John R Cutcliffe’s research while affiliated with Nursing School of Coimbra and other places

Aim: People with mental disorders have higher risk of suicide compared to the general population. Assessment of risk factors can help nurses reducing suicidal risk. The Nurses' Global Assessment of Suicide Risk scale (NGASR) has proven valid and reliable in supporting the nursing evaluation of suicidal risk in different studies. The aim of the study was to examine the psychometric properties of the NGASR in the Italian population. Methods: We translated the scale and administered it to a sample of 121 patients admitted to acute psychiatric wards. Results: The Content Validity Index-Scale (CVI-S) was 96.7%, the correlation with the Scale for Suicide Ideation (SSI) score was high (r=.98, p<.001). Inter-rater reliability (rho=.97, p<.001), and test-retest stability (p=.96) were satisfactory. Factor analysis pointed out 5 factors and the 15 items of the NGASR-ita explained 61.29% of total variance. Of the 121 subjects assessed upon admission, 25.62% had average or higher suicidal risk. Discussion and conclusions: The use of valid screening tools in support of Suicide risk assessment is recommended. The NGASR-ita is a valid and reliable tool, suitable for nursing assessment of suicidal risk in the acute psychiatric setting.

According to the international, extant literature published during the last 20 years or so, clinical supervision (CS) in nursing is now a reasonably common phenomenon. Nevertheless, what appears to be noticeably ‘thin on the ground’ in this body of literature are empirical evaluations of CS, especially those pertaining to client outcomes. Accordingly, the authors undertook a systematic review of empirical evaluations of CS in nursing to determine the state of the science. Adopting the approach documented by Stroup et al. (JAMA, 283, 2000, 2008), the authors searched for reports of evaluation studies of CS in nursing – published during the years 1995 to 2015. Keywords for the search were ‘clinical supervision’, ‘evaluation’, ‘efficacy’, ‘nursing’, and combinations of these keywords. Electronic databases used were CINAHL, MEDLINE, PsychLIT, and the British Nursing Index. The research evidence from twenty-eight (28) studies reviewed is presented, outlining the main findings with an overview of each study presented. The following broad themes were identified and are each discussed in the study: narrative/anecdotal accounts of positive outcomes for clinical supervision, narrative/anecdotal accounts of negative outcomes for clinical supervision, empirical positive outcomes reported by supervisee, and empirical findings showing no effect by supervisee.

This chapter focuses on one of the most important developments in European mental health care in recent decades—Trauma-Informed Care. It begins by exploring the nature and epidemiology of trauma. Following this, the chapter examines assessment of trauma and then considers the ten principles of Trauma-Informed Care services. The chapter then concludes by looking at the Psychiatric/Mental Health (P/MH) nursing responses within Trauma-Informed Care models. The acknowledgement and acceptance of Trauma-Informed Care in mental health-care policy, practice, research and, to a lesser extent, education, at least for some, is considered to be perhaps the most significant development in European mental health care in recent decades. Such models accentuate the need for mental health-care practitioners, including P/MH nurses, and the organizations that they work within, to recognize and accept the prevalence and pervasive impact that trauma can (and does) have on the lives of the clients they work alongside (SAMHSA 2015, 2016). Further, such models posit the need for mental health services to adapt and become even more trauma-sensitive and trauma-responsive.

This chapter focuses on the Biopsychosocial (BPS) model of care to as it is operationalised for Psychiatric/Mental health care. Instead of simply examining physical symptoms of illness, the BPS uses a multidimensional, holistic approach to explore a patient’s biological, psychological and social dimensions of suffering that affect health outcomes. The chapter begins with a general background and analysis of the essential theoretic elements followed by specific examples of how the BPS model has been applied to the practice of Psychiatric/Mental health nursing. Evidence is presented which demonstrates the effectiveness of BPS in understanding complex health-care issues such as depression and substance abuse. The model is not without criticism, and some literature suggests BPS uses an outdated, vague, pluralistic approach which introduces uncertainty that can confuse treatments and compound expense. Finally the chapter presents a discussion of the components needed to create a comprehensive assessment tool.

Examination of the names used to signify a nurse who specializes in working with people with mental health problems indicates the absence of a shared nomenclature and the frequent conflation of the terms ‘psychiatric’ and ‘mental health’. Informed by the work of Derrida (Writing and difference. London: Routledge, 1978) and de Saussure (Course in general linguistics (trans. Roy Harris). London: Duckworth, 1916/1983), the authors encourage the deconstruction and problematization of these terms, and this shows that what nurses who work with people with so-called mental illness are called has depended on where they have worked, the vagaries of passing fashion and public policy. Further, there are irreconcilable philosophical, theoretical and clinical positions that prevent nurses from practising simultaneously as ‘psychiatric’ and ‘mental health’ nurses. Related service user literature indicates that it is disingenuous to camouflage ‘psychiatric’ services as ‘mental health’ services, and as signifiers, signified and signs, psychiatric and mental health nursing are sustained by political agendas, which do not necessarily prioritize the needs of the person with the illness. Clearly demarked and less disingenuous signs for both mental health and psychiatric care would not only be a more honest approach but would also be in keeping with the service user literature that highlights the expectation that there are two signs (and thus two services): psychiatric and mental health services.

Spurred by the original contribution of Peplau, who in turn was inspired by Harry ‘Stack’ Sullivan’s work, the notion of interpersonal, psychoanalytical-based Psychiatric/Mental Health (P/MH) Nursing has both a relatively long history and contemporary currency. This history notwithstanding examination of the current relevant literature and patterns of P/MH Nursing practice in Europe and the rest of the world indicates that psychoanalytical P/MH Nursing has ‘fallen out of favour’, in much the same way that psychoanalytical psychotherapy has passed its zenith. However, psychoanalysis in the twenty-first century now, due mainly to the advances in our understanding of neuroscience over the last 20 years, has an increasing body of work that validates and/or lends credibility to several traditional psychoanalytic concepts (Solms and Turnbull 2002). With its origins firmly located in mental health/psychological thinking, aspects of psychoanalytical principles can now be detected in some higher education programmes, in analysis of institutional function, in understanding and helping family and group processes/dynamics and in other related domains such as anthropology. Within the domain of mental health care, it is difficult to ignore the significant historical influence that psychoanalytic thinking, principles and practices have had. And concomitantly, in P/MH Nursing, this influence is clearly evident in the work of Hildegard Peplau. Peplau established in her book Interpersonal Relations in Nursing (1952) the first theoretical and practical bridge between psychoanalysis and nursing under what later came to be known as the school of interpersonal psychoanalysis. In this chapter we continue to explore that bridge between psychoanalysis and Psychiatric/Mental Health Nursing.

The concept of ‘Green Care’ can increasingly be found in mental health and addictions literature, and some psychiatric/mental health nurses are practicing in facilities who base their approach on some or all underpinning theoretical elements of Green Care. However, ‘Green Care’ is not yet widely considered to be part of mainstream psychiatry. Unearthing and articulating its theoretical underpinnings and clinical applications may further advance its legitimacy. Accordingly, this chapter identifies four principle theoretical elements of Green Care: connectedness, contact with nature, benefits of exercise, and occupation/work as therapeutic, each of which is explored and articulated by drawing on relevant literature.

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