attitudes to and perceptions of mental health problems. Nurses with a diploma report significantly higher role competency than those nurses with a degree. The ethnicity of nurses played a role in the stereotyping of the mentally ill. No significant differences were evident between those professional nurses who had completed the advanced mental health course and those whom had not. However, the combined effects of learning the appropriate course and experience in the practical field of the mentally ill are necessary for the task of impacting positively on the attitudes of the nurses towards the mentally ill.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.

Psychiatric illnesses can sometimes lead to behavioral outbursts that need to be addressed quickly to deescalate potentially explosive situations. Nurses are in a unique position to respond to such outbursts by calling for a rapid response team. Nurses who are part of the rapid response team should be well-informed of their roles and responsibilities in managing aggressive and violent behavior. The purpose of this project was to explore RN's and LPN's knowledge and perceptions of a rapid response team in a psychiatric facility. The Iowa model of evidence-based practice provided the framework to integrate theory into practice to improve care. A quantitative descriptive design was implemented with a convenience sample of nurses using a 4-part questionnaire. Of the 64 surveys distributed on 5 wards, 59 were completed for a response rate of 92%. Descriptive statistics were used to analyze nurse responses to demographic data and background data. A Chi-square statistic was calculated to investigate the relationship between RN and LPN responses to the Likert Agreement Scale; no significant difference in responses was found. Open-ended questions allowed nurses to comment on their role and position during a code. The comments were sorted into categories of reoccurring themes. Results suggested that nurses need to understand signs of behavioral escalation and strategies to deescalate a potentially volatile patient. Nurses commented that knowledge during a code, reasons for calling a code, and good communication skills are essential in code situations. Findings from this project can benefit nurses who work psychiatric emergencies by underscoring the need to development of psychiatric rapid response teams and to update current standards of inpatient care.

Magister Curationis - MCur
Research reported that it is very challenging for mental health care users to quit smoking and the risk of relapsing after quitting is high. However, tobacco dependence treatment is possible and potentially lifesaving for people. The delivery of tobacco dependence treatment by nurses is influenced by a variety of factors, including lack of knowledge and skills, limited professional leadership, and smoking within the profession. There is a strong link between mental illness and smoking-related diseases, including cancer, respiratory diseases and heart diseases that are linked with depression. There is a high incidence of cancer in people with bipolar mood disorder and schizophrenia due to smoking. In spite of this, smoking is regarded as part of the culture of psychiatric institutions and tobacco is seen as “necessary self- medication for the mentally ill”.

Psychiatric recovery-oriented care is aimed at improving patients' quality of care while increasing the efficiency of health care providers. Despite the benefits of recovery-oriented care, this approach is often lacking in health care settings. The purpose of this project was to implement a recovery-oriented training on psychoeducational groups on a 26-bed psychiatric unit. The Iowa model of evidence-based practice and adult learning theory provided the framework for the project. The objectives were to (a) assess training needs, (b) evaluate barriers for recovery-oriented psychiatric nursing, (c) develop strategies to address barriers, (d) train staff in psychoeducational approaches, and (e) evaluate the training effectiveness. Information on knowledge, confidence, training needs and barriers in conducting psychoeducational groups was collected from 24 nursing staff. Open-ended interviews were conducted to ascertain staff perceptions on training needs and barriers. Interview responses were analyzed for common themes. Staff expressed a need for training and perceived a lack of knowledge and time as barriers in conducting psychoeducational groups. A questionnaire was used to collect data on knowledge (8 items) and confidence (5 items) pre and post training. Pre/post responses were analyzed using descriptive statistics and paired sample t test. Results showed a significant increase in staff knowledge, but not confidence in conducting psychoeducational groups from pre to posttest. Results may be used by psychiatric nursing staff to improve the quality of recovery-oriented care, patient satisfaction, and efficiency of the care delivery system. Recovery-oriented psychiatric care implicitly changes social norms by helping individuals with mental health problems integrate back into their communities.

Workforce shortages are a major concern of health care and the creation of a positive workplace is central to the attraction and retaining of employees where employees are motivated to be loyal towards their employer by a positive work experience rather than by financial rewards (Manion, 2009:XIII). This positive work experience can include the providing of workplace support that is tailored to the specific experiences and wishes of psychiatric nurses working at a private mental health care setting. Work demands encountered by psychiatric nurses can vary from personal stresses related to the interpersonal nature of working with the challenging behaviour of mental health care users, to environmental stresses related to an environment reflecting inadequate workplace support. Stuart and Laraia (2005:11) described the role of the psychiatric nurse in any mental health care setting as depending on certain factors in the organisation. This include the philosophy, goals, prevailing understanding of mental health, the needs of the mental health care users, number of available personnel, communication structure, understanding of their individual roles, available resources and the presence of effective nurse mentoring. As a professional psychiatric nurse, I identified the need for effective workplace support to psychiatric nurses working in a private mental health care setting by observing signs of burnout in psychiatric nurses and by listening to employees verbalising their need for workplace support. The purpose of the research was to conduct an Appreciative Inquiry in order to generate an in-depth understanding of the experiences and wishes of psychiatric nurses regarding workplace support in a private mental health care setting. The objectives of the research were to explore and describe the experiences of psychiatric nurses regarding workplace support, to explore and describe the wishes of psychiatric nurses regarding workplace support in a private mental health care setting and to propose recommendations regarding workplace support. Proposed recommendations will have reference to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice, in order to facilitate more effective means to provide workplace support and to facilitate the promotion of the mental health of psychiatric nurses. I decided to use an Appreciative Inquiry framework in order to explore the experiences and wishes of psychiatric nurses regarding workplace support. The importance of Appreciative Inquiry lies in the appreciation of the behaviour and the responses of individuals instead of focusing on their problems. Appreciative Inquiry identifies that which is positive in any system and connects to or builds on it in order to “heighten energy, vision and action for change” (Cooperrider, Whitney&Stavros, 2008:XV). The meta-theoretical perspective that guided this researcher was the Theory for Health Promotion in Nursing. The essential purpose of this theory is health promotion for an individual, group, family or community (University of Johannesburg, 2009:4). The individual is in interaction with the environment, which consists of an internal and external environment. The internal environment comprises the body, mind and spirit dimensions of the individual. The external environment comprises the physical, social and spiritual dimensions of the individual. The interactions of these dimensions in the environment of the individual influence the health status of the individual on a continuum (University of Johannesburg, 2009:5). The experiences and wishes regarding the providing of workplace support pertaining to the internal and external environments of the psychiatric nurse were examined in order to facilitate the promotion of the mental health of the psychiatric nurse. The theoretical and methodological perspective that guided this research was Appreciative Inquiry. Appreciative Inquiry uses a process known as the 4-D cycle, which is the process that is employed to facilitate change or to generate the power of Appreciative Inquiry (Whitney&Trosten-Bloom, 2003:6). For this research on workplace support, I employed the first two phases of Appreciative Inquiry, namely the discovery phase and the dream phase as part of the data collection. The discovery phase involves the appreciation or discovering of that which is positive, life giving or effective and the dream phase involves the imagining of new possibilities. As a unique paradigm, Appreciative Inquiry questions traditional approaches to problem solving by accepting organisational challenges using an affirmative approach. An affirmative approach includes an appreciation of the positive by focussing on successes, strengths and potential (Cooperrider, Whitney&Stavros, 2008:433). Appreciative Inquiry views organisations as an individual centre of immense imagination and possibilities, intended to function as solutions (Cooperrider, Whitney&Stavros, 2008:16-17). I used a qualitative design, which was exploratory, descriptive and contextual. I integrated an Appreciative Inquiry approach into this design. I used purposeful sampling, which Polit and Beck (2007:763) define as a sampling method where participants are selected based on who will be the most informative regarding the topic of the research, namely workplace support in this research. The data collection methods used was naïve sketches, small core group inquiries and individual interviews with members of nursing management. The small core group inquiries included written answers on the interview schedule from the one-on-one interviews, transcribed feedback from the discussion phase, the positive core map, the nominal group technique, field notes and reflective interviews. The small core group inquiries were structured around one-on-one interviews that participants conducted with each other in groups of two, using an interview schedule. During the data analysis phase, I used two different techniques in order to analyse the available data, namely the nominal group technique and open coding. I used a tree as symbol for workplace support at this mental health care setting. The roots of the tree symbolised the willingness of management to provide workplace support to their employees. The trunk of the tree symbolised the holistic approach to workplace support. The branches of the tree symbolised the identified themes. I represented the discovery phase categories as the green leaves of the tree. I represented the dream phase categories as pink buds. I proposed recommendations relating to psychiatric nursing research, psychiatric nursing education, psychiatric nursing management and psychiatric nursing practice. The aim of these recommendations was to facilitate more effective means of providing workplace support, from a holistic perspective, in order to facilitate the promotion of mental health of psychiatric nurses working at this mental health care setting.
AFRIKAANS : Tekorte in die arbeidsmag is ʼn bron van groot besorgdheid vir gesondheidsorg, en die skep van ʼn positiewe werkplek is sentraal tot die aantrekking en behoud van werknemers in gevalle waar werknemers deur middel van ʼn positiewe werkservaring, eerder as ʼn finansiële vergoeding, gemotiveer word om lojaal teenoor hul werkgewer te wees (Manion, 2009:XIII). Hierdie positiewe werkservaring kan die verskaffing van werkplekondersteuning, wat op die spesifieke ervarings en wense van psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, geskoei is, insluit. Werkseise wat psigiatriese verpleegspraktisyns teëkom kan wissel van persoonlike stres verwant aan die interpersoonlike aard van om met die uitdagende gedrag van geestesgesondheidsgebruikers te werk, tot omgewingstres verwant aan ʼn omgewing wat ontoereikende werkplekondersteuning bied. Stuart en Laraia (2005:11) beskryf die rol van ʼn psigiatriese verpleegspraktisyn in enige geestesgesondheidsomgewing as afhanklik van sekere faktore in die organisasie. Dit sluit die filosofie, doelwitte, heersende begrip van geestesgesondheid, die behoeftes van die geestesgesondheidsgebruikers, die aantal beskikbare personeel, die kommunikasiestruktuur, begrip vir die individuele rolle, beskikbare hulpbronne en die teenwoordigheid van effektiewe verpleegsbegeleiding in. As ʼn professionele psigiatriese verpleegspraktisyn het ek die behoefte aan effektiewe werkplekondersteuning vir psigiatriese verpleegspraktisyns wat in ʼn privaat geestesgesondheidsomgewing werk, waargeneem toe ek na tekens van uitbranding by die psigiatriese verpleegspraktisyns opgelet het, en na die werknemers geluister het wanneer hulle hul behoefte aan werkplekondersteuning verwoord het. Die doel van hierdie studie was om ʼn Waarderende Ondersoek te loods ten einde ʼn indiepte begrip van die ondervindings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te bewerkstellig. Die doelstellings van die studie was om die ondervindings van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te beskryf ten einde die wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning in ʼn privaat geestesgesondheidsomgewing te ondersoek en te beskryf en om aanbevelings te maak met betrekking tot werkplekondersteuning. Voorgestelde aanbevelings verwys na psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegs-bestuur en psigiatriese verpleegspraktyk, om meer effektiewe metodes te fasiliteer ten einde werkplekondersteuning te voorsien en die geestesgesondheid van psigiatriese verpleegspraktisyns te bevorder. Ek het besluit om ʼn Waarderende Ondersoekraamwerk te gebruik te einde die ervarings en wense van psigiatriese verpleegspraktisyns met betrekking tot werkplekondersteuning te ondersoek. Die belangrikheid van ʼn Waarderende Ondersoek lê in die waardering van die gedrag en terugvoer van individue, in plaas van om op hul probleme te fokus. Waarderende Ondersoek identifiseer dit wat positief is in enige stelsel en sluit daarby aan of bou daarop om energie, visie en aksie vir verandering te verhoog (Cooperrider, Whitney&Stavros, 2008:XV). Die meta-teoretiese perspektief wat die navorser gelei het, was die Teorie vir Gesondheidsbevordering in Verpleging. Die hoofdoel van hierdie teorie is die gesondheidsbevordering van ʼn individu, groep, gesin of gemeenskap (Universiteit van Johannesburg, 2009:4). Die individu is in interaksie met die omgewing, wat uit ʼn interne en eksterne omgewing bestaan. Die interne omgewing sluit die liggaamlike, verstandelike en geestelike dimensies van die individu in. Die eksterne omgewing sluit die fisiese, sosiale en geestelike dimensies van die individu in. Die interaksies van hierdie dimensies in ʼn individu se omgewing beïnvloed die gesondheidstoestand van die individu op ʼn kontinuum (Universiteit van Johannesburg, 2009:5). Die ervarings en wense met betrekking tot die voorsiening van werkplekondersteuning wat met die interne en eksterne omgewings van die psigiatriese verpleegpraktisyn verband hou, is ondersoek ten einde die bevordering van die geestesgesondheid van die psigiatriese verpleegpraktisyn te fasiliteer. Die teoretiese en metodologiese perspektief wat hierdie studie gelei het, was Waarderende Ondersoek. Waarderende Ondersoek gebruik ʼn proses wat as die 4-D siklus bekend staan. Hierdie proses word gebruik om verandering te fasiliteer of om die krag van Waarderende Ondersoek te verseker (Whitney&Trosten-Bloom, 2003:6). Vir hierdie navorsing oor werkplekondersteuning het ek die eerste twee fases van Waarderende Ondersoek, naamlik die ontdekkingsfase en die droomfase, as deel van dataversameling gebruik. Die ontdekkingsfase sluit die waardering of ontdekking van wat positief, lewegewend of effektief is, in, en die droomfase sluit die verbeelding van nuwe moontlikhede in. As ʼn unieke paradigma, bevraagteken Waarderende Ondersoek tradisionele benaderings tot probleemoplossing deur organisatoriese uitdagings met ʼn regstellende ingesteldheid te benader. ʼn Regstellende benadering sluit die waardering van die positiewe in, deur op suksesse, sterkpunte en potensiaal te fokus (Cooperrider, Whitney&Stavros, 2008:433). Waarderende Ondersoek sien organisasies as ʼn individuele sentrum met onmeetlike verbeelding en moontlikhede, met die voorneme om met oplossings vorendag te kom (Cooperrider, Whitney&Stavros, 2008:16-17). Ek het ʼn kwalitatiewe ontwerp, wat verduidelikend, beskrywend en kontekstueel van aard was, gebruik. Ek het ʼn Waarderende Ondersoekbenadering met hierdie ontwerp geïntegreer. Ek het doelbewuste steekproefneming, wat Polit en Beck (2007:763) definieer as ʼn steekproefnemingsmetode waar deelnemers gekies word op grond van wie die meeste inligting oor die tema van die navorsing sal verskaf, wat in hierdie navorsing werkplekondersteuning is. Die dataversamelingsmetodes wat ek gebruik het, was naïewe sketse, klein kerngroep-ondersoeke en individuele onderhoude met lede van die verpleegsbestuur. Die klein kerngroep-ondersoeke het geskrewe antwoorde op die onderhoudskedule van die een-tot-een onderhoude, getranskribeerde terugvoer van die besprekingsfase, die positiewe kernkaart, die nominale groeptegniek, veldnotas en reflektiewe onderhoude ingesluit. Die klein kerngroep-ondersoeke was gegrond op een-toteen onderhoude wat die deelnemers met mekaar, in groepe van twee, gevoer het, deur van ʼn onderhoudskedule gebruik te maak. Tydens die dataontledingsfase het ek twee verskillende tegnieke gebruik om die beskikbare data te ontleed, naamlik die nominale groeptegniek en oopkodering. Ek het ʼn boom as simbool vir werkplekondersteuning in hierdie geestesgesondheidsomgewing gebruik. Die wortels van die boom het die bestuur se vrywilligheid om werkplekondersteuning aan hul werknemers te bied, gesimboliseer. Die stam van die boom het die holistiese benadering tot werkplekondersteuning gesimboliseer. Die takke van die boom het die geïdentifiseerde temas gesimboliseer. Die kategorieë van die ontdekkingsfase is deur die groen blare voorgestel, en die kategorieë van die droomfase deur pienk botsels. Ek het aanbevelings gemaak met betrekking tot die psigiatriese verpleegsnavorsing, psigiatriese verpleegsopleiding, psigiatriese verpleegsbestuur en psigiatriese verpleegspraktyk. Die doel van hierdie aanbevelings is om meer effektiewe metodes vir die verskaffing van werkplekondersteuning, uit ʼn holistiese perspektief, te fasiliteer, ten einde die geestesgesondheidsbevordering van psigiatriese verpleegpraktisyns wat in hierdie geestesgesondheidsomgewing werk, te fasiliteer.
Dissertation (MCur)--University of Pretoria, 2011.
Nursing Science
unrestricted

"The present study was conducted to explore the perception and views of primary care staff about Depression related Stigma and Discrimination. The Basic Qualitative Research Design was employed and an In-Depth Semi-Structured Discussion Guide consisted of 7 question was developed on the domains of Pryor and Reeder Model of Stigma and Discrimination such as Self-Stigma, Stigma by Association, Structural Stigma and Institutional Stigma, to investigate the phenomenon. Initially, Field Test and Pilot study were conducted to evaluate the relevance and effectiveness of Focus Group Discussion Guide in relation to phenomena under investigation. The suggestions were incorporated in the final Discussion Guide and Focus Group was employed as a data collection measure for the conduction of the main study. A purposive sampling was employed to selected a sample of Primary Care Staff (Psychiatrists, Medical Officers, Clinical Psychologists and Psychiatric Nurses) to elicit the meaningful information. The participants were recruited from the Department of Psychiatry of Pakistan Medical and Dental Council (PMDC) recognized Private and Public Sector hospitals of Lahore, having experience of 3 years or more in dealing with patients diagnosed with Depression. However, for Medical Officers, the experience was restricted to less than one year based on their rotation. To maintain equal voices in the Focus Group, 12 participants were approached (3 Psychiatrist, 3 Clinical Psychologists, 3 Medical Officers and 3 Psychiatric Nurses) but total 8 participants (2 Psychiatrists, 2 Medical Officers, 3 Clinical Psychologists And 1 Psychiatric Nurse) participated in the Focus Group. The Focus Group was conducted with the help of Assistant Moderator, for an approximate duration of 90 minutes at the setting according to the ease of the participants. Further, it was audio recorded and transcribed for the analysis. The Braun and Clarke Reflexive Thematic Analysis was diligently followed through a series of six steps such as Familiarization with the Data, Coding, Generating Initial Themes, Reviewing Themes, Defining and Naming Themes. The findings highlighted two main themes i.e., Determining Factors of Mental Health Disparity and Improving Treatment Regimen: Making Consultancy Meaningful. The first theme was centered upon three subthemes such as Lack of Mental Health Literacy, Detached Attachment and Components of Stigma and Discrimination. The second theme included Establishing Contact and Providing Psychoeducation as a subtheme. The results manifested the need for awareness-based Stigma reduction intervention for Primary Care Staff aims to provide training in Psychoeducation and normalization to reduce Depression related Stigma and Discrimination among patients diagnosed with Depression."

Abstract: Multiple studies have found that psychiatric disorders, like mood disorders and substance use disorders, are highly comorbid among adults with either disorder. Integrated treatment refers to the treatment of two or more conditions and the use of multiple therapies such as the combination of psychotherapy and pharmacotherapy. Integrated therapy for comorbidity per numerous studies has consistently been superior to the treatment of individual disorders separately. The purpose of this QI project was to identify the effectiveness of Cognitive Behavioral Therapy (CBT) instead of current treatment as usual for treating Substance Use Disorder (SUD) or mental health diagnosis independently. It is a retrospective chart review. The review examines CBT's efficacy for engaging individuals with co-occurring mood and substance u se disorders in treatment by enhancing adherence and preventing disengagement and relapse. Methods: Forty adults aged 26-55 with a DSM-IV diagnosis of a mood disorder of Major Depressive Disorder and/or anxiety and concurrent substance use disorder (at least weekly use in the past month). Participants received 12 sessions of individual integrated CBT treatment delivered with case management over a 12-week period. Results: The intervention was associated with significant improvements in mood disorder, substance use, and coping skills at 4, 8, and 12 weeks post-treatment. Conclusions: These results provide some evidence for the effectiveness of the integrated CBT intervention in individuals with co-occurring disorders. Of note, all psychotherapies are efficacious; however, it would be more advantageous to develop a standardized CBT that identifies variables that facilitate treatment outcomes specifically to comorbid disorders of substance use and mood disorders. It is concluded that there is potentially more to be gained from further studies using randomized controlled designs to determine its efficacy.

Description The goal of the study was to assess mental health, socio-psychological and behavioural aspects in the representative sample of Latvian general population in online survey, and to identify vulnerable groups during COVID-19 pandemic and develop future recommendations. The study was carried out from 6 to 27 July 2020 and was attributable to the period of emergency state from 11 March to 10 June 2020. The protocol included demographic data and also data pertaining to general health, previous self-reported psychiatric history, symptoms of anxiety, clinically significant depression and suicidality, as well as a quality of sleep, sex, family relationships, finance, eating and exercising and religion/spirituality, and their changes during the pandemic. The Center for Epidemiologic Studies Depression scale was used to determine the presence of distress or depression, the Risk Assessment of Suicidality Scale was used to assess suicidal behaviour, current symptoms of anxiety were assessed by the State-Trait Anxiety Inventory form Y. (2021-02-04) Subject Medicine, Health and Life Sciences Keyword: COVID19, pandemic, depression, anxiety, suicidality, mental health, Latvia

Background. Untreated maternal mental health disorders can have devastating sequelae for the mother and child. For women who are currently or planning to become pregnant or are breastfeeding, a critical question is whether the benefits of treating psychiatric illness with pharmacologic interventions outweigh the harms for mother and child. Methods. We conducted a systematic review to assess the benefits and harms of pharmacologic interventions compared with placebo, no treatment, or other pharmacologic interventions for pregnant and postpartum women with mental health disorders. We searched four databases and other sources for evidence available from inception through June 5, 2020 and surveilled the literature through March 2, 2021; dually screened the results; and analyzed eligible studies. We included studies of pregnant, postpartum, or reproductive-age women with a new or preexisting diagnosis of a mental health disorder treated with pharmacotherapy; we excluded psychotherapy. Eligible comparators included women with the disorder but no pharmacotherapy or women who discontinued the pharmacotherapy before pregnancy. Results. A total of 164 studies (168 articles) met eligibility criteria. Brexanolone for depression onset in the third trimester or in the postpartum period probably improves depressive symptoms at 30 days (least square mean difference in the Hamilton Rating Scale for Depression, -2.6; p=0.02; N=209) when compared with placebo. Sertraline for postpartum depression may improve response (calculated relative risk [RR], 2.24; 95% confidence interval [CI], 0.95 to 5.24; N=36), remission (calculated RR, 2.51; 95% CI, 0.94 to 6.70; N=36), and depressive symptoms (p-values ranging from 0.01 to 0.05) when compared with placebo. Discontinuing use of mood stabilizers during pregnancy may increase recurrence (adjusted hazard ratio [AHR], 2.2; 95% CI, 1.2 to 4.2; N=89) and reduce time to recurrence of mood disorders (2 vs. 28 weeks, AHR, 12.1; 95% CI, 1.6 to 91; N=26) for bipolar disorder when compared with continued use. Brexanolone for depression onset in the third trimester or in the postpartum period may increase the risk of sedation or somnolence, leading to dose interruption or reduction when compared with placebo (5% vs. 0%). More than 95 percent of studies reporting on harms were observational in design and unable to fully account for confounding. These studies suggested some associations between benzodiazepine exposure before conception and ectopic pregnancy; between specific antidepressants during pregnancy and adverse maternal outcomes such as postpartum hemorrhage, preeclampsia, and spontaneous abortion, and child outcomes such as respiratory issues, low Apgar scores, persistent pulmonary hypertension of the newborn, depression in children, and autism spectrum disorder; between quetiapine or olanzapine and gestational diabetes; and between benzodiazepine and neonatal intensive care admissions. Causality cannot be inferred from these studies. We found insufficient evidence on benefits and harms from comparative effectiveness studies, with one exception: one study suggested a higher risk of overall congenital anomalies (adjusted RR [ARR], 1.85; 95% CI, 1.23 to 2.78; N=2,608) and cardiac anomalies (ARR, 2.25; 95% CI, 1.17 to 4.34; N=2,608) for lithium compared with lamotrigine during first- trimester exposure. Conclusions. Few studies have been conducted in pregnant and postpartum women on the benefits of pharmacotherapy; many studies report on harms but are of low quality. The limited evidence available is consistent with some benefit, and some studies suggested increased adverse events. However, because these studies could not rule out underlying disease severity as the cause of the association, the causal link between the exposure and adverse events is unclear. Patients and clinicians need to make an informed, collaborative decision on treatment choices.

Background: Major depressive disorder is a common mental disorder. Many pressing questions regarding depression treatment and outcomes exist, and new, efficient research approaches are necessary to address them. The primary objective of this project is to demonstrate the feasibility and value of capturing the harmonized depression outcome measures in the clinical workflow and submitting these data to different registries. Secondary objectives include demonstrating the feasibility of using these data for patient-centered outcomes research and developing a toolkit to support registries interested in sharing data with external researchers. Methods: The harmonized outcome measures for depression were developed through a multi-stakeholder, consensus-based process supported by AHRQ. For this implementation effort, the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, each recruited 10 pilot sites from existing registry sites, added the harmonized measures to the registry platform, and submitted the project for institutional review board review Results: The process of preparing each registry to calculate the harmonized measures produced three major findings. First, some clarifications were necessary to make the harmonized definitions operational. Second, some data necessary for the measures are not routinely captured in structured form (e.g., PHQ-9 item 9, adverse events, suicide ideation and behavior, and mortality data). Finally, capture of the PHQ-9 requires operational and technical modifications. The next phase of this project will focus collection of the baseline and follow-up PHQ-9s, as well as other supporting clinical documentation. In parallel to the data collection process, the project team will examine the feasibility of using natural language processing to extract information on PHQ-9 scores, adverse events, and suicidal behaviors from unstructured data. Conclusion: This pilot project represents the first practical implementation of the harmonized outcome measures for depression. Initial results indicate that it is feasible to calculate the measures within the two patient registries, although some challenges were encountered related to the harmonized definition specifications, the availability of the necessary data, and the clinical workflow for collecting the PHQ-9. The ongoing data collection period, combined with an evaluation of the utility of natural language processing for these measures, will produce more information about the practical challenges, value, and burden of using the harmonized measures in the primary care and mental health setting. These findings will be useful to inform future implementations of the harmonized depression outcome measures.

The autism community identified mental health as their top research priority in 2016.¹ Autistic children and adolescents are more likely than their general population counterparts to have psychiatric disorders.² For bipolar disorder, rates of 7% are seen in autistic children and adolescents versus 1% in their general population peers.