In celebration of International Nurses Day 2025
Editor's Recommended Reads
Table of Contents
Editor's Recommended Reads Nurses who return to work in clinical practice require bespoke support and development Tackling nurses’ mental health issues: key risk factors, consequences and organisational solutions for improving well- being Importance of supporting registered nurses and nursing students from culturally and linguistically diverse backgrounds Valuing internationally educated nurses and diversity in the community nursing workforce Factors that can enhance resilience in mental health nursing staff who work in high-secure forensic hospitals
Commentary: Nursing issues
Nurses who return to work in clinical practice require bespoke support
Commentary The authors of this study acknowledged that the methods used, the small sample size and the narrow geographical focus all limited generalisation of findings to the wider nursing workforce. In addition, with data collec- tion taking place between November 2021 and July 2022, it is likely that the impact of the COVID-19 pandemic will have been a time-specific factor in the experience of participants. Nonetheless, the study does provide an important reminder of work- force challenges within nursing and the potential to mitigate those chal- lenges by harnessing the experience and knowledge of nurses who are no longer practising. It also offers some useful clues to the specific moti- vators, enablers and needs of nurses seeking to return to the profession. One of the key factors associated with identifying the needs of returning nurses is the reason they left in the first place. This brings into focus another limitation of the study by Yamamoto et al , in that all participants primarily left the profession for personal reasons and not because of issues associated with their work as a nurse. This could be framed as participants leaving nursing because of ‘pull’ factors: responsibilities or opportunities outside of the profession, such as child- care, looking after an older relative or pursuing full-time postgraduate education. The study overlooks those nurses who leave the profession for other reasons, which evidence shows include work-related stress, lack of support from leaders, lack of opportunities for career development and experiences of bullying and discrimination. 3 As a profession, we not only need to work to encourage back those nurses who have left due to these ‘push’ factors but also to reduce the likelihood of them leaving in the first place. This involves valuing nurses, providing opportunities for profes- sional development and career progression, effective mentorship and preceptorship, ensuring safe staff levels and reducing workplace stress— all steps which serve to reduce attrition. 4 More broadly still, the approaches advocated by Yamamoto et al to support returning nurses are only one element of addressing the nursing workforce shortage. The workforce needs an increased supply of knowl- edgeable, caring and compassionate nursing students from all areas of society. Crucially, we also need to ensure that the existing nursing work- force is respected, properly rewarded and—as a result—retained. 4 X David Barrett @barrett1972 Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
and development 10.1136/ebnurs-2024-104105
David Barrett
Correspondence to: Professor David Barrett, Department of Health Sciences, University of York, York, UK; david.i.barrett@york.ac.uk
Commentary on : Yamamoto K, Nasu K, Nakayoshi Y, et al . Sustaining the nursing workforce - exploring enabling and motivating factors for the retention of returning nurses: a qualitative descriptive design. BMC Nurs 2024;23:248.
Implications for practice and research
► The returning nurse workforce provides a valuable pool of experience, knowledge and skills. ► Large-scale research is required into approaches that encourage nurses to return to the workforce and enable them to stay. Context Shortages in the nursing workforce impact on the quality of patient care and pose a complex challenge for governments and healthcare organisa- tions across the globe. There are estimated to be approximately 29 million nurses worldwide as of 2020, with a shortage of approximately 7 million against required levels. Despite growth in the workforce over the coming years, the nursing shortage is still projected to be 4.5M by 2030. 1 One approach to addressing this shortage is to encourage those who have previously left the profession to return to nursing. The study by Yamamoto et al 2 aimed to discover more about the factors which influ- ence the retention of returning nurses. Methods The authors used a qualitative descriptive design, encompassing conve- nience sampling and semistructured interviews. Participants were regis- tered nurses from Japan who had returned to nursing after a break from the profession of at least 3 years. Interviews were recorded, transcribed verbatim and analysed using an inductive approach that facilitated the identification of themes. Findings 15 registered nurses were interviewed, and analysis of data generated five themes. Two of these themes—one linked to work–life balance and one focused on career development—were framed as enablers for returning nurses to continue in practice. The other three themes—pride in their role, passion for professional growth and enrichment of their life—motivated participants to continue to pursue their careers. The authors concluded that nursing managers need to maximise enablers and motivators that encourage returning nurses to remain in practice. Approaches proposed included family-friendly working envi- ronments, peer support, constructive feedback and opportunities for continuing professional development. 2
ORCID iD David Barrett http://orcid.org/0000-0003-4308-4219
References 1 Boniol M , Kunjumen T, Nair TS, et al . The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage. BMJ Glob Health 2022;7:e009316. 2 Yamamoto K , Nasu K, Nakayoshi Y, et al . Sustaining the nursing workforce - exploring enabling and motivating factors for the retention of returning nurses: a qualitative descriptive design. BMC Nurs 2024;23:248. 3 Bahlman-van Ooijen W , Malfait S, Huisman-de Waal G, et al . Nurses' motivations to leave the nursing profession: a qualitative meta-aggregation. J Adv Nurs 2023;79:4455–71. 4 Peters M . Time to solve persistent, pernicious and widespread nursing workforce shortages. Int Nurs Rev 2023;70:247–53.
1
Evid Based Nurs Month 2024 | volume 0 | number 0 |
Commentary: Mental health
Tackling nurses’ mental health issues: key risk factors, consequences and organisational solutions for improving well-being 10.1136/ebnurs-2024-104113 Ebtsam Aly Abou Hashish 1,2 1 Faculty of Nursing, Alexandria University, Alexandria, Egypt, 2 College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
assessment methods and revealed an increase in global publications between 2009 and 2021. Risk factors were analysed through the social ecological model, covering intrapersonal, interpersonal, organisational, political and environmental domains. Key modifiable factors included unhealthy lifestyles, a lack of social support, work- place violence, job demands and sleep disturbances. The consequences of poor mental health included negative physical, behavioural, occupational and intrap- ersonal impacts. 2 Commentary This comprehensive scoping review significantly advances our understanding of nurses’ mental health by synthesising longitudinal evidence and offering a holistic view of the multilevel influences on nurses’ well-being. Identifying modifiable risk factors highlights several intervention opportunities. The review confirms that behaviours and lifestyles can predict nurses’ mental health, aligning with previous meta-analyses. 2 5 The review’s strength lies in its focus on cohort studies, which provide stronger evidence for causal relationships than cross-sectional research. This approach allows for a nuanced understanding of the predictors and consequences of mental health issues among nurses. It reveals bidirectional relationships between some risk factors and mental health, emphasising the complex, cyclical nature of these associations. Findings suggest that targeted strategies—such as improving social support, addressing workplace violence and managing job demands—could signifi- cantly enhance nurses’ mental well-being. 2 6 However, the review has limitations such as bias from self-reported data, lack of quantification of risk factors and outcomes and predominance of studies from high-income countries, limiting global applicability. Additionally, the absence of male participants highlights a gap in understanding gender differences in mental health experiences. 2 Overall, the review highlights the need for multilevel interventions to support nurses’ mental health. While individual approaches are vital, addressing organ- isational risk factors is crucial for supportive environments. Future research should evaluate intervention strategies and the long-term impacts of mental health problems on nurses and patient outcomes. This review also underscores the urgent need for evidence-based policies to protect nurses’ mental well-being. X Ebtsam Aly Abou Hashish @Ebtsam Abou hashish. @ebtsam_aly Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Ethics approval Not applicable. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. ORCID iD Ebtsam Aly Abou Hashish http://orcid.org/0000-0003-0492-7615 References 1 Yunitri N , Chu H, Kang XL, et al . Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis. Int J Nurs Stud 2022;126:104136. 2 Yang J , Chen Y, Tian Y, et al . Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies. Int J Ment Health Nurs 2024. 3 Arksey H , O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–32. 4 Tricco AC , Lillie E, Zarin W, et al . PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018;169:467–73. 5 De Nys L , Anderson K, Ofosu EF, et al . The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. Psychoneuroendocrinology 2022;143:105843. 6 Carter H , Dennis A, Williams N, et al . Identity-based social support predicts mental and physical health outcomes during COVID-19. Br J Soc Psychol 2023;62:845–65.
Correspondence to: Professor Ebtsam Aly Abou Hashish; ebtsam_ss@ hotmail.com
Commentary on : Yang J, Chen Y, Tian Y, Li X, Yu Q, Huang C, Chen Z, Ning M, Li S, He J, Du J, Huang B, and Li Y (2024). Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies. International Journal of Mental Health Nursing . Advance online publication. https://doi.org/10.1111/inm.13337
Implications for practice and research
► Implement interventions to reduce workplace bullying, violence and job demands while promoting healthy lifestyles and social support for nurses. ► Future research should investigate nurses’ mental health in low-income and middle-income countries, explore gender differences and evaluate the effectiveness of mental health interventions. Context Mental health issues among nurses are widespread and jeopardise healthcare systems and patient care. 1 Yang et al 2 conducted a pioneering scoping review using cohort study evidence to explore the risk factors and consequences of these issues, marking the first comprehensive longitudinal analysis in this area. Given the heightened mental health challenges during the COVID-19 pandemic, the review is particularly timely. It offers crucial insights for developing targeted policies and interventions to support nurses’ mental well-being. The findings are vital for advancing nursing practice, education, research and policy. 2 Methods The researchers conducted a systematic search across six major databases (PubMed, EMBASE, Epistemonikos, Web of Science, CINAHL, PsycINFO) for cohort studies published before March 2023. Following Arksey and O’Malley’s framework 3 and Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews guidelines. 4 Study selection was managed by screening titles, abstracts and full texts, with inclusion criteria specifying cohort studies involving nurses with at least one year of follow-up, mental health as an exposure or outcome and English language. Data extraction was conducted independently by five researchers, focusing on study characteristics, mental health variables, risk factors and consequences. Descriptive statistics and visual representations, including global mapping, were used to summarise findings with Stata V.16.0. 2 Findings The review examined 171 cohort studies on nurses’ mental health from 16 coun- tries, predominantly high-income nations. The studies used diverse mental health
1
Evid Based Nurs Month 2024 | volume 0 | number 0 |
Evidence for contemporary nursing education
Importance of supporting registered nurses and nursing students from culturally and linguistically diverse backgrounds This is an education commentary on Martikainen, R. M., Kuivila, H. M., Koskenranta, M., Kamau, S., Oikarainen, A., Matinlompolo, N., Juntunen, J., & Mikkonen, K. (2024). Exploring the integration of culturally and linguistically diverse nurses and nurs- ing students in healthcare: A cross-sectional study. Nurse Education in Practice, 80, 104129. https://doi. org/10.1016/j.nepr.2024.104129
Background and purpose
10.1136/ebnurs-2024-104255
Despite the growing prevalence of multicultural working environments, cultural and lin- guistically diverse (CaLD) nurses and student nurses experience challenges in integrating with new healthcare systems, including perceived equality, communication difficulties and differences in working practices. 1 This study aimed to explore how CaLD nurses and student nurses integrate into healthcare systems and to understand their experience of integration.
1 Health Science, Faculty of Health Studies, University of Bradford, Bradford, UK 2 Faculty of Health Studies, University of Bradford, Bradford, UK
Methods
Correspondence to: Mrs Sobia Jabeen; s jabee13@ bradford.a c.uk
The study used a cross-sectional observation approach to explore the percep- tions and experience of integration among CaLD nurses and nursing students in Finland. Registered nurses from four organisations, and students from 15 uni- versities were invited to participate via email. Data were collected electronically and analysed using exploratory factor analysis and SPSS Statistics (V.28.0.1.1, IBM Corporation).
