34th Annual International Australian College of Mental Health Nurses

Patients, nursing staff and patients’ relatives perceptions of ward atmosphere in four Jordanian psychiatric hospitals

AHMAD AL-SAGARAT, JANETTE CURTIS, PATRICK CROOKES

University of Wollongong, Wollongong/NSW, Australia

Background

The atmosphere of the ward is one crucial dimension in the treatment and process of recovery from mental illness. Ward atmosphere is composed of a unique set of characteristics that give the setting unity and coherence and relates to the internal environment of an organisation as perceived by staff, patients and visitors (Ajdukovic 1990). These properties are assumed to have a major influence on behaviour and therefore on recovery. By measuring ward atmosphere, changes can be made which will ultimately result in better patient outcomes.

Methods

A Ward Atmosphere Scale consisting of two measures, the Real form, which requires participants to rate their ward as they perceive it, and the Ideal form which requires participants to rate their ward on how they would like to see it were distributed to 267 mental health patients, their relatives and nurses in four Jordanian Psychiatric hospitals.

Results

Participants in all hospitals expressed the opinion that many changes could be implemented to improve the atmosphere of the wards. They recommended higher levels of involvement by patients, including more group activities and skills to assist them to rehabilitate back into the community. The participants also recommended that more support should be given patients by nurses and other patients. Importantly, they felt that anger and aggression could be minimized and that organization and programme clarity should be improved.

Conclusion

This study demonstrates that ward atmosphere is an important component in the treatment and rehabilitation from mental illness. By listening to patients, their relatives and staff and implementing relatively minor changes to treatment programmes could result in better patient outcomes, may reduce aggression and make the ward more cohesive and productive. Ultimately, by offering better treatment it could result in shorter hospital stays for patients and improve ward atmosphere for both staff and patients

Top of page

Re-evaluating the design of seclusion rooms for psychiatric intensive care units.

Katrina Anthoney

University of New England, Armidale, Australia

This paper explores options for seclusion room design in a typical Australian PICU. To incorporate into clinical practice, current advances in thinking and technology and to improve the humanity of seclusion, if seclusion is to be used at all. Examination of work practices, shows that seclusion is used for many reasons for many different types of patients and illness crisis, therefore a modifiable room design is proposed, primarily developed with Snoezelen Room principles as a foundation, incorporating the best current practice, modern technology and alternative ways of thinking. Parallels exist between original methods of seclusion and those methods we use today, by questioning our practice and adopting alternatives, the quality of our care in intensive care units can be upgraded. International perspectives have recently highlighted the context of seclusion in today’s health care environment, where maintaining wellness is a priority and minimising any longer term effects of harm of seclusion on the patient is a prime objective.

Top of page

An evaluation of the impact of the Chief Nursing Officer's Review of Mental Health Nursing – preliminary findings of a national review of Higher Education Institutions and Mental Health Trusts in England.

John Baker, John Playle, Karina Lovell, Pauline Nelson

The University of Manchester, Manchester, United Kingdom

Background: Nurses are the biggest professional group in mental health in the UK. Mental Health Nursing takes place in an increasingly wide variety of contexts and throughout the last decade, rapid developments in mental health and social care policy, research and service delivery have significantly affected the work of MHNs. In April 2005, the Chief Nursing Officer for England announced a major review of mental health nursing and the final report made 17 recommendations for current and future practice and education (DoH, 2006). The current study was consequently carried out to provide a rigorous, evidence-based assessment of both progress and impact, to help identify key facilitators and barriers to change and to enhance the sharing of good practice.

Aim: To evaluate progress towards and impact of implementation of CNO review recommendations in Mental Health Trust’s (MHTs) and Higher Education Institutions (HEIs) in England.

Study Design: A structured, web based, secure electronic survey, of all MHTs (n=69) and HEIs (n=49) (offering MHN branch programmes) in England.

Expected outputs: 1) A national picture of MHT and HEI’s implementation of the recommendations. 2) Identification of successful and less successful implementers of the recommendations 3) Indicators of perceived key facilitators and barriers for implementation of recommendations which will form a basis for in-depth exploration in a later stage of the research.

Top of page

Enhancing the use of PRN psychotropic medications in acute mental health wards.

John Baker, Karina Lovell, Neil Harris

The University of Manchester, Manchester, United Kingdom

Background. Pro re nata (PRN) psychotropic medication is regularly prescribed and administered in inpatient mental health care. Approximately 80% of inpatients receive PRN psychotropic medications during an admission. The most frequently administered PRN medications are benzodiazepines and typical antipsychotics. The use of antipsychotic medications as PRN contributes to polypharmacy, high doses and potentially dangerous drug interactions. Previous research into this area has mainly been retrospective analysis of case notes, and has been hampered by poor quality and imprecise documentation.

Aims. The aim of this study was to contribute to improving the practice of prescribing and administering psychotropic PRN medication in acute mental health wards through the development and testing of a good practice manual.

Methods. The study employed a two phase design. The first developed a good practice manual. Four studies contributed to this, a literature review, interviews with the multi-disciplinary team (n=59) and service users (n=22), and a Delphi study with experts (n=18). The second phase used a pre-post test design to undertake an exploratory and acceptability trial of the manual.

Results. In phase one (theory and modelling phase) nine themes of good practice emerged. In phase two (the trial) 28 of 35 patients received 484 doses of PRN in the 10 week period. Patients had a mean of 3.6 prescriptions of 14 different PRN medications in 34 different dose combinations prescribed. Prescription quality improved following the introduction of the intervention but quality of nursing notes reduced. Acceptability of the manual to both nursing and medical staff was high.

Top of page

Normalising ECT as a treatment option for patients’ and their family

Danielle Barnes¹, Pauline Nathan², Fiona Laird¹, Geraldine Rolfe¹, Shane Combs¹

¹Joondalup Hospital, Perth, WA, Australia, ²Curtin University of Technology- School of nursing and midwifery, Perth, WA, Australia

Electroconvulsive therapy (ECT) is a treatment often used for a number of mental illnesses. ECT is surrounded by stigma, prejudice and ignorance which adversely impacts on the suffering individual and their family. The sense of isolation, inadequacy and uselessness is reinforced through the negative societal feedback experienced by those suffering from a mental illness and or accepting electroconvulsive therapy as a treatment option.

As mental health workers it is imperative we strive to create encounters where our patients’ experience and dignity are confirmed in a positive manner. All patients have the right to an effective treatment option of his or her preference without having to combat the associated myths and biases that surround ECT.

The purpose of this project is to normalise the treatment process and address the underlying fears and anxieties for both the patient and their significant others. The aim of this development is to decrease wariness associated with the procedure, demystify the process and improve compliance and support from the family members.

The package consists of

· Frequently asked questions

· Step by step process, from work up procedures to return to ward observations

· A memory diary

· Access to an explanatory DVD.

This presentation will highlight data collected through a quality assurance survey of the patients’ feedback on the process and help identify if there is any effect on lessening any fear, confusion or negative expectations of the treatment.

Top of page

What defines the therapeutic relationship of Nurses working in the Mental Health settings? Does the uniform play a part in this relationship?

Danielle Barnes¹, Pauline Nathan², Geraldine Rolfe¹, Kate McGivern¹, Rose Chapman², Shane Combs¹

¹Joondalup health campus, Perth, WA, Australia, ²Curtin University of Technology- School of nursing and Midwifery, Perth, WA, Australia

Nurses working in the mental health setting often identify ‘therapeutic relationship’ as being one of the key tools they use when coping with patients displaying extreme emotions such as aggression, violence, abuse and other symptoms such as depression and anxiety. Although, a review of literature indicated that therapeutic relationship is seen as a key element of mental health nursing, it is often one that nurses’ in this setting have difficulty articulating (Scanlon, 2006).

Does the uniform in the mental health setting play a role in the nurse patient therapeutic relationship? Uniforms in the mental health setting have been gradually abolished since the early 80s, yet the debate of whether some form of uniform should be reintroduced continues. Many studies reported that the wearing of ordinary clothes created a better nurse patient interaction, with levels of anxiety and aggression decreasing. While others reported that there was much to be gained by nurses going back to wearing uniforms.

This qualitative pilot study explored nurses’ ‘definition’ of what constitutes a therapeutic relationship. The following question in relation to uniforms was also explored: Can the uniform be seen as an effective therapeutic tool in the nurse patient relationship in the mental health setting? Does it foster or hinder this relationship? Is there a place for it in some mental health settings? This study was conducted in a setting that had recently introduced a semi-formal uniform. Data was analysed using the constant comparative method of analysis. These findings will be presented in this presentation.

Top of page

Use Of Collaborative Web-Based Technology In Mental Health – Wiki Use In Practice

Rick Bastida

Princess Alexandra Hospital Mental Health Service, Brisbane, Queensland, Australia

Emerging web-based technologies take the online domain to new heights with collaborative platforms enabling communication and sharing.

A wiki is an editable web page. Wikipedia would be the most renowned, however wiki technology offers more than an encyclopaedia - wikis are being used increasingly in private enterprise as a platform for communicating and sharing information and as a collaborative project management tool, due to the inherent ability to allow users to add or update information, while keeping a chronological record for tracking and audit purposes. The education sector uses wikis to create virtual classrooms, where students can work collaboratively on projects and share resources. Libraries use wikis to improve access to catalogues of reference material.

The author could see numerous uses for this technology in public mental health services for clinicians to exchange information and share resources. Due the flexibility of being an online medium without geographical boundaries, use of this type of technology in creating virtual ‘groups’ for mental health service consumers and their carers presents an exciting possibility. While there are advantages to using this technology, there are also potential risks. These must be considered and addressed within any project.

To inform the development and direction of future wiki projects the first step is to undertake a critical review of the literature to learn of others’ work in this field. This paper will present the results of a systematic critique into the use of wikis in mental health.

Top of page

Decisions, decisions: A PECC or a POD?

Michael Blair¹, Anthony Sweeney², Kim Foster³

¹C&HHSD, Cairns, Australia, ²C&HHSD, Cairns, Australia, ³James Cook University, Cairns, Australia

The author will present the development of a mental health POD within a newly redeveloped Emergency Unit in a regional hospital in Australia. Psychiatric Emergency Care Centres (PECC) having been established in many hospital emergency departments around the country, have been the centre of much controversy and discussion amongst the Mental Health Nursing profession.

The decision not to establish a PECC was one that the User Group arrived at through lengthy debate and research. The model of a Mental Health POD as an alternative was considered to be a practical option worthy of examination. The art of design and unit architecture is an aspect of mental health care that followed the decision to adopt this model. The author will attempt to provide an insight into this decision making process and share the design concepts with colleagues.

Top of page

Morale on acute inpatient psychiatric wards in England: the reality is much better than the rhetoric

Len Bowers

City University, London, United Kingdom

Morale on acute psychiatric wards in the UK has been considered to be problematic, and is reported to contribute to lower quality patient care. The aim of this analysis was to assess the relationship of staff morale to patient, service environment, physical environment, patient routines, conflict, containment, staff demographics, and staff group variables. A multivariate cross sectional study was undertaken collecting data on morale (Maslach Burnout Inventory) and other variables on 136 acute admission psychiatric wards in England. Morale was higher than published comparison samples. Length of time in post was correlated with low morale, and qualified nurses had higher emotional exhaustion but also higher personal accomplishment. The level of verbal abuse on a ward was associated with low morale, as was a higher level of social deprivation among patients. Higher levels of order and organisation correlated with better morale. Clear policies relating to the management of verbal abuse by patients, high levels of order and organisation, and staff rotation and education, may all support high morale. Acute inpatient psychiatry is generally a happy and rewarding work environment, and identified problems are likely to be due to other factors.

The tragedy of inpatient suicide. What we know, and the implications for future research and practice.

Len Bowers

City University, London, United Kingdom

As part of an ongoing research program into conflict and containment in inpatient psychiatry, literature reviews are being conducted covering the whole area to identify potential common causes. A systematic review of empirical research findings about inpatient suicide is being undertaken, including all post-1960 published work in English, Dutch and German. Searches of electronic databases, coupled with subsequent follow up work, has so far identified 71 studies. Most of these are retrospective descriptive studies, however there are a significant number of case control studies, longitudinal studies, and qualitative studies focusing on suicide ‘epidemics’. This poster will describe the potentially identifying features of inpatient suicides, how and where they occur, and how frequently they occur. Potential preventive strategies will be outlined, and lessons for future research and practice drawn.

Top of page

Paramedics and Mental Health – transdisciplinary approaches to better training and better care

Richard Brightwell, David Buchanan

Edith Cowan University, Perth, Australia

Mental health consumers entail nearly 30% of all paramedical clinical engagements (St Johns, 2007). At the same time a growing interface of acute response services in tertiary mental health services occur in Emergency Departments (ED) across Australia. This means that for paramedics dealing with mental health consumers is not only a substantial part of their work but a part that will likely grow. There is a prima facie case for a better understanding of mental health dynamics between the paramedical, ED and Mental Health Services to integrate and better both training and the level of care ultimately given. The paramedical program has been running at ECU since 2004. It has in common with most professional health programs introduced the contemporary care of mental health in to the first year of the paramedic program. The object of this study is to ascertain if the present course components satisfy the need of the complex dynamics of the practising paramedic and whether a transdisciplinary approach with nursing and post graduate medicine could better facilitate improved educational and clinical outcomes.

Top of page

Sensory (chill out) room trial: A culture change

Graeme Browne, Sue Wentworth, Sarah Cook, Andrea Browne

Gold Coast Mental Health Service, Robina, Australia

Seclusion and restraint are topical as mental health services in Australia and internationally attempt to develop strategies to reduce their incidence. This paper reports on the early stages of a project that evaluates the implementation of a sensory room in an acute inpatient unit. Sensory rooms have various names including Snoezelen rooms, multi sensory rooms and sensory modulation rooms. The Snoezelen room was developed in the 1970s for people with developmental disabilities. It aimed to provide a positive, warm hopeful, calming, recovery oriented treatment environment. Since their inception sensory rooms have been used in a number of settings. These rooms began to be used in mental health services less than 10 years ago.

There is conflicting evidence about the effectiveness of these rooms in the disability and aged care literature. Studies report no effect to significant change to disruptive, acting out and aggressive behaviour. Use of sensory environments is new in mental health care. Where it has been found to be effective it seems to coincide with a cultural change from a rigid routine in the ward to an environment that values the therapeutic relationship between nurse and patient. A culture that respects the patients views on how they can monitor their own behaviour and “handle themselves”. Sensory rooms are one of the tools that nurses can use in collaboration with patients.

It provides more options in crisis management by focusing on early intervention and prevention.

Top of page

Lessons from literature in self efficacy? Why Derrida is important to understanding the science and art of psychiatry.

David Buchanan

Edith Cowan University, Perth, Australia

Jacques Derrida is one of the least understood but most influential philosophers of the last fifty years (Smith 2006). The very term deconstruction reflects both this misapprehension and influence in that the term is commonly used in a way that Derrida never intended. His influence over the demise in the certitude of New Criticism in literature may well yet have huge ramifications for the difficulties psychiatry faces in being certain about what may be going on in mental illness. In particular, this presentation will examine how the presence of that which Derrida termed play in literature is also at work in many of the proclamations we make in mental health and how this play haunts our scientific measures like HoNOS as well as psychiatric nosology apropos the delay the DSM V currently faces. When this play it contextualised with the play that occurs in the neuroplastic brain then Derrida’s true worth as a philosopher is worthy of a much closer inspection in the everyday and very practical applications of clinical mental health practice - particularly when clinical models of self efficacy are about to make their appearance in Australian mental health services (Australian Health Commission on Quality and Safety). This presentation will examine the four main steps of Self Efficacy (Packer 2007) and then examine how an apprehension of play into these steps may not only be important but vital to the future of mental health services as universal and absolute truths continue to elude us.

Top of page

An ethnographic study of forensic nursing culture: Where to from here?

Andrew Cashin¹, Michelle Eason², Claire Newman²

¹The University of Technology Sydney, Sydney NSW, Australia, ²NSW Justice Health, Sydney NSW, Australia

An ethnographic study was conducted in the NSW Justice Health prison hospital beginning in 2006 and completing in 2008. The study involved in depth interviews with the hospital nurses, observation of practice, and collection of cultural artefacts including nursing notes and reports at two distinct periods separated by one year. A migration in the culture was observed across time. The culture moved from one of primarily languid custodial tones to one characterised by a latent energy. Like all energy, to promote movement and transformation of the energy from latent to kinetic, something was needed. This paper describes the ethnography process and findings and what came next, the supported introduction of a nursing model to scaffold practice.

Top of page

Assessing Risk For Older People: A Comprehensive Perspective

Leonie Clancy, Brenda Happell, Lorna Moxham

¹Central Queensland University, Rockhampton, Queensland, Australia, ²Gold Coast Mental Health Service, Gold Coast, Queensland, Australia

The purpose of this presentation is to communicate initial findings from the second stage of the qualitative study titled “Assessing Risk in Aged Mental Health Care”. This four stage study aims to explore current practices, understandings and experiences of risk assessment in aged mental health care, and to use this data to develop, implement and evaluate a model of assessing and managing risk in aged mental health care. In particular this presentation will focus on the findings of focus groups conducted with nurses, consumers and carers, within an older persons’ mental health service. These results provide an important component which serves to inform the development of the model.

It is widely acknowledged that the assessment of risk is a fundamental part of a comprehensive mental health assessment. However, current tools and models of risk assessment used by mental health professionals, focus on adult or child and youth populations. While there may be some commonalities across populations, older people with mental health issues have unique needs. The literature confirms there is limited research exploring risk assessment in relation to older people in mental health care. Additionally, risk assessment in general is often service driven, the needs and voices of consumers and even more so of carers are little heard. This research project intends to address this imbalance.

A portrait of the artist as a young nurse: the making of mental health nurses.

Greg Clark

Sydney South West Area Mental Health Service, Sydney, Australia

Mental health nurses are unique. We all know this even though the reasons for this uniqueness are elusive and difficult to articulate. Some possible reasons for our uniqueness are the ordinary way that we relate to people (Barker, 1999, Jubb-Shanley and Shanley, 2007), being with people at the extremes of human experience and working with the abject body (Bucknell, 2004).

However, this is not the main focus of this paper. The issue of how ordinary citizens who have trained to be nurses develop this uniqueness is what interests me. Altschul (1997) suggests that these people have certain personal characteristics in common. Benner (1984) demonstrated the importance of experiential learning in the making of nurses and clearly, professional socialisation plays a part (du Toit, 1995). This paper discusses these important issues to highlight the essential role that experiential learning and socialisation play in the making of mental health nurses. The qualities and abilities that make us unique are, in many cases, finely nuanced variations of “ordinary” behaviour delivered with extraordinary skill, the “unteachable things of mental health nursing” (Horsfall, 2003).

As experienced mental health nurses it is imperative that we pay close attention to the important work of socialising new nurses and providing opportunities for rich and varied experiential learning. This is the only way to pass on the unteachable things. The future of our profession depends on it and it is vital that we get it right.

Top of page

A mental health nursing assessment in practice: deal or no deal?

Tim Coombs, Patrick Crookes, Janette Curtis

University of Wollongong, Wollongong, Australia

Introduction

Accurate assessment or the gathering and interpretation of information to inform action is the foundation of nursing practice. However, there is little research into the content and process of contemporary practice.

Method

This paper describes a qualitative study of the assessment practice of mental health nurses. Eighteen nurses with various experience, with different roles, and working in either inpatient or ambulatory settings were interviewed and asked to describe the content and process of a comprehensive mental health nursing assessment. Using a grounded theory approach these interviews were reviewed and themes identified.

Results

Data analysis revealed that contemporary mental health nursing assessment is much like the popular television program “deal or no deal”, a game of chance. The interviews revealed no consistent model of assessment with attributes of the consumer, nurse, and environment having a significant impact on the content and process of that assessment. A reliance on organisational factors to define the scope of practice along with a focus on risk assessment and a lack of training were also emergent themes.

Discussion

Without an organizing framework, the ability of nurses to accurately interpret information and take coherent action is compromised. The variability seen in these interviews raises significant issues around the relationship between the accuracy of assessment and the appropriateness of interventions in contemporary practice. The findings have implications for the preparation and ongoing supervision of nurses and highlight the need for further research in this area.

Top of page

Benchmarking mental health services: Harnessing information for quality improvement.

Tim Coombs¹, Jane Pirkis², Philip Burgess³

¹New South Wales Institute of Psychiatry, Sydney, Australia, ²University of Melbourne, School of Population Health, Melbourne, Australia, ³University Queensland, Queensland Centre for Mental Health Research, Brisbane, Australia

Introduction: The National Mental Health Plan¹ has seen significant investment to establish a culture within mental health services were the use of information for quality improvement and benchmarking is the norm. This paper will outline the information development agenda in Australia with particular reference to establishment of a national mental health benchmarking project.

Method – Utilising a nationally agreed mental health performance framework that describes key aspects of organisational performance (effectiveness, appropriateness, efficiency, responsiveness, accessibility, safety, continuity, capability and sustainability) and thirteen agreed key performance indicators², a National Mental Health Benchmarking project brought together 23 mental health services across four program streams (Child and Adolescent, Adult, Older Persons and Forensics) to undertake collaborative benchmarking.

Result – Using the agreed indicators participants were able to compare organisational performance. Examples of variability in indicators across organisations will be presented along with the benchmarking and organisational activities this variability generated.

Conclusions – Collaborative benchmarking to support quality improvement is possible within mental health services. However, benchmarking does require a commitment to the process and an investment of resources. The National Mental Health Benchmarking project has provided valuable insight into organisational performance and developed capacity to support benchmarking in mental health.

References -
1. Australian Health Ministers. National Mental Health Plan. Canberra: Australian Government Publishing Service; 1992.
2. NMHWG Information Strategy Committee Performance Indicator Drafting Group (2005) Key performance indicators for Australian Public Mental Health Services. ISC Discussion Paper No 6 Australian Government Department of Health and Ageing, Canberra.

Top of page

Technology and routine outcome measurement, the opportunity to support decision-making and care planning.

Tim Coombs¹, Philip Burgess², Rod McKay³, Jane Pirkis⁴

¹New South Wales Institute of Psychiatry, Sydney, Australia, ²University Queensland, Queensland Centre for Mental Health Research, Brisbane, Australia, ³Sydney South West Area Health Service, Sydney, Australia, ⁴University of Melbourne, School of Population Health, Melbourne, Australia

Introduction

Computerised clinician decision support systems are information systems that use software algorithms to provide clinicians with such things as alerts on critical values, reminders on overdue preventative tasks or suggestions for active care. With the introduction of measures such as the Health of the Nation Outcome Scales (HoNOS) and K-10 to clinical practice, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has created an online information system called the DST (Decisions Support Tool: http://wdst.mhnocc.org/) designed to give clinicians access to the results of the routine collection of these measures.

Method

A series of consultation workshops with clinicians from adult, child and adolescent and older persons services has been undertaken and a set of clinical prompts have been developed aimed at providing guidance to junior clinicians on appropriate actions given certain scores on measures such as the HoNOS and K-10.

Results

With the use of the DST clinicians are able to access information on the population under care in mental health, not only at points in care such as admission, review and discharge but the amount of change that has occurred overtime. Consultation with clinicians has shown that the DST can be enhanced to provide suggestions for care, supporting decision-making and care planning activities.

Discussion

The use of clinician decision support systems has been shown to improve clinician performance. The ongoing development of systems such as the DST to improve clinician access to information holds significant promise for practice development.

