Conectar
To examine competencies, attitudes, barriers and factors that influence the provision of mental health services by nurses in schools and higher education institutions in the post COVID-19 era in Taiwan.
This cross-sectional study used nationwide proportionate stratified random sampling to recruit nurses from K–12 schools and higher education institutions.
Data were collected through an online survey administered between July and December 2024, with 305 responses received (response rate = 46.4%).
Among the respondents, 55.1% provided advanced mental health services, while 38.3% delivered basic mental health services. The main barriers to the delivery of mental health services were lack of mental health-screening training (63.3%), insufficient brief screening tools (46.2%) and time constraints (42.6%). Nurses in junior and senior high schools were 5.78 and 3.07 times more likely, respectively, to provide advanced mental health services compared to those in universities. Furthermore, significant predictors of the provision of advanced mental health services included working in junior or senior high school, higher competence, and more positive attitudes; perceiving time constraints was a significant barrier.
Working in junior and senior high school settings was the most significant predictor of delivering advanced mental health services. These results underscore the need for targeted professional training, enhanced resources, and inter-professional collaboration to improve the quality of school-based mental health services.
Enhancing the attitudes and competencies of nurses in schools and higher education institutions towards mental health care is essential. Training should target nurses working in junior and senior high schools. Administrators must improve workflows, provide better tools and address barriers such as time constraints and limited referrals to support students' mental well-being.
This study adhered to the relevant cross-sectional EQUATOR STROBE guidelines.
No Patient or Public Contribution.
This study examined the barriers to mental health service delivery among nurses in schools and higher education institutions and identified key determinants influencing their provision of such services. Nurses in schools and higher education institutions face challenges in providing mental health services due to a lack of mental health training, insufficient brief screening tools and time constraints. Advanced services were more common in junior and senior high schools, with competence and attitude being key predictors of their delivery.
This study uses a convergent mixed methods approach to investigate the frailty phenotypes and risk factors in peritoneal dialysis (PD) patients.
A cross-sectional mixed methods research study was employed.
This study follows the MMR-RHS reporting guidelines. From November 2023 to August 2024, 213 patients were recruited from the PD centre of a tertiary hospital in Chongqing, China. Quantitative data were collected using a general information questionnaire and standardised scales, including Fried Frailty Phenotype (FFP), Charlson Comorbidity Index (CCI), Mini Nutritional Assessment-Short Form (MNA-SF), Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS). Concurrently, 19 PD patients in pre-frail or frail states participated in semi-structured interviews. The quantitative and qualitative findings were then integrated for analysis.
Amongst the 213 PD patients, 46.5% were non-frail, 41.3% were pre-frail and 12.2% were frail. Integrated analysis indicated that fatigue and low muscle strength were the primary frailty phenotypes amongst the patients. Age, sedentary behaviour, comorbidities, nutritional status, cognitive function, polypharmacy, psychological state and social connections were identified as risk factors for frailty in this patient population.
Many factors influence the frailty of PD patients. Future research should further explore the complex interactions amongst these factors and effective modulation strategies to mitigate the frailty progression. Incorporating the patients' perspectives in designing comprehensive intervention programmes will help identify key challenges and focal points for intervention.
This study identifies risk factors for frailty in PD patients, offering healthcare professionals a basis for designing targeted interventions. These factors encompass multiple dimensions, indicating the need for multidisciplinary collaboration in managing frailty.
The PD patients in this study provided valuable quantitative data and shared their frailty experiences, enhancing the research conclusions' practical value.
Family engagement in care has been advocated to promote recovery for patients with mental health conditions. Attitudes of mental health nurses toward the importance of families influence the way they partner with families in mental healthcare. However, little is known about how mental health nurses engage with families and quality of family-centered care (FCC) perceived by patients and caregivers. The study aimed to examine the mediating effect of family nursing practice on the association between mental health nurses' attitudes toward integrating families into care and quality of FCC perceived by patients with schizophrenia and caregivers.
A cross-sectional study was conducted.
A convenience sample of 143 dyads of patients with schizophrenia and their caregivers and 109 mental health nurses were recruited from inpatient wards at two psychiatric hospitals in Taiwan. Demographic and clinical questionnaires, Families' Importance in Nursing Care-Nurses' Attitudes scale, Family Nursing Practice Scale, and Measure of Process of Care for Adults were used to collect data. Data were analyzed using descriptive statistics, independent-sample t-tests, one-way analysis of variance, Pearson correlation coefficients, paired-sample t-tests, and intraclass correlation coefficient (ICC). Mediation analyses were performed using Hayes' PROCESS macro in SPSS (Model 4) with bootstrapping.
Mental health nurses exhibited supportive attitudes toward integrating families into care (Mean = 98.96) and greater perceptions of family nursing practice (Mean = 2.44). The concordances between patients and caregivers on perceived quality of family-centered care were significant (ICC = 0.63–0.77). Attitudes of mental health nurses toward integrating families into care had both the total and direct effects on all domains of quality of FCC perceived by patients and caregivers, respectively. The indirect effects of mental health nurses' attitudes toward integrating families into care on aspects of quality of FCC through family nursing practice were significant for patients (95% bias-corrected bootstrap CI of 0.015–0.053) and caregivers (95% bias-corrected bootstrap CI of 0.004–0.041). The magnitude of the indirect effects was medium to large for patients (ES = 0.209–0.257) and caregivers (ES = 0.148–0.221).
Family nursing practice partially mediated the association between mental health nurses' attitudes toward integrating families into care and aspects of quality of FCC from perspectives of patients and caregivers.
Interventions tailoring mental health nurses' practice skills and reciprocity with families have the potential to enhance supportive attitudes of mental health nurses toward working with families and further improve perceived quality of FCC in patient-caregiver dyads in mental healthcare practice.
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