Findings
Fifteen nurses and 87 nursing students participated in the study. Most participants were women (78.4%) and Asian (42.1%). More than half of participants were edu- cated in their home country (55.9%) and considered themselves as beginners in their proficiency of Finnish language. Greater integration was experienced by international nurses and students who were educated in Finland, by those with clinical experience, and by participants with intermediate Finnish language proficiency. These participants experienced fewer incidents of discrimination. Language proficiency was strongly linked with integration, impacting on perceptions of competence, development oppor- tunities and building relationships. Support from colleagues, formal mentorship programmes and their employing organisation was essential in the integration process.
83
Jabeen S and Pickering A. Evid Based Nurs April 2025 Vol 28 No 2
Evidence for contemporary nursing education
Take home messages
► ► Nurses and nursing students from culturally and linguistically diverse (CaLD) backgrounds can experience challenges integrating into their workplace. ► ► Communication and cultural differences are central to their experience and can be a barrier to building relationships with colleagues, patients and families. ► ► Intergration is a two-way process; experiences can be improved by better support from colleagues, mentorship and effective leadership which can lead to better role awareness and maximise the positive difference a diverse workforce can make.
Why this paper matters
Social media summary
Due to better salary and living conditions, developed countries such as UK and Fin- land have a large number of international nurses. 2 Effective communication among nurses, patients and relatives allows nurs- es to demonstrate the knowledge, skills and humanitarian aspects, for example, being empathetic and compassionate towards patients while providing individ- ualised care. 3 Even though international nurses take authentic language tests for their host countries, communication and cultural differences remain commonly faced challenges for them as communi- cation is a skill which is not taught in traditional language courses. 3 Introducing mentorship programmes for CaLD nurses and students could ensure that staff have the required language skills to commu- nicate effectively and deliver safe care as well as recognising available development opportunities. 2 4 It is important to rec- ognise knowledge gaps to ensure a safe transition, using methods such as clinical simulation placements for international nurses to ensure a safe transition to new clinical settings and to develop cultural competence. 4 Integration is a two-way process, educating nurse leaders on work- force diversity is imperative to improve managerial readiness to build and support culturally and linguistically diverse team, 5 improving experiences of integration.
Students & registered #nurses from cultur- ally & linguistically diverse backgrounds can face challenges in integrating into healthcare systems. Support from col- leagues, #mentorship & effective #leader- ship can improve #integration and maxim- ise the benefits of a diverse workforce. Authors Sobia Jabeen 1 and Alice Pickering 2 Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Ethics approval Not applicable. Provenance and peer review Not commissioned; internally peer reviewed. ORCID iDs Sobia Jabeen http://orcid.org/0009-0008-6594-069X Alice Pickering http://orcid.org/0009-0004-6170-3428 References 1 Martikainen RM , Kuivila HM, Koskenranta M, et al . Exploring the integration of culturally and linguistically diverse nurses and nursing students in healthcare: A cross-sectional study. Nurse Educ Pract 2024;80:104129. 2 Evans N . Overseas recruitment: why international nurse. Nurs Stand 2022;37:14–7. 3 Ugiagbe IM , Liu LQ, Markowski M, et al . A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses’ recruitment to and working conditions in the United Kingdom. Nurs Inq 2023;30:e12512. 4 Correa-Betancour M , Marcus K, Balasubramanian M, et al . Barriers and facilitators to the professional integration of internationally qualified nurses in Australia: a mixed methods systematic review. Aust J Adv Nurs 2024;41. 5 Kamau S , Oikarainen A, Kiviniitty N, et al . Nurse leaders’ experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings: An interview study. Int J Nurs Stud 2023;146:104559.
84
Jabeen S and Pickering A. Evid Based Nurs April 2025 Vol 28 No 2
Opinion
Valuing internationally educated nurses and diversity in the community nursing workforce Ben Bowers, 1,2 Noor Ul Haq, 3 Amanda Young, 2 Crystal Oldman 2
with NHS England to develop resources for providers employing internationally educated nurses, often for the first time. 11 In 2023, the QNI released a film show- casing the opportunities of working in the community as international nurses. These are useful starting points. However, evidence-based initiatives to develop, nurture and retain internationally educated nurses are needed. The QNI has recently worked with Leeds Commu- nity NHS Health Care Trust to deliver a development programme specifically for internationally recruited nurses. Opportunities for career progression were discussed alongside practical advice on the UK recruit- ment process. The nurses on the programme had all been in the UK for longer than 6 months and they agreed that a period of settling into the NHS was needed before thinking about career progression. The use of person specifications in job descriptions was not culturally familiar and having the opportunity to look at transfer- able skills in alignment with job descriptions was consid- ered very useful. Opportunities for further education and training in community nursing were also reported as being beneficial as this was a new area of clinical prac- tice for many of the internationally educated nurses on the development programme. We have shared some promising initiatives and developments for meaningfully supporting interna- tionally educated nurses in the community. These are primarily pilot projects and resources informed by expert consensus. Further high-quality research is needed to understand what works well in supporting successful transitions and equal career opportunities in community settings, especially from internationally educated nurses’ perspectives. Nothing about us without us applies here; we need to empower and support inter- nationally educated nurses to co-design and lead this important research. Funding Ben Bowers is supported by the Wellcome Trust [225577/Z/22/]. Competing interests None declared. Ethics approval Not applicable. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. References 1 Safari K , McKenna L, Davis J. Transition experiences of internationally qualified health care professionals: a narrative scoping review. Int J Nurs Stud 2022;129:104221. 2 Health Foundation . Thinking local and global: exploring the UK’s reliance on international nurses and the impact of COVID-19. 2023. Available: https://www.health.org.uk/news- and-comment/charts-and-infographics/thinking-local-and- global-exploring-the-uks-reliance-on-international-nurses
The contributions of internationally educated nurses are one of our under-recognised strengths in the community health and social care workforce. Interna- tional colleagues possess valuable skills and expertise, multi-cultural perspectives and insights that strengthen patient-centred care and teams. The UK and many high- income countries actively recruit international nurses to meet expanding healthcare needs. 1 2 For example, healthcare services in the UK and Norway employ high proportions of people from overseas 3 4 ; many inter- nationally qualified nurses work in care homes and increasingly in the community. 1 4 But do we really value the diversity and skill set of our international workforce? Sadly, evidence suggests we do not. Many internationally educated nurses experi- ence deskilling and loss of status when they arrive in the UK. 1 5 6 Nurses describe transitioning from highly expe- rienced nurses in their countries of origin to providing predominantly basic care interventions, often working at unregistered nurses level, equivalent to healthcare assistants, with limited opportunities to use their clin- ical expertise and progress their careers. 5 6 Experiences of discrimination in the workplace, being marginalised, undervalued and overlooked by managers and nursing colleagues are all too commonplace in published studies. 1 3 6 7 Adjusting to new healthcare cultural norms, language differences and colloquialisms in new host countries takes time. Some clinical interventions and interac- tions with families, including relatives’ roles and social responsibilities in providing care, can be very different from international nurses’ countries of origin. This can come as a culture shock, especially in palliative and end- of-life care situations. The responsibility for supporting successful transitions and equal opportunities for inter- national nurses lies with employers, managers and colleagues. Ugiagbe et al 8 (2023) highlight how this support is uneven or inadequate. Research to date consistently recommends insti- gating a range of concurrent strategies to value cultural diversity and support workplace integration. This includes preceptorship programmes, continual learning and career development opportunities, workshops for all staff on working cross-culturally and valuing diver- sity, alongside tailored long-term mentorship and buddy schemes for international nurses. 1 6 9 NHS England, NHS Employers and numerous NHS Trusts are working together to support, develop and retain international educated nurses in different ways. These initiatives include the International Nurses’ Recruitment Toolkit, 10 Stay and Thrive programme and Pastoral Support Quality Award. Recognising the need to act and better support inter- national nurses in adjusting to working in the commu- nity, The Queen’s Nursing Institute (QNI) partnered
10.1136/ebnurs-2024-104158
1 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK 2 Queen’s Nursing Institute, London, UK 3 Leeds Community Healthcare NHS Trust, Leeds, UK
Correspondence to: Dr Ben Bowers; b b527@ medschl.c am.ac.u k
1
Evid Based Nurs Month 2024 | volume 0 | number 0 |
Opinion
3 Pendleton J . The experiences of black and minority ethnic nurses working in the UK. Br J Nurs 2017;26:37–42. 4 Debesay J , Arora S, Fougner M. Organisational culture and ethnic diversity in nursing homes: a qualitative study of healthcare workers’ and ward nurses’ experiences. BMC Health Serv Res 2022;22:843. 5 Adhikari R , Melia KM. The (mis)management of migrant nurses in the UK: a sociological study. J Nurs Manag 2015;23:359–67. 6 Smith PA , Allan H, Henry LW, et al . Report from the REOH study: researching equal opportunities for overseas-trained nurses and other healthcare professionals. In: Valuing and recognising the talents of a diverse healthcare workforce . 2006. (Https://books.google.co.uk/books/about/Valuing_and_ Recognising_the_Talents_of_a.html?id=NeOt0AEACAAJ&redir_ esc=y). 7 Alexis O , Vydelingum V, Robbins I. Engaging with a new reality: experiences of overseas minority ethnic nurses in the NHS. J Clin Nurs 2007;16:2221–8.
8 Ugiagbe IM , Liu LQ, Markowski M, et al . A critical race analysis of structural and institutional racism: rethinking overseas registered nurses’ recruitment to and working conditions in the United Kingdom. Nurs Inq 2023;30:e12512. 9 O’Callaghan C , Loukas P, Brady M, et al . Exploring the experiences of internationally and locally qualified nurses working in a culturally diverse environment. Aust J Adv Nurs 2018;36:23–34. 10 NHS Employers . International retention toolkit. NHS Employers; 2024. Available: https://www.nhsemployers.org/ system/files/2024-05/international-retention-toolkit-1833.pdf 11 Queen’s Nursing Institute . International recruitment – support for employers. 2024. Available: https://qni.org.uk/nursing-in- the-community/international-recruitment-to-the-community/ support-for-employers/
2
Evid Based Nurs Month 2024 | volume 0 | number 0 |
Commentary: Mental health
Factors that can enhance resilience in mental health nursing staff who work in high-secure forensic hospitals 10.1136/ebnurs-2024-103950 Lolita Alfred , 1 Christopher Chigozie Udushirinwa 2 1 School of Health and Medical Sciences, City St George's, University of London, London, UK, 2 North East London NHS Foundation Trust, London, UK
be times when there are challenges associated with individuals in severe emotional distress, where progress was difficult to identify, however, it was the role of the nursing staff to support patients to work through the challenges and collabora- tively plan a path towards recovery. The fourth theme was Work Life Balance , where participants highlighted that creating a separation between work life and home life was an important part of maintaining resilience. Commentary Resilience research with MHNs is limited when compared with the wider nursing field, 6 therefore the study by Rooney and colleagues presents a timely contribution to the field. Given the organisational stressors, practice demands and challenges associated with working in high-secure settings, the study findings bring into sharp focus the factors that MHNs and healthcare assistants perceive as crucial for building staff resilience. Although staff work-life balance and teamwork are not necessarily new recom- mendations in nursing spaces, this study adds an understanding of how the partici- pants made sense of these in the specific context of a high-secure male personality disorder unit. Additionally, the study identifies that while organisational support can help build staff resilience, it is important to also consider adaptability based on an understanding of the wider and individual staff factors that can foster resilience. The study has important considerations for managers in secure mental health settings—emphasising they can put systems and structures in place to support staff resilience. Clinical supervision—mentioned briefly in the discussion—is a good example of how managers in secure settings can invest in a robust support mech- anism to help build staff resilience and provide individualised staff support. Clin- ical supervision as a support mechanism is underpinned by decades of research and is recognised as contributing to professional development, quality care, and supporting the safe practice of the profession. 7 Furthermore, regulatory bodies such as the Care Quality Commission highlight its benefits. 7 Although the sample size in the study was small, it was deemed sufficient for the authors goal of using IPA methodology to gain deep insights into staff experi- ences. These experiences may resonate with mental health nursing staff practising in other secure environments. There is scope for future research to explore resil- ience in MHNs in different secure settings, and in different countries to enhance generalisability of the findings. X Lolita Alfred @loli_alfred and Christopher Chigozie Udushirinwa @ DrChris2019925 Competing interests None declared. Provenance and peer review Commissioned; internally peer reviewed. © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
Correspondence to: Dr Lolita Alfred; lolita.alfred@city.ac.uk
Commentary on : Rooney, C, Pyer, M, & Campbell, J. Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit. J Adv Nurs , 00, 1–13. (2023) https://doi.org/10.1111/jan.15947
Implications for practice and research
► Organisational structures and systems of support such as clinical supervision can support resilience in mental health nursing staff who work in high-secure forensic settings. ► Future studies in different high-secure forensic settings and different countries are required to enhance the generalisability of the findings. Context High-secure mental health hospitals, also known as high-secure forensic hospitals, are a specialism within mental healthcare. 1 They have the dual role of providing a safe healthcare environment and a secure setting for individuals with co-occurring mental health conditions and behaviour that is considered extremely dangerous or high risk. 2 Mental health nurses (MHNs) play a key role in providing health- care and maintaining a high level of security within secure mental health services. However, the setting presents unique environmental, relational and clinical chal- lenges, 3 which can lead to occupational stress, burnout 4 and make it challenging to recruit and retain staff. 1 In light of these challenges, Rooney and colleagues sought to explore the factors that support resilience in mental health nursing staff working at a high-secure unit for men diagnosed with personality disorders. 5 Methods Rooney and colleagues undertook a qualitative phenomenological study to explore staff experiences and resilience factors. They conducted semi-structured interviews with six experienced staff members (four MHNs and two healthcare assistants) who had worked in a high-secure male personality disorder ward for 5–10 years. The study used Interpretative Phenomenological Analysis to explore the nuanced meanings behind the participants’ accounts, providing a rich understanding of the participants perspectives and experiences regarding factors that are important for building staff resilience. Findings The first theme identified was Management of Emotions , where participants artic- ulated the difference between ‘caring personally’ for patients, and ‘providing care’. Participants highlighted the importance of providing the latter in a conscious and boundaried way, as part of a nurse’s duty of care. The second theme was Teamwork , and it highlighted that an environment where staff felt able to discuss clinical situ- ations and receive supportive feedback was central to building staff resilience and well-being. The third theme was Understanding the Setting. This included devel- oping an understanding of personality disorder, and the experiences of individuals diagnosed with personality disorder. Additionally, understanding that there would
ORCID iD Lolita Alfred http://orcid.org/0000-0001-8087-3191
References 1 Oates J , Topping A, Ezhova I, et al . Factors affecting high secure forensic mental health nursing workforce sustainability: Perspectives from frontline nurses and stakeholders. J Psychiatr Ment Health Nurs 2021;28:1041–51. 2 Department of Health . Environmental design guide adult medium secure services. Environmental design guide adult medium secure services (publishing.service.gov. uk). 2011. 3 Kinghorn G , Halcomb E, Thomas S, et al . Forensic mental health: Perceptions of transition and workforce experiences of nurses. Collegian 2022;29:693–700. 4 de Looff P , Didden R, Embregts P, et al . Burnout symptoms in forensic mental health nurses: Results from a longitudinal study. Int J Ment Health Nurs 2019;28:306–17. 5 Rooney C , Pyer M, Campbell J. Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit. J Adv Nurs 2024;80:2880–92. 6 Foster K , Roche M, Delgado C, et al . Resilience and mental health nursing: An integrative review of international literature. Int J Ment Health Nurs 2019;28:71–85. 7 Masamha R , Alfred L, Harris R, et al . “Barriers to overcoming the barriers”: A scoping review exploring 30 years of clinical supervision literature. J Adv Nurs 2022;78:2678–92.
1
Evid Based Nurs Month 2024 | volume 0 | number 0 |
ebn.bmj.com
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10Powered by FlippingBook