NHS England's confusion over mental health makes us fearful.

A key recommendation of the Francis report was for the National Institute for Health and Care Excellence (NICE) to review the evidence base for safe nurse staffing levels across care settings in England

What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis.

Background Young people with complex or severe mental health needs sometimes require care and treatment in inpatient settings. There are risks for young people in this care context, and this study addressed the question: ‘What is known about the identification, assessment and management of risk in young people (aged 11–18) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’ Methods In phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO) was undertaken. Items included were themed and presented to members of a stakeholder advisory group, who were asked to help prioritise the focus for phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and Web of Science) were searched. Websites were explored and a call for evidence was circulated to locate items related to the risks to young people in mental health hospitals relating to ‘dislocation’ and ‘contagion’. All types of evidence including research, policies and service and practice responses relating to outcomes, views and experiences, costs and cost-effectiveness were considered. Materials identified were narratively synthesised. Results In phase 1, 4539 citations were found and 124 items included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing the risks of ‘dislocation’ and ‘contagion’ were included supplemented by 20 policy and guidance documents. The quality of studies varied. Materials were synthesised using the categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis. Although we found evidence of consideration of risk to young people in these areas we found little evidence to improve practice and services. Conclusions The importance to stakeholders of the risks of ‘dislocation’ and ‘contagion’ contrasted with the limited quantity and quality of evidence to inform policy, services and practice. The risks of dislocation and contagion are important, but new research is needed to inform how staff might identify, assess and manage them

Introducing compassion into the education of health care professionals; can Schwartz Rounds help?

Whilst health care professionals embark on their careers with high ideals these can be eroded by the pressures and stress of the system. This paper explores the problems, which may lead both students and professionals, working in health care, to feel isolated and stressed. It considers the value of Schwartz Rounds as an initiative that can be used to enhance student well-being and ultimately enable students to treat each other, colleagues and patients with more compassion

Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2). A study protocol.

Background One in six five 16-year-olds have a probable mental health difficulty. Of these, almost half of older teenagers and a quarter of 11–16-year-olds report having self-harmed or attempted suicide. Currently, there is little research into mental health crisis services for young people, with little understanding of what services exist, who uses them, or what works best. Question ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? Objectives To describe National Health Service (NHS), local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales.To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services.To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families. Methods A sequential mixed methods approach, underpinned by normalisation process theory will be employed. A survey will create a detailed record of how crisis responses across England and Wales are organised, implemented and used. Subsequently, eight contrasting services in relation to geographic and socioeconomic setting, populations served, and service configuration will be identified as case studies. Interviews will be conducted with children, young people and parents/carers who have used the service, as well as commissioners, managers and practitioners. Operational policies and service usage data will also be examined. Analysis of how each service is provided, experienced, implemented and sustained will be conducted both inductively and deductively, reflecting normalisation process theory constructs.</ns4:p

Nursing students' trait mindfulness and psychological stress: A correlation and mediation analysis

Background Nursing students face a great amount of psychological stress during their nursing education. Mindfulness-based training has received increased recognition from nurse educators regarding its effect on reducing students' psychological stress. Study evidence has supported that cultivation of trait mindfulness through Mindfulness-based training was the key to this effect. However, there is a lack of research that focuses on intricate relationships between various facets of trait mindfulness and psychological stress. Objective Examining the relationships between various trait mindfulness facets and psychological stress. Design A cross-sectional design was used to collect data on trait mindfulness facets and psychological stress. Participants A convenience sample of 99 undergraduate nursing students from a Bachelor of Nursing program completed this study. Setting This study was conducted in a university in the south-eastern United States. Method Participants completed an online questionnaire, which collected their demographic information, trait mindfulness (the Five Factor Mindfulness Questionnaire), and psychological stress (the Perceived Stress Scale-10). Correlation and mediation analyses were applied. Results Other than the trait mindfulness facet of observing, the remaining three facets (acting with awareness, non-judging, and non-reactivity) were negatively correlated with psychological stress. Observing had little to low correlations with non-judging and acting with awareness, but attained a moderately positive correlation with non-reactivity. Moreover, observing could indirectly predict psychological stress, when non-reactivity served as a mediator. Finally, non-judging partially mediated the relationship between acting with awareness and psychological stress. Conclusions The results of the current study can help nurse educators better understand the intricate relationships between various facets of trait mindfulness and psychological stress. Specifically, facets of acting with awareness, non-judging, and non-reactivity are directly relevant to the reduction of psychological stress. Therefore, regardless of formal or informal practices of mindfulness, nurse educators ought to assist students in cultivating these facets as means toward stress management

Qualified and Unqualified (N-R C) mental health nursing staff - minor differences in sources of stress and burnout. A European multi-centre study

BACKGROUND: Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care. METHODS: A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ). RESULTS: (a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems. CONCLUSION: The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt)

Qualified and Unqualified (N-R C) mental health nursing staff - minor differences in sources of stress and burnout. A European multi-centre study

<p>Abstract</p> <p>Background</p> <p>Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.</p> <p>Methods</p> <p>A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).</p> <p>Results</p> <p>(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.</p> <p>Conclusion</p> <p>The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).</p

The meaning of compassion fatigue to student nurses: an interpretive phenomenological study

Background: Compassion fatigue is a form of occupational stress which occurs when individuals are exposed to suffering and trauma on an ongoing basis. The purpose of this study was to explore the experiences of compassion fatigue among student nurses following their first clinical placement in a UK health care setting during 2015. Methods: The aim of this study was to explore students’ thoughts and feelings about compassion fatigue using reflective poems as a source of data. An interpretive phenomenological approach was taken using a purposeful sampling strategy which aimed to explore in depth meaning of the concept as experienced by the students. Results: From this study it is clear that students experience compassion fatigue and this has a psychological effect on their wellbeing and ability to learn in the clinical practice setting. Reflective poetry writing enabled articulation of feelings which were at times negative and linked to the student’s status as a novice nurse. Conclusions: Students experience compassion fatigue and educators need to find ways to provide support in both clinical and university settings. Positive practices such as shared reflection and the use of creative teaching methods might be beneficial, to support exploration of feelings, build resilience and effective ways of coping