OBJECTIVE:This study investigated the effects of an art psychodrama-based group intervention on psychological flexibility and alexithymia in adolescents with substance use disorders undergoing inpatient treatment at a ÇEMATEM unit. METHODS:A randomized controlled experimental design was used. Adolescents were assigned to experimental or control groups. The Multidimensional Psychological Flexibility Inventory-Short Form and the Toronto Alexithymia Scale were administered pre- and post-intervention. Within- and between-group comparisons were performed. RESULTS:No significant pre-post change was observed in the rigidity subdimension of psychological flexibility, though the experimental group showed a decreasing trend. A significant reduction was found in the difficulty identifying feelings subscale of the TAS in the experimental group compared to controls (p = 0.044). Decreases in difficulty describing feelings, externally oriented thinking, and total alexithymia scores were not statistically significant (p > 0.05). Psychological flexibility scores increased in the experimental group, but this improvement was not statistically significant. CONCLUSION:The art psychodrama-based intervention improved emotional identification in adolescents with substance use disorders. However, effects on psychological flexibility and other alexithymia dimensions were limited. Larger randomized controlled trials are needed to confirm clinical effectiveness.
Peer support is increasingly recognised in schizophrenia care, but evidence of its effects on medication adherence and recovery remains limited. This study examined a structured, face-to-face peer support programme in community mental health centres. A non-randomised quasi-experimental time-series study allocated 40 participants by centre to intervention and comparison groups, assessed at baseline, post-intervention, and 9-month follow-up. The intervention comprised eight peer-led group sessions delivered under a structured framework and professional supervision. Outcomes were assessed using the Scale of Medication Adherence in Individuals Diagnosed with Mental Illness and the Subjective Recovery Assessment Scale. Mixed-design analyses demonstrated significant group-by-time interactions for both medication adherence and subjective recovery. Medication adherence and subjective recovery improved in the intervention group and were largely maintained at follow-up, whereas no comparable improvement occurred in the comparison group. Although the non-randomised design requires cautious interpretation, the observed pattern suggests that structured peer support may represent a feasible and promising adjunct to routine community mental health services for individuals with schizophrenia. The findings also highlight the relevance of integrating recovery-oriented peer interventions into community-based mental health nursing practice, particularly in settings where nurses play a central role in care coordination, continuity, and the implementation of structured psychosocial interventions.
Digital platforms enhance family involvement in in community-based psychiatric care, with nurses playing a central role in coordinating these interventions. However, little is known about which specific patterns of caregiver-patient interaction contribute most to functional recovery. This retrospective observational study investigated how patterns of digitally supported caregiver-patient interaction-frequency, duration, and responsiveness-are associated with functional recovery and caregiver burden in schizophrenia. Digital engagement was quantified via objective system logs (contact frequency, video consultation duration, and response latency). Functional recovery was measured using the Personal and Social Performance (PSP) scale. Data were analysed using linear mixed-effects models, adjusting for baseline characteristics. Higher caregiver responsiveness, indicated by shorter response latency (β = -0.43, p < 0.001), and increased frequency of digital contacts (β = 1.29, p = 0.013) were significantly associated with improved PSP scores. Conversely, cumulative duration of video consultations showed no independent association with functional recovery (p = 0.318). Higher engagement also correlated with significantly reduced caregiver burden on the Zarit Burden Interview. The findings suggest that patterns of caregiver-patient interaction, particularly timely responsiveness and regular contact, may be more closely associated with functional recovery than the overall duration of digital communication.
The aim of this study is to evaluate the effect of an artificial intelligence (AI)-powered virtual patient application (ChatGPT) on the development of Mental Status Examination (MSE) skills in psychiatric nursing internship students and to explore how this process is reflected in their experiences. This study employed a sequential explanatory mixed-method design, consisting of a quantitative pre/post-test phase followed by a qualitative phase. In the quantitative phase, the MSE Competency Assessment scores of 27 undergraduate psychiatric nursing internship students were evaluated using a pre-test/post-test model. In the qualitative phase, in-depth individual interviews were conducted with 18 volunteer students. As part of the intervention, students participated in the "AI-Supported Virtual Patient Intervention: Structured Prompting Framework". The quantitative findings of the study revealed that the mean MSE Competency Assessment scores increased from 42.00 ± 6.43 in the pre-test to 49.57 ± 3.44 in the post-test (Z = -6.266, p < 0.001). Thematic analysis of the qualitative data yielded five main themes: Skill Development, Learning Experience, Impact of AI, Debriefing, and Limitations. Students reported that the application enhanced their MSE examination and communication skills; they also described a unique learning experience through AI, highlighted the importance of guided support.
Workplace bullying in nursing is widely documented, yet its consequences beyond the workplace, particularly for family life, remain insufficiently understood. Guided by spillover-crossover perspectives and the Conservation of Resources (COR) framework, this qualitative study explored how nurses experience workplace bullying and how these experiences extend into family relationships. Semi-structured face-to-face interviews were conducted with nurses in Türkiye (N = 13) who reported exposure to bullying, and the data were analysed using reflexive thematic analysis. The analysis generated three interrelated themes: Institutionalised Workplace Hostility, Psychological Harm and Emotional Depletion, and Relational Consequences in Family Life. Participants described workplace bullying as embedded in organisational practices that contributed to emotional exhaustion and diminished psychological well-being. These experiences frequently spilled over into family life through reduced emotional availability, relational withdrawal, and communication difficulties. In several cases, stress also crossed over to partners, generating tension, protective responses, and shifts in family roles, while spousal support sometimes buffered these effects. The findings suggest that workplace bullying may extend beyond the workplace, shaping nurses' family relationships and everyday relational well-being, with implications for nurses' mental health and the delivery of person-centred care.
The aim of this study was to explore in depth the experiences of psychological violence among male nurses in Turkey. A qualitative research design, specifically the phenomenological approach, was used in this study. It was conducted with 11 male nurses working in public hospitals. Interviews were conducted using an online semi-structured interview form. Colaizzi's phenomenological analysis method was used for data analysis. Through Colaizzi's phenomenological analysis, five interconnected themes were developed that reflected male nurses' lived experiences of psychological violence: "psychological violence", "experiences of psychological violence", "effects of psychological violence", "coping strategies" and "suggestions for the prevention of psychological violence". Male nurses were found to experience feelings of anger, discomfort, inadequacy, exhaustion and worthlessness in response to psychological violence. Participants reported constant mental preoccupation, which was associated with mental fatigue, sleep problems, loss of motivation, low morale, loss of appetite, negative impact on social life and self-isolation. In addition, they felt that they had no professional rights and that their profession was perceived as lacking status in society.
This concept analysis aims to clarify the uncertain and underexplored concept of repressed anxiety, addressing its complexities and ambiguities to better inform nursing practice, research, and the development of clinical interventions. The Walker and Avant method of concept analysis was applied to literature across psychology, nursing, and sociology. Articles were reviewed using search terms such as "repressed anxiety," "repression," "defense mechanism," and "emotional suppression." Antecedents, characteristics, and consequences of repressed anxiety were identified, and model and borderline cases were developed. Five defining characteristics of repressed anxiety were established: unawareness, physical symptoms, emotional dysregulation, impaired relationships, and avoidance behaviors. Antecedents included chronic stress, past trauma, adverse childhood development, personality traits, and cultural, societal, or familial norms. Consequences encompassed heightened stress responses, maladaptive coping, chronic physical conditions, and mental health problems such as depression or generalized anxiety. This analysis clarifies the concept of repressed anxiety, highlighting its hidden but significant impact on health and well-being. A conceptual model for repressed anxiety is then presented. Greater conceptual clarity can aid in the development of assessment tools and inform nursing interventions aimed at enhancing emotional awareness and regulation.
Speaking up is widely positioned as a core expectation of nursing practice, embedded in professional standards, codes of conduct, and organisational policy. Nurses are taught that raising concerns is central to patient safety, ethical care and professional accountability. Yet for many nurses, the experience of speaking up in practice falls short of this promise. This discussion paper examines the gap between policy rhetoric and workplace realities, and how this disconnect shapes nurses' behaviour, wellbeing, and professional identity. Drawing on contemporary literature, we explore how nurses learn informal rules about voice through everyday interactions, observing how concerns are received, who is protected, and whose voices are marginalised. In settings where encouragement to speak up is not matched by reliable protection, nurses are required to navigate significant psychosocial risk. Repeated exposure to negative responses, scrutiny, or exclusion can contribute to moral distress, hypervigilance and emotional exhaustion. Some nurses respond by limiting engagement, withdrawing from discussions, or avoiding situations in which concerns may arise. These behaviours are frequently misinterpreted as disengagement or a lack of resilience, rather than understood as adaptive strategies for self-protection in environments perceived as unsafe. We argue that silence in nursing should be recognised as a rational response to organisational conditions that fail to safeguard those who raise concerns. Reframing silence in this way shifts attention away from individual blame and towards the structural, cultural and leadership factors that shape whether speaking up is genuinely safe in practice.
Digital communication channels and social media platforms have created new terrains in which nurses can be scrutinised, targeted, and attacked in ways that are often difficult to anticipate, detect, or contain. In this discursive paper, we draw on relevant published literature to examine digitally mediated violence against nurses as a form of occupational harm that is persistent, scalable, and difficult to contain. We consider how online harassment, intra-professional hostility in digital channels, and the non-consensual disclosure of personal information can erode wellbeing, professional identity, and workforce stability. We argue that digital aggression should be recognised and managed as a workplace safety issue rather than an individual burden. Implications are outlined for organisations, regulators, educators, and professional bodies, including clearer reporting and response pathways, workforce education for digital safety, and stronger protections for nurses who are targeted online. If left unaddressed, digitally mediated violence will continue to compound workforce pressures and retention risks.
Due to discrimination and structural cisheteronormativity, the LGBTQ+ population faces high stress and mental health issues within both historical oppression and the current sociopolitical environment. The historical struggle for rights remains a key pathway to empowerment, a multidimensional process involving control, agency, and participation at intrapersonal, interpersonal/community, and sociopolitical levels. To map the scientific literature on the relationship between empowerment and the mental health of the LGBTQ population. A scoping review in accordance with the guidelines of the Joanna Briggs Institute. A total of 294 publications were identified; after blind and paired assessment of titles, abstracts, and full texts, 25 studies were included. Empowerment in the community (connection and support), intrapersonal (self-acceptance), and sociopolitical (activism) dimensions was associated with positive mental health outcomes, such as greater resilience and lower depression. The absence of empowerment, marked by isolation and limited family support, was linked to worse mental health outcomes, including suicidal risk. Activism showed ambivalent effects, with long-term benefits, but also political fatigue in hostile contexts. This review positions empowerment as a strategic axis for promoting LGBTQ+ mental health, fostering protective factors, reducing vulnerabilities, and promoting well-being, autonomy, and social participation.
