I'd like to say that asking Professor Michael Clinton to write the Editorial for this issue was good management; in reality, it was good luck. Michael is known to many of us for the enormous contribution he made to mental health nursing in Australia. He is now in the Middle East, and I was confident that his insights about mental health and mental health nursing in that region would be of interest to our international audience. The luck was in the timing. This is the first issue of the Journal to go into press following the release of the 2011 impact factors. For those unfamiliar with this term, the impact factor refers to the number of times manuscripts from a journal have been cited for the previous 2 years. The higher the citations, the greater the ranking. I am very proud to announce that in its first year of this ranking, The International Journal of Mental Health Nursing (IJMHN) received an impact factor of 1.427, placing it at number 16 (of 88) in the world for nursing journals, and the highest ranking mental health nursing journal. Impact factor is only the measure of a journal's success, and with this being our first, it could be a ‘one off’, rather than a longer-term trend. It is an international benchmark, and the already favourable reputation of the IJMHN is likely to be further boosted. The IJMHN has been so named since 2002, but its history extends back to 1980 when the first edition of the Journal of the Congress of Mental Health Nurses was published under the editorship of Dennis (Denny) Cowell, followed by Ron Dee, Owen Sallis, Linda Salomons, and Andrew King as Editors of this important publication. The Australian Journal of Mental Health Nursing was first published as a fully-refereed journal in 1992, with Michael Clinton as Editor. It was later to become the Australian and New Zealand Journal of Mental Health Nursing, and in 2002, the first issue was published as the IJMHN under the editorship of Mike Hazelton. I have been privileged to be Editor since 2004, but as all editors will agree, producing a journal is a team effort. My thanks to all of those who have contributed over the years: Editorial Board members, staff from Wiley–Blackwell, reviewers, authors, and of course, you the readers. Let's all celebrate this fantastic achievement. Now onto the Editorial from Michael Clinton, the pioneer of the Journal in its current form.
Having sufficient power to detect effect sizes of an expected magnitude is a core consideration when designing studies in which inferential statistics will be used. The main aim of this study was to investigate the statistical power in studies published in the International Journal of Mental Health Nursing. From volumes 19 (2010) and 20 (2011) of the journal, studies were analysed for their power to detect small, medium, and large effect sizes, according to Cohen's guidelines. The power of the 23 studies included in this review to detect small, medium, and large effects was 0.34, 0.79, and 0.94, respectively. In 90% of papers, no adjustments for experiment-wise error were reported. With a median of nine inferential tests per paper, the mean experiment-wise error rate was 0.51. A priori power analyses were only reported in 17% of studies. Although effect sizes for correlations and regressions were routinely reported, effect sizes for other tests (χ(2)-tests, t-tests, ANOVA/MANOVA) were largely absent from the papers. All types of effect sizes were infrequently interpreted. Researchers are strongly encouraged to conduct power analyses when designing studies, and to avoid scattergun approaches to data analysis (i.e. undertaking large numbers of tests in the hope of finding 'significant' results). Because reviewing effect sizes is essential for determining the clinical significance of study findings, researchers would better serve the field of mental health nursing if they reported and interpreted effect sizes.
The impact of published research is sometimes measured by the number of citations an individual article accumulates. However, the time from publication to citation can be extensive. Years may pass before authors are able to measure the impact of their publication. Social media provides individuals and organizations a powerful medium with which to share information. The power of social media is sometimes harnessed to share scholarly works, especially journal article citations and quotes. A non-traditional bibliometric is required to understand the impact social media has on disseminating scholarly works/research. The International Journal of Mental Health Nursing (IJMHN) appointed a social media editor as of 1 January 2017 to implement a strategy to increase the impact and reach of the journal's articles. To measure the impact of the IJMHN social media strategy, quantitative data for the eighteen months prior to the social media editor start date, and the eighteen months after that date (i.e.: from 01 July 2015 to 30 June 2018) were acquired and analysed. Quantitative evidence demonstrates the effectiveness of one journal's social media strategy in increasing the reach and readership of the articles it publishes. This information may be of interest to those considering where to publish their research, those wanting to amplify the reach of their research, those who fund research, and journal editors and boards.
Back to table of contents Previous article Next article CommentaryFull AccessMental Health Response to the COVID-19 Outbreak in ChinaJunying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Junying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Published Online:7 May 2020https://doi.org/10.1176/appi.ajp.2020.20030304AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Transmission of the 2019 novel coronavirus (COVID-19) (1) has now widely and rapidly spread around the world. On March 11, 2020, the World Health Organization announced that COVID-19 is a pandemic (2). The rapid transmission and mortality risk of the COVID-19 infection may increase the risk of mental health problems among healthy individuals in the general public and worsen preexisting psychiatric problems in psychiatric patients, although data are still being gathered. A constellation of difficult feelings and psychological distress, including panic, worries, and depression, could be triggered by the fear of possible infection, being quarantined at hospitals and home, social isolation, and even the shortage of protective gear.A number of mental health surveys associated with the COVID-19 outbreak are being conducted in different vulnerable populations, which include infected patients, medical staff, students, and the general population. Liu et al. have reported results from a multicenter survey conducted among 1,563 medical staff members and found that the prevalence of depression and anxiety was 51% and 45%, respectively (3). So far, data on the mental health repercussions of the COVID-19 pandemic in outpatient populations have not been available. Thus, we conducted a questionnaire survey, from February 25 to March 9, 2020, among outpatients who sought care in the Departments of Psychiatry, Neurology, and Sleep Medicine in West China Hospital of Sichuan University (Chengdu, China). A self-report questionnaire was completed by outpatients, who provided consent, via the WeChat-based survey program Questionnaire Star. A total of 2,065 out of 3,441 patients completed the survey, including 589 new patients and 1,476 existing patients. The prevalence rates of mental health problems related to the COVID-19 outbreak, including anxiety (defined as a total score ≥5 on the Generalized Anxiety Disorder 7-item scale), depression (defined as a total score ≥5 on the Patient Health Questionnaire 9-item scale), and insomnia (defined as a total score ≥8 on the Insomnia Severity Index), were 25.5%, 16.9%, and 26.2%, respectively. Furthermore, 20.9% of patients (N=300) with preexisting psychiatric disorders (N=1,434) reported a deterioration of their mental health condition related to the pandemic. In particular, transportation restrictions, isolation at home, and fear of cross-infection in hospitals have inevitably become major concerns and barriers to treatment for these patients during the outbreak. Our survey also showed that 24.5% of new patients, including those with anxiety (N=46), depression (N=37), insomnia (N=79), and psychosis (N=21), could not receive timely diagnoses and treatment. Similarly, 22.0% of existing patients with diagnosed mental disorders, including depression, bipolar disorders, and schizophrenia (N=315), could not receive routine psychiatric care because of suspended hospital visits. Consequently, 18.1% of patients (N=259) have self-reduced medication dosages, and 17.2% of patients (N=247) stopped taking their medication because they could not gain access to prescriptions from physicians during the outbreak. As the lifetime prevalence of mental disorders is 16.6% among adults in China (4), millions of psychiatric patients may face barriers to help seeking for timely management of their mental health condition. The long-term repercussions of the viral pandemic on the management of psychiatric patients warrant further investigation. Nonetheless, our data reiterate the importance of implementing appropriate mental health care measures in the face of the COVID-19 pandemic.In response to the COVID-19 outbreak, there have been ongoing measures and concerted efforts in China that emphasize the importance of dealing with the potentially concurrent mental health crisis. On January 26, 2020, the National Health Commission of China released principles for emergency psychological crisis intervention for the COVID-19 pandemic (5). Mental health hotlines were quickly established across China and provided the public with counseling and psychological services. The telephone and Internet have been widely used to deliver mental health care services, and social media platforms (e.g., WeChat, Weibo) have been used to share strategies, guidelines, and education programs for managing potential mental distress. In addition, a series of self-help handbooks for psychological care associated with COVID-19 have been published by the China Association for Mental Health, medical institutions, and universities.Furthermore, a number of hospitals in China have initiated telemedicine services for patients in need during the outbreak of COVID-19. On January 26, 2020, West China Hospital of Sichuan University, as one of the leading hospitals in China, opened a free online outpatient service involving more than 100 medical doctors across specialties. This online outpatient service was created mainly to provide prescriptions to existing patients and to offer consultation to new patients. Our hospital collaborated with commercial courier services to deliver medication to patients' homes at no cost. To date, thousands of patients have received health care provided by this online outpatient service. Interestingly, only 7.4% of patients with mental disorders (N=136) in our survey have sought online help for medical care. Thus, there is a need to promote online mental health care services across China to manage mental health problems during the pandemic.The long-term outcomes of the mental health interventions in both community and hospital settings need further evaluation to determine how we can ameliorate the negative effects of viral outbreaks in the general public, especially among vulnerable patients with mental health problems.Sleep Medicine Center (Zhou, Xue, Tang), Department of Anesthesiology, Translational Neuroscience Center (Liu), and Outpatient Department (Yang), West China Hospital, Sichuan University, Chengdu, China.Send correspondence to Dr. Zhou ([email protected]).The authors report no financial relationships with commercial interests.The authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan University.References1 Lu R, Zhao X, Li J, et al.: Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395:565–574Crossref, Medline, Google Scholar2 World Health Organization (WHO): WHO director-general's opening remarks at the media briefing on COVID-19: 11 March 2020 (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020)Google Scholar3 Liu S, Yang L, Zhang C, et al.: Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020; 7:e17–e18Crossref, Medline, Google Scholar4 Huang Y, Wang Y, Wang H, et al.: Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry 2019; 6:211–224Crossref, Medline, Google Scholar5 National Health Commission of China: [Principles for emergency psychological crisis intervention for the new coronavirus pneumonia.] http://www.nhc.gov.cn/jkj/s3577/202001/6adc08b966594253b2b791be5c3b9467.shtml (Chinese)Google Scholar FiguresReferencesCited byDetailsCited byRelationship between depression and burnout among nurses in Intensive Care units at the late stage of COVID-19: a network analysis1 April 2024 | BMC Nursing, Vol. 23, No. 1Effects of Long COVID on Psycho-Physical Conditions in the Italian Population: A Statistical and Large Language Model Combined Description27 April 2024 | European Journal of Investigation in Health, Psychology and Education, Vol. 14, No. 5The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis11 December 2023 | Psychology, Health & Medicine, Vol. 29, No. 4Descripción de un Programa de Telesalud Mental en el Marco de la Pandemia de COVID-19 en ColombiaRevista Colombiana de Psiquiatría, Vol. 53, No. 2Longitudinal trajectories of anxiety and depression in subjects with different mental disorders after one year in the COVID-19 pandemicPsychiatry Research, Vol. 334The Impact of the COVID-19 Pandemic on the Mental Health of Families16 April 2024Effect of anxiety and depression on self-reported adverse reactions to COVID-19 vaccine: a cross-sectional study in Shanghai, China3 March 2023 | BMC Public Health, Vol. 23, No. 1Evaluation of cognitive functions in a group of Egyptian recovered COVID-19 patients22 May 2023 | Middle East Current Psychiatry, Vol. 30, No. 1Trends in telemedicine utilization for mental illness during the COVID-19 pandemic: an analysis of a nationwide database in Korea24 October 2023 | BMC Psychiatry, Vol. 23, No. 1Investigating the dynamic relationship between stigma of fear, discrimination and employees performance among healthcare workers during Covid-19 pandemic31 July 2023 | Cognition, Technology & Work, Vol. 25, No. 4"I Can't See an End in Sight." 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Psychiatry, Vol. 11, No. und und February 2021 | der Vol. No. prevalence of depressive and anxiety symptoms and their associations with quality of life among patients with psychiatric disorders during the COVID-19 January 2021 | Translational Psychiatry, Vol. 11, No. COVID-19 pandemic and mental of The Vol. of COVID-19 pandemic on the mental health of May 2021 | Journal of associated with mental health and quality of life during the COVID-19 pandemic in May 2021 | Open, Vol. No. and risk of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: from the COVID-19 mental health April 2021 | Medicine, Vol. in The impact of protective and on and Medicine in Psychiatry, Vol. COVID-19 the of March 2021 | Current Psychiatry Reports, Vol. 23, No. Medicine in Psychiatry in the COVID-19 era: the impact of the pandemic on mental Medicine in Psychiatry, Vol. and in the age of October 2020 | Psychology & Vol. No. in mental health problems related to COVID-19 in Hospital 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2021 | Vol. Mental Health the of in the April 2021 | Journal of Education in the Health Vol. No. from November to the Mental Health of by COVID-19 in China: A December 2020 | Frontiers in Psychiatry, Vol. of in 100 Patients Disorder During the COVID-19 Pandemic in December 2020 | Frontiers in Psychiatry, Vol. in of November 2020 | Current Psychiatry Reports, Vol. 22, No. adverse with during COVID-19 Journal of Psychiatry, Vol. of patients with Journal of Psychiatry, Vol. health response for and adolescents during the COVID-19 outbreak in Research, Vol. to COVID-19 to in and from a for Sleep in December 2020 | International Journal of Research and Public Health, Vol. 17, No. awareness of suicide during the October 2020 | Reports, Vol. No. of and health anxiety during COVID pandemic among of a psychiatric an Journal of impact of COVID ‐19 on individuals with disorders: A survey of individuals in the and the July 2020 | International Journal of Disorders, Vol. 53, No. and Distress COVID-19 Among University in the October 2020 | Frontiers in Psychiatry, Vol. pandemic and mental health review of the and Vol. and to the COVID-19 crisis in the of Psychiatric Research, Vol. of COVID-19 on Youth Mental Health, and A of and de la COVID-19 la de et adolescents un et July 2020 | The Journal of Psychiatry, Vol. No. Network Analysis of During the COVID-19 October 2020 | Frontiers in Psychology, Vol. of suicide during and after the COVID ‐19 September 2020 | World Psychiatry, Vol. 19, No. psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public A systematic review and Research, Vol. changes during COVID-19 and the potential A June 2020 | Journal of Health Psychology, Vol. 25, No. and July 2020 | Journal of Psychiatry, Vol. No. COVID-19-Pandemie die und Psychotherapie, Vol. No. 2019 (COVID-19) and Psychiatric in Anxiety and Journal of Medicine, Vol. 2, No. of COVID-19 on Mental Health in the September 2020 | Journal of Internet Research, Vol. 22, No. an Outpatient Psychiatric to During the COVID-19 Pandemic: A October 2020 | Journal of Internet Research, Vol. 22, No. disorders in people infected with the coronavirus September 2020 | Journal of Public Health, Vol. No. 4 July authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan April 2020 online May 2020 in 1 July 2020
Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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Psikoterapilerdeki Dini İzler15 December 2018 | Cumhuriyet İlahiyat Dergisi, Vol. 22, No. 3Women's Perceptions of Using Short Films to Integrate Spirituality in TherapyJournal of Systemic Therapies, Vol. 37, No. 4Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool Lauren C. DiLello, Karen Mulvihill, Jennifer Delli Carpini, Riddhi Shah, Julia Hermanowski, and Damanjeet Chaubey29 October 2018 | Journal of Palliative Medicine, Vol. 21, No. 11Understanding, assessing, and in the spiritual of medical and October 2018 | Theology, Vol. 11, No. and of in Living with October 2018 | Journal of & Social Services, Vol. No. for the spirituality as October 2018 | Revista de Vol. 71, No. An of an aged psychiatry March 2018 | Psychiatry, Vol. 26, No. de de vida de de Vol. 25, No. support and with in Care in the Care A Narrative June | Journal of Care Medicine, Vol. No. Care in Cancer: in the of of Clinical Oncology Educational Vol. 3, No. religion/spirituality in clinical practice: A among social and and October | Journal of Clinical Psychology, Vol. 74, No. Spirituality in Care December | Journal of Religion and Health, Vol. 57, No. of to spiritual care at the of a phenomenological exploration from the of palliative care February 2018 | Journal for the Study of Spirituality, Vol. 8, No. Existential Distress in Pediatric Cancer December and Patient Spiritual in the through October of Spirituality in November Psychological/Psychiatric, Social, and Spiritual Problems and July and End-of-Life Care in Cancer in Oncology Nursing, Vol. No. Care in Hospice and Palliative Journal of Hospice and Palliative Care, Vol. 20, No. and Spirituality: Literature review and Journal of Counseling, Vol. 18, No. of the tool existential communication between and cancer August | European Journal of General Practice, Vol. 23, No. Education and of Christian Nursing, Vol. 34, No. Care Interventions in to and Therapy C. and D. September | Journal of Palliative Medicine, Vol. 20, No. in Patients with A Qualitative September | Journal of Research in Nursing and Vol. 14, No. theory on the and in an exploratory case study September | Vol. 69, No. of the of Spirituality and Palliative Care Research and of Pain and Symptom Management, Vol. No. of a spiritual care training program for staff on November | Palliative and Supportive Care, Vol. 15, No. 4Spiritual distress and spiritual care in advanced heart July | Reviews, Vol. and Spiritual Patient Simulation in Nursing, Vol. No. Vol. 42, No. 4The impact of a spiritual in patients with and and their support December | Vol. 26, No. 3The Importance of a Spiritual History in Healthcare Vol. No. About Substance Use DisordersJournal of Psychosocial Nursing and Mental Health Services, Vol. No. and Spiritual Beliefs of April | Journal of Religion and Health, Vol. No. Care Perceptions of and With of Hospice & Palliative Nursing, Vol. 19, No. in Substance Use What to Know to Practice30 November | in Mental Health Nursing, Vol. 38, No. End-of-Life Care to Religious and Vol. No. of Social Education, Vol. 53, No. Nursing Care and of Christian Nursing, Vol. 34, No. 1The of taking a religious and spiritual July | Psychiatry, Vol. 24, No. religion and spirituality in Vol. No. the role of religious in the at the of of Vol. No. care spiritual March | Supportive Care in Cancer, Vol. 24, No. Spiritual Care and the Role of An Review of Literature and April | Journal of Religion and Health, Vol. No. of the Spiritual Needs of of with Is in the June | Journal of Palliative Medicine, Vol. 19, No. Impact of a Tool for Comprehensive Assessment of Palliative Care on Assessment at and of Pain and Symptom Management, Vol. No. from Healthcare Students to Understand Spiritual Assessment in Clinical Practice29 October | Journal of Religion and Health, Vol. No. Spirituality in January | Journal of Religion and Health, Vol. No. 3Development and of to Assess Nurse Provision of Spiritual August 2014 | Journal of Holistic Nursing, Vol. 34, No. and Validation of the Practice Assessment September 2014 | Research on Social Practice, Vol. 26, No. and the Medical A of July | Journal of Health Care Chaplaincy, Vol. 22, No. history taking in palliative care: A controlled September | Palliative Medicine, Vol. 30, No. Is Is Using A and the Life With American in Spiritual March | Journal of in Mental Health, Vol. 11, No. and spiritual in September | International Journal of and Mental Health, Vol. No. 1The of Hospital to and Patients’ Spiritual A May | Journal for the Study of Spirituality, Vol. No. 1The and to March End-of-Life Spiritual March in Holistic Patient Journal of Nursing, Vol. No. of spiritual assessment for older September 2014 | and Vol. No. und der der Care, Vol. No. Spirituality and A for Holistic January | Journal of Religion and Health, Vol. No. and Belief, in Care spiritual history tool by C. M. Puchalski as an for an interdisciplinary in January | Journal for of and Social Vol. 21, No. the of Spiritual A Pain and Palliative Care Service Quality of Pain and Symptom Management, Vol. No. of Spiritual Assessment in September | Vol. No. the of Christian Nursing, Vol. 32, No. 4Spiritual care: is the assessment tool for palliative Journal of Palliative Nursing, Vol. 21, No. und Spiritualität in der September | Vol. 60, No. of September of spirituality assessment in palliative care patients in November 2014 | Progress in Palliative Care, Vol. 23, No. 4The for Spiritual A Mixed-Methods July | Oncology Nursing Vol. 42, No. 4The Integration of Religion and Spirituality in Social Practice: A May | Social Vol. 60, No. 3The and Educational of a Spiritual Life Review for Patients with and June 2014 | Journal of Cancer Education, Vol. 30, No. in Geriatric Palliative in Geriatric Medicine, Vol. No. An for Spiritual Well-Being May | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 34, No. Spiritual Assessment March | Journal of Health Care Chaplaincy, Vol. 21, No. American on Mental Health, and Help April | and Vol. 60, No. of Christian Nursing, Vol. 32, No. the Spiritual Needs and of Oncology Patients in Nursing Practice, Vol. 29, No. Care Training to Healthcare Professionals: A Systematic April | Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, Vol. 69, No. analysis of spiritual
The first officially documented management of the mentally ill in China was in the Tang Dynasty (618–907 AD), when homeless widows, orphans and the mentally ill were cared for in the Bei Tian Fang, a type of charity facility administrated by monks 1. The first western style psychiatric hospital for the homeless mentally ill was established and funded in 1898 by an American missionary, John Kerr, in what is currently the Guangzhou Brain Hospital. In the next 50 years, psychiatric hospitals were built very slowly in a limited number of large cities. The number of psychiatrists gradually increased to 100, and the number of beds gradually amounted to 1,000. After the founding of the People's Republic of China in 1949, psychiatric hospitals were gradually built in every province. The role of these early provincial hospitals was to maintain social security and stability. Following the first National Mental Health Meeting in 1958, community mental health work started in Beijing, Shanghai, Hunan, Sichuan and Jiangsu. Facilities were established in these areas to train professionals and to develop work plans for the prevention and treatment of psychoses, including early detection and treatment and relapse prevention 2. Though community mental health programs almost ceased during the Cultural Revolution (1966–1976), work-rehabilitation centers for patients with psychoses and caring networks were organized by neighborhood committees (the lowest level of governmental facilities) in Shanghai 3, and a treatment model for 256 patients with schizophrenia and their families was developed in a suburb of Beijing 4. In the 1980s, the health, civil affairs and public security sectors set up a three-tier network (at city, district/county and street/town levels) for the prevention and treatment of psychoses. Successful experiences with treatment models, such as work-rehabilitation centers in urban communities in Shanghai and Shenyang, and family-based therapy in rural areas in Haidian District in Beijing and Yantai Shangdong, were extended to other places 2. With the economic reform, hospitals were encouraged, as part of the market economy, to make a profit. Financially dependent mental health rehabilitation facilities closed or were transformed into small-scale psychiatric hospitals. In Shanghai, before 1990, there was at least one community-level rehabilitation facility in each district or town. By June 2004, the numbers of these facilities had decreased by 62% 5. By the late 1990s, some psychiatrists started to doubt the rationale for large hospital-based and profit-making models for mental health service delivery, and the Ministry of Health began to reconsider principles and approaches for mental health care. Through advocacy by the Ministry, senior ranked officials facilitated the establishment of a mental health plan. In November 1999, a high-level mental health seminar was convened by ten Chinese Ministries and the World Health Organization (WHO) in Beijing. The meeting resulted in a declaration that all levels of government would improve their leadership for and support of mental health care, strengthen inter-sectoral collaboration and cooperation, establish a mental health strategy and action plan, facilitate the enactment of a national mental health law, and protect patients’ rights 6. The first National Mental Health Plan (2002–2010) was signed by the Ministries of Health, Public Security and Civil Affairs, and China Disabled Persons’ Federation (CDPF) in April 2002. It identified a series of detailed targets and indices to achieve the main goals of: a) establishing an effective system of mental health care led by the government with the participation and cooperation of other sectors; b) accelerating the process of mental health legislation development and implementation; c) improving the knowledge and raising the awareness of mental health among all citizens; d) strengthening mental health services to decrease burden and disability; and e) developing human resources for mental health services and enhancing the capacity of current psychiatric hospitals 7. In August 2004, the Proposal on Further Strengthening Mental Health Work was approved by the Ministries of Health, Education, Public Security, Civil Affairs, Justice and Finance, and the CDPF. This proposal provides explicit instructions on interventions for psychological and behavioral problems for key population subgroups (including children and adolescents, women, the elderly and victims of disasters), treatment and rehabilitation of mental disorders, research on mental health and surveillance of mental disorders, and the protection of the rights of the mentally ill. The Proposal serves as the de facto Chinese national mental health policy. The mental health service model proposed in the above two documents is led by psychiatric hospitals, supported by departments of psychiatry in general hospitals, community-based health facilities and rehabilitation centres. In a large epidemiological study carried out in four provinces (Shandong, Zhejiang, Qinghai and Gansu) from 2001 to 2005, the adjusted 1-month prevalence of any mental disorder in people aged 18 years or older was 17.5% (95% CI 16.6–18.5), and that of psychotic disorders was 1.0% (95% CI 0.8–1.1) 8. In health economic terms, the estimated total disability adjusted life years (DALYs) of ten psychiatric conditions, including unipolar depressive disorder, bipolar disorder, schizophrenia, alcohol use disorders, Alzheimer's and other dementias, drug use disorders, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, and insomnia (primary), was 253,851,896 years in China in 2004 9. This translates into a loss of gross domestic product (GDP) amounting to a country-wide total of CNY 2,681 billion, with schizophrenia and bipolar disorder accounting for CNY 532 billion. The huge burden of mental disorders highlights the pressing need for improved mental health services. However, similar to most countries, the rate of treatment gap of those with mental disorders is unacceptably high in China, with 91.8% of all individuals with any diagnosis of mental disorders never seeking help. For psychotic disorders, 27.6% never sought help and 12.0% saw non-mental health professionals only 8. The vast majority of mental health professionals in China are psychiatrists or psychiatric nurses, with few clinical psychologists and social workers, and no occupational therapists. Psychiatrists and licensed psychiatric nurses are accredited by the Ministry of Health, psychological counselors by the Ministry of Human Resources and Social Security, and psychotherapists by both Ministries. In 2004, there were 16,103 licensed psychiatrists and psychiatric registrars (1.24/100,000 population) and 24,793 licensed psychiatric nurses (1.91/100,000 population) 9. Relative to the global average mental health workforce (i.e., 4.15 psychiatrists and 12.97 psychiatric nurses per 100,000 population respectively) 10, mental health human resources in China are quite limited. The shortage of skilled mental health professionals represents one of the most critical issues facing the Chinese mental health system currently. In 2004, there were 557 psychiatric hospitals. Among them, 359 (64.5%) had 100 or more beds, and 44 (7.9%) had 500 or more beds. The total number of psychiatric beds was 129,314, i.e. 1.00/10,000 population 11, which is significantly lower than the global average of 4.36/10,000 psychiatric beds 10. China does not organize its services in catchment areas. Specialist mental health services remain the predominant component of the system. China's community-based mental health system was largely eliminated with the introduction of the market economy. Therefore, mental health service provision has become primarily hospital-based. Patients can access tertiary psychiatric hospitals directly, bypassing the primary and secondary health care levels. This partly reflects the disproportionate concentration of health resources in large cities. The funding model for the mental health system is complex, with hospital inpatient services provided by three ministries, Health, Civil Affairs and Public Security, while other facilities are administered under other ministries. According to the WHO, only 2.35% of the total health budget is spent on mental health and less than 15% of the population has health insurance that includes coverage of psychiatric disorders 10. China is undergoing a rapid change, with an economic growth rate of 7.5–13.0% per annum in the last ten years 12. However, the growth in wealth has not been equitably distributed, resulting in an increasing gap between the rich and the poor. It is evident that those with the greatest socio-economic disadvantage are often those with the highest mental health care needs 13. In October 2003, supported by the Ministry of Health, an application process was initiated for specialized public health projects that would have investment from the Ministry of Finance. All relevant public health sectors were active in developing appropriate models with critical indicators and drafting proposals for funding. Although several approaches and different models were considered, the mental health sector was yet to identify a suitable and practical model for China. A delegation led by Guihua Xu (Vice Director of China Centre for Disease Control) and three psychiatrists, Xin Yu, Hong Ma and Jin Liu from Peking University Institute of Mental Health, visited Melbourne, in order to build knowledge and understanding of the Victorian community mental health service system. The delegates and their Australian hosts also began to analyze the concept of community in China, and to investigate possible ways to integrate mental health care into secondary and tertiary facilities in the country. Complemented by other international exchanges with the USA, Norway, Thailand, Japan, UK and Germany, and guided by international benchmarks on mental health services by WHO and previous experiences in community mental health in China, a mental health sector model for reform emerged. The model has at its core a patient-centered approach that is community-based, seamless, function-oriented and multi-disciplinary. Due to China's vast, multi-ethnic and diverse population, social harmony and stability is a well recognized concern for the Chinese government. The focus on psychoses, especially those associated with violent or socially disruptive behaviours, was considered as a critical step to engage government in mental health issues. Although community-based mental health services were the long-term goal, current lack of resources and capacity in community mental health and primary mental health, combined with the difficulty in attracting mental health professionals to work in the community, meant that a different, less ambitious and more targeted model needed to be followed initially. An integrated hospital and community treatment model for psychoses was suggested, and a pilot project that included monitoring, intervention, prevention and rehabilitation management of psychoses was proposed. In September 2004, after competing with over fifty proposals and supported by a group of leading sociologists, economists and psychiatrists in China, the program for mental health service reform was the only non-communicable disease program included in China's national public health program. This event became a major historical milestone for China: mental health became officially included into public health. The mental health reform program formally received support from Ministry of Finance in December 2004, and was named the 686 Program after its initial funding of CNY 6.86 million. The National Centre for Mental Health of China located at Peking University Institute of Mental Health was authorized to be the implementing facility for this program by the Ministry of Health. The project was overseen by a national working group as well as an international advisory group with experts mainly from the University of Melbourne. By early 2005, 60 demonstration sites were established, with one urban and one rural area in each of the 30 provinces of China, covering a population of 43 million. The priority in the first year was to build a capable mental health workforce through an extensive training program. A two-level training mode was adopted, first at the national level utilizing a train-the-trainer approach, and then with trained trainers delivering the programs at the provincial level. The contents of the training included guidance on project management, standardized treatment protocols, case management, information management, family education, and the training of police and neighborhood committees. In 2006, the 686 Program incorporated an intervention component into the training program, which was then called the National Continuing Management and Intervention Program for Psychoses. The aim was to consolidate the reform through the key provisions of continuity of care, treatment accessibility, and equitable mental health care. Four types of psychoses were included: schizophrenia, bipolar disorder, delusional disorder, and schizoaffective disorder. Patients screened for possible psychosis were referred from psychiatric hospitals or departments, the CDPF, community and village health centres, and neighborhood or village committees. These patients were subsequently examined by psychiatrists, and those who met diagnostic criteria for psychotic disorders were evaluated for their risk of violence based on a 0 to 5 score scale established by the national working group. The patients at risk of violence received monthly follow-up and, if they were socio-economically disadvantaged, were provided with free medication, laboratory tests, and a subsidy for hospitalization. About 5% of patients who received free medications were treatment refractory and were therefore provided with second generation antipsychotics, mainly risperidone. In the event of any psychiatric emergencies or severe cases of medication side effects, the program provided free crisis management. Moreover, as some patients were physically restrained or chained at home, the program provided support for the unlocking and freeing of these patients, and hospitalization when necessary. After hospitalization, if patients lacked finances to pay for treatment, they were included in the free services mentioned above. A key challenge for successful implementation of the 686 Program was the limited capacity of the workforce to deliver the program at the local level. To meet this enormous challenge, a tripartite training program was collaboratively developed in 2007 by the Peking University Institute of Mental Health, the University of Melbourne and the Chinese University of Hong Kong. The primary aim of the program was to train up multi-skilled case workers by: a) developing understanding of the key principles of community-based mental health care in general and case b) practical in developing service plans to and continuity of c) appropriate ways to build with the families and d) to work in and e) to and for principles from health social occupational a set of knowledge and for case management was A key for the training program was to a rehabilitation