The mental health of nurses in acute teaching hospital settings: A cross-sectional survey

Background: Nursing is an emotionally demanding profession and deficiencies in nurses\u27 mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses\u27 health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods: A cross sectional survey design was used. Results: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n=49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12month. Conclusion: Nurses and their managers should strive to create workplaces where working practices promote nurses\u27 health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration

“Mental health day” sickness absence amongst nurses and midwives: Workplace, workforce, psychosocial and health characteristics

Aim To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’. Background The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a ‘mental health day’ as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. Design Online cross-sectional survey. Methods Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of ‘mental health day’ reportage were determined using logistic regression. Results Fifty-four percentage of the n = 5041 nurse and midwife respondents took ‘mental health days’. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. Conclusion Specific characteristics of nurses and midwives who report taking ‘mental health day’ sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

Aim and objectives: To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals. Background: Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate. Design: A cross‐sectional survey using the STARD guidelines was used. Methods: The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open‐ended question on violence prevention management strategies was also conducted. Results: Comprising of 14 items with two factors (patients and staff), the study revealed a 9‐item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies. Conclusions: The use of the 9‐item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting. Relevance to clinical practice: The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence

Mental health liaison nursing, taking a capacity building approach

Purpose: This paper explores the use of capacity building practice as an approach for the mental health liaison nurse (MHLN). Conclusions: The role of the MHLN has established itself within nursing, with various approaches to the role documented in the nursing literature. Most descriptions of the role are limited by simply explaining what the MHLN does, rather than explaining the underlying approach and evaluation of the model suggested. Capacity building practice is explored in the context of the liaison role, and its use is demonstrated in a clinical example of suicide risk in a general hospital setting. Practical Implications: The future scope of MHLN and their use of capacity building approaches may lead to the improvement of consumer health outcomes and also develop the skill of the non-mental health nurse in generalist settings

Risk analysis : an integrated approach to the assessment and management of aggression/violence in mental health

Assessing a patient's risk of violent behaviour, predicting dangerousness and the development of a subsequent management plan have become integral and important aspects of contemporary mental health practices. What is less clear, and much discussed within the literature, is how we should best implement risk assessment and risk management practices within mental health care. The aim of this paper is to critically discuss risk assessment practices in order to propose a systematic approach to the effective assessment and management of aggression and violence in mental health settings. A critical review of the risk literature in mental health was undertaken. The literature search highlighted different generations or approaches to risk assessment methodology, which were critically reviewed. From this critical review a proposed model entitled ‘risk analysis’ is argued from the appraisal and critique of the literature as a more encompassing and collaborative approach to the assessment and management of risk

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the 'cardiometabolic mental health nurse' is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness

Challenging behaviour, risks and responses

It has been argued that the nurse–consumer relationship is central to nursing care. Nurses in general are in continuous and direct contact with consumers and, as such, spend extended periods of time with them. Continuous contact places nurses in a unique position to develop therapeutic relationships with consumers through processes of collaboration, inclusiveness, mutuality and respect. However, there may be times when the relationship nurses have with consumers is tested, placing nurses in a difficult position and facing challenging behaviour (Stein-Parbury 2014). ‘Challenging behaviour’ is a term used by nurses to describe behaviour that disrupts relationships with others and complicates healthcare delivery—for example, aggression, manipulation, self-harm, suicide and psychosis-related behaviour. The terms ‘difficult behaviour’, ‘problem behaviour’, ‘difficult patient’ and ‘behaviours of concern’ have all been used to describe challenging behaviour (Farrell et al. 2010). Challenging behaviour occurs in inpatient units, community settings, emergency departments, general hospitals and primary care settings

The 'difficult' nurse-patient relationship : development and evaluation of an e-learning package

Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care. This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed. Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations