Journal of Psychiatric and Mental Health Nursing (J Psychiatr Ment Health Nurs)

Publications in this journal

• Article: Self-reports of faulty parental attachments in childhood and criminal psychopathy in an adult-incarcerated population: an integrative literature review.

  C Bailey, D Shelton
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  ABSTRACT: ACCESSIBLE SUMMARY: This study examined self-reports of psychopathic offenders' childhood interactions with their parents to better understand what variables influence adult criminal psychopathy. The findings showed that childhood separations, physical abuse and indifferent parenting styles were more prominent in self-reports of incarcerated male psychopaths than with incarcerated males who were not psychopathic. To better understand the worldview of the criminal psychopath, and the trajectory of psychopathy, there is a need for more studies that examine childhood interactions with parental figures as reported by the adult criminal psychopath. ABSTRACT: Despite the high percentage of incarcerated psychopaths, few studies attempt to assess the past parent-child bonds of these individuals by asking them to report childhood attachments with their parents. Currently, there is limited data regarding common variables that contribute to a break in parent-child attachment and later adult criminal psychopathy. The data that presently exist concentrate on juvenile or community samples and do not explore the attachment variables that continue into adult criminal psychopathy. This paper presents the current literature regarding self-reports of childhood attachment to parents as indicated by male-incarcerated adult psychopaths compared with self-reports of childhood attachment to parents as indicated by male-incarcerated adult non-psychopaths. Variables that influence a break in attachment between the offenders and their parents and suggestions for future clinical research are provided.
  Journal of Psychiatric and Mental Health Nursing 05/2013;
• Article: Reasons for recall following conditional discharge: explanations given by male patients suffering from dual diagnosis in a London Forensic Unit.

  J Chiringa, J E Robinson, C Clancy
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  ABSTRACT: ACCESSIBLE SUMMARY: Patients who have been discharged from forensic services often have conditions they have to abide by as part of their discharge, and failure to do so leads to recall. We interviewed six men who had been conditionally discharged from forensic services and then been recalled into hospital to find out what they thought went wrong. The reasons they gave for why things went wrong included feeling that the system was unfair and made them feel like criminals even though they did not feel they had put anyone at risk. Some of them were not fully aware of the conditions they needed to adhere to, and some of them had breached the conditions but did not take responsibility for what had happened. In addition, supervision was felt to be very controlling and disruptive rather than supportive when patients were often lonely, bored and needing support. Most participants reported that they experienced poor standards of aftercare in hostels they were required to reside in. In the future, care of patients after conditional discharge should include better communication between patients and their supervisory team, recognition of the need for more support and improvements in the standards of care in hostels, as well as a collaborative approach to risk assessment that might reduce the frequency of relapse and readmission. ABSTRACT: This study explores how male patients suffering from dual diagnosis in a forensic unit perceive being recalled and readmitted following conditional discharge and their views about how services might be improved. A qualitative approach was used drawing on grounded theory techniques. Audiotaped semistructured interviews collected data from a purposefully selected sample of six participants who had been recalled and met the inclusion criteria of the study. Data were analysed using the constant comparative method. Most participants perceived the recall system as unfair, inappropriately criminalized their behaviour and was based on an assessment of risk that they did not understand or accept. Participants were not fully aware of the conditions of their discharge, and most did not accept responsibility for their role in being recalled and blamed the system. Care following discharge was rarely seen as positive, and poor standards in hostels were reported by most participants. Supervision was often seen as disruptive and controlling, and focused more on surveillance rather than support. Better communication might have helped them understand and adhere to the conditions of their discharge. Participants identified the importance of family and friends to their recovery, the importance of having their own accommodation, and the need to be more independent.
  Journal of Psychiatric and Mental Health Nursing 05/2013;
• Article: From distress to illness: a critical analysis of medicalization and its effects in clinical practice.

  J D Jacob, M Gagnon, J McCabe
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  ABSTRACT: ACCESSIBLE SUMMARY: Construct validity of 'mental illness' remains elusive and has been replaced by the more manageable problem of reliability. Health-care professionals may reliably diagnose similar clusters of symptoms but, realistically speaking, these conditions may not be mental disorders. Labelling individuals as mentally ill only accentuates the burden of disease by situating the problem within the person, rather than to engage in the difficult task of addressing the contextual elements that may be at the source of distress. Drawing on research findings in the field of HIV/AIDS nursing, we can see the impact of psychiatric pathologization of women who experience treatment-induced body changes and subsequently, must accept that their response to these changes become the target of psychiatric labelling and interventions. We believe that health-care providers first need to challenge the idea that distress associated with lipodystrophy should result in pathologization. We argue that nurses should be at the forefront of such an initiative because they have the professional responsibility to act as patient advocates. ABSTRACT: This paper is precisely aimed at exposing the limits of psychiatry's scientific claim-making and exploring how psychiatric diagnoses come to be utilized in practice and affect those who become pathologized. Drawing on research findings in the field of HIV/AIDS nursing, we portray the impact of psychiatric pathologization of women who see their bodies transformed by antiretroviral therapy and subsequently, must accept that their response to these changes become the target of psychiatric labelling and interventions. In this paper, we therefore engage with the reader in a critical analysis that exposes the tensions that exist between individual experiences of distress and psychiatric pathologization. The first section of the paper is dedicated to the presentation of a theoretical framework in which we explore the medicalization process and the ontological issues regarding psychiatric diagnoses. The second section seeks to present the results from a qualitative research study in the field of HIV/AIDS nursing and serves as a case example to foster discussions on the implications of psychiatric pathologization in clinical practice.
  Journal of Psychiatric and Mental Health Nursing 05/2013;
• Article: Turbulent life: the experiences of the family members of patients suffering from depression.

  M Radfar, F Ahmadi, M Fallahi Khoshknab
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  ABSTRACT: ACCESSIBLE SUMMARY: Families of patients suffering from depression tolerate a great amount of stress during provision of care to the patients. Penetration of the illness in family members, daily life's hardship, too much attention to the patients, delay in the acceptance of the illness and concern about the patient's current and future conditions result in turbulent life in the families. If nurses educate families about how to gain financial and emotional support, the families' life inflammation will reduce. ABSTRACT: Families of patients suffering from depression have an important role in provision of care to the patients, which also may impose a great amount of stress on them. The purpose of this study was to explore and describe the experiences of the family members of patients suffering from depression on the impact of provision of care to the patients. A qualitative design using a content analysis approach was used to gather and analyse data. Unstructured interviews were conducted with 26 family members of patients suffering from depression chosen using purposeful sampling. During data analysis, 'turbulent life' was developed as the main theme along with five other categories including: 'penetration of the illness in the family', 'daily life's hardship', 'too much attention to the patient', 'delay in the acceptation of the illness' and 'concern about the patient's current and future conditions'. Each category consisted of several subcategories. It is concluded that the psychological, physical and financial factors imposed on families result in 'turbulent life'. Nurses can reduce the burden of providing care to patients suffering from depression through improving the knowledge of family members about how to communicate with patients and increase emotional supportive resources to the patients and their family members.
  Journal of Psychiatric and Mental Health Nursing 05/2013;
• Article: Violent behaviour in a forensic psychiatric hospital in Finland: an analysis of violence incident reports.