Top of page

Exploring Staff Perceptions of a Youth Early Psychosis Program

Wendy Cross¹, Anne Arnott², Claire Graham², Rosemary Dowling², Dorrie O'Connor², Elizabeth Sommerville², Charanjit Singh¹

¹Monash University, Melbourne, Victoria, Australia, ²Southern Health, Melbourne, Victoria, Australia

Purpose of the Study

The study’s broad aim is to evaluate a youth early psychosis program in a large metropolitan mental health service to gain an understanding of the experience of the individual with a mental illness from a subjective perspective; their carers; the experience of internal stakeholders and referrers to the service. Concepts and insights gained from the study would build on the existing knowledge of early psychosis interventions and its effects on the construction of the self-concept and of related diagnoses. This paper addresses the experience of staff.

What are the mental health service needs of young people, especially those experiencing emerging signs and symptoms of psychosis?

What service delivery aspects and qualities facilitate engagement with mental health services?

What are the attributes of clinicians that facilitate interaction with the service delivery system for young people, their careers /significant others?

Methods

Focus groups were conducted with internal stakeholders. All focus groups and individual interviews are audiotaped with permission and transcribed verbatim. The interview data were analyzed using thematic analysis

Results

Main themes emerging within the data include: engagement, continuity of care, access, staying out of hospital, loss & grief, and support

Conclusions

The results are consistent with reports of other early psychosis programs within the Australian context and note that it isn’t just the timeliness of the intervention that is crucial but the nature of the response to individual need.

Top of page

Drowning In Paper? The Documentary Practices Of Community Mental Health Nurses in the age of information technology

Maureen Deacon

Manchester Metropolitan University, Manchester, United Kingdom

This paper will examine the perceived burden of excessive documentary work by Community Mental Health Nurses (CMHNs). This group, in common with other occupations, persistently complain that such work is growing and that it is having a negative impact on their clinical practice.

The debate will be informed by an ongoing study aiming to explore documentary practices in-depth using a mixed method approach. This includes semi-structured interviews with CMHNs working within two mental health services; collection of the paperwork that they routinely use and following the paperwork to its source through the organisational infrastructure. The data collected will be analysed both qualitatively and quantitatively.

There are few previous studies where the documentary practices of CMHNs have been investigated as a topic in their own right. This study will untangle the complexities involved more rigorously than has been attempted thus far.

I will argue that the solutions proposed to date work from the assumption that current forms of paperwork are necessary. These solutions include proposals that paperwork could be streamlined and supported through bespoke information technology, enabling the work to be achieved more effectively, and that CMHNs should have consistent access to a standard amount of administrative support. A more radical alternative might consist of challenging the need for different types of paperwork and taking the risk of refusing to continually feed the ‘bureaucratic machine’ in favour of paperwork designed specifically to enable quality, personalised care. Given the political and organisational drivers for documentary work, this may require a small revolution.

Top of page

To admit or not to admit that is the question. Can acute inpatient admissions be a therapeutic part of the overall treatment for Borderline Personality Disorder?

Deborah Dick

Spectrum, Personality Disorder Service of Victoria, Victoria, Australia

Acute inpatient admissions for clients dealing with borderline personality disorder (BPD) continue to be a contentious issue for mental health clinicians. Perhaps the question is not if this client group should be admitted or not but about how an acute inpatient admission can be part of a therapeutic approach for an individual.

Without careful treatment planning, with consideration of the treatment principles and the goals of treatment, inpatient admissions can have profound iatrogenic effects for clients coping with BPD. Alternatively if attention is given to thinking through how an acute inpatient admission could be used therapeutically it can be an invaluable part of the overall treatment for BPD. Issues of risk and clinician anxiety often drive the clinicians need to admit a client to hospital. This often occurs without thought about how to support a client to keep herself safe and to perhaps even have a reasonable and maybe even rewarding life in the future.

This paper/workshop will look at the Spectrum’s (the statewide personality disorder service of Victoria) overall principles of treatment for BPD and consider how these need to inform clinicians to work toward the possibility of acute inpatient admissions being a therapeutic part of treatment for BPD.

Top of page

Validity, viability and vitality.

Helen Douglas, Olivia Falvey

Ipswich Hospital, Ipswich, Australia

West Moreton and South Burnett Integrated Mental Health Service has been evolving over the last 14 years from its foundations as a tertiary influenced inpatient care service based in a large institution. From this background evolved a mental health care model that now integrates acute inpatient, case management, community, rural and urban services.

This presentation focuses on the inpatient model and will seek to provide the audience with information to promote, stimulate and strengthen practices, individually and organisationally. The historical and current perspectives and knowledge gained in this service’s evolution is translatable to other services. Some of the achievements include shared consumer and service provider satisfaction, high staff retention rates, a transitioning model for staff movement across inpatient and community settings, inpatient recovery programs, rural outreach clinics, specialist mental health training for shared services and an inpatient based clinical supervision model.

Achieving and sustaining service ‘validity, viability and vitality’ in an evolving and demanding mental health system is complex and testing. An increasingly socially informed consumer group now expects more in these economically challenging times. However, it is possible to meet those expectations, satisfying both people in care and the staff providing that care.

Top of page

Being Resilient As Described By People Who Experience Mental Illness

Karen-leigh Edward

Deakin University, Victoria, Australia

Aim: The purpose of this research was to explore resilience as described by consumers of mental health services in Australia who have experienced mental illness.

Background: Most qualitative research pertaining to resilience has focused on child and adolescent groups. In relation to the Australian context there appears to be a paucity of qualitative studies on resilience and the experience of mental illness.

Method: The study utilized a phenomenological approach elucidated by Colaizzi as the philosophical underpinnings of the study. In keeping with Colaizzi’s (1978) approach to inquiry, information was gathered through in-depth, semi-structured individual interviews. Information analysis utilised Colaizzi’s (1978) original seven-step approach with the inclusion of two additional steps, making this study’s analysis a nine step process.

Findings: Emergent themes explicated from participant transcripts follow: Universality, Acceptance, Naming and knowing, Faith, Hope, Being the fool and, Striking a balance, Having meaning and meaningful relationships, and ‘Just doing it’. The emergent conceptualisation which encapsulated the themes was; Viewing life from the ridge with eyes wide open. - choosing to walk through the darkness all the while knowing the risks and dangers ahead and making a decision for life amid ever-present hardships.

Conclusion: The findings of this study suggest being resilient can be learnt and therefore, should be a fundamental consideration in guiding therapeutic interventions within the context of clinical practice.

Top of page

The Role of Primary Care Practice Nurses in The Delivery Of Depression Treatment To Enhance Clinical Outcome. An Audit of Training Outcomes, Clinical Effect and Satisfaction.

David Ekers

Tees Esk & Wear Valleys NHS trust, Co Durham, United Kingdom

Background

Depression affects 5-10% of the population, is the third most common reason for primary care consultation & a major cause of distress & disability. Most treatment is via primary care costing nearly twice that of inpatient mental health. Less than 10% of depressed people receive treatments such as CBT. In primary care medication is often the only available treatment, optimal outcomes are rare. Collaborative care improves outcomes (Gilbody et al 2006, meta-analysis 37 RCTs 12,3555 participants), such outcomes require replication in routine care.

Method

A 3 day training programme was delivered rural based primary care practice nurses in the UK. Training included depression information, key ingredients of collaborative care, modelling and skills practice. Participants incorporated the approach alongside other chronic condition services (CHD, Diabetes). Clinical outcome and satisfaction (staff/patient) was audited via self report questionnaire (PHQ9) 6 months post training.

Results

Participants rated training as highly acceptable and beneficial. Service users mean symptom level change (PHQ-9) pre-post intervention was 9.07 (SD 6.68, P<0.001) with a large paired sample effect size (Cohen’s d, 1.36) N=136. Results indicate equal efficacy and superior outcomes to cluster TAU control groups. Satisfaction was overwhelmingly positive.

This presentation will outline the rational, training and detailed evaluation of this innovative service. Results will be benchmarked against best available evidence. Incorporating depression into chronic care clinics provides one option of enhancing treatment outcomes. Discussion will focus on potential benefits to UK health settings and beyond and the vital role mental health nurses play in supporting such schemes.

Top of page

Behavioural Treatments of Depression: Do they Work And Can Mental Health Nurses Deliver Them Effectively

David Ekers

¹Tees Esk & Wear Valleys NHS Trust, Co Durham, United Kingdom, ²Integrated health Care Research Dept, Durham University, Co Durham, United Kingdom

Introduction

Depression affects 5-10% of the population, is set to become the second largest cause of disease burden by 2020 and is the third most common reason for primary care consultation. Cognitive Behavioural Therapy (CBT) is the gold standard treatment consisting of both behavioural and cognitive interventions; lack of clarity exists regarding the optimum mix of these. Access to CBT is limited due to the scarcity of therapists. Behavioural therapy alone has been seen to be as effective as full CBT although simpler in construct. Such approaches may offer increased access if BT is suitable for delivery by a wider range of mental health staff.

Method

We conducted a systematic review and meta analysis of randomised trials of individual behavioural treatments of depression to ascertain clinical efficacy of such approaches & develop a pragmatic RCT.

Results

Twenty randomised controlled trials were identified. We found BT to be an effective intervention compared to controls (SMD -0.70, 95% CI -1.0~-0.39) and as effective as CBT (SMD 0.08 95% CI -0.14 to 0.30). All trials used experienced psychotherapists hence parsimony has not yet been demonstrated.

RCT design

A pragmatic randomised trial of clinical & cost effectiveness of BT delivered by junior mental health nurses based upon results of our review has been designed.

In this presentation we outline methodology and results of our review, relate to our trial design and present analysis from our training phase. This will be considered in relation to mental health nurses role in improving access to psychological therapies.

Top of page

Mental Health Nurses’ Therapeutic Optimism: A Tale of Two Conferences

Stephen Elsom, Kay McCauley-Elsom

¹Centre for Psychiatric Nursing; University of Melbourne, Melbourne, Victoria, Australia, ²Monash University, Melbourne, Victoria, Australia

The need for health professionals to have an optimistic clinical stance when working with people who have mental illness has been recognised in the clinical practice guidelines developed by the UK-based National Institute of Clinical Excellence and by the Royal Australian and New Zealand College of Psychiatrists. Therapeutic optimism is defined as the clinician’s expectation of a positive outcome for the consumer. To date, little work has been conducted to determine whether mental health professionals do have an optimistic approach to their patients.

Delegates to two mental health nursing conferences in 2007, the 8th Victorian Collaborative Psychiatric Nursing Conference and the 33rd Annual International Conference of the Australian College of Mental Health Nurses, were invited to participate in a study designed to measure therapeutic optimism. A total of 256 mental health nurses attending the conferences completed a previously developed survey instrument, the Elsom Therapeutic Optimism Scale (ETOS).

This paper will present and discuss the findings of the study with a specific focus on similarities and differences between the two conferences as well as relationships between a range of demographic factors and the delegates’ ETOS scores. Some important directions for further research will also be identified.

Top of page

Starting with a Blank Canvas, How to Manage a Waiting List in a busy CAMHS Service

Julie Ferguson, Rudi Crncec, Greg Clark

Sydney South West Area health Service, NSW, Australia

In many Child & Adolescent Mental Health Services (CAMHS) referral rates are often higher than the service’s ability to provide quality intervention in a timely manner. When trying to find information on how other CAMHS manage their waiting lists there is a dearth of information. Literature searches yield little with one of the main projects that has been conducted being in Western Canada (Smith et al, 2002). The Western Canada project created a tool to manage waiting lists that was a very comprehensive and time consuming process.

The importance of using a simple and user friendly approach was paramount in a busy Sydney CAMHS team. The Children’s Global Assessment Scale (CGAS) has been trialled as a potential tool that is readily available and used by all clinicians working in the field.

With the assistance of the research team the tool was implemented and evaluation of the effectiveness has been reviewed. Validity of the tool was tested within the team; the collection of CGAS data was collected initially with clinicians being aware of the CGAS at intake versus CGAS at assessment. This was then changed to the clinicians being blind to the CGAS scores at intake when allocating CGAS at assessment.

The results have been interesting. The management of the waiting list has been a systematic approach to allocating young people to the waiting list versus being allocated to a clinician immediately. These outcomes have implications for other CAMHS teams dealing with the difficult and often complex issue of how to manage waiting lists effectively

Top of page

Smoke-free Workplace Policy: Reconciling Obedience to Authority, Consumer Rights and Excellence in Evidence-Based Nursing Leadership

Patrizia Fiorillo

The University of Sydney, Sydney, Australia

Introduction: The implementation of the NSW Health Smoke-free Workplace Policy has been a challenging process leading to its temporary suspension of Phase 4 (total ban). Occupational health and safety and concerns about litigation have been the primary aims of the policy and the clinical needs and human rights of people with mental illness have been overlooked.

Methods: This paper describes the process and actions taken by nursing staff in a large, long-term mental health facility to ensure clinically and morally appropriate interventions for people with severe and enduring mental illness. While managers and clinicians initially proceeded with implementation as required by NSW Health they became aware of the need for a more in-depth look at the strategies used and their consequences. Issues such as dependence, withdrawal, diagnosis, psychiatric treatment, paternalism, human rights and funding needs were highlighted.

Results: Increased awareness of organizational, clinical and ethical issues led nurses to advocate for an evidence-based approach considering the rights and needs of consumers, staff and the organization. Medical and Pharmacy staff were enlisted to participate in a step-by-step reduction/cessation plan. Experts in the field were consulted and a nicotine replacement plan that challenges current knowledge and assumptions has been put in place.

Discussion: As nurses we are responsible for identifying areas for improvement and advocate for the wellbeing of consumers in our care. Sound clinical evidence gives power to change policy and practices. Many consumers want to quit and they deserve the best possible assistance in achieving their goals.

Top of page

Evidence Based Practice in Mental Health Nursing – Art or Science?

Jacklin Fisher, Kierrynn Davis

Australian Catholic University, North Sydney, NSW, Australia

In this paper a critique of Evidenced Based Practice (EBP) in mental health nursing will be used as a model to gain insights into the ‘art and science’ of mental health nursing. The critique will examine ‘levels of evidence’ in terms of the major concerns of, and driving forces within mental health nursing practice. Criticism of EBP by mental health nurses is often centred on the belief that EBP and qualitative research are incompatible or that acknowledging the ‘art’ of healing inherent in nursing practice is incompatible with EBP. The debate centres on what counts as evidence in mental health nursing practice. It will be argued that incorporating EBP into mental health nursing is critical in today’s climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health care services. Rather than viewing the art and science of mental health nursing as mutually exclusive it is argued that it may be more useful to nursing practice to regard them as existing on a continuum on which nursing practice constantly shifts. Finally, it is argued that what counts as evidence requires reconstruction within the context of the constant movement between the art and science of mental health nursing practice.

Top of page

Psychotherapeutic Relationship Skills: An Education Program in the Art of Adolescent Mental Health Nursing Practice

Maria Fitzgerald¹, Louise O'Brien², Julie Ferguson¹, Lisa Gartshore¹, Greg Clark¹, Maggie Walker¹, Etienne Kitto¹

¹Sydney South West Area Health Service, NSW, Australia, ²University of Western Sydney, NSW, Australia

This paper describes a collaborative and innovative project between a university and a health service in the development and delivery of a psychotherapeutic relationship education program for nurses working in an acute adolescent mental health inpatient unit.

This initiative arose in the context of national and state plans that promote reform to a recovery model of mental health care. Clinicians in the adolescent unit elected to adopt a recovery model of mental health nursing practice, the Tidal Model.

A high level of knowledge, skill, experience and commitment is required of nurses to provide mental health care to the adolescent and their family whilst maintaining a therapeutic milieu. Few of the nurses had specialist mental health nursing qualifications or experience. The program was designed increase knowledge and skill of psychotherapeutic relationships and interventions, in preparation for the implementation of the Tidal Model of mental health nursing.

A team of nurses came together to develop, deliver and evaluate the education program, delivered in the workplace by senior clinical nurses. Evaluation includes individual consumer, carer, nurse and multidisciplinary team surveys, pre and post intervention. Consumer and carer surveys are conducted by consumer and carer support workers. Impact of the education program on the therapeutic milieu is measured through constant monitoring of data relating to incidents, complaints, and the use of seclusion. To detect any possible effect of the intervention on consumer health outcomes, standardised outcome measures, already in use, are monitored.

This paper details the development and delivery of the education program during the first months.

Top of page

Practice Development and Creative Mental Health Nursing

Maria Fitzgerald

SSWAHS, NSW, Australia

This discussion paper reviews the current context of mental health nursing practice in relation to workforce, mental health reform and nursing governance, and suggests practice development as a leadership vehicle for creative and cohesive professional growth towards mental health reform.

Population changes, a high prevalence of mental health problems, shortfalls in the available and projected mental health nursing workforce, changing settings, scope of practice and models of care, invoke the need for a system that supports innovation in mental health care, care settings, and the configuration and preparation of the mental health nursing workforce.

Restructure and amalgamation have led to massive change in some public sector mental health services. In one of these, amalgamation led to the introduction of a nursing governance structure for mental health nursing. To find practical ways for mental health nurses in the amalgamated service to move forward together, a review of the literature was conducted.

Just as the Magnet Hospital movement contributed to the body of nursing knowledge in relation to recruitment, retention and professional practice in the USA, practice development, a term arising in the nursing literature originating from the UK over a similar timeframe, has impacted on both the nursing academy and the clinical setting.

This paper suggests that practice development could be a vehicle to bring together mental health nurses across the domains of clinical, leadership and management, education and research, together developing our creative practice.

Top of page

Interdisciplinarity: An Art And Science

Elma (Elizabeth Margaretha) Fourie

ANZAP, Sydney, NSW, Australia

Interdisciplinarity[1] draws on insights and perspectives from relevant disciplines and/or models of mind[2] in the way that they are compatible and complement to synthesize a more comprehensive integrated understanding and holistic clinical experience.

Models of mind such as Geropsychology, Psychiatric Nursing, Ministry and one of the best-validated contemporary psychodynamic therapies currently available in Australia: The Conversational Model are applied on a de-identified clinical case study to demonstrate how a person can become valuable and be transformed from severe trauma back into society fully functioning.

The Conversational Model was devised by the English psychiatrist Robert Hobson and refined by the Australian psychiatrist Russell Meares [3] since 1965. Hobson listened to recordings of his own practice with severely disturbed clients. The audio-taped recording of the clinical material is still a practice today and involves the listening to minute particulars of what is said during the clinical encounter.

This audio-taped material is then brought to supervision to create a deeper awareness of the ways in which a person’s self - their unique sense of personal being - would come alive and develop, or be destroyed, in the flux of the conversation. The genesis of the Conversational Model at its fundamental core is built around the notion of ‘personal being' or 'self'.

Aspects of Graham & Van Biene’s (2007) further elaboration on the Conversational Model, utilizing their ‘Hierarchy of Engagement’, will be utilised to describe the interdisciplinary clinical encounter as an art and scientific process.

Top of page

Spirituality and Anxiety in Nursing Students of Faculty of Nursing and Midwifery Iran University of Medical Science -2006

Tahereh Ganji, Fatemeh Hosseini

Faculty of Nursing & Midwifery of Iran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of

Introduction: Anxiety is a widespread human phenomenon accompanying the painful expectation of an undesirable event, and it is a common response to tension, an unpleasant mental situation. Stress and anxiety would result in hopelessness, lacking power, proficiency and control over life.

We can reduce the affects of anxiety by applying some methods. The research results, as an example, showed that we can reduce the negative affects of anxiety through increasing the religious beliefs, and generally there is a strong relation between people’s religious beliefs and their health.

Objective: The purpose of this study was to determine the relation between spirituality and level of anxiety in nursing students of Faculty of Nursing and Midwifery, Iran University of Medical Science, during 2005-2006.

Methods: The research population was all of the students of Faculty of Nursing and Midwifery Iran University of Medical Science who were studying at the time of this research.

Among them, 108 students were selected by chance. We had 3 questionnaires for data collection. The first was concerned with personal characteristics. The second was concerned with the spirituality and. Third questionnaire was anxiety scale.

Results: Findings have shown that most of sample had highly spirituality (76.9%), consequently there was a meaningful relation between spirituality and religious activities (p = 0.000). Results also indicated that 51.9% of samples had no anxiety (mean ± 12.86 ± 10/87). There was a meaningful statistical relation between anxiety and crisis experience within the last 6 months (p = 0.001).

Concerning the relation between spirituality and level of anxiety, Spearman’s test showed that the higher the level of spirituality, the lower the level of anxiety (r = -0.398 p = 0.001), as a result, the hypothesis was accepted.

Top of page

Therapeutic Friendliness and the Development of Therapeutic Leverage by Mental Health Nurses

Andrew Gardner, Helen McCutcheon, Maria Fedoruk

University of South Australia, Adelaide, Australia

In a world dominated by technology and driven by fiscal policy the emphasis on the therapeutic relationship as a healing modality is still a central theme to Mental Health Nurses (MHN). The delicate art of balancing the therapeutic relationship and constant maintenance of the professional boundary are as vital today as they were in our past.

Contemporary research in the area of therapeutic relationships and professional boundaries is discovering new themes that have not previously been well described. Therapeutic friendliness, relating to the way in which an MHN will engage a client and get to know them. And, therapeutic leverage are emerging as important concepts in the area of community based mental health nursing practice, where clients engage with MHN’s over extended periods of time. MHN’s rely on therapeutic leverage when working with their clients during the phases of recovery where a client’s level of wellness may be fluctuating. Difficulty is often expressed by MHN when clinical situations arise that test the level of therapeutic leverage they have with clients, which can result in MHN having to revert to more coercive measures of care and the eventual loss of trust and therapeutic leverage. Therapeutic leverage can also be compromised by over-familiar relationships with clients where the blurring of a professional boundary occurs.

This presentation will outline how therapeutic friendliness sets an initial foundation for the therapeutic relationship and how MHN’s invest in the therapeutic relationship in order to develop therapeutic leverage with their clients in community mental health rehabilitation settings.

Top of page

Understanding and responding to unmet needs: Challenging Behaviours in Residential Aged Care: A Nursing Practice Development Initiative for Division 2 Nurses

Robyn Garlick

Melbourne Health - NorthWestern Aged Persons Mental Health, Vic, Australia

Challenging behaviours in the elderly with dementia such as screaming, physical aggression, resistance , sexual disinhibition and spitting are significant issues facing nursing practice today (Burgio , Scilley & Hardin et al 1994). Unfortunately psychotropic medications can be the first intervention adopted. This project will discuss translating existing research into practice using a person centred holistic approach and will outline the building of a training program primarily for Division 2 nurses addressing areas of unmet need

Whose Care Plan Is It Anyway??? Care Planning Quality Improvement Strategy

Robyn Garlick

Melbourne Health - NorthWestern Mental Health, Victoria, Australia

Continued practice development of care planning is a quality improvement that needs to be embraced by all health professionals and plays a considerable role in the provision of health care. The application of best practice Care Planning principles allows for continuity of care, provides accountability and ultimately may have a positive impact on client outcomes.

Aged mental health program – (NorthWestern Mental Health) identified a need for quality improvement in the area of care planning within the acute inpatient and community settings.

This presentation will outline and discuss the implementation of the Care Planning Quality Improvement strategy, including the current and upcoming project milestones.

Several surveys, audits, reviews and team focus groups were undertaken in relation to individual service plans and care plans in acute and community. These processes highlighted the areas in which the service required improvements.

Several areas have been addressed including, consumer and carer participation, interdisciplinary collaboration, clear and accessible documentation and information systems, drawing together assessment and discharge processes to ensure continuity of care and use in clinical review. All are seen as key requirements of service delivery within a specialist mental health service. Evidence based practice and relevant legislation and standards were used to form a basis for the strategy.

Implementation of the Care Planning project is currently in progress. Several practice advances and improvements in the area of Care Planning, have been achieved this development will be discussed.

Top of page

Back to Basics :Building a Healthy Workforce

Robyn Garlick

Melbourne Health - NorthWestern Aged Persons Mental Health, Vic, Australia

North Western Aged Persons’ Mental Health in metropolitan Melbourne delivers a comprehensive range of specialist community, hospital and aged care residential facilities to approximately 155,000 persons over the age of 65.

The workforce is predominantly nursing with a significant proportion being Enrolled Nurses (RN Division 2’s).

This paper details a process of education and development aimed education of direct patient care nurses. The Program returned to basics and reviewed delivery of education and training. An internal review suggested that education and training was not driven by client need but was rather an ad hoc process based on staff preferences and individual interests.

The program aimed to meet the needs of a complex service working in collaboration with five major hospitals and changing client profile. Core clinical skills were then prioritised and development of the workforce was aligned to priorities. Senior Nurses and Clinical Educators within the service have taken a leadership role in educational developments grounded in research evidence and reflective practice.

The following initiatives have been undertaken:

Review of undergraduate, graduate and postgraduate nurse programs with the aim of raising the profile of Aged Persons Mental Health early in nurses’ professional careers. Opportunities for Enrolled nurses to undertake registered nurse training
Opportunities for PSOs, PCAs and ward clerks to undertake enrolled nurse training
Enrolled Nurse development programs to address co-morbidity
Enrolled Nurse Medication Administration Endorsement
Development of professional portfolios including aggression management, falls and back attack

These initiatives are now being undertaken in a climate of reflective practice and a positive approach to access to conference and study leave.

Aged Psychiatric Residential Care: A Reflective Model

Robyn Garlick

Melbourne Health - NorthWestern Aged Persons Mental Health, Vic, Australia

North Western Aged Persons’ Mental Health is the largest public funded provider of Aged Mental Health services in Australia. The service includes 5 residential facilities. The Aged Care Accreditation Agency assess against a set of rigorous standards incorporating management systems, health and personal care, resident lifestyles and physical environments. The workforce within these facilities is predominantly nursing with significant proportions being Enrolled Nurses (RN Div2’s)

This paper details a process of investigation and evaluation of nurse’s attitudes and beliefs in relation to the core business of the facilities. Clinical Nurse Educators conducted a series of focus groups within the facilities over a period of six weeks. These focus groups were semi-structured and asked staff to discuss their views about the core purpose of the facilities, what the facilities do well and what improvements could be made. Data from the focus groups was themed and from these suggestions for a range of educational activities, practice development and quality planning were proposed and discussed with staff groups. A significant driver for development was the staff’s perceived lack of opportunity for peer review of resident’s management and the lack of opportunity to contribute to the development and implementation of care plans

The importance of the relationship between professional nursing and operational management within the facilities was recognised as an important factor to the success of this project. Significant outcomes of this investigation into staff opinions are

1. structured case presentations enabling peer review and reflective practice

2. establishment of reflective practice groups

3. development of staff training planned by nurse educators to address identified needs

Top of page

Reducing Seclusion In Acute Psychiatric Inpatient Settings: A Need For Strong Leadership

Cadeyrn Gaskin, Stephen Elsom

Centre for Psychiatric Nursing, Melbourne, Australia

Background: Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for psychiatric consumers. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.

Aims: To review the research on seclusion-reduction initiatives in psychiatric facilities.

Methods: We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and post-seclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review.

Results: Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion.

Conclusion: Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Top of page

‘About Helen’ – Psychosis and Pregnancy (A Case Study)

Heather Gilbert, Jayashri Kulkarni

Monash Alfred Psychiatry Research Centre, Melbourne, Australia

Introduction: The desire to reproduce is both a powerful urge and a basic human right for women, regardless of mental health status. Currently, mental illness is treated with antipsychotic medication, however, research is limited regarding the effect of this medication upon foetal development and maternal health. The challenge for clinicians, and women in this population group, is to balance the risk to the mother’s mental health and wellbeing, against any possible risk of foetal abnormalities, and developmental problems in the infant. We follow the pathway of one woman’s pregnancy, delivery and first postnatal year, as she not only learns to cope with her mental illness, but also to accept that her baby will be put into foster care.

Method: Helen, a 39 year old woman with a history of paranoid schizophrenia, is observed on her journey through pregnancy, to gather information on psychiatric and medication history, including any side effects, family, medical and obstetric history; and her progress as her pregnancy advances. Observation continues at delivery, and into her baby’s first year, noting maternal and infant health and wellbeing.

Results: The outcomes for Helen and her baby are not optimal; Helen becomes unwell, being deemed unfit to provide the necessary parenting skills required by her baby; while her baby has developed foetal abnormalities.

Conclusion: The combination of poor psychosocial history, existing involvement with child protection agencies, psychiatric diagnoses and admissions, medications and substance abuse, present many issues affecting outcomes for both mother and baby during the perinatal period.

Top of page

'The Roller Coaster Ride" - In vitro Fertilisation and Depression

Heather Gilbert, Jayashri Kulkarni

Monash Alfred Psychiatry Research Centre, Melbourne, Australia

Introduction: Although recent studies show that infertile couples are generally well adjusted and stable in their relationships and psychological wellbeing, long term infertility is stressful in itself and IVF treatment is demanding for both women and men, although in different ways. To highlight the stressors of cause and effect by following the pathway of one woman on her journey with in vitro fertilisation (IVF).

Method: Most couples present to an IVF clinic following 6-12 months of unprotected sex, without conception. IVF is not one procedure, but a series of timed steps over several weeks. A programme is structured for each patient, and includes stimulating the ovaries, collecting the eggs, fertilisation and embryo transfer and blood tests for pregnancy results.

Results: Literature in the area will be reviewed, and a case study will be presented to highlight key issues surrounding depression and IVF treatment.

Discussion: If IVF treatment is unsuccessful, the couples face new decisions such as whether or not to undertake further treatment. Studies have shown that women who did not become pregnant showed higher levels of anxiety than their spouses, and that these women were also less positive than men, about their marital and sexual relationships.

Top of page

One Year Later: Evaluating a Brief Intervention for Deliberate Self Harm Presentations in the Emergency Department

Susan Glennon, George Farquharson, Mohammed Usman

The Queen Elizabeth Hospital, Adelaide South Australia, Australia

From the nominal inception of improving the art/craft of nursing Emergency Department presenters in Deliberate Self Harm Crises, a comparative quantitative study in two Australian Capital cities has developed. Combining the craft of mental health nursing with the technology of quantitative nursing research will lead to an accessible alternate clinical pathway that mental health services can offer via Emergency Departments.

Utilising a patient-centred, problem solving brief intervention (ranged over three individualised sessions) clinical outcome data based on the self-reporting questionnaires DASS 21, FANTASTIC Lifestyle Checklist, and an ‘Identifying Your Priorities’ checklist have been collected. After routine psychiatric and risk assessment, clinic attendees identify their difficulties. Their mood is monitored across all three sessions and there is a follow up at 3 and 6 months. The main hypothesis is that clinic attendees will demonstrate a significant improvement in DASS21 scores from first to third Green Card Clinic visit and if this improvement is maintained at follow-up.

Initial results from the second arm of the comparative, quantitative study, will be presented in order to demonstrate a reduction in self–harm events and an increase in consumer satisfaction with their mental health service contacts.

The focus is on reviewing progress in problem area(s), developing interventions, plans for future treatment and a care plan in collaboration with the patient and the general practitioner. Our aim is to evaluate the effectiveness of the new clinical pathway compared to previously evaluated consumer dissatisfaction.

Top of page

Mental Health Nursing - A Broad Canvas: The art of perinatal and infant mental health nursing in the age of technology and science'

Patricia Glossop, Kathryn Solanki

AAIMHI, NSW, Australia

Much adult psychopathology has its roots in pregnancy and infancy. The foetus and infants brain develops in the context of the relationship with its primary caregiver. Both mental and physical health is affected by events occurring in pregnancy and the early years of life. Parental health and well being at this time are of paramount importance. Through routine, universal assessment any factors that might adversely affect the mother or family to care for the new infant can be identified and appropriate intervention offered. By incorporating mental health concepts into mainstream health provision, linkage across health and other relevant service will support holistic care.

This presentation will focus on the science of brain development and how providing early intervention based services facilitates and supports secure attachment and improved mental health incomes for the infant and their family. We will be presenting a case study to demonstrate how a family have been supported from identification of risk factors in early pregnancy through to the postnatal period. The case will demonstrate collaboration between mental health, midwifery and other community services. We will highlight a variety of parent infant therapies with the use of video material. This presentation will emphasize the infant’s abilities to engage with their adult carer and be active participants in the therapy.

Top of page

Mental Health First Aid Training For Advisory And Extension Agents Working With Farmers.

Don Gorman, Delwar Hossain, Rob Eley, Jeff Couts

University of Southern Queensland, Toowoomba, Qld, Australia

The purpose of this project is to explore whether training Advisory Extension Agents (AEA) in mental health first aid will reduce their anxiety and increase their confidence to deal with farmers exhibiting signs of mental ill health.

The issues of depression and suicide in rural communities are very well-known. One of the biggest problems is that of ensuring that farmers receive support, given their reluctance, and in many cases a lack of awareness of the need for support. Another factor that is a barrier to them gaining support is the lack of appropriately skilled people for them to approach.

This project provides people who are in contact with them with the skills to recognise need and the knowledge of where to refer them for appropriate support. It is increasing the knowledge of mental health symptoms and pathways amongst AEA who see farmers regularly and feel powerless to help on mental health issues.

The project uses a pretest / post-test design assessing the effects of the existing and well researched course in mental health first aid on a group of AEAs. A control group will also be subjected to the pre and post test for comparison. For ethical reasons the control group will be offered the course after testing.

Top of page

Developing Suicide Prevention Expertise With Aboriginal Communities

Don Gorman, Raelene Ward

University of Southern Queensland, Toowoomba, Qld, Australia

This in progress project aims to implement and disseminate successful Indigenous suicide prevention activities developed by one Indigenous community to another Indigenous community. It will extract critical elements of this community-driven process, expand these activities, and enable horizontal knowledge transfer of risk-reducing and resilience-enhancing strategies and activities through partner organisations. The process will utilise understandings of how knowledge is communicated across Indigenous families, communities and institutions (meetings, workshops, training, networking), as well as innovative information technology and multi-media approaches. Importantly it will not be simply about taking strategies that have worked in one community and applying them in another. Critical to the success of the project is the principle that all communities are different and that what works for one won’t necessarily work for another. Rather the idea is to take the learnings of one community and make them available to another community which will develop its own approaches taking what works for it from the experiences of the other.

Top of page

Improving Care: Managing Physiological Pain in an Inpatient Mental Health Unit

Karen Gullick, Stephanie Mattys, Jeff Butterfield

Hollywood Private Hospital, Perth WA, Australia

Nursing and allied health teams working in mental health must take a holistic view to assessment of patients being admitted for inpatient care. However, at times the complexity of the contribution that living with chronic pain can have on mental health can be overlooked, despite the knowledge that mental illnesses are characterized by poor stress tolerance, and consequently poor pain tolerance. This presentation will describe the process of improving the management of pain for patients admitted to a mental health inpatient unit.

Information specifically related to pain was collected from all patients admitted over a 3 month period. Those who suffered from chronic pain were asked how they managed the pain, and their understanding of the relationship between pain and mental health. Following this care plans for those patients were audited to ascertain whether pain was acknowledged as a problem, and if so, what nursing actions were suggested. In addition, nursing entries in the integrated notes were reviewed for evidence of effectiveness of prescribed pain medications.

Results suggested that both nursing staff and patients required education about current thinking in relation to pain management. Actions that followed included education for staff, and the development of a cognitive behavioural therapy-based pain management group for patients suffering from chronic pain. This is being piloted presently, and early anecdotal results suggest that patients are finding the group useful and are making the connection between physical well being and mental health. Further outcomes and lessons learnt will be included in the presentation.

Top of page

Getting The MHNIP Off The Ground For A GP Network

Wendy Hall, Steven Springett

HMPGN, port Macquarie, Australia

The paper describes how a Mental Health Nurse Incentive Programme was introduced by the local GP Network, into a rural area in Northern New South Wales.

It describes how the service was marketed to GPs, who the clients were (breakdown by diagnosis, age, and sex), what the various, and most commonly requested interventions were, and some of the comments the GPs using the service had to say about it.

The paper describes how the work undertaken differs from Case Management, what the main challenges have been and how these have been addressed.

The paper concludes by presenting the change in severity ratings after one year based on HONOS Scores administered by the mental health nurse and K10’s scored by clients.

Top of page

Deinstitutionalization - Has it changed outcomes for some of the most vulnerable people in our community?

Ann Hamden

Monash Unversity, Victoria, Australia

As part of a broader policy of deinstitutionalisation, the Frankston Community Care Unit (CCU) opened in 1996 as residential accommodation for clients that were previously in long term psychiatric hospital settings. While carers and relatives prefer the CCU setting little is known about the long term outcomes of these clients and the impact on the younger generation with chronic, severe mental illness.

This exploratory and prospective study examines the impact of deinstitutionalisation on clients admitted to the Frankston CCU between 1996 and 2006 to look at length of stay and the impacts this may have on quality of life and readmissions to hospital. Staffs views are also captured via a questionnaire.

Results showed that the original and current residents of the CCU have improved quality of life through friendships, a homelike environment and reduced readmissions to hospital, however further improvements can be made with the a co-located employment/vocational service and community integration. More concerning is those who miss out on a CCU bed due to chronic CCU bed shortages. This group, referred to as the “new long term patient” tend to become victims of ‘the revolving door phenomena”, homelessness and substance abuse. The Assertive Community Treatment model of care is recommended for people on waiting lists for the CCU to try and reduce the level of disability that is likely to occur with frequent relapses.

This important study has implications for health service and policy development in relation to providing optimal care for some of the most vulnerable members of the local community.

Top of page

Doing the obs and chatting: Empathic nursing in the machinery of care

Bridget Hamilton

University of Melbourne, Melbourne, Victoria, Australia

Nurses’ use of empathy with patients is considered a cornerstone of quality nursing care, but its application in acute inpatient psychiatric nursing practice is problematic. Aspects of acute units, such as the focus on the efficient management of care, constrain nurses’ use of empathy toward patients. In this paper, I present a key finding from an 18-month ethnographic study within a metropolitan acute inpatient unit, in which I considered nurses’ use of empathy in everyday assessment practice. The participants were 11 psychiatric nurses and the field work involved participant observations, reflections from my own practice in the unit, individual interviews and focus groups.

I found that nurses exercised empathy in distinctive ways: through the way they looked at patients, through brief verbal exchanges and through caring for patient’s bodies. My analysis highlights how power relations of institutional routines limit empathy and reward nurses for disengaged practices. I focus on the ways nurses resist these pressures, describing empathy as a practice against the tide, or a counter-practice. I suggest ways that empathic nursing practice might be both recognised and realistically reinforced, in this and other nursing settings.

Top of page

Strategies to sustain and extend seclusion reduction achievements in a Victorian inpatient unit.

Bridget Hamilton

¹St Vincent's Mental Health, Melbourne, Australia, ²National Institute of Clinical Studies, Melbourne, Australia

Background

In 2007/8 seclusion reduction (S/R) is the focus of several government funded projects in Australia. But the quality improvement literature and international S/R experience suggests that the key challenge will be sustaining and extending practice change. This paper reports on S/R outcomes at a hospital in metro-Melbourne at 12 months and explores the strategies to pursue greater change.

Method

The service has developed and implemented a S/R plan, based on reported “S/R core strategies”. The strategies include: Exercising leadership towards organisational change; Using data to inform practice; and Workforce development. The S/R project is supported by a two-year NH&MRC funded Fellowship. The service also benefits from the Victorian Creating Safety pilot project, which has provided input to local change processes and S/R training.

Results

In 2007 seclusion was reduced by 49% from 2006 rates (2006 µ per quarter = 32.7 seclusions per 1000 occupied bed days; 2007 µ = 16.7, (p = 0.007)). This reduced seclusion rate compared favourably with the DHS reported 2006 statewide mean rate of 34.3, for all 27 acute units.

Discussion

There is a real risk that S/R efforts will founder at the end of projects. The discussion centres on 2 strategies: 1) the efforts to engage managers, shift-leaders and medical staff in alternatives to seclusion and 2) the use we are making of seclusion data at a ward level and between services, to raise accountability and sustainability. We aim to provide local evidence to services investing in S/R efforts.

Top of page

Raising Our Standard: The review and renewal of the “Standards of Practice for Mental Health Nurses’ in the 21^st century

Catherine Hangan², Christine Neville¹, James Weir³, John Quinn⁴, Tom Meehan⁴, Dianne Eley¹

¹University of Queensland, Brisbane, Queensland, Australia, ²University of Southern Queensland, Toowoomba, Queensland, Australia, ³Queensland Health, Toowoomba District Mental Health, Queensland, Australia, ⁴Queensland Health, The Park Centre for Mental Health, Queensland, Australia

The study presented here describes a project to comprehensively review and, as indicated, rewrite, the existing ‘Standards of Practice for Mental Health Nursing” (ANZCMHN, 1995) for endorsement and adoption by the ACMHN. The study took place in stages commencing with a comprehensive literature review which was the published with funding from the Commonwealth Department of Health and Ageing. This literature review incorporated an examination of the existing ‘Standards’ in terms of their relevance to current mental health nursing practice and the congruence with State and National policies and standards - such as the National Standards for Mental Health Services (NSMHS), the National Practice Standards for the Mental Health Workforce (NPSMHW) and the ANMC ‘Competencies for the Registered Nurse’ – and international documents on standards of practice for mental health nurses and the United Nations ‘Charter for the protection of people with a mental illness’. The review highlighted significant gaps in the congruence with the NSMHS and the NPSMHW. The second phase commenced with a survey of over 200 registered nurses working in mental health in Australia in which participants were asked to review the existing ‘Standards for Practice’ and comment on each standard. The feedback from this survey was utilised to create a draft version of standards which was then workshopped at the 2007 ACMHN Conference. The workshop responses were then used to complement a Delphi technique of gaining consensus from a panel of 15 experts and stakeholders. The final version of the ‘Standards’ was then completed for endorsement by the ACMHN.

Top of page

Experiences in using risperidone long-acting injectable in aged patients with schizophrenia

Kathleen Harrington, Josie Onufryk

Southern Health, Melbourne, Australia

The use of, risperidone long-acting injectable (RLAI) an atypical antipsychotic, has not been well studied in elderly schizophrenic patients. This poster offers an insight into our experiences in using RLAI in patients within the Aged Person’s Mental Health Unit by examining a series of 8 case studies. All patients are over 65 years old, 6 are female and 7 patients had extended histories of schizophrenia. Patients were commenced on RLAI if there were issues of adherence, lack of response to other medications, side effects from other medications or other symptoms of their illness. All patients commenced RLAI at 25-37.5mg fortnightly. The 25mg dose was found to be an effective starting point to assess tolerability but dose escalation up to 75 mg fortnightly was often required in patients with long-term antipsychotic exposure. One patient experienced a negative response to RLAI, 2 patients had no change compared to their previous antipsychotic treatment and 5 patients had marked improvements. Patients with long-term exposure to depot antipsychotics, while requiring higher doses of RLAI, generally achieved better outcomes with reduced side effects compared to their previous therapy. We found that patients with no or minimal prior exposure to antipsychotic drugs were able to be maintained on lower doses of RLAI.

Top of page

Bringing it all together: the link between transformational leadership, emotional intelligence and the clinical education

Derith Harris, Shane Price

Southern Health, Melbourne, Australia

The role of the clinical nurse educator has been inexistence for many years. In some clinical areas, educators have enormous impact yet in others, their influence is less obvious. What factors come into play that make the role potentially so influential and why are not all educators having the same effect. This paper will examine the influence Mental Health nurse educators can have clinically, what supports, resources, and leadership qualities are required for them to achieve this level of culture change and how organisations can maximise the role of mental health nursing education in the clinical setting. The paper will look at the need to develop not only clinical skills in the educator but also the importance of developing the qualities of emotional intelligence and transformational leadership in order to advance the role.

Top of page

Re-establishing Social Connectedness In A Community Mental Health Setting

Carole Harrison¹, Maureen Wiltshire², Dianne Wynaden¹, Zenith Zeeman², Stephen Addis²

¹Curtin University of Technology, Perth, Western Australia, Australia, ²Fremantle Mental Health Service, Perth, Western Australia, Australia

Introduction:

Community based mental health care is now a constant that has been shown as both economical and preferred by consumers and their families. However, despite decades of deinstitutionalisation, many consumers remain isolated in the community and experience stigma on a regular basis. As social exclusion remains a persistent problem for these individuals, programs that build and re-establish social connectedness, are of particular importance.

Methodology:

A medical record retrospective audit of mental health consumers’ who had accessed respite care over a two year period was completed. Demographic data determined the frequency that each consumer had accessed respite care and also mapped each consumer’s contact with ED and Mental Health Triage facilities during this period.

Results:

The consumers’ mean age was 36.7 years, with personality disorder subtypes (46%) and schizophrenia (38.5%) being the most common diagnostic categories assigned to individuals included in the data collection. All consumers had made repeated contact with ED and Mental Health Triage until establishment on a formalised respite program, when consumers in the personality disorder subtype (46%) category significantly reduced and/or ceased this practice. The remaining consumers (54%) displayed no change in their behaviours.

Discussion:

Offering a formalised respite care program to consumers is fundamental to reducing the frequency of presentations at Mental Health Triage and/or ED as well as building a social connectedness in the consumer. It promotes facilitation of addressing the social dimensions of living with mental illness in a way that was not possible in an ED or triage encounter.

Top of page

The Intersection of Behavioural Phenotypes in Clinical Psychiatry: A Case Study

Brent Hayward

The Alfred, Melbourne, Victoria, Australia

Biological aspects of psychiatry are often viewed by clinicians as outside their realm of everyday clinical work. The association between genetics, behaviour and illness is difficult to comprehend unless one is perhaps faced with a clinical scenario that challenges the consideration of an alternative basis for a psychiatric presentation.

Behavioural phenotypes are syndromes with a chromosomal or genetic aetiology comprising both physiological and behaviour manifestations including distinctive social, linguistic, cognitive and motor profiles. The consideration of behavioural phenotypes outside the specialities of clinical genetics, paediatrics and intellectual disability is uncommon, however the distinction between a behavioural phenotype and symptoms of mental illness is imperative in order to accurately diagnose, treat and manage a functional psychiatric illness versus the identification of a genetic syndrome, the interventions for which are significantly different.

This presentation describes a case study of a homeless and itinerant man with an intellectual disability with a long history of contact with mental health services throughout Australia. Following referral by a Homeless Outreach Psychiatric Service, assessment was undertaken by a specialist dual disability service. With clinical genetic investigation, the man was found to have a chromosomal deletion, indicating a behavioural phenotype rather than mental illness.

The importance of accurate diagnosis through consideration of other origins of behaviour results in more detailed biopsychosocial intervention and improved service delivery for consumers with specific health needs and underscores the necessity of comprehensive assessment of features uncommon in routine adult clinical psychiatry.

Top of page

'I'm the professional, I know what’s wrong and how to fix you': That's not what the Stats say.

Deanne Hellsten

¹University Southern Qld, Toowoomba, Australia, ²Qld Health, Townsville, Australia

This program was developed from a need that has been identified in clinical practice.

Clinicians on the coalface have long been saying that to improve outcomes for indigenous people the practice of individuals needed to move past "cultural awareness" to culturally appropriate practice. Who though should decide what is appropriate in any given community? This program aims to build the capacity of the practitioner to work with any given indigenous community to gain these skills.

Top of page

Broadening the canvas: determining the art and science of mental health nurse prescribing.

Steve Hemingway

University of Huddersfield, Huddersfield, United Kingdom

Prescribing of medication is a potentially radical shift in the responsibilities of Mental Health Nurses (MHNs). Prescribing medication has been up till now the sole responsibility of the Doctor, with nurses administering what was prescribed. However in the new world -view extending who can prescribe to nurses potentially provides more choice and flexibility to the consumer, whilst, increasing the role of the MHN with medication (NPC 2005 DH 2007). In the professional literature examining efficacy of the education to prepare clinicians for competence in new roles the input –output model has been shown not to produce competence and the case of nurses’ prescribing is no exception about the professional journey from novice prescriber to competence. It would appear education plus experience enables the translation of knowledge through practise into competence. Therefore it seems that examining the period following educational input to uncover what works to enable or prevent the development of effective prescribing by the MHN would provide insights about the professional journey from novice prescriber to competence.

This presentation will:

Explore the phenomenon of prescribing
Explore how experiential knowledge of the MHN informs their journey to prescriber of medicines
Present findings emerging from the presenters doctoral studies evaluating how the MHN progresses from novice to expert prescriber

References

Department of Health. (2007) Mental Health: New ways of working for everyone. developing a capable and flexible workforce. DOH. London.

National Prescribing Centre (2005.). Improving mental health services by extending the role of nurses in prescribing and supplying medication: a good practice guide. National Prescribing Centre, National Institute for Mental Health, Department of Health.

Top of page

Title Medicines with Respect: collaboratively establishing the art and the science of medicines administration

Steve Hemingway, Jacqueline White, James Turner, Robert Maginnis, Juanita Gray

University of Huddersfield, Huddersfield, United Kingdom

In mental health settings much of the activity involves the administration of psychotropic medication by mental health nurses (MHNs). The competencies needed by nurses to safely undertake this intervention are far from clear and significantly difficult to establish how they are systematically developed in pre-registration mental health nursing curricula and beyond.

A collaboration of mental health trusts and associated mental health nurse academics across the three higher education institutions in the Yorkshire and Humber Strategic Health Authority (Huddersfield, Hull and Sheffield Hallam) have identified a developmental framework – a stepped approach – for the incremental enhancement of medication knowledge and skills in pre-registration mental health branch curricula and the qualified mental health nursing (MHNs) population. This framework utilises the competency framework developed by Turner et al (2007, 2008). Subsequently a project will evaluate the outcomes of the use of the framework on the confidence and practice of student and registered MHNs:

This presentation will

Give an overview of the project
Share results from the project evaluation
Give examples of how the project is impacting on clinical practice.
Highlight the major findings and how a ‘stepped approach’ to the art and science of the administration of medicines can be implemented from the academic setting to the clinical area

Turner J, Gardner B, Staples P, and Chapman J (2007) Medicines with Respect: developing an

Integrated collaborative approach to medication management, Mental Health Nursing, 27(6):16-19.

Turner J Gardner B, Staples P, and Chapman (2008) Medicines with respect: developing an integrative collaborative approach to medication management (2). Mental Health Nursing 28 (1) 11-14

Top of page

‘Seeing’ the Practice of Mental Health Nursing: Creating Space for the Experiences of Mental Health Nurses to be Heard

Gylo Hercelinskyj

Deakin University, Melbourne, Victoria, Australia

The concept of therapeutic engagement is viewed by many authors as the corner stone of contemporary mental health nursing (Barker 1998, Chambers 1998, Peplau 1952 and Travelbee 1966). Scanlon 2006 argues that mental health nursing and the therapeutic relationship are inextricably linked.

In 1999, O’Brien investigated experienced nurses’ perceptions of expertise in relation to their practice. An important theme identified in this project related to minimising visibility. Minimising visibility was viewed as a process of negotiation in which they [nurses] “negotiated … involvement while recognizing and respecting the client’s interpersonal boundaries and …[the] social boundaries which surround mental illness” along with the idea that a “clinical professional role was seen as a potential barrier to their relationships with their clients” (p. 158).

The tension between what is regarded as central to mental health nursing practice and the social and contextual manner in which therapeutic connection is negotiated will be explored in this paper. The author will propose that it is this tension that makes it difficult to articulate the practice of mental health nurses; the craft of their engagement with consumers and how this contributes to the understanding of what constitutes nursing and its practice domain. The author will present the results of a series of interviews with mental health nurses about their experience of their practice. It is the aim of this paper to give voice to those aspects of their practice that is unseen and therefore unspoken.

Top of page

Online Learning in Mental Health Emergency Care

Danny Hills, Tracy Robinson, Sophie Heathcote

Centre for Rural and Remote Mental Health, the University of Newcastle, Orange, NSW, Australia

Introduction

While mental health nurses play a major role in mental health emergency care, a range of professional and support personnel are directly involved in managing acute mental health presentations. The development, implementation and outcomes of an online, interdisciplinary education program in mental health emergency care, and the implications for future online workforce development programs are discussed.

Methods

Pilot implementation of the Mental Health Emergency Care (MHEC) online learning program was conducted during 2007 in four rural Area Health Services and one metropolitan Area Health Service in NSW. Participants comprised public sector health workers who provide services to people presenting to emergency departments with acute mental health problems. A descriptive survey evaluation of the impact of the program was conducted.

Results

There were demonstrable improvements in participants’ levels of confidence in IT-related and online learning skills (12-44% increase), levels of confidence in managing key mental health issues (12-47% increase) and perceived self-efficacy in dealing with challenging, aggressive behaviours (29% increase).

Discussion

Based on the positive outcomes and evaluations of the pilot, there is considerable support for the deployment of online learning programs that address mental health emergency care. What has been learnt from the pilot can also be applied to new programs. The results confirm that mental health educational programs can be effectively delivered online and that participants can quickly develop skills in using online programs. This has important implications for staff in rural and remote locations in regard to accessing clinically and professionally relevant educational programs.

Top of page

Developing and Facilitating Groups: staff nurse focussed.

Linda Howie

Eastern Health, Melbourne, Australia

There has been recognition within the Eastern Health Mental Health inpatient facilities that inpatient groups are a multidisciplinary responsibility. Staff nurses who are expected to facilitate the groups feel that their lack of theoretical and practical knowledge of groups is hindering them. They feel inadequate to the role and the shift leader is often unavailable to provide guidance. Consequently the momentum and energy to galvanize the group evaporates.

The nurse educators have organized an inpatient group learning program specific for the staff nurse to inspire confidence, flexibility and contemporary understanding of the spectrum of groups available to them. This program focuses on experiential learning to effectively challenge the staff nurses inhibitions. Active participation in the workshop is important to learn new skills and develop new attitudes.

Utilization of groups within High Dependency Units as part of the management of seclusion reduction is an important feature of the program as is the continual feedback and liaison with consumers and the consumer consultant. Gender sensitive groups shall also be addressed.

The program extends over 6 months with 2 hour monthly workshops. During this time the participant shall be instructed in various group theories and identify a group they wish to develop more expertise in. They will be supported with peer supervision and expected to complete workbooks during this time.

Top of page

Empowering the Shift Leader

Linda Howie, Kirstie O'Carrol

Eastern Health, Melbourne, Australia

Within Eastern Health, senior nurses, and other disciplines, identified the need for training of RPN 2’s who are interested in acting as Shift Leaders on our acute inpatient units. A number of RPN2’s also approached their managers and Practice Development Team (PDT) members in regard to receiving training to better equip them to perform this function.

The PDT developed and implemented a shift leader training initiative which allowed Grade 2 RPN nurses to gain a transition into leadership practice. It’s in the interests of the in-patient nurses to provide leadership and shift management training to RPN2’s, given that they are asked to fill the role of shift leader during planned and unplanned absences by regular shift leaders. Through this training initiative RPN2’s can feel confident to effectively run a shift.

The program framework is informed by the National Practice Standards for the Mental Health Workforce (2002). It is multifaceted consisting of classroom based theory combined with supervised shift leader practice. Theory is provided via three full day educational workshops and participants will be supported in practical experience throughout the program as well as participating in their own clinical supervision.

Top of page

Valuing the Psychiatric Clinical Nurse Specialist

Linda Howie, Heather Needham

Eastern Health, Melbourne, Australia

The Psychiatric Clinical Nurse Specialist (PCNS) position was established with the aim of recognizing advanced practice nurses as a potential resource and career development incentive.

There are a number of PCNS positions at Eastern Health throughout Mental Health and these nurses work in a variety of psychiatric in-patient settings. Quite often these nurses work autonomously within their role as PCNS and at times lose visibility when work areas get overloaded and their role gets overtaken by day to day issues. In order to support the PCNS’s as clinical leaders, portfolio holders and advocates of best practice they need to be valued and supported.

The Practice Development Team have begun to run workshops that are designed to enhance and expand the PCNS role and offer them a supportive environment, to assist them in achieving their potential.

The PCNS program framework is informed by the National Practice Standards for the Mental Health Workforce (2002). The workshops are for one day. Presentation of theory and utilisation of experience are the dominant features with a major focus on portfolio development. They will also continue to be supported in the workplace by the Clinical Nurse Educators from the Practice Development Team.

Top of page

Taking the Lead: Introducing the Art and Science of Mental Health Nursing to Undergraduate Student Nurses

Margaret Hughes, Maria Fitzgerald

Sydney South West Area Mental Health Service, Sydney NSW, Australia

Undergraduate clinical placements provide an opportunity to firmly etch metal health nursing into the student’s portfolio of career options. Rapid service expansion and an increased number of undergraduates requiring clinical placements informed the development of a health service based program for clinical placements in mental health nursing.

The program addressed the expressed needs of registered nurses to provide a positive experience for undergraduates during clinical placements in a range of hospital and community based mental health settings.

Undergraduates evaluated their experience of the art and science of mental health nursing specialty practice in the supportive learning environment. The majority noted positive perceptions in relation to their learning objectives, variety of experience, registered nurse support, and understanding of mental health issues that enhances nursing practice. More then seventy percent of undergraduates indicated they would consider a career in mental health nursing.

A formal undergraduate clinical placement program, leading to the creation of a supporting learning environment in mental health nursing practice, has the potential to enhance both the student experience and the health service.

Top of page

Facilitating the Link Between Technology and Clinicians: The Quality Through Outcomes Project

Catherine Hungerford, Briony Holdsworth, Danny Farrow

Mental Health A.C.T. (Australian Capital Territory), ACT, Australia

While there has been an explosion in the use of technology and information in providing mental health care, clinicians often struggle to integrate it into their practice. This has been evidenced by difficulties identified nationally in meeting the requirements around reporting and providing data, including mandatory measures such as the HONOS, LSP 16, BASIS 32 and SDQ.

This paper describes the Quality Through Outcomes Project in one Australian jurisdiction, undertaken in 2007-08 to improve efficiencies related to the National Outcomes Casemix Collection. Goals of the Project included an increase in completion rates for mandatory measures; and improved protocols around usage, including completed matched pairs, timely completion, links to recovery planning, increased consumer involvement, and use in Multi-Disciplinary Team reviews. Project workers also saw it as a priority to ensure the sustainability of the Project goals beyond the life of the Project itself.

