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Accessible summary: What is known on the subject?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences.AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities.However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice.Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process.More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation.The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Introduction: Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim: To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method: We cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results: Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. Discussion: Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice: The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate the mental health status, stressors and self‐adjustment of nurses in isolation wards at different periods in Wuhan, China. Background: Mental health issues easily occurred among the frontline medical workers of a major epidemic. However, the stressors and psychological adjustments experienced by nurses have not been well described. This is crucial to improving clinical quality and nursing safety and ensuring nurses' physical and psychological health. Methods: We performed a cross‐sectional prospective study using the Self Reporting Questionnaire‐20, stressor and self‐adjustment questionnaire administered to frontline nurses in Wuhan at two time points: after they had worked in isolation wards for 7–10 days (T1) and 2 months (T2). This paper complies with the STROBE reporting guideline for cross‐sectional studies. Results: T1 has 92 respondents, and T2 has 86. The positive rates of mental health problems were 26.09% and 9.30%, respectively, showing significantly different in the two periods. The main factors influenced mental health were self‐perceived stress and only child status. The most common stressors were as follows: a large infected population, high infectivity; concerned about family's health status; high mortality if not treated in time (T1); and long duration of the epidemic, separate from family for a long time (T2). In terms of self‐adjustment, 97.83%(T1)/88.04%(T2) of nurses thought it was necessary, but 9(T1) /5(T2) chose to avoid addressing it, and 8(T1) /5(T2) utilised a professional psychological counselling hotline. Conclusions: Mental health problems among frontline nurses fighting COVID‐19 need special attention, so administrators should offer timely counselling and strengthen effective psychosocial support to improve their mental resilience. Relevance to clinical practice: This study surveyed the mental problems and self‐adjustment status among nurses working Wuhan during the outbreak of COVID‐19, to provide administrators with a scientific basis to effectively intervene. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Adolescents who partake in one health risk behaviour (HRB) easily adopt other HRBs, simultaneously or subsequently.Multiple HRBs might threaten adolescents' future health in adulthood.Adolescents with psychological problems have higher rates of smoking, alcohol use, early sexual initiation and activity, and illicit substance use compared with others. What does this paper add to existing knowledge?: A considerable number of Korean adolescents with mental health problems were engaged in multiple HRBs. For those with mental health problems, more than half of the Korean adolescents with multiple HRBs tended to use alcohol and cigarettes concurrently.Korean adolescents who felt depressed and had suicidal ideation were more likely to engage in a greater number of HRBs.Substance abuse is the most prevalent problem that is combined with other HRBs among those with depression and suicidal ideation compared to those who exhibited other HRBs. What are the implications for practice?: When mental health nurses working in schools and community centres for mental health identify Korean adolescents with significant depression and suicide ideation levels, they should also assess adolescents' engagement in multiple HRBs.Population‐based campaigns and policy changes that emphasize both psychological health and risky behaviour reduction among adolescents should be provided simultaneously to students and school nurses. Introduction: There is limited understanding about whether poor mental health is associated with certain combinations of multiple health risk behaviours (HRBs) such as smoking, drinking, early sexual activity and substance abuse. Aim: To determine the prevalence of multiple HRBs and to identify associations between poor mental health and multiple HRBs as the number of HRBs increases. Methods: This cross‐sectional study was conducted using the 2016 Korea Youth Risk Behavior Web‐based Survey (N = 65,528). Descriptive statistics and multinomial logistic regression analyses were conducted using the complex sample data. Results: Overall, 28.6% and 13.9% of Korean adolescents were involved in one or multiple HRBs, respectively. Adolescents who were depressed (OR = 1.43–4.47, 95% CI = 1.37–1.49 to 3.23–6.20) and/or who had suicidal ideation (OR = 1.33–3.19, 95% CI = 1.25–1.42 to 2.25–4.51) were more likely to engage in multiple HRBs. Discussion: A considerable numbers of Korean adolescents are engaged in multiple HRBs. When adolescents self‐reported depression and suicidal ideation, they were more likely to engage in a greater number of HRBs than single HRB. Implications for practice: Tailored interventions to decrease multiple HRBs should be designed and provided by considering adolescents' mental health status and needs. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Participatory photography has been reported to have therapeutic benefits for participants, such as a sense of empowerment and increased self‐knowledge.No known review has examined the potential of participatory photography as a therapeutic intervention in people with mental health problems. What the paper adds to existing knowledge?: Participatory photography can have many therapeutic benefits for people with mental health problems. It can be used to work through problematic issues, can promote a sense of empowerment and strengthen therapeutic relationships.The most significant potential drawback of the process is the ethical issues that may arise with taking photographs of identifiable people. What are the implications for practice?: Participatory photography can be a helpful therapeutic intervention for some adults with mental health problems, though not all.Further research is required for the effectiveness of this intervention before it can be considered as evidence‐based. Introduction: Participatory photography (PP) has been reported to have therapeutic benefits for its participants, such as empowerment and critical reflection. No known review has examined this potential exclusively in people with mental health problems. Aim: To identify what therapeutic benefits and limitation adults with mental health problems have experienced through PP. Method: Six academic databases were systematically searched. Eleven articles met inclusion/exclusion criteria and were of medium to high quality. Themes were extracted using thematic analysis. Results: Seven themes were identified: empowerment, mental processing, enhanced therapeutic relationships, peer support, creative expression, sense of achievement and enjoyment, and limitations. Discussion: The limited evidence base prevents firm conclusions. PP projects higher in personal relevance and intensity were linked with the greater therapeutic benefits. Most identified themes are supported by the wider literature on PP. The limitations indicate that PP is not suitable for all and requires adaptation for individuals and the potential seriousness of ethical issues. Implications for practice: Participatory photography can be a helpful therapeutic intervention for some adults with mental health problems, though not all. Further research is required to develop the limited evidence base, particularly quantitative research that would enable comparisons to be made with other interventions. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Research findings indicate the percentage of knowledge‐related errors in medicines management is high, accounting for approximately 75% of all errors, with insufficient knowledge levels one of the most significant contributors of medication errors. Patients should be able to trust nurses to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. However, without knowledge of pharmacology, it is impossible for nurses to be able to provide adequate advice. What the paper adds to the existing knowledge?: This study has examined an area that had not yet been systematically examined previously, which draws together previous research findings on mental health nurses' knowledge of adverse events, including side effects and medication errors, related to antipsychotic medication within NHS inpatient settings. What are the implications for practice?: A recent study has found that almost three‐quarters (73%) of patients taking antipsychotic medication reported side effects to some degree. This high number of people experiencing antipsychotic medication side effects is likely to compromise care, especially in situations where nurses have inadequate knowledge of side effects and are unable to provide effective advice to patients.The findings from this study allow the mental health nursing profession an opportunity to reflect on the best means to increase knowledge and increase patient safety awareness and benefits for mental health service users. Introduction: Antipsychotic medications play a significant role in the treatment and recovery of people with several psychiatric disorders. However, research findings indicate mental health nurses are insufficiently knowledgeable about antipsychotic medication side effects. Aim: To assess practising mental health nurses' knowledge of antipsychotic medication side effects using a Multiple‐Choice Questionnaire (MCQ) across National Health Service (NHS) Trusts in England. Hypothesis: Knowledge of antipsychotic medication side effects amongst registered mental health nurses is related to their academic qualification, clinical banding and length of experience. Method: A national survey of registered mental health nurses was carried out using an online questionnaire which was disseminated by Research and Development departments. Results: A total of 504 questionnaires were returned, 245 of which had full data and further analysed. The mean score for the sample was 14.4 and only 21 participants attained a mark of >80%. Implications for Practice: Two out of three of our hypotheses (that length of experience and clinical banding are directly related to knowledge of antipsychotic medication side effects) were supported. Our study found many nurses have a suboptimal working knowledge of antipsychotic medication side effects which has the potential to compromise care. Strategies need to be put in place to enhance pharmacology knowledge. [ABSTRACT FROM AUTHOR]

