Research quality and psychological theory in publications on school shooters with multiple victims : a systematic review of the literature

School shooting homicide events generate considerable attention. A substantial number of research reports have tried to explain the phenomenon. However, the outcome of these studies has produced a conflicting picture of the issue. Our systematic review explored the quality of research in publications on school shooters. Research quality was assessed concerning description of design, method, and interpretation of results according to PRISMA and CRD criteria. We investigated evidence of the impact of psychological theories on how research was designed and interpreted. A total of ten papers met the criteria for inclusion in the review. With a few exceptions the research quality was low. Only three studies contained a separate methods section. Two out of ten studies reported from an interview with a school shooter. Secondary sources such as school, hospital and/or psychological evaluations, were used in four studies, while the rest had only applied tertiary data sources. There was a void of psychological theoretical analysis to inform the creation of relevant research designs. No study discussed psychological theories to inform inference from empirical data to conclusion. Higher quality of research and enhanced focus on theoretical understanding of psychological factors in school shooting are called upon. Keywords: School shootings, homicide, violent crime, psychological theory, literature reviewpublishedVersio

Interprofessional collaboration concerning persons in transition between mental health and criminal justice services : PINCOM used as a framework for HCR-20V3 assessment

This chapter provides a novel framework for risk assessment and management by combining the Perception of Interprofessional Collaboration Model (PINCOM) and Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3). PINCOM was developed to identify central aspects of interprofessional collaboration, whereas HCR-20V3 is the most used instrument in risk assessment of violence worldwide. The main scope of this chapter is to introduce and discuss the feasibility of combining the two tools to enhance collaboration between service providers in the mental health and criminal justice systems. First, we describe the HCR-20V3 and suggest how parts of it can be jointly used as a tool for concrete collaboration in the practice field. Next, we present the PINCOM tool, containing a conceptual model (PINCOM) and a research methodology (PINCOM-Q). It is suggested that the HCR-20V3 serves as a meeting point between different professionals for being concrete in joint casework. PINCOM can then be used within a larger social innovation framework and as a reflective tool during or after this structured professional assessment and acting as a catalyser for constructive collaboration.publishedVersio

Protective factors against psychological distress among inpatients in substance use treatment : a cross-sectional study

Several studies have found co-occurrence between substance abuse and mental health problems, as well as an association between treatment retention and psychological distress. The aim of this study was to investigate the association of possible protective factors with psychological distress. The present study tested physical activity, self-esteem and sense of coherence, and psychological distress level among inpatients in substance use treatment. The study design was cross-sectional and multicenter. Patients (N = 167) were recruited in 2018 from 10 Norwegian inpatient facilities. They self-reported on 3 validated measurement instruments: Rosenberg Self-Esteem Scale, Antonovsky’s Sense of Coherence Scale, and frequency of physical activity. The Hopkins Symptom Checklist-10 was used as an outcome variable of psychological distress. The associations were investigated with multiple linear and logistic regression methods. The results suggested that high self-esteem and sense of coherence were protective factors against high levels of psychological distress: self-esteem (β = −.39, P < .001) and sense of coherence (β = −.352, P < .001). The results offer support for a salutogenic approach in substance use disorder (SUD) treatment by enhancing individuals’ protective factors to reduce psychological distress. Keywords: Inpatient treatment; protective factors; psychological distress; self-esteem; sense of coherence.publishedVersio

Development and reliability testing of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI) : an assessment instrument of mental health nursing documentation

Aim: To develop and test the reliability of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI). Therapeutic nurse–patient interactions are fundamental in mental health nursing. However, little is known about how these interactions are recorded in nursing documentation and there is no instrument available for collecting this type of information for quantitative analysis. Design: Instrument development and reliability testing. Methods: The development of the SESPI was based on qualitative analyses of progress notes retrieved from patient records in two mental health services. A self psychological attunement perspective guided the analyses. SESPI was tested for internal consistency and inter‐rater reliability after 22 nurses independently scored 10 progress notes. Results: Cronbach's alpha for the entire instrument was 0.977, indicating that the raters’ scores had very high internal consistency. ICC was 0.770. The alpha and ICC values for each step were high, varying between 0.970 and 0.992. Keywords: empathy, inpatients, instrument development, medical record, nurse–patient relations, nursing assessment, psychiatric nursingpublishedVersio

The quality and quantity of staff-patient interactions as recorded by staff : a registry study of nursing documentation in two inpatient mental health wards

Background: Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. Methods: The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. Results: Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. Conclusion: These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.publishedVersio

The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education : an integrative review

Background: An important goal in mental health education is for students to develop their ability to provide care and help to people with different degrees of mental problems. Positive experiences with the use of clinical role-play and subsequent reflection inspired us to investigate whether previous empirical studies had evaluated similar methods of teaching and to scrutinize the effects on students’ development of therapeutic skills and clinical reflection. Method: An integrative review was conducted to search the literature for findings from both qualitative and quantitative research. Systematic searches of literature were done in Ovid (MEDLINE, PsycInfo), Cinahl, Cochrane, ScienceDirect, SweMed, Norart, ProQuest, and Google Scholar. Results: The systematic literature search provided 42 full-text articles and four articles met the inclusion criteria. The results suggest that role-play in health education enhances students’ therapeutic and communicative skills. Nevertheless, there is limited research on the use of role-play in teaching therapeutic skills, and few studies that investigate how role-play affects students’ reflections on own practice. The literature search did not discover studies investigating whether practicing role-play in educational settings has consequences for clinical practice. Conclusion: Based on this current review, role-playing in supervised groups seems to promote reflection and insight not only for students in the patient and therapist roles, but also for peers observing the group sessions. According to the included studies, clinical role-play facilitates helper–user equality and increases students’ involvement, self-efficacy, and empathic abilities in mental health practice. Keywords: review, education, nursing, role-play, reflection, therapeutic communicationpublishedVersio

Using social innovation as a theoretical framework to guide future thinking on facilitating collaboration between mental health and criminal justice services.

Offender mental health is a major societal challenge. Improved collaboration between mental health and criminal justice services is required to address these challenges. This paper explores the potential social innovation as a concept that offers an alternative perspective on collaborations between these services and a framework to develop theoretically informed strategies to optimize interorganizational working. Two key innovation frameworks are applied to the offender mental health field and practice illustrations provided of where new innovations in collaboration, and specifically cocreation between the mental health system and criminal justice system, take place. The paper recommends the development of a competency framework for leaders and front line staff in the mental health system and criminal justice systems to raise awareness and skills in the innovation process, especially through cocreation across professional and organizational boundaries

Factor analytical examination of the evidence-based practice beliefs scale : indications of a two factor structure

Background: Promotion of Evidence-Based Practice (EBP) in nursing appears to be developing slowly. Research indicates that nurses’ beliefs in EBP may play an even more significant role than knowledge and resources in making implementation feasible. To address this issue, measurement of nurses’ beliefs regarding EBP is paramount. Aims and objectives: This study explores the internal consistency reliability and the construct factor structure of the Norwegian version of the original Evidence- Based Practice Beliefs Scale (EBP-BS). Methods: The study has a Non-experimental exploratory survey design. A Norwegian translation of the EBP-BS was tested in a convenience sample of 118 healthcare professionals (95% nurses) attending a continuing education program at a University College in Norway. The response rate was 95% (n = 112). The internal consistency of the scale was measured by Cronbach’s alpha, and an explorative Principal Component Analysis (PCA) was used to explore the construct structure. Results: The overall internal consistency of the EBP-BS was acceptable. The PCA indicated a four-factor structure. The psychometric properties of two of the factors were too weak for expanding to a four-factor model. Based on our investigation of the EBP-BS, we suggest a two-factor structure model. The factors were named 1) General knowledge and confidence concerning EBP and 2) Task specific beliefs in EBP. This finding differs from previous results that indicated a unidimensional structure. Conclusion: As a starting point, reliable and valid measurement of nurses’ beliefs about EBP is required in order to identify possible obstacles and to optimize implementation in the individual clinical setting. Our results indicate that the EBP-BS has a two-factor structure. Further exploration of the factor structure is needed. Further empirical research may contribute to the resolving of controversies concerning basic understandings of the concept of EBP. Keywords: evidence-based practice, beliefs scale, nurses, Psychometric Evaluation, Principal component analysispublishedVersio

Are symptoms assessed differently for schizophrenia and other psychoses in legal insanity evaluations of violent crimes?