  S Kuivalainen, K Vehviläinen-Julkunen, A Putkonen, O Louheranta, J Tiihonen
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  ABSTRACT: ACCESSIBLE SUMMARY: Over half of the violent incidents considered in this study were unexplained. The risk for violent behaviour inside the hospital was the highest for civil patients. The risk rate in this group was 12 compared to criminal patients' risk rate of one. ABSTRACT: The aim of this paper was to explore the frequency and provocation of physically violent incidents in a Finnish forensic psychiatric hospital. Three years (2007-2009) of violent incident reports were analysed retrospectively. The data were analysed by content analysis, and statistically by Poisson regression analysis. During the study period a total of 840 incidents of physical violence occurred. Six main categories were found to describe the provocation of violence where three of these categories seemed to be without a specified reason (61%), and three represented a reaction to something (36%). The risk for violent behaviour was highest for the civil patients (RR = 11.96; CI 95% 9.43-15.18; P < 0.001), compared to criminal patients (RR = 1). The civil patients represented 36.7% of the patients, and in 43.6% of the studied patient days, they caused 89.8% of the reported violence incidents. Patients undergoing a forensic mental examination did not frequently behave aggressively (RR = 1.97; CI 95% 0.91-4.28). These results can be used in the reorganization of health-care practices and the allocation of resources.
  Journal of Psychiatric and Mental Health Nursing 05/2013;
• Article: The use of psychological therapies by mental health nurses in Australia.

  J E Fisher
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  ABSTRACT: ACCESSIBLE SUMMARY: This paper examines the usage of psychological therapies by mental health nurses. The paper presents the findings from a questionnaire survey of 528 practising mental health nurses in Australia. Key findings include: Mental health nurses believe employing psychological therapies such as cognitive behaviour therapy in their practice will improve therapeutic outcomes for consumers. Mental health nurses overwhelmingly want to employ psychological therapies in their practice. They think mental health nursing and hospital and community health management is too focussed on medical treatment and risk management, which means that their nursing practice is dominated by the administration of medication, excessive documentation, and patient observation. They identify barriers preventing them from practising psychological therapies. These include lack of confidence, low nurse morale, no support from other nurses, low staffing levels, lack of training opportunities, and inadequate support from nursing management. ABSTRACT: This paper reports on a research project which examines the feasibility of mental health nurses employing psychological therapies in the nursing care of people with severe mental illness. Attitudes towards current usage and factors influencing the adoption of psychological therapies are investigated. The paper addresses the gap in the Australian nursing literature regarding the therapeutic role of mental health nurses (MHN)s in relation to the use of evidence-based psychological therapies. This paper presents the findings from an online questionnaire survey of 528 practising MHNs in Australia. The findings demonstrate enthusiastic support among nurses towards employing psychological therapies, with 93% of respondents indicating they would like to use psychological therapies in their current practice. Correspondingly, there is strong demand for education and training in applying psychological therapies. A number of barriers to implementing psychological therapies are identified. It is noted that place of employment is a significant factor, with mental health nurses working in the public sector more likely to state institutional barriers are restricting their therapeutic potential and preventing them from implementing psychological therapies.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Sexual behaviours on acute inpatient psychiatric units.

  L Bowers, J Ross, P Cutting, D Stewart
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  ABSTRACT: ACCESSIBLE SUMMARY: We do not know very much about the sexual behaviours of adult psychiatric inpatients, or about the patients who engage in them and what other challenges they pose to the staff. This was a large study of many patients in many different hospitals, based on information extracted from case records. More than 1 in 10 patients engaged in some form of challenging sexual behaviour during the first 2 weeks of their admission. There were no differences in the rates of sexual behaviours between mixed and singe gender wards, but men were more likely to touch another person sexually without their consent, or engage in masturbation in a public area. ABSTRACT: The purpose of the study was to assess the types and frequency of sexual behaviours displayed by patients during the first 2 weeks of admission to acute psychiatric units and what relationship these have to other challenging patient behaviours. The method used was a survey of sexual behaviours, conflict and containment events carried out by 522 patients during the first 2 weeks of admission in 84 wards in 31 hospitals in the South East of England. Incidents of sexual behaviour were common, with 13% of patients responsible for at least one incident. Although exposure was the most frequent of these behaviours, non-consensual sexual touching, was instigated by 1 in 20 patients. There were no differences in the numbers of sexual events between single sex and mixed gender wards. Few associations were found with the demographic features of perpetrators, although all those engaging in public masturbation were male, and male patients were more likely to sexually touch another without their consent. Single sex wards do not seem to necessarily offer significant protection to potentially vulnerable victims. Perpetrators do not seem to be predictable in advance, nor was there any common set or pattern of disruptive behavioural events indicating that a sexual incident was about to occur.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Axis IV - psychosocial and environmental problems - in the DSM-IV.

  A Ramirez, L Ekselius, M Ramklint
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  ABSTRACT: ACCESSIBLE SUMMARY: The aim of this study was to extensively explore the properties of the revised axis IV of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Psychosocial and environmental problems, which are believed to exacerbate current mental disorders, were evaluated by using a questionnaire and through clinical interviews. The reliability between self-assessment and professional assessment was also examined. The results showed that the revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. These findings could be useful for the upcoming DSM-V revision as well as help clinicians and patients to better identify mental health problems. ABSTRACT: The aim of this study was to further explore the properties of axis IV in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). In a naturalistic cross-sectional design, a group (n = 163) of young (18-25 years old) Swedish psychiatric outpatients was assessed according to DSM-IV. Psychosocial and environmental problems/axis IV were evaluated through structured interviewing by a social worker and by self-assessment on a questionnaire. Reliability between professional assessment and self-assessment of axis IV was examined. Concurrent validity of axis IV was also examined. Reliability between professional and self-assessed axis IV was fair to almost perfect, 0.31-0.83, according to prevalence and bias-adjusted kappa. Categories of psychosocial stress and environmental problems were related to the presence of axis I disorders, co-morbidity, personality disorders and decreasing Global Assessment of Functioning (GAF) values. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Parents' experience of living with and caring for an adult son or daughter with schizophrenia at home in Ireland: a qualitative study.

  R McAuliffe, L O'Connor, D Meagher
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  ABSTRACT: ACCESSIBLE SUMMARY: This paper reports a study that explored the experience of now older parents living with and caring for, an adult child with schizophrenia in Ireland. Parents reported mixed emotions that gave insight into the severe psychological distress they experienced when their son or daughter was diagnosed with schizophrenia. The period immediately after diagnosis can be particularly stressful. On the contrary; parents also experienced acceptance of their new caring role underpinned by their sense of love and responsibility for their son or daughter with schizophrenia. There is a lack of studies on the experience and needs of parents of a son or daughter with schizophrenia in Ireland. This study offers insights from legitimate experts in illuminating what the experience is really like. A family-centred approach is required to deal with the uniqueness of individual parents' circumstances. Assessment and care planning should take into account the family as a unit. ABSTRACT: This study explored the experience of parents living with, and caring for, an adult son or daughter with schizophrenia. There is increasing emphasis on the involvement of carers and users in the care for people with schizophrenia. 'A Vision for Change' highlights the need for a partnership approach and emphasizes that carers are an integral part in the planning and delivery of mental health services. In order to meet such requests, it was necessary to explore the meaning of caregiving for Irish families. A descriptive qualitative design was used to enable parents to describe their experiences. Semi-structured, in-depth interviews with a convenience sample of six parents in Ireland were carried out in 2007. The study encompassed four major themes: psychological tsunami, caring activities, coping with enduring illness and an uncertain pathway. Parents reported severe psychological distress when their son or daughter was diagnosed with schizophrenia. Their deep sense of loss was followed by acceptance of the situation. Feelings of love and a sense of responsibility helped to give meaning to their caring role. This study gave a voice to some parents of a son or daughter with schizophrenia. A family-centred approach should be at the core of care planning for this vulnerable population.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: An investigation of duration of untreated psychosis and the affecting factors.

  S Sadeghieh Ahari, H Nikpou, P Molavi, R Abdi, F Amani, B Shirinzadeh
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  ABSTRACT: ACCESSIBLE SUMMARY: The mean duration of untreated psychosis (DUP) were 261.3 ± 110.8 and 212.5 ± 143.5 days for patients referring to Razi and Fatemi hospital. The DUP mean here was found to be higher as compared with that of the developed countries. Lower education, implausible beliefs and culturally rooted social stigma status of visiting a psychiatrist were found to be playing a role in making DUP longer. ABSTRACT: One of the main goals in treatment planning of psychiatric disorders is early diagnosis of patients in the early psychosis period so that duration of untreated psychosis (DUP) is decreased and the treatment response and outcome is improved. The aim of this study was to investigate the DUP of psychosis and factors affecting it. In this cross-sectional study, 80 patients from the psychiatric clinic of Fatemi hospital in Ardabil and Razi hospital in Tabriz who were in the first episode of psychosis completed a questionnaire. The data were analysed by SPSS statistical software. In this study, the mean DUP measured from the appearance of the first symptoms of psychosis were 261.3 ± 110.8 and 212.5 ± 143.5 days for patients referring to Razi and Fatemi hospital, respectively. About 65% of the patients in Fatemi hospital and 32.5% of them in Razi hospital considered visiting a psychiatrist as hard and very hard. The DUP mean here was found to be higher as compared with that of the developed countries. The following factors were found to be playing a role in making DUP longer: lower education, implausible beliefs and culturally rooted social stigma status of visiting a psychiatrist.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Group therapy in public mental health services: approaches, patients and group therapists.

  S Lorentzen, T Ruud
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  ABSTRACT: ACCESSIBLE SUMMARY: There is a plethora of different types of group therapy in public mental health services. Psychodynamic groups are most frequent, followed by cognitive-behavioural and psycho-educative groups. Groups with mixed theoretical background are frequent. Patients with similar diagnosis are offered different group approaches, but some trends exist. The development of clinician-researcher networks will facilitate research on regular patients in clinical contexts. The largest proportion of group therapists are nurses. More group therapists should be trained. ABSTRACT: Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration <6 or >12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Emotional intelligence, life satisfaction and subjective happiness in female student health professionals: the mediating effect of perceived stress.

  D Ruiz-Aranda, N Extremera, C Pineda-Galán
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  ABSTRACT: ACCESSIBLE SUMMARY: The relevance of the scientific study of happiness and well-being in health professionals has been emphasized. In this sense, the intelligent use of emotions is considered essential for one's psychological adaptation and well-being. Health professionals have to deal with high levels of occupational stress and students in nursing, and allied health sciences need to develop the ability to manage their own emotions because an affective deficit in self-regulation can lead to lower subjective well-being. This study aimed to examine the relationship between emotional intelligence (EI) and well-being indicators (life satisfaction and happiness) in a 12-week follow-up study in female student health professionals. Moreover, we examined the mediator role of perceived stress on the relationship between EI and well-being indicators. Our study found that emotionally intelligent people evaluate situations as less stressful which results in a higher satisfaction with life and happiness. Specific EI training programmes to help students to cope with the challenges they face should be included in the curriculum for students in nursing and allied health sciences. ABSTRACT: The objective of the present study was to extend previous findings by examining the relationship between emotional intelligence (EI) and well-being indicators (life satisfaction and happiness) in a 12-week follow-up study. In addition, we examined the influence of perceived stress on the relationship between EI and well-being. Female students from the School of Health Sciences (n = 264) completed an ability measure of emotional intelligence. After 12 weeks, participants completed the Perceived Stress Scale, Satisfaction with Life Scale and Subjective Happiness Scale. Participants with higher EI reported less perceived stress and higher levels of life satisfaction and happiness. The results of this study suggest that perceived stress mediates the relationship between EI and well-being indicators, specifically life satisfaction and happiness. These findings suggest an underlying process by which high emotional intelligence may increase well-being in female students in nursing and allied health sciences by reducing the experience of stress. The implications of these findings for future research and for working with health professions to improve well-being outcomes are discussed.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Exploring the experience of Canadian registered psychiatric nurses: a phenomenological study.

  J Jackson, P J Morrissette
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  ABSTRACT: ACCESSIBLE SUMMARY: This study was undertaken to explore the experience of registered psychiatric nurses in the province of Manitoba, Canada. Results of this study revealed six predominant themes including how psychiatric nursing is perceived by the public and allied professionals, the aggressive behaviour and management of patients, the involvement of family members regarding the care of their loved ones, the relationship between physicians and psychiatric nurses, the sense of responsibility and worry associated with psychiatric nursing, and the gradual shift in educational standards and movement towards traditional medical intervention. Results from this study can benefit patients, psychiatric nurses, and psychiatric nurse educators. ABSTRACT: This paper describes a phenomenological study that was conducted in 2012 and investigated the experiences of registered psychiatric nurses working in the province of Manitoba. Ten registered psychiatric nurses participated in semistructured, audio-recorded interviews, during which they described their experiences, yielding written protocols that were thematically analysed. Results from this study revealed six predominant themes that included (1) perception of psychiatric nursing; (2) patient aggression; (3) patient family involvement; (4) nurse-doctor relationship; (5) responsibility and worry; and (6) shift in practice and educational standards. The results of this study can assist in better understanding registered psychiatric nursing practice, inform educational programmes, and spawn future research.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Methodology and mental illness: resistance and restorying.

  P Fisher, D Freshwater
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  ABSTRACT: ACCESSIBLE SUMMARY: This paper compares two post-modern methodological approaches, post-structuralist and narrative, and considers their usefulness in relation to emancipatory research in mental health. The paper finds that post-structural analyses can be useful in deconstructing oppressive practices and in indicating emerging forms of resistance. Narrative approaches potentially offer greater emancipatory scope than post-structuralism as they enable people with mental health problems to restore their lives and enact their own subjective transformation. However, narrative templates may perpetuate injustice if they erase the complexity of people's stories. This raises ethical issues in relation to narrative interpretation. ABSTRACT: Concerns with social justice have been traditionally associated with a modernist concept of the individual whose actions express an underlying, essential and unified self. This paper compares the usefulness of two methodologies (post-structuralist and narrative) that are based on a rejection of identity of a unified self and compares their usefulness in relation to the development of a social justice paradigm within mental health. It considers how professional forms of knowledge may be deconstructed by post-structural analyses, arguing that these have also been used by service users to articulate more enabling discursive alternatives. The notion of agency is central to our understanding of social justice. We question the commonly held assumption that although post-structuralism deconstructs power and challenges its legitimacy, it is nevertheless unsuited to facilitating the necessary agency to put forward viable alternatives. The second half of the paper considers how narrative research offers greater emancipatory potential by enabling the research subject to author their stories and thereby brings about their own subjective transformation. Nevertheless, the interpretation of people's stories by researchers may result in the imposition of narrative templates that erase complexities and contribute to the perpetuation of oppression. This raises ethical implications in relation to how people's stories are interpreted.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: The impact of mixed, hope and forgiveness-focused marital counselling on interpersonal cognitive distortions of couples filing for divorce.

  A Navidian, F Bahari
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  ABSTRACT: ACCESSIBLE SUMMARY: Hope and forgiveness are effective strategies for reducing family conflicts. These are two modern approaches for resolving marital conflicts. Merging hope- and forgiveness-focused interventions can be used to decrease irrational marital beliefs among couples. Divorce is the most common outcome of conflicts among couples, who seek counselling going through the process of divorce. The study explores the effects of mixed, hope- and forgiveness-focused interventions on couples filing for divorce in Isfahan, Iran. In hope-focused counselling, it seeks to strengthen relationship of married couples and reduce the rate of divorce. Forgiveness is a curative approach used in marriage therapy, suggested for helping manage the feelings of resentment and anger related to being hurt by separation. Results emphasize that hope-oriented interventions had no effect on the total number of interpersonal cognitive distortions in comparison with the control group. A similar pattern was observed in the forgiveness group. In contrast, a comparison of the mixed and control groups revealed significant differences, indicating that mixed interventions were significantly more effective than a non-intervention control period in reducing the two dimensions of interpersonal irrational expectations and misconceptions among divorcing couples. ABSTRACT: Divorce and conflict are overlapping processes. Previous findings suggest that spirituality-related interventions in mental health nursing may play a significant role in reducing the level and amount of conflict. We examined the effects of hope and forgiveness-focused marital counselling and a combination of the two intervention types on interpersonal cognitive distortions of couples filing for divorce in Isfahan, Iran. We conducted a quasi-experimental study with a pre-test and post-test design. Of 440 couples referred to the Crisis Intervention Center undergoing pre-divorce counselling, 60 were randomly assigned to four groups: hope-focused, forgiveness-focused, mixed and control. Data were gathered using the Interpersonal Cognitive Distortions Scale and analysed using the non-parametric Kruskal-Wallis, Mann-Whitney's U and Wilcoxon tests. Hope- and forgiveness-focused interventions did not have a significant effect on the total number of interpersonal cognitive distortions in comparison with the control group. However, the mixed intervention significantly reduced irrational expectations and interpersonal rejection among couples. Combining hope- and forgiveness-focused interventions can be used to decrease irrational marital beliefs among couples. In addition, rating the level of conflict among couples is important for determining the type of intervention that should be used by mental health nurses (psycho-educational or therapeutic).
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Evaluating the impact of an embedded psychodynamic psychotherapist in an early intervention in psychosis service.

  R Duggins, P Veitch
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Predictors of expressed emotion, burden and quality of life in relatives of Mexican patients with psychosis.

  L Gómez-de-Regil, T R Kwapil, N Barrantes-Vidal
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  ABSTRACT: ACCESSIBLE SUMMARY: Families play an important role in the recovery of mental health patients providing daily informal care. Without support from and an alliance with clinical professionals, family members may feel overwhelmed by the challenge of having a relative with a mental disorder. The study explores whether the relatives' own feelings of burden, expressed emotion and quality of life can be affected not only by the symptoms of their ill relative but also by how relatives themselves perceive the illness and how psychologically distressed they feel. From a public psychiatric hospital located in Mexico, 65 patients with psychosis were interviewed along with their closest caregiver. Feeling psychologically distressed increases relatives' burden, expressed emotion and negatively affects their quality of life. Regardless of the patient's mental health status, perceiving the illness as chronic increases relatives' burden. Moreover, when relatives believe that they, rather than treatment or the patient, control or influence the illness, they feel more burden, and their quality of life is poorer. The quality of life of the relatives is also disrupted by their perception of illness as affecting their own lives as well as patients'. Results underscore the relatives' need of support to overcome their own distress and concerns about the illness, for the psychological well-being of both patients and relatives. ABSTRACT: Expressed emotion, burden and quality of life of relatives received attention because of the increasing interest in predicting and preventing relapse in psychotic patients; but they have subsequently acquired interest of their own as important aspects of families' psychological well-being. The study explores whether the psychological distress and illness perception of a sample of relatives of Mexican patients with psychosis can predict their levels of expressed emotion, burden and quality of life above patients' clinical and functional status. Sixty-five patient-relative dyads were interviewed. Relatives self-reported on expressed emotion, burden, quality of life, psychological distress and illness perception. Patients' clinical and functional status was rated by an interviewer. Pearson correlations and hierarchical multiple linear regressions were used for statistical analyses. Patients' functional status and relatives' psychological distress were significantly associated with expressed emotion, burden and quality of life. Patients' clinical status and relatives' illness perception were most strongly related to expressed emotion and burden. Relatives' psychological distress and illness perception dimensions predicted both burden and quality of life, over and above patients' clinical and functional status. Results underscore the relatives' need of support to overcome their own distress and concerns about the illness, for the psychological well-being of both patients and relatives.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: Promoting critical perspectives in mental health nursing education.

  A McKie, S Naysmith
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  ABSTRACT: ACCESSIBLE SUMMARY: Contested philosophical, conceptual, social and ethical dimensions of contemporary mental health nursing practice should be addressed in pre-registration educational curricula. By interlinking knowledge and being, educational curricula can encourage students to become 'critical practitioners'. Issues of students' knowledge, self-awareness and personal development can be promoted via engagement with selected literary texts. ABSTRACT: This paper explores themes relevant to mental health nursing using the example of one educational module of a nursing degree. The authors argue that the educational preparation of mental health nursing students in higher education must address certain contested philosophical, conceptual, social and ethical dimensions of contemporary mental health care practice. These themes are discussed within the context of a third-year mental health nursing module within a Scottish nursing degree programme. By interlinking epistemology and ontology, the notion of student as 'critical practitioner', involving the encouragement of 'critical thinking', is developed. This is shown via engagement with parallel perspectives of the sciences and the humanities in mental health. Narratives of student nurse engagement with selected literary texts demonstrate the extent to which issues of knowledge, self-awareness and personal development are central to a student's professional journey as they progress through an academic course. The paper concludes by suggesting that these 'critical perspectives' have important wider implications for curriculum design in nursing education. Insights from critical theory can equip nurse educators to challenge consumerist tendencies within contemporary higher education by encouraging them to remain knowledgeable, critical and ethically sensitive towards the needs of their students.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: A literature review of to inform mental health practice.

  M Rainforth, M Laurenson
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  ABSTRACT: ACCESSIBLE SUMMARY: Explain the use of case formulation as a way of involving people experiencing mental health issues in their treatment options. Case formulation is a framework that informs a choice of psychological treatments and links assessment and treatment phases to guide practitioners and individuals on treatment options. This paper investigates its value and discusses training and supervision of professionals undertaking case formulation. It includes information on how individuals with mental health issues are fully included in the process. The findings conclude that case formulation is worthwhile and suggests improved training to improve individual outcomes. ABSTRACT: Changes in mental health provision have led to practitioners and service providers reviewing how they incorporate service users in assessment processes and treatment decisions. Case formulation (CF) is a framework that informs a choice of psychological treatments providing a bridge between assessment and treatment phases to guide treatment options. However, CF is not routinely practised in mental health; hence this paper reviews CF literature to establish its efficacy for service users experiencing mental health issues. The purpose of this study is to assess the efficacy, reliability and validity of CF and its process and function in providing treatment for service users experiencing mental health issues and to explore practitioner training requirements. A systematic search of English language publications on CF and treatment frameworks from 1999-2011 was conducted searching electronic databases. Additionally, two seminal pieces of CF work were included. The findings demonstrate evidence of CF's efficacy and suggest practitioner training programmes to increase professional expertise and enhance service user outcomes. However, limited evidence exists and further research is required to address efficacy and training implications of CF.
  Journal of Psychiatric and Mental Health Nursing 04/2013;
• Article: I spy with my little eye something beginning with O: looking at what the myth of 'doing the observations' means in mental health nursing culture.

  D-D Holyoake
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  ABSTRACT: ACCESSIBLE SUMMARY: This paper uses ethnographic research conducted in psychiatric in-patient settings to explore the phenomenon of observation. The discussion uses a post-structural frame to offer an alternative analysis and rethinking about what the performance of observing could and might mean in psychiatric nursing culture. The traditional aim of viewing observation as a task to keep clients safe is juxtaposed against the possibility that it is the psychiatric culture (which subjects both the carer and the cared for) that is actually doing the observing. The justification of observation beyond the analysis of keeping clients safe is negotiated by the way nurses observe one another and are themselves observed by psychiatric culture to ensure validated representation and performance. ABSTRACT: Those who are familiar with psychiatric inpatient settings will be aware of the expressions 'doing the obs', 'being on checks' and 'special observations'. That is because the task of observing patients is seen as being pivotal to the mental health nursing role. This paper describes an ethnographic research project that offers a rethinking of psychiatric observation. The author uses data from an ethnographic research project to provide an examination of the structure, process and outcome of this seemingly straightforward nursing task and explores how 'doing the obs' has additional symbolic and cultural meaning similar to what Barthes terms myth. The symbolic connotations are numerous and wide-ranging and expose a practice that could be said to punctuate daily activities and an ordering of relationships between nurses and services users. The classic sociological issues of status, power and containment are all relevant, yet rethought. The use of ethnographic research allowed the author to focus on the more symbolic cultural dynamics and develop five initial ethnographic themes concerning the constituting experience of watching and being watched.
  Journal of Psychiatric and Mental Health Nursing 04/2013;