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Aim and objectives: To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices. Background: Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self‐determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities. Methods: This study employed a phenomenological research design, involving individual semi‐structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to. Results: Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. "I definitely look at people with mental health conditions in a different light." At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change. Conclusions: Recovery Camp may have facilitated the transfer of knowledge that is more person‐centred among nursing students, consequently impacting their current nursing practices. Relevance to clinical practice: Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? Primary care and, in particular, general practice ( GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems., What this paper adds to existing knowledge? Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service ( PCLS), developed in 2011 in inner London., The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria., What are the implications for practice? This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary., Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness., Abstract Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse ( PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. [ABSTRACT FROM AUTHOR]

Prior literature examining the antecedents of employee affect has largely ignored subtle affective influences in the workplace and their impact on employees' affective experiences and behaviors. A substantial body of evidence from basic psychology research suggests that individuals' affect can be influenced by minimal stimulus input. The primary objective of this research is to take an initial step towards understanding the 'real-world' impact of subtle affective stimuli in the workplace. Specifically, in a field experiment with a within-subjects design, we collected data from 68 sales representatives and examined the effect of a subtle affective stimulus (i.e., a black-and-white picture of a woman smiling printed on the backdrop of paper-pencil surveys) on employees' affect, well-being, and performance. Results showed that the smiling picture significantly enhanced participants' positive affect, which in turn influenced employees' extra-role performance and emotional exhaustion. The smiling picture also indirectly influenced employees' in-role performance and emotional exhaustion via negative affect. Theoretical and practical implications of these findings are discussed at the end of the paper. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on this subject? Young people's mental health is a concern to people around the world. Good emotional health promotes mental health and protects against mental illness, but we need to know more about how to help young people look after their emotional health., We are learning that research is better if the public are involved in it, including children and young people. Therefore, we need to listen carefully to what young people have to say., In this paper, we describe some research that involved young people from start to finish. We were asking what kind of emotional health support would be useful to them., What this paper adds to existing knowledge? We developed a useful way to involve young people in research so their voice can be heard., Young people like to use the Internet to find emotional health support and information, but need to know which web sites they can trust., What are the implications for practice? Our method of bringing young people together to tell us their views was successful., It is important to explore ways to help young people judge the quality of emotional health web sites., Abstract Introduction Youth mental health is a global concern. Emotional health promotes mental health and protects against mental illness. Youth value self-care for emotional health, but we need better understanding of how to help them look after their emotional health. Participatory research is relevant, since meaningful engagement with youth via participatory research enhances the validity and relevance of research findings and supports young people's rights to involvement in decisions that concern them. Aim We aimed to develop a participatory approach for involving youth in research about their emotional health support preferences. Method Our team included a young expert-by-experience. We developed a qualitative, participatory research design. Eleven youth (16-18 years) participated in focus groups, followed immediately by a nominal group exercise in which they analysed the data, thus enhancing methodological rigour. Results This process highlighted youth perspectives on self-care strategies for emotional health. Discussion and implications for practice Our simple participatory research approach generated trustworthy and credible findings, which accurately reflect youth perspectives and are consistent with the literature, endorsing our method. Young people said that they want reassurances of quality and safety when accessing digital mental health resources. These findings can inform future development of youth-oriented digital mental health resources. [ABSTRACT FROM AUTHOR]

Accessible summary Anorexia nervosa (AN) affects many young people but they can be reluctant to accept treatment. If we understood the views of young people with AN we might be able to develop more acceptable treatments. At the moment, most of what we know about their views is taken from studies of girls and young women., For some young people, having AN means being able to control something, but AN can also be an illness that controls the person. Confusion about control is one of the things that make AN hard to treat., It is difficult to find the right combination of treatments for the physical and psychological symptoms of AN. The research evidence we have does not offer enough guidance for clinicians., Good relationships with clinicians can be difficult to achieve. Young people with AN want clinicians to look after them but at the same time they may resent it when clinicians tell them what to do. However, once they have recovered they often say that they needed firm treatment in order to get better., Abstract This paper reviews current literature in which adolescents with anorexia nervosa (AN) were consulted about their views of their treatment. Published research was systematically retrieved and interrogated during 2009-2010 and analysed using a four-stage model. Eleven studies met the inclusion criteria. Three core themes were identified. AN was perceived as a means of taking control and also something that controlled the individual. Tensions were recognized between client preferences for psychological interventions and treatments that prioritized physical care. Therapeutic alliance emerged as a strategy for overcoming these difficulties but was challenged by client ambivalence towards treatment. Most included studies were qualitative. Young males and individuals who dropped out of treatment were underrepresented in the studies. Adolescents' perspectives on treatment for AN were characterized by paradoxes and tensions. Egosyntonic theory was used as a theoretical construct to interpret findings. [ABSTRACT FROM AUTHOR]

UK health policy has used the terms 'frailty' and 'complexity' synonymously but there is no common definition for either. Understanding these concepts is important if demand for health care created by the increasing number of older people in society is to be managed effectively. This paper explores some findings from a study into how mental health nurses who work with older people construct and operationalize the concept of 'age-related complexity'. Constructivist grounded theory was used. Audio-taped interviews were undertaken with 13 registered nurses and were analysed using a constant comparative method. This paper addresses the relationship between frailty and complexity, which was identified as a theme within the category 'dynamic complexity'. The findings suggest that nurses understand important differences between the two concepts. Frailty is exclusively used to describe physical states while complexity is a more encompassing term that has resonance and relevance in mental health services. The dynamic nature of complexity means that older people can become both more and less complex and this has implications for nursing practice that require further study. [ABSTRACT FROM AUTHOR]

This paper aims to explore the effectiveness of the mental health nurse practitioner role in the emergency department in the context of the growing use of special units or segregated areas to manage particular kinds of mental health presentations, often complicated by substance use. In recent years, there has been a significant increase in mental health presentations to emergency departments, often complicated by substance abuse. Emergency departments have introduced a variety of mechanisms to address this growing problem. With the introduction of mental health nurse practitioners, opportunities arise to reconsider these mechanisms. Discursive paper. In this discursive paper, contemporary practices are described in relation to 'special care areas', 'psychiatric emergency centres' and 'short-stay units'. The mental health nurse practitioner role in training and capacity building is also explored and the notion of 'locational processes' described. Rather than being presented as an alternative to short-stay units, the mental health nurse practitioner role is explored in its potential to enhance mental health nursing practice in a sometimes difficult clinical environment. The paper provides evidence from literature and practice that the clinical outcome for consumers is enhanced through the mental health nurse practitioner role. It is argued that the introduction of the mental health nurse practitioner role in the emergency department leads to increased staff competence and confidence in interacting with those presenting with mental health issues. The mental health nurse practitioner role also addresses the serious problem of stigma associated with those with a mental health issue. It is expected that those presenting with mental health issues to the emergency department will benefit through the increased assessment and management skills of staff. [ABSTRACT FROM AUTHOR]

Accessible summary • Theoretical frameworks that are multidimensional provides a standpoint within nursing practice to acknowledge that such care requires the ability to recognize and tailor services to meet the needs of diverse individuals. • Theoretical praxis advocate for a type of raised consciousness that regards how social structures operate to oppress some members of society while systematically privileging others. • It is through critical praxis that action can be mitigated to examine the existing social realities for Aboriginal women and serve to reduce these inequities. This paper describes theories from various disciplines that are useful in conceptualizing and reflecting on the mental health of Aboriginal women. Critical social theory (sociology), Parse's human becoming theory (nursing) and ecological systems theory (developmental psychology) are considered valuable theories that aid in nursing praxis. These papers discuss how these different theoretical approaches are beneficial for achieving different goals and therefore provide important foundational underpinnings to challenging traditional assumptions that effect human behaviour and practice. [ABSTRACT FROM AUTHOR]

Accessible summary • This paper advances the debate that considers critical realism as an alternative approach for understanding gender and mental health and its relatedness to research and practice. • The paper highlights the potential for mental health research and practice because critical realism facilitates changes in our understanding while not discarding that which is already known. • It allows the biological (sex) and social (gender) domains of knowledge for mental health and illness to coexist, without either being reduced to or defined by the other. • Both ‘sex’ and ‘gender’ need to be viewed as having separate influences on mental health and illness. This paper seeks to advance the debate that considers critical realism as an alternative approach for understanding gender and mental health and its relatedness to mental health research and practice. The knowledge base of how ‘sex’ and ‘gender’ affect mental health and illness is expanding. However, the way we conceptualize gender is significant and challenging as quite often our ability to think about ‘gender’ as independent of ‘sex’ is not common. The influences and interplay of how sex (biological) and gender (social) affect mental health and illness requires consideration. Critical realism suggests a shared ontology and epistemology for the natural and social sciences. While much of the debate surrounding gender is guided within a constructivist discourse, an exploration of the concept ‘gender’ is reflected on and some key realist propositions are considered for mental health research and practice. This is achieved through the works of some key realist theorists. Critical realism offers potential for research and practice in relation to gender and mental health because it facilitates changes in our understanding, while simultaneously, not discarding that which is already known. In so doing, it allows the biological (sex) and social (gender) domains of knowledge for mental health and illness to coexist, without either being reduced to or defined by the other. Arguably, greater depth and explanations for gender and mental health issues are presented within a realist metatheory. [ABSTRACT FROM AUTHOR]

yearwood e. & riley j.b. (2010) Curriculum infusion to promote nursing student well-being. Journal of Advanced Nursing 66(6), 1356–1364. Title. Curriculum infusion to promote nursing student well-being. Aim. This paper is a report of a study of baccalaureate nursing students’ experiences with curriculum infusion of college health issues into academic courses and students’ well-being. Background. Bringing Theory to Practice is an ongoing project at a number of colleges in the United States of America. Its goal is to use the academic classroom and campus community to engage students actively in self-reflection on a variety of common college student health and well-being issues. Method. This qualitative study was based on 159 students’ experiences with curriculum infusion in two undergraduate nursing courses at a university in the United States of America over a 2-year period from 2006 to 2008. Student reflection papers, photo-essays, narrative course evaluations, classroom engagement with educators and peers and student use of campus health resources were the data examined. Findings. As a result of the integration of personal wellness concepts into classroom pedagogy, students experienced a variety of feelings and needs including isolation, shock and anger, taking time, awareness and valuing. Conclusion. In light of the increasing rigour of baccalaureate nursing programmes, it is important for educators to be aware of the health-related effects of stress and isolation on students. By increasing student self-awareness and changing relational dynamics in the classroom, student well-being can be supported. [ABSTRACT FROM AUTHOR]

