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Shane Kirwan and colleagues describe the virtual mental health inpatient wards implemented in Ireland in response to the COVID-19 pandemic and discuss the continuing development of this model of care delivery. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed.There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. What this paper adds to existing knowledge?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED.This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. What are the implications for practice?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme.The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery.This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment.Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. Introduction: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. Aim: To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. Method: A qualitative descriptive methodology informed the study. In‐depth semi‐structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. Results: Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. Discussion: An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real‐time anxiety as they endeavour to negotiate an effective support network. Implications for Practice: The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Lived experience narratives of recovery can provide an insight and subtlety where academic papers can often fall short.There is a need for people who work in mental health services to address and take care of their own psychosocial needs. What the paper adds to existing knowledge?: This paper provides a unique insight into a care professional's recovery from mental ill health.Looked at through this dual lens of service user and care professional provide the reader with a rich narrative from the perspective of both sides of the caring role. What are the implications for practice?: People who work in caring roles need to be vigilant of their own needs and the impact that the work can have on them.Safety protocol for managing one's own mental health should be a requirement for people within the caring profession. Introduction: This is an account of my experiences becoming unwell and accessing general and mental health services in Ireland. Aim: It is hoped that this lived narrative of my recovery will shed light on accessing mental health services from a dual lens; that of service user and social worker. Method: It traces this experience from initial contact with my general practitioner, to admission to a secure psychiatric ward where recovery slowly began. Results: It is also hoped that reading my experiences of recovery and some of the insights shared will help those in the nursing or social care profession consider how they may be affected by their work. Discussion: It is important to note that this account views my experiences within a neurobiology framework and this might not align to other people's experiences. However, my narrative of help‐seeking is complex and includes multiple points where I uncover insights and encounter different healthcare professionals. [ABSTRACT FROM AUTHOR]

The use of physical restraint is a contentious practice in the acute mental health setting. There are a plethora of guidelines surrounding the safe use of restraint. However, there is a scarcity of literature dedicated specifically from the perspective of the patient. The existing literature suggests that there are serious physical and psychological implications associated with the use of physical restraint for both mental health patients and nurses alike. The debate surrounding this practice has been intensified by the compelling evidence suggesting that the application of restraint is not compatible with the values of recovery in mental health care. To influence clinical practice that governs the use of restraint, it is essential to explore patient experiences of its use. Therefore, this review aims to explore patient experiences of physical restraint in the acute setting. PubMed, CINAHL and PsycINFO were systematically searched using keywords; "physical restraint" and "patient experience" and "acute setting". The search yielded n = 482 papers in total. Following the application of rigorous inclusion and exclusion criteria and data extraction, a total of n = 9 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, three themes were identified: 'the bio-psychosocial impact of restraint on patients', 'the impact of restraint on the therapeutic relationship' and 'patient needs concerning the use of restraint'. Future research opportunities have been identified that will add to the body of evidence in developing appropriate health interventions and supports for this population. [ABSTRACT FROM AUTHOR]

The aim of this research was to assess the psychological effects of the novel coronavirus disease (COVID-19) on mental health nurses. An internet-based questionnaire that included the Impact of Event Scale-Revised (IES-R) and the Zung Self Rating Anxiety Score (SAS) was used to assess the impact of the pandemic on the wellbeing of mental health nurses in an Irish mental health service. Among the nurses surveyed (n = 161), 12% of the participants had an overall IES-R score from 24 to 32 indicating that posttraumatic stress disorder (PTSD) was a clinical concern, while 38% had an overall IES-R score >32 indicating that PTSD was a probable diagnosis. The mean SAS score that had been converted to anxiety index scores was 40.78 (SD = 9.25). The results showed that 30% of mental health nurses experienced anxiety levels from moderate to extreme. Overall findings confirm that mental health nurses are experiencing psychological distress as a result of working during the COVID-19 pandemic. Nurses who were <30 years of age or who were in their current roles for less than a year or were ward-based and worked full-time, were most likely to be affected. Working during COVID-19 has not been routine work practice and for a cohort of workers who are already under pressure, the sacrifice in terms of general well-being has been immense. The offer of individualized psychological support for mental health nurses working during the pandemic should be both practical in nature and flexible enough to meet individual needs. [ABSTRACT FROM AUTHOR]

The article evaluates self-reported confidence of mental health nurses in recognizing and managing physically deteriorating older patients in a mental health setting in Ireland. The study assessed the confidence of mental health nurses in the soundness of their clinical decision-making before and after an educational workshop using the National Early Warning Score (NEWS). The nurses were asked to make clinical judgment in two case studies of physically deteriorating adult patients.

Prescribing in mental health nursing in the Republic of Ireland is still an unusual occurrence and despite an uptake in prescriber training, this does not often translate to practice. Recent Irish research, however, has identified that nurse prescribing when offered, is perceived to enhance care and offer better delivery of services. Since the legislation was introduced in the Republic of Ireland to enable nurses and midwives to prescribe in May 2007, there are now 1,123 nurses registered to prescribe medication. Mental health nurses, however, do not tend to be a priority when it comes to training in prescribing; in the UK it took two years after nurse prescribing was rolled out to extend the scheme to mental health nursing. Although nurse and other professional perspectives explored this topic, there is limited research specifically detailing the experience of service users in long term care who are prescribed by mental health nurse practitioners in a home care setting. This research follows a qualitative exploratory research design using thematic analysis to explore service user (n = 12) experiences of mental health nurse prescribing. The following four themes emerged from the analysis: 'empowerment and trust'; 'person-centered care'; 'time and flexibility' and 'collaborative approach'. Results indicate a positive and rich experience of nurse prescribing, which facilitate a more trusting, holistic and autonomous therapeutic relationship. Future research looking at other issues relating to medication including reduction and support for coming off where appropriate is recommended [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: ECT is a fast‐working and potentially life‐saving treatment, but it is still considered a controversial treatment choice.Due to lack of knowledge and public stigma, ECT can be an anxiety‐inducing treatment for people experiencing severe depression.The nurse's role is to alleviate this anxiety, aid recovery and minimize the risk of relapse. They manage this onerous task ideally through the therapeutic relationship, and use the skills of assessment and risk identification in order to maximize patient outcomes. What this paper adds to existing knowledge?: The views of mental health nurses who provide care for adults receiving treatment of ECT for severe depressive illness are in the main positive.The knowledge of and attitude towards ECT among nurses may reflect on patients and influence treatment choice. If stigma is not addressed, then patients will not be appropriately informed regarding their treatment options.Mental health nurses need to engage in reflective practice to ensure that the dignity of the patient is maintained throughout this treatment. What are the implications for practice?: Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care in the delivery of ECT.Education modules should include a presentation of evidence of effectiveness of ECT as a treatment option.Dialogue among mental healthcare colleagues is important about caring for people presenting for ECT treatment. This will ensure that the mental health nurse can remain cognizant of the potential for patient distress throughout this treatment. Background: There is a considerable dearth of literature on attitudes towards Electroconvulsive Therapy (ECT) as a treatment for severe depression. Despite being a highly effective treatment, it is still stigmatized even among professionals. Understanding perceptions and knowledge related to ECT treatment among healthcare providers is important for ensuring that treatment can be safely explored as a treatment option with patients. Aim: The overall aim of this study is to explore the views of mental health nurses who provide nursing care to people receiving ECT for severe depressive illness in a mental health setting. Methods: This is a qualitative study using focus groups (n = 2) with 14 mental health nurses who had a minimum of 3 months experience caring for older adults receiving ECT. Transcripts were subjected to a thematic analysis. Full ethical approval was granted for this study. Results: In total, four themes were identified exploring attitudinal changes, managing patient dignity, reflecting changes in practice and managing the unknown. In general, participants experienced ECT as a positive treatment option for adults with severe depressive illness contributing to an enhanced quality of life. Conclusion: Findings indicate a desire to improve person‐centred care for patients undergoing ECT. Educational support for nurses who work in this area would improve confidence on work practices and lead to improved patient experience. Mental health personnel without direct experience of the treatment should be exposed to educational modules to decrease stigma and to best facilitate informed decision‐making among the patient cohort. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to help to identify and support the person with the associated challenges of child sexual abuse (CSA).Feelings of discomfort have been identified by mental health nurses (MHNs) when working with survivors of CSA due to a lack of knowledge, poor confidence and feeling unprepared to inquire and respond to such a sensitive topic. What does the study add to existing knowledge?: MHNs are willing to engage in CSA dialogue; however, the level of engagement is often conditional with clear parameters set by participants.Whilst all participants reported they were willing to engage in conversation initiated by the service user, some were unwilling to listen to details of the CSA and used strategies to censor service users from providing details of the CSA. What are the implications for practice?: Whilst self‐protecting boundaries helped MHNs to engage in CSA dialogue, strategies to censor aspects of the service user's dialogue may reinforce the belief that their experience of CSA is too shameful to talk about, hence denying the reality of their experience and contributing to feelings of re‐shaming.MHNs need a combination of theoretical knowledge and psychosocial skills to achieve clinical competence when working with CSA; therefore, training should not only include information pertaining to facts and statistics but also case presentations, clinical training and supervision.Clinical supervision was highlighted by all participants as a necessary means of formal support, more specifically group clinical supervision whereby peer support can also be availed of in a formalized setting. Introduction: The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to support the person with the associated challenges of CSA, yet little is known about the preparedness of MHNs to work with this client population. Aim: To explore MHNs' perceived preparedness to work with adults who have CSA histories, and to elicit their views, skills and confidence in relation to working with this sensitive issue. Method: In‐depth semi‐structured interviews were conducted with five consenting MHNs. A qualitative descriptive methodology informed the study. A thematic analysis framework guided the data analysis. Results: The findings assert that MHNs are willing to work with survivors of CSA despite feeling unprepared to so, MHNs described feeling ill‐prepared in how to respond to CSA, calling for not just education and training specific to CSA but also citing the need for clinical supervision and additional guidelines to enhance their preparedness. Discussion: Results of this study further highlighted the omission of CSA within nursing curricula and the absence of role models within clinical practice as a major barrier to preparedness to work with survivors of CSA. Recommendations are made for training, education and the inclusion of clinical supervision. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the processes involved in introducing electronic health records in a healthcare organisation • To explore the challenges of implementing large-scale digital change in a mental health service • To gain awareness of the need for nurse representation and nurse leadership in digital change Electronic health record (EHR) systems can contribute to improve the quality of care, but mental health services have been slow to adopt them. There is little research about introducing EHRs in mental healthcare settings and even less research on the role of nurses in such digital change projects. This article describes the implementation of an EHR system in a private mental health service in Ireland, focusing on the role of the nurse lead for the project. It describes the process of change according to a five-stage framework and explains how the nurse lead's role was central in brokering knowledge and innovation and in spanning boundaries between disciplines and departments. [ABSTRACT FROM AUTHOR]

LGBTI clients present specific challenges for the mental health profession with key issues for transgender people identified as including isolation, fear, stigma, and family rejection, all of which contribute to the transgender community's high levels of depression, anxiety, substance misuse, self-harm, and suicide. This qualitative research paper explores the experiences of Irish psychotherapists working with transgender clients to explore specifically the nature of the therapeutic relationship. Using an interpretive phenomenological approach, it examines the subjective experience of three participant psychotherapists and endeavours to make sense of the phenomenology that emerged from semi-structured interviews. The phenomenological analysis of the data collected resulted in three salient themes emerging: (i) Therapeutic identification, (ii) Maternal countertransference, and (iii) Confusion. It is hoped that these findings which relate to the therapeutic relationship will be of utmost importance to others working within the mental health profession where recovery is dependent on the strength of this relationship. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including electroconvulsive therapy (ECT), clinical evidence demonstrating its efficacy and safety, and wider mental health community.

The aim of this study is to explore mental health student nurses' perceptions and application of a CBT-orientated training programme – the Decider Life Skills programme. The undergraduate nursing degree programme is a challenging one and places high demands both professionally and personally on students. Mental health nursing students are faced with particular stressors including working with people in significant psychological distress, which can result in students feeling overwhelmed and emotionally burdened. There is a requirement for student nurses to be supported to cope with professional and personal difficulties while on practice placement. The Decider Life Skills is a one-day training programme that aims to build resilience and increase effective coping skills. This programme was offered to internship mental health nursing students with the aim of providing them with a toolbox of skills to maintain their wellbeing while on clinical placement. A qualitative descriptive design was used, and data were collected through two 45-min focus group interviews with mental health students (n = 10) on their internship placement. These students had received a one-day training in Decider Life Skills prior to their clinical placements. Full ethical approval was achieved for this study. Participants reported that they found the skills imparted in the training easy to understand and apply in both their professional and their personal lives. The findings from this study that the Decider Life Skills helped students cope in stressful situations and become more mindful of protecting their own mental health is important, as there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners. • The Decider Life Skills had a positive influence on participants' clinical placement. • The skills were understandable and easily applied professionally and personally. • Participants' used skills during their interactions with staff when receiving feedback. • Training increased participants' confidence in facilitating service-user groups. • Training improved participants' self-care and protection of their mental health. [ABSTRACT FROM AUTHOR]