Preliminary results of the Project are positive. By mapping the NOCC measures and creating a linked suite of global indicators that can be incorporated into the database, a platform has now been laid which not only increases audit-ability but provides for a flow-on effect from completion of NOCC measures to the development of a Recovery Plan. In addition, the Project has shown that it is only when mental health workers engage with technology and are provided with meaningful information on how technology, research and information can improve, support and enhance their everyday practice, that real progress is made and consumer outcomes are measured and improved effectively and sustainably.

Top of page

Has The Integration of Technology into Mental Health Nursing Practice Affected Levels of Competency?

Catherine Hungerford, Rose Roberts

Mental Health ACT (Austalian Capital Territory), ACT, Australia

Many jurisdictions around Australia have implemented computer programmes or similar tools to improve consumer outcomes (e.g. MHOAT in NSW, MHAGIC in the ACT). Broadly speaking, these programmes aim to facilitate, enable, standardise and safeguard the assessment, treatment, and care provided to mental health consumers; and allow for greater accessibility of clinical notes to all relevant members of the multidisciplinary team.

However, results of a survey attached to a quality improvement project undertaken across acute inpatient and community settings in one Australian jurisdiction, identified some dissatisfaction amongst mental health nurses with the technology in relation to its impact upon their skills and competency. For example, when clinical documentation around assessment, treatment, and discharge is restricted to a particular framework, formula, or ‘drop-down menu’, clinical practice can be likewise restricted. Many mental health nurses felt obliged to focus their practice upon obtaining information to satisfy technological requirements rather than developing the therapeutic relationship. Finally, some suggested that the rolling out of standardised software packages that frame the provision of mental health care has exacerbated the confusion they increasingly felt about their role within a multidisciplinary team, where all clinicians are providing standardised information.

This presentation discusses how the integration of technology into the provision of mental health care has affected the skills and competency of the nursing workforce, and also their capacity to define themselves. It also explores ways in which leaders may provide future direction to mental health nurses, their use of technology, and their unique work in the 21^st Century.

Top of page

Determination of the Quality of Lives and its Relations with Severity of Stress in Patients Undergoing Hemodialysis

Mahshid Jafarpour, Amir Erfani, Hamid Haghani

Iran University, Tehran,Tehran, Iran, Islamic Republic of

Background : Long life hemodialysis is a must for patients with end stage renal diseases. Imposing restrictions in many ways eventually, manipulate the quality of lives of these patients.

Objective: To determine the quality of lives and its relations with severity of stress in patients undergoing hemodialysis in Mashad University of Medical Science Hospitals, 1383.

Design: This was a correlative study, in which correlation between quality of life and severity of stress was identified.

Sample: Through enumeration sampling method 97 patients were selected and contributed in this study.

Results: Finding showed that 58.4% of those with semi desirable quality of life had intermediate level of stress. There were also significant meaningful relations between the quality of life and weekly frequency of hemodialysis (P=0.02, T=2.48), and the quality of live and severity of stress (r=0.749).

Discussion: Results of this research revealed that stress declines the quality of life, and in order to improve the living circumstances physicians and nurses can help a lot, improving social support and well fair is the responsibility of the managers, and nursing educators should consider stress concepts as a fundamental part in their education programs.

Top of page

A Portrait Of An Abstract Landscape: A Student Nurse's Reflection Of A Fast Track Mental Health Course

Lorna Jain

University of Leeds, Leeds, United Kingdom

This paper is a personal case study which draws upon data from a reflexive diary complied whilst undertaking a post graduate pre-registration mental health nursing programme. This programme is often referred to as ‘fast track’, the course being completed in two years rather than the traditional three years. The data maps out the abstract territory that needed to be made sense of in order to arrive at the destination of becoming a qualified mental health nurse. In this journey into the unknown I visualised mental health nursing as a vast uncharted landscape spread before me. The practice, theory and research were continuous and at times contradictory experiences in acquiring knowledge and knowing. At times the incredible complexity of nursing overwhelmed me. Starting with being taught the basics of nursing within university followed by experiences of three short clinical placements, my learning in the fast lane is explored in terms of promoting confidence whilst at the same time realising the need to learn many new skills in a short space of time. The journey continues with an exploration of my experiences of the branch programme and my growing awareness of the political boundaries of mental health nursing. Insights are offered regarding how the course made me feel anxious, defeated and yet given me a strong sense of achievement. The papers conclusion discusses how as a postgraduate student nurse I feel I now have confidence to outline my needs, confront my deficits and challenge different viewpoints of mental health nursing practice.

Top of page

Challenges In Mental Health Literacy Within Top End Remote Indigenous Communities

Lorin James, Deb Spurgeon

Mental Health Program, Northern Territory Government, Northern Territory, Australia

Provision of quality mental health services can only occur if contact by non-health or health personnel correctly identifies a mental illness or problem in an individual. For people in Australia’s Northern Territory remote indigenous communities, mental health problems and illnesses are often not recognised or remain undetected and therefore untreated for long periods. While males are regularly referred to mental health services, at times inappropriately, women’s presentations are often ‘explained’ as being due to the ‘Aboriginal way’, ‘tradition’, ‘custom’, ‘family problem’, or as arising from domestic/relationship circumstances, language/communication problems, or substance effects and consequently no mental health referral is made.

Poor recognition and identification of mental illness amongst Indigenous people in remote communities has many causes. These include the absence of mental health workers, inadequately resourced local health centres, overburdened generalist health workers, and the difficulties inherent in creating a ‘middle ground’ between two culturally and racially diverse communities in order that clear communication can occur.

This paper will consider the conditions obstructing the provision of quality mental health services in remote communities, and will draw on the authors’ experiences in trying to provide a culturally acceptable mental health service to people in remote indigenous communities in the Top End. The complexity and challenges for mental health nurses in adapting a ‘European’, ‘white’ medical model approach to mental health literacy issues and service delivery will be discussed.

Top of page

On-line/ Off-line Simulations for Teaching Graduate Psychiatric/Mental Health Nursing Students in a Web-based Program

Merrie Kaas

University of Minnesota School of Nursing, Minneapolis, MN, United States

The number of Web-based graduate psychiatric/mental health (PMH) education nursing programs continues to increase and nursing faculty constantly strive to develop and test on-line and off-line teaching strategies that balance the rigor of nursing academics and the flexibility of student-centered learning. The use of simulations, both on-line and in-person, can replicate real life experiences when fewer clinical experiences are accessible to students today. Simulated learning can assist the graduate PMH nursing student to develop critical thinking and decision-making skills, critically evaluate their own actions, and systematically hone their therapeutic communications with patients who demonstrate a wide range of behavioral disorders.

As a result of a federally funded training grant, the 7 courses in our graduate PMH program were converted from all on-campus courses to Web-based courses with 4 face-to-face, on-campus meetings per course. Faculty struggled with converting the didactic and laboratory experiences to an on-line format. On-line and off-line simulations were developed to teach specific knowledge and skills and assess the students’ competencies in problem-solving, diagnostic assessment, and psychotherapeutic communication.

The presentation will describe 3 types of simulations developed in this first year of on-line teaching moving from low-fidelity to higher-fidelity simulation: longitudinal, problem-based case studies used to teach critical thinking in psychopharmacology; standardized patients and Objective Structured Clinical Evaluations used to teach psychiatric assessment and diagnostic decision; and the Interactive Scenario Builders used to teach therapeutic communication skills in psychotherapy. Student and faculty summative evaluations will be discussed.

Top of page

Identifying the “Right Patient”: Nurse and Patient Perspectives on How to Verify Patient Identity During Medication Administration

Teresa Kelly, Cadeyrn Gaskin, Cath Roper, Stephen Elsom

Centre for Psychiatric Nursing, Melbourne, Australia

In this paper, we report on a research project funded by the Australian College Mental Health Nurses’ and Bristol Myers Squibb Research Grant in 2007. We examined ways in which mental health nurses could correctly identify patients during medication administration that promote medication safety and that are acceptable to both consumers and nurses.

Central to the safe practice of medication administration are the “five rights”- giving the right drug, in the right dose, to the right patient, via the right route, at the right time. In non-psychiatric settings, such as medical and surgical inpatient units, the use of identification aids, such as wristbands, are common. In most Victorian psychiatric inpatient units, however, standardised identification aids are not used. Anecdotally, consumers dislike some methods of patient identification, such as wearing wrist bands, and some nurses perceive consumers' rights are infringed through wearing personal identifiers.

In focus groups, mental health consumers and mental health nurses were invited to discuss their experiences of patient identification during routine psychiatric inpatient medication administration. They were also asked their opinions of, and preferences for, different ways of verifying “right patient” during routine medication administration. In our paper, we will present the findings of a qualitative research project in which we explored the experiences, opinions, and preferences of mental health consumers and mental health nurses towards methods of correctly identifying patients during medication administration.

Top of page

Power and Authority is the Empowerment of Subordinates in Forensic Mental Health Nursing.

Rik Koopman², José van Breukelen¹, Cor Schroder¹

¹Sigma Theta Tau/Rho Chi Chapter/University of Utrecht, Utrecht, Netherlands, ²Australian College of Mental Health Nurses, NSW, Australia, ³Sigma Theta Tau/Xi Omicron Chapter/University of Western Sydney, NSW, Australia

Power and authority is a “hot” topic in forensic care in the Netherlands. The present dilemma of Dutch forensic mental health nurses is that they are willing to accept a subservient role, which is further compounded by fairly autocratic leadership styles within the provision of forensic mental health care, which in turn may result in chronic disempowerment

The FPK’s are organisations with a rigid centralised authority structures that limit the professional freedom of their workers to control their work activities. This contributes to an increase dissatisfaction and powerlessness within their work domain.

This presentation aims to provide the results of an analysis of an extensive literature search dealing with empowerment and authority issues in forensic mental health nursing.

In addition the writers will attempt to prove that a detailed understanding of these mechanisms may help them to become empowered and use their power for better patient care. Power is a widely used concept in sciences that deal with health and social issues, so there are many definitions. A number of definitions of power have also been used in nursing and can be related to forensic nursing care. Aside from the theoretical issues that were identified by the writers, a real-life case study will confirm the concerns, hopes and proposed strategies that were raised in the initial part of the presentation.

Top of page

Despite Issues Such As Aggression, Increasing Patient Acuity, Staff And Bed Shortages Why Do Nurses Keep Returning To The Mental Health Arena?

Tamara Kos, Pauline Nathan

Curtin University of Technology, Perth, Western Australia, Australia

Workplace violence is the most dangerous occupational hazard that nurses face daily in the mental health setting. Nurses in this setting are exposed to aggression because of issues such as poor implementation or an absence of strong violence prevention programs and protective regulations. Violence in the workplace continues to be an organisational reality due to reasons such as nursing staff and bed shortages and increases in patient acuity (McPhaul & Lipscomb, 2004).

So, the question to ask is why do nurses keep returning to such a high risk environment? And what are the key attributes of a mental health nurse that seem to buffer them from the stressors of the everyday realities in their workplace?

This presentation will examine the literature on the key qualities of a mental health nurse. Using Antonovsky’s (1996), salutogenic model as a framework, the idea of a person’s sense of coherence will be explored. It describes generalised resistance resources such as resilience that embrace a person, situation or organisation. Although, most nurses are not aware of it, the findings from the literature will indicate that nurses working in the mental health setting are already using these generalised resistance attributes successfully to manage the daily stressors they experience.

This presentation will highlight strategies that nurses can adopt to strengthen their current practice, hence leading to an improvement in their physical and mental well being.

Top of page

The National Register of Antipsychotic Medication in Pregnancy (NRAMP)

Jayashri Kulkarni¹, Heather Gilbert¹, Caroline Gurