Clinical

Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.

The ‘shift reflection’ model of group reflective practice: a pilot study in an acute mental health setting

The ‘shift reflection’ model of group reflective practice: a pilot study in an acute...

Why you should read this article: • To enhance your awareness of the challenges that mental health professionals commonly experience, and the support they require • To gain knowledge of the ‘shift reflection’ model of group reflective practice and its components • To understand the potential benefits of shift reflection for staff working in acute mental health settings Background ‘Shift reflection’ is a novel, structured method of group reflective practice at the end of a shift. It involves a facilitator asking open questions about the shift, then using a mapping process to draw and make connections between the experiences of staff. Aim To undertake a pilot study of shift reflection in an acute mental health unit and to gather feedback from staff and service users on its effect on staff well-being, teamwork and ward culture. Method A mixed-methods design was used. Staff members provided feedback using the Professional Quality of Life (ProQOL) scale, completed pre-pilot (n=10) and post-pilot (n=14), a staff feedback questionnaire (n=14) and a focus group (n=7). Data from the questionnaires were examined using descriptive statistics and effect sizes, while the focus group data were analysed using thematic analysis. Findings The preliminary findings suggest that shift reflection was effective in supporting staff and that it improved team cohesion and morale. The ProQOL scale results indicated a small increase in compassion satisfaction, a medium reduction in secondary traumatic stress and a large reduction in burnout scores post-pilot. Five themes emerged from the focus group: value of shift reflection; team benefits; supportive role of facilitation; implementation challenges; and future directions. Conclusion While several challenges in implementing shift reflection were identified, the findings of this pilot study provide a foundation for developing and testing its effectiveness in future research.

Differentiating between borderline personality disorder and autism spectrum disorder

Differentiating between borderline personality disorder and autism spectrum disorder

Why you should read this article • To enhance your knowledge of the similarities and differences between borderline personality disorder (BPD) and autism spectrum disorder (ASD) • To assist you in developing effective treatment and management plans for people with BPD and/or ASD • To understand the complexities involved in diagnosing and managing people with co-morbid BPD and ASD One of the main issues that people with borderline personality disorder (BPD) and/or autism spectrum disorder (ASD) experience is that they find emotional and relational interactions challenging. This article reviews the available literature on the similarities and differences between BPD and ASD, and aims to raise awareness of the complexity of co-morbid presentations. This is important because, if a person’s diagnosis is inaccurate or incomplete, their treatment may be ineffective or inappropriate. The authors provide practical guidelines to assist front-line mental health practitioners in diagnosing BPD and/or ASD, thereby enabling them to develop appropriate and effective management plans. These guidelines were drawn from the available literature and the authors’ experience in clinical practice. When BPD and ASD co-occur, a formulation approach should be used to provide person-centred care, rather than an assessment approach that simply defines the issues a person is experiencing.

Three issues for mental health nurse educators preparing new preregistration programmes

Three issues for mental health nurse educators preparing new preregistration programmes

Areas nurse educators need to address when developing preregistration nursing programmes

Sensory modulation in mental health practice

Sensory modulation in mental health practice

An introduction to sensory modulation, identifying optimal practice and requirements

Timely diagnosis and disclosure of dementia for patients and their families: exploring the views of GPs

Timely diagnosis and disclosure of dementia for patients and their families

Mental health nurses have an important role in providing expertise to GPs

Alcohol use of UK military personnel during active service and on return to civilian life: veterans’ experiences

Veterans’ experiences of alcohol use of UK military personnel

On leaving active service, veterans should be provided with greater mental health support

Use of a mnemonic to support suicide intervention training for nursing students

Use of a mnemonic to support suicide intervention training for nursing students

Update your knowledge of the nurse’s role in suicide assessment and management

Effects of a mindfulness-based stress reduction group programme on family carers

Effects of a mindfulness-based stress reduction group programme on family carers

Study identified that mindfulness skills can be used in various ways in family carers’ lives

An interprofessional practice development group for newly qualified and new-to-role clinicians in community mental health

An interprofessional practice development group for newly qualified and new-to-role...

There is a wealth of literature focusing on the transition from being a new graduate to being a newly qualified member of staff. However, the needs of the new-to-role practitioner, who may be expected to manage challenging caseloads and coordinate care, are rarely explored. New-to-role mental health clinicians, particularly in the community, can work alone and experience complex challenges. To meet these demands, an interprofessional practice development group was formed. Clinical practice educators, alongside clinical team managers, designed a programme of six sessions of three hours to be delivered over a six-month period. The programme was delivered to two cohorts of new-to-role or newly qualified mental health staff from a nursing, occupational therapy or social work background. The sessions focused on the role of the care coordinator, on how the last month had been for participants and on discussing relevant articles and case studies. To evaluate the course, participants completed a pre- and post-group questionnaire. There was an improvement in their confidence and competence, but not in their skills.

Efficacy of mental health crisis houses compared with acute mental health wards: a literature review

Efficacy of mental health crisis houses compared with acute mental health wards: a...

Background Crisis houses are an alternative to acute psychiatric hospital admission. Aim To review evidence of the efficacy of mental health crisis houses as an alternative to acute hospital admissions. Method A systematic search of studies drawing on eight databases was undertaken, with a total of 135 articles identified. After the selection process, six quantitative and two qualitative studies met the inclusion criteria of the review. Of these, the quantitative studies were assessed for methodological quality using a 21-item tool and all studies were analysed using thematic synthesis. Findings Four of the studies were rated methodologically strong and two as methodologically moderate. It was found that people admitted to crisis houses experience fewer negative events, have more autonomy, receive more holistic care and spend more time with staff members. They also receive more peer support and report more therapeutic relationships with staff. Conclusion Service users who access crisis houses rather than acute wards tend to rate their recovery as lower and think that pharmacological treatments are less available. Crisis house admissions are shorter and less expensive than acute ward stays, but do not always prevent admission to hospital.

Rethinking concurrent disorders: implications and future directions for nursing practice

Rethinking concurrent disorders: implications and future directions for nursing practice

Concurrent disorders as conceptualised in academic literature and practice guidelines

Development of a suicide intervention training programme for secondary mental health services

Development of a suicide intervention training programme for secondary mental health...

This article describes the elements of a suicide intervention training programme, known as the ‘I CARED and Shared’ model

Using cognitive behaviour therapy techniques with people who hold delusional beliefs

This article uses a case study approach to increase awareness of CBT skills

Clozapine-induced constipation: a service evaluation

All nurses need to be aware of the dangers associated with clozapine-induced constipation

An evaluation of nurse-led mental health training for benefits staff

Delivery of training by mental health nurses to staff in a benefits district in west Scotland

Peer-to-peer mentoring for and by at-risk young people

Delivery of training by mental health nurses to staff in a benefits district in west...

Validity of a two-question tool in detecting antenatal depression in Malawi

Establishing the validity of a two-question tool based on the Whooley questions

Mental health service needs and experiences of asylum-seeking children in the UK

A literature review of the needs and experiences of unaccompanied asylum-seeking children

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