AbstractThere are increasing calls for positive education to integrate holistic and system approaches to both the understanding and implementation of mental health and well‐being interventions across all levels of a school community. The purpose of this study was to examine educators' perspectives of the most significant changes that occurred at an Australian primary and secondary college following the delivery of a system‐informed positive education program (titled Resilient IMPACT). A multi‐stage evaluation was conducted, with educators providing written descriptions of the most significant perceived changes following program implementation, with 18 educators taking part in one of three focus groups to discuss these changes. Three main themes were identified from the focus groups: (1) Common and consistent language, which focused on the use of a language and communication framework for well‐being conversations; (2) Consideration and empathy, where understanding of emotions and demonstrating empathy for students were stressed across interactions; and (3) Community commitment, which involved the building of a holistic community approach to well‐being that is supportive and embedded in teaching practice. Findings support the need for holistic interventions in the school setting, focused upon the broader school community and a committed ‘well‐being first’ approach to foster positive relationships amongst educators and students to support both academic and psychological outcomes.

Fans may experience significant upset and distress when a television series ends. However, grief and loss reactions to the end of a fictional series have seldom been investigated. It is likely that the degree to which such reactions are felt is influenced by viewing motives (e.g., pleasure, meaning making), connection to the series and its fan community, relationships formed with characters, including parasocial bonds and experiences of empathy, and tendency to engage with others’ perspectives and emotions, including fictional characters. The purpose of this study was to examine predictors of fans’ grief and loss reactions to the end of the television series Neighbours, which aired from 1985 to 2022. Fans (n = 1289) completed an online survey shortly after the screening of the final episode. The survey measured grief emotions and cognitions, acceptance that the series had ended, distress at the loss of a parasocial relationship with a favourite character, feelings of closure, and expressions of gratitude for the series. Predictors of these grief and loss reactions examined in the survey were viewing motives, fan identity, strength of a parasocial relationship formed with a favourite character, empathy towards that character, and tendency to take others’ perspectives, experience empathic concern and personal distress, and tendency towards engagement with fictional characters. Greater grief and loss reactions were experienced by fans whose motives for watching involved being entertained and exposed to different lifestyles, who felt a stronger fan connection to the series, and who formed stronger parasocial empathic relationships with their favourite character. Factors such as gender, age, and empathic tendencies predicted various types of grief reactions. Understanding fan experiences when a long-running series ends advances theory and research on viewer parasocial relationships and engagement with media, as well as providing evidence that the loss of a series or favourite character can be viewed as a type of grief experience.

By working in partnership with parents, school counsellors can assist in the early identification of mental health and wellbeing issues and facilitate timely access to professional support. However, very little is known about parents' understanding of the role of school counsellors and the barriers and enablers influencing the relationship between parents and school counsellors. Therefore, this qualitative study employed one-on-one interviews of 10 parents and employed a reflexive thematic analysis approach. Results revealed that parents expect school counsellors to provide a safe and supportive environment for students. Parents believe the school counsellor should be offering curriculum and behaviour support to teachers, individual and group work to students, and career counselling. In terms of the barriers and enablers influencing collaboration between school counsellors and parents, participants overwhelmingly felt that the role was hidden away and ill-defined. Advertising services more and getting the counsellor out into the school community at times suitable to working parents were seen as important considerations. Parents value the role of school counsellors. Future research on parental attitudes towards school counsellors could gain insights by diversifying participant profiles, including various genders, socio-economic backgrounds and occupations, to capture a wider range of perspectives.

Marriage equality has been a topic of political debate worldwide, with several countries legalising marriage between two consenting adults regardless of sex or gender since the early 2000s. In 2017, Australia legalised marriage equality through the Marriage Amendment (Definition and Religious Freedoms) Act 2017. This decision followed a voluntary postal survey open to adult citizens to gauge public support for marriage equality. Although marriage equality was legislated, there is a need to understand community attitudes in order to promote safe environments for all citizens. Our study investigated demographic, personality characteristics, and social factors predictive of both attitudes towards marriage equality and response to the postal survey. Data were obtained from 250 Australian respondents through an anonymous online survey. Participants held positive attitudes towards marriage equality and 82% had returned a survey in favour of marriage equality. Attitudes towards LGBTQ+ people, sex, sexuality, geographic location, religious fundamentalism, social political conservatism, degree of comfort with gay and lesbian people, attitudes to marriage and marriage gender roles, gender role beliefs, general empathy, empathy towards same sex attracted people, and right-wing authoritarianism predicted attitudes to marriage equality and/or survey response. Findings suggest that increasing empathy towards and contact with LGBTQ+ people may increase more positive attitudes towards LGBTQ+ people and marriage equality.

