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.
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Evid Based Nurs Month 2024 | volume 0 | number 0 |
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