focus in a community to a of community mental health facilities hospitals, training centres, mental health support and by the community mental health provided for such clinical The program needed to build that included different sectors and facilities into the mental health service including local health, civil public the and In a total of facilities in this program, including 44 provincial hospitals, hospitals, hospitals, urban community health urban community health village urban neighborhood committees and village committees. A mental health was also By the of a total of for the program. Among who were mainly for the patients and leading community for case for who mainly crisis intervention for for psychiatrists for psychiatric nurses for and at different levels for from the police in demonstration sites that the number of violent from in to in of and that of major violent from to of By the of general population in were by this program. A total of patients were patients received follow-up (the average follow-up in demonstration sites was patients received free medication, free crisis management interventions were and patients were a subsidy for restrained patients were In the first year of the 686 a total of training were and people were including psychiatrists, psychiatric nurses, community case community workers, public security and family To 500 mental health professionals from in China have in tripartite program training of ten mental health professionals from China have had practical training in Hong and more than 100 hospital and of mental health departments have study in Melbourne. of the most of the program has been in the area of This has the greatest on long-term with the 686 national on mental health have been the on of National Mental Health Work to improve and reform mental health work the Work the first in Chinese mental were in the of the the of Health hospitals were to be improved as part of public health service capacity the on of Public Health which the management of psychoses was included as one of national public health service and the on Management of which of different sectors in the management of psychoses, and the relevant were A government is an for in a of in China. However, the and the of the mental health problems as well as the are the of mental health All of mental health services in China and of this be the mental health service system development and service in China of the main problems are the is huge in China. Although national are quite and a among provinces and in of and levels. In some rich and or the mental health service system is provinces or cities. However, in some western the reform process is by and lack of resources and In those the national mental health become Resources are not between the community and psychiatric hospitals. Though community mental health is as part of the of public health and national funding has been to each to and up of the patients at community general lack knowledge and for these In the next two or three years, CNY to the of psychiatric hospitals that are often located in less and the funding primarily based on psychiatric hospital beds than care received from and treatment This hospitals to be in community services. In social insurance only the of hospitalization, leading more patients to use inpatient services. are psychoses. It is from the social stability of psychosis treatment and management is the priority of the government. However, to the lack of relevant and is under the of mentally Social and resources the treatment rate of patients with psychoses. However, of psychosis is or patients’ levels are are yet to be is less The focus on psychosis management psychiatry less are to be trained as psychiatrists, and psychiatric hospitals professionals with levels of education, training and The is to psychiatric facilities into health in which are as This from training in with other sectors is Although the of each relevant or sector has been in cooperation and collaboration is not or established, with the health and mental health sectors working in in areas. In a with government such as China, mental health development needs and support from government at all levels. this the mental health sector to the management of psychoses by In China needs to develop awareness of the of and their role in social resources and services for mentally ill patients in the community to their in urban areas and village in rural areas training in order to and develop care plans for four types of psychotic patients to the 686 at the primary care and to up patients at least four per the large number of patients with mental disorders in China, community and care for most patients needs to be and be supported to care in the community for their mentally ill The limited of funding only support the and of in the national program, the mental health facilities that these professionals have to make a in order to pay their Mental health service for psychoses be provided by the government as of the service or insurance for the support and investment in clinical and health research are to establish treatment and that are relevant in a Chinese Moreover, economic from the of and long-term and for patients with mental disorders are needed to and provided by the Social Security This reform program in China is with in years by the WHO and supported by other international In the WHO that develop community-based services for people with mental disorders This has been by a for action to scale up services for people with mental disorders the development of the Mental Health the of the and the in World The work on the 686 Program and other in China are in and in mental health service However, mental health services in China, as in and have a to to meet the of mental health care in the research provides relevant information to in the of effective and health services However, of this work to national and international is by the of from in psychiatric work by has a level of by China well as and of these countries, and no in the and is by a psychiatric in the main international supported action to improve of and research the of from this and similar The World and the the of the of have the to this Although China's mental health service reform has only on psychoses the scale of the reform, and the numbers of psychiatric patients a and ambitious program, which has had to huge The reform began than the reform of general health care in China, and is with the Chinese public health strategy and the for to the WHO With of needs and development of appropriate public health of effective strengthening of human of and China be in a to build and strengthen a national community mental health system and service for the of the mental health of its Jin Liu and Hong Ma to this and Xin is the The and for their and support to mental health reform in China, and for to the and as to also all those who have or in the establishment implementation of the 686
HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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"I broke down and cried today. I cried of exhaustion, of defeat. Because after 4 years of being an ER nurse, I suddenly feel like I know nothing" (Sydni Lane, USA, Instagram and Facebook). (Fick , 2020) “It's an experience I would compare to a world war” Roberta Re, Italy. (Giuffrida, 2020) “we're on our knees here, and it's really difficult and we're all trying the best we can and we don't feel… we feel like we could be doing more, and I know we can't … we're staying away from our families and we're putting ourselves in danger to try and save other people's loved ones, it feels like a losing battle but it's not, we've all got hope and we're all trying to do what we can.” (Shirley Watts, UK ICU Nurse, BBC news 04 April 2020) As the coronavirus disease 2019 (COVID-19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time. At the bedside 24 hr a day seven days a week, in similar outbreaks, nurses have had the highest levels of occupational stress and resulting distress compared with other groups (Cheong & Lee, 2004; Maunder et al., 2006; Nickell et al., 2004). Nurses are already a high-risk group, with the suicide rate among nurses 23% higher than the national average (ONS, 2017). Despite this, the RCN (Royal College of Nursing in the UK) has reported that nurses feel “repeatedly” ignored by their employers when they raise concerns about their mental health (Mitchell, 2019). A focus on personal responsibility for psychological health and well-being and an overemphasis on nurses being “resilient” in the face of under-staffing and often intense emotional work is consistently challenged by nurses and nurse academics (Traynor, 2018). Treating resilience as an individual trait is seen to “let organisations off the hook” (Traynor, 2018), yet has often been the focus of organisational strategies to date. This does not work at the best of times and certainly is not appropriate now in these most difficult of circumstances. Here, we discuss the stressors and challenges and present evidence-informed guidance to address the physical and psychological needs of nurses during the COVID-19 pandemic. We stress the importance of peer and team support to enable positive recovery after acutely stressful and emotionally draining experiences, and outline what managers, organisations and leaders can do to support nurses at this most critical of times. The high prevalence of COVID-19 in the general population of many countries, its novelty and highly infectious nature, and the associated morbidity and mortality rates are placing an unprecedented demand on health and social care services worldwide. In addition to the admission to hospital of high numbers of critically ill patients, care demands on nurses and care assistants have also increased in the community, in care homes and in learning disability and mental health services. These demands must be met by an already-depleted workforce (+44,000 RN vacancies in the UK pre-COVID-19) and one that is further depleted at this time due to infection, self-isolation and family responsibilities in the face of the crisis. The nature of care itself and new ways of working are potentially highly stressful for staff. Nurses are not only experiencing an increase in the volume and intensity of their work, but are having to accommodate new protocols and a very “new normal.” For instance, many mental health services have transformed almost overnight from providing face-to-face care and treatment to a predominately virtual service of telephone or video consultations. In many other areas, nurses are adjusting to providing end-of-life care more frequently and often in the face of more rapid deterioration than they are used to. Isolation rules mean the presence of family at the bedside is rarely possible. Nurses are therefore frequently standing in for family members and facilitating remote access for loved ones. Established nurse–patient ratios are under strain. In ITU in the UK, for instance, staff-patient ratios of one-to-one are changing to ratios of one ITU nurse to six or more patients, with the shortfall being made up by staff without ITU experience. To boost the nursing workforce, many countries have also fast-tracked their final-year nursing students to join the nursing register early and have encouraged retired colleagues back to practice (Jackson et al., 2020). Many nurses have been redeployed, working in new specialities or in higher acuity areas. All of these factors are likely to be adding stress for existing staff, with additional implications for the well-being of new members of the team. Evidence from studies on COVID-19 and other infectious respiratory disease outbreaks reflects high concern among nurses for personal or family health in the face of direct contact with a potentially deadly virus and the stress of balancing this concern with the ethical obligations of continuing to provide care (Jiang, 2020; Khalid, Khalid, Qabajah, Barnard, & Qushmaq, 2016; Kim & Choi, 2016; Nickell et al., 2004). Other stressors evident from research to date include concerns about shortages of staff and of personal protective equipment (PPE), navigating an unfamiliar setting or system of care and lack of organisational support (Kim, 2018; O'Boyle, Robertson, & Secor-Turner, 2006; Shih et al., 2009). Additionally psychological conflicts between healthcare workers' responsibility to care for the ill and their right to protect themselves from a potentially lethal virus were reported (Chen, Wu, Yang, & Yen, 2005). Our own anecdotal sources in the UK and Europe endorse these findings for COVID-19 as (at time of writing) we approach the peak of the pandemic, but also raise the possibility of other stressors including moral distress resulting from treatment decisions based on finite resources, the lack of access to antigen or antibody testing for most front-line staff, and the discomfort and fatigue resulting from long shifts spent wearing full PPE. On social media, nurses speak of crippling tiredness after long shifts with sore faces after so many hours in masks, as well as communication barriers with colleagues and patients when wearing full PPE; nurses often cannot hear patients, and patients can struggle too; not being able to see nurses' faces or hear what is said. Nurses also speak of the difficult ethical and moral judgements that are being taken in hospitals; care homes and the community throughout the world. They tell of experiencing stigma in the wider community, being perceived as a threat to the safety of others and as “disease-carriers.” As the number of COVID-19 patients grow, there will be increasingly stringent rules about who can be offered ventilation, with one doctor suggesting “soon many of our own staff would not meet the criteria” (Anon & The Guardian, 2020). Reflecting on the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) COVID-19 guidelines for the criteria that doctors and nurses should follow, the moral philosopher Yascha Mounk reflects: “If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?” (Mounk, 2020). Nurses are likely to experience moral and ethical conflict with the potential for stress and moral distress or moral injury (Bridges et al., 2013; Greenberg, Docherty, Gnanapragasam, & Wessely, 2020; Morley, Ives, Bradbury-Jones, & Irvine, 2019). These stressors are present across settings in health and social care, and relevant to all members of the nursing team, including care assistants and temporary members of the team drafted in from their studies or from retirement. There is also an emerging narrative of guilt and some of potential shaming among nurses and students who are unable to contribute to direct patient care due to their own high risk and vulnerability to coronavirus. Nurses and their unions are speaking up about the lack of testing for front-line staff and the variation in access to PPE. Nationally and internationally it appears there is wide variation in access to PPE and the Royal College of Nursing in the UK and its counterparts across the world have been campaigning for adequate PPE for nurses suggesting the nursing voice has been side-lined in the relevant debates (Ford, 2020). In many countries, the focus has been on acute and intensive care; however, nurses in the community and mental health and learning disability settings may also have inadequate access to PPE. The UK priorities for PPE distribution and testing are being interpreted as further discrimination against nurses who do not work in acute physical health settings, leading to further anger that some lives appear to matter less. A failure to protect nursing staff adequately is causing anger and frustration, making nurses feel unsafe at work, while they are risking their own health and fearful of transmission to their families. Unless nurses feel well supported by their organisations and governments, that anger may linger after the crisis potentially causing some to leave the profession. It would be difficult as a nurse not to have strong emotional reactions to the COVID-19 virus and its impact on one's work (fear, anger, frustration, worries). Such fear and anxieties are normal, as are the intense feelings evoked when nurses feel unable to care for patients as they would have otherwise. Nurses and healthcare or nursing assistants, in acute, community mental health and social care settings are having to make extremely difficult decisions from one moment to the next. They are having to be very creative about new ways of working with very ill patients with mental health needs or learning disabilities or dementia. Legal frameworks to support the continuation of care at times of mental health crises such as (in the UK) potential temporary amendments to the Mental Health Act 1983 and the Coronavirus Act 2020 which enforce isolation; place further strain on therapeutic relationships and the delicate balance between nursing care and restrictive practice. In situations where compliance with social distancing and isolation with COVID-19 is low on the list of priorities for people in receipt of care, nurses are having to weigh up human rights, safeguarding and infectious disease protocols all of which may potentially conflict. There are some good signs that health systems are recognising how important it is to support healthcare staff. In the UK, NHS staff have been given free access to more than 1,500 specialists, online therapy and group counselling sessions and will receive practical and financial assistance as well as specialist bereavement and psychological support. Volunteers from charities including Hospice UK, the Samaritans and Shout are staffing phone and text helplines. The NHS is also offering free access to support from Apps such as Headspace, UnMind and Big Health for healthcare staff and their families to include guided meditation and tools to battle anxiety and help with sleep problems. This is a good start, but these services rely on the individual seeking help, and this may well not be sufficient. Investment in a range of supportive measures that do not just place the onus on the individual is almost certainly necessary. Supporting nurses practically and psychologically is essential to preserving their health in the short and long term, particularly when occupational stress levels are so high. Ensuring psychological well-being requires a layered response, with different components at different times, comprising strategies aimed at prevention through to treatment, and strategies/actions at different levels, from organisational and team/ward responses to those aimed at individual self-care and peer support. Response to the specific unprecedented challenge of COVID-19 will also need a flexible strategy as needs and requirements are likely to change over the course of the pandemic response. Furthermore, nurses working outside acute hospitals, working autonomously or in dispersed teams across large geographical areas can find accessing support challenging. Having reviewed the literature and gathered intervention resources from a variety of sources, it is evident that there is much to learn from other similar crisis situations such as SARS, MERS and Ebola. The evidence base in this area is considered weak, and most research is observational or has focussed on early interventions after major incidents and once the crisis has passed (Billings et al., 2020). From a nursing perspective, few studies consider nursing outside of hospital walls. In Figure 1, we present strategies and interventions aimed at supporting nurses' psychological well-being during the COVID-19 crisis. This guidance is led by best-available evidence, underpinned by