Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, IncR Colin Blenis
BACKGROUND: Developmental dysgraphia affects 5% to 20% of school-age children and reaches 59% among children with ADHD or autism. The condition produces task avoidance, eroded self-esteem, and behavioral presentations that frequently result in psychiatric referral for anxiety, depression, school refusal, and behavioral disturbance. More than 37% of children with learning disabilities reach clinical thresholds for affective and ADHD problems. Despite this clinical footprint, dysgraphia remains nosologically contested and rarely identified within psychiatric evaluation. OBJECTIVES: This integrative review synthesizes the multidisciplinary evidence on developmental dysgraphia and examines its implications for child and adolescent psychiatric-mental health nursing. DATA SOURCES: Eight databases (PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, ERIC, Cochrane, OTseeker, Web of Science) yielded 8290 records published between January 2000 and March 2026. After deduplication, 6308 records were screened, 1476 were assessed for eligibility, and 56 contributed to synthesis. Synthesis followed Whittemore and Knafl (2005) under PRISMA 2020 reporting conventions. CONCLUSIONS: Findings document definitional disagreement, fragmented assessment, underpowered intervention evidence, and substantial psychosocial burden. Three nursing publications addressed dysgraphia, and none reported original research on the condition. IMPLICATIONS FOR PRACTICE: Dysgraphia screening may be integrated into psychiatric evaluations of children referred for ADHD, anxiety, depression, school refusal, or behavioral disturbance. Handwriting may be monitored as a stimulant medication outcome. On inpatient units, writing-based therapeutic activities require adaptation when dysgraphia is suspected. Pediatric primary care and school health represent upstream identification opportunities.
International journal of mental health nursingSini Jacob, Sebastian Samuel, Greety Antony, Susan Hua, Nisha Antony
Mental health nursing requires specialised training in therapeutic communication and related soft skills. Innovative, digitally enhanced strategies may support competency development, particularly amid clinical placement shortages. This article outlines insights from a scoping review of technology use in undergraduate mental health nursing education. The objectives were to (a) explore the impact of using these technologies in students' experience and (b) develop insights that can contribute to the development of a curriculum that embed innovative educational technology with strong theoretical foundations and pedagogical strategies. This review was guided by the modified Arksey and O'Malley methodological framework. The PCC (Population, Concept, Context) framework was used to formulate the eligibility criteria. A review protocol was registered with the Open Science Framework (OSF). The databases for searching included CINAHL, MEDLINE, Scopus, PsycINFO, Web of Science. The results were reported according to the PRISMA-ScR checklist. The review included 35 studies and the evidence showed that, virtual reality simulations (VRS) with varying immersive abilities were the most popular innovative educational technology used in undergraduate mental health nursing education. Interestingly, no articles were identified that used other innovative educational technologies as outlined in the search strategies. Both immersive and non-immersive VRS were equally effective in improving student learning experiences compared to traditional learning modalities. The main benefits included enhanced learning experiences and comprehension and the development of necessary skills and confidence before entering clinical settings. Advanced technologies offer future-focused benefits for mental health nursing education; however, core therapeutic skills remain essential. Virtual learning should therefore complement, not replace, realistic learning experiences.
International journal of mental health nursingAntony Mullen, Brenda Happell, Bridget Hamilton, Stephanie Skinner
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
International journal of mental health nursingSuyoun Ahn, Eunmi Hwang
As community mental health services expand in scope and responsibility, mental health nurses are playing a central role in delivering integrated, recovery-oriented care. However, they face substantial challenges in adapting to community practice and sustaining professional development. Clinical supervision can mitigate these demands through its formative, normative, restorative functions. This study explored the supervision experiences of community mental health nurse specialists in South Korea to provide evidence for specifying the effective functions and operational systems of supervision using an exploratory qualitative design. Twelve community mental health nurse specialists participated in three focus group interviews conducted between June 2024 and July 2025. Data were analysed using reflexive thematic analysis. Four themes and 10 subthemes were generated: translating community mental health ideals into professional practice; serving as an anchor in unfamiliar terrain; supervision undermined by superficiality and disrespect; and competency development constrained by structural barriers. Supervision was perceived as a critical space for clarifying clinical direction, regulating emotional involvement and supporting professional adaptation. However, formalistic delivery and structural constraints limited its impact. These findings highlight the need for integrated and systematic supervision approaches aligned with the community mental health paradigm, supported by organisational and policy commitments to protected time, staffing, education and financial resources. Strengthening supervision under such conditions may enhance practitioner development and service user outcomes.
International journal of mental health nursingEsario Iv Daguman, Dane Owen, Jacqui Yoxall, Richard Lakeman, Marie Hutchinson
Interventions aimed at reducing restrictive practices are also designed to enhance the service experience in acute mental health units. However, people with experience of coercive engagement with these services are seldom involved as active contributors in evaluative research on interventions to reduce restrictive practices. With the meaningful involvement of lived experience practitioners, this research was aimed at examining care recipients' service experiences and perspectives on nurses' therapeutic responses during the implementation of a de-escalation intervention in three adult inpatient units within New South Wales, Australia, from March 2024 to April 2025. Nested within a larger study employing a mixed concurrent control design, this research evaluated the effectiveness and process of the Safe Steps for De-escalation through comparisons of unmatched measures of empowerment, dehumanisation, and staff actions on violence prevention across three time points, as well as through a reflective thematic analysis of semi-structured interviews. Safe Steps is a structured approach for therapeutic responding, targeting nurses' relationship-promotion behaviours to increase focus on minimising the use of restrictive practices. Eighty-six inpatients completed the unmatched measures, with nine participating in interviews following discharge. No significant changes were noted in quantitative measures over time. Five themes emerged from the qualitative analysis: (i) Clarity calms; confusion harms, (ii) Control cuts deep, (iii) Systems strain; people break, (iv) Connection is treatment in itself, and (v) Meaning-making outweighs medicine. These findings cast acute inpatient units in a light akin to a power circuit, elevating the need to make inpatient admissions more reflective of everyday life outside the units.
International journal of mental health nursingSophie Isobel
There are increasing guides and expectations for being trauma informed in research practices. This perspective paper builds upon this emerging field of literature to consider what it means to be trauma and violence informed in mental health nursing research and evaluation. Being trauma and violence informed requires all the same in-the-moment application of the principles of trauma informed care when engaging with participants or data, while also contextualising trauma in the context of wider social contexts. This includes recognising the role that structural violence plays in compounding and sustaining trauma for groups and individuals. To be trauma and violence informed in research requires attention to the power that research and evaluation hold and ongoing reflection on the implications of the design, measures, outcomes and findings of research and evaluation, while informing all decisions by awareness of trauma and the forms of violence that cause and sustain it.
PloS oneAmal I Khalil, Alhanouf A Almuhalbidi, Reema T Almutairi, Shahad S Almutairi, Hatun H Alansari, Atheer S Almarri, Shaima K Alzahrani, Joud S Alzahrani
BACKGROUND: Polypharmacy is often crucial for managing complex and treatment-resistant psychiatric disorders, yet it carries risks such as adverse drug interactions, medication non-compliance, and suboptimal health outcomes. Interprofessional perspectives on polypharmacy significantly influence clinical decision-making and prescribing practices. AIM: This research evaluates healthcare providers' knowledge and attitudes regarding psychiatric polypharmacy, comparing the views of psychiatric nurses, psychiatrists, and pharmacists. It also explores how these factors impact prescribing behaviors and interprofessional collaboration. METHODS: A convergent mixed-methods approach was employed at the Erada Complex for Mental Health and Addiction in Jeddah, Saudi Arabia. The study involved 221 healthcare providers, including psychiatrists (n = 32), psychiatric nurses (n = 158), and pharmacists (n = 31). Quantitative data were collected using validated scales to assess knowledge and attitudes, while qualitative insights were gathered through open-ended responses and group discussions. RESULTS: Knowledge levels varied among the professionals, with psychiatrists possessing the most comprehensive understanding (84.2 ± 11.0), followed by pharmacists (81.5 ± 10.0) and psychiatric nurses (79.5 ± 9.8). Attitudes toward polypharmacy also differed, with psychiatrists showing the most favorable views (3.79 ± 0.49), whereas nurses and pharmacists were more cautious due to concerns about adverse effects and medication burden. A significant positive correlation (r = 0.653, p < 0.05) was observed between knowledge and attitude scores. Sociodemographic factors, such as professional experience and confidence in medication management, influenced both knowledge and attitudes regarding medication management. Qualitative findings highlighted interprofessional tensions, with psychiatric nurses advocating for more conservative approaches, psychiatrists emphasizing clinical necessity, and pharmacists focusing on optimizing medication safety. CONCLUSION: Healthcare providers demonstrated varying levels of awareness and attitudes toward psychiatric polypharmacy, shaped by their professional roles and responsibilities. While psychiatrists were more accepting of polypharmacy, psychiatric nurses expressed concerns about patient burden, and pharmacists prioritized safety considerations. Enhancing interprofessional collaboration and ongoing education on polypharmacy practices are essential for improving patient outcomes.
Nursing inquiryDave Holmes, Jennifer Kilty, Jean-Laurent Domingue, Rochelle Einboden, Julie Chartrand, Chad Hammond
Infanticide is defined as the killing of a child under 1 year of age by their mother. In Canada and many other jurisdictions, infanticide is a legal offense that can be committed only by women. Although it is a rare and complex phenomenon, social and legal attitudes toward women convicted of infanticide are strongly gendered. This gendered legal construction has generated considerable debate regarding whether such laws acknowledge or obscure the complex social realities of motherhood; whether they privilege or disadvantage women within the criminal justice system; and whether they facilitate access to appropriate mental health care for women experiencing psychological distress. In this study, a qualitative critical discourse analysis (CDA), informed by feminist and poststructuralist theory, was conducted to examine nurses' social representations of women convicted of infanticide. More specifically, this empirical investigation explored the social factors shaping forensic psychiatric nursing practices toward mothers convicted of infanticide. Five forensic psychiatric nurses who had provided care to women convicted of infanticide were interviewed as part of this qualitative research. We organized our analysis of the interviews into three key findings: (1) Participants constructed specific, medicalized discourses of pathology and responsibility around the women in their care; (2) Threaded into these discourses of willfulness was a stigmatizing figuration of women convicted of infanticide as "the disordered mother"; and (3) Participants worked to manage the stigma and abjection they felt toward their patients through two particular orientations to care: objectivity and context-sensitivity. The findings highlight the need, across legal, media, public, and medical domains, for narratives that enable women to reclaim agency from the gendered, classed, and medicalized stories that often define them. A context-sensitive orientation to care may represent one possible avenue for challenging and dismantling the construction of the "disordered infanticidal mother" within forensic psychiatric institutions.
Journal of psychosocial nursing and mental health servicesDristi Basnet, Lisa Beauvois
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and restricted, repetitive behaviors, frequently accompanied by comorbid psychiatric conditions, such as anxiety and attention-deficit/hyperactivity disorder. Symptom overlap complicates diagnosis, whereas the absence of tailored clinical guidelines contributes to variable practices and the risk of over- and undertreatment. The current article examines the efficacy and safety of guanfacine extended-release (GXR) for the treatment of hyperactivity, impulsivity, and associated behavioral symptoms in children with ASD and comorbid psychiatric conditions. Current evidence supports GXR as an effective nonstimulant option with a tolerable safety profile, particularly for children with co-occurring anxiety or sleep disturbance or those who are poor candidates for stimulant therapy. Careful titration and ongoing monitoring remain essential given this population's heightened sensitivity to adverse effects. For psychiatric-mental health nurse practitioners, these findings underscore the importance of individualized, family-centered care; ASD-specific assessment; and interdisciplinary collaboration. Ethical prescribing, ongoing clinical monitoring, and meaningful caregiver engagement are essential to optimizing outcomes and enhancing quality of life for children with ASD and comorbid psychiatric conditions.
Japan journal of nursing science : JJNSSho Nagai, Emiko Shinozaki
AIM: To describe how experienced psychiatric nurses notice, interpret, and respond to adult inpatients whom they clinically judge to have childhood maltreatment-related attachment difficulties and to clarify the practical reasoning underlying these judgments. METHODS: Eleven experienced psychiatric nurses from two private psychiatric hospitals in Japan were purposively sampled. Participant observation and semi-structured interviews focused on care of adults clinically understood to have childhood maltreatment-related attachment difficulties. Case identification relied on nurses' clinical judgment and routine team discussions or record information; no standardized attachment assessment or independent verification of childhood maltreatment history was used. Data were analyzed using the steps for coding and theorization (SCAT) method. RESULTS: SCAT generated 54 themes or concepts organized into 10 categories and 24 subcategories. Nurses noticed recurrent relational patterns, including distrust, checking behavior, dependency-aggression cycles, misinterpretation of staff intentions, self-harm, and distress around proximity, and adjusted their responses to stabilize the patient-nurse dyad, avoid re-traumatization, support emotional expression, and coordinate team care. Only a limited subset of subcategories was attachment-specific; many others reflected broader psychiatric nursing practices applied through an attachment-informed lens. A trauma-focused noticing process was visible in nurses' attention to nonverbal cues and early behavioral change. CONCLUSIONS: The findings describe situated clinical reasoning rather than a new diagnostic technique or intervention model. Experienced psychiatric nurses adapted everyday psychiatric nursing practices to relational patterns they understood as childhood maltreatment-related and attachment-relevant. The model may inform education, supervision, and future patient-inclusive research.
Journal of the American Psychiatric Nurses AssociationVanessa Oliphant, Gabriella Martinez, Courtney Harold, De'ja Broyles, Jennifer Williams, Paul Nabity, Donald McGeary, Meredith Stensland
OBJECTIVE: This discussion paper explores the intersection of cultural factors and Black women's experiences with chronic pain and suicidality. It aims to inform the continued development of tailored pain interventions and culturally responsive psychiatric nursing care. METHODS: Using existing literature, we identified six domains of cultural factors potentially influencing Black women's pain experiences and suicide risk. The six domains were conceptually organized into two categories: culturally specific risk factors and culturally specific protective factors. RESULTS: In terms of risk factors, the endorsement of the superwoman schema, intersectionality, and history of medical mistrust were identified. For protective factors, spirituality, culture, and reliance on social support were identified. CONCLUSIONS: Drawing on the disciplines of African American Studies, Black Psychology, and Clinical Health Psychology, we provide clear recommendations for the development of culturally tailored interventions that can uniquely address Black women's pain and suicide-related experiences while receiving psychiatric nursing care.
