Systematic review of studies of mental health nurses' experience of anger and of its relationships with their attitudes and practice

IntroductionEmotional regulation is important in mental health nursing practice but individual emotions may require different regulation strategies. There is ample evidence that nurses experience anger specifically during their work, for example when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice.AimWe aimed to systematically identify, evaluate, and synthesise results from studies about mental health nurses and anger, where anger was measured objectively.MethodsSystematic literature review based on PRISMA guidelines.Results.We identified 12 studies. A range of validated and non-validated instruments were used. Mental health nurses may have lower levels of anger than normative samples but anger is commonly reported as an issue for them. Anger was studied in relation to its links with i) clinical management of patients, notably violence containment; and ii) employment issues more generally, notably job motivation. Anger is related to nurses’ attitudes about the acceptability of coercion but there is no evidence that it results in more coercion.Implications for practiceNurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for example in clinical supervision. Emotional regulation training should target anger

Mixed methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Aims and objectives: To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of Borderline Personality Disorder. Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ).Background: Attitudes towards people with a diagnosis of Borderline Personality Disorder are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of borderline personality disorder. No previous intervention has been co-produced with an expert-by-experience. We developed and delivered a 1-day intervention comprising these elements.Design: A mixed-methods design was used comprising prospective uncontrolled cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK.Methods: Measurement of cognitive and emotional attitudes to people with a borderline personality diagnosis at pre- and post- intervention (N =28) and at 4-month follow-up. Focus groups were used to explore participants’ experiences of the intervention (N =11).Results: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies, and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert-by-experience. Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful.Relevance to clinical practice: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert-by-experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care. <br/

Foodservice in hospital: development of a theoretical model for patient experience and satisfaction using one hospital in the UK National Health Service as a case study

Hospital foodservice does not operate in isolation but requires the cooperation and integration of several disciplines to provide the ultimate patient experience. The objective of this research was to explore the antecedents to patient satisfaction and experience, including the service element. Accordingly, focus groups were conducted with doctors (n = 4), nurses (n = 5), ward hostesses (n = 3) and patients together with their visitors (n = 10), while open-ended interviews were conducted with the foodservice manager, facilities manager, chief dietitian, orthopaedic ward dietitian and chief pharmacist. Themes centred on ‘patients’, ‘foodservice’ and ‘mealtimes’, and results show that food qualities, particularly temperature and texture, are important factors impinging on patient satisfaction, and the trolley system of delivery is an acceptable style of service. Service predisposition demonstrates little relevance to patient satisfaction towards overall meal enjoyment. A theoretical model has been developed that identifies hospital foodservice in a cyclic relationship with the community primary healthcare team

Exploring Predictors of Teamwork Performance in an Interprofessional Education Setting

Abstract EXPLORING PREDICTORS OF TEAMWORK PERFORMANCE IN AN INTERPROFESSIONAL EDUCATION SETTING By Danah M. Alsane, MS. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Pharmaceutical Science at Virginia Commonwealth University Virginia Commonwealth University, 2016 Advisor: Patricia Slattum, Pharm.D., Ph.D. Professor and Director of the Geriatric Pharmacotherapy Program Department of Pharmacotherapy and Outcomes Science Objectives: The primary objective of this study was to explain how individual characteristics influence teamwork development. In addition, it evaluated how teamwork development, in conjunction with content knowledge, impact students’ performance on a team-based project in an Interprofessional Quality Improvement and Patient Safety (IPQIPS) course. Methods: This cross sectional study included medical, pharmacy, and nursing students enrolled in an IPQIPS course offered for the first time at VCU. Predictors of teamwork development examined included collective orientation (measured using the Collective Orientation Scale, which included dominance and affiliation subscales), and prior interprofessional teamwork experience (measured using self-report). The Team Development Measure (TDM) was used to measure teamwork development. The Statistical Process Control Quiz (SPCQ) was used to assess content knowledge acquired during the course. The final project score was used to evaluate students’ performance on a team-based project. Structural equation modeling was used to test study hypotheses. Results: Among the proposed predictors (dominance, affiliation, and interprofessional teamwork experience), only dominance was related to TDM. No significant relationship was found between teamwork development combined with content knowledge and successful accomplishment of team-based project. Conclusion: This study was the first to our knowledge to simultaneously assess the impact of individual characteristics on teamwork development, and how teamwork development (combined with individual student knowledge) influences students’ performance on team-based project in an interprofessional education setting. Although findings were not conclusive, several potential avenues for future study are highlighted

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

© 2019 Author(s). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJConducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity. Aim : To identify variability in the research infrastructure of UK intensive care units (ICUs) and their ability to conduct research and recruit patients into clinical trials. Design: We evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analysis of two datasets (one dataset had been analysed previously) was undertaken in the thematic analysis. Findings: The synthesis yielded an overarching core theme of Normalising Research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: Organisational, Human, Study, Practical resources, Clinician, and Patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined. Conclusions: The central and transferable tenet of Normalising Research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is requisite for all healthcare individuals from organisational to direct patient contact level.Peer reviewedFinal Published versio

Perception of Patient Cooperation Among Dentist, Guardian, and Child

Purpose: Evaluate behavior assessment and agreement among dentist, guardian, and child. Evaluate child behavior by appointment type. Methods: Patients recruited from the pediatric dental department at Virginia Commonwealth University for this convenience sample. Inclusion criteria: patients presenting for clinical exams and/or restorative treatment without the use of advanced behavior guidance between August 29, 2018, and March 7, 2019; ages 4-12-years-old; and scheduled with a single clinician. Appointments were stratified by difficulty. Behavior was assessed by dentist and caregiver using the Frankl Scale. Patient self-assessed cooperation using an age-appropriate modified Frankl Scale, developed for this study. Agreement assessed among the 3 scores at each appointment using descriptive statistics and Cohen’s Kappa. Behavior trends across appointment type assessed using Kruskal-Wallis test. SAS software (2013, Cary, NC). P-value \u3c 0.05. Results: Forty-one patient-guardian dyads enrolled in the study. Five dyads experienced multiple encounters. Demographics for the patients enrolled: 59% male; 44% Caucasian, 29% African American, 5% Asian, 2% Hispanic, 20% other/multiracial. Average patient age: 7.6 (range: 4- 12). Most patients had 1 encounter (n=36, 88%). Frankl Score agreement for provider/guardian was 79% (k=0.335), provider/child was 70% (k=0.248), and guardian/child was 81% (k=0.314). In disagreements, guardians rated behavior better than provider. Disagreement was split for provider/child and guardian/child, with the child tending to rate themselves higher, and the guardian tending to rate the child higher respectively. Marginal evidence that hard appointments resulted in poorer behaviors. Conclusion: There is fair agreement between child, guardian, and provider. In disagreements, guardians tend to rate the child’s behavior better compared to the provider and child self-assessment. Dental providers tend to be more critical of patient behavior. Marginal evidence to support harder appointments result in poorer behaviors

Clinical Psychologists\u27 Perceptions of Persons with Mental Illness

Clinical psychologists have an ethical responsibility to monitor the nature and appropriateness of their attitudes toward persons with mental illness. This article presents the results of a survey of randomly selected clinical psychologists who were asked to rate the effectiveness, understandability, safety, worthiness, desirability, and similarity (to the rater) of persons with moderate depression, borderline features, and schizophrenia. The results show that psychologists perceive these individuals differently with respect to these characteristics. The results also suggest that psychologists disidentify or distance themselves from persons with personality and psychotic conditions. Implications for quality improvement and stigma reduction in the field of professional psychology are discussed

Medical-Surgical Nurses\u27 Attitudes Toward Patients who are Homeless: How Attitudes Develop and Transform

People who are homeless rely heavily on acute health care facilities to meet basic health care needs. Medical-surgical nurses play a fundamental role in the health care and health outcomes of patients who are homeless. According to the Institute of Medicine, health care providers’ bias and stereotyping contribute to health disparities among marginalized and vulnerable populations. Because attitudes are linked to clinical decision making and behaviors, revealing how nurses’ attitudes towards patients who are homeless develop and transform is paramount to improving health disparities of the homeless population. The purpose of this study was to explore nurses’ clinical experiences with patients who are homeless in order to discover how attitudes toward care of the homeless develop and transform. Interpretive phenomenology was used to describe and interpret the experiences of 11 medical-surgical nurses who cared for patients who were homeless and reported their attitudes toward this marginalized population had transformed. Nurses’ clinical experiences ranged from 3 to 40 years. Audiotaped semi-structured interviews were conducted. Data analysis was ongoing throughout data collection as delineated by Diekelmann and Allen (1989) and expanded by Minick (1992). Five themes were revealed through interpretation of the rich data. The themes were ‘Discovering homelessness,’ ‘Finding common ground,’ ‘Piecing it together,’ ‘A daily struggle,’ and ‘Relationships based on distrust.’ Nurses’ attitudes were in constant development and transformation. Nurses’ life and clinical experiences created opportunities for attitude transformations. Experiences associated with attitude transformation were identified. Nurses’ experiences revealed how nurses enter practice with an established attitude toward this marginalized population. As nurses came to realize that homelessness was no longer an abstract, intangible concept rather homelessness existed and was present in their day-to-day nursing practices their attitudes began to transform. Nurses sought common experiences with patients who were homeless to create a sense of connectedness in nurse-patient relationships. Nurses described a daily struggle of maintaining positive, non-judgmental attitudes. Nurses shared how early experiences of negative encounters with patients who were homeless created feelings of distrust thus altering nurse-patient relationships with future patients who were homeless. This study contributes to nursing knowledge by revealing how medical-surgical nurses’ attitudes develop and transform and how experiences are associated with attitude change. Recommendations for nursing practice, education, research are identified