INTRODUCTION:Forensic psychiatric nursing is a distinct field in which caregiving, security, legal responsibility and ethical decision-making processes are closely intertwined. AIM/QUESTION:This study aimed to explore in depth the experiences of forensic psychiatric nurses regarding violence and ethical dilemmas encountered in clinical practice. METHOD:A qualitative phenomenological design was employed. Data were collected through semi-structured, in-depth individual interviews with 18 nurses working in forensic psychiatry units. The interviews were analysed using Colaizzi's phenomenological analysis method. RESULTS:The findings revealed that nurses experienced violence and ethical dilemmas as routine and multidimensional aspects of their professional lives. Two main themes emerged from the analysis: 'Balancing Safety, Care, and Ethics' and 'Support Needs and Expectations'. Within the first theme, participants described experiences related to managing multiple roles simultaneously, providing care under constant risk, striving to determine appropriate actions, and making sense of their experiences. The findings demonstrated that nurses continuously attempted to balance therapeutic care with control, patient rights with institutional security and professional values with emotional responses including fear and anxiety. Furthermore, participants emphasized that structural factors such as inadequate physical environments, staff shortages, and limited training opportunities contributed to experiences of both violence and ethical dilemmas. DISCUSSION:The study highlights the need for structured institutional support for forensic psychiatric nurses, particularly in violence management, ethical decision-making processes, and clinical supervision. IMPLICATIONS FOR PRACTICE:Strengthening these areas may contribute to both staff well-being and the quality of patient care.
INTRODUCTION:Artificial intelligence technologies are increasingly transforming mental healthcare through predictive analytics, language-based systems and digital innovations. Mental health nurses play a central role in implementing and evaluating these technologies. AIM/QUESTION:This bibliometric review aimed to analyse publication trends, knowledge structures, influential contributions and emerging themes in artificial intelligence research within mental health nursing. METHOD:A comprehensive search of the Scopus database was conducted in May 2026. After eligibility screening following the PRISMA 2020 reporting framework, 141 English-language articles and reviews published between 2018 and 2026 were included. Bibliometric mapping and keyword co-occurrence analyses were performed using VOSviewer. RESULTS:Publication output increased substantially after 2023, with 72.3% of studies published in 2025-2026. The United States, China and Türkiye were the most productive countries. Five thematic clusters emerged: prediction and risk assessment, nursing education and simulation, nurses' attitudes and workforce impact, generative artificial intelligence applications and ethical-professional issues in mental health nursing. DISCUSSION:Findings indicate a transition from traditional predictive modelling toward implementation-focused, generative artificial intelligence and ethically informed research. IMPLICATIONS FOR PRACTICE:Mental health nurses require enhanced artificial intelligence literacy, critical appraisal skills and ethical competencies to support safe implementation. RECOMMENDATIONS:Future research should evaluate clinical effectiveness, implementation outcomes, cross-cultural validation, international collaboration and ethical governance of artificial intelligence technologies in mental health nursing.
INTRODUCTION:Trauma is a risk factor for mental health problems. Pathological dissociation is often theorized as a response to trauma, yet it remains a controversial topic. AIM:The present study is one of the very few to examine trauma and dissociation in a representative general population sample and is the first of its kind in the Chinese context. We examined the prevalence of pathological dissociation and its association with trauma, potential iatrogenic effects, and functional impairment. METHODS:A random sample of community Hong Kong Chinese adults (N = 945) completed validated measures of trauma exposure, dissociative symptoms, depressive symptoms, and functional impairment. RESULTS:In this sample, 33.3% endorsed at least one potentially traumatic event; 16.5% exhibited clinically significant pathological dissociation, of whom only 14.8% had ever sought professional mental health services. Childhood betrayal and non-betrayal trauma and adulthood betrayal trauma were significantly associated with dissociative symptoms, while adulthood non-betrayal trauma was not. Dissociative symptoms were the strongest predictor of functional impairment (β = 0.443, p < 0.001), even stronger than depressive symptoms (β = 0.384, p < 0.001). DISCUSSION:This study highlights the public health and clinical importance of recognizing dissociation, which is comparably prevalent to depression and even more strongly linked to functional impairment. Our results support the trauma model in general, but do not support the betrayal trauma theory or the iatrogenic model. IMPLICATIONS:Dissociative symptoms are prevalent and clinically significant in the community. Nurses should be trained to identify and support people affected by pathological dissociation.
INTRODUCTION:Workplace stress is prevalent in psychiatric nursing, with compassion fatigue significantly challenging nurses' well-being and care quality. Effective prevention requires identifying at-risk nurses using validated assessment frameworks. The contemporary approach to workforce mental health emphasises proactive, targeted interventions tailored to individual risk profiles. Nurses play a central role in sustaining therapeutic environments, and their psychological resources are critical to this process. However, the heterogeneity of compassion fatigue among psychiatric nurses remains underexplored. AIM:To empirically identify distinct subtypes of compassion fatigue among psychiatric nurses and examine their key predictors: METHODS: Using convenience sampling, 297 psychiatric nurses were selected from five Chinese hospitals to participate in a cross-sectional online survey. Measures of sociodemographic traits, occupational stress, social support, psychological resilience, coping methods, and compassion fatigue (as measured by the Professional Quality of Life Scale) were all filled out by the participants. Standardised scores for burnout, secondary traumatic stress, and compassion satisfaction were used as indicators in latent profile analysis. To find the ideal number of profiles, model fit indices such as the Lo-Mendell-Rubin likelihood ratio test, entropy, Bayesian information criterion, and Akaike information criterion were compared. Subsequent multivariate logistic regression examined predictors of profile membership. Data analysis was conducted using statistical methods, and the STROBE guideline was followed in reporting. RESULTS:Three distinct compassion fatigue profiles were identified among psychiatric nurses: Mild Fatigue-Traumatic Stress (18.5%, n = 55), Moderate Fatigue-Low Burnout (64.0%, n = 190), and Severe Fatigue (17.5%, n = 52). Multivariate logistic regression revealed that older age, higher work stress, and greater use of negative coping were significant risk factors for more severe profiles, whereas not working night shifts, higher social support, greater positive coping, and higher psychological resilience were associated with reduced risk. The Severe Fatigue group exhibited the most adverse profile-highest work stress, lowest resilience and support, and greatest reliance on negative coping. Conversely, the group with the highest levels of resilience and social support was Mild Fatigue-Traumatic Stress. CONCLUSION:There are different subgroups of psychiatric nurses who feel compassion fatigue, each with unique risk and protective characteristics. These results highlight the necessity of profile-specific, focused treatments that address organisational and personal issues. Early career nurses and those working night shifts may benefit from priority support to mitigate occupational psychological burden and enhance workforce well-being.
INTRODUCTION:Mental health care professionals face emotionally demanding work and often carry invisible personal trauma histories. AIM:To examine cumulative lifetime trauma exposure among employed psychiatric mental health care professionals and its associations with burnout, secondary traumatic stress, and compassion satisfaction. METHOD:A cross-sectional survey among 309 staff (31.4% registered nurses, 43.7% healthcare assistants, 12.0% psychiatrists and psychologists, 12.9% other) at a Danish psychiatric centre assessed cumulative lifetime trauma exposure, operationalised as a count of ten potentially traumatic event categories, using the Brief Trauma Questionnaire and professional quality of life (ProQOL). RESULTS:Among those reporting trauma, 34.3% endorsed two or more categories. Higher trauma exposure was associated with secondary traumatic stress (β = 1.27, p = 0.005) and burnout (β = 1.05, p = 0.028) but not compassion satisfaction (p = 0.759). DISCUSSION:Cumulative trauma exposure is a largely invisible background characteristic contributing independently to trauma-related professional strain. Thisis particularly relevant for nursing, as nurses and nursing support staff constitute 75.1% of the inpatient workforce. LIMITATIONS:Cross-sectional design and single-centre sample limit causal inference and generalisability. IMPLICATIONS:Findings support universal, trauma-informed organisational approaches that do not require disclosure of personal trauma histories, making them feasible for all staff. RECOMMENDATIONS:Longitudinal studies should examine associations between trauma exposure and occupational demands. RELEVANCE STATEMENT:Mental health nursing takes place in emotionally demanding environments where staff are routinely exposed to patients' traumatic experiences. This study demonstrates that employed psychiatric mental health care professionals commonly carry cumulative lifetime trauma histories that are associated with secondary traumatic stress and burnout, independent of workplace exposures. These findings are directly relevant to mental health nursing practice, as they highlight a largely invisible source of workforce vulnerability that is unlikely to be effectively addressed through individual screening or targeted interventions. The findings support the implementation of universal, trauma-informed organisational strategies that protect all mental health care staff, including nursing staff, regardless of personal trauma history.
INTRODUCTION:The Strengths Model offers a framework for mental health treatment, emphasising individuals' strengths over deficits. Traditional deficit-focused practices often lead to feelings of helplessness among people with mental illness and clinicians. The Strengths Model's alignment with the principles of recovery has seen it become viewed as a synergistic approach to support recovery-oriented practice. AIM/QUESTION:This meta-ethnography aims to synthesise qualitative research to understand how the Strengths Model is perceived, experienced and operationalised across different contexts. METHOD:The review followed Noblit and Hare's meta-ethnography method, synthesising qualitative research studies identified through systematic searching and appraisal of the literature. Seven studies were included, focusing on the Strengths Model in mental health services. RESULTS:Three overarching themes emerged: collaborative practice, empowering people and a mix of limitations. The Strengths Model fosters a therapeutic relationship between service users and clinicians, emphasises strengths over deficits and promotes a recovery-oriented approach. DISCUSSION:The Strengths Model enhances therapeutic relationships and collaborative working alliances, crucial for successful mental health outcomes. However, challenges include its suitability for all service users and potential resistance from clinicians. IMPLICATIONS FOR PRACTICE:The model aligns with recovery-oriented reforms and human rights-based approaches, enhancing personal strengths and goals.
INTRODUCTION:Postpartum mental health research has traditionally focused on depression, though anxiety is gaining attention. Alarmingly, nearly half of the affected women do not seek help, leaving conditions frequently unrecognised and untreated. AIM:This study explores barriers to professional psychological help-seeking among postpartum women in Latvia with postpartum depression (PPD), generalised anxiety disorder (GAD), or both. METHOD:Using the qualitative comparison groups design and thematic analysis, seventeen semi-structured interviews were conducted, with four participants diagnosed with PPD, six with GAD, and seven with both PPD and GAD. RESULTS:Overarching domains of help-seeking barriers were: (1) Individual barriers (hesitation and internal rationalisations, lack of awareness and information about symptoms, stigmatisation and emotional barriers); (2) Family barriers (difficulties arranging childcare); and (3) Systemic and socioeconomic barriers (financial constraints, accessibility and systemic issues, lack of information). Specifically, women with PPD reported emotional unawareness and guilt; those with GAD feared burdening others. Comorbid cases emphasised logistical and access barriers. IMPLICATIONS AND RECOMMENDATIONS:Help-seeking behaviour in the postpartum period is influenced by individual, family, and structural factors. To improve access to psychological care, it is essential to foster maternal mental health literacy, normalise help-seeking through public discourse, and ensure health systems proactively support and inform parents.
ABSTRACT Background and Aim Mechanical restraint is the use of devices or equipment, such as bandages and ropes, to confine patients to a hospital bed, thereby restricting their movement. It is frequently employed in intensive care units to prevent falls and the removal of intravenous cannulas or other medical devices. Despite substantial empirical evidence of its adverse psychological and physiological effects, mechanical restraint remains a common practice, particularly among older adults experiencing delirium. Therefore, this dialogic narrative approach aimed to explore the lived experiences of a granddaughter witnessing the mechanical restraint of her beloved grandfather, who experienced delirium and was mechanically restrained on multiple occasions across two different hospitals. Methods A descriptive qualitative design underpinned by social constructionism was employed, using multiple semi‐structured interviews for data collection and a dialogic narrative approach to construct the granddaughter's narrative. Findings This lived experience was conceptualised into five narratives: (1) Carers and the loved one, (2) Caring for the person, not the diagnosis, (3) Calling for the humanisation of ICUs, (4) Witnessing the tying up of my grandfather, (5) Exposing the status quo: Mechanical restraint as the first resort, and (6) Shattering the muscular man identity. The study used the Consolidated Criteria for Reporting Qualitative Research checklist. Discussion The carer's narrative reveals compelling evidence of the complexity surrounding the use of mechanical restraint to control disturbing behaviours among elderly patients with delirium in ICU environments. Although many carers might relate this study to their lived experiences, the transferability of this dialogic narrative remains limited to Hana and her family context.
INTRODUCTION:Safewards effectively reduces restrictive practices within acute inpatient mental health units. Consumers' experiences of Safewards impact on broader experiences within these settings. Given the influence mental health nurses have on consumers' experiences, nurses' responses to these experiences require further exploration. AIM:To explore the responses of mental health nurses to consumers' experiences of Safewards within acute inpatient mental health units. METHODS:A qualitative exploratory method was used for this study, involving semi-structured focus groups with mental health nurses from two acute inpatient mental health units. Participants were asked to respond to a summary of themes about consumers' experiences of Safewards. RESULTS:Thematic analysis uncovered three themes: (1) Prioritising respectful communication and investing time with consumers; (2) Relating Safewards to everyday work with consumers; (3) Safewards and its impact on restrictive practices. DISCUSSION:Participants acknowledged consumers' experiences of Safewards and their frustrations when mental health nurses were unavailable. Some participants expressed uncertainty about the suitability of Safewards, despite consumers' endorsement, highlighting a possible discrepancy between mental health nurses' and consumers' views. Most participants perceived Safewards to be effective but inconsistently applied, in part due to varying acceptance and understanding of Safewards. LIMITATIONS:Differences between the units may not be captured in combined data analyses and other views about the consumers' experiences of Safewards may not be represented. Researcher bias may have influenced the way in which data were collected, analysed and reported. IMPLICATIONS FOR PRACTICE:Safewards requires partnership between mental health nurses and consumers, and a more nuanced understanding of its application within an acute inpatient mental health setting to realise its full potential. Task-based approaches that hinder mental health nurse engagement with consumers may impact Safewards' effectiveness. RECOMMENDATIONS:Discrepancies between the views of mental health nurses and consumers' experiences require further exploration. Increasing consumers' involvement in the everyday application of Safewards should be considered.
Aim: This paper examines the value of Oller-Vallejo's (2001) ego state model as a framework for understanding emotional dynamics in mental health nursing clinical supervision, and its integration with Proctor's (1986) model of supervision. Background: Mental health nursing is characterised by high emotional demand, relational complexity and exposure to psychological distress. Clinical supervision is increasingly recognised as essential for supporting emotional well-being, professional development and safe practice. However, there remains a need for more psychologically informed frameworks to better understand the emotional processes occurring within supervisory relationships. Method: This paper adopts a conceptual, theory-informed approach, drawing on published literature relating to ego state theory and clinical supervision models. A narrative synthesis is used to explore how these frameworks can be integrated to enhance understanding of emotional processes in supervision. Discussion: The ego state concepts of caregiving, caregetting and individuating are used to explore emotional roles and relational dynamics within supervision. These are considered alongside Proctor's (1986) restorative, formative and normative functions of supervision. The integration of these models provides a structured way to understand emotional containment, dependency, autonomy and professional development within supervisory relationships in mental health nursing. Conclusion: The paper proposes that combining ego state theory with established supervision models offers a psychologically informed framework for enhancing clinical supervision. This has implications for supporting emotional resilience, improving reflective practice and strengthening workforce well-being and sustainability in mental health nursing.
INTRODUCTION:Psychiatric and mental health services have been increasingly scrutinized for sustaining coercive and epistemically unjust practices. Allyship, conceptualized as a commitment to power redistribution, has emerged as a strategy to address such injustices. AIM:The aim of this study is to map the literature and current state of knowledge regarding allyship in psychiatry and mental health. METHOD:A scoping review was carried out. Tirthy-four (n = 34) reports were subjected to a descriptive and thematic analysis. RESULTS:The analysis of the literature identifies four interrelated and complementary themes characterizing allyship: (1) the scope of allyship in mental health, (2) its general principles, (3) the qualities expressed by allies and (4) their repertoire of actions. DISCUSSION:Reviewed studies depict allies as reflexive agents aware of their privilege and advocating for patients. However, findings reveal ethical tensions between performative and effective allyship, with risks of reinforcing paternalistic structures rather than dismantling them. IMPLICATION FOR PRACTICE:The results highlight the ethical responsibility of psychiatric and mental health professionals to resist mere symbolic or performative allyship. RECOMMENDATIONS:This synthesis underscores the ethical imperative to anchor allyship in principles of social justice, epistemic humility, and mutual emancipation. RELEVANCE TO MENTAL HEALTH NURSING:Allyship has been the subject of significant debate in psychiatric nursing. The results of this review inform nursing practice by identifying the principles, qualities, and defining actions of individuals who seek to become and act as allies. The findings presented also outline avenues for action aimed at adapting educational curricula to incorporate key dimensions of allyship, including the recognition of privilege, the redistribution of power, and epistemic humility. Finally, this scoping review serves as a caution against the uncritical use of the ally concept, to avoid the erasure of its political foundations.
Introduction: Social phobia is a mental health condition often misunderstood as shyness and mostly undiagnosed. This condition significantly affects the academic performance, practical skills, and psychological well-being of individuals, resulting in reduced contribution to society and the nation's economy. The aim of this lived experience narrative is to present the experience of social phobia within nursing education and emphasize the implications for mental health nursing practice. Method: This is a first-person narrative to describe the personal experience with social phobia and its impact on personal, professional, and social life. This reflects the presentation of signs and symptoms, delayed diagnosis, therapeutic experience, pharmacological management, and adaptation related to the nursing education context. Conclusion: Social phobia is not a barrier to achievements, but it increases the psychological cost of performance. Early recognition and treatment can significantly improve the lives of individuals. Mental health nurses have an important role in providing compassionate care and support to individuals with social phobia to help them recover.
Background and Aim: Conversion practices (sometimes referred to as 'conversion therapy') refer to interventions that aim to change a person's sexual orientation or gender identity. While these are often associated with faith-based settings, they can also occur in secular healthcare contexts. The practices are associated with significant psychological harm. This paper aims to provide a lived experience account of gender identity conversion practices perpetrated in the context of inpatient eating disorder (ED) treatment. Methods: This paper provides the first author's narrative of his inpatient ED treatment as a young trans man and maps this experience to the key features aligned with accepted definitions of conversion practices and their enduring impact. Findings: This paper describes an inpatient ED treatment experience characterised by (1) pathologisation of the first author's gender diversity; (2) the use of coercion and institutional power to enforce cisnormative developmental outcomes; (3) the persistent withholding, delaying, and problematising of gender-affirming medical care; and (4) the enduring psychological harm and extended disengagement from further treatment-seeking that results from these practices. Discussion: This narrative highlights the urgent need to safeguard against conversion practices within inpatient mental health settings and ensure ED treatment is provided from a gender-affirming framework.
INTRODUCTION:Nurses are at high risk for mental health problems, including anxiety and depression, as well as burnout symptoms. The COVID-19 pandemic intensified these challenges, yet little is known about its long-term impact. AIM:To assess the prevalence of burnout symptoms, anxiety, depression and suicidal ideation among nurses in Northern France 2 years after the pandemic began, and to identify their risk and protective factors. METHODS:The COSMIN study is a multicentre cross-sectional survey conducted in eight public hospitals in Hauts-de-France. Data were collected via an anonymous online questionnaire (May-October 2022), using validated scales (Copenhagen Burnout Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory). Logistic regression identified associated factors. RESULTS:Among 632 respondents, 25% had at least one clinically significant mental health problem: 16.5% anxiety, 2.5% depression, 13.9% burnout and 4.4% suicidal ideation. Burnout included professional (13.0%), personal (8.7%) and relational (5.1%) forms. Despite a decline from earlier phases, vigilance-level symptoms remained common. History of mental health problems increased risk, while institutional supports, especially multidisciplinary meetings, were protective. Personal impacts included increased conflict and breakups. DISCUSSION:Mental health symptoms remain prevalent among nurses post-pandemic. Supportive measures appear beneficial. IMPLICATION FOR PRACTICE:Reinforcing institutional support and mental health resources is essential to address ongoing distress and protect care quality. RELEVANCE TO MENTAL HEALTH NURSING:This study highlights the enduring psychological impact of the COVID-19 pandemic on nurses, revealing high rates of burnout, anxiety, depression and suicidal ideation 2 years after the crisis began. It underscores the critical role of institutional support-such as multidisciplinary meetings and supervision-in protecting staff well-being. These findings are directly relevant to mental health nursing by informing strategies to support nurses' psychological health, improve working conditions, and maintain the quality of patient care. The results advocate for the integration of structured mental health support within nursing practice and organizational policies in post-crisis healthcare settings.
