Dr Jennifer Oates

In university settings, peer support brings people together based on their student identity. Peer support has been advocated as an innovative intervention to aid student mental health and wellbeing as part of a whole university approach, especially post-pandemic when student support is critical. While the literature describes three types of university peer support for student mental health and wellbeing, peer-led support groups, peer mentoring, and peer learning, the sector lacks agreed definitions for these interventions. Formal reporting on peer support initiatives is rare, suggesting further types of peer support practice may exist. This qualitative study, comprising semi-structured interviews with 16 university staff members at 14 different institutions, aimed to generate comprehensive definitions of the types of peer support used in the sector through template analysis. The study also sought to understand the current practice, experiences, and challenges around implementing peer support interventions for undergraduate and postgraduate students’ mental health and wellbeing from the perspective of the staff who support and coordinate these programmes. Five types of peer support were identified and defined. In addition, the challenges of engagement, resource and capacity, and evaluation were highlighted. Finally, lessons learnt provided potential ways to address the challenges outlined and provided sector guidance for further developing peer support as part of a whole university approach to student mental health and wellbeing.

This chapter contains sections titled: Introduction Clinical risk assessment Principles of risk assessment and management The process of risk assessment and management Conclusion References

The aim of this article is to present selected findings from a doctoral study on the subjective well-being and subjective experience of mental health problems in UK mental health nurses. Here the concept of 'nurses' well-being' is explored. Data were drawn from a survey of 237 mental health nurses about their mental health and well-being and from interviews with 27 mental health nurses with personal experience of mental health problems and high subjective well-being. While nurses' subjective well-being is relatively low, some use strategies to support their well-being in and outside the workplace. Activities outside work that improved their wellbeing were physical exercise, mindfulness practice, spending time in nature and listening to music. Well-being was associated with clear boundaries between home and work life, regular clinical supervision and translating learning from work with patients to nurses' own lives. Healthcare employers' staff health and well-being strategies should be informed by nurses' insights into what works for them. This may mean offering opportunities to take part in well-being activities. There are also opportunities to improve staff well-being through shared initiatives open to nurses and patients, and through an inclusive and empowering approach to staff engagement.

Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention.

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing.

Purpose The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service. Design/methodology/approach Thematic analysis of data from seven semi-structured interviews is performed in this paper. Findings Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment. Research limitations/implications This was a small scale study of a previously unresearched population. Practical implications These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace. Originality/value This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.

Purpose This study aims to explore how student nurses conceptualise their well-being and their views on how to improve student nurses’ well-being. Design/methodology/approach Qualitative inquiry using semi-structured interviews with 17 final year students. Tran-scripts were thematically analysed using Braun and Clark’s six-phase approach. Findings Three themes were identified as follows: “student nurses” “experience of the university”, “the meaning of student nurse well-being” and “how the faculty could improve student well-being”. The findings are interpreted with reference to notions of social capital and a sense of belonging. Practical implications University nursing programmes should embed approaches to student well-being. Higher education institutions should ensure that their social and pastoral offer is accessible and relevant to nursing students. Originality/value The study offers unique insight into student nurses’ self-concept as “university students” in the context of their well-being.

To discuss the use of Skype as a medium for undertaking semi-structured interviews. Internet-based research is becoming increasingly popular, as communication using the internet takes a bigger role in our working and personal lives. Technology such as Skype allows research encounters with people across geographical divides. The semi-structured interview is a social encounter with a set of norms and expectations for both parties ( Doody and Noonan 2012 ). Proceedings must take account of the social context of both semi-structured interviews per se, and that of internet mediated communication. The findings of the qualitative phase of a mixed-methods study are compared with other reports comparing the use of Skype with face-to-face and telephone interviews. This paper is a methodological discussion of the use of Skype as an online research methodology. Choosing Skype as a means of interviewing may affect the characteristics of participants and decisions about consent. Rapport, sensitivity and collaboration may be addressed differently in Skype interviews compared with face-to-face interviews. Skype offers researchers the opportunity to reach a geographical spread of participants more safely, cheaply and quickly than face-to-face meetings. Rapport, sensitivity and degrees of collaboration can be achieved using this medium. The use of Skype as a medium for semi-structured interview research is better understood. This paper contributes to the growing body of literature on the use of the internet as a medium for research by nurses.

Purpose Health-care student resilience is a well-researched topic, although the concept continues to evolve, not least as “resilience-building” has become an expected feature of health-care student professional education. The study aimed to understand the concept of resilience from the point of view of student nurses and midwives. Design/methodology/approach The study used a novel arts-informed method, informed by Miller’s and Turkle’s work on “evocative objects.” A total of 25 student nurses and midwives from a London-based university selected “resilience objects” which were photographed and discussed during interviews with an artist-researcher. Findings Analysis of the interviews revealed that “resilience” was founded on identity, connection, activity and protection. “Resilience objects” were used in everyday rituals and “resilience” was a characteristic that developed over time through the inhabiting of multiple identities. Practical implications Given that resilience is intertwined with notions of identity, health-care faculties should enhance students’ sense of identity, including, but not exclusively, nursing or midwifery professional identity, and invite students to develop simple rituals to cope with the challenges of health-care work. Originality/value To the best of the authors’ knowledge, this is the first study to locate health-care students’ resilience in specific material objects. Novel insights are that health-care students used everyday rituals and everyday objects to connect to their sense of purpose and manage their emotions, as means of being resilient.

Purpose This paper aims to present a thematic analysis of student nurses’ experiences of an innovative collaboration between a mental health Recovery College and a nursing faculty, where Recovery College trainers’ expertise in co-production and peer facilitation were foregrounded. The aim of this study is to understand how nursing students experienced being peer facilitators of well-being workshops for fellow students following training with Recovery College trainers. Design/methodology/approach Thematic analysis of qualitative data from eight semi-structured interviews and a focus group with 15 participants. Findings The overarching theme that emerged was “The process of being a student Peer Facilitator”. Six themes emerged from the data: “What we brought”; “Conceptualisation”; “Adaptation”; “we’re giving them the tools”; “What we gained”; and “Development”. Practical implications Mental health nurse educators could forge collaborative relationships with Recovery College colleagues with a broader remit than service users’ “lived experience” of mental distress. Student nurses should be given opportunities to be peer facilitators and draw on their lived experience as student nurses as means of addressing their and their peers’ mental health. Originality/value Original findings were that the student experience of being a peer facilitator was different to their other experiences in education and clinical practice. They drew on their lived experience throughout and found that they learned skills to address their well-being through supporting other students to improve theirs.

The aim of the present study was to measure the subjective well-being of a group of 225 UK registered mental health nurses (MHN) using three survey measures, and to identify whether certain demographic and workplace factors correlated with subjective well-being measure scores. An online survey incorporating the subjective well-being questions used by the Office for National Statistics, the Satisfaction with Life Scale, and the Warwick Edinburgh Mental Well-Being Scale was administered to members of two professional bodies for MHN. There was good consistency between the three subjective well-being measures, each demonstrating that UK MHN had a relatively low subjective well-being. Apart from the Office for National Statistics question, 'Overall, to what extent do you feel the things you do in your life are worthwhile?', demographic and workplace factors did not correlate with subjective wellbeing measure scores, although the characteristics of being male, living alone, and being aged 40-49 years were associated with lower mean scores on all three measures. The findings of the exploratory study suggest that a similar study should be undertaken with a larger representative population of MHN, and that qualitative research should explore why and how UK MHN have relatively low subjective well-being. The limitations of this study, namely the response rate and sample representativeness, mean that the results of the present study must be tested in further research on the MHN population.

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jpm.12376. The Accepted Manuscript version is under embargo until 9 April 2018. INTRODUCTION: Expertise by experience' is a highly valued element of service delivery in recovery-oriented mental health care, but is unacknowledged within the mental health nursing literature. AIM: To explore the extent and influence of mental health professionals' personal experience of mental ill health on clinical practice. METHOD: Twenty seven mental health nurses with their own personal experience of mental ill health were interviewed about how their personal experience informed their mental health nursing practice, as part of a sequential mixed methods study. RESULTS: The influence of personal experience in nursing work was threefold: first, through overt disclosure; second, through the 'use of the self as a tool'; third, through the formation of professional nursing identity. DISCUSSION: Mental health nurses' experience of mental illness was contextualised by other life experiences and by particular therapeutic relationships and clinical settings. In previous empirical studies nurses have cited personal experience of mental illness as a motivator and an aspect of their identity. In this study there was also an association between personal experience and enhanced nursing expertise. IMPLICATIONS FOR PRACTICE: If drawing on personal experience is commonplace, then we must address the taboo of disclosure and debate the extent to which personal and professional boundaries are negotiated during clinical encounters. This article is protected by copyright. All rights reserved. Peer reviewed Final Accepted Version

Responsible Clinicians are professionals who are primarily accountable for the care and treatment of patients detained under the Mental Health Act, 1983 in England and Wales. The role has only been taken up by under 100 nurses and psychologists since 2007. The aim of this study was to explore the experiences of non-medical Responsible Clinicians, to inform our understanding of interprofessional dynamics and professional identity in contemporary mental healthcare. A qualitative study comprising thematic analysis of interviews with twelve non-medical Responsible Clinicians. A major theme of ‘Interpretations of responsibility’ emerged, with two sub themes: ‘Responsibility as leadership ‘and ‘Responsibility as decision making’. Taking on the role had implications beyond the care of specific patients. Participants saw themselves as having the power to shape their team and service whilst exercising their authority to make difficult decisions about risk and restrictions. More widespread adoption of the non-medical Responsible Clinician role should not be seen solely as a solution to workforce shortages or lack of opportunities for professional advancement. Consultant nurses and psychologists who take on this role are seising the opportunity to steer service developments more widely, influencing team dynamics and perceptions of accountability.

Analysis of co-production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co-production as a concept is open to multiple interpretations. Core components of co-produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co-production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co-trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co-trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues' mental health needs should be established and refined during co-produced working. Negotiating personal disclosure and professional role identity must be explored further in both co-production research and practice. Introduction Co-production between service users and clinicians is a desirable element of recovery-oriented practice in mental health, but the effect of co-production on clinicians has not been explored thoroughly. Aim To explore the meaning of co-production for clinicians based on their experience of co-production in a Recovery College. Method Thematic analysis of eight semi-structured interviews with clinicians who have co-produced and co-delivered workshops with a Recovery College Peer Trainer. Results The "meaning of co-production" had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians' experience of co-production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co-produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice Engaging in co-produced educational workshops can alter clinicians' perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges.

This is a pre-copyedited, author-produced version of an article accepted for publication in Occupational Medicine following peer review. Under embargo until 16 June 2019. The version of recordJ. Oates, J. Jones, and N. Drey, ‘Mental health nurses’ encounters with occupational health services’, Occupational Medicine, kqy084, (2018), is available online at: https://doi.org/10.1093/occmed/kqy084. Background: Staff wellbeing is vital to the functioning of the UK National Health Service (NHS). Mental health nurses with personal experience of mental illness can offer a professionally and personally informed insight into the occupational health service offered by their employer. Aims: To investigate mental health nurses’ views of occupational health provision in the NHS, based on their personal experience. Methods: A qualitative interview study using a purposive sample of mental health nurses with personal experience of mental illness. Results: Twenty-seven mental health nurses met the inclusion criteria. Thematic analysis identified three themes: comparisons of ‘relative expertise’ between the mental health nurse and the occupational health clinician; concerns about ‘being treated’ by a service at their work; and ‘returning to work’. Conclusion: Occupational health provision in mental health settings must take account of the expertise of its staff. Further research, looking at NHS occupational health provision from the provider perspective is warranted. Peer reviewed

The effects of mental health nurses' own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses' lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six-phase approach. The analysis revealed the broad context of nurses' experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses' lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses' mental illness could be much broader than the effect of workplace stress.

•Student midwives’ experience of pre-registration training may be described as ‘a rollercoaster’ of emotional fluctuation and relentless change.•Students were aware of the importance of emotion management and self care as part of professional socialisation but were not confident regarding how to develop such skills.•Student midwives value opportunities for individual support from midwifery educators and regular opportunities to connect with their peers. Midwifery student mental wellbeing is an important consideration for the sustainability of the profession, however it has seldom been the subject of empirical research. Previous studies of the lived experience of midwifery students have focused on the impact of transition experiences and student satisfaction, rather than specifically on mental health and students’ views on support for their mental wellbeing. A qualitative descriptive study using semi-structured interviews. A midwifery undergraduate programme in one university in the South of England. 20 BSc midwifery students. Two inductive themes were developed from our analysis. The theme of ‘the rollercoaster’ encapsulated students’ experience over the length of the course, characterised by multiple culture shocks of being in different worlds, from one clinical placement to the next, from university to clinical placement. This experience was emotionally taxing. The theme of ‘being noticed, feeling connected’ encapsulated midwifery students’ views on what could help them enjoy their training. They wanted to be seen as individuals by at least one educator, they wanted opportunities to connect with their peers and they wanted the support available to them to be consistent. Listening to students’ insights into the lived experience of being a midwifery student can enable midwifery educators to improve the way courses are designed and support structures are put in place. The importance of having consistent contact with peers and educators cannot be underestimated. The emotional demands of midwifery training must be acknowledged. Educators should identify ways in which they can provide students with consistent individualised support and regular opportunities to meet with their peers.

Accessible summary What is known on the subject? There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals. Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high-risk patients in a locked environment. What this paper adds to existing knowledge? There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting. As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded. They also identified that some strategies that were employed to address workforce shortages, such as day-to-day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. What are the implications for practice? Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff. There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations. Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. Introduction There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships.

The 2007 amendments to the Mental Health Act, 1983 in England and Wales enabled non-medics to take on the role of legally 'responsible clinician' for the overall care and treatment of service users detained under the Act, where previously this was the sole domain of the psychiatrist as Responsible Medical Officer. Following state sanction as an 'Approved Clinician', certain psychologists, nurses, social workers or occupational therapists may be allocated as a Responsible Clinician for specific service users. Between 2007 and 2017 only 56 non medics had become Approved Clinicians. This study reports on a first national survey of 39 non-medical Approved Clinicians. Descriptive statistics and thematic analysis of free text answers are presented here. The survey results show the limited uptake of the role, save for in the North Eastern region of England. Nonmedical Approved Clinicians were motivated by a combination of altruistic intents (namely a belief that they could offer more psychologically-informed, recovery-oriented care) and desire for professional development in a role fitting their expertise and experience. Barriers and facilitators to wider uptake of the role appear to be: organisational support, attitudes of psychiatrist colleagues and a potentially lengthy and laborious approvals application process. The survey is a starting point to further research on the interpretation and implementation of the range of statutory roles and responsibilities under English and Welsh mental health law. (C) 2018 Elsevier Ltd. All rights reserved.

Within mental health legislation in England and Wales the Responsible Clinician for specific patients should be the Approved Clinician with the most appropriate expertise to meet their primary assessment and treatment needs. The study aimed to explore nurse and psychologist perspectives on becoming a Responsible Clinician in the context of their limited uptake of the role and calls for an increase in advanced practice roles within mental health. It comprised a qualitative inquiry in the form of a thematic analysis of 12 semi-structured interviews. Four sub-themes emerged under the theme of 'becoming a Responsible Clinician'. They were: (i) the Responsible Clinician amongst other roles; (ii) developing in the role; (iii) working with psychiatrist colleagues; and (iv) organisational context. Responsible Clinicians were juggling the role with other senior clinical responsibilities, often without a coherent programme of ongoing educational development or organisational support structures. If mental health service provider organisations adopt this extended role more widely then role-specific support and supervision arrangements should be in place as part of a coherent workforce strategy. This is particularly important given the legal and ethical responsibilities of the Responsible Clinician.

Objectives: This study explored healthcare professionals' accounts of being practitioner trainers in a mental health Recovery College, where they worked with peer trainers, who were people with lived experience of mental illness, to co-produce workshops for mental health service users and staff. The aim of this study was to understand the process of co-production in the Recovery College from the perspective of practitioner trainers. Design: Single-site case study. Setting: A Recovery College in the South of England, open to staff and service users from one mental health care provider organisation. Methods: Semi-structured interviews with eight mental healthcare professionals. Transcripts were thematically analysed. Results: A central image of 'the workshop as crucible' emerged from the three themes derived from the analysis. Co-facilitating the workshop was a 'structured' encounter, within which health professionals experienced 'dynamism' and change. For them, this involved experiences of 'challenge and discomfort'. Conclusion: Findings from this study contribute to the evidence base for the evaluation of Recovery Colleges by focusing on the training impact on staff. Findings suggest that taking on a trainer role in Recovery College co-production is beneficial for healthcare professionals as well as mental health service users, especially if healthcare professionals are open to the dynamism and possible discomfort of these workshop encounters. Future research, however, should expand beyond single-site case studies to test the extent to which this metaphor and themes are appropriate to describing the 'transformative' element of co-production.

Objective: To summarize and evaluate evidence for the effect of yoga on menstrual disorders. Methods: PubMed, CINAHL/MEDLINE, Web of Science, AMED, and Scopus were searched for English-language literature relevant to the review question. All primary research studies were included. Results: Fifteen studies described in 18 papers were included in the review. A range of yoga interventions were used. Some studies used a combination of Asana, Pranayama, and other yogic relaxation or meditation techniques. All included studies reported some change in their outcome measures, suggesting reduced symptoms of menstrual distress following a yoga intervention; however, the heterogeneity and intensity of the interventions and outcome measures meant that findings have limited generalizability and applicability in practice settings. Conclusions: Further research on the relationship between yoga practice and menstrual disorders is warranted, but there must be both consistency in the methods, measures, and quality of studies and a shift toward research on yoga practices that are replicable outside of the clinical trial setting.

•There is growing concern about the mental wellbeing of both midwives and university students.•This integrative review presents a summary of the evidence on the state of midwifery students’ mental health and wellbeing.•There is insufficient evidence to define the ‘state of’ midwifery student mental health, when compared to other students or healthcare professionals.•Qualitative studies on the midwifery student experience report that experiences in both the academic and clinical setting impinge on student wellbeing, including lack of support from mentors and bullying by qualified staff.•Future research should focus on interventions, longitudinal and cross-site comparisons.

Aims To identify the experiences of nursing in high secure forensic mental health settings that may affect staff recruitment and retention. Background Recruitment and retention of Registered Nurses is a vital international concern in the field of mental health. The high secure forensic setting presents unique challenges for the nurse. Studies of nurse's experiences in this setting have not previously been reviewed in the context of workforce sustainability pressures. Design An integrative review (Whittemore and Knapfl, 2005). Data sources A systematic search of data sources: MEDLINE (PubMed), PsycINFO, EMBASE, CINAHL, International Bibliography of the Social Sciences, Applied Social Sciences Index and s (ASSIA), Social Services s, ProQuest Social Sciences Premium collection (IBSS, PAIS, and Sociological s), and Web of Science from inception to December 2019. Review methods Data extraction, quality appraisal, and convergent qualitative synthesis. Results Fifteen papers were selected for inclusion in the review, describing 13 studies. Six studies were quantitative, all cross-sectional surveys. There were seven qualitative studies, using a variety of methodologies. Four themes were identified: engagement with the patient group, the ward social environment, impact on the nurse, and implications for practice. Conclusion When policymakers address workforce shortages in high secure forensic nursing they must take account of the unique features of the setting and patient group. Nurses must be adequately prepared and supported to function in an ethically and emotionally challenging environment. Impact This study identified factors affecting workforce pressures in the speciality of forensic mental health nursing. Findings are of interest to national nursing policymakers and workforce leads in mental health service provider organizations, seeking to promote forensic nursing as a career option and retain nursing staff.

Nurses' mental health is of paramount importance, both in terms of patient safety and the sustainability of the workforce. Age, years in the profession, in post and personal experience or exposure to mental health problems are relevant to the mental health nursing workforce crisis in the United Kingdom. This study aimed to determine the relationship between age, years in the profession and post and self-reported experience of mental health problems using an online cross-sectional survey of 225 UK mental health nurses. Number of years in post was inversely correlated with overall experience of mental health problems, particularly living with someone else with mental health problems. Those with experience of living with someone with mental health problems had significantly fewer years of professional experience than those without. This article discusses possible explanations for this phenomenon and makes the case for future research on the topic.