Abstract: Registered nurses (RN) coordinate acute mental health units on a 24-hour basis and it behoves researchers to actually ask these nurses what they think contributes to their ability to work with patients in optimistic ways. In this study, 40 RN working in acute mental health settings were asked a series of questions to explore positive aspects of nursing work, which includes therapeutic optimism. Three themes were identified: (i) different ways nurses foster therapeutic optimism; (ii) perceptions of how an optimistic environment is fostered, and (iii) improvement of ward culture. Findings show the pivotal role mental health nurses have in improving teamwork, good communication, sharing, and collaboration, in addition to preceptoring and supervision. Furthermore, effective clinical management is essential to therapeutic optimism and, in this research, is considered to be the aspect of acute mental health nursing most relevant to improving the ward culture.
Abstract: Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.
Abstract: BACKGROUND: The self-identification of nursing students with the profession has been linked with a successful transition, from being a student to being a professional nurse. Although there is no empirical evidence, there are suggestions that students with high professional identity are more likely to persist and complete their studies in their chosen profession. OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of a professional identity scale and to determine the relationship between professional identity and student retention in a large group of first year nursing students. DESIGN AND METHODS: A survey design was used to examine the professional identity of first year nursing students, as measured by the Macleod Clark Professional Identity Scale (MCPIS-9). Baseline data obtained from the initial surveys were then compared with student drop-out rates 12months later. RESULTS: Exploratory factor analysis of the MCPIS-9 yielded a one-component solution, accounting for 43.3% of the variance. All 9 items loaded highly on one component, ranging from 0.50 to 0.79. Cronbach's alpha coefficient of the MCPIS-9 was 0.83 and corrected item-total correlation values all scored well above the 0.3 cut-off. Students who: were females, had previous nursing-related vocational training, reported nursing as their first choice, or engaged in nursing-related paid work, had statistically significant higher professional identity scores. Using logistic regression analysis, students with high professional identity scores at baseline were more likely to be still enrolled in the nursing program at 12months, controlling for gender, language spoken at home and engagement in nursing-related employment. These results support the psychometric properties of the MCPIS-9. CONCLUSIONS: Professional identity has a direct relationship with student retention in the nursing program. It is important to adequately measure professional identity in nursing students for the purpose of monitoring and identifying students who are at risk of leaving nursing programs.
Abstract: Abstract A wide range of statutory and non- statutory child protection and family support services exist to prevent the occurrence or re-occurrence of maltreatment. They may be oriented towards primary, secondary or tertiary levels of prevention, employ various types of professional and/or paraprofessional workers, and target a diverse range of groups. The purpose of this study was to examine the experiences of parents who were directed by child protection authorities to attend a tertiary level child protection and family enhancement program. In depth unstructured interviews were used to gather data about these parents experience. Thematic content analysis of these transcripts identified four major themes as follows: 1) It's a good place to be: Participation as an affordable social outlet; 2) Learning about kids: Participation as a source of learning; 3) They are there for me: Participation as a source of practical help and support; and, 4) I am a good mother: Participation as a source of tension and conflict. Participants' perceptions of friendship with workers emerged as the most significant and valued aspect of their experience. These feelings of friendship were tested when staff undertook their mandatory reporting role. Feelings of betrayal arose that challenged the women's previous unconditional feelings of trust, and jeopardized the therapeutic relationships that had been established.
Abstract: In acute mental health inpatient units, it is not surprising that culture, peers, immediate management, and sources of support and acknowledgment all contribute to positive nursing outcomes. In this qualitative study, four questions targeting leadership, culture, support, and acknowledgement of work well done were asked of 40 registered nurses (RN) working in acute mental health units. Findings convey a mixed picture indicating variation across units. Three-quarters believe that senior nursing staff actively contribute to a positive working environment. Almost half of the RN nominated peers as the providers of counsel and support when required, and a similar percentage believed that senior nursing staff fulfil these roles. Of interviewees, 33% said their nursing achievements are never, or rarely, acknowledged. For these RN, management, peers, and nurse unit managers are the preferred personnel to provide appropriate positive feedback. Thus, there is a gap between the expectations and hopes that nurses have for senior management approaches and behaviours and the reality of their daily experience. Overall, the responses portray a culture that underpins and enables both subtle interpersonal interactions that might arise out of necessity given the perceived lack of support from non-hands-on RN and administrators.
Abstract: PURPOSE:  This paper provides an overview of some challenges facing mental health practice nurses transitioning to academic life, and suggests possible strategies to prevent foreseeable difficulties. FINDINGS:  New and existing mental health faculty will benefit from a greater awareness of barriers and developing entry protocols to enhance the transition experience and reduce early workplace stressors. PRACTICE IMPLICATIONS:  Preparation and support for mental health staff transitioning from practice to the academe are essential to enhance the transition experience and reduce early workplace stressors.
Abstract: This article synthesises principles and ideas from relevant literature on professional boundaries and applies them to higher education settings with the intention of contributing to contemporary debates on appropriate, respectful, and ethical conduct in academia. This is against a background of structural changes and growing complexity of academic institutions in concert with decreasing adherence to rules of conduct and established privileges historically handed down from traditional universities. The professional and personal conduct of nurse academics is increasingly unfettered in association with 'market' forces and simultaneously more available for scrutiny in association with a greater awareness of and institutionalisation of human rights and protections across all sectors of society.
Abstract: An overview of approaches used in contemporary mental health research to consider when coordinating research agendas is presented. Connections between the research-practice gap and evidence-based practice are explored. Collaboration, as a key concept and practice, is investigated particularly in relation to community and consumer participation in mental health research.
Abstract: In clinical settings, nursing staff often find themselves responsible for students who have varying time management skills. Nurses need to respond sensitively and appropriately, and to teach nursing students how to prioritize and better allocate time. This is important not only for developing students' clinical skills but also for shaping their perceptions about the quality of the placement and their willingness to consider it as a potential work specialty. In this column, some simple, practical strategies that nurses can use to assist students with improving their time management skills are identified.
Abstract: In this qualitative study, the experiences of a small cohort of registered nurses (RN) during the first 2 years of mental health employment were documented. A total of 13 semistructured interviews were completed from within a specialist mental health setting. Eleven issues were identified: (i) teamwork; (ii) experiential learning; (iii) self-development; (iv) confidence; (v) listening; (vi) rapport; (vii) keen observation; (viii) patience; (ix) empathy; (x) learning from colleagues; and (xi) maintaining a positive approach towards patients. The nurses focused on the here-and-now circumstances, rather than on future plans, or past preparation, and were able to elucidate the qualities and skills that they brought to their clinical work. Participants were most proud of achievements that bridged the personal and professional, such as self-development, working closely with patients to develop rapport, experiential learning, and teamwork. Findings highlight the importance of teamwork to newly-graduated RN entering the mental health environment. It is known that teamwork can convey a sense of belonging and help create an environment in which applied experiential clinical learning can occur. Therefore, it is important that efforts are made to facilitate team building and opportunities for teamwork when new graduates are transitioning into the mental health clinical practice environment.
Abstract: Developing a researchable question or quality improvement project from a broad clinical problem is a key challenge for mental health nurses. In this paper, we provide an overview of some of the steps involved in proceeding from an initial ?problem? within a clinical setting to determining a research question with clear conceptual components that leads to appropriate methods to explore the topic or answer the question. The focus of the proposed quality or research study must be clear to clinicians and potential participants and meet professional responsibilities. Conducting high quality research and quality initiatives will likely improve care and outcomes for mental health consumers as well as providing a reliable evidence-based foundation for further improvements.
Abstract: Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education.
Abstract: Commonly, the expression 'PhD' evokes a level of trepidation amongst potential candidates from both the clinical and academic spheres. In contemporary settings, a Doctor of Philosophy is highly regarded and increasingly necessary for a successful academic nursing career. The aim of this paper is to explore the options for doctoral education for nurses, and consider the role of the doctorate in career planning for nursing, and in the attainment of career goals. Here we discuss some key issues and practicalities including career planning, selecting a doctoral program, choosing a university, supervision, committees and panels, achieving a work-life balance and dealing with conflict. The PhD process should be an enriching and satisfying experience which may lead to enhanced professional and personal growth; however, there are potential pitfalls that nurses should be aware of before embarking on doctoral training. Future studies are needed to assess the impact of the different doctorates offered to see if, in fact, they are advancing nursing practice and research endeavours.
Abstract: Undergraduate nurses are employed as assistants in nursing (AIN) in inpatient mental health settings; however, there is a paucity of published research exploring registered nurses' (RN) views about the AIN role in these settings. This qualitative study documents the views and experiences of RN working with undergraduate AIN. Fifty structured face-to-face interviews were analysed, and the results are discussed in three sections. The first section outlines RN perceptions of qualities and skills required of AIN in mental health, and the responses primarily focus on communication skills, initiative, and willingness to learn. The second section targets factors in the workplace that might enhance the interest of AIN in a mental health nursing career; the responses emphasize their need to work with experienced staff. The last section outlines RN expectations of AIN, most of which are met and involve physical observations and technical tasks; less fulfilled activities primarily cluster around interactions with patients. Findings highlight the advantages and disadvantages of drawing on undergraduate nursing students as AIN in mental health settings. Communication skills, personal initiative, safety training to prevent violence, and education to increase knowledge and awareness about mental illness, diagnosis, and mental status-related skills were all important concerns articulated by RN.
Abstract: It is clear that many university students across all disciplines (including nursing) experience a diverse range of intrapersonal and interpersonal difficulties. Some students are exposed to circumstances and expectations that may place them at risk for mental health or substance use disorders or exacerbate pre-existing problems. Research shows increasing rates of diagnosable mental health conditions such as substance use disorders, depression, personality disorders, and behavioural challenges that present themselves while students are undertaking their university education. It is therefore important that nurse educators are able to identify student problems in both academic and clinical settings, so that symptoms, signs and inexplicable behaviours are not ignored, and steps towards referral and early intervention are taken. In this paper, we discuss rates of mental health problems and substance use among undergraduate nursing students, problems in the teaching-learning and clinical settings which nurse educators are likely to witness, and the consequences of unacknowledged psychiatric difficulties and problematic behaviours.
Abstract: In clinical disciplines, continuing education courses should be practical, engaging, and evidence-based. Such courses should be formally reviewed at regular intervals. This column examines the various issues clinical nurses need to consider if they are invited to review a clinical continuing education course.
Abstract: Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed.
Abstract: Interestingly, there are very few guidelines in the literature to assist novice nurse PhD examiners. In this paper, we aim to provide information to nurses, researchers or early career academics who have little experience in assessing a university thesis. The article provides background information about recent changes in the university sector; overviews some research on experienced examiners views; presents factors that differentiate between high and low quality PhD theses; and outlines some pointers that may be useful when marking at the doctoral level.
Abstract: The aim of this paper is to discuss issues impacting on consumer workforce participation and challenges that continue to arise for these workers, other service providers, and the mental health system. The literature identifies the following issues as problematic: role confusion and role strain; lack of support, training, and supervision structures; job titles that do not reflect actual work; poor and inconsistent pay; overwork; limited professional development; insufficient organizational adaptation to expedite consumer participation; staff discrimination and stigma; dual relationships; and the need to further evaluate consumer workforce contributions. These factors adversely impact on the emotional well-being of the consumer workforce and might deprive them of the support required for the consumer participation roles to impact on service delivery. The attitudes of mental health professionals have been identified as a significant obstacle to the enhancement of consumer participation and consumer workforce roles, particularly in public mental health services. A more comprehensive understanding of consumer workforce roles, their benefits, and the obstacles to their success should become integral to the education and training provided to the mental health nursing workforce of the future to contribute to the development of a more supportive working environment to facilitate the development of effective consumer roles.
Abstract: The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates.
Abstract: Each nurse educator's pedagogy underpins their understanding of and approach to teaching and learning, regardless of whether this has been reflected upon or articulated. In this paper, we overview factors and issues that should be considered when developing a teaching philosophy of nursing education and set out broad differences between traditional and contemporary pedagogic models and various ways of knowing. As values underpin any teaching framework these are considered in relation to pedagogies, epistemologies and their relevance to nursing practice. Key teacher roles and strategies that are congruent with a contemporary pedagogy for teaching nursing in the classroom or the clinical setting are also outlined. A premise for writing this paper was that clarifying one's own understandings of education and knowledge and the implicit values held within those terms and processes will contribute to greater self-awareness and more effective teaching of nursing. Education approaches underpinned by a sound teaching philosophy and framework can facilitate an educationally sound and positive experience for learners.
Abstract: Attrition from undergraduate nursing programs continues to warrant investigation particularly in the climate of nursing shortages and fiscal reflection on academic institutional programs. This three-year study used a prospective longitudinal survey design to determine entry characteristics of students, attrition, progression and completion in an undergraduate program. Students were surveyed in the first three weeks of commencing their program and gave permission for academic grades to be collected during their six session, three year Bachelor of Nursing program. Of the 740 students enrolled 48% (357 students) were surveyed and 352 students (99%) gave consent for their grades to be collected. One-third of the student cohort graduated in the expected three-year timeframe, one-third had dropped out and one-third was still completing their studies. A higher Grade Point Average and being a native English speaker were most predictive of students completing their course in the minimum expected timeframe.
Abstract: This discussion paper argues for the critical importance of successful leadership for effective mental health nursing, observing that nursing leadership has long been regarded problematically by the profession. Using empirical and theoretical evidence we debate what leadership styles and strategies are most likely to result in effective, recovery-orientated mental health nursing. Models of transformational and distributed leadership are found to be highly congruent with mental health nursing values, yet the literature suggests it is a type of leadership more often desired than experienced. We note how the scholarly literature tends to ignore the "elephant in the room" that is organizational power, and we question whether transformational leadership pursued within a specific clinical context can influence beyond those confines. Nevertheless it is within these contexts that consumers experience nursing, effective or otherwise, thus we should advocate what is known about effective leadership wherever it is required.
Abstract: Mid-career students who undertake doctoral studies have often achieved standing and success in their careers and may already hold quite senior leadership positions in the profession. In view of this, mid-career students may struggle with the transition to student, particularly if they have not studied for a number of years and have multiple pressures on their time. Supervisors on the other hand, operate within cultures of performance based indicators, and are under pressure to facilitate timely student completions. While students must take ultimate responsibility for their doctoral work, it is possible for supervisors to identify problems early, and offer practical solutions to assist mid-career students overcome their problems, and facilitate optimal engagement. In this paper we highlight some of the challenges this vulnerable student group can present, and identify some practical strategies supervisors can suggest to assist in the timely and successful completion of doctorate degrees.
Abstract: The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.
Abstract:   E-mail interviewing-not to be confused with "online surveying"-shows promise for researchers working with adolescent mental health populations as a data collection method.
Abstract: If practice development (PD) is to be implemented in diverse mental health-care settings, it is important that managers, researchers, and policy makers are all clear about the nature of the processes involved. The authors draw on the literature to broadly set out local strategies, practicalities, and issues that should be considered and addressed by those planning to undertake PD projects in mental health. Before implementing PD projects, pre-existing requirements should be recognized and expedited. All aspects of who does what, when, and how should be widely communicated so that continuous evaluation and improvements are generated. Staff need to be adult learners, be aware of their practice values, be able to access supervision, and confront contradictions and tensions between values and practice. PD programmes that are effective are built into mainstream activities, considered core business, utilize existing resources to build sustainable and realistic improvements, take direction from practitioners, and incorporate client needs.
Abstract: OBJECTIVE: We aimed to describe medication side effects in a cross-section of young people taking low-dose risperidone, using a self-report measure. METHODS: The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) was completed by 66 patients aged between 6 and 18 years who had been taking low-dose risperidone (alone or in conjunction with other medications) for up to 13 years. RESULTS: Young persons, overall, seemed to tolerate risperidone well, but longer exposure to the medication was associated with higher side effect levels, particularly for the psychic (pertaining to mind and emotion) and extrapyramidal subscales. The most common complaints related to psychic side effects, such as tiredness, difficulty concentrating, difficulty remembering things and increased dreaming. CONCLUSIONS: Clinicians need to monitor the side effects of young patients taking low doses of risperidone, and other psychotropics, and maintain vigilance in those who have been taking medication for extended periods.
Abstract: In this column, we outline key points about feedback for staff to consider in everyday practice, with a view to making the task less daunting. In turn, we address the meaning of feedback, elements of good feedback, placement objectives, setting, frequency, identifying areas of weakness, recognition and praise, dealing with unfavorable reactions, and dissatisfaction with the feedback process.
Abstract: Bullying activities can be overt and intimidating or comparatively invisible to others. Nurses who work in a culture of bullying may experience job dissatisfaction and physiological and psychological consequences. Failure to adhere to professional responsibilities and engage in acceptable interpersonal behaviours sets the scene for unhealthy workplaces. Bullying is also costly to organisations due to increased leave and nurse attrition and decreased nurse productivity, satisfaction, and morale. This review provides an overview of bullying, how this impacts on nursing staff, and ways to reduce bullying incidents to cultivate a more positive work environment.
Abstract: OBJECTIVE: The aim of this study was to provide an overview of a new 'phase of illness' model of care after relocation of Rozelle Hospital to the new purpose built Concord Centre for Mental Health and discuss its implementation and progress thus far. METHOD: One year after relocation, staff were asked to provide feedback of their views of the new model of care in order to identify implementation barriers and ways forward. RESULTS: The new model has clear benefits for the consumer, but there are a number of practical challenges and dilemmas emerging that necessitate some refinement and evaluation. Feedback from staff provided a wide range of opinions indicating that some were quite cynical of the new model while others were very supportive and thought that patient care was enhanced. CONCLUSIONS: Further development and consolidation of the model is required, including more education sessions and a clear mission statement at unit, hospital and community levels. Further research is also required to assess the impact and ability of the new model to deliver better patient outcomes, especially in regard to continuity of care.
Abstract: There is a growing expectation for staff to participate in benchmarking activities. If benchmarking projects are to be successful, managers and clinicians need to be aware of the steps involved. In this article, we identify key aspects of benchmarking and consider how clinicians and managers can respond to and meet contemporary requirements for the development of sound benchmarking relationships. Practicalities and issues that must be considered by benchmarking teams are also outlined. Before commencing a benchmarking project, ground rules and benchmarking agreements must be developed and ratified. An understandable benchmarking framework is required: one that is sufficiently robust for clinicians to engage in benchmarking activities and convince others that benchmarking has taken place. There is a need to build the capacity of clinicians in relation to benchmarking.
Abstract: Acute inpatient mental health units can be seen as one important link in the chain of complementary mental health specific and generic community support services that need to address the real needs of people in the area from which clients are drawn. This article reviews the reasons for admission to these units and research initiatives to evaluate alternative models of care within the community. Assertive community treatment and other alternative programs are discussed within a continuum of community-psychiatric support intervention models. An argument is then developed for mental health systems to be conceived within a continuous care framework for all service users, and with recovery in the forefront of service design and delivery. Further research is required to define nursing clinical priorities and philosophies to ensure a recovery focus in which care is aligned with that of consumer expectations and is consistent with other service providers.
Abstract: Clinical educators may have difficulty determining how best to respond to uncivil behaviors from students in clinical settings. This column describes communication, ground rules, and policy enabling clinical educators to teach effectively and minimize inappropriate student responses.
Abstract: For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than be ing told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients' questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.
Abstract: Increasingly, nurses are expected to undertake activities to demonstrate community engagement as part of their continuing professional development. Such collaborative education activities can be mutually beneficial and stimulating, and when goals are aligned, valuable outcomes can be produced.
Abstract: There are numerous barriers to improving healthcare delivery. This article summarizes contemporary theories and research evidence to focus on ways to motivate change within the hospital system to provide better health care.
Abstract: Aims and objectives.  In this article, we identify key aspects for enhancing real-world research in mental health care clinical settings and broadly discuss some practicalities and issues that must be considered beforehand. Background.  Practice which is evidence-based uses interventions or treatment methods that are supported by research findings for their quality and efficacy. Modern mental health settings endorse evidence-based practice and welcome the development of innovative, evidence-based approaches to care. Often, however, research findings are inaccessible, inconclusive, inconsistent, contradictory and overwhelming in sheer volume. Further, where there is no evidence, the absence of evidence is frequently mistaken for evidence of absence of the effectiveness of services. Design.  Discursive paper. Method.  The main themes expressed in the literature were collated by the authors into themes, and their relevance to the development of real-world clinical mental health research is summarised with the aid of a vignette. Conclusions.  Ideally, research should be part of mainstream activities and as such constitute core business. Staff in mental health services should be encouraged to be research productive, and prospective clinical researchers should consider linking their studies to higher research degree programmes so that they can access resources, support and expertise to sustain motivation and morale. Relevance to clinical practice.  For research findings to make the leap to evidence-based practice, the research needs to include real-world consumers and families typical of clinical practice supported by clinically relevant outcomes. Clinical and research leaders should create opportunities for academic and clinical nurses to collaborate in research, and researchers should ensure that clinically relevant outcomes are presented in ways that are meaningful and accessible to clinicians.
Abstract: There is considerable debate on the use and abuse of journal impact factors and on selecting the most appropriate indicator to assess research outcome for an individual or group of scientists. Internet searches using Web of Science and Scopus were conducted to retrieve citation data for an individual in order to calculate nine variants of Hirsch's h-index. Citations to articles published in a wide range of psychiatric journals in the periods 1995-99 and 2000-05 were analyzed using Web of Science. Comparisons were made between journal impact factor, h-index of citations from publication to 2008, and the proportion of articles cited at least 30 or 50 times. For up to 14 years post-publication, there was a strong positive relationship between journal impact factor and h-index for citations received. Journal impact factor was also compared to the percentage of articles cited at least 30 or 50 times-a comparison that showed wide variations between journals with similar impact factors. This study found that 40%-50% of the articles published in the top ten psychiatry journals ranked by impact factor acquire 30 to 50 citations within ten to fifteen years. Despite certain flaws and weaknesses, the h-index provides a better way to assess long-term performance of articles or authors than using a journal's impact factor, and it provides an alternative way to assess a journal's long-term ranking.
Abstract: After decades of discussion about clinical supervision and mental health nursing, the reality is that many acute mental health inpatient settings continue to struggle with the notion of clinical supervision and the implementation process. In this article we delineate the key elements of clinical supervision, explore practical and dynamic difficulties associated with clinical supervision and question whether too much is being asked of this one process, especially in acute inpatient settings. For many mental health nurses, existing practices offer many of the purported benefits of clinical supervision. Ultimately, unless clinical supervision is better understood and implemented effectively, it is unlikely to meet expectations. Clinical supervision should ultimately be defined by the nurses participating in it. This article contributes to current discussions regarding the purpose of clinical supervision, the realities of its implementation, and in particular considers the role of clinical supervision relative to existing professional support opportunities.
Abstract: In acute inpatient mental health services, patients commonly demonstrate extreme behaviours. A number of coercive practices, such as locked doors, enforced medication and seclusion, are used in these settings to control such behaviours. The aim of this report is to explore briefly some of the contemporary debates pertaining to seclusion. A perusal of the literature reveals a clarion call to end the practice of seclusion, without consideration of feasible alternatives. It is hoped that this brief report will encourage further evidence-based discussion and research initiatives on this important ethical topic.
Abstract: In this study, we surveyed clinical staff to ascertain their views regarding the delivery of difficult news (DDN), such as the need for lifelong medication with possible side effects, in inpatient mental health settings. Nearly all staff agreed patients had a right to information about their diagnosis, two thirds thought the doctor was the best person to inform patients of their diagnosis, and approximately half believed full diagnosis and treatment disclosure may have negative consequences. Providing hope when delivering difficult news was endorsed by almost all staff, and most took special precautions (e.g., greater monitoring) after DDN. Two thirds had never received specific training for DDN, yet most considered themselves competent in DDN. In DDN, staff usually or always considered patients' level of insight/awareness, likely distress, diagnosis, and whether they would understand the consequences of the diagnosis.
Abstract: Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals' experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.
Abstract: Clinicians should strongly consider using toolkits in their workplaces with students on clinical placement. These toolkits could include brief quizzes, crossword puzzles, vignettes, role-playing, storytelling, or reflective activities to engage students in context-specific, collaborative learning.
Abstract: Recent reports indicate an absence of respect in workplace culture. Every person has the right to a workplace that is fair and equitable and in which he or she is treated with respect and dignity. Working in a collegial manner is challenging when environments have staff who engage in unprofessional or disruptive behaviors. A number of steps can be taken to support a healthy workplace and prevent bullying. Healthy workplaces are ones in which leaders and managers lead by example, champion respect, and set the tone and expectation for behaviors essential for fostering a harmonious and collaborative environment. The role of the leader/manager is crucial in developing a positive workplace culture that supports a high level of professionalism and a culture of zero tolerance toward bullying.
Abstract: Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research.
Abstract: Access to the most relevant articles with recent evidence is essential for writing peer-reviewed articles and informing clinical decision making. A clear method is needed to undertake a mental health literature review to ensure the topic is covered adequately. Choosing the right key words and search strategies and using appropriate databases are essential starting points. Drawing on different search methods to access a variety of sources ensures the most relevant articles are retrieved for a high-quality clinical literature review. Advanced searching includes the use of the medical subject headings thesaurus and other strategies to refine and focus the search for optimum sensitivity and specificity. Regardless of whether a search is basic or advanced, stages of the search procedures, such as determining key terms, databases used and the date range used within each, fields selected, dates of access, a history of search sets, and the justification for excluding data, should be documented to provide an audit trail. This article provides an overview of these search steps.
Abstract: Numerous contemporary factors, including issues pertaining to continuing education and professional development, influence nursing careers in all areas of health research. This article provides an overview of international trends, practices, and questions that impinge on nurse educators and health researchers. These factors include the status of randomized controlled trials, the influence of evidence-based practice, gaps between research results and patient requirements, and the relationships between available evidence and clinical decision making. Added to this research and evidence environment are government concerns about the relevance and usefulness of health research. Finally, the questions an individual career researcher may ask, specifically regarding specialization versus a broad research agenda, are considered.
Abstract: Locked inpatient units are an increasing phenomenon, introduced in response to unforseen abscondences and suicides of patients. This paper identifies some value issues concerning the practice of locked psychiatric inpatient units. Broad strategies, practicalities and ethical matters that must be considered in inpatient mental health services are also explored. The authors draw on the published research and commentary to derive relevant information to provide to patients and staff regarding the aims and rationales of locked units. Further debate is warranted in relation to best practice. Inpatient staff need to be aware of their practice values, be able to access education and supervision and negotiate apparent contradictions. Further patient/clinician focused enquiry is necessary to mitigate the negative and stigmatising effects of locked mental health units.
Abstract: AIM: This paper is a report of a study assessing nurses' satisfaction with a 12-month transition to practice programme into mental health nursing and its impact on their perceived knowledge, confidence and self-concept. BACKGROUND: Transition to practice programmes are necessary to facilitate graduate nurses' professional adjustment into nursing and experienced nurses' movement from one clinical setting or speciality to another. Role transition can be a difficult process, and those who have realistic expectations may experience less stress during the actual transition. METHOD: A quantitative evaluation design carried out in Australia, using questionnaires for data collection. The study began in 2005 and the participants were three groups (n = 45) of Registered Nurses who all completed the programme during 2006 and 2007. FINDINGS: Forty-four nurses (98%) completed pre- and postprogramme surveys. There was a relatively high level of satisfaction with the programme. Most participants found all aspects of the programme to be substantially positive, with the majority intending to continue to work in mental health nursing at programme completion. Data concerning knowledge of and confidence in undertaking a number of nursing tasks showed statistically significant gains postprogramme for most items. No differences were found in The Nurses' Self-Concept Questionnaire scores between pre- and post-test phases, apart from a trend towards improved communication and caring. CONCLUSION: Transition programmes have the potential to make a positive contribution to the mental health nursing workforce. Continuing professional development opportunities are essential to ensure that skill development is maintained. Future longitudinal research could ascertain the benefits of the programme on staff retention.
Abstract: With the development of peer support networks in the mental health system, formal training should be provided regarding the adverse effects of substance use. Four educational workshops were conducted with caregivers and consumer workers to increase their knowledge and confidence to support people with a dual diagnosis. Workshops were evaluated through presurvey and postsurvey. The workshops were well received, and postworkshop, participants reported fewer negative attitudes toward people with a dual diagnosis and increased understanding and knowledge regarding substance misuse. This study highlights the effectiveness of targeted workshops for caregivers and consumer workers and advocates that nurses take a more active role in educational projects involving stakeholders.
Abstract: Handover is a tradition in mental health settings and can occupy a significant amount of time each day, yet the topic has commanded limited attention in the psychiatric literature. Increasing staff changes and growing reliance on casual staff has heightened the need for the effective and efficient transfer of essential information, as staff will often find themselves in settings with unfamiliar patients. In this context, effective and timely handovers are crucial. The aim of this article is to examine handover and consider how it may be used optimally to enhance service delivery. To reduce information loss and increase accuracy, verbal handover could be supplemented with computer-generated patient data. This combination will ensure face-to-face interaction remains and perhaps decrease time spent unproductively. Further research is necessary to evaluate such a handover system.
Abstract: AIM: This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. BACKGROUND: Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. DATA SOURCES: Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. REVIEW METHODS: Results from studies using meta-analysis, randomized and non-randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. RESULTS: Fifty-four studies were included: one systematic review with meta-analysis, 30 randomized controlled trials and 23 non-experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long-term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. CONCLUSION: These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.
Abstract: INTRODUCTION AND AIMS: Substance misuse by people with a serious mental illness may exacerbate psychiatric symptoms and contribute to relapse. The aim of the study was to ascertain the views of a wide range of Australian mental health service providers on staff education and training, client contact and management, assessment, and treatment effectiveness and service delivery. DESIGN AND METHODS: A survey was sent to a sample of 171 mental health stakeholders in Australia identified through internet searches, state and territory mental health departments and professional organisations. RESULTS: Of the 66 respondents (39% response rate), the substances identified to be most problematic were alcohol and cannabis. Integrated service models of treatment were identified as the most preferable and effective. Barriers to treatment included client motivation to reduce substance use, poor communication and coordination between treatment services, and lack of specific services for dual diagnosis clients. Almost all indicated a need for further training in the area of dual diagnosis. DISCUSSION AND CONCLUSIONS: Dual diagnosis is common and the reality is that this vulnerable clientele will continue to challenge service providers and treatment approaches into the foreseeable future. Issues include the organization and delivery of treatment services, education and training, resource allocation, collaboration between treatment agencies and clinically relevant research evaluating the effectiveness of practice. It is thus surprising that with so much investment in this area the majority of stakeholders are still dissatisfied with access to and the level of care for dual diagnosis clients.
Abstract: Mental health services have developed transition programs to attract staff, including new graduates, staff with mental health nursing experience without formal qualifications, experienced nurses wishing to move into mental health, and nurses returning to the workforce. Transition to psychiatric/mental health programs are considered to be particularly significant in the mental health field because of the relative under-representation of mental health content in undergraduate curricula. Unfortunately, transition programs have received only minor attention in the literature and there is a paucity of published evaluations to determine their effectiveness. The aim of this paper is to examine transition programs and consider how they meet the expectations of stakeholders, such as consumers of mental health services, and program participants' expectations. It is concluded that published systematic evaluations are lacking, particularly those considered from the perspective of stakeholders. Consideration of these expectations should be reflected in the design and delivery of mental health nursing transition programs.
Abstract: OBJECTIVES: The objectives were, first, to determine attitudes towards psychiatry as a career among medical students currently enrolled at the University of Sydney and, second, to establish the immediate impact on those attitudes of a promotional DVD, released by the Royal Australian and New Zealand College of Psychiatrists. METHOD: Medical students enrolled in the University of Sydney in 2008 were invited to complete a voluntary online questionnaire, in which their attitudes towards psychiatry were explored, and the immediate effects of a 15-minute DVD were ascertained. RESULTS: A total of 123 students participated. Only one student identified psychiatry as their chosen career. Medical students viewed psychiatry as the least attractive specialty for the degree to which patients are helped effectively and in terms of having a reliable scientific foundation. However, it rated well in regard to being intellectually challenging, a rapidly advancing field of medicine, and providing research opportunities and a good lifestyle. Psychiatry is less respected than most other specialties by students and they perceive this discipline to be poorly respected by other medical students and current medical practitioners. After viewing the DVD, there were improved student ratings of the benefits of a career in psychiatry, especially in relation to the specialty being enjoyable, offering effective treatment and having a scientific foundation. There was also enhanced understanding of the role of a psychiatrist in just over half of the participants and increased interest in psychiatry in about 30% of participants. The DVD was most effective in increasing awareness of the diversity of subspecialties available within psychiatry, good lifestyle factors, and the training involved. CONCLUSION: Among medical students, psychiatry is perceived as unattractive and fails to command the respect afforded other specialties. The viewing of a promotional DVD by medical students was found to be effective in improving their attitudes towards psychiatry and increasing their interest in pursuing a career in the specialty. However, the long-term impact of this modest improvement is unknown and the low survey response rate limits the extent to which the results can be generalized.
Abstract: OBJECTIVE: This study measured patient satisfaction levels and staff views regarding their expectations and workplace and other opinions after relocation to a new purpose-built mental health facility within the grounds of a general repatriation hospital. METHOD: Patients were interviewed face-to-face using a standardized satisfaction survey at least 2 months after the move to the new facility. In addition, surveys were sent by mail to all clinical staff rostered to work the same period that the patient interviews were conducted. RESULTS: One hundred patients were interviewed and 123 staff returned the survey (56% response rate). Patients and staff rated the new ward environment and food services most highly and were least satisfied with patient information and medical services. Less satisfaction was expressed about resource issues such as information technology and dedicated staff facilities. Most staff (70-80%) rated services provided to patients to be the same or better than their original expectations. CONCLUSIONS: The results indicate that the hospital move did not have any measurable negative impact on overall service provision or patient satisfaction. In fact, expectations were met or improved for several clinically relevant areas after relocating the mental health facility. Another survey is planned in 12 months to assess if patient and staff ratings change.
Abstract: Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.
Abstract: Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted and its role in evidence-based practice. Information regarding participants' attitudes towards research, knowledge about research practice and participation was also examined. The findings provide evidence that workshop attendance increases knowledge and encourages participation in future research projects, particularly when participants have confidence in the researcher.
Abstract: Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 25 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.
Abstract: BACKGROUND: Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES: To assess the effects of psychosocial interventions for substance reduction in people with a serious mental illness. SEARCH STRATEGY: For this update (2007) we searched the Cochrane Schizophrenia Group Trials Register (May 2006) which is based on regular searches of major databases. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where data were homogeneous. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model. MAIN RESULTS: Evaluation of long-term integrated care included 4 RCTs (total n=735). We found no significant difference on measures of substance use (n=85, 1 RCT, RR 0.89 CI 0.6 to 1.3) or loss to treatment (n=603, 3 RCTs, RR 1.09 CI 0.8 to 1.5). For the non-integrated intensive case management trials (4 RCTs, total n=151) we also found no significant difference for loss (n=134, 3 RCTs, RR 1.35 CI 0.8 to 2.2). Motivational interviewing plus cognitive behavioural therapy (3 RCTs, total n=276) did not reveal any advantage for retaining participants (n=36, 1 RCT, RR lost to treatment 0.50 CI 0.1 to 5.0) or for relapse (n=36, 1 RCT, RR 0.58 CI 0.3 to 1.1), and no benefit for reducing substance use (n=119, 1 RCT, RR 0.19 CI -0.2 to 0.6). Cognitive behavioural therapy alone (4 trials, total n=260) showed fewer participants lost from treatment (n=260, 4 RCTs, p=0.02, RR 0.61 CI 0.4 to 0.9). No benefits were observed on measures of lessening cannabis use (n=47, 1 RCT, RR 1.30 CI 0.8 to 2.2) or on the number of participants using substances (alcohol; n=46, 1 RCT, RR 5.88 CI 0.8 to 44.0, drugs; n=46, 1 RCT, RR 2.02 CI 0.9 to 4.8) and no differences were observed on measures of mental state (n=105, 1 RCT, RR 0.52 CI -0.8 to 1.8). We found no advantage for motivational interviewing alone (5 trials, total n=338) in reducing 'lost to evaluation' (n=338, 5 RCTs, RR 0.96 CI 0.6 to 1.5) compared with treatment as usual, although significantly more participants in the motivational interviewing group reported for their first aftercare appointment (n=93, 1 RCT, RR 0.69 CI 0.5 to 0.9, NNT 4 CI 3 to 12). Some differences were observed in abstaining from alcohol favouring treatment (n=28, 1 RCT, RR 0.36 CI 0.2 to 0.8, NNT 2 CI 2 to 5), but not other substances (n=89, 1 RCT, RR -0.07 CI -0.6 to 0.4) and no differences were observed in mental state (n=30, 1 RCT, WMD -4.20 CI -18.7 to 10.3). Finally, we found no significant differences for skills training in the numbers lost to treatment by 12 months (n=94, 2 RCTs, RR 0.70 CI 0.4 to 1.1). AUTHORS' CONCLUSIONS: We included 25 RCTs and found no compelling evidence to support any one psychosocial treatment over another to reduce substance use (or improve mental state) by people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results; high drop out rates, varying fidelity of interventions, varying outcome measures, settings and samples and comparison groups may have received higher levels of treatment than standard care. Further studies are required which address these concerns and improve the evidence in this important area.
Abstract: In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.
Abstract: OBJECTIVE: The aim of this study was to ascertain the experiences, views and monitoring practices of Australian child psychiatrists regarding the metabolic and other side effects of second-generation antipsychotics (SGAs). METHOD: A 19-item questionnaire was posted to all members of the RANZCP Faculty of Child and Adolescent Psychiatry living in Australia. RESULTS: Of the 290 eligible members of the Faculty of Child and Adolescent Psychiatry, 126 (43%) returned a useable survey. SGAs are commonly prescribed for a range of disorders. The majority of respondents expressed a high level of concern regarding weight gain and other metabolic side effects. Weight gain was the most frequently observed and monitored side effect in clinical practice. Other side effects were observed and monitored to a variable extent. Notably, monitoring practices did not parallel psychiatrists' reported level of concern or knowledge regarding weight gain and metabolic side effects,nor coincide with published recommendations. CONCLUSIONS: Further research is required into the use, efficacy, side effects and monitoring of SGAs in children and adolescents, and there is a need to ensure that monitoring guidelines are implemented in clinical practice. This need is heightened by the likelihood that our data on clinicians' practice, which is based on their perceptions, may overestimate what actually occurs.
Abstract: Working with and treating individuals with co-occurring substance misuse presents unique challenges for mental health nurses. Substance misuse is common in mental health settings, and its clinical challenges with system barriers impede positive treatment outcomes. To work effectively in everyday clinical practice with dual diagnosis clients, nurses need to consider potential guiding principles. These principles pertain to treatment aims, engagement, assessment, symptoms, care plans, cycle of change, motivational interviewing, traps to avoid, active treatment, relapse prevention, agency collaboration, and treatment diversity. Clinical tools are easily accessible resources that can provide a framework for contemporary practice in a range of settings. Such resources are helpful in practice and as a foundation for orientation, education, self-reflection, and peer review. Setting expectations for everyday practice and ensuring that clients with a dual diagnosis receive the best care possible are important goals for the nursing profession.
Abstract: The centerpiece of quality workshops is guided learning through a balance of group activities and facilitator input. Preferably, a variety of presentation modes are used so that the material is accessed via different learning pathways. It is imperative that the facilitator prepare adequately so that the workshop runs smoothly, is interesting, and targets the appropriate educational level for the participants. This article provides teaching tips on how to prepare for and conduct well-structured, quality workshops.
Abstract: The influence of substance use on patient's needs and caregiving consequences has received insufficient research attention. We sought to determine whether patients with comorbid substance use have higher levels of need, anxiety, depression, and caregiving consequences than those of patients who do not use substances. A total of 520 patients participated, and those who used substances (n = 216) reported higher levels of unmet needs, anxiety, and caregiving consequences than did patients who did not use substances. Carers of patients who used substances also reported higher anxiety and more caregiving consequences. Very few patients were actively involved in treatment programs to reduce their substance use.
Abstract: Without evidence, clinicians may inadvertently be providing treatment that is not necessarily best for some consumers. If consumers, carers, and staff have different views about what type of services are best and which treatments are most effective, it is in all our interests to know more about these differences and find common ground. This article provides an overview of factors that require consideration and action for collaborative research to be successful. Actively involving consumers and carers in mental health research may improve the quality of research and has the potential to enhance clinical outcomes. However, a range of challenges must be overcome, which include insufficient training, extra time requirements, stress and non-representativeness, and the impact on research projects, consumers, and researchers. These factors apply equally to carers and, arguably, staff. With sufficient motivation, commitment, and funds for the requisite time, all of these disadvantages could be overcome or at least minimized.
Abstract: The purpose of this research was to survey staff and patients about their experience, knowledge, and attitudes regarding research. One hundred and sixty patients were interviewed using a questionnaire. In addition, a modified version of the same questionnaire was sent to multidisciplinary staff (n = 476), and about two-fifths (n = 181, 38%) were returned. Participants were interested in research and keen to know more about methods and processes. There were significant differences between staff and patients in terms of attitudes towards evidence-based practice and knowledge about research. The findings support the notion that staff and patients hold similar views about research methods and influences.
Abstract: OBJECTIVE: To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. METHOD: The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. RESULTS: When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. CONCLUSIONS: Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.
Abstract: We aim to increase understanding about issues affecting 'consumer consultants' at an Area Mental Health Service level in the hope that consumers and mental health staff are informed of the challenges and changes associated with that role. Anecdotal feedback indicates that consumer consultants are working harder than ever and that their role is more diverse and challenging than before. Increased organizational demands and responsibilities are testing traditional roles and approaches. There is opportunity for greater sharing of expertise and skills among health professional staff and consumer consultants to enhance current work practices, increase workplace satisfaction, and achieve positive patient outcomes.
Abstract: OBJECTIVE: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. METHOD: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. RESULT: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. CONCLUSION: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published--and getting started in writing--does not hinge on conducting formal research or receiving research funding.
Abstract: This cross-sectional study was conducted across inpatient facilities of a metropolitan mental health service in Sydney, Australia. Given shorter lengths of stay in acute inpatient facilities, it is important to ascertain differences between patients' and carers' perceptions of need and support in order to guide delivery of care in the community. The objectives were to: (1) assess the needs of patients recently admitted to hospital and ascertain the level of carer involvement while in hospital; (2) compare the degree of agreement between patients' and carers' perceptions of need and caregiver burden; and (3) determine the relationship between levels of need and carer burden prior to hospitalization. Over a 2-month period, consecutive patients (n = 200) were interviewed using the Camberwell Assessment of Need Short Appraisal Schedule and a modified version of the Involvement Evaluation Questionnaire to assess basic needs and patient perceptions of caregiver burden, respectively. Of the 200 patients interviewed, 68% (n = 135) identified a carer. Patients with schizophrenia had most met needs, those with affective disorders had most unmet needs and patients with other diagnoses recorded the lowest number of needs overall. The level of agreement between patient and carer perceptions of need was low, possibly because of confusion about the definition of need or different views about the support required to fulfil a need. Patients underestimated the consequences of caregiving, especially the impact of strained atmosphere, global burden, worrying about their future and encouragement to undertake an activity, indicating that carers were more burdened than patients perceived them to be.
Abstract: In this study, individual semi-structured interviews with key nursing staff were undertaken across a metropolitan mental health service in Sydney, Australia to ascertain their views, knowledge and experiences in regard to the development of nursing programmes for nurses new to mental health nursing, trainee enrolled nurse programmes and undergraduate placements. Interview topics were based on information obtained from a survey of nurses participating in these programmes, a review of the literature, consultation with senior nurses and exit interviews. The interviews were analysed for recurring themes to increase understanding of factors that facilitate satisfaction. These findings are valuable for health administrators, nurse educators and clinical support staff and may contribute to the development of 'better practice' in the areas of recruitment and retention and nurse education.
Abstract: Clinical supervision [CS] for mental health nurses in inpatient settings in Sydney, Australia, is virtually nonexistent despite over a decade of discussion regarding its benefits to staff, patients, and organisations. Whilst there is general agreement about the merit of CS, its ad-hoc implementation and the use of models that do not correspond to the realities of the environment have led to its adoption being somewhat half-hearted. It is unsurprising then that there is an absence of achievable policy regarding CS making its integration into modern inpatient units even harder to attain. In this paper, we outline some pragmatic issues concerning CS and advocate for facility-specific professional development and support processes that incorporate succession planning opportunities. This we believe has the potential to promote professional behaviour, continuous learning and development, cohesive teamwork, and ultimately a change in culture regarding CS.
Abstract: For many mental health consumers living in the community, friends or relatives provide day-to-day care and support. Consequently, mental health nurses are increasingly required to work collaboratively with carers and integrate their perspective into patient care. Despite this, research suggests that communication between healthcare workers and carers is poor and training in imparting information to carers effectively and encouraging their involvement has been negligible. In recognition of this, it was deemed important to develop a self-directed learning programme for mental health nurses who wish to enhance their skills in carer partnership. Many nurses are interested in developing their clinical leadership abilities and this programme provides an opportunity to demonstrate expertise through portfolio development in a key area of healthcare delivery. This innovative programme provides educative opportunities to nurses who are frequently busy, work rotating rosters, and have competing demands upon their time. It is open to all nurses irrespective of position or setting and utilises a purpose-designed workbook based on contemporary learning principles. This approach is not without its limitations however. In this paper we share our experiences and hope that it may inform others planning innovations to develop practice through education.
Abstract: There is increasing emphasis on enhancing consumer and carer participation in the planning and provision of mental health services. However, health professionals, consumers, and carers have different perceptions about what constitutes optimal care; identifying, negotiating, and meeting their respective needs can be challenging. The aim of the paper is to highlight the challenges of facilitating carer participation in daily practice and emphasize the broader issues that would benefit from more extensive discussion among health professionals. By examining the strategies used to enhance consumer participation, there is the potential to avoid many of the mistakes of the past and create a flexible and responsive framework to increase carer involvement. The authors anticipate that this discussion will resonate with many clinical staff as well as carers themselves. Identifying barriers to carer participation opens the way to promoting collaboration and enhancing care.
Abstract: A structured clinical leadership program was developed to assist nurses working in a metropolitan mental health service to develop and consolidate clinical leadership skills. The Nurses' Self-Concept Questionnaire (NSCO) was used to elicit responses from participants prior to commencement of the leadership program and again at completion. Findings indicate that the program was considered useful and its benefits were carried over into the workplace via the sharing of information. The self-directed nature of this program was found to be an effective way for clinical nurses to undertake continued professional development within the exigencies of clinical practice.
Abstract: This note is about the use of email and its role in mental health settings. We anticipate that it may be of assistance to mental health nurses unfamiliar with the benefits and pitfalls of email and wanting to learn more about how to use it professionally and effectively. In mental health nursing, we pride ourselves on our interpersonal skills and being able to communicate. However, transferring these skills to an electronic medium is not always easy. Because many of us are self-taught, there is potential for email to be a hindrance rather than a help in the quest for good collegial relationships. In this note, we discuss some of the common situations that can arise when email use goes awry and provide some helpful tips for getting the most out of email. It is hoped that the information and checklist provided in this paper will strike a chord with many, encouraging discussion and promoting appropriate use of this form of communication.
Abstract: Various lifestyle factors contribute to morbidity and mortality. Health promotion programs have the potential to increase awareness about, and possibly modify, some of these factors. In the workplace, these programs can be accessed by large groups of people. A healthy lifestyles programme was piloted for non-clinical staff in Central Sydney Area Mental Health Service, Australia. The aim of the programme was to provide non-clinical staff working in a mental health setting with education and information on a range of health conditions and topics. A needs analysis survey, along with formal and informal liaison and discussion, informed the programme's development and implementation. A total of 28 sessions were held; attendance ranged from 1 to 51 with a mean of 13.57 and a median of 12.5. Feedback regarding the programme has generally been positive. This pilot demonstrates that nurses, with their colleagues from other disciplines, are well positioned to deliver health promotion and education initiatives that may contribute to increasing awareness, and possibly modification, of lifestyle factors.
Abstract: In recent years, efforts have been directed towards making mental health nursing more evidence-based. Making evidence based practice (EBP) a reality in modern health services requires due attention to service planning and management. It is acknowledged that there are many challenges and barriers to implementing EBP as outlined in this article. However, by using an example from our mental health service and drawing upon the literature, we show that a variety of techniques can be used to incorporate EBP into everyday practice. A combination of approaches is recommended, including education and training, leadership programs, research units, dissemination of research findings and structural changes to draw upon the expertise of key clinical, education, management and research staff.
Abstract: Workbooks are often used for discipline-specific learning in academic institutions but there is growing recognition of their potential usefulness in the clinical setting to promote learning and professional development. The purpose of this paper is to share some tips/guidelines for those clinical staff interested in developing self-directed learning programs using a workbook approach. Combined with skilled facilitation, custom designed workbooks based on adult learning theories can enhance skills and encourage portfolio development in the clinical setting. This cost and time effective approach utilises existing resources to cater to diverse needs and topics, building sustainable collaborations. This paper will argue that the proposed program has the potential to contribute to healthcare improvement by promoting skill development amongst staff and contributing to evidence-based practice.
Abstract: The difficulty in attracting graduates of undergraduate nursing programs into mental health remains a challenge for the field. Positive clinical experience has been identified as a potential strategy in encouraging students to regard mental health nursing positively. This paper reports the findings of a survey administered to Undergraduate Nursing Students and Trainee Enrolled Nurses within the mental health area. The purpose of the survey was to measure satisfaction with clinical placements within an Area Mental Health Service. The information provided from the survey is directing the on-going development of clinical placements, clinical supports, education programs and recruitment and retention initiatives for nurses within the Central Sydney Area Mental Health Service. The findings indicate a generally high level of satisfaction with the clinical placement undertaken, however a number of strategies to improve satisfaction with placements were identified.
Abstract: Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.
Abstract: Increased consumer participation, clinical governance, accreditation, and occupational health and safety requirements have contributed to considerable changes in the demands placed upon mental health staff, and many are now expected to undertake or participate in research. However, many staff have not received formal training in research design and methodology, and the multitude of policies, procedures, and committees, designed to protect research participants, can seem like insurmountable barriers to clinicians new to the field. In response to this, a guide was developed based on self-directed learning principles, to compliment other resource material and promote effective research work. It was considered important to clarify some of the issues surrounding research development, ethics, and scholarly integrity, and to educate staff as to the appropriate approval processes, which must be followed before embarking on research work. This paper seeks to describe the process of developing a guide for novice researchers, its key characteristics, and its implications for practice. The guide 'Undertaking research: a guide for the beginner' described in this paper, provides a helpful resource that can be readily adapted and developed for a variety of workplaces and professional backgrounds. It is a strategy intended to encourage research and ongoing education and narrow the research-practice gap while placing minimum demand upon existing organizational infrastructure.
Abstract: OBJECTIVE: The objectives of this study were to: (i) obtain baseline data on the extent of carer involvement across a representative sample of hospital and community patients within an integrated area health service; and (ii) examine perspectives on discharge planning and community care among patients and their carers to identify information and resources they consider important. METHOD: Over a 4-month period, inpatients before discharge and patients accessing community mental health services participated in face-to-face interviews. Information was collected about carer involvement and, with the patient's consent, the identified carer was sent a similar survey to determine demographics and information needs. This resulted in a representative sample of patients and carers accessing inpatient and community settings across a metropolitan mental health service. Support needs and carer burden were also assessed but are not reported here. RESULTS: A total of 407 interviews were completed, 207 in inpatient settings and 200 in the community. An inpatient response rate of 70% and a community response rate of 75% was achieved. Across both settings, 67% of patients identified a carer and a carer response rate of 28% was then obtained. We found carers and patients have different priorities regarding the information they want and information is often not provided to carers. Furthermore, patients were more confident in their ability to manage their mental health in the community than carers. CONCLUSIONS: This study yielded important baseline data about the number of patients who have a carer. We were also able to determine that routine clinical information provided to patients and carers is inadequate from their perspective. It is anticipated that this initiative will assist ongoing service planning and improve partnerships with patients and their carers.
Abstract: The recruitment and retention of the mental health nursing workforce has been identified as a major issue both nationally and internationally. Transition to practice programmes has been identified as an important strategy in addressing these issues. There is, however, a paucity of literature addressing the potential or effectiveness of transition programmes in achieving these aims. This paper reports the findings of a survey administered to registered nurses at the commencement and completion of the Transition Programme into Mental Health Nursing, in Sydney, Australia. The findings suggest a high level of satisfaction with the programme. The results are directing the ongoing development of clinical placements, clinical supports, education programmes and recruitment and retention initiatives for nurses within the Central Sydney Area Mental Health Service.
Abstract: In this paper, the cultural realities of clinical supervision (CS) in acute inpatient mental health settings are explored using an ethnographic approach. Findings suggest that there is a verbal acceptance of CS by mental health nurses but a cultural belief that it has limited experiential value and, thus, a cautious attitude towards its adoption is in practice. This may, in part, be attributable to many nurses believing that they are already undertaking CS, although the informal supervision described does not fit with established definitions of formal supervision. The language used by nurses demonstrates an understanding and appreciation of the benefits of clinical supervision. However, the belief that existing structures inherent to nursing practice already convey these benefits may contribute to the culture of passive resistance to clinical supervision revealed by the findings. This study contributes to current discussions regarding the purpose of CS, the realities of its implementation, and its role relative to existing professional support opportunities.
Abstract: There is a general expectation for health service employees to present their work in oral or written format to showcase clinical ideas, innovations, service developments, and quality and research initiatives. This research note outlines the types of forums where work can be presented and highlights their relative merits. It is anticipated that this discussion will be of interest to clinicians, managers and researchers when considering where best to present their work.
Abstract: The purpose of this ethnographic study was to understand how nurses construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reform. During a 5-month period, fieldwork observations, interviews and discussion groups occurred in a 22-bed acute inpatient mental health facility in New South Wales, Australia. The findings demonstrate how the current role of acute care has resulted in nurses working in increasingly complex environments characterized by competing priorities and new demands. Nurses struggled to fit the changed service philosophy with traditional models of practice within this fluid and changing environment. The findings are relevant within the context of current debates and can be used to enhance the understanding of contemporary acute mental health nursing practice and inform the continued development of mental health nursing in these settings.
Abstract: The oral and written presentation of work arising from clinical practice, service development, quality improvement projects and research is presently encouraged and supported. Because this work may involve consumers, staff and the organization, it is important that proper consideration is given to how the work is disseminated, including any ethical implications. There is a need to ensure that consumers, staff, facilities, the organization and intellectual property are protected from any potential concerns that may arise. This research note provides protocols and a checklist that may be of interest and may be relevant for clinicians and researchers to review and appraise their work before oral or written presentation.
Abstract: This ethnographic investigation was concerned with the way mental health nurses' construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reforms of the 1990s. The setting for this study was a 22-bed acute inpatient mental health facility. Over a 5-month period, data were collected through fieldwork observations, focused interviews and discussion groups. In this article, common cultural practices in relation to the imperatives of relationships, power, restrictions and safety are discussed. The findings demonstrate how the client stabilization role of the unit locates these imperatives as central to the delivery of nursing care. The discussion reveals nurses negotiating relationships that are contradictory and challenging in ordinary and everyday ways within the exigencies of daily practice.
Abstract: Seclusion continues to be used as a last resort in many acute in-patient mental health facilities, hence, mental health nurses must consider a range of strategies to improve seclusion practice. This article reviews selected literature to glean relevant information to provide to patients regarding seclusion protocols, rationales, and aims. Some postseclusion debriefing, nurse education, and organizational monitoring issues are also briefly discussed. The provision of supplementary written patient information about seclusion processes has the potential to decrease patient anxiety and fear. This initiative involves collaboration with consumer consultants to creatively develop effective solutions to some long-standing patient-identified problems associated with the experience of seclusion.
Abstract: This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.
Abstract: BACKGROUND: Gaining consumer feedback about nursing care and discharge planning is especially important given the changes that have occurred in acute inpatient mental health facilities. Consumers can best define the quality of the service they receive and surveys are considered to be good sources of information about nursing care and discharge planning. AIM: The aims of this study were to clarify consumer discharge needs, ascertain consumer perceptions of helpful practice, identify areas that require improvement, identify resources consumers deem important, ascertain satisfaction with specific aspects of services, and obtain baseline data to improve future discharge planning. METHOD: Satisfaction-with-services and discharge questionnaires were completed by clients (39 and 45, respectively) prior to discharge from three acute inpatient mental health units over a 2-month period. FINDINGS: Findings indicated that clients were most satisfied with the respect they received from staff, attention staff gave to concerns and worries, quality of service provided by nurses, way treatment met client needs and overall stay in hospital. The majority of respondents (95%) indicated that their discharge arrangements were explained to them and 90% were satisfied with these. Whilst over two-thirds indicated that the information provided in hospital to assist with discharge had been helpful, they highlighted some areas for service improvement. Resources to prepare them better for discharge included increased contact with consumer consultants and more information about mental health problems, medication and relapse prevention. CONCLUSION: This study constitutes another small step towards decreasing the gap between consumer expectations and actual treatment by asking consumers about their perceptions of discharge planning. The findings provide the basis for the development of more appropriate strategies to improve the continuity of services between hospital and community mental health settings.
Abstract: Ethical practice guidelines (EPGs) were developed for use in Central Sydney Area Mental Health Service to guide contemporary mental health nursing practice and serve as a resource for clinical mental health nurses in relation to their professional conduct and practice. This survey of mental health nurses aimed to ascertain feedback on the application of the EPGs in the clinical arena. Nurses from the Central Sydney Area Mental Health Service (n = 350) were asked to complete a 15-item survey developed by the authors. A total of 121 nurses completed the survey. Findings from the survey reveal that the information provided in the EPGs is useful (91%) and the EPGs provide sufficient guidance for practice (94%). Most respondents (96%) reported feeling confident dealing with ethical practice situations and 75% indicated interest in further education and training in this domain. Findings from this survey support the need to explore avenues to facilitate education, discussion and reflective practice in relation to ethical mental health nursing practice.
Abstract: Nurses are increasingly developing and coordinating quality improvement projects under the auspices of state, area health service and organization policies, however, ethical frameworks are commonly absent. This study aims to define key terms, provide an overview of current policy in relation to ethics and outline some procedures and processes for mental health nurses involved in such projects. The use of appropriate ethical frameworks has the potential to foster participation and safeguard participants by providing a greater assurance of integrity and confidentiality regarding quality improvement data collection, utilization and dissemination.
Abstract: It is increasingly common for mental health nurses to develop and implement quality improvement and/or research projects. The requirement that these activities be conducted in accordance with local, state and national policy; organizational accreditation frameworks; and within ethical frameworks is daunting. This paper aims to define relevant terms, relate some of the competing demands to each other and outline a pathway for developing nurse-based quality-related projects. When a specific exemplar is required, protocols from Central Sydney Area Mental Health Service will be drawn upon as it is likely that policy developed in this health area will not be significantly different to that of other health areas in New South Wales and other Australian States.
Abstract: There is an increasing pressure for mental health nurses to engage in research and quality improvement activities to demonstrate how nursing care contributes to improved patient outcomes. This paper describes the evaluation of an educational program, particularly its impact on participants' attitudes towards and confidence in the measurement of patient outcomes. Nurses from the Central Sydney Area Mental Health Service (n = 38) participated in one of two 1-day workshops. The participants were asked to complete three surveys. The first prior to the commencement of the workshop, the second on completion of the workshop and the third 3 months later. The findings suggest the workshops were beneficial to participants in many areas relevant to the measurement of outcomes. The recommendations made on the basis of this study are described.
Abstract: A survey of mental health staff experience, knowledge and attitudes regarding the management of clients with a diagnosis of borderline personality disorder (BPD) aimed to obtain baseline data to provide direction for developing planned education and determining staff willingness to participate in such training. A 23-item questionnaire was developed and posted to mental health staff in a public Area Mental Health Service in New South Wales (n = 516). A total of 229 staff completed the questionnaire. Most staff (85%) reported having contact with clients who have a diagnosis of BPD at least once a month or more frequently, with 32% of respondents reporting daily contact. Eighty per cent of respondents found dealing with clients who have a BPD to be moderate to very difficult; 84% of staff felt that dealing with this client group was more difficult than dealing with other client groups. Most staff (82%) believed that, as mental health professionals, they had a role in the assessment, management and referral of clients with BPD, as well as in educating and providing information. Staff readily identified resources which would be helpful to them when working with such clients. It was encouraging to see that the majority of staff (95%) indicated their willingness to gain further education and training in the management of these clients. Although many staff believed they were knowledgeable about and confident in managing these clients, most staff also indicated difficulties posed by these clients and perceived a need for further education and training in this area.
Abstract: The management of aggression in inpatient psychiatric facilities is a major concern for nurses. Despite the prevalence of research on aggression within psychiatric settings, very few studies have tracked the clinical management of identified patients in a systematic manner. The overall aim of this study was to explore the clinical management of patients identified as potentially aggressive in psychiatric inpatient settings. A multimethod approach was used to collect the data. This included surveys, focus groups, and a file audit of patients identified from a random sample of completed aggression incident forms. The findings indicated that 88% of nurses who participated in the survey were assaulted and indicated the need for risk assessment; team management and review; and the importance of the first 5 days of admission as crucial for assessment and review. The development of support structures, formal preceptoring and supervisory arrangements and postincident supports were suggested as part of an overall strategy to support nurses working in acute inpatient settings.
Abstract: The practice of special observation (or constant observation) is widely used in inpatient psychiatric facilities for the care of people who are suicidal. In this study, the policy of special observation was examined using a discourse analysis method to discern prevailing ideas and practices highlighted within the policy. After reading, studying and analysing the special observation nursing policy, the authors briefly describe the document and outline the terms and phrases prevalent within the document. These recurrent ideas are then organized into five categories: professional responsibilities, suicidality, the patient's immediate context, the patient's observable behaviour and the nursing checklist. In discussion of the policy document, the invisibility of the authors, target audience and patients is noted. The authors attempt to elicit evidence for the therapeutic nurse-patient relationship in the document. In the analysis of patient, nurse and doctor roles and responsibilities, it is evident that the policy document reinforces the traditional medical hierarchy of power relations. Some assumptions that underpin the document are postulated. Questions regarding the nature of risk assessment and the evidence base for the medical prescription of special observation are raised. As well as ideas and themes evident in the document, the absence of some relevant issues is explored. While the need for succinctness and clarity in policy documents is acknowledged, the fact that patient rights, therapeutic processes and ethical dilemmas are absent is deemed significant.
Abstract: There is limited information on the views of mental health staff about computers. The present study aimed to ascertain the patterns of use, attitudes and expectations of staff from a comprehensive mental health service regarding computers before and after the purchase of new equipment and training. A questionnaire was sent to staff of the Central Sydney Mental Health Services working in sites targeted for new computer equipment and training. Most respondents, especially those with computer experience or who had worked in mental health for less than 5 years, viewed computers favourably. At the same time, half the respondents did not feel they had sufficient access to a computer at work and the vast majority had not received training as intended. Commitments to provide computer equipment and training must be followed through, otherwise staff may feel disenchanted and computers may be regarded less favourably. A measure of the positive views about computer use ('positivity index') developed during the course of the current study may have wider applicability.
Abstract: OBJECTIVE: The aim of this study was to assess the experience, knowledge and attitudes of mental health staff regarding patients' problematic drug and alcohol use in order to provide direction for planned drug and alcohol education. METHOD: A 47-item questionnaire was developed and individually posted to all mental health staff employed by Central Sydney Area Health Service (n = 536). RESULTS: Three hundred and thirty-eight (63%) staff members completed the questionnaire. Thirty-six percent of respondents had received drug and alcohol training and 41% had drug and alcohol work experience. Drug and alcohol training and work experience were associated with increased drug and alcohol knowledge. Respondents' perception of their knowledge and competence was positively correlated with their actual knowledge. Most staff reported having regular contact with patients with psychotic illnesses and drug and alcohol problems. The majority considered the management of this patient group difficult and currently inadequate. Seventy percent believed that as mental health professionals they had a role to play in the management of their patients' drug and alcohol problems. Almost all (95%) were willing to participate in further education and training in this area. CONCLUSIONS: Mental health staff are often confronted with drug and alcohol problems in patients with psychotic illnesses. They perceive a need for drug and alcohol education and training specific to the management of these patients. Future research will need to evaluate outcomes of education and training programs for both staff and patients.
Abstract: Nurse-patient interaction in acute psychiatric in-patient facilities has been the subject of much discussion in the literature and remains a contentious issue. How and why nurses interact with patients in the acute care setting requires definition within the current dynamic environment of mental health service provision. Factors which impact on the manner in which nurses care for patients also require investigation. This article presents the findings of a collaborative research study that investigates factors that influence nurse-patient interaction in the acute psychiatric setting. Ten nurses on the study ward were given opportunity, through semi-structured interviews, to outline and describe the factors perceived to influence nurse-patient interaction. Factors identified as influencing interaction included the ward environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. Issues which emerged from the study provide managers and clinical nurses with an opportunity for generating new possibilities for nurse-patient interaction. However, these issues must be addressed in a sensitive way that takes into account the complex and dynamic nature of acute care settings.
Abstract: Special observation is a nursing practice utilized in in-patient psychiatric facilities for patients who are suicidal. Special observation is carried out by an allocated registered nurse remaining continuously at arms length from, or within sight of (as specified), the patient; or a registered nurse observing the patient within a 30 min interval. In this exploratory study, we investigated the role of the registered nurse when caring for patients on special observation. Semistructured interviews were conducted with 10 randomly selected registered nurses from 4 acute psychiatric wards. The 9 themes that emerged were: 1) Safety; 2) Therapeutic relationships; 3) Supporting patients and carers; 4) Consequences of special observation for nurses; 5) Continuity of care concerns; 6) Peer support; 7) Suicide indicators; 8) Responsibilities and rights: nurses and patients; and 9) Nurses, doctors and the hospital hierarchy. Recommendations for alleviation of the concerns about the practice of special observation are outlined and discussed.
Abstract: In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.
Abstract: Outcome measurement is becoming an integral part of health-care delivery. The attitudes of staff towards this development are important as they may influence ratings themselves, improve the design of measures and indicate how outcome assessment should be introduced into services. In this preliminary study, we surveyed staff from Central Sydney Mental Health Services who had taken part in a Commonwealth-funded project which had required them to rate patient outcome. The major concern expressed by respondents was that rating outcome was too time-consuming. More than half were not in favor of measuring outcome routinely even if it meant providing a better service to patients. The study methodology had limitations. However, if our findings are corroborated, attention will need to be paid to staff attitudes to outcome assessment so that ratings are more reliable and valid, properly inform treatment and meaningfully influence resource allocation.
Abstract: The present study explored residents' perceptions of life in boarding houses within the Central Sydney Area Health Service. A purposeful sample of 14 people with a mental illness participated in semistructured interviews. The transcribed interviews were analysed for lifestyle issues to increase understanding of the factors that impact on quality of life from the consumers' perspective. It was encouraging to find that basic needs were being met, but it would appear that there is considerable room for improvement in quality of life for this vulnerable group of people. The findings of the present study should prove valuable for policy makers and health professionals who provide services to people with mental illness resident in boarding houses.
Abstract: In recent years, expressions of concern about the safety of women in mixed sex wards have been noted. The purpose of this exploratory study was to give hospitalized women with a diagnosis of mental illness the opportunity to describe their experiences in mixed sex wards. A qualitative study, using focus groups, was conducted. The three major themes that emerged from the study were: (i) environment; (ii) gender; and (iii) vulnerability. The study incorporated a feminist and phenomenological perspective. In essence, the study found that although some women had experienced problems with safety, they indicated they would prefer mixed sex to single sex wards.