OBJECTIVES: Time Together (TT) is a nursing intervention designed with a focus on increasing the possibility of patients and staff engaging in joint activities. Previous research points towards implementation difficulties but there are no studies specifically investigating the process of implementing TT in psychiatric inpatient care (PIC). Therefore, the aim of this study is to explore mid-level leaders' and implementation leads' perspectives on implementing TT in PIC, analysed through the Consolidated Framework for Implementation Research (CFIR). DESIGN: This qualitative study used semistructured interviews with 11 mid-level leaders and implementation leads who took part in implementing TT. The interviews were analysed using deductive qualitative content analysis, with the CFIR applied as a structured matrix in the analysis. SETTING: The study was conducted in PIC settings at three wards within secondary care healthcare services in northern Sweden. PARTICIPANTS: Participants were 11 mid-level leaders and implementation leads involved in the implementation of TT in PIC. INTERVENTIONS: TT is scheduled for 1 hour, 5 days a week. During this hour, nursing staff and patients engage in joint activities, while one or two staff members oversee administrative duties. No meetings, visits or other ward-related activities are scheduled during this hour. RESULTS: Deductive content analysis resulted in 15 categories sorted into 4 domains and 11 constructs. TT was perceived as advantageous and aligned with the wards' mission. However, one key finding was that mid-level leaders and implementation leads found implementation challenging as they perceived that some innovation deliverers viewed joint activities within TT as lacking value and not being 'proper work'. Furthermore, there was a need for more information and a clearer rationale for the intervention in order to improve implementation and delivery. CONCLUSIONS: The findings indicate a discrepancy in values and attitudes between leaders and innovation deliverers regarding what constitutes meaningful care in psychiatric inpatient settings. Implementation was further influenced by challenges related to leadership and motivating others. Barriers to implementing TT may not be addressable through implementation and intervention training alone. Instead, implementation planning should also consider intervention deliverers' values and beliefs.
Actas espanolas de psiquiatriaJavier Sanz Calvo, Alina Mariana Renghea, Mercedes Gómez Del Pulgar García-Madrid
BACKGROUND: Research has explored how undergraduate nursing students or Registered Nurses acquire and assess competences through simulations or training programs. However, there is limited evidence regarding Mental Health Nurses (MHNs) in regular clinical practice. This review aims to identify the clinical competences-knowledge, skills, or attitudes-of MHNs in their clinical practice, and how these are evaluated. METHODS: A scoping review was conducted across four databases (PubMed, CINAHL, MEDLINE, PsycInfo) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) extension guidelines, applying a double screening process. RESULTS: Twenty-three studies were selected, focusing on nursing competency acquisition programs and assessments tools. The quality of the included studies was deemed acceptable. The findings indicated that educational programs improved professional competences. Among the assessment tools identified, sixty-six were validated while thirty-four were researcher-developed. Most tools targeted core MHN competences, such as physical health (Physical Health Attitude Scale for Mental Health Nurses) and psychiatric emergencies (Attitudes towards Containment Measures Questionnaire). Fewer tools addressed crosscutting competences (Clinical Competency of Mental Health Nursing). CONCLUSIONS: There is a clear need to develop tools specifically designed to assess mental health nursing within Specialized Health Training Programs. To strengthen competency acquisition and evaluation, it is recommended that complementary methods, such as simulations, feedback, and targeted tools, be integrated into MHN training and assessment.
Frontiers in public healthDeyu Liu, Junyu Liu, Yuan Luo, Liping Zhao, Haiye Ran, Linjing Zhang, Yusheng Tian, Jianjian Wang
BACKGROUND: Psychiatric nurses face high turnover rates and increasing levels of turnover intention. Workplace violence is associated with turnover intention among psychiatric nurses. Social exchange theory suggests that ward atmosphere and social distance may play a significant role in this process. However, the mechanisms underlying this relationship remain unclear. OBJECTIVE: To explore how workplace violence influences nurses' turnover intention through ward atmosphere and social distance, and to provide strategies for promoting nurses' wellbeing. METHODS: A questionnaire survey was conducted among 1,485 psychiatric nurses recruited through the Mental and Psychological Care Alliance from September to October 2024. Variables were measured using a demographic questionnaire, a turnover intention item, the Workplace Violence Scale, the Ward Atmosphere Scale, and the Social Distance Scale. Statistical analysis and model construction and validation were performed using SPSS 29.0 software. RESULTS: Ward atmosphere was negatively correlated with turnover intention (r = -0.423), social distance (r = -0.340), and workplace violence (r = -0.307). Turnover intention was positively correlated with both social distance (r = 0.221) and workplace violence (r = 0.214). Workplace violence was positively correlated with social distance (r = 0.159). Workplace violence directly affected turnover intention among psychiatric nurses (β = 0.181, p < 0.001). The workplace violence also indirectly affects turnover intention among psychiatric nurses through the simple mediating effect of ward atmosphere (β = 0.232, p < 0.001) and social distance (β = 0.010, p < 0.001). And the sequential mediating effect of ward atmosphere and social distance between workplace violence and turnover intention is also significant (β = 0.017, p < 0.01). Additionally, that ward atmosphere and social distance totally mediated the link between workplace violence and turnover intention (indirect effect = 0.259, 95% CI: 0.207-0.313), explaining 58.863% of the total effect. CONCLUSION: This study suggests that we should pay attention to the influencing factors of the turnover intention and take effective measures. It is imperative to mitigate the occurrence of workplace violence within the ward. Additionally, we should cultivate a positive ward atmosphere, enhance the attitudes of psychiatric nurses toward their patients, and diminish expectations of social distance. These actions may reduce nurse turnover.
