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Nurses working in acute mental-health services are vulnerable to occupational stress. One stressor identified is the challenging behaviour of some service users (Jenkins and Elliott, 2004). The purpose of this paper is to discuss the discourses drawn on by nurses to understand challenging behaviour and talk about its management.

Nurses working on acute and psychiatric intensive care unit (PICU) wards were interviewed, and data were analysed using discourse analysis.

Biomedical and systemic discourses were found to be dominant. Alternative psychosocial and emotional discourses were drawn on by some participants but marginalised by the dominant biomedical construction of challenging behaviour.

Existing studies have not considered how discourses socially construct challenging behaviour and its management in inpatient mental-health services.

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

The purpose of this paper is to further understand the needs of carers when a relative with dementia is admitted to an organic impatient ward.

A constructivist grounded theory approach was employed to generate a substantive theory to understand the needs of carers and how staff perceive carer needs when a relative is admitted to a dementia ward. Five relatives and six members of staff were interviewed using purposive and theoretical sampling. Interview transcripts were analysed using initial, focused and theoretical coding using constant comparative methods to develop the end theory.

The grounded theory concluded that carers have three categories of needs: “The Safe and Cared for Relative”, “The Informed Carer and “The Understanding, Responsive and Available Service”. Underpinning the needs are the relationships between carers, their relative and staff. Three barriers were identified which can impact on these needs being effectively met. These identified barriers were: Loss, Time and Ineffective Communication.

The grounded theory demonstrates that carers needs fundamentally relate to their relatives being safe and cared for and being included and informed during the admission. Relationships can be ruptured when a barrier prevents the needs from being effectively met. Recommendations are made to aim to reduce the impact of the barriers and to aid staff in developing their understanding of the carer experience.

The purpose of this paper is to undertake a systematic literature review to appraise the current evidence relating to the factors associated with violence and aggression in adult psychiatric hospital inpatient settings.

A systematic search of following four databases was conducted: Scopus, PsychINFO Medline, CIHAHL and PsychArticle. Following the application of the inclusion criteria, ten papers were extracted and included in the review. A quality appraisal tool, Mixed Methods Appraisal Tool (MMAT) version 2011 (Pluye et al., 2011), was employed for the appraisal of the qualitative and quantitative studies. MMAT has been designed for systematic literature reviews that include qualitative, quantitative and mixed methods studies. Of these, eight were of quantitative methodology and two were of qualitative studies.

These ten papers provide an insight into factors associated with violence and aggression towards nursing staff. Three main themes were identified: the environment, attitudes/interaction of staff, and the patient’s mental illness. The themes were important factors in the causes of violence but were interlinked highlighting the complex nature of violence towards nursing staff. The findings support the need for training for nursing staff and the development of ongoing support and for organisations to consider both the environment and the restrictive procedures to help reduce violence and aggression towards nursing staff.

The paper concludes by outlining the importance of considering the three main themes for clinical practice, training and development of secure services.

This paper gives insight into the factors associated with patient violence and aggression towards nursing staff in a secure setting.

While the literature contains plenty of theoretical models for cultural competence training of health care staff, the personnel and clinicians have seldom been asked for their views on transcultural competence. Focus group interviews that we carried out in this study showed that the main concern of the participants (interprofessional teams in Swedish psychiatry) is to understand the culturally diverse in psychiatry, rather than being culturally competent. Three major themes of the process of understanding emerged in our analyses: (1) diversity reflection (sub‐themes: reflecting on co‐existent cultural differences and similarities, moving from a one‐dimensional to a multi‐dimensional approach to cultural diversity and self‐reflection), (2) cultural knowledge and skill acquisition (generic and specific) and (3) communication (sources, discrimination). Listening to staff's learning needs may motivate greater sensitivity to the needs of their culturally diverse patients.

The purpose of this paper is to investigate optimal resources to promote resilience in staff working in inpatient mental health services. The study also provides an example of card sorting methodology used as an efficient way to identify the most helpful resources for resilience.