Restrictions introduced during the COVID-19 pandemic disrupted many retirees from being able to pursue their lifestyle retirement goals. This study examined the impact of lifestyle retirement goal disruption during the pandemic, sources of meaning in life, and goal setting behaviors (planfulness) on retiree wellbeing. In this quantitative study, retirees ( n = 141) in Victoria, Australia completed an online survey in mid-2021 containing measures of sources of meaning in life, planfulness, and wellbeing. Qualitative data were also collected using a series of open-ended questions regarding the nature of retirement goal disruptions. Findings revealed that greater sources of meaning in life and planfulness significantly predicted greater wellbeing in retirees, as did being in a relationship and living in an urban/city location. Age, gender, and years retired were not associated with wellbeing. Planfulness moderated the association between COVID-19 goal-disruption and wellbeing. Open-ended responses indicated that retirement goals commonly affected by COVID-19 were travel and family-time. The study revealed that older adults were able to adjust during a time of crisis, with sources of meaning in life and planfulness being useful resources for wellbeing. Planfulness was an important buffer for those experiencing goal-disruption due to COVID-19.

Support for marriage equality (i.e. extending the privilege of marriage beyond heterosexual couples) is gaining global momentum as evidenced by the increase of countries introducing related legislation, yet little research has attempted to understand factors predicting the rejection of marriage equality. In this paper, we explore the multi-faceted role of religion in explaining the relationship between sexual prejudice and the rejection of marriage equality. Specifically, we explored the role of religious affiliation (i.e. religious-group membership; Study 1: n= 81) and multiple forms of religiosity (i.e. trait-like conceptualisations; Study 2: n= 168) in explaining the rejection of marriage equality beyond variance accounted for by simple sexual prejudice. As expected, negative attitudes towards marriage equality were related to being higher in sexual prejudice and religious fundamentalism, being lower in Quest, and being Christian (vs. non-religious). In addition, both religious fundamentalism and intrinsic religiosity moderated the marriage equality rejection-sexual prejudice relationship. Importantly, in multiple regression analyses, religious affiliation did not predict the rejection of marriage equality, and religious fundamentalism was the only significant religiosity predictor. Taken together, religiosity emerged as a more useful quantification of religion than religious affiliation in the context of explaining the rejection of marriage equality.

While donor-conceived children have similar mental health outcomes compared to spontaneously conceived children, there is an inconsistency between studies investigating mental health outcomes of donor-conceived people in adulthood. This study is an online health survey that was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor sperm-conceived adults had increased diagnoses of attention deficit disorder (P = 0.004), and autism (P = 0.044) in comparison to those conceived spontaneously. Donor sperm-conceived adults self-reported increased incidences of seeing a mental health professional (P < 0.001), identity formation problems (P < 0.001), learning difficulties (P < 0.001), panic attacks (P = 0.038), recurrent nightmares (sperm P = 0.038), and alcohol/drug dependency (P = 0.037). DASS-21 analysis revealed that donor sperm-conceived adults were also more stressed than those conceived spontaneously (P = 0.013). Both donor sperm and spontaneously conceived cohorts were matched for sex, age, height, alcohol consumption, smoking, exercise, own fertility, and maternal smoking. The increase in adverse mental health outcomes is consistent with some studies of donor-conceived adult mental health outcomes. These results are also consistent with the Developmental Origins of Health and Disease (DOHaD) phenomenon that has linked adverse perinatal outcomes, which have been observed in donor-conceived neonates, to increased risk of chronic disease, including mental health. Further work is required to reconcile our observations in adults to contrary observations reported in donor-conceived children.