International journal of mental health nursingAnna Sandsten, Maria Strömbäck, Sebastian Gabrielsson, Git-Marie Ejneborn Looi, Britt-Marie Lindgren
Mental health nursing in inpatient psychiatry is shaped by control and standardisation, yet little is known about how these conditions are sustained in everyday care for persons with anorexia nervosa. This study aimed to explore how nursing staff experience and understand care for persons with anorexia nervosa within general psychiatric inpatient care settings, with particular attention to the conditions shaping what comes to count as legitimate nursing practice. Nine nursing staff with experience caring for persons with anorexia nervosa in general psychiatric inpatient care in Sweden participated in the study. Data were collected in 2025 using semi-structured qualitative interviews and were subjected to qualitative content analysis with a Foucauldian-inspired abductive approach. Findings are presented as two themes, Nursing practice governed by a risk-oriented care logic and Responsibility as a burden and a possibility within nursing practices. Within those themes are five sub-themes, Making sense of AN through risk and stabilisation; Enacting control through routines and treatment plans; Normalising coercion in everyday care; Navigating responsibility under unstable care conditions and Producing alternative care practices through relational work. Findings suggest that discourses of risk and stabilisation organise nursing practice through a risk-oriented care logic that shapes what is recognised as legitimate care and professional competence. Within these conditions, relational and individualised nursing practices become difficult to sustain while responsibility and coercive measures are framed as necessary responses to risk. This study is reported in accordance with the COREQ guidelines.
International journal of mental health nursingPromise Ezinne Ekezie, Alexander Rozental, Git-Marie Ejneborn-Looi, Ursula Werneke, Sebastian Gabrielsson
In psychiatric settings, recovery-oriented care follows a relational, person-centred approach. In mental health nursing, such care extends beyond merely reducing symptoms to foregrounding hope, identity, meaningfulness, empowerment, and personal agency. Because an important aspect of putting that approach into practice is engaging in conversations that promote recovery, understanding the concept of recovery-oriented conversations (ROCs) is essential. In this review, we aim to synthesise existing research on ROCs and offer insights into their implementation, challenges, and impact on patients' recovery. An integrative review of studies (i.e., qualitative, quantitative, and mixed-methods) published between 2015 and 2025 in PubMed, CINAHL, PsycINFO, Scopus, and Web of Science returned 5298 studies, 49 of which we included in a narrative synthesis using deductive coding from an inductive perspective. The findings suggest that ROCs are conceived as being well-structured, context-sensitive conversations that create space for expression and the co-creation of recovery-oriented pathways while probing personal and social realities. ROCs are effective when grounded in deep engagement, shared goal-setting, and supportive environments. The practice, reflecting the connectedness, hope, identity, motivation and empowerment (CHIME) framework, is perceived as nurturing safety, promoting relational depth, and reaffirming personhood. Whereas barriers to implementation include limited time, staffing constraints, hierarchical cultures, and inconsistent leadership, facilitators include clear communication, culturally responsive practices, and organisational support. Altogether, ROCs allow mental health nurses to deliver care, strengthen therapeutic relationships, and foster shared decision-making. Embedding them into successful practice, however, calls for more research, training, cultural sensitivity, and systemic alignment.
Journal of nursing managementTing Tang, Qiuxiang Sun, Qinghua Lu, Yuandong Gong
AIMS: To explore the classification of interpersonal conflicts among psychiatric nurses and to compare the differences in psychological capital, sleep quality, and conflict coping styles among nurses with different conflict types. METHODS: From July to August 2024, a survey was conducted among all clinical nurses in 6 tertiary psychiatric hospitals in Shandong Province using the General Information Questionnaire, Workplace Interpersonal Conflict Scale (WICS), Psychological Capital Questionnaire-Revised (PCQ-R), Simplified Coping Style Questionnaire (SCSQ), and Pittsburgh Sleep Quality Index (PSQI). Latent profile analysis was applied to explore the classification of interpersonal conflicts among psychiatric nurses. Univariate analysis and multivariate logistic regression analysis were used to identify the influencing factors of nurses' conflict types. RESULTS: The survey revealed that clinical psychiatric nurses could be divided into four types: low conflict-adaptive type, moderate-to-high conflict-clinical high-pressure type, moderate-to-high conflict-management contradiction type, and ultra-high conflict-omnidirectional high-pressure type. Age, married status, total score of psychological capital, total score of sleep quality, and negative coping style of psychiatric nurses had significant effects on their conflict types. CONCLUSION: There is group heterogeneity in the conflict types of clinical psychiatric nurses. Poor sleep quality and negative coping styles increase the likelihood of belonging to higher-risk conflict profiles, while psychological capital may not always function as a protective factor in interpersonal interactions. These findings highlight the importance of adopting person-centered conflict management approaches for psychiatric nurses. IMPLICATION FOR NURSING MANAGEMENT: Nursing managers should pay more attention to nurses with moderate-high conflict and ultra-high conflict profiles. Measures such as improving the working environment, providing sufficient organizational support, and optimizing the scheduling system should be taken to reduce the incidence of interpersonal conflicts among psychiatric nurses. In addition, management should focus not only on enhancing psychological capital but also on fostering empathy and interpersonal collaboration skills to reduce conflict escalation and improve nursing care quality.
Nurses play a key role in person-centered psychiatric care by supporting patient recovery, fostering independence, and building trusting relationships. However, organizational rules may conflict with nurses' ethical values, leading to moral distress, burnout, and resignation. Drawing on the theory of positive deviance, previous research has identified how nurses may engage in positive rebel leadership, leading and practicing nursing in ways that diverge from prevailing norms, rules, codes of conduct, and workplace strategies. This study explores how such leadership in psychiatric care can support professional standards and improve patient outcomes. The aim was to describe nurses' experiences of rebel nurse leadership in psychiatric care. A qualitative descriptive design was employed, using semistructured individual interviews with 33 nurses experienced in psychiatric care. A qualitative content analysis and meta-synthesis were conducted, with the support of generative artificial intelligence in the synthesis process. The results describe nurses' experiences of rebel nurse leadership in psychiatric care as taking responsibility, guided by professional competence and an internal ethical compass; leading change and challenging hierarchies to enable holistic care that respects patients' rights and dignity; relying on the support of colleagues and management, while facing the risk of exclusion. The study shows how rebel nurse leadership, grounded in professional competence and ethical conviction, might support person-centered and high-quality psychiatric care. The findings illustrate how such leadership emerges in response to organizational norms that constrain nursing practice and frame acts of resistance as expressions of professional responsibility. The study emphasizes the importance of supporting nurses' autonomy to enable improvements in care quality and patient outcomes.