Search Results (156)

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ attitudes toward coercion and their associations with sociodemographic and professional characteristics. Methods: A cross-sectional study was conducted on 356 MHCWs from a mental health department in Southern Italy. Participants completed the Staff Attitude to Coercion Scale (SACS), which assesses negative, pragmatic, and positive attitudes toward coercion. Descriptive statistics (i.e., frequencies, percentages, means) and bivariate analyses (i.e., one-way ANOVA) were used to explore the associations between variables. Results: The majority of participants were male (56.7%), nurses (50.3%), and worked in acute psychiatric settings (52%), with a mean age of 51.08 years (±10.59) and 13.74 years (±12.14) of experience in mental health. Attitudes differed significantly according to age, sex, professional role, and work setting. More negative attitudes were found among staff in residential settings and non-caring roles (p < 0.001). Pragmatic attitudes were lower among older staff (p = 0.012) and among those in residential settings and non-caring roles (p < 0.001). Positive attitudes were higher among males (p = 0.001), nursing staff (p < 0.001), and staff in acute settings (p = 0.049). Conclusions: Italian MHCWs reported different attitudes toward coercion, which was influenced by personal and professional factors. These findings highlight the need for targeted interventions and policy strategies to promote attitudinal change, particularly in settings where positive attitudes are prevalent. Full article

Background: Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence. Methods: We conducted a retrospective case–control study to evaluate the impact of sexual assault center (SAC)—centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault. Results: We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; p = 0.666) and adjusted (OR: 0.81, 95%CI 0.58–1.11; p = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; p < 0.001) and delayed (67.3% vs. 33.7%; p < 0.001) psychological support. Conclusions: SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. What is already known on this topic—Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. What this study adds—This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy—Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers. Full article

Introduction: Few applications worldwide focus on psychosocial rehabilitation, and none specifically address psychosocial rehabilitation projects. This justifies the need for an application to assist mental health professionals in constructing and managing such projects in the Brazilian mental health scenario. Objective: This study aimed to present a web application, the “Psychosocial Rehabilitation Application” (Psychosocial Rehab App), and describe its development in detail through a technological survey conducted between May 2024 and February 2025. Method: The development process of the web app was carried out in the following four stages, adapted from the Novak method: theoretical basis, requirements survey, prototyping, and development with alpha testing. The active and collaborative participation of the main researcher (a psychiatric nurse) and two undergraduate software engineers, supervised by a software engineer and a professor of nursing and psychology, was essential for producing a suitable operational product available to mental health professionals. Interactions were conducted via video calls, WhatsApp, and email. These interactions were transcribed using the Transkriptor software and inserted into the ATLAS.ti software for thematic analysis. Results: The web app “Psychosocial Rehabilitation Application” displays a home screen for registration and other screens structured into the stages of the psychosocial rehabilitation project (assessment, diagnosis, goals, intervention, agreements, and re-assessment). It also has a home screen, a resource screen, and a function screen with options to add a new project, search for a project, or search for mental health support services. These features facilitate the operation and streamline psychosocial rehabilitation projects by mental health professionals. Thematic analysis revealed three themes and seven codes describing the entire development process and interactions among participants in collaborative, interrelational work. A collaborative approach between researchers and developers was essential for translating the complexity of the psychosocial rehabilitation project into practical and usable functionalities for future users, who will be mental health professionals. Discussion: The Psychosocial Rehab App was developed collaboratively by mental health professionals and developers. It supports the creation of structured rehabilitation projects, improving decision-making and documentation. Designed for clinical use, the app promotes autonomy and recovery by aligning technology with psychosocial rehabilitation theory and the actual needs of mental health services. Conclusions: The Psychosocial Rehab App was developed through collaborative work between mental health and technology professionals. The lead researcher mediated this process to ensure that the app’s functionalities reflected both technical feasibility and therapeutic goals. Empathy and dialog were key to translating complex clinical needs into usable and context-appropriate technological solutions. Full article

Background/Objectives: Postoperative delirium has not been well explored in patients undergoing elective hip and knee arthroplasty. This study assessed the incidence of delirium in these patients in the postanesthetic care unit (PACU) and throughout their hospital admission. Predictors of postoperative delirium and impact of delirium on length of stay were also analyzed. Methods: This prospective observational study recruited patients (n = 978) with normal cognitive function presenting for elective primary hip or knee arthroplasty at a single tertiary academic center. Delirium was assessed using the Nursing Delirium Scoring Scale (NuDESC) in the PACU, and twice daily after that on postoperative days 1, 2 and 3, or until discharge, whichever came first. Results: In total, 26 (2.7%) patients developed delirium postoperatively. Unadjusted logistic regression analyses revealed that age; history of cardiovascular, central nervous system, hematologic, endocrinologic, psychiatric disease; postoperative opioid use; and ASA level were associated with an increased risk of delirium, with odds ratios (95% confidence interval) of 1.7 (1.35 to 2.11), 3.6 (1.09 to 12.25), 3.5 (1.53 to 8.03), 2.7 (1.09 to 6.45), 2.3 (1.04 to 4.97), 4.7 (2.10 to 10.70), 0.4 (0.17 to 0.89), and 2.37 (1.05 to 5.33), respectively. A Mann–Whitney U test showed no difference in PACU or hospital length of stay between patients who did and did not have delirium in the PACU (within the first hour). Conclusions: Age, ASA > 3, a history of cardiovascular disease, central nervous system disease, hematologic disease, endocrinologic disease, psychiatric disease and postoperative opioid use are individually associated with postoperative delirium. A future study with an even larger sample size is needed to further evaluate these factors in an adjusted analysis. Full article

Objectives: This study examined factors influencing community mental health service utilization and identified strategies to improve accessibility for psychiatric outpatients receiving care at the Department of Psychiatry. Methods: This cross-sectional descriptive survey utilized a structured questionnaire to collect data from 136 patients receiving outpatient psychiatric care at a tertiary medical institution in Seoul, Korea. Logistic regression analysis was performed using SPSS version 26.0 for Windows. Results: Logistic regression analysis identified significant factors influencing the utilization of community mental health services: being a man (OR = 3.33), duration of illness (OR = 2.31), recognition of service institutions (OR = 39.09), internalized stigma (OR = 4.90), and stress (OR = 3.14). Conclusions: To encourage the utilization of community mental health services by patients with mental illness, psychiatric nurses should increase the level of understanding and information about community-based mental health support. Additionally, details on community mental health services should be provided from the earliest stages of illness in a variety of gender-specific ways during discharge education, and patients with high levels of internalized stigma and stress should be encouraged to have an insight of their illness and to take an active role in their recovery. Full article

Background/Objectives: The use of coercive measures in psychiatry is an ethically controversial issue. Staff attitude towards coercive measures could explain the different application frequencies of coercive measures across psychiatric services. Methods: We analyzed the attitude towards coercion held by professionals working in a psychiatric department using the Staff Attitude to Coercion Scale (SACS). We statistically evaluated the correlation between the SACS score and the demographic and work characteristics of professionals. Results: The most represented category of participants was nurses (73.03%). Most professionals worked in a Mental Health Community Service (MHCS) (72.09%). We reported a score of 41.9 ± 8.8 SD in total SACS and high scores in two SACS factors: “Coercion as offending” and “Coercion as care and security”. Professionals working in Service for Psychiatric Diagnosis and Care (SPDC) showed reduced scores in total SACS and the SACS dimension “Coercion as offending” score. Place of work, particularly “working in SPDC”, was statistically significantly associated with total SACS in a positive way and with the “Coercion as offending” score in a negative way in our regression multivariate test. Conclusions: Our professionals showed a predominantly critical and pragmatic attitude towards coercive measures. The professionals who are more frequently exposed to violent and aggressive behavior, such as those who work in SPDC, showed a reduced critical attitude towards coercion in comparison with those working in MHCS, suggesting that exposure to violence can shape the response of professionals. Full article

Background/Objectives: Advanced psychiatric nurses’ clinical skills and expertise are increasingly challenging registered nurses in mental health. Understanding registered nurses’ perceptions of the role of advanced psychiatric nurses is vital for improving mental healthcare delivery and fostering collaboration for effective patient outcomes. This integrative review aims to explore how registered nurses perceive the role of advanced psychiatric nurses in mental healthcare. Methods: An integrative review methodology was used to synthesize the existing literature following PRISMA guidelines. Both qualitative and quantitative studies provided a comprehensive understanding of the registered nurses’ perceptions regarding the role of advanced psychiatric nurses in mental health nursing. Results: Several key themes emerged from studies included in this review, including recognition of expertise, role ambiguity and boundaries, and the need for structured education and training. Conclusions: This review highlights the need to clarify roles and how communication is essential for improving collaboration, team cohesion, and patient outcomes while promoting interprofessional education to optimize mental healthcare, in addition to bridging the knowledge gap or the discrepancy between registered nurses and advanced psychiatric nurses. What registered nurses know and what they need to know to perform tasks will improve the quality of mental healthcare and optimize services for individuals with mental health needs. Full article

In the United States (US), a longstanding solution to the unmet need for mental health treatment is integrated behavioral health care (IBH). Within a primary care model, problems are identified and treatment combines care for physical, mental and substance use disorders. Treatments are delivered through the collaboration of primary and behavioral health providers. According to US federal billing guidelines, in one integrated model, the Collaborative Care Model (CoCM), the psychiatric consultant must be a medical professional trained in psychiatry and capable of prescribing medications, i.e., either a psychiatrist, Psychiatric Mental Health Nurse Practitioner (PMHNP) or Physician Assistant. The development of integrated care has been slow for particular vulnerable populations, in part due to the lack of psychiatric consultants. PMHNPs are increasingly taking on the role of psychiatric consultants on CoCM teams and creating nurse-led IBH models for underserved populations. In this paper, eight such models are discussed along with implementation challenges and the strategies used to address them. Nurse leaders have the capacity to enhance and expand integrated care, particularly for underserved populations, through the optimal utilization of care teams, expanding measured outcomes, and developing measures for team-based effectiveness. Future directions are proposed that will accelerate this PMHNP-led expansion of IBH. Full article

Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16–1.46) or having an intermediate (1.66, 1.46–1.88) or high frailty risk (2.57, 2.10–3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer. Full article

There are scanty empirical and theoretical studies focusing specifically on the implementation models for the care of psychiatric nurses caring for children. Staff contribution in the process of putting clinically relevant actions into practice contributes to effective implementation, increased acceptance, and commitment. These practises can be used to improve mental health care services of children at different levels. The aim is to deepen an understanding of the perspective of care for children with mental health challenges. A qualitative, exploratory, and descriptive design was used to allow for innovative thoughts to restructure the practice of child psychiatric nursing and is based on the Practice-Orientated Theory of Dickoff. A positive focus on aspects that facilitate care for children with mental health problems is informed by the data collected. A suite of services that include practice environment, trainings, and practical assistance is feasible to support psychiatric nurses. This framework implies that psychiatric nurses need professional competence to understand the context of the environment. Psychiatric nurses need to move beyond engagement to demonstrate how they help children with psychiatric challenges and to enable the development of psychiatric nursing practice through international collaboration. Full article

On 1 January 2024, a magnitude 7.5 earthquake struck the Noto Peninsula in Ishikawa Prefecture, Japan, causing substantial damage to northern Noto. This study aimed to clarify the experiences of patients using a psychiatric visiting nurse service who were affected by the earthquake, and the influencing factors of worsening mental health symptoms after the earthquake. Participants were 114 patients using a psychiatric visiting nurse service in northern Noto. Data were collected retrospectively from nursing records. Factors associated with signs of worsening mental health symptoms were the continued use of home visiting nursing services after the disaster (n = 43, 46.7%; p = 0.040) and the intervention of a disaster psychiatric assistance team (DPAT) (n = 7, 77.8%; p = 0.034). No significant correlation was found between the number of relocations owing to evacuation and signs of worsening mental health symptoms. Although 61.4% of participants experienced more than one evacuation, the number of evacuations and relocations did not seem to directly affect the worsening of mental health symptoms. However, the results suggest a need for more direct interventions, such as the continued use of home visiting nursing services and the involvement of DPATs as an external resource, for patients exhibiting signs of worsening mental health symptoms. Full article

Background: Falls among older adults are a pervasive and significant concern worldwide. A practice guideline has been developed to address the prevention of falls and their resulting consequences in hospital and long-term care settings. Aim: The study aimed to assess the fall down rate and preventive tools among older adult patients in nursing homes. Methods: A cross-sectional study was conducted on randomly selected older adult patients by using a questionnaire with the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool in nursing homes at the Ministry of Human Resource and Social Development. Results: Among 323 older adult patients, most of them (73.1%) were male, 23.8% were from Makkah, and the age ranged from 60 to 90 years and older. Results showed that 64.8% had a psychiatric disorder, 41.8% had hypertension, 38.4% had diabetes, 38.1% had movement disorders, 11.3% had heart diseases, and 1.5% had no chronic conditions. The mean STEADI tool score was 3.5 out of 12, and of the 323 older adult patients, 51.7% had a low risk to fall and 48.3% had a high risk to fall. Of the 13 interventions used to prevent falls, the most used intervention was rehabilitative physical therapy, followed by providing patient facilities and muscle strengthening exercises. Conclusions: The level of falls was markedly low, and a significant correlation was observed between the risk of falling and the participants’ region of residence. Full article

The lack of evidence synthesis studies on the role of psychiatric mental health nursing in the context of psychiatric home hospitalization underscores the limited research on nurses providing care in these teams, particularly concerning their experiences and responsibilities and the actual role of nurses in this context. This knowledge has the potential to improve the quality of mental healthcare by guiding nursing practices. Objective: To map the concepts related to the role of mental health nurses in psychiatric home hospitalization. Methods: A scoping review was conducted using the methodology proposed by the JBI, involving five methodological stages. No search limits were applied except for language. Results: The review identified five key dimensions of nursing in psychiatric home hospitalization: satisfaction; care models; the therapeutic relationship; the care environment; the organization of care. These interconnected dimensions influence quality care. Satisfaction among nurses, patients, and families is associated with improved outcomes and reduced stigma. The therapeutic relationship is characterized by a humanistic approach, emphasizing dialogue, empathy, and shared decision making. Additionally, the importance of care organization is highlighted, including individualized care plans, medication management, and intersectoral collaboration. Discussion: The five nursing dimensions align with the Quality Standards of the Portuguese Nursing Council and are consistent with the scientific literature. Conclusions: Although there is a shortage of studies on this topic, this review allows for the synthesis of nursing interventions and reflection on the paradigm shift in care within the scope of psychiatric mental health nursing interventions. Future studies highlighting the value of mental health nursing interventions, with a particular focus on nursing-sensitive indicators and employing quantitative or mixed methods, will be crucial to furthering the analysis conducted thus far. Full article

Work-related stress has been linked to various negative outcomes among healthcare professionals. For nurses, stress can arise from numerous sources, including their interactions with patients. It is often perceived that nurses working in psychiatric hospitals experience greater stress and occupational burnout compared to nurses working in somatic hospitals. However, there is limited research addressing this specific issue. To bridge this gap, a study was conducted to compare the stress levels of nurses working in a psychiatric hospital and a somatic hospital within the same city. Background/Objectives: The aim of this paper was to report on the prevalence of stress and burnout among surveyed nurses employed in a somatic hospital and in a psychiatric hospital. Methods: The study group consisted of a total of 379 nurses—189 employed at a somatic hospital and 190 employed at a psychiatric hospital. The primary test used for statistical analyses was the nonparametric Mann–Whitney U test for assessing differences. Additionally, correlations between ordinal or quantitative variables were analyzed using Spearman’s rho coefficient. Results: Among respondents working at a somatic hospital, the average levels of occupational burnout, emotional exhaustion, depersonalization, and sense of personal accomplishment were moderate. Similar results were observed among respondents employed at a psychiatric hospital. Conclusions: The workplace does not significantly differentiate professional burnout or coping strategies among the nurses surveyed. Among nurses working in hospitals for somatic patients, levels of depersonalization, turning to religion, and seeking support increase with age and seniority. In contrast, psychiatric nurses show higher levels of emotional exhaustion and overall MBI burnout as they age. Full article

The aim of this study was to investigate aggression-related work accidents in an inpatient psychiatric unit before and after implementing a no-restraint policy in Italy. Results revealed that, over the study period (2007–2022), 113 accidents occurred, mostly related to physical aggression (81.4%), with healthcare assistants and psychiatric nurses being the most affected and more accidents occurring during the morning shift (49.6%). A transitory peak of accidents occurred during the policy transition (χ²₂ = 16.0, p < 0.001; V = 1.000), falling rapidly in the subsequent years. In conclusion, adopting a no-restraint policy is not associated with increased aggression toward staff in psychiatric healthcare in the longer term, although greater support is needed during the transition phase to minimize risks. Full article