Accessible summary • This paper considers the need for enhanced skills and knowledge to fulfil the role of a Specialist Nurse in the field of Mental Health & Deafness. • Informs professionals of a new group called the Mental Health & Deafness National Nurse Specialist Forum. • By enhancing the knowledge and skills of professionals in this specialized area of work will contribute to a high quality of assessment and treatment and attract staff in to an exciting, challenging and developing field. This opinion paper considers the need for enhanced clinical skills and knowledge to fulfil the role of a Specialist Nurse in the field of Mental Health & Deafness and informs professionals of a new group called the Mental Health & Deafness National Nurse Specialist Forum. Their knowledge and skills enable therapeutic interventions to be accessible and meaningful for Deaf people. A case study illustrates the complex nature of assessment and treatment in Mental Health & Deafness and highlights the potential devastating consequences that may occur if a Deaf person is misdiagnosed and does not access appropriate services. An increased awareness of the field and forum aims to increase the interest of nurses outside of the field and support a developing evidence base for Deaf sensitive interventions and opportunities for further pioneering work. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The mental health of health professionals is affected by their own work. Nurses and nursing students face high levels of stress, which results in anxiety, burnout, and depression.There are scales that allow the measurement of specific stress levels of nursing students, especially when they first attend their clinical practices in real settings such as hospitals. What this paper adds to existing knowledge?: Our study consists of validating an existing scale (the Stressors in Nursing Students Scale, SINS) that measures these stress levels in Spanish.Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. What are the implications for practice?: The validation and adaptation of this scale to Spain will allow us to adequately assess the stress levels of our students to give them adequate tools for the emotional control of their anxiety and stress.Once we have a reliable and appropriate tool for measuring the factors of greater impact in the generation of stress, we can implement preventive measures which may be very useful for the control of anxiety. Introduction: Nursing professionals and students suffer a greater number of stressors with negative health consequences. Aim: To translate and test a Spanish version of the Stressors in Nursing Students Scale (SINS‐S), with a cohort of nursing students in Spain. Also, we sought to examine the factor structure of this test and explore the psychometric structure of stress among this population. Method: The SINS scale was translated into Spanish and administered to a cohort (n = 398) of male and female Spanish nursing students in the final three years of their nursing program. Data were analyzed using exploratory factor analysis. Results: Exploratory factor analysis revealed four factors: "Clinical," "Financial," "Confidence," and "Education." Discussion: There were similarities between the perception of stressors by nursing students in Spain compared with the original version of the SINS from the United Kingdom. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Positive aspects of care are considered an essential part of caregiving research. They have been related to a wide range of dimensions of the caregiving circumstances, but there are few valid, reliable and brief measures to assess them. One of the most frequently used internationally is the Positive Aspects of Caregiving (PAC) scale, whose psychometric properties have received little attention. What the paper adds to existing knowledge?: The present study analyses the psychometric properties of the Portuguese version of the PAC scale in a sample of informal caregivers of someone with dementia and further explores the association of different factors (e.g. caregiver health, sociodemographic variables) with the PAC.The Portuguese version of PAC scale presented good psychometric characteristics, and the factor analysis revealed the presence of two factors: affirming self and enriching life.Our study also verified that higher levels of PAC are more likely to be associated with better caregiver health perception, lower levels of psychological distress and burden, the care recipient's older age, providing care to more than one care recipient, not receiving social support services and not considering institutionalizing the care recipient. What are the implications for practice?: Findings from this study can assist professionals, including mental health nurses, to develop and implement effective interventions that help dementia caregivers to maintain their emotional health by identifying and focusing specific positive aspects of care. The study stresses the Portuguese version of the PAC scale as a reliable and valid measure for practice. Introduction: Positive aspects of care refer to the psychosocial benefits of caregiving. The Positive Aspects of Caregiving (PAC) scale is one of the instruments most frequently used internationally, but its psychometric properties and correlates within the caregiving experience have received limited attention. Aim: To examine the factorial structure of the Portuguese version of PAC scale and to analyse background and contextual factors that are more likely to be associated with higher levels of PAC. Method: The PAC scale, a sociodemographic questionnaire and measures assessing burden and physical and mental health were administered to 204 informal caregivers of dementia patients. Results: Exploratory factor analysis revealed a two‐factor structure; internal consistency was adequate. Higher scores were negatively correlated with caregiver burden and distress. Better health perception, care recipient's older age, providing care to more than one care recipient and overall self‐reliance were correlated with higher levels of PAC. Discussion: The PAC scale was found to be a reliable and valid measure. Dementia caregiving circumstances and caregivers' and care receivers' characteristics play an important role for the presence of PAC, but relate distinctively with its dimensions. Implications for Practice: Findings can help mental health nurses to recognize distinctive relations between PAC and caregiving variables. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. Background: Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. Design: A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. Method: A Fairclough‐inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016–2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). Results: From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. Conclusion: Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self‐care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. Relevance to clinical practice: Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery‐oriented approach, if the agenda is to be truly adopted and strengthened. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on this subject?: Domestic and family violence contributes to mental distress and the development of mental illness and can reverberate throughout a person's life. What this paper adds to existing knowledge?: Therapeutic work with people who experience domestic and family violence needs to take considerable time to allow the process to unfold.Understanding the triggers that cause past traumas to be re‐experienced helps people to recognize and change their conditioned emotional responses. What are the implications for practice?: Time needs to be invested to develop a secure and trusting relationship to enable a person to work through childhood experiences that have the potential to overwhelm.It is important for adults who have experienced childhood trauma to have an opportunity to process the abuse to help minimize its intrusion in their lives. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care.Internalized stigma among nurses can affect personal self‐care and limit help‐seeking behaviours.Stigma around mental health nursing can adversely affect recruitment into this already underserved field. What the paper adds to existing knowledge: This is the first report on the adaptation and use in a nursing student sample of two widely used stigma‐related instruments that have been normed among medical students.The attitudes to psychiatry (ATP‐30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti‐stigma curricular interventions.Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI.Nursing educators and fellow nurses willing to share their own experiences with mental illness—including diagnosis, health–seeking, treatment and recovery—may prove especially powerful and germane during nursing school. What are the implications for practice: Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession.Comparison and potential synergy between ATP‐30, AMI and OMS‐HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time.The addition of validated instruments, such as the Self‐Compassion Scale–Short Form (SCS–SF) and the Self‐Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health‐seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma‐decreasing initiatives in nursing education.Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help‐seeking, treatment and recovery. Introduction: Stigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing. Aim/question: We adapted two stigma‐related instruments in a sample of nursing students and examined change in scores after participation in an eight‐week preclinical psychiatry curriculum. Our goal was to identify stigma‐malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing. Method: We made minor adaptations to the attitudes to psychiatry (ATP‐30) and the attitudes to mental illness (AMI) instruments. We invited first‐year nursing students to complete assessments at two time points: before and after completion of an eight‐week core course in preclinical psychiatry. Results: Seventy‐one students completed the assessment at both time points. ATP‐30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores. Discussion: The ATP‐30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti‐stigma educational interventions. Implications for practice: A general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health treatments have become patient‐centred. Evaluating recovery in people with mental health difficulties living in the community can help to develop better client‐centred services.Community integration is critical to recovery in patients with mental health difficulties. What does this paper add to existing knowledge?: This is the first study to use a single integrated measure of mental health recovery to evaluate the effect of community integration.Physical community integration was the easiest goal for most to reach. Developing independence/self‐actualization was harder.In mental health recovery, most people were able to overcome stuckness. Developing abilities for basic functioning was harder.Participating in mental health centre day programmes promoted mental health recovery in people with mental health difficulties living in the community.Independence/self‐actualization, psychological integration and social support improved mental health recovery in people with mental health difficulties living in the community. What are the implications for practice?: There is a need to develop and actively promote programmes that attract people with mental health difficulties living in the community so that they will actively use mental health centre services.Offering systematic social skills training and occupational rehabilitation therapy to people with mental health difficulties living in the community may help them function independently.Mental health service programmes should provide volunteer opportunities for people with mental health difficulties living in the community to facilitate a sense of belonging.Mental health nurses should serve as a social support resource for people with mental health difficulties living in the community by providing education to family and friends on how to support patients' recovery, and invigorating integration projects such as "making healthy friends." Introduction: Although community integration of people with mental health difficulties and a consumer‐centred recovery paradigm are of global importance, little research has been conducted on community integration factors that directly affect mental health recovery. Aim: This study investigated the relationship between community integration and mental health recovery in people with mental health difficulties living in the community in South Korea. Method: Data were collected from 155 people with mental health difficulties living in the community, using the Self‐Reporting Scale of Community Integration and the Mental Health Recovery Measure (Korean version), and analysed using hierarchical regression analysis. Results: Among the community integration subscales, independence/self‐actualization, psychological integration and social support were significant factors in mental health recovery, explaining 47.3% of the variance. Discussion: An effective intervention strategy for mental health recovery of people with mental health difficulties living in the community may reinforce community integration by carefully considering independence/self‐actualization, psychological integration and social support. Implications for practice: Mental health nurses should provide intervention to people with mental health difficulties living in the community to help them develop strategies for functioning independently, experiencing a sense of achievement and developing a sense belonging in the community. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The barriers and facilitators to incident reporting are becoming well known in general healthcare settings due to a large body of research in this area.At present, it is unknown if these factors also affect incident reporting in mental healthcare settings as the same amount of research has not been conducted in these settings. What the paper adds to existing knowledge: Some of the barriers and facilitators to incident reporting in mental healthcare settings are the same as general healthcare settings (i.e., learning and improvement, time and fear).Other factors appear to be specific to mental healthcare settings (i.e., the role of patient diagnosis and how incidents involving assault are dealt with). What are the implications for practice?: Interventions to improve incident reporting in mental healthcare settings may be adapted from general healthcare settings in some cases.Bespoke interventions for mental healthcare settings that focus specifically on violence and aggression should be co‐designed with patients and staff.Thresholds for incident reporting (i.e., what types of incidents will not be tolerated) need to be set, communicated and adopted Trust wide to ensure parity across staff groups and services. Introduction: Barriers and facilitators to incident reporting have been widely researched in general health care. However, it is unclear if the findings are applicable to mental health care where care is increasingly complex. Aim: To investigate if barriers and facilitators affecting incident reporting in mental health care are consistent with factors identified in other healthcare settings. Method: Data were collected from focus groups (n = 8) with 52 members of staff from across West London NHS Trust and analysed with thematic analysis. Results: Five themes were identified during the analysis. Three themes (a) learning and improvement, (b) time and (c) fear were consistent with the existing wider literature on barriers and facilitators to incident reporting. Two further themes (d) interaction between patient diagnosis and incidents and (e) aftermath of an incident—prosecution specifically linked to the provision of mental health care. Conclusions: Whilst some barriers and facilitators to incident reporting identified in other settings are also prevalent in the mental healthcare setting, the increased incidence of violent and aggressive behaviour within mental health care presents a unique challenge for incident reporting. Clinical implications: Although interventions to improve incident reporting may be adapted/adopted from other settings, there is a need to develop specific interventions to improve reporting of violent and aggressive incidents. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people.There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties.There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. What does the paper add to existing knowledge?: The positive evolution of attitudes towards mental illness does not last over time.Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. What are the implications for practice?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices.The design of any anti‐stigma intervention must include the factor of "time". Introduction: The stigma of health professionals is a contributing factor to morbi‐mortality among people with mental health difficulties. There is a lack of research on long‐term outcomes in nursing students. Objective: To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method: A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self‐education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15 months. Results: Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion: Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications: Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti‐stigma activities. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: The intersection of sexuality and psychosis has a long history, yet research in this area has been minimal over the past few decades.Mental health clinicians practice from within the confines of a mental health system that is founded on a conflict between containment and care and that positions the consumer as an object of care.At the same time, mental health services often have a Recovery approach to care. This presents a difficulty and tension in mental health clinical work because the Recovery approach is opposed to positioning the consumer as an object. What this paper adds to existing knowledge: The findings suggest that sexuality and sexual needs are common to both clinicians and consumers, and via identification, make the two groups more similar than different.Sexuality can problematize and so open up questions about the objectification of consumers.Consideration of consumers' sexuality and sexual needs can therefore work as a resistance to the dominant mental health approach and, in doing so, produce a more Recovery‐oriented approach to treatment in terms of how the consumer is positioned.Other aspects of living that escape capture by the diagnostic system may also operate as organizing factors for a more subject‐to‐subject approach to treatment. The implications for practice: Focusing on sexuality and other aspects of living that escape capture by the diagnostic system can bring into question the way consumers are objectified by the psychiatric model of care. Introduction: The Recovery approach introduced a radical shift in the positioning of consumers as subjects rather than objects of mental health treatment. While this approach has been internationally adopted, the practice of Recovery has been under‐researched and a knowledge gap exists regarding the intersection of sexuality and psychosis. Aim: The study aim was to investigate how sexuality was governed in a long‐stay mental health rehabilitation facility that was Recovery‐oriented. Method: A case study methodology with a conceptual framework using Foucault's work on disciplinary power was used. Results: The findings illustrated how mental health clinicians were caught between two main and incompatible models of care: a psychiatric one and a Recovery one. Discussion: While the policy framework authorized a Recovery approach, clinicians practised surveillance, hierarchical observation and normalization, which are tenants of a psychiatric model of care. However, the study found that sexuality was an area that opened questions about the psychiatric model for clinicians. Consideration of consumers' sexual needs allowed the clinicians to think of consumers more as subjects like themselves than as objects to be treated. Implications for practice: Consideration of consumers' sexuality opens up possibilities for questioning the objectification of the consumer via the psychiatric model. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about shared decision‐making?: There is increasing evidence of the positive impact of shared decision‐making on health outcomes.There has been little exploration of shared decision‐making regarding people diagnosed with serious mental illness from the perspectives of key stakeholders including consumers, families and mental health professionals. What this paper adds to existing knowledge?: Consumers show variability in the preference for their involvement.Most stakeholders acknowledge the importance of family involvement.MHPs should share the responsibility and right to facilitate consumer involvement.There is bidirectional association between shared decision‐making and therapeutic relationships.The practice of shared decision‐making is related to multiple factors, and one main perceived barrier is time.The majority of studies are from Western countries. What are the implications for practice?: Elicit consumer preferences and establish a collaborative therapeutic relationship.Encourage and engage families in treatment decision‐making.Inter‐professional collaboration should be integrated into shared decision‐making.It might require lengthier consultation time.Studies in non‐Western countries are needed to fully understand the impact of culture on shared decision‐making. Introduction: Shared decision‐making (SDM) has been broadly advocated in health services and constitutes an important component of patient‐centred care and relationship‐based care. Aim: To review available literature related to perceptions of key stakeholders about shared decision‐making in serious mental illness. Method: An integrative review was conducted through a search of four online databases from January 2012 to June 2019. Results: Forty‐six articles were included. Six themes were generated from the data analysis: (a) dynamic preferences for SDM, (b) various stakeholders are rarely involved, (c) SDM is not routinely implemented, (d) multiple facilitators and barriers to SDM, (e) SDM and therapeutic relationships interact, (f) SDM has a promising impact on health outcomes. Discussion: Overall, most stakeholders have recognized the importance and flexibility of SDM in serious mental illness, although it is not routine in mental health service. Consumer preferences show variability in their involvement. Most stakeholders acknowledged the importance of family involvement to treatment decision‐making. There are several significant challenges to practice SDM. It may require extended consultation times and increasing empirical evidence regarding the SDM outcomes, as well as integrating inter‐professional collaboration into SDM. Most studies were conducted in Western culture. Implications for practice: Mental health nurses should elicit consumer preferences and establish a collaborative therapeutic relationship. Encourage and engage families in treatment decision‐making when consumers prefer their families to be involved. Inter‐professional collaboration should be integrated into shared decision‐making. The practice of shared decision‐making might need extended consultation time and more robust evidence about the outcome of shared decision‐making. Studies in non‐Western cultures are needed to fully understand cultural issues of shared decision‐making. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital.Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts.The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. What the paper adds to existing knowledge?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units.Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. What are the implications for practice?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model.The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. Introduction: The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim: To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method: Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health‐related emergency department visit rates were compared using segmented regression analyses. Results: Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion: Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice: Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources. [ABSTRACT FROM AUTHOR]