theory (see Figure 1), expert opinion and models used in the military, as well as experiences from other countries and other infectious disease outbreaks (Watson, 2020; Watson, Brymer, & Bonanno, 2011; Watson et al., 2013). Below, we highlight physiological and safety needs; peer support; team support; and the roles and needs of managers and leaders as well as long-term recovery support needs. While at work and outside of work, nurses should prioritise their own well-being as much as possible, paying attention to meeting their essential needs for drinks, food, rest and sleep, and building in rest and comfort breaks (Cole-King & Dykes, 2020). At times of crisis, human physiological and safety needs come to the forefront—adequate food, shelter, rest, sleep and safety needs for example (Kenrick, Griskevicius, Neuberg, & Schaller, 2010). Recent interviews with medical staff (including nurses) treating COVID-19 in a hospital in Hunan Province support this (Chen et al., 2020). A detailed psychological intervention package (online course to deal with psychological problems; a psychological assistance hotline; and group interventions) encountered obstacles, as staff were reluctant to participate. Staff reported not needing a psychologist at this time, as they were concerned with more immediate worries including not wanting their families to worry; more rest without protective and support and with anxiety and The psychological intervention measures were therefore to include a place to and of their work to with families to to psychological problems; and access to staff for psychological the rest areas to to staff and and provide support (Chen et al., 2020). In countries with the threat of the from the there are from nurses for adequate PPE; and access to the right for psychological support with the wider evidence base that early with more intense for example psychological can be & & Wessely, 2009). on the work of Watson (Watson, 2020; Watson et al., we know that to the healthcare work is by stress may be the to it and stigma can be an to for often do not prioritise good care of recognising it may on or they fear the team without after nurses cannot after health are to after others and not are therefore likely to need others and to to of For week a of a of for a nursing team who had not had a for more than Figure for strategies and interventions for individual and peer support. the pandemic, nurses may be working with people who are not their team therefore need to support other and find ways to help new members feel and as as (see Figure with more colleagues can help support colleagues who have from have been or are final-year students who are in the numbers or in some countries have been early et al., needs to be so that the people are not support and should be so that is not seen as an for organisations they are not providing adequate psychological or other support. All members of the and access to support during and after the In the for Care (Bridges et al., 2018), nurses and healthcare assistants the of nursing teams in to in on This other that the of for members to learning and social support for nurses difficult work with Staff in the an to meet to in on well-being the safety and other evidence at the and of shifts can also help to social support for other (see Figure In times, there is evidence that group such as can team and increase for colleagues and patients et al., 2018). to psychological safety in our that staff by members should not be staff should have had the to and a difficult or experience to protect staff from et al., 2009). as to all in the and face to may not be the at the of the pandemic. The of Care in the UK is therefore their in to in has the of but in a virtual to be in existing teams across the with by of and for a time of an with present 2020). These sessions are being in practice and in and other teams in the few and we to with our students at the of these will A from studies of members of the is that team and leaders and their is highly with mental with a reported in mental health between who perceived themselves as having a good or et al., There is therefore much managers and leaders can do to support nurses in their teams and organisations (see Figure for strategies and guidelines also and communication is as well as and access to physiological and safety needs (Billings et al., 2020; & Dykes, 2020). It is also important that nurses support for so that they have the to support others and are able to good to decisions and access to a are particularly important for where they can through the difficult decisions they are having to make in to COVID-19 They will need their healthcare and to on during the pandemic. or seeking a for peer support is therefore Evidence it is important not to what are and anxieties in such and situations and stress and that needs change over time (Billings et al., 2020). to highly or resilience and do not long-term psychological Greenberg, & Wessely, 2005). some will in most these without the need for interventions Wessely, & is evidence of staff experiencing stress after infectious disease outbreaks for example et al., that does not mean all staff will experience mental health it will be important to the psychological needs of the nursing workforce the of the pandemic, so that in teams and across organisations as well as across we can learn and make nurses have access to adequate support in the recovery to a of nurses with psychological or in the of the acute staff may be on some may have staff colleagues have or family members there has been time to and some may have or guilt (Cole-King & Dykes, 2020; et al., It is important that interventions do and are to individual at and groups should be early or detailed could an and psychological is now with A of research has the of the of as a in of long-term for a of psychological may in et al., et al., 2009). to treatment for those staff who of mental health such as therapy and and which are to be in et al., may be may be for this, and it will be important that there is of access and that this is to nurses as well as other members of the healthcare team. to this unprecedented some resilience is but nurses need their their the and the to support with and and front-line staff throughout Europe is to and some nurses at the of and of such as and other There are also of teams in and in and intensive care to but a this is not nurses also need to feel their needs are for and that they are with adequate PPE equipment in all settings where health and social care are being They need access to rest good peer and team support and leaders that will to care for well after the pandemic is As who have nurse well-being for it is to see the increased focus on healthcare staff yet that it takes a pandemic to its critical staff will need but resilience must be seen as an individual it is a and organisational Evidence from the the resilience of the team appears to be to the between team members than the psychological or of et al., The resilience is now as staff can feel it is to staff are and psychologically lack of resources or ethical and emotional challenges as in nurses can feel it is their they have not the adequately or been This is not this be an to the and emotional strain that nurses on of and not only through this crisis but after it is all health care is back to support for nurses' well-being will critically While COVID-19 particularly high stress on there is very in the guidance that not relevant to staff well-being and when the pandemic is we to the guidelines being used to support for nurses and nursing the We are to our colleagues for their support in the of this to who had the for guidance and through the different levels of while being with are also due to the colleagues who on the and for evidence and
AIMS AND OBJECTIVES: To present the findings of a systematic review on (1) the attitudes of undergraduate nursing students towards mental health nursing and (2) the influence of undergraduate nursing education on the attitudes of undergraduate nursing students towards mental health nursing. BACKGROUND: Recruitment and retention of mental health nurses is challenging. Undergraduate nursing students' attitudes towards mental health nursing may influence whether they choose to practice in this specialty upon graduation. DESIGN: A systematic review. METHOD: Searches of the CINAHL, MEDLINE and PsycINFO electronic databases returned 1400 records, of which 17 met the inclusion criteria for this review. A further four papers were obtained through scanning the reference lists of those articles included from the initial literature search. RESULTS: Research on the attitudes of undergraduate nursing students towards mental health nursing has consistently shown that mental health is one of the least preferred areas of nursing for a potential career. With respect to the influence of undergraduate nursing education on the attitudes of students towards mental health nursing, quasi-experimental studies have generally demonstrated that students tended to have more favourable attitudes towards mental health nursing when they had received more hours of theoretical preparation and undertaken longer clinical placements. CONCLUSION: Many nursing students regard mental health nursing as the least preferred career option. Education, via classroom teaching and clinical placements, seems to engender more positive attitudes towards mental health nursing. There is no evidence, however, that changing student attitudes results in more graduates beginning careers in mental health nursing. REFERENCE TO CLINICAL PRACTICE: The constancy of negative attitudes to mental health nursing over time suggests the focus of research should shift. Clinicians have the capacity to promote a more positive view of mental health nursing. This requires further exploration.
Objective The International Journal of Adolescent Medicine and Health ( IJAMH ) is an interdisciplinary, peer-reviewed, scientific journal which aims to publish original research on the promotion, prevention and improvement of adolescents’ health and well-being globally. Starting 2025, the journal will be transferred to Diamond Open Access on a year-by-year basis . All articles will thus immediately appear under the Creative Commons license CC-BY. There will be no publication costs for the authors. The Open Access transformation is based on Subscribe-to-Open , an alternative model that enables the full Open Access transformation of journals by continuing existing subscriptions. The prerequisite for successful transformation is that subscriptions are continued to the same extent as before. The editors of the International Journal of Adolescent Medicine and Health and the publisher De Gruyter would therefore like to thank all subscribers for their support in making the transformation to Open Access possible. Our mission is to enhance the health and well-being of individuals during adolescence. To achieve this, we aim not only to publish research that supports their healthy growth and development but also to empower young people with chronic conditions and special health needs to successfully transition from pediatric to adult care. Starting in 2025, the journal will feature a dedicated section "Transitions in Medicine and Health Care", focusing on this important topic. We work closely with the Society for Transition Medicine ( Gesellschaft für Transitionsmedizin e.V. , GfTM), whose official publication the journal is. We seek original manuscripts, review articles, short communications, and letters to the editor from all disciplines worldwide. We welcome manuscripts from our colleagues in medicine, nursing, health services research, social work, psychiatry, psychology and youth work, public health and policy, and other disciplines working to improve the health and well-being of adolescents and young adults. International Journal of Adolescent Medicine and Health regularly identifies focus topics that the editorial team considers to be of particular global relevance. Focus Topics in 2024 and 2025 Innovations in Adolescent Health Climate Change and Health Refugee and Migrant Health Promoting Mental Health Diversity and Inclusion Sexual and Reproductive Health Our International Editorial Team is dedicated to producing a high-quality scientific journal that is essential reading for healthcare professionals, practitioners, researchers, educators, managers, policymakers, students, and other learners. All contributions submitted for publication undergo single-anonymized peer review by at least two renowned experts in the field, selected and invited by the Editors-in-Chief or the Associate Editors. Article formats Original Articles, Review Articles, Short Communications, Letters to the Editor
Mental health is fundamental to health, according to Mental Health: A Report of the Surgeon General, the first Surgeon General’s report ever to focus exclusively on mental health. That report of two years ago urged Americans to view mental health as paramount to personal well-being, family relationships, and successful contributions to society. It documented the disabling nature of mental illnesses, showcased the strong science base behind effective treatments, and recommended that people seek help for mental health problems or disorders. The first mental health report also acknowledged that all Americans do not share equally in the hope for recovery from mental illnesses. This is especially true of members of racial and ethnic minority groups. That awareness galvanized me to ask for a supplemental report on the nature and extent of disparities in mental health care for racial and ethnic minorities and on promising directions for the elimination of these disparities. This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best available research, however, indicates that these groups have less access to and avail-ability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs. A hallmark of this Supplement is its emphasis on the role that cultural factors play in mental health. The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.
Despite rising international needs for mental health practitioners, the mental health nursing workforce is underutilized. This is in part due to limited understandings of their roles, identities, and capabilities. This paper aimed to collate and synthesize published research on the clinical roles of mental health nurses in order to systematically clarify their professional identity and potential. We searched for eligible studies, published between 2001 and 2021, in five electronic databases. Abstracts of retrieved studies were independently screened against exclusion and inclusion criteria (primarily that studies reported on the outcomes associated with mental health nursing roles). Decisions of whether to include studies were through researcher consensus guided by the criteria. The search yielded 324 records, of which 47 were included. Retained papers primarily focused on three themes related to mental health nursing clinical roles and capabilities. Technical roles included those associated with psychotherapy, consumer safety, and diagnosis. Non-technical roles and capabilities were also described. These included emotional intelligence, advanced communication, and reduction of power differentials. Thirdly, the retained papers reported the generative contexts that influenced clinical roles. These included prolonged proximity with consumers with tensions between therapeutic and custodial roles. The results of this scoping review suggest the mental health nurses (MHNs) have a wide scope of technical skills which they employ in clinical practice. These roles are informed by a distinctive cluster of non-technical capabilities to promote the well-being of service users. They are an adaptable and underutilized component of the mental health workforce in a context of escalating unmet needs for expert mental health care.
BACKGROUND: College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. OBJECTIVE: This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. RESULTS: A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. CONCLUSIONS: Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
PURPOSE: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population. DESIGN AND METHODS: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework. RESULTS: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes. IMPLICATIONS: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.
Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.
BACKGROUND AND AIM: Social support is an important factor that can affect mental health. In recent decades, many studies have been done on the impact of social support on mental health. The purpose of the present study is to investigate the effect size of the relationship between social support and mental health in studies in Iran. METHODS: This meta-analysis was carried out in studies that were performed from 1996 through 2015. Databases included SID and Magiran, the comprehensive portal of human sciences, Noor specialized magazine databases, IRANDOC, Proquest, PubMed, Scopus, ERIC, Iranmedex and Google Scholar. The keywords used to search these websites included "mental health or general health," and "Iran" and "social support." In total, 64 studies had inclusion criteria meta-analysis. In order to collect data used from a meta-analysis worksheet that was made by the researcher and for data analysis software, CMA-2 was used. RESULTS: The mean of effect size of the 64 studies in the fixed-effect model and random-effect model was obtained respectively as 0.356 and 0.330, which indicated the moderate effect size of social support on mental health. The studies did not have publication bias, and enjoyed a heterogeneous effect size. The target population and social support questionnaire were moderator variables, but sex, sampling method, and mental health questionnaire were not moderator variables. CONCLUSION: Regarding relatively high effect size of the correlation between social support and mental health, it is necessary to predispose higher social support, especially for women, the elderly, patients, workers, and students.
The covid-19 pandemic has heavily burdened healthcare systems throughout the world. We performed a rapid systematic review to identify, assess and summarize research on the mental health impact of the covid-19 pandemic on HCWs (healthcare workers). We utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence on 11 May and included 59 studies. Six reported on implementing interventions, but none reported on effects of the interventions. HCWs reported low interest in professional help, and greater reliance on social support and contact. Exposure to covid-19 was the most commonly reported correlate of mental health problems, followed by female gender, and worry about infection or about infecting others. Social support correlated with less mental health problems. HCWs reported anxiety, depression, sleep problems, and distress during the covid-19 pandemic. We assessed the certainty of the estimates of prevalence of these symptoms as very low using GRADE. Most studies did not report comparative data on mental health symptoms before the pandemic or in the general population. There seems to be a mismatch between risk factors for adverse mental health outcomes among HCWs in the current pandemic, their needs and preferences, and the individual psychopathology focus of current interventions.
Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic sociodemographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early to middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, nonheterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
BACKGROUND: Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user's uptake and sustained interactions with these interventions. OBJECTIVE: This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. METHODS: A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. RESULTS: A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one's own health. CONCLUSIONS: Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
BACKGROUND: With technological developments and modernised sedentary lifestyles has come an increase in diseases associated with inactivity such as obesity and other non-communicable diseases. Emerging evidence suggests that time spent sedentary may also interact with mental health. This systematic review examined the associations between sedentary behaviour and mental health problems among adolescents. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and applied a quality assessment tool for quantitative studies to identity best available evidence. Following stringent search strategy of the databases; Cumulative Index to Nursing and Allied Health Literature, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsychARTICLES and PsycINFO, we identified 32 articles eligible for review. RESULTS: All studies reported leisure screen time among adolescents, and two thirds of identified studies examined depressive symptomatology. Other mental health measures were; anxiety symptoms, self-esteem, suicide ideation, loneliness, stress, and psychological distress. Strong consistent evidence was found for the relationship between both depressive symptomatology and psychological distress, and time spent using screens for leisure. Moderate evidence supported the relationship between low self-esteem and screen use. Poorer mental health status was found among adolescents using screen time more than 2-3 h per day, and gender differences exist. Essential information was missing for quality of evidence including heterogeneity in mental health and screen time-based measures, and self-report data collection methods. CONCLUSIONS: The findings are of particular significance given the global public health concern of lifestyle-attributed diseases and the possibility for novel approaches to mental health. Future research should examine the psychological impact of reducing time spent using screens for leisure among adolescents, whilst accounting for possible confounding factors such as physical activity and dietary behaviours. It is critical that the reciprocal relationship between lifestyle behaviours and mental health is represented in both the psychiatric and public health forum.