Therapeutic communication is central to effective mental health nursing, enabling nurses to build trust, engage with patients’ experiences and support psychological healing. Rooted in Buddhist philosophy, the seven factors of enlightenment offer a conceptual framework to enhance therapeutic communication in psychiatric settings. The article explores each factor's relevance to the emotional, cognitive and interpersonal aspects of mental health care, and discusses ways to integrate them into nursing practice. The seven principles can deepen relational attunement, support emotional regulation and promote compassionate, person-centred care.
Background: Nursing education is associated with high attrition, yet little is known about students who temporarily take a break in study. This study explored the incidence and reasons for break in study and students’ experiences of returning to higher education. Methods: A mixed-methods design was used. An online survey was sent to 68 healthcare students who had returned from a break in study and semi-structured interviews were conducted with six nursing students. Quantitative data were analysed descriptively and interview data were analysed using reflexive thematic analysis. Results: Health-related reasons, family responsibilities, academic pressures and life transitions were the main factors influencing students’ decision to take a break. Interview data identified three themes: difficulty reintegrating into the course, emotional wellbeing and administrative challenges. Students commonly described taking a break in study as a last resort, and reported anxiety about returning and inconsistent communication as reasons that interfered with smooth reintegration. Conclusions: Taking a break in study is a significant but underexplored aspect of healthcare education, and is shaped by intersecting personal and institutional pressures. Implications for practice: Structured, proactive support and clearer communication are needed to improve students’ experiences of returning from a break in study, which may also help reduce attrition.
Background/Aims: International adult nurses are increasingly recruited into UK services to address workforce shortages, yet little is known about how they integrate into community mental health teams. Therefore, this study aimed to examine the experiences and integration of international adult nurses working within community mental health teams in England. Guided by legitimate peripheral participation theory, this study explored the barriers, support mechanisms and facilitators influencing their professional and social integration. Methods: A qualitative design was employed. Semi-structured interviews were conducted with international adult nurses and open-ended electronic questionnaires were completed by community mental health team staff. Data were analysed thematically to identify shared experiences and perspectives. Results: Two overarching themes were identified. First was relocation and integration, which encompassed sub-themes, including motivation and challenges in relocation, language and cultural differences and integration into the workforce. The second theme was role adaptation and professional development, including sub-themes of clinical role expectations and workplace challenges, preconceived attitudes and role clarity, and training and professional development. Conclusions: Successful integration of international adult nurses within community mental health teams requires structured mentorship, cultural competence training, clear role definition and supportive leadership. Implications for practice: Healthcare organisations must implement strategies that enable international adult nurses to transition from peripheral newcomers to fully integrated and confident team members, thereby enhancing both workforce stability and quality of mental health care delivery.
Background: Many young people admitted to adolescent psychiatric inpatient services in the UK have a history of sexual trauma. This study aimed to investigate whether sexual health assessments are conducted in these settings. Methods: This study used quantitative analysis to review the clinical notes of 33 adolescents admitted to a psychiatric inpatient service over a 15-month period. In addition to studying the record of sexual health assessments, the number and type of risk behaviours, diagnoses and adverse childhood experiences were also reviewed to explore if there were any links between these factors. Results: No sexual health assessment documentation was found for any of the patients. All young people had at least one adverse childhood experience recorded, 73% had six or more, and the most prevalent form of abuse recorded was sexual abuse (64%). Conclusions: Adolescents admitted to psychiatric units have a high risk of sexual trauma and adverse sexual health outcomes; however, sexual health assessments are often neglected. Young people should be offered an opportunity to talk about sexual safety and health and relationships in inpatient settings, as this has the potential to reduce the risk of long-term negative sexual health and relationship outcomes. Implications for practice: Assessment of sexual health and relationships in the inpatient environment should be prioritised by mental health services, as it could lead to more appropriate support, treatment and better preventative interventions. A trauma-informed approach could also lead to better holistic and patient-centred care.
In this comment piece, the author discusses ways that AI can support better education for mental health nurses, while also highlighting some of the ethical, practical and pedagogical challenges that need to be considered before implementation.
In this comment piece, the author reflects on her visit to a drug consumption room in Amsterdam and the holistic care provided. She questions if it is important to rethink current mental health practices in the UK towards one that prioritises psychosocial needs over pharmacological treatment.
This article discusses nursing interventions for managing comorbidity in patients living with paranoid schizophrenia and type 2 diabetes mellitus. The author discusses important aspects of holistic care based on the biopsychosocial model in healthcare, including the importance of collaborative working between different multidisciplinary agencies. This review could inform clinical practice, nursing education, policy and service development. These implications are crucial for understanding the comorbidity of mental health patients, and developing expertise in managing mental health and physical health issues, including managing chronic health conditions.
Many people living with serious mental illness experience physical health issues, making it important to adopt an integrated approach to care. Assessing the training needs of mental health nurses in providing physical health care can help to implement appropriate training in holistic care. This study aimed to understand mental health nurses' perceptions of knowledge and confidence in delivering physical health care to determine the type of training requirements they require personally and as a group. A mixed methods approach was used for the study. An anonymous survey with Likert-type questions was sent to all nurses in an Irish independent mental health service. Open-ended questions were thematically analysed. Ethical approval was received. The largest perceived gaps in physical healthcare knowledge related to the delivery of intravenous fluids (64.8%), vascular skin changes (58.1%), interpretation of bloods (45.9%) and wound care (41.8%). Three themes were identified from the thematic analysis: value of interactive sessions, method and frequency of educational sessions, and mental health upskilling. This study found that there was a need for flexible and consistent training for mental health nurses to effectively provide physical health care for people in hospitals experiencing mental ill health. This study highlights the need for consistent, flexible, and skills-based physical health training to strengthen mental health nurse competence in core areas such as wound care, diabetes management, intravenous therapy and interpretation of blood results. Strengthening these skills can enhance early recognition of physical deterioration, improve holistic care, and ultimately support safer outcomes for mental health service users. Further studies evaluating the effectiveness of educational modules relating to physical healthcare should be conducted, examining their effectiveness both in terms of nurse- and patient-related outcomes.
Existing ward capacity models in mental health settings focus on bed availability and safe staffing, but neglect other crucial factors related to the delivery of care. Increasing complexity of needs in children and young people in tier 4 inpatient services have highlighted the importance of establishing an alternate resource-based ward capacity model. The study aimed to develop an objective tool to understand resource-based ward capacity. Focus groups were used to adapt the Universal Needs Based Resource Assessment (UNBRA) tool—which evaluates the support needed for people living with intellectual disability—to assess the needs of children and young people experiencing mental health issues. The UNBRA tool is useful for objectively determining resource requirements and capacity for children and young people in inpatient services. It enables intra- and interpersonal comparison as well as comparison between different wards. The UNBRA tool helps to establish resource-based ward capacity and can aid decisions on safe admissions, resource allocation and system-wide bed management. Introducing the UNBRA tool for children and young people in tier 4 inpatient settings can result in needs-led resource allocation, and enable planning on a clinical, managerial and strategic level. This can have a significant positive impact on patient safety, quality of care and patient outcomes.
The effective assessment of wounds caused by non-suicidal self injury is an important skill for mental health nurses working in both acute and community based mental health care settings. The Nursing and Midwifery Council's standards of proficiency for registered nurses also identifies the assessment and management of wounds as an essential competency for all nursing professionals. This article discusses one approach to wound assessment that can be applied both in the context of non-suicidal self-injury and other unintentional traumatic wounds.
This article explores the ethical and practical challenges of de facto prescribing in mental health nursing. De facto prescribing occurs when non-prescribing practitioners guide or instruct prescribers on medication decisions. This practice can involves risks such as misdiagnosis, adverse reactions or polypharmacy. Practical strategies for mitigating risks at individual and trust levels include consulting registered prescribers, accessing supervision, implementing and using patient group directions, engaging in continuous professional development, and reviewing audit and policy. The article emphasises the importance of adhering to professional guidelines and maintaining clear communication to ensure patient and professional safety, and effective medication management.
In this comment piece, Ian Peate discusses England's first-ever men's health strategy that was launched last year, including key focus areas in mental health, implementation challenges and practice implications for mental health nurses.
The Mental Health Act 1983 remains a cornerstone of mental health legislation in England and Wales; however, its outdated, paternalistic framework presents ethical challenges for nurse educators. This article explores the tensions inherent in teaching a law that is essential to practice yet widely recognised as inadequate. The authors examine the Mental Health Act's limitations, including its failure to promote autonomy, safeguard against coercion and address racial disparities. Key omissions such as lack of statutory advocacy, absence of advance decision making, and insufficient protections for children are critically analysed. The authors argue that nurse educators must go beyond statutory instruction to foster ethical awareness, cultural sensitivity and advocacy skills in students. By embedding critical reflection and person-centred values into education, academics can prepare nurses to uphold human rights and challenge discriminatory practices, even within a flawed legal framework. Reforming the law is essential but until then, education must bridge the gap between law and ethical care.
In this article, the author highlights the importance of using patient-preferred and culturally sensitive language to describe the experiences of voice hearing in people living with mental illnesses, including approaches for mental health nurses to build trust and strengthen therapeutic relationships.
In this fundamentals article, the author discusses the most common respiratory issues experienced by people with severe mental illness, and important management strategies for mental health nurses.
Lecturers from one higher education establishment were concerned about the use of stigmatising language they were hearing in the classroom from student mental health nurses. The study aimed to explore the perspectives of first year student nurses on personality disorders, and if there was a difference between their understanding of personality disorders in university and their experiences during placement. A case study approach was used, consisting of two data collection methods. First year student mental health nurses were asked to take part in a poster creation exercise to indicate signs of a personality disorder and then participate in follow-up semi-structured interviews to gauge their views on the diagnosis of personality disorders. Data were analysed thematically. Thematic analysis revealed four main themes; fear, stigma, professionalism, and knowledge and understanding. Evaluation revealed that student mental health nurses attending clinical placement had witnessed clinical staff emotionally distancing themselves from their patients with personality disorder. Student mental health nurses were fearful about caring for patients with personality disorder and wanted help to feel more confident, sometimes turning to social media to try and learn more. During their placement, student nurses observed stigmatising behaviour towards patients with a personality disorder. They reported needing help to make sure they can care for patients with a personality disorder according to their professional nursing values. Further exploration is required to look into educational approaches that can strengthen mental health nursing students' confidence in tackling stigma and working with patients with personality disorders. This study enables practitioners to pause and reflect on their own practice while caring for those with personality disorders and consider the influence they have over the students they teach and work with.
In this comment piece, the author uses the analogy of jelly to understand the complexity of working with the risk of suicide ethically and effectively, including the impact of acts or omissions of mental health service interventions. The article explores the dilemma of how to contain risk, emphasising that while recognition of the complexity is important, perfection is impossible when working with the risk of suicide.
Mental health nursing is increasingly recognised as requiring an integrated approach to care, as individuals with severe mental illnesses are at a higher risk of poor physical health. The Nursing and Midwifery Council requires all nursing students to be able to provide essential physical healthcare; however, integrating these skills into mental health nursing courses has posed challenges. This study explored the mental health nursing students' perceptions of the teaching and relevance of physical health skills. Focus group discussions were used to explore students' perceptions. Data were analysed using thematic analysis. Findings revealed that students recognised the importance of physical health skills in addressing the physical health disparities experienced by individuals with mental illness, highlighting that competence in these skills increased their confidence in providing holistic care. However, challenges were noted, including limited opportunities to practice physical health skills in mental health settings. A need to better integrate physical health skills training into pre-registration mental health nursing programmes was identified to prepare students for the complex demands of contemporary mental health practice. Findings from the study could be used to support the development of initiatives to enhance students' confidence and competence in delivering holistic care. Mental health services and academic institutions should collaborate to create clinical placements and learning environments where physical health assessment is routinely practiced, helping to bridge the gap between theory and practice, ultimately improving outcomes for individuals with severe mental illnesses.
In this fundamentals article, the author discusses the main symptoms of sepsis and how mental health nurses can use The UK Sepsis Trust's screening tool for assessing and diagnosing the condition.
Effective monitoring enables preventive care and early intervention for individuals with severe mental illness on psychotropic medications. St Patrick's Mental Health Service established a multidisciplinary physical health monitoring programme, combining psychiatry and nursing expertise to ensure continuous surveillance. This article outlines the service's development, implementation and evaluation of adherence rates. The Health Service Executive model of improvement was used to develop and implement the physical health monitoring service. A monthly audit was conducted to collect and assess physical health monitoring data from electronic health records of service users aged between 12–82 years. A total of 1827 inpatient electronic health records were reviewed from January–December 2024. Adherence to physical health monitoring standards were generally high across all five medications in the initial audit. Clozapine demonstrated the most complete compliance, with mostly 100% adherence rate. In contrast, quetiapine and olanzapine exhibited greater variability, particularly in electrocardiogram monitoring, where adherence ranged from 87% to 100%, and body mass index measurement, which ranged from 72% to 100%. Among mood stabilisers, sodium valproate achieved 100% overall adherence, with one instance of reduced compliance (90%). Lithium monitoring showed minor inconsistencies, with electrocardiogram and body mass index adherence raging at 92% to 100% and serum lithium ranging around 95% but overall achieving 100% adherence. Challenges around implementation of the service demonstrated the importance of clear communication and collaborative stakeholder involvement during all phases of the new initiative. Responsive leadership allowed the management team and the physical health monitoring clinicians to address adaptive problems by exploring concerns in a supportive and collaborative way. Technical problems were addressed and resolved through updated policies and procedures clarifying changes and managing expectations. The data on adherence rates highlighted ongoing challenges to achieve consistency in completing 100% adherence. Overall, the implementation of a physical health monitoring service improved early detection of outstanding physical healthcare requirements. Additionally, ongoing regular surveillance enabled early identification of compliance gaps, allowing for prompt corrective actions by healthcare staff, ensuring the highest standards of patient safety and individualised care. This study could inform further development of physical health monitoring services in mental health settings, particularly the use of ongoing monitoring to facilitate improvements and enhancements in practice. Future service developments should encourage and promote continuous training for mental health nurses to minimise inconsistent monitoring among service users. This will improve the impact of the service and ensure adherence to monitoring standards.
