Milieu Improvement in Psychiatry Using Evidence-Based Practices: The Long and Winding Road of Culture Change

Espinosa, Linda; Harris, Beth Perret; Frank, Joyce; Armstrong-Muth, Julie; Brous, Ellen; Moran, Janet; Giorgi-Cipriano, Judi

doi:10.1016/j.apnu.2014.08.004

Cited by 22 publications

(30 citation statements)

References 17 publications

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“…A therapeutic milieu is characterized by a culture of trust, person‐centred care, attentiveness to patients' needs and patient participation (Beyene, Severinsson, Hansen, & Rørtveit, ). Such a milieu promotes personal growth, security and satisfaction for both patients and staff (Espinosa et al, ). Mental health nurses who feel safe and supported and able to cope with challenging events, might not feel a need to stereotype patients as dangerous and unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

Mabala

Wath

Moagi

2019

Psychiatric Ment Health Nurs

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Accessible summary What is already known about the topic? Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments. Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. What the paper adds to existing knowledge? Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety. Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. What are the implications for practice? Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses. Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not “go the wrong way” and decrease confidence levels. AbstractIntroductionMuch has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities.AimTo explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa.MethodFollowing a qualitative descriptive design, 11 newly qualified nurses in their first 6–18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed.ResultsFour themes emerged from the analysis: fear related to the mental healthcare environment; self‐doubt upon meeting the expectations of the inter‐professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals.DiscussionDuring the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self‐confidence in both managerial and therapeutic realms.Implications for practiceManagement of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation.

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Section: Discussionmentioning

confidence: 99%

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

Mabala

Wath

Moagi

2019

Psychiatric Ment Health Nurs

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“…Hamrin et al () point to the impact of creating environments that foster the ability to build therapeutic relationships. In this context, meeting the patient's need instead of following the house rules requires a continuous focus and critical reflection on one's own caring practice, as supported in the work of Espinosa et al (), Gabrielsson et al () and Looi Rpn et al (). In our opinion, professionals should discuss the structural conditions of their professional practice in the mental healthcare context and participate in reorganize their services in line with changes in external conditions to create a secure working environment.…”

Section: Discussionmentioning

confidence: 99%

“…A discipline‐oriented focus based on the belief that “the patient has to learn” characterized the professionals’ attitude, implying keeping a distance by not responding to the patients, this finding was also supported by Bachmann et al () and Vatne and Fagermoen (). To improve the milieu for psychiatric inpatients Espinosa et al () concluded in their literature review a more therapeutic milieu could occur through a long‐term culture change.…”

Section: Introductionmentioning

confidence: 99%

Professional vulnerability in mental healthcare contexts: A focus group study of milieu‐therapists’ experiences

2019

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Aims and objectives To gain insight into how the workplace influences milieu‐therapists’ vulnerability in the mental healthcare context. Background Mental health services have experienced substantial changes. Reduced institutional treatment capacity is replacing the development of locally based treatment. Changes in external conditions in mental health services have influenced the working conditions of nurses and milieu‐therapists. Design Qualitative design. The study complied with the COREQ checklist. Methods Focus group interviews. Results “Vulnerability due to unpredictable and threatening working context” was the common key theme that emerged in both contexts. Two key themes were different and opposite. In municipal mental health care, “Alone and unprotected” and in institutional care, “Together and protected.” Conclusion The participants from both specialized and community mental health care, experienced vulnerability at different levels interpreted as a contradictory relationship between the healthcare system and their own ideals of what professional practice ought to be. Relevance to clinical practice This study contributes to extended knowledge and understanding about the experienced influence of the working environment on professional vulnerability of nurses and milieu‐therapists` in mental health services. The impact of contextual conditions on health professionals’ working conditions has multi‐professional relevance for milieu‐therapists and managers of mental health services, and it is an important topic in health and social higher education.

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“…While the specialty has taken great strides in reduction of seclusion and restraint, latest data indicate the practice continues as does incidents of violence and injury (Staggs, , ). One would anticipate DNP projects might be focused on evidence‐based restraint reduction, including employing one or more of the six core strategies (Azeem, Aujla, Rammerth, Binsfeld, & Jones, ); improving staff de‐escalation skills or perhaps contributing to the unit’s efforts to adopt a trauma‐informed philosophy of care (Espinosa et al, ). One such project from the Rush College of Nursing is currently in publication; it focused specifically on reducing the use of emergency PRNs via increasing staff engagement and strengthening trauma‐informed care principles (Aremu et al, ).…”

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confidence: 99%

“…In a DNP project, students and advisors would need to bring such projects and their measurement to a single‐unit scale. Alternately, the DNP student could take a role in the implementation of unit‐based programming or development of a specific group (Espinosa et al, ). A related area is delineating staff interventions and how they contribute to positive outcomes (Bobier, Dowell, & Swadi, ).…”

mentioning

confidence: 99%

Potential impact of DNP projects on child mental health services

Delaney

Lusk

2018

Child Adoles Psych Nursing

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Milieu Improvement in Psychiatry Using Evidence-Based Practices: The Long and Winding Road of Culture Change

Cited by 22 publications

References 17 publications

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

Professional vulnerability in mental healthcare contexts: A focus group study of milieu‐therapists’ experiences

Potential impact of DNP projects on child mental health services

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