Despite rising cases of COVID-19 in the United States of America, several states are easing restrictions (e.g., relaxing physical distancing requirements, reopening businesses) that were imposed to limit community transmission of the virus. Individuals hold differing opinions regarding whether restrictions should continue to be imposed or lifted, evidenced, for example, by debate and protests regarding reopening of businesses and venues. Health and social psychological research suggest that perceptions of COVID-19related risk, experiences of the virus, and individual difference factors can help explain individuals’ attitudes towards health initiatives and their tendency to be persuaded towards a specific course of action. The purpose of this study was to investigate what factors influence support or opposition to easing COVID-19-related restrictions. A sample of 350 United States citizens, responding to an anonymous survey, were asked about the extent to which they support/oppose easing of COVID-19-related restrictions, both generally and in relation to specific restrictions. Respondents completed measures of their experiences of COVID-19, individual difference factors, and demographic variables, including political affiliation and degree of social and economic conservatism. In a series of regression analyses, significant demographic predictors of support or opposition for easing restrictions were gender, age, ethnicity, and education, with political affiliation and degree of social and economic conservatism also predicting attitudes. Experiences related to COVID-19 that predicted attitudes were concerns for self and family, perceptions of threat posed by the virus, perceived ability to adhere to restrictions, willingness to take government direction, and belief in COVID-19-related conspiracy theories. At an individual differences level, uncertainty avoidance, collectivism, long-term orientation, masculinity, empathic concern, personal distress, reactance, and general conspiracy theory beliefs all significantly precited attitudes to easing restrictions. Understanding the factors that help explain attitudes towards COVID-19 restrictions can inform how best to position health messaging and initiatives going forward, particularly as states or countries open borders.

Increasing the saliency of existing sources of meaning and purpose in life could be a practical focus area for innovative wellbeing interventions. This randomised controlled study aimed to assess the impact of a brief seven-day technology-based intervention on meaning in life, life satisfaction, and affect compared to a waitlist control group. A mobile phone application was used to deliver daily activities and momentary reflection questions. Significant improvements where observed in the presence of meaning in life (p = .02, η2 = .05), life satisfaction (p = .00, η2 = .08) and positive affect (p = .02, η2 = 0.05) for the intervention versus the control group. Ecological momentary assessment data found increases in life satisfaction and meaning in life (b = 0.044, p = .041) and shed insight into activities that fostered fulfillment. These findings pave the way for future meaning and purpose interventions to build mental health and well-being.

Background: Chemical restraint (CR) is emergency drug management for acute behavioural disturbances in people with mental illness, provided with the aim of rapid calming and de-escalating potentially dangerous situations. Aims: To describe a systematic review of Randomised Controlled Trials (RCTs) reporting on short-term safety and effectiveness of drugs used for CR, administered to non-consenting adults with mental health conditions, who require emergency management of acute behavioural disturbances. A meta-analysis was conducted of those RCTs with comparable interventions, outcome measures and measurement timeframes. Method: Academic databases were searched for RCTs published between 1 January 1996 and 20th April 2020. Relevant RCTs were critically appraised using the 13-item JBI checklist. All RCTs were described, and step-wise filters were applied to identify studies suitable for meta-analysis. For these, forest and funnel plots were constructed, and Q and I-2 statistics guided interpretation of pooled findings, tested using MedCalc Version 19.1. Results: Of 23 relevant RCTs, 18 (78.2% total) had excellent methodological quality scores (at least 90%). Eight RCTs were potentially relevant for meta-analysis (six of excellent quality), reporting 20 drug arms in total. Adverse events for 6-36% patients were reported in all 20 drug arms. Four drug arms from two homogenous studies of N = 697 people were meta-analysed. These RCTs tested two antipsychotic drugs (droperidol, olanzapine) delivered intravenously in either 5 mgs or 10 mg doses, with outcomes of time to calm, percentage calm within five or 10 min, and adverse events. There were no significant differences between drug arms for either measure of calm. However, 5 mg olanzapine incurred significantly lower risk of adverse events than 10 mg olanzapine (OR 0.4 (95%CI 0.2-0.8)), although no dose differences were found for droperidol. Conclusion: 5 mg intravenous olanzapine is recommended for quick, safe emergency management of people with acute behavioural disturbances associated with mental illness. (C) 2020 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.

It is hard to overestimate the deleterious mental health and well-being effects of COVID-19 on communities around the world. Nurses, as part of their communities, face similar stressors to others, but also deal with the additional strain of working in fast-paced, changing, and risky environments. Nurses have reported elevated mental health concerns during the pandemic (Sampaio et al. 2020), often connected to perceived threat of virus transmission in the healthcare setting (G azquez Linares et al. 2021). For mental health nurses, both those working in inpatient services and the community, COVID-19 has required fast adaptation to a changing environment and has resulted in more complexity in attending to consumer mental health and physical needs (Foye et al. 2021; Usher et al. 2020). All the while, they are expected to perform what is at the heart of mental health work: that is to ‘be’ with their consumers in an empathic and compassionate way (Gerace et al. 2018). Concerningly, recent research has suggested that COVID-19-related concerns and responsibilities may have impacted both nurses’ health and their relationships with consumers. Nurses working during the pandemic have reported symptoms of burnout and emotional exhaustion (Chen et al. 2021) and that they feel physical distancing requirements and protective equipment (e.g., masks) make it more difficult to provide empathic care (Eddy 2021). Perhaps, more so than nurses working in other specialties, mental health nurses depend on their ability to empathize and provide compassionate care to consumers. Empathy and compassion require a good understanding of self and other boundaries, acute awareness of the inherent worth, value and uniqueness of the other person, and understanding of the shared humanity between oneself and the recipient of one’s concern and care (Gerace 2020; Jeffrey 2016; Strauss et al. 2016). The process of taking another person’s perspective, often referred to as cognitive empathy, and experiencing an emotional response to their plight, whether it be empathic concern, warmth, compassion, sympathy, or a range of other responses, allow nurseconsumer connection and a shared vantage point for nurses to ‘do’ the work of mental health nursing (Forchuk et al. 1998; Gerace 2020; Gerace et al. 2018; Peplau 1997). These cognitive processes and emotional outcomes have positive impacts for both the helper (e.g., compassion satisfaction; Smart et al. 2014) and helpee (assistance with their concern; Gerace 2020). In recent years, compassion has particularly received attention. Compassion involves processes of empathy, such as understanding another’s perspective (Strauss et al. 2016), but more recent conceptions (e.g., Gilbert 2014) stress that it involves both being sensitive to another’s suffering and being motivated to alleviate it; that is, to help the person in some way to reduce their suffering. For nurses, this may be through a treatment or therapy to help their consumer, and particularly in the case of mental health nurses, through lending a supportive ear and expressing understanding through voice, touch, or other actions (Gerace et al. 2018; Gleeson & Higgins 2009). We know that mental health nurses engage in these complex and efficacious processes of relating to and treating others warmly and with an empathic and compassionate approach. But do they do this for themselves? Self-compassion is when we enact compassion for ourselves – that is, we become aware of our suffering and attempt to do things that will be helpful for us, such as addressing a problem, attempting to put a failing in perspective, and being kind to ourselves. Based on the research, I suggest that nurses who engage in self-compassion will positively impact their well-being and resilience, and in turn, the care that they provide to consumers. Correspondence: Adam Gerace, College of Psychology, School of Health, Medical and Applied Sciences, CQUniversity Australia, 44 Greenhill Road, Wayville, SA, 5034 Australia. Email: a.gerace@cqu.edu.au Authorship statement: The author meets the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors.

BackgroundProviding end-of-life care to patients and their families in the emergency department (ED) is challenging, with high workloads, the busy environment, and a focus on providing lifesaving treatments to patients at odds with providing end-of-life and palliative care.AimThe purpose of this study was to investigate nurses’ experiences of providing end-of-life care in EDs, including their perceptions of the most vital elements of care, ability to provide aspects of care, as well as perceptions of their role, communication processes, family presence/involvement, and the ED environment.MethodsNurses (n = 211) working in Australian EDs for at least 12 months completed an anonymous online survey.FindingsNurses identified vital elements of care for dying patients including adequate pain control and a move away from burdensome treatments, sensitive care of families and family access to loved ones, and a quiet environment. However, nurses were not always able to provide such care to their patients. Often, the ED was seen as an unsuitable place for end-of-life care or care of families once the patient had died, and communication between staff and between staff and families was challenging.DiscussionThe ED physical environment, lack of staff training and debriefing, and lack of time to communicate with family, particularly after death, may compromise nurses’ ability to provide end-of-life care that is satisfying to them, their patients, and families.ConclusionThere is a need for focus on the ED physical environment, staff training, and consideration of the emotional experiences of frontline nurses caring for patients at the end of life.

Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself for from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.

Accessible summaryWhat is known on the subject? The use of chemical restraint in emergency situations is to control aggression or violence to protect consumers and staff and is to be used as a last resort when all other behavioural control alternatives have been exhausted. Chemical restraint involves the use of medication. What the paper adds to existing knowledge? This is the first paper to systematically review the prevalence of the use of chemical restraint. The use of chemical restraint is common across emergency departments and acute psychiatric inpatient units worldwide. Consumers who are restrained are also likely to receive chemical restraint. The studies reviewed demonstrate that there is a need for more standardized data collection so that clearer comparisons can be made between healthcare settings and countries. What are the implications for practice? Implications of practice include the need to report adverse events post‐chemical restraint as these can deleteriously affect a person's physical health. Identification of and staff education about first‐line management techniques before chemical restraint is administered are significant to reduce its use. AbstractIntroductionChemical restraint is used to manage uncontrolled aggression, agitation or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings.AimThis systematic review aimed to synthesize the international prevalence of chemical restraint for non‐consenting adults.MethodPsycINFO, CINAHL, MEDLINE/PubMed and Google Scholar databases were searched for peer‐reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice.ResultsForty‐eight papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint.Discussion and implications for practiceThis is the first known comprehensive meta‐view of chemical restraint use worldwide, highlighting the need for standardized data collection to enable comparisons between healthcare settings and countries.Relevance statementThere is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesizing the international prevalence of chemical restraint for non‐consenting adults. This meta‐view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use.

Empathy and related concepts such as sympathy and compassion are considered fundamental to mental health nurses' work with consumers. However, there is often little consensus on the relationship between these interpersonal interaction factors and their similarities and differences. In this paper, these three concepts are discussed. Theoretical frameworks of empathy, sympathy, and compassion are presented with a social psychological model of empathy focused upon. From this, discussion is undertaken of how the mental health nursing process may be explained by such frameworks, as well as what unique aspects of the nursing relationship need to be considered. It is contended that precise definitions and understandings of empathy, sympathy, and compassion are vital, and the use of models allows researchers to consider where gaps are in current knowledge, and to identify what might be important to consider from a nurse education perspective.

Reducing and/or eliminating the use of coercive measures in psychiatric services is a priority worldwide. Chemical restraint is one such measure, yet to date has been poorly defined and poorly investigated. The aim of this study was to examine chemical restraint use in 12 adult acute inpatient psychiatric units in Adelaide, South Australia. Methods involved the analysis of all reported chemical restraint events occurring over a 12-month period analysed using a descriptive quantitative design. There were 166 chemical restraint events involving 110 consumers. The highest prevalence rate in an individual unit was 28.78 events per 1000 occupied bed days, with the lowest being 0.12 events per 1000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Schizophrenia, schizotypal, and delusional disorders were the predominant diagnoses among consumers who were chemically restrained. The most events occurred during three time blocks: 14.00-14.59 pm, 16.00-16.59 pm, and 21.00-21.59 pm. The two most common medications used were olanzapine and clonazepam. The study presents a general picture of the practice of chemical restraint in Adelaide and identifies areas of concern in relation to the need for monitoring of side effects and completion of systematic processes of documentation regarding chemical restraint events. Findings highlight the need for sustained focus on reducing the need for chemical restraint and exploring less restrictive measures with those most likely to receive medication against their will.

IntroductionThe number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians’ perceptions and experiences of providing such care when the death is sudden and unexpected.AimThis study explored nurses’ perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED.MethodsOpen-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically.Results211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected.ConclusionsED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED.