Journal of Psychiatric Nursing - J Psy Nurs: 14 (3)
Volume: 14  Issue: 3 - 2023
FRONTMATTER
1.Front Matter

Pages I - IV

EDITORIAL
2.Editorial
F. Yasemin Kutlu
Page V

RESEARCH ARTICLE
3.Perceptions of nursing image of nursing students and affecting factors in the COVID-19 pandemic: A cross-sectional study
Raziye Çelen, Sibel Küçükoğlu, Emriye Hilal Yayan, Aynur Aytekin Özdemir
doi: 10.14744/phd.2023.45556  Pages 193 - 199
INTRODUCTION: This study investigated the perceptions of nursing image and the affecting factors in the COVID-19 pandemic of nursing students.
METHODS: A cross-sectional study was conducted at two public universities in Türkiye that provide undergraduate nursing. The study sample consisted of 355 undergraduate nursing students. Data were collected between April and July 2020 using an online questionnaire, student information form, and image scale for the nursing profession.
RESULTS: The majority of the participants were women (78.6%). Participants had a mean age of 21.23±2.049. More than half the participants chose to pursue a career in nursing willingly (63.4%). Most participants were proud of being nursing students (85.4%). The majority of the participants stated that the COVID-19 pandemic had positively affected the image of nursing. Most participants noted that they were happy about the posts shared on social media platforms about nursing. Participants had a mean “Scale for the Image of Nursing Profession” score of 148.51±16.5. Gender and conscious choice of the nursing profession explained 6% of the total variance. Taking pride in being a nursing student explained 10% of the total variance (p<0.05).
DISCUSSION AND CONCLUSION: Nursing has a positive image in the eyes of nursing students during the COVID-19 pandemic. Some variables (gender, conscious choice of the profession, and taking pride in being a nursing student) are significant predictors of the image of nursing in the eyes of nursing students.

4.Efficacy of a communication skills training for nursing students: a quasi-experimental study
Neşe Mercan, Sabahat Coskun, Zeynep Apaydın Demirci
doi: 10.14744/phd.2023.02438  Pages 200 - 209
INTRODUCTION: Effective communication skills enable nurses to understand their patients and gather essential information or care. In addition, the patient care period runs shorter as a result of effective communication. However, in cases where effective communication cannot be established with the patient, medical errors can arise, while the quality of patient care declines as well. Therefore, the nursing education curriculum is required to include sufficient programs for communication skills. The objective of this study is to explore the effects of staging through roleplaying the sketches of formed by the students based on their own lives on the development of communications skills.
METHODS: In this study, quasi-experimental and pre-post designs were used. Participants included in the study were randomly divided into two as experimental (n=40) and control (n=38) groups. In the evaluation of the learning, “Interpersonal Problem Solving Inventory” and “Communication Skills Inventory” were at the pre-training and the post-training.
RESULTS: As a result, “Confidence,” “Satisfaction,” “Feedback,” “Staging Sketches Through Role Play,” and the “Communica-tion Skills Gained” themes were revealed. It was determined that the communication and interpersonal problem-solving skills (IPSI) of students in the experimental group developed more compared to pre-training. Upon examination of the difference between the experimental and control groups, it was found that the communication and IPSI of the students in the experimental group are better compared to the control group.
DISCUSSION AND CONCLUSION: In this study, it has been shown that the training provided through student-based sketches and under the management of an expert in their field, is effective in terms of developing communications skills and interpersonal problem-solving in nursing students. Considering the results of this study, role-playing, displacement, giving feedback, and staging students’ life stories can be added to the education framework.

5.Perceptions of frontline ground zero nurses in Lebanon regarding psychological needs and coping mechanisms during the most recent COVID-19 outbreak
Mirna Fawaz, Ahmad El Tassi, Mohammad Itani
doi: 10.14744/phd.2022.46872  Pages 210 - 216
INTRODUCTION: Lebanese frontline nurses were not only fighting off a pandemic for the past year but also facing escalating political, social, economic, and humanitarian turmoil that have accentuated the pressures exerted upon them. However, their needs for psychological support and coping mechanisms have been uncharted in light of the documented stress frontline nurses have been living for the past year. This paper aimed at exploring the perceptions of frontline ground zero nurses in Lebanon regarding their psychological needs and coping mechanisms during the most recent COVID-19 outbreak.
METHODS: This study was conducted in 2 main ground-zero hospitals in Beirut. This research paper has adopted a qualitative exploratory research design through employing the phenomenological approach, where online interviews were carried out among 15 frontline ground zero nurses in the 2nd week of January 2020.
RESULTS: The results of this study showed that the nurses perceived a need for significant psychological support led by their hospital, while they had to employ various coping mechanisms. The qualitative analysis of the verbatim conveyed by participating nurses have resulted in the emergence of five themes; “Need for actual support,” “Need for formal psychological counseling,” “Praying and being spiritual,” “Avoiding the news,” and “Self-reminders.”
DISCUSSION AND CONCLUSION: This study demonstrated that sufficient action has not been taken to enhance the mental health of these frontline nurses, where they shared their perspective of inadequate support mechanisms and the necessity for technical, systemic, and structured mental health support.

6.Assessment of the mental health and associated factors among healthcare workers in Iran during COVID-19 pandemic
Behzad Khedri, Sajad Sajadi, Ziba Shahini, Vahid Rashedi, Asghar Tavan, Mohsen Aminizadeh
doi: 10.14744/phd.2022.29964  Pages 217 - 223
INTRODUCTION: Several studies show that the new coronavirus (COVID-19) has jeopardized the health dimensions of healthcare workers. The present study was designed to evaluate the mental health and determined factors of healthcare providers in Iran during the COVID-19 pandemic.
METHODS: This cross-sectional analytical research was conducted in three hospitals, in Tehran. The questionnaires, including the General Health Questionnaire (GHQ-12), and Kessler Psychological Distress Scale (K10), with demographic/job characteristics questions, were implemented to collect data.
RESULTS: Results show that 31% of the total population was at risk for psychiatric disorders (36% nurses and 13% physicians). Female, frontline, and married healthcare workers showed the highest prevalence rate of mental health disorders. In addition, elderly healthcare workers, front-line, married, and female participants demonstrated a high level of distress, respectively.
DISCUSSION AND CONCLUSION: Results from this study decree further monitoring and psychosocial interventions for healthcare workers during the viral pandemic to preserve healthcare workers from long-term mental health disorders impacts.

QUALITATIVE RESEARCH
7.Professional experiences of nurses working in community mental health centers: A phenomenological study
Nurcan Düzgün, Satı Demir
doi: 10.14744/phd.2023.17037  Pages 224 - 231
INTRODUCTION: This study was carried out to determine the professional experiences of the nurses working in community mental health centers (CMHCs). A phenomenological design was used in this qualitative study, which was carried out with 13 nurses working in 8 CMHCs located in the Central Anatolia Region of Türkiye.
METHODS: Data were collected through in-depth individual interviews. Semi-structured interview questions developed by the researchers based on expert opinions were used during the interviews. Colaizzi’s seven-step phenomenological analysis method was used to analyze the data.
RESULTS: Five main themes were identified as a result of the data analysis. These themes were (i) the meaning of being a CMHC nurse, (ii) nursing practices, (iii) advantages of being a CMHC nurse, (iv) disadvantages of being a CMHC nurse, and (v) recommendations for CMHCs.
DISCUSSION AND CONCLUSION: CMHC nurses have various roles, authorities, and responsibilities. Working with a multidisciplinary team and having comfortable working conditions are considered advantages of CMHC nursing, while the possibility of being exposed to violence or the difference of CMHCs from other clinics are considered disadvantages. Recommendations include increasing the number of CMHCs and nurses, providing an orientation program to the nurses before starting to work in CMHCs, and improving the physical conditions of CMHCs.

8.The clinical competency in post graduate psychiatric nursing students: a qualitative study
Effat Sheikhbahaeddinzadeh, Tahereh Ashktorab, Abbas Ebadi
doi: 10.14744/phd.2022.37132  Pages 232 - 239
INTRODUCTION: "Clinical competency" is an ambiguous and context-based concept. This study aims to define the postgraduate psychiatric nursing students` clinical competency.
METHODS: This qualitative study, the part of a larger study and extracted from the Ph.D. thesis, was approved by the Ethics Committee. It is a qualitative content analysis study conducted in the nursing schools holding postgraduate psychiatric nursing program. 21 participants were instructors and postgraduate students in psychiatric nursing, psychiatric nurses, psychiatrist and psychologist who have experienced working in psychiatric settings. Data collection was conducted from November 2019 to August 2020 using a purposeful sampling. Individually semi-structured interviews were conducted. The conventional content analysis of data was performed using Graneheim & Lundman method.
RESULTS: Three themes and eight categories were recognized. The emerging themes include "Personal characteristics"(with categories" Individual and family properties", "Ethical principles", "Physical and mental competence"), "Technical competency"(with categories "Specialized knowledge", "Application of knowledge in practice"), and "Meta competency"(with categories "Ability to think and clinical reasoning", "Dynamic learning", "Human and organizational management").
DISCUSSION AND CONCLUSION: The postgraduate psychiatric nursing students` clinical competency is" to dynamically learn specialized knowledge and skills, creatively apply in clinical practice, and critically do clinical reasoning besides having individual& family properties, physical & mental competence, commitment to ethical principles. Furthermore, managing nursing cares provides integrated care for the patient. Conceptualizing the concept of psychiatric nurses' competency appropriate to context can lead to the integrated educational program and objective evaluation of student competency.

9.“Know Safety, No Pain”: Exploring perceptions of nursing staff on Patient Safety in a mental health-care setting in Pakistan
Taskeen Mansoor, Sawera Mansoor
doi: 10.14744/phd.2023.69926  Pages 240 - 247
INTRODUCTION: In psychiatric wards, nursing staff plays a central role in handling unique patient safety issues due to their proximity and extended interaction with the patients. This qualitative exploratory study aims to understand the socio-cultural and institutional factors that act as opportunities and/or barriers to provision of patient safety in an in-patient psychiatric unit.
METHODS: Employing participant observation and critical incident technique that guided the semi-structured interviews, 23 nursing staff of a tertiary care hospital in Rawalpindi, Pakistan, were approached in their natural setting, that is, the wards or outpatient departments during the months of March–June 2021.
RESULTS: Using a-priori and emerging codes, six themes were revealed: “Socialization” of mental health, Role Conflict: Nurturing versus Controlling, Approaches: Proactive versus Reactive, Potential Risks to Patient Safety, Indigenous “Pain-less” procedures for physical restraint, Gender roles matter. The study discusses how the increasing awareness around mental health influences care decisions, how family members act as extensions to nursing role and how the nurses exhibit ambivalence toward the use of restraints.
DISCUSSION AND CONCLUSION: The study concludes that the conceptualization of nurses regarding mental health issues, patient safety, physical restraints, seclusion, cultural, and gender norms is also reflected in their care provision. Nurses’ autonomy, decision-making, cultural context, and training in clinical interventions are significant for patient safety in psychiatric nursing practice.

SYSTEMATIC REVIEW
10.A systematic review of the impact of physical activity on elderly mental health
Sitti Musdalifah Ahmad, Yuliana Syam, Ariyanti Saleh
doi: 10.14744/phd.2023.43179  Pages 248 - 255
INTRODUCTION: The purpose of this study was to conduct a systematic assessment of the available data about the benefits of physical activity and the appropriate forms of exercise for older adults’ mental health.
METHODS: LILACS, PubMed, SciELO, CINAHL, Scopus, Google Scholar, ProQuest, and ScienceDirect were all searched. Based on PRISMA, the reviewing guideline was selected. The Quality Assessment Tool (QAT) for Quantitative Studies was used to evaluate the methodological quality of each included study. We only included studies with moderate to strong quality.
RESULTS: Fourteen studies were eligible for inclusion (six randomized controlled trials and eight pretest-posttest studies). A variety of exercises, including aquatic, aerobic, yoga, and muscle-strengthening ones, have been shown to improve elderly people’s physical and mental health. According to QAT, five studies with Cohen’s Kappa values of at least 0.80 and 11 high-quality studies with p<0.05 had a significant impact on the mental health of the elderly.
DISCUSSION AND CONCLUSION: This comprehensive study demonstrated how an exercise program benefits elderly people who are both usually healthy and have suffered a variety of symptoms.

REVIEW
11.A literature review of nurses’ experience working with COVID-19 patients
Yoyok Bekti Prasetyo, Safera Rodatul Ula, Sri Sunaringsih, Yulis Setiya Dewi, Titih Huriah
doi: 10.14744/phd.2023.71354  Pages 256 - 261
Objectives: Nurses who worked long hours and contacting with coronavirus diseases 2019 (COVID-19) patients often felt stress, worry, and infection fears. However, there was a nurse’s responsibility toward the patient’s safety. This study aimed to describe nurses’ experiences while treating COVID-19 patients.
Methods: This study was conducted with a systematic review. Preferred reporting items for systematic reviews and meta-analyses guidelines were used, with keywords “Determinant Factors” and “Mental Disorder” or “Mental Health,” and (COVID-19 or “coronavirus diseases 2019”). The databases used were PubMed, Proquest, Springer Link, Taylor and Francis, and Science Direct. There were 72 articles from PubMed, 1012 from ProQuest, 2143 from Springer Link, 167 from Taylor Francis, and 2705 from Science Direct were used to identify phases. However, only 16 articles were analyzed. Results: Nurses caring for COVID-19 patients endure stress and anxiety, according to eight articles. According to three studies, nurses are socially stigmatized in society. Listening to prayer produces mental peace and calming sentiments for both nurses and patients, according to the spiritual experience of nurses.
Conclusion: Nurses’ psychological reactions to caring for COVID-19 patients were mostly fear, sadness, nervousness, worry, and exhaustion as a result of the condition in the COVID-19 isolation ward. They require appropriate psychological care to alleviate their psychological distress and provide comfort.

12.Contextual factors of the placebo effect in psychiatric care
Yeliz Karaçar, Yağmur Çolak Yılmazer, Kadriye Buldukoglu
doi: 10.14744/phd.2023.68984  Pages 262 - 269
Interest in studies of the use and effects of placebos in the nursing discipline has increased in the last decade. The placebo effect is the effect of the psychosocial context that accompanies any treatment and care rather than an ineffective drug or intervention administered to relax or please individuals. Contextual factors, considered as psychosocial components of nursing care, are essential for the interpretation of care perception and therapeutic interventions by both patients and healthcare professionals. Psychiatric nurses have an important role in determining placebo effects and applying therapeutic factors that contribute to the emergence of those effects in psychiatric care. The fact that psychiatric nurses provide individual-centered care by considering contextual factors such as therapeutic relationships, empathetic and compassionate communication, and the therapeutic environment increases the level of the placebo effect and impacts the therapeutic process. Nurse researchers are increasingly using usual care in their control groups rather than placebo controls in their studies since the placebo effect in care is not easy to measure. In this regard, it is important to define usual care, observe placebo effects on individuals by identifying potential problems, and include a placebo group in nursing studies. It is accordingly necessary to carry out studies on the contextual factors that increase the effects of placebos in nursing practices and psychiatric care, and to increase the awareness of nurses regarding placebo effects. Within this framework, this review was conducted to explain the issues regarding contextual factors of the placebo effect in psychiatric care and the ethical dimensions of placebo application from the perspective of psychiatric nursing.

CASE REPORT
13.An evaluation of the use of the NANDA NIC NOC system in psychiatric nursing
Kardelen Eray, Fahriye Oflaz
doi: 10.14744/phd.2022.01878  Pages 270 - 279
It is known that the use of classification systems in nursing care is beneficial in the context of creating and using standard language in nursing, evaluating and increasing the quality of nursing care, and creating evidence for nursing care. NANDA-I taxonomy is the most widely used in nursing. It is recommended to use NANDA-I with nursing intervention classification interventions and nursing outcomes classification indicators. Despite the many possible benefits that this system, called NNN, can provide, it is known that it is not used effectively by nurses and is believed to be complex, and therefore, its potential benefits cannot be proven. This study was carried out to explain the NNN system through the story of a case diagnosed with bipolar disorder and to set an example for the use of this system in the nursing process applied in the field of psychiatry. In addition, possible difficulties that may prevent the use of the NNN system in psychiatric nursing are discussed in the study. In this way, with the increase in the frequency of use of classification systems in practice, it will be possible to develop nursing care and to determine the effects of care on patient outcomes. The knowledge gained in this way will enable the development of evidence-based practices in nursing.

RESEARCH ARTICLE
14.Development of psychiatric nursing in Türkiye: Experience of creating a memory
Kadriye Buldukoglu, Buket Şimşek Arslan, İlkay Keser, Dudu Karakaya, Saliha Hallaç, Sultan Taş Bora, Gökhan Evecen, Mehmet Emre Gül, İsmail Ayşad Güdekli
doi: 10.14744/phd.2023.41961  Pages 280 - 286
INTRODUCTION: The primary aim of this article is to share the outcomes of the project titled “Historical Development of Psychiatric Nursing in Türkiye: A Documentary Film Project”, executed between 2018 and 2021, and the experiences encountered throughout its duration.
METHODS: The significance of understanding the historical development of a profession immensely benefits its members and the profession as a whole. Prevailing knowledge about nursing primarily revolves around events tailored for educational entities aimed at achieving professional recognition. Recognizing the necessity, this project sought to capture firsthand accounts detailing the evolution of psychiatric nursing in Türkiye. For this project, the progression of psychiatric nursing was detailed through participants' experiences. The participants were chosen using the purpose sampling method, culminating in a cohort of 25 academic psychiatric nurses. Data collection methods included face-to-face interviews and online video recordings.
RESULTS: The obtained recordings were meticulously analyzed by the research team and subsequently utilized in various mediums, including a documentary film, a booklet, an article, and presentations. These products provide viewers and readers with a direct glimpse into the foundational values, philosophies, principles, and practices introduced by the trailblazers of psychiatric nursing in Türkiye.
DISCUSSION AND CONCLUSION: It is emphasized that similar research endeavors be undertaken across different nursing domains. Such studies stand to significantly bolster the professional identity of nurses and aid in preserving their legacy.

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