In total, 25 clinical staff participated in the study. A preliminary focus group and brief literature search identified resources used in two tasks. Two card sorting tasks identified resources participants found helpful vs unhelpful and abundant vs scarce, and resources they would find valuable to use more often.

The results indicate that most resources helpful to resilience and available to staff were personal resources (relating to positive outlooks or ways of working), whereas resources valuable to resilience but scarce in the working environment were organisational resources (relating to management or social workplace culture). Resources found to not be valuable to resilience were largely personal tangible resources (e.g. smoking, massages).

The findings and method may be generalisable to other mental health services, giving insight into promoting resilience within individuals and organisations. This information could serve as guidelines to streamline the allocation of organisational resources to best promote resilience across various mental health settings.

Staff resilience to working in mental health services contributes to high-quality, sustainable patient care. This study provides further insight into how personal and organisational resources are both vital to resilience in staff working in highly challenging environments.

This paper explains the service model devised in one London borough to help and support people with dual diagnosis. As well as discussing management, decision‐making and training issues, the authors outline what works, what does not work and what other organisations can learn from their experiences.

This paper describes how psychosocial interventions (PSI) have been integrated into an undergraduate mental health nursing programme. The first part of the paper provides the broad context of PSI in nurse education and justifies the need to incorporate skills for PSI into the undergraduate nursing curriculum. A variety of educational theories and research are presented, which have informed the development, structure and delivery of the skills programme underpinned by PSI into the undergraduate programme. The successes and limitations of this skills programme are considered in light of the key issues and challenges concerning the integration of PSI skills into undergraduate nursing education.

This paper aims to explore inpatient staff experiences of seeking to meet the religious and cultural needs of Black, Asian and Minority Ethnic (BAME) inpatients on mental health wards.

Nine semi-structured interviews were undertaken with inpatient staff in one NHS Trust in England to explore their views and experiences of supporting BAME inpatients to meet their religious and cultural needs. Anonymised transcripts were analysed thematically.

Inpatient staff reported lacking the confidence and knowledge to identify and meet BAME inpatients’ religious and cultural needs, especially inpatients from smaller ethnic groups and newly emerging communities. There was no specific assessment used to identify religious and cultural needs and not all inpatient staff received training on meeting these needs. Concerns were raised about difficulties for staff in differentiating whether unusual beliefs and practices were expressions of religiosity or delusions. Staff identified the potential role of inpatients’ family members in identifying and meeting needs, explaining religious and cultural beliefs and practices, and psychoeducation to encourage treatment or medication adherence.

Potential ways to address this gap in the knowledge and confidence of inpatient staff to meet the religious and cultural needs of BAME patients include training for inpatient staff; the production and updating of a directory of common religious and cultural practices and needs; local resources which can help to support those needs; and religious and cultural practices and needs being documented by mental health practitioners in community teams such that this information is readily available for inpatient staff if a service user is admitted.

This is the first study to consider inpatient staff views on meeting the religious and cultural needs of BAME informal patients and patients detained under the Mental Health Act 1983.

The purpose of this paper is to explore the extent to which inpatient mental health services attend to the religious needs of service-users. Literature is presented to argue that whilst the importance of religion is highlighted in consumer accounts, research and policy; inpatient services continue to neglect religion and service-users consistently report insufficient attention to religious needs during hospitalisation.

This review adopts a narrative approach to the literature, drawing upon published journal articles, book chapters and policy documentation.

Literature into the topic area is reviewed and discussed within three themes. First, the extent to which religious needs are currently met is explored. Second, potential reasons for neglect of religion are considered. Finally, examples of religiously informed group programmes, individual psychotherapy and the use of traditional healers are detailed.

Findings of the review point towards the requirement for inpatient services to more adequately meet religious needs in terms of available facilities. The need for spiritual assessment and collaboration with hospital chaplains is also highlighted, along with the call for increased staff training.

It is expected that this review will be of interest to a range of stakeholders including professionals, policy makers and service users. It highlights the void in clinical attention to religious needs and offers practical suggestions for meeting this need.