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.
Why you should read this article: • To recognise the physical health needs of people with severe mental illness (SMI) • To understand the role that physical health passports could have in meeting the health needs of people with SMI • To learn how a physical health passport was developed and implemented in mental health services People with severe mental illness (SMI) experience significant health inequalities, and their physical health needs are often not addressed. This article describes the development and implementation of a physical health passport, known as My Physical Achievement Log (My PAL), which aims to improve physical health monitoring in people with SMI. The article explains how a literature search and information from official reports were used to identify physical health indicators and to devise a system for recording these. It also describes how feedback was obtained from mental health nurses to improve the My PAL tool and pilot it in mental health services. Further research to evaluate service users’ experiences of using the My PAL tool is being undertaken to enhance its usability.
Why you should read this article: • To reflect on the benefits of using simulation-based learning in pre-registration nursing programmes • To enhance your knowledge of the skills nursing students can develop by acting out simulation scenarios • To consider how pre-registration nursing programmes could be improved to support nursing students’ learning and practice In simulation-based learning, nursing or medical students are exposed to hypothetical scenarios that mimic the realities of clinical practice. This provides them with an opportunity to practise and reflect on clinical skills in a safe environment. This article details a small-scale evaluation that was undertaken to explore two nursing students’ perspectives on clinical simulation. The aim of this evaluation was to identify what these students learned from clinical simulation and the effects it had on their practice. It also aimed to inform the programme’s academic revalidation and therefore improve the university’s offering. Taking part in simulation before undertaking their first clinical placement increased the students’ confidence and it improved their fundamental nursing, communication, psychomotor and reflective skills.
Why you should read this article: • To be aware of the incidence of sexual safety incidents in mental health settings • To recognise the reasons why sexual safety incidents may not be reported • To understand the actions that could be taken to improve sexual safety in your area of practice Concerns have been raised about the sexual safety of people in mental health inpatient settings and it has been identified that the reporting of sexual safety incidents is inconsistent across healthcare services. This article describes the strategy developed by Humber Teaching NHS Foundation Trust (HTFT) to improve sexual safety for people using mental health services and comply with recommendations from the Care Quality Commission. The strategy was informed by a literature review and several reports into sexual safety. The literature review found that staff are often unsure how to identify and categorise sexual safety incidents, while debriefing and support for those who experience such incidents are often lacking. In addition, not all healthcare services have policies and protocols in place to guide staff who experience sexual safety incidents. Based on the findings of the literature review, along with recommendations from various organisations, HTFT developed a strategy to ensure the delivery of safe and accountable care. This strategy included: a review of trust policies and procedures; staff and service user focus groups; and the development of a staff education programme. The aim is to disseminate this learning across other inpatient services in the trust.
Why you should read this article: • To understand the principles behind the concept of mindfulness • To familiarise yourself with the skills required to become a mindful nurse practitioner • To be aware of how mindfulness can contribute to nurse education Reflection is an important skill for nurses. Building on these reflective skills, mindfulness offers opportunities for personal development by increasing nurses’ awareness of sensory experiences, other people and their environment. Mindfulness is also an important element of self-care. This increased awareness can contribute to the nurse’s ability to make skills-based healthcare decisions and act in the ‘present moment’. The authors argue that these qualities are essential in developing the future nursing workforce, particularly given stressful challenges faced by the profession, for example increased work pressures at times of crisis such as the COVID-19 pandemic. This article discusses the evidence for, and benefits of, offering mindfulness programmes during nurse education and for the wider nursing profession.
Why you should read this article: • To understand why men are less frequently diagnosed with depression than women, but are at higher risk of suicide • To recognise the factors that can discourage men from engaging in help-seeking behaviours • To consider strategies that could be used to improve men’s engagement in mental health services and interventions In the UK, more women are being treated for depression than men, yet men are up to three times more likely to die by suicide. It has been suggested that stigma has a role in the lower rate of depression diagnosis in men and may reduce the likelihood of them engaging in help-seeking behaviours. This article discusses a literature review of the available evidence on the help-seeking behaviours of men with depression. The Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, PsycINFO and Medline databases were searched, and a total of 18 articles were included in the review. Following analysis, two themes emerged: social stigma and self-stigma, both of which were found to affect help-seeking behaviours. Therefore, it is important for healthcare professionals to consider the factors that can influence stigma and help-seeking behaviour, and for mental health services to be accessible and appealing to men with depression.
Why you should read this article: • To recognise the co-morbid mental health conditions that patients with chronic obstructive pulmonary disease commonly experience • To gain knowledge of the potential benefits of including a psychoeducation session as part of pulmonary rehabilitation programmes • To understand the barriers to accessing psychological support, particularly from improving access to psychological therapies services, that patients may encounter Background Chronic obstructive pulmonary disease (COPD) is a chronic and life-threatening inflammatory lung disorder that results in progressive symptoms and significant disability. Co-morbid depression and/or anxiety are highly prevalent in people with COPD and are linked with higher mortality and symptom burden. Aim To explore if a psychoeducation session on depression and anxiety is a useful addition to a pulmonary rehabilitation programme. Method In total, 74 psychoeducation sessions, attended by 214 patients with COPD, took place. The sessions involved providing information on the symptoms and potential triggers for depression and anxiety, as well as basic cognitive behavioural therapy strategies on how to cope with these experiences. A total of 163 patients completed session evaluation forms and 12 patients participated in focus group discussions. Thematic analysis was used to analyse the data. Findings The evaluation forms indicated that 95% of respondents found the psychoeducation session useful. Six themes were identified from the focus group data: education on depression and anxiety; normalising; the benefits of being in a group; learning skills to manage symptoms; knowing that support is available; and barriers to accessing the group and making referrals to an improving access to psychological therapies (IAPT) service. Conclusion The addition of a psychoeducation session may be a useful adjunct to pulmonary rehabilitation programmes. Participants reported that they learned about the signs and symptoms of depression and anxiety, and most of them felt more confident in recognising these after the session. However, only a few participants were referred to the IAPT service, potentially because of several barriers to accessing this service.
Why you should read this article: • To improve your understanding of the health risks to which offenders with a dual diagnosis are exposed • To enhance your awareness of rehabilitative community sentencing options as an alternative to custodial sentences for vulnerable offenders • To recognise the importance of ensuring professionals in the judiciary are aware of the challenges and vulnerabilities experienced by people with a dual diagnosis Many people who serve custodial sentences in the UK have a dual diagnosis – that is, mental health issues combined with problematic alcohol or substance use. As an alternative to custodial sentences, magistrates can issue community orders and make these conditional to requirements such as mental health treatment, drug rehabilitation and alcohol treatment. However, since their introduction in 2005, the uptake of these community sentencing options has been low. In Northamptonshire, England, Substance to Solution, the regional branch of the charity Change Grow Live, delivers mental health treatment in the community to male offenders with a dual diagnosis. In parallel, a magistrate-led vulnerable-person focus group has developed training to increase magistrates’ awareness of the potential mental health needs of offenders and of community sentencing alternatives. This article discusses the need for magistrates to consider the complex psychological and social needs of offenders with a dual diagnosis in their sentencing decisions. It describes the initiative in Northamptonshire as an example of how to provide treatment in the community for male offenders with a dual diagnosis and how to deliver mental health awareness training for magistrates. It is hoped that this will reduce the number of vulnerable people being given custodial sentences when there are rehabilitative community sentencing options available.
An examination of a transitional support service from custody to the community
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.
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.
Areas nurse educators need to address when developing preregistration nursing programmes
An introduction to sensory modulation, identifying optimal practice and requirements