Background: Forensic evaluations of legal insanity include the experts’ assessment of symptoms present at the mental state examination (MSE) and the mental state at the time of offense (MSO). Delusions and hallucinations are most important. We explored how often symptoms were recorded in written forensic reports. Design: This exploratory, cross-sectional study included 500 reports of legal insanity written in 2009–2018 from cases of violent crimes in Norway. The first author read all reports and coded symptoms recorded from the experts’ assessments of the offenders. Two co-authors repeated this procedure for 50 randomly selected reports. Interrater reliability was calculated with Gwet’s AC1. Generalized Linear Mixed Models with Wald tests for fixed effects and Risk Ratios as effect sizes were used for the statistical analyses. Results: Legal insanity was the main conclusion in 23.6% of the reports; 71.2% of these were diagnosed with schizophrenia while 22.9% had other psychotic disorders. Experts recorded few symptoms from MSO, but more from MSE, although MSO is important for insanity. We found a significant association between delusions and hallucinations recorded present in the MSO and legal insanity for defendants with other psychotic disorders, but no association for defendants with schizophrenia. The differences in symptom recordings between diagnoses were significant. Conclusion: Few symptoms were recorded from the MSO. We found no association between presence of delusions or hallucinations and legal insanity for defendants with schizophrenia. This may indicate that a schizophrenia diagnosis is more important to the forensic conclusion than the symptoms recorded in the MSO. Keywords: delusions, hallucinations, forensic, insanity, bias, stigmapublishedVersio

Ledelse som balansekunst. Når tverrsektorielle ambisjoner møter kommunale rammebetingelser

Denne studien handler om lederes betydning for tverrsektorielt samarbeid. Å lykkes med samarbeid på tvers er en utfordring som mange organisasjoner og ledere kan kjenne seg igjen i. Dette er også noe vi selv har erfart fra ulike roller i forskjellige organisasjoner. Det er lagt til grunn tre forskningsspørsmål for studien: 1. Hva er konteksten for ledere i en kommune? 2. Hvilke faktorer hemmer og fremmer ledelse av tverrsektorielt samarbeid? 3. Hvordan kan man som leder jobbe for å fremme tverrsektorielt samarbeid? Vi har tatt utgangspunkt i kommunen som organisasjon, og brukt institusjonell teori for å beskrive kompleksiteten som kjennetegner det landskapet ledere skal forholde seg til. Videre har vi belyst hvilke faktorer som fremmer eller hemmer tverrsektorielt samarbeid. For å drøfte lederrollen og hvilken betydning denne har for å skape samarbeid på tvers av “siloer” utvider vi fortolkningsrammen ved å drøfte hvilken form for ledelse som synes å kunne bidra til dette arbeidet. Datamaterialet er basert på intervjuer av syv ledere på forskjellige nivåer i en kommune, samt en dokumentanalyse. Resultatet av studien viser at ledere oppfatter at det er flere faktorer som påvirker det tverrsektorielle samarbeidet. I tilfeller hvor samarbeid på tvers lykkes fremheves felles mål, personlige relasjoner, felles møtearenaer og kultur for samhandling. Økonomi, byråkrati, strenge rapporteringsrutiner og føringer fra gjeldende lovverk ser ut til å hemme samarbeidet. Spesielt virker økonomiske spørsmål å overskygge ambisjoner om tverrsektorielt samarbeid, Videre ser ledelse ut til å ha en betydning for hvorvidt man lykkes med tverrsektorielt samarbeid. Karismatiske ledere med en overbevisende visjon, som er tillitsskapende og relasjonsorienterte, kan bidra til endring av fokus og mål i organisasjonen, og kan således utfylle en mer transaksjonsorientert lederstil