Aims and objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women.Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels.To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post‐partum health experiences. What this paper adds to existing knowledge?: This study provides unique insights into immigrant women's perceptions of what influences their post‐partum mental health and ability to access services for PPD.Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services.Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation.Assessment approaches and organizational wait times created barriers to accessing care. What are the implications for practice?: Relationship building by providers is foundational to effective care for immigrant women with PPD.Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno‐cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services.Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Introduction: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women yet face multiple barriers to care at individual and system levels. Aim: To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods: A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results: Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion: Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno‐cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice: Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: A clear association exists between serious mental illness (SMI) and poor physical health.Individuals with SMI have markedly higher risks for mortality and morbidity.Mental health nurses play an important role in enhancing service users' mental and physical well‐being.The attitudes of mental health nurses towards physical health care have been explored in the western part of the world. However, cross‐country differences should be determined to reveal the importance of this global issue. What the paper adds to existing knowledge?: This study adds new data to the literature on the Physical Health Attitude Scale's (PHASe) validity and nurses' attitudes when working in acute mental health services in different cultures.Nurses in acute mental health wards mostly focus on the basic physiological indicators of patients' existing physical health problems, so health promotion practices such as sexual health and eye/dental examinations are neglected for individuals with SMI.Nurses' higher level of confidence about their delivery of physical health care is due to their familiarity with basic nursing practices (e.g. monitoring blood pressure and checking blood glucose levels).Differences that exist between countries in relation to smoking habits are probably due to different regulations. What are the implications for practice?: To improve patients' physical healthcare outcomes, nurses should be provided with additional training and supervision to strengthen their skills and confidence.Nurses' perceived need for additional training reflects the importance of physical health care in mental health settings, in which training could substantially improve patient outcomes.Authors believe that standard protocols must be established in acute psychiatric care to eliminate obstacles to holistic patient care.Training needs of mental health nurses on health promotion practices should be considered by administrators of mental health settings. Introduction: Nurses play an important role in improving the physical health of individuals with serious mental illnesses. The literature on the attitudes of mental health nurses towards physical health care provides a small amount of data. Assessing trends in nurses' attitudes through suitable surveys is important to ensure holistic care. Aim/Question: This study sought to examine the Turkish version of the Physical Health Attitude Scale's (PHASe) validity and reliability and to survey Turkish mental health nurses' attitudes towards physical health care. Method: The sample consisted of 174 nurses working in acute psychiatric wards. Firstly, the psychometric properties of the scale were analysed using factor analysis and measures of internal consistency and reliability. Then, the survey results of the attitudes of mental health nurses towards the physical health of patients with serious mental illnesses were determined using the Physical Health Attitude Scale (PHASe). Results: The translated PHASe functioned best as a 24‐item version and 4‐factor solution that explains 51.3% of the variance. The internal consistency value was 0.83. The respondents' attitudes were generally positive about their role. There was less agreement for the involvement of nurses in practices of health promotion, such as sexual health, eye and/or dental examinations. The nurses surveyed also tended to use smoking for therapeutic purposes. Implications for practice: Mental health nurses' knowledge and attitudes should be enhanced by additional training in the ways of meeting patients' biopsychosocial needs. Obstacles to physical health care can be removed by implementing standard protocols nationwide. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Depression affects 1 in 20 Americans, and people living with HIV experience depression at 2–3 times the rate of the general population.Recent research has shown that a person's level of social connectedness (e.g., social networks) is important to understanding their health and ability to get help when they need it.The scientific rationale of this work is to determine whether there is a direct relationship between levels of depression and a measure of social connectedness in people with HIV who are at higher than normal risk of depression and depressive symptoms. What this paper adds to existing knowledge?: We examined the relationship between levels of depression and social capital in people living with HIV to determine whether depression may influence their beliefs about their social connectedness and available resources.We found that as depression increases, self‐reported social capital decreases, suggesting that people living with HIV who are depressed may feel less socially connected and/or not be confident they can access resources when they need them. What are the implications for practice: Mental health nurses are particularly well‐positioned to help people living with HIV who are living with depression by helping them build skills for building and maintaining relationships, adhering to co‐administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness.Helping people living with HIV to address depression and promoting social connectedness can not only improve quality of life, but have major long‐term health benefits. Introduction: People living with HIV (PLWH) are disproportionately burdened by depression, with estimates as high as 80% of PLWH reporting depressive symptoms. Depression in PLWH is complex, and has been linked with biological and psychosocial causes, including low social capital. Few studies have examined the relationship between social capital and depression in PLWH. Aim/Question: We conducted a secondary analysis of the relationship between social capital (Social Capital Scale score) and depression (Beck Depression Inventory‐II scores) to determine whether depression predicted levels of social capital in a sample of 108 PLWH. Results: Depression was significantly associated with lower social capital r(105) = −.465 p <.001. Depression remained a significant predictor of social capital in the linear regression model, F(5,101) = 8.508, p <.000, R2 = 0.296, when controlling for age and education level. Discussion: Our results suggest that depression may be a significant predictor of low social capital, and these factors may have cyclical relationships that explain persistent depression in this population. Implications for practice: Mental health nurses are particularly well‐positioned to help PLWH who are living with depression by helping them build skills for building and maintaining relationships, adhering to co‐administered HIV and mental health medical treatments, and helping these individuals to identify and address barriers to social connectedness. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Contemporary mental health policy stipulates consumer participation in all aspects of mental health services including service evaluation and other forms of mental health research.Research is identified as underpinning quality mental health services, and therefore, consumers researchers could enhance the mental health sector by contributing to the quality, credibility and relevance of mental health research. What this paper adds to existing knowledge?: Non‐consumer researchers generally supported the concept of a consumer expert reference group for researchers at the individual and institutional level.A consumer expert reference group should reflect diversity and offer expertise relevant to the topic of research and may represent one way to normalize partnerships with consumer researchers and realize the benefits they can bring to research. What are the implications for practice?: Quality mental health services are underpinned by robust research evidence. It is crucial that consumers are active participants in research activity.The availability of a consumer expert reference group could facilitate collaborations between consumer and non‐consumer researchers and contribute to a stronger consumer focus embedded in mental health research. Introduction: Contemporary mental health policy identifies consumers as active participants in all aspects of mental health services from design to evaluation. Consumer researchers should be actively involved in mental health research and contribute to quality service delivery. Aim: To gain a snapshot of mental health researcher views on strategies for increasing research by or with consumers in mental health through the establishment of an Expert Consumer Researcher Group (ECRG). Methods: Cross‐sectional survey of 41 non‐consumer mental health researchers from Australia or New Zealand. Results: The introduction of an ECRG was considered an effective strategy for linking consumer and non‐consumer researchers and providing specialist advice on research design and methodology. The most suitable location for this group was identified as within consumer advocacy agencies (71%), universities (66%) or research funding bodies (66%). Participants rated their likelihood of seeking advice from the ECRG as high. Discussion: Research participants supported the value of an ECRG. They emphasized the importance of ensuring the group reflected a diversity of views and offered specialized expertise related to the specific topic. The ECRG could benefit both individual researchers and larger research organizations. Implications for practice: An ECRG could facilitate collaborations with consumer researchers and in turn enhance the quality of mental health research. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goalInvolving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change What this paper adds to existing knowledge?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience"An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries What are the implications for practice?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practiceNurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. Introduction: Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim: To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method: A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results: Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion: This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice: Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context.The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable.No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers' knowledge and attitudes is warranted. What does the paper add to existing knowledge?: The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices.This study illuminates the prevailing paternalistic provider–user relationship as the main barrier surrounding AHD management in terms of decision‐making.Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. What are the implications for practice?: Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care.Obtaining up‐to‐date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement.The implementation of AHDs in the Spanish mental health system requires macro‐ and micro‐changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. Introduction: An advance healthcare directive (AHD) is a written document that contains a patient‐in‐care's will and preferences concerning the treatment options available to them, should they lack decision‐making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs. Aim: To explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health. Method: A qualitative study was conducted using semi‐structured interviews that were thematically analysed. Findings: Three main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient‐in‐care AHDs. Discussion: Professionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non‐technical skills through training is required. Such training should include users and families and allow for compliance with United Nations requirements. Implications for practice: Advance healthcare directives offer important information regarding user preferences, although they pose challenges for practices. Acquiring an up‐to‐date perspective on the attitudes of professionals towards AHDs allows organizations to attend to particular aspects that require reinforcement. Wider awareness, staff training and new ways of relating to users are necessary to implement AHDs in Spanish context. Relevance statement: A better understanding of the attitudes of Spanish mental health professionals towards AHDs was achieved. Despite the implementation of AHDs being an important and potentially beneficial initiative, mental health professionals find many pragmatic issues that need addressing before AHDs become a reality in their clinical practice. Wider awareness, staff training, personalized assistance and new ways of relating to users are required to implement AHDs in everyday practice. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to report on the role of an action researcher in a study investigating the change process in a health service context where a new assessment clinic was developed to manage the excessive waiting list for that service. Background For effective organisational change in health, there is a suggestion that change agents need to be emotionally intelligent; recognising the emotional state of individuals, reconciling that with the organisational drivers and making an assessment of readiness for organisational change. Anxiety features throughout this literature and there is a suggestion that being aware of anxiety and managing anxiety is within the emotionally intelligent change agent's repertoire, but there is a gap in the literature that explains this relationship in detail. Methods Data were generated to investigate the discrete nature of the role of the action researcher during this organisational change that spanned two years, through three methods: participant observations in the field captured in field notes ( n = 72); observations of team meetings that had been recorded and transcribed ( n = 13); interviews with key informants pre- and postintervention ( n = 14); a reflexive diary one document of 8920 words ( n = 1). Findings The data illuminating the interaction between the action researcher and participants were synthesised into two broad themes: how the action researcher introduced anxiety into the system; how the action researcher facilitated the participants to tolerate change anxiety. Discussion/relevance to clinical practice The findings from this study can be applied in clinical practice where change in practice is planned. Part of the requirement of a change agent in the NHS might be to be sufficiently emotionally literate to understand anxiety in the participant system and manage it to effect change. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? There is emerging evidence highlighting the counter therapeutic impact of the use of restraint and promoting the minimization of this practice in mental health care., Mental health nurses are often the professional group using restraint and understanding factors influencing their decision-making becomes critical., To date, there are no other published papers that have undertaken a similar broad search to review this topic., What this paper adds to existing knowledge? Eight emerging themes are identified as factors influencing mental health nurses decisions-making in the use of restraint., The themes are: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'., 'Last resort' appears to be the mantra of acceptable restraint use, although, to date, there are no studies that specifically consider what this concept actually is., What are the implications for practice? These findings should be considered in the evaluation of the use of restraint in mental health settings and appropriate strategies placed to support shifting towards restraint minimization., As the concept of 'last resort' is mentioned in many policies and guidelines internationally with no published understanding of what this means, research should prioritize this as a critical next step in restraint minimization efforts., Abstract Introduction While mechanical and manual restraint as an institutional method of control within mental health settings may be perceived to seem necessary at times, there is emergent literature highlighting the potential counter-therapeutic impact of this practice for patients as well as staff. Nurses are the professional group who are most likely to use mechanical and manual restraint methods within mental health settings. In-depth insights to understand what factors influence nurses' decision-making related to restraint use are therefore warranted. Aim To explore what influences mental health nurses' decision-making in the use of restraint. Method An integrative review using Cooper's framework was undertaken. Results Eight emerging themes were identified: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'. These themes highlight how mental health nurses' decision-making is influenced by ethical and safety responsibilities, as well as, interpersonal and staff-related factors. Conclusion Research to further understand the experience and actualization of 'last resort' in the use of restraint and to provide strategies to prevent restraint use in mental health settings are needed. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited., What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans., What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services., Abstract Introduction The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. Aim It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. Method Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. Results The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. Discussion This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. Implications for Practice With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge. [ABSTRACT FROM AUTHOR]

Introduction: Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad‐hoc and tokenistic, with limited input at the program development level. Aim: To explore the co‐design processes and outcomes of a collaborative revision of an Australian post‐registration mental health nursing curriculum. Method: Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co‐designing a post‐registration mental health nursing curriculum were explored. Results: Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. Discussion: While it was possible to support and augment stakeholder knowledge in the context of post‐registration education, co‐design processes were ultimately bound by the university's relatively inflexible bureaucratic context. Implications for Practice: To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co‐design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development. [ABSTRACT FROM AUTHOR]

Aims: To comprehensively examine the prevailing condition of care dependence among middle‐aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post‐acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon. Design: A single‐centre, cross‐sectional study design. Methods: During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease‐related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods. Results: The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke. Conclusion: The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice. Relevance to Clinical Practice: The incidence of care dependence in middle‐aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post‐acute rehabilitation period and improve the quality of life of hemiplegia patients. Reporting Method: Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross‐sectional studies (see Table S1). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt.Definitions of recovery from high‐income and English‐speaking countries should be carefully adapted to other settings.Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. What the paper adds to existing knowledge?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low‐middle‐income country were clear in the findings of this paper.There are differences in the definition of family and service user engagement in the current study and in high‐income countries.Seeking faith healers as a barrier to mental health recovery is culturally unique.Functional recovery prevails as a model in Egypt as there is limited service user involvement.Nursing values and code of ethics are consistent with enablers of mental health recovery. What are the implications for practice?: Changing the pre‐registration nursing education to prepare specialized graduates in mental health nursing.Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. Introduction: Recovery‐oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim: To explore perspectives of Egyptian mental health professionals on recovery. Method: Semi‐structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results: The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self‐awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion: The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice: There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about this topic?: Integrating mental health counselling into primary care services is a recommended strategy for reducing the mental health treatment gap in low‐ and middle‐income countries.To support this strategy, potential barriers to counselling integration must be identified and addressed.Organizational preparedness for implementation may influence the extent to which the introduction of counselling is successful.Features of primary care facilities associated with preparedness for the implementation of mental health counselling have not been explored. What the paper adds to existing knowledge?: This study uses a novel approach to explore variations in preparedness of primary care services to implement counselling and factors potentially associated with these variations.Findings suggest there is considerable variation in the preparedness of facilities to implement counselling.Organizational factors such as resource availability, management style and facility environment are potentially associated with capability for implementing mental health counselling. What are the implications for practice?: Health planners could use this method to identify poorly functioning services that may benefit from additional interventions to build preparedness for counselling implementation.Future research should examine whether differences in facility preparedness impact on the implementation and outcomes of this service. Introduction: Differences in primary care facilities' preparedness for implementing mental health counselling may affect the implementation process but have rarely been studied. Aim: To assess the feasibility of using a novel methodological approach to explore variations in capability for implementing mental health counselling and factors potentially associated with this variation among primary care services in the Western Cape, South Africa. Methods: Staff from 26 facilities participated in discussions about their facility's mental health implementation capability. Three researchers conducted observations of the facility's environment, staff–patient interactions and resources. We used qualitative comparative analysis to identify factors potentially associated with implementation capability. Results: Facilities appeared to vary in their capability for implementing counselling services. The availability of person‐centred health services, a therapeutic environment and sufficient human resources may be requirements for implementation preparedness. Other factors that seem to support preparedness include the availability of confidential space for counselling and an adequately managed facility. Discussion: This study identified several features of well‐functioning primary care facilities. Facilities with these features may be better prepared to implement a new counselling service. Implications for practice: This method may identify facilities that are poorly prepared for implementation that could benefit from preparedness‐building interventions. Whether differences in preparedness affect counselling outcomes is yet to be established. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Physical appearance, as in the case of individuals with physical disabilities who use a cane, walker or wheelchair, also influence others' reactions and as a result, may lead to one's negative or positive feelings and thoughts.A disability that is not observable by others, as in the case of individuals with psychiatric disabilities (mental illnesses), may also have a negative impact on one's feelings and thoughts, due to stigma associated with psychiatric disabilities.To date, research has mainly focused on the way persons with a noticeable type of disability think about themselves. It is also important to evaluate the impact of disability type on ones' feelings and thoughts, and compare persons with visible and invisible disabilities. What the paper adds to existing knowledge?: We asked 119 adults (over the age of 18 years) with different types of disabilities to complete a set of questionnaires and found that those who had a disability that was not observable by others (a psychiatric disability) felt more negative about themselves and their body than those who had a disability that was observable by others (a physical disability).The study extends the current knowledge on the impact of disability type and its visibility on the way persons with disabilities think about themselves. What are the implications for practice?: The findings suggest that healthcare services should be modified to address the psychological needs of people with different types of disability.Mental health nurses should identify practices in the community that will improve the feelings and thoughts of consumers with disabilities, and especially those who cope with a psychiatric disability. Introduction: Individuals with disabilities often face stigma and discrimination, which may negatively affect their self‐concept. To date, research has mainly focused on the psychological implications of living with a noticeable physical disability. Less attention has been given to individuals with invisible psychiatric disabilities as a stigmatized subgroup in the disability community. Aim: To evaluate the impact of disability type and its visibility on the self‐concept and body image. Method: A cross‐sectional quantitative study design was implemented to compare the self‐concept and body image of individuals with visible physical disabilities and individuals with invisible psychiatric disabilities (n = 119). Pearson correlations, ANOVA and multiple linear regression models were performed. Results: Individuals with invisible psychiatric disabilities reported lower levels of self‐concept and body image compared to individuals with visible physical disabilities. Gender, family status and the severity level of the disability were found to be associated with self‐concept and body image. Discussion: The study extends the current knowledge by showing that disability visibility might play a protective role for persons with physical disabilities compared to persons with psychiatric disabilities. Implications for Practice: Mental health nurses should apply practices to enhance the self‐concept and body image of consumers with invisible psychiatric disabilities. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mothers with mental health problems are at risk of well‐being and experience lack of support.There is little research focusing on the effect of household composition on health of Hispanic mothers with mental illness.As the family is a central feature in Hispanic lives and there is a high dependence on the family for help, it is crucial to understand how household composition and family functioning influences Hispanic mothers' health and well‐being. What does the paper adds to existing knowledge?: Living with at least one other adult in the household are related to better Hispanic mothers' physical and psychological health.Mothers living with a greater number of adult in the house are more likely to have fatigue and depression.More family hassles are associated with worse health outcomes in Hispanic mothers with mental health problems What are the implications for practice?: There is a need to assess family members who are supportive to Hispanic mothers and to address families' basic needs in the intervention.Interventions for Hispanic mothers with mental health problems should be grounded in supporting the strengths of the Hispanic familial networks.A family‐centred approach for mothers with mental health problems requires integrated assessments and interventions including the families as units. Introduction: Household composition is seen as a critical factor for recovery of Hispanic mothers with mental illness, but little research has examined the relationship of household composition and health. Aim: This study examined how household composition and family functioning impact on both physical and psychological health of Hispanic mothers receiving outpatient mental health services. Method: The study analysed baseline data of 137 Hispanic mothers participating in a randomized trial of "Healthy Home," a family‐strengthening home health intervention. A bilingual (English/Spanish) research assessor interviewed participants regarding household composition, family hassles, family cohesion and mother's physical and psychological health. Results: Mothers living with at least one other adult and having fewer family hassles had better health outcomes. Mothers living with a greater number of adult in the house were more likely to have fatigue and depression. Discussion: Hispanic mothers having no adults to help them in the house are less able to maintain their physical and psychological health. A family‐centred approach for mothers requires integrated assessments and interventions including the families as units. Implication for practice: Interventions for Hispanic mothers with mental health problems should be grounded in supporting the values and strengths of the Hispanic familial networks. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Laughter yoga is claimed to promote mental health and has become increasingly popular worldwide.There has been no systematic review of laughter yoga intervention studies and thus evidence of its effects on mental health is unclear. What the paper adds to existing knowledge?: Laughter Yoga interventions improved depressive symptoms in two studies over the short term.There is a lack of good quality evidence to show that laughter yoga is more effective than other group‐based interventions in improving mental health. What are the implications for practice?: Well‐conducted and clearly reported trials of laughter yoga are needed before the intervention can be considered as an evidence‐based intervention to improve mental health. Introduction: Laughter Yoga is claimed to promote mental health and is increasingly popular worldwide. Despite its popularity, there has been no systematic review of Laughter Yoga intervention studies and thus evidence of its effects on mental health is unclear. Aim: This review aimed to critically evaluate the effects of group‐based Laughter Yoga on improving mental health in adults. Method: We conducted a systematic review of experimental studies (published from 1995 to 2017). Study quality was assessed, the effect sizes for individual mental health outcomes were calculated and all reviewed studies were narratively synthesized. Results: Six experimental studies with inconsistent results were included in this review. The most promising effect of Laughter Yoga is the improvement of depressive symptoms, indicating significant medium‐large effect sizes in two studies over the short term. The overall level of evidence was weak due to poor study quality and risks of bias. Discussion: Laughter Yoga shows potential, but currently there is insufficient evidence to support its effectiveness in improving mental health when compared to other group‐based interventions. Implications for practice: This review highlights the need to conduct rigorous trials of laughter yoga before the intervention can be considered as an evidence‐based intervention to improve mental health. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known of the subject: Consumer participation in mental health services is an expectation articulated through mental health policy.Consumers as researchers could contribute significantly to mental health services. Barriers to participation are significant and limit consumer involvement. What the paper adds to existing knowledge: Enhanced understandings of collaborative relationships between consumer and nonconsumer researchers.Researchers from the health disciplines find value in consumer involvement in mental health research.These researchers can support and facilitate consumer research by being allies to consumer researchers. What are the implications for practice: Understanding the role of allies is necessary to strengthen their capacity to support consumer researchers.Involving consumers in mental health research is likely to lead to improved practice. Introduction: Australia and New Zealand mental health policy requires consumer participation in all aspects of mental health services. Systemic participation informs and improves the quality of mental health services. Collaboration with consumer researchers should be similarly required. Enhanced understandings of collaborations are needed. Aim: To enhance understanding of the perspectives and experiences of nonconsumer researchers in working collaboratively with consumers as researchers. Method: This qualitative exploratory study involved interviews with nonconsumer mental health researchers who have worked collaboratively with consumers in research. Interviews were conducted with participants from Australia and New Zealand. Results: "Allyship" emerged as a major theme. This describes nonconsumer researchers playing an actively supportive role to facilitate opportunities for the development and growth of consumer research roles and activities. Seven subthemes were identified: establishing and supporting roles, corralling resources, guiding navigation of university systems, advocacy at multiple levels, aspiring to coproduction and consumer‐led research, extending connections and partnerships, and desire to do better. Discussion: Allyship may have an important role to play in the broader consumer research agenda and requires further consideration. Implications for practice: Embedding meaningful consumer participation within mental health services requires active consumer involvement in research. Allies can play an important facilitative role. [ABSTRACT FROM AUTHOR]

Aims and objectives To review current research into the adherence to mental health treatment by adolescents. Background Nonadherence to medication among adolescents has been studied much more extensively than nonadherence to other forms of treatment. Monitoring adherence to all recommended services is essential when assessing the long-term effectiveness of different treatment programmes. Healthcare professionals who treat patients with mental illness must be able to accurately determine which of their patients are adhering to all prescribed treatments. Design This is a systematic narrative literature review of the current literature. Methods Using a narrative synthesis, the data from 15 relevant articles concerning adolescents in inpatient or outpatient mental health care were extracted and synthesised. Results The reviewed papers are discussed in terms of the methods used to study treatment adherence, the working definition of adherence used in each case and the results obtained concerning adherence in adolescents. Thirty-four to sixty-seven per cent of adolescents treated are fully adherent to their medication and exhibit reasonably good follow-through for the recommended treatments. However, rates of noncompliance with medication are quite high, and significant numbers of adolescents choose to discontinue their medication. Conclusions This review synthesises current published data on adherence to mental health treatment among adolescents in order to provide practitioners and researchers with a better understanding of this important area. It is recommended that future investigations should focus on adherence in inpatient care, adherence to nonpharmacological treatments and the identification of factors that influence adherence. Relevance to clinical practice The monitoring and understanding of adherence to recommended services is important. Therefore, these findings can be used by healthcare professionals who treat patients with mental illness to help them assess which of their patients are adhering to the prescribed treatments. [ABSTRACT FROM AUTHOR]

Accessible summary This paper reports on the issue of resuscitation in mental health inpatient environments. It reviews the literature on national standards and best practice when emergency situations arise in mental health settings. The discussion on the best practice literature takes place alongside the reporting of a national evaluation of how National Patient Safety Agency improvement guidelines for the provision for life support, and resuscitation for mental health service users was effectively implemented across health-care providers in England., Methods used to establish the effective use of the guidelines include feedback from clinical staff and staff responsible for the implementation of the new national standards for resuscitation. Serious incident data were also compared prior to the release of the national guidelines and after the guideline release dates. This included looking at events around choking and cardiac/respiratory arrest in inpatient areas., There were five deaths post-implementation of the guidelines that were considered to have serious enough error associated with the resuscitation process. This was down from 18 prior to the release of the guidelines. However, our survey showed that despite organisations reporting 100% compliance with the implementation of the guidelines, around half of frontline clinical staff were not aware of them., Although our survey responses show a contradiction between organisational and clinical staff awareness, our analysis suggests a reduction in moderate and severe harm cases and of deaths. There is evidence of a reduction in the worst types of error resulting in death, albeit with small numbers., Abstract In 2008, the National Patient Safety Agency issued a Rapid Response Report ( RRR) aimed at health-care organisations providing inpatient care for mental health and learning disability patients, requiring organisations to make proper provision for life support and resuscitation for these patients. This paper examines whether effective implementation of the RRR recommendations had occurred across health providers in England. The methods used in this paper are the following: (1) Questionnaires were distributed nationally to clinical staff and implementation leads; (2) A national comparison of the number and severity of pre- and post- RRR release-related incidents involving choking/cardiac/respiratory arrest in Mental Health and Learning Disabilities settings was conducted; (3) Organisational compliance with the patient safety alert for all National Health Service Organisations in England was measured. There were five deaths post-implementation of the RRR that were considered to have serious enough error associated with the resuscitation. This was down from 18 deaths pre the RRR release. Although our survey responses show a contradiction between organisational implementation and clinical staff awareness, our analysis suggests a reduction in moderate and severe harm cases and of deaths. There is evidence of a reduction in the worst types of error resulting in death, albeit with small numbers. [ABSTRACT FROM AUTHOR]

Accessible summary Reflections upon what it might mean to think, and about what inherited presuppositions or images might influence what thinking is thought to consist of, are not readily considered in the mental health care literature., However, the work of the 20th century French philosopher Gilles Deleuze and, in particular, his account of 'the dogmatic image of thought' can be employed to illustrate how such considerations can be of relevance to the theoretical and practical concerns of mental health professionals., In doing so, Deleuze's work can be understood as seeking to sensitize mental health professionals to the dangers of unreflectively adopting a restrictive notion of what it means to think, as well as an exhortation to develop critical, creative thinking in the mental health professions that moves beyond the bounds of the traditional, dogmatic image of thought., Abstract Considerations about what it might mean to think, and about what inherited presuppositions determine what thinking is thought to consist of, are not readily reflected upon in the mental health care literature. However, this paper will propose that such considerations are of relevance to, and possess important implications for, the mental health professions, and it will do so within the context of the work of the 20th century philosopher Gilles Deleuze. In particular, the paper will provide an accessible exposition of what Deleuze refers to as the 'dogmatic image of thought', along with an examination of his suggestion that this traditional image, and its associated presuppositions, not only determine what is considered to be the ostensible 'nature' of thought, but also delineate what the activity of thinking ought to be concerned with. Moreover, it will be argued that Deleuze's exposition and critique of the image of thought can be understood as seeking to sensitize mental health professionals to the dangers of unreflectively perpetuating a restrictive notion of what it means to think, as well as being an exhortation to develop critical, creative thinking in the mental health professions that moves beyond the bounds of that traditional, dogmatic image of thought. [ABSTRACT FROM AUTHOR]

Accessible summary Explain the use of case formulation as a way of involving people experiencing mental health issues in their treatment options., Case formulation is a framework that informs a choice of psychological treatments and links assessment and treatment phases to guide practitioners and individuals on treatment options., This paper investigates its value and discusses training and supervision of professionals undertaking case formulation., It includes information on how individuals with mental health issues are fully included in the process., The findings conclude that case formulation is worthwhile and suggests improved training to improve individual outcomes., Abstract Changes in mental health provision have led to practitioners and service providers reviewing how they incorporate service users in assessment processes and treatment decisions. Case formulation ( CF) is a framework that informs a choice of psychological treatments providing a bridge between assessment and treatment phases to guide treatment options. However, CF is not routinely practised in mental health; hence this paper reviews CF literature to establish its efficacy for service users experiencing mental health issues. The purpose of this study is to assess the efficacy, reliability and validity of CF and its process and function in providing treatment for service users experiencing mental health issues and to explore practitioner training requirements. A systematic search of English language publications on CF and treatment frameworks from 1999-2011 was conducted searching electronic databases. Additionally, two seminal pieces of CF work were included. The findings demonstrate evidence of CF's efficacy and suggest practitioner training programmes to increase professional expertise and enhance service user outcomes. However, limited evidence exists and further research is required to address efficacy and training implications of CF. [ABSTRACT FROM AUTHOR]