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Evidence for Psychiatric and Mental Health

Nursing Interventions: An Update (2011
through 2015)
Abir K. Bekhet
College of Nursing, Marquette University, Milwaukee, WI
Jaclene A. Zauszniewski
School of Nursing, Case Western Reserve University (CWRU), Cleveland, OH.
Denise M. Matel-Anderson
College of Nursing, Marquette University, Milwaukee, WI
Jane Suresky
School of Nursing, Case Western Reserve University (CWRU), Cleveland, OH
Mallory Stonehouse
College of Nursing, Marquette University, Milwaukee, WI
Abstract
This state-of-the-evidence review summarizes characteristics of intervention studies published from
January 2011 through December 2015, in five psychiatric nursing journals. Of the 115 intervention
studies, 23 tested interventions for mental health staff, while 92 focused on interventions to promote
the well-being of clients. Analysis of published intervention studies revealed 92 intervention studies
from 2011 through 2015, compared with 71 from 2006 through 2010, and 77 from 2000 through 2005.
This systematic review identified a somewhat lower number of studies from outside the United States;
a slightly greater focus on studies of mental health professionals compared with clients; and a
continued trend for testing interventions capturing more than one dimension. Though substantial
progress has been made through these years, room to grow remains. In this article, the authors discuss
the background and significance of tracking the progress of intervention research disseminated within
the specialty journals, present the study methods used, share their findings, describe the intervention
domains and nature of the studies, discuss their findings, consider the implications of these studies,
and conclude that continued track of psychiatric and mental health nursing intervention research is
essential.

Key Words
best practices, evidence-based practice, psychiatric nursing journals, psychiatric nursing research,
published research, research dissemination, research utilization, systematic review, tradition,
intervention research

Implementation science is concerned with the translation of research into practice...

The past five years have seen a rapidly growing interest in the field of implementation science
(Sorensen & Kosten, 2011). Implementation science is concerned with the translation of research into
practice; it involves the examination of the challenges and the opportunities for successful, evidence-
based changes in practice (Nilsen, 2015). Translating research into practice depends heavily on the
dissemination of findings from intervention research to those most likely to use those findings in
clinical or community settings. In contrast to implementation, dissemination involves the spread of
information about an intervention, for example, through publication of the intervention in professional
journals. Dissemination strategies that are actively targeted toward spreading evidence-based findings
concerning an intervention may prompt future implementation in clinical practice (Proctor et al.,
2009).

Translating research into practice depends heavily on the dissemination of findings

from intervention research...

Important for psychiatric and mental health nurses, it is critical that implementation of evidence-based
findings occurs across multiple settings (i.e., beyond specialty mental healthcare units) to medical
settings, such as primary care areas in which mental health services are provided, and to non-
specialized settings, such as criminal justice and school systems and community social service agencies,
where mental healthcare is delivered (Proctor et al., 2009). However, before implementation can
happen, dissemination of findings from well-designed intervention studies that can inform psychiatric
and mental health nursing practice is needed.

One of the best mediums for disseminating evidence-based findings in psychiatric and mental health
nursing is the professional nursing journals that are most available to practicing psychiatric and mental
health nurses. Nursing journals that are specifically designed a specialty are more likely to be read by
persons in the given specialty area than are other nursing research journals. Nurses in practice settings,
including those at an advanced practice level, may not have access to scientific research journals or
may choose not to read them if the research does not appear meaningful for their practice. The goal of
this review was to describe the findings from intervention studies disseminated through publication in
one of the five psychiatric and mental health nursing specialty journals published from 2011 through
2015.

Background and Significance

Through the years, more psychiatric and mental health nurse researchers have been targeting specialty
journals for disseminating findings from intervention research. For example, in previous reviews of
intervention studies published in the five major psychiatric and mental health specialty journals, there
was a higher percentage of quantitative intervention studies conducted from 2006 through 2010 (84%)
than in a similar review conducted from 2000-2005 (64%) (Zauszniewski, Suresky, Bekhet, & Kidd,
2007; Zauszniewski, Bekhet, & Haberlein, 2012), indicating increased use of more rigorous, statistical
analytic methods in published intervention research over time (Zauszniewski et al., 2007; Zauszniewski
et al., 2012).

Tracking the progress of intervention research disseminated within the specialty journals in psychiatric
and mental health nursing is important for two reasons. First, it provides data to show improvements
in dissemination efforts of psychiatric and mental health nurse researchers. Second, it calls attention to
the importance for continued dissemination of intervention research to practicing psychiatric and
mental health nurses who are in the best positions to implement the findings in practice. Therefore,
the purpose of this review of the same, five, peer-reviewed psychiatric and mental health nursing
journals, covering 2011 through 2015, was to determine the number and types of intervention studies
within the specified review period. For consistency, the same criteria for selecting the intervention
studies that were described in the previous review (Zauszniewski et al., 2012) were applied: A study
was determined to be an intervention study if nursing strategies, procedures, or practices were
examined for effectiveness in enhancing or promoting health or preventing disability or dysfunction
(Kane, 2015).
Methods
Five peer-reviewed nursing journals, regarded as the most frequently read in the mental health nursing
profession, were analyzed for the years 2011 through 2015. The journals included in the analysis
were Archives of Psychiatric Nursing; Issues in Mental Health Nursing; Journal of the American
Psychiatric Nurses Association; Journal of Psychosocial and Mental Health Services; and Perspectives in
Psychiatric Care.

Journals were reviewed for the type of intervention study (qualitative or quantitative); the study
domain (biological, psychological, or social); and the number of intervention studies found within the
journals. After review, the agreed upon intervention studies were extracted and individually analyzed
by the co-authors.

There were 832 databased articles published from January 2011 through December 2015. However,
only 115 (14%) evaluated or tested psychiatric nursing interventions. Of these 115 intervention studies,
14 tested interventions with nursing students, nine involved nurses and mental health professionals,
while 92 focused on interventions to promote mental health in clients of care.

Findings
This section describes the findings from the 115 intervention studies included in the review. The 23
studies that included nursing students, nurses, and mental health professional, and the 92 that
involved recipients of mental health services or care are presented in this section. First, the research
settings in which the 115 studies were conducted, and descriptions of the targeted populations are
described. Next, the 23 studies’ designs, purposes, and findings are discussed in detail. Third, the 92
studies that involved recipients of mental health services or care are presented using the categories of
the bio-psycho-social framework. Finally, the type of data (quantitative, qualitative, or mixed) are
discussed and presented in the table.

Research Settings
Sixty-six of the 115 intervention studies were completed in the United States. Five studies each were
done in Australia and United Kingdom. Four each were completed in Korea, China, and Turkey; three
each in Norway, Canada, and Iran; and two each in Taiwan, Mexico, Sweden, France, and Netherlands.
One study each was conducted in Jordan, Europe, Iceland, Pacific Islands, Thailand, Spain, Greece, and
Singapore

Targeted Populations
Fourteen of the 115 intervention studies involved interventions with nursing students, while nine
studies focused on nurses and mental health professionals. Ninety-two of the studies examined the
effect of the intervention on the client. Examples of the studies describing each of these groups are
described below.
 Fourteen of the 23 nursing intervention studies involved
undergraduate nursing students.
Nursing students.

Fourteen of the 23 nursing intervention studies involved undergraduate nursing students. One study
was conducted in Australia regarding consumer participation (Happell, Moxham, & Plantain-Phung,
2011). In this study, researchers investigated whether education programs introducing nursing
students to mental health nursing lead to more favorable attitudes towards consumer participation in
the mental health setting after completing the mental health component of the nursing program.
Study participants were in the first semester of the final year of the Bachelor of Nursing program. The
study used a within-subject design using two points (pre-and post-educational program
implementation). Results indicated that students demonstrated positive attitudes toward consumer
participation even before completing the mental health component. Only marginal and non-significant
changes were noted at the post-test stage. The authors concluded that the findings were not surprising
given the positive scores recorded at baseline (ceiling effect) (Happell et al., 2011). Another study
investigated the effect of pedagogy of curriculum infusion on nursing students’ well-being and the
improvement of quality of patients’ care (Riley & Yearwood, 2012).

Pedagogy of curriculum infusion involves instilling the university values and mission with a focus on
educating the whole person, and encouraging faculty to translate the core mission of the university
into practice in the classroom. this can be accomplished through a variety of courses that provide
students with opportunities for contemplation, reflective engagement, and also action through
volunteerism, service, and study abroad. The ultimate goal of the study was to encourage critical
thinking through reflective exercises and group discussion. Results indicated that students who have
experienced the curriculum infusion showed an ability to be self-advocates when discussing their work
challenges. Also, they were able to identify specific nursing actions for patient safety; to recognize the
patient as a partner in care; and to demonstrate respect for patients' uniqueness, values, and desires
as evidenced by case analysis and personal reflections (Riley & Yearwood, 2012).

Three intervention studies explored simulation to see its impact on improving the
learning experiences of the nursing students.

Three intervention studies explored simulation to see its impact on improving the learning experiences
of the nursing students (Kameg, Englert, Howard, & Perozzi, 2013; Kidd, Knisley & Morgan,
2012; Masters, Kane, & Pike, 2014). Different simulations were used in the three studies; all of them
were deemed effective. For example, the results of the study conducted by Kidd and colleagues
indicated that undergraduate, mental health nursing students perceived that Second Life® virtual
simulation was moderately effective as an educational strategy and slightly difficult as a technical
program (Kidd et al., 2012). Also, second degree and traditional BSN students found that a tabletop
simulation, which was developed as a patient safety activity and involved checking-in a patient
admitted to a psychiatric care unit, was a good learning experience and helpful to prepare students for
situations they may experience in the workplace (Masters et al., 2014). The third study used a high-
fidelity, patient simulation (HFPS) to assess senior level nursing student knowledge and retention of
knowledge utilizing three parallel, 30-item Elsevier Health Education Systems, Inc. (HESITM) Custom
Exams. Although students’ knowledge did not improve following the HFPS experiences, the findings
provided evidence that HFPS may improve knowledge in students who are at risk (defined as those
earning less than 850 on HESI exam). Students reported that they viewed this simulation as a positive
learning experience (Kameg et al., 2013).

An additional intervention study used a quasi-experimental design to explore perceptions of student

nurses toward nurses who are chemically dependent, using a two-group, pretest–posttest design (prior
to formal education and after receiving substance abuse education). Results indicated that the student
nurses in this study had positive perceptions about nurses who are chemically dependent before the
intervention; and the education program appeared to reinforce their existing attitudes. (Boulton &
Nosek, 2014).

Mitchell et al. (2013) investigated the impact of an addiction training program for nurses consisting of
Screening, Brief Intervention, and Referral to Treatment (SBIRT), and embedded within an
undergraduate nursing curriculum, on students’ abilities to apply an evidence-based screening and
brief intervention approach for risky alcohol and drug use in their nursing practice. Results indicated
that the SBIRT program was effective in changing the undergraduate nursing students’ self-perceptions
of their knowledge, skills, and effectiveness in screening and intervening for hazardous alcohol and
drug use. Furthermore, this positive perception was maintained at 30-day follow-up (Mitchell et al.,
2013).

Luebbert and Popkess (2015) investigated the impact of an innovative, active-learning strategy using
simulated, standardized patients on suicide assessment skills in a sample of 34 junior and senior
baccalaureate nursing students. Additionally, Schwindt, McNelis, and Sharp (2014) evaluated a theory-
based educational program to motivate nursing students to intervene with persons having serious
mental illness. Other intervention studies among nursing students focused on improving students'
interpersonal relationships; communication competence; empathetic skills; and confidence in
performing mental health nursing skills among nursing students (Choi, Song, & Oh, 2015; Choi & Won,
2013; Fiedler, Breitenstein, & Delaney 2012; Ozcan, Bilgin, & Eracar, 2011; Stiberg, Holand, Ostad, &
Lorem, 2012).

Nursing staff and mental health professionals.

Interventions among the nursing staff and mental health professionals accounted for nine of the
nursing intervention studies. The majority of these studies were nursing interventions to educate the
nursing staff. Educational interventions included: training videos (Irvine et al., 2012); a continuing
education course on suicide awareness (Tsai, Lin, Chang, Yu,& Chou, 2011); an education program
using simulation (Usher et al., 2014; Wynn, 2011); an educational workshop (White, Hemingway, &
Stephenson, 2014); training on family-centered care (Wong, 2014); and the impact of the completion
of a 26-week trial on nursing staff’s experience for working as a cardio-metabolic health nurse (Happell
et al., 2014).

Terry and Cutter (2013) used a mixed methods pilot study to evaluate the effect of education on
confidence in assessing and addressing physical health needs following attendance at a module titled
“Physical Health Issues in Adult Mental Health Practice.” The majority of the participants had studied at
the university during the previous five years, at either the diploma or the degree level. Results showed
improvement in confidence scores for all study participants following the module; participants were
able to identify new knowledge and perspectives for practice change.

Results indicated that care zoning increased the nursing team’s capacity to share information and to
communicate patients’ clinical needs...

Finally, the study conducted by Taylor and colleagues (2011) used a pragmatic approach to increase
understanding of the clinical-risks needs in acute in-patient unit settings. Each patient was classified
according to three zoning levels using a traffic light system: red (high level of risk), amber
(medium/moderate level of risk), and green (low level of risk). The level of risk was based on multiple
factors including clinical judgment and team discussion (Taylor et al., 2011). Results indicated that care
zoning increased the nursing team’s capacity to share information and to communicate patients’
clinical needs, as well as to enhance their abilities to address complex clinical presentation and to seek
support when needed.

Intervention Domains
Ninety-two of the studies examined the effect of an intervention for the client. In the following section,
we will describe the intervention domains of these 92 articles and provided examples. Additional detail
is included in the Table.

Interventions in the Biological Domain

Eight interventions were in the biological domain. Study interventions included yoga, dancing, diet,
medication, electroconvulsive therapy (ECT), exercise, walking, and educational intervention on
metabolic syndrome. Four interventions used various kinds of exercises, including walking (Beebe,
Smith, Davis, Roman, & Burke, 2012); dancing (Emory, Silva, Christopher, Edwards, & Wahl, 2011); yoga
(Kinser, Bourguigion, Whaley, Hauenstein, & Taylor, 2013); and group exercise program (Stanton,
Donohue, Garnon, & Happell, 2015). Diet was also used as an intervention. For example, Lindseth,
Helland, and Caspers (2015) used dietary intake of a high or low tryptophan diet as an intervention.
Results indicated improvement in patients’ mood, depression, and anxiety for those consuming a high
tryptophan diet as compared to those who consumed a low tryptophan diet (Lindseth et al. 2015).

A third category within the biological domain was the use of medications as an intervention. One study
tested the use of different psychotropic medications for patients diagnosed with schizophrenia (Zhou
et al., 2014). A second used ECT as a treatment modality and measured scores on the Montgomery
Asberg (MA) Depression Rating Scale before and after the course of treatment (Pulia, Vaidya, Jayaram,
Hayat, & Reti, 2013). A final category was an educational program on metabolic syndrome provided to
mental health counselors who performed intake assessments on patients newly admitted to two
outpatient mental health facilities. (Arms, Bostic, & Cunningham, 2014). Prior to the intervention,
neither facility screened for metabolic syndrome at intake or referred patients with a body mass index
(BMI) >25 for medical evaluation. Following the intervention, 53 of 132 patients had a documented
BMI >25, and 47 of 53 patients were referred to a primary care provider for evaluation. These findings
suggested that screening for metabolic syndrome and associated illnesses will increase the rate of
detection of chronic conditions (Arms et al., 2014).

Interventions in the Psychological Domain

...the psychological domain had the largest number of intervention studies.

Compared to the other domains, the psychological domain had the largest number of intervention
studies. Twenty-four of the 92 total intervention studies extracted were in the psychological domain.
The intervention studies in the psychological domain included emotion, behavior, and cognition (e.g.,
counseling) in addition to studies that focused on behavior therapy and psychoeducational programs.
Examples of psychological domains studies included: counseling regarding tobacco cessation treatment
(Battaglia, Benson, Cook, & Prochazka, 2013); counseling regarding sexual assault (Lawson, Munoz-
Rojas, Gutman, & Siman, 2012); resourcefulness training intervention for relocated older adults
(Bekhet, Zauszniewski, & Matel-Anderson, 2012); and resilience training and cognitive therapy in
women with symptoms of depression aged 18-22 years of age (Zamirinejad, Hojjat, Golzari, Borjali, &
Akaberi, 2014) Please see the Table for further details.

One study utilizing an intervention from the psychological domain examined a brief, six- session,
cognitive-behavioral intervention among patients with alcohol dependence and depression. The
researchers used a quasi-experimental design with a control group and pretest, posttest, and follow-up
assessments. Results indicated that the mean depression scores decreased significantly in both the
experimental (n = 33) and control groups (n = 27) at the one-month follow-up (Week 7). However, only
the experimental group showed significant differences in their mean depression scores between pre-
and posttest. At Week 7, the experimental group showed significantly lower mean depression scores
than the control group (Thapinta, Skulphan, & Kittrattanapaiboon, 2014).

Interventions in the Social Domain

The social domain considers the patients’ environment and its impact on patients’
adjustment and responses to stress.

Nine studies involved use of the social domain in their interventions. The social domain considers the
patients’ environment and its impact on patients’ adjustment and responses to stress. Interventions in
this domain included family, friends, and social support, as well as community interactions
(Zauszniewski et al., 2012). One example of an intervention in the social domain involved studying the
long-term impact of safe shelter and justice services on abused women’s ability to function after
receiving services (Koci, 2014). Another example of an intervention study in the social domain was a
pilot, randomized, controlled trial study by Simpson, Quigley, Henry, and Hall (2014). In this study, the
researchers evaluated the selection, training, and support of a group of peer workers recruited to
provide support to service users discharged from acute psychiatric unites in London, comparing peer
support with usual care (Simpson et al., 2014) (see Table). A third example in the social domain was
designed to help participants successfully transfer from hospitals to the community by enhancing staff
participation, creating/maintaining supportive ward milieus, and supporting managers throughout the
implementation process (Forchuk et al., 2012).

The study conducted by Horgan, McCarthy, and Sweeny (2013) was another example of research in the
social domain. This study included designing a website for people ages 18-24 who were experiencing
depressive symptoms. The website provided a forum to allow participants to offer peer support to
each other; it also provided information on depression and links to other supports (Horgan et al.,
2013).

Combinations of the Domains

Many studies used more than one domain as interventions.

Many studies used more than one domain as interventions (see Figure). Almost half (49%) of the 92
reviewed studies (n = 45) tested an intervention that included two domains. Thirty studies were
psychosocial, twelve were biopsychological, and three were biosocial. In addition, six studies (7%)
tested intervention with all three domains (biopsychosocial). In the following section, one study from
each combination will be described. Again, additional information is provided in the Table.
Figure. Psychiatric Nursing Interventions: Examples of Domains and Their Total Numbers

l
Counseling, resourcefuln ess
training, resilience training,
and cognitive therapy.
24studies

Psychosocial
30 studies

Bio psychosocial
Biologic 6 stud ies Social
Yoga, dancing, diet, Safe shelter and justice
medicat ion, ECT, services, peer support,
exercise, walking, and Biosoclal and
educational intervent ion 3 studies creat ing/maintaining
on met abolic syndrome. .__ _,,....., supportive wa rd milieus.
Sstudles 9studies

Iskhandar Shah and colleagues (2015) studied and tested an intervention from the biopsychological
domain using a single-group, pretest–posttest, quasi-experimental research design. Their intervention
program included three daily, one-hour sessions incorporating psychoeducation and virtual-reality-
based relaxation practice in a convenience sample of twenty-two people with mental disorders. Results
indicated that those who completed the program had significantly lowered subjective stress,
depression, and anxiety, along with increased skin temperature, perceived relaxation, and knowledge
(Iskhandar Shah et al., 2015).

Pedersen, Nordaunet, Martinsen, Berget, and Braastad (2011) studied an intervention from the
biosocial domain. Their intervention program tested the impact of a 12-week, farm-animal-assisted
intervention consisting of work and contact with dairy cattle, on levels of anxiety and depression in a
sample of fourteen adults diagnosed with clinical depression. The twice-a-week program involved
video recording each participant twice during the intervention. Participants were given the choice of
either choosing their work tasks with animals (e.g., milking, feeding, hand feeding, moving animals) or
the choice of spending their time in contact with farm animals (e.g., patting, stroking, and other non-
work-related physical contact). Results indicated that levels of anxiety and depression decreased, and
self-efficacy increased during the intervention. Interaction with farm animals (social) via work tasks
showed a greater potential for improved mental health than merely animal contact, but only when
progress in working skills (biological aspect) was achieved, indicating the role of coping experiences for
a successful intervention. (Pedersen et al., 2011).

The NP often accompanied the participant to medical and mental health appointments...

Chandler, Roberts, and Chiodo (2015) conducted a study in the psychosocial domain that examined the
feasibility and potential efficacy of implementing a four-week, empower-resilience intervention (ERI) to
build resilience capacity with young adults who have identified adverse childhood experiences. The
intervention included using mindfulness-based stress reduction (psychological domain) and social
support with guided peer and facilitator interaction (social domain). The study randomly assigned a
purposive sample of female undergraduate students between the ages of 18 and 24 years of age into
two groups: intervention (n = 17) and control (n = 11), and used a pretest–posttest design to compare
symptoms, health behaviors, and resilience before and after the intervention program. Results
indicated that subjects in the intervention group reported greater building of strengths, reframing
resilience, and creating support connections as compared with the control group (Chandler et al.,
2015).

Interventions in the biopsychosocial domain include all three components (biological, psychological,
and social). There were six studies that included all three domains in their interventions. Hanrahan,
Solomon, and Hurford (2014) used a randomized controlled design to deliver a transitional care model
(TCM) intervention to patients with serious mental illness who were transferring from hospital care to
home. The intervention group (n = 20) received the TCM intervention delivered by a psychiatric nurse
practitioner (NP) for 90 days post hospitalization and the control group (n = 20) received the usual
care. The intervention by the nurse practitioner included helping the patients adapt to the home by
focusing on managing problem behaviors and physical problems, managing risk factors to prevent
further cognitive or emotional decline, promoting adherence to therapies, and integrating physical and
mental care approaches. The NP often accompanied the participant to medical and mental health
appointments to facilitate communication, translate information to specialty providers, and advocate
for the participant (Hanrahan et al., 2014).

Table. Research Classifications by Domains, Design, and Type of Data Used

Source Topic- Principle Finding Study Design Type of data Domain
Intervention
Studied
Beebe et al. (2012) Walking program Self-efficacy for Random Quantitative Biological
exercise was assignment,
significantly higher researchers
in experimental blinded, pre-/
participants than in posttest
controls after
intervention.
Emory et al. (2011) Line dancing The fall rate post Pretest-posttest Quantitative Biological
program intervention was
2.8% compared with
3.2% before
intervention.
Kinser, Bourguignon, 8-week yoga Yoga served as a Qualitative data Qualitative Biological
Taylor, & Steeves intervention self-care technique through daily logs
(2013) for the stress and in which
ruminative aspects participants
of depression. Yoga documented their
facilitated feelings before
connectedness and and after daily
helped in sharing home yoga
practice.
 experiences in a
safe environment.
Stanton et al. (2015) Evaluate More inpatients Site evaluation Quantitative Biological
satisfaction with (50%) rated exercise upon discharge;
inpatient group as “excellent” evaluation survey
activities compared with all was completed
designed to assist other activities. anonymously.
with recovery, Nonattendance
including rates were lowest
cognitive for cognitive
behavioral behavioral therapy
therapy, creative (6.3%), highest for
expression, the relaxation group
relaxation, (18.8%), and for the
reflection/ group exercise
discussion, and program (12.5%).
exercise.
Lindseth et al. (2015) Dietary intake of Improvement in Within-subjects Quantitative Biological
high or low patients’ mood, crossover-
tryptophan diet. depression, and designed study,
anxiety for those random
consuming a high assignment to
tryptophan diet as control
compared to those /experimental
who consumed a
low
Tryptophan.
Zhou et al. (2014) Examine the Higher scores, Random Quantitative Biological
predictive value reflecting better assignment,
of time-based TBPM, at baseline pretest-posttest
prospective were more likely to
memory (TBPM) achieve remission
and other after 8 weeks of
cognitive optimized
components for antipsychotic
remission of treatment.
positive
symptoms in first
episode of
schizophrenia.
Pulia et al. (2013) ECT technique. Compared with A retrospective Quantitative Biological
Two changes patients receiving analysis was
were introduced: ECT with RUL performed on two
(a) switching the placement prior to inpatient groups
anesthetic agent the changes, treated on Mood
from propofol to patients who Disorders Unit.
methohexital, received RUL ECT
and (b) using a after the changes
more aggressive had a significantly
ECT charge dosing shorter inpatient
regimen for right Length of stay (27.4
unilateral (RUL) versus 18 days, p =
electrode 0.028).
placement.
Arms et al. (2014) Education session No difference in Pretest/posttest, Quantitative Biological
about metabolic educational pre- chart audit
syndrome for posttest scores.
clinicians. Clinicians increased
referral to Primary
Care Provider for
BMI >25.
Battaglia et al. (2013) Counseling The intervention Pilot study, single Quantitative Psychological
regarding tobacco had minimal group, unblinded and
cessation impacts on intervention trial Qualitative
treatment internalized stigma
designed to and personal
increase patient recovery. Peer
engagement support
while demonstrated
hospitalized. positive effects on
internalized stigma
and personal
recovery.
Lawson et al. (2012) “Men's Program”- Promising change in Exploratory study, Quantitative Psychological
rape prevention attitudes about rape mixed methods and
intervention. beliefs and design, pre- and Qualitative
bystander behaviors post-test, focus
in Hispanic males group
exposed to the transcription
educational thematic coding
intervention.
Bekhet, Resourcefulness 76.3% of the older Pilot study, Quantitative Psychological
Zauszniewski, & training (RT) for adults scoring below random and
Matel-Anderson relocated older 120, indicating a assignment, Qualitative
(2012) adults assessing strong need for RT. convenience
necessity, Participants sample
acceptability, indicated
feasibility, safety acceptability,
and effectiveness feasibility, safety,
of RT. and effectiveness
with
recommendations
for intervention
improvement.
Zamirinejad, Hojjat, Resilience The resilience Three-group Quantitative Psychological
Golzari, Borjali, & training and training group and design with
Akaberi (2014) cognitive therapy cognitive therapy control, pretest-
for young women group showed a posttest
with depression significant decrease
in the average
depression score
from pretest to
posttest and from
pretest to follow-
up. There was no
significant
difference between
effectiveness of
resilience training
 and cognitive
therapy on
depression but
there was a
significant
difference between
these two
treatment groups
and the control
group.
Thapinta, Skulphan, Brief Cognitive The mean Quasi- Quantitative Psychological
& Kittrattanapaiboon Behavioral depression scores experimental,
(2014) Therapy decreased control group,
intervention to significantly in both pretest/ posttest
reduce the experimental design
depression and control groups
among alcohol- at the one-month
dependent follow-up. However,
individuals only the
experimental group
showed significant
differences in their
mean depression
scores between pre-
and posttest. At
Week 7, the
experimental group
showed significantly
lower mean
depression scores
than the control
group.
Koci et al. (2014) shelter and At 4 months Prospective study Quantitative Social
justice services following a shelter
for abused stay or justice
women services,
improvement in all
mental health
measures; however,
improvement was
the lowest for PTSD.
minimum further
improvement at 12
months.
Simpson et al. (2014) peer support Participants Pilot randomized Quantitative Social
workers for indicated that the controlled trial and
inpatient training was (RCT), focus Qualitative
aftercare valuable, groups
challenging, yet
positive experience
that provided them
with a good
preparation for the
role.
Forchuk et al. (2012) Transitional Results: Group C Randomized Quantitative Social
Relational Model implemented the controlled trial;
(TRM) was used TRM model compared three
to help mental significantly quicker groups of hospital
health clients than the other wards; Group A
transitioning from groups. wards had already
a psychiatric adopted the TRM,
hospital setting to Group B wards
the community. implemented the
Strategies TRM in Year 1, and
included Group C wards
enhancing staff implemented the
participation, TRM in Year 2.
creating/
maintaining
supportive ward
milieus.
Horgan, McCarthy, & online peer No statistical Mixed method, Quantitative Social
Sweeney (2013) support for young significance involving and
adults difference pre- and quantitative Qualitative
experiencing post-test. The forum descriptive, pre-
depressive posts revealed that and post-test and
symptoms the participants' qualitative
main difficulties descriptive designs
were loneliness and
perceived lack of
socialization skills.
The website
provided a place for
emotional support.
Iskhandar Shah et al. Virtual reality Those who Single-group, Quantitative Bio-
(2015) (VR)-based stress completed the pretest–posttest, and psychological
management (VR program had quasi- Qualitative
DE-STRESS) significantly experimental
program for lowered stress, research design
people with depression, anxiety. and convenience
mood disorders sample
Pedersen et al. Farm animal- Levels of anxiety Pretest-posttest, Quantitative Bio-Social
(2011) assisted and depression video recording and
intervention decreased, and self- thematic coding Qualitative
consisting of work efficacy increased
and contact with during the
dairy cattle intervention.
Chandler et al (2015) Empower Subjects in the Purposive Quantitative Psychosocial
resilience intervention group sampling, random and
intervention (ERI) reported building assignment, Qualitative
to build resilience strengths, reframing intervention and
resilience, and control, pretest-
creating support posttest design
connections.
Hanrahan et al. Transitional care Emergency room Randomized Quantitative Bio-
(2014) model (TCM) use was lower for controlled trial psychosocial
intervention to intervention group
patients with but not statistically
serious mental significant.
 illness Continuity of care
transferring from with primary care
hospital care to appointments were
home significantly higher
for the intervention
group. The
intervention group's
general health
improved but was
not statistically
significant
compared with
controls.

Discussion
Although substantial progress is being made to develop and test interventions for persons with
psychiatric and mental health challenges and their families, there remains much work to be done.
Nurse scientists and practitioners share a professional obligation to persons entrusted to their care,
which includes providing the highest quality care grounded in solid empirical evidence (Willis, Beeber,
Mahoney, & Sharp, 2010). This review yields evidence for the continued dissemination of findings from
intervention studies from 2011 through 2015. To perform the analysis reported here, we employed
methods that were similar to those used for amassing information from the intervention studies in two
previous reviews (Zauszniewski et al., 2007; Zauszniewski et al., 2012) in order to facilitate comparisons
over time.

... the continued publication of evidence from countries outside the

United States remains important...

During the review period (2011-2015), 57% of the published intervention studies took place in the
United States (U.S.) while 43% were conducted outside the U.S. (i.e., internationally). These
percentages compare with 72% and 54% of published U.S. intervention studies and 28% and 46%
published international intervention studies in the 2000-2005 and 2006-2010 reviews, respectively.
The somewhat lower percentages (28% and 46%) of international intervention studies within the
current time frame (2011-2015) may indicate a need for more descriptive research to identify
distinguishing characteristics of international populations and important phenomena that may be
amenable to intervention prior to the systematic testing of interventions. However, the continued
publication of evidence from countries outside the United States remains important for developing
globally relevant interventions for psychiatric nursing practice.

...there have been dramatic increases through the years in the overall number of studies that have tested
interventions that tap more than one domain.
Of the 115 intervention studies from 2011 through 2015 found in the five journals, nurses, student
nurses, nursing staff, or other mental health professionals were the intervention recipients in 23,
representing 20% of the intervention studies. This percent is higher than the 14% reported in the
previous review conducted from 2006 through 2010, indicating a slightly greater focus on testing
interventions in mental health care professionals in recent years. Although the interventions tested in
these populations are not focused directly on outcomes for clients with mental health issues,
promoting or preserving the mental health of professional caregivers most certainly affects those for
whom they provide care.

Analysis of published intervention studies in the 5-year interval from 2011 through 2015 revealed an
increase in the number of studies of psychiatric patients or clients in the five selected journals. For this
time frame, we found 92 intervention studies in comparison with 71 from 2006 through 2010 and 77
from 2000 through 2005, which reflect 5 and 6-year intervals respectively.

We also noted fewer intervention studies where all three domains

were integrated within the intervention...

Moreover, there have been dramatic increases through the years in the overall number of studies that
have tested interventions that tap more than one domain. For example, 33% of intervention studies
from 2011 through 2015 tested psychosocial interventions, compared to 17% in the previous review
(2006-2010) and 12% in the one prior to that (2000-2005). In addition, 13% of the studies from 2011
through 2015 tested biopsychological interventions compared with 4% and 5% in the previous two
reviews. However, there was a slightly lower percent of biosocial intervention studies, specifically 3%
in comparison with 4% from 2000-2005 and 6% from 2006-2010. We also noted fewer intervention
studies where all three domains were integrated within the intervention, specifically only 6% in
comparison with 17% in the previous time frame (2006-2010). Yet, our review revealed a larger
percent of biopsychosocial intervention studies than from the review conducted from 2000-2005 (1%).
Despite the lower number of studies that integrated all three intervention domains, there was an
overall trend toward testing interventions that were not restricted only to one domain, indicating
increased attention toward more holistic interventions.

... the overall trend shows a lesser focus on testing interventions

within a single domain over time...

There were 41 intervention studies between 2011 and 2015 that focused solely on one domain. With
the exception of the biological domain (9%), interventions within the psychological (26%) and social
(10%) domains were fewer than in previous reviews. For example, there has been a clear downward
trend in the percent of psychological intervention studies over time with 57% from 2000-2005 to 38%
from 2006-2010 and 26% in this current review. Intervention studies within the social domain
decreased from 17% in 2006-2010 to 10% in this review. Studies of interventions in the biological
domain have fluctuated over time from 11% in 2000-2005 down to 1% from 2005-2010 and up to 9% in
the review reported here. However, the overall trend shows a lesser focus on testing interventions
within a single domain over time, pointing perhaps to a growing interest in determining effective
interventions that are multifaceted and target multiple factors that affect a person’s health.

Implications: Research Needed

The mind and body do not function independently of each other; therefore, when considering the
focus of nursing research, we need to target both systems. Nursing has as its foundation a holistic
approach to patient care. At this point in our history as we build a knowledge base, a multifaceted
approach is needed when planning nursing research. This study of nursing interventions in our
research has explored the biological, psychological, and social domains. Studies in the biopsychosocial
domain would benefit our knowledge base and improve the criteria for more accurate, evidence-based
nursing interventions.

Medicine has increasingly focused on the mental health component of medical illnesses. Nursing
research would be strengthened by focusing on the possibility of medical illness and its relationship to
mental illness. This nursing research approach would support our holistic philosophy of care and
increase our knowledge of the whole person. It would provide the best evidence-based approach to
planning treatment. In addition, it would serve to increase the sphere of psychiatric nursing beyond
the psychiatric unit in health care settings.

...an increase in multicultural studies is needed to further strengthe

our evidenced based practice.

Finally, an increase in multicultural studies is needed to further strengthen our evidenced based
practice. The individual person is complex. Identified culture provides important information as to how
patients view health and illness. This information is an important component when planning our
evidenced based care and should not be isolated from the patient presentation.

Conclusion
Tracking the progress in intervention research relevant for psychiatric
and mental health nursing practice is essential to identify evidence gaps.

This current, systematic review of intervention studies published in the most accessible psychiatric and
mental health nursing journals for practicing nurses, educators, and researchers in the United States
has revealed a somewhat lower number of studies from outside the United States; a slightly greater
focus on studies of nurses, nursing students, or other mental health professionals as compared with
clients who receive their care or services; and a continued trend for testing interventions that captured
more than one dimension. Tracking the progress in intervention research relevant for psychiatric and
mental health nursing practice is essential to identify evidence gaps. Though substantial progress has
been made through the years, there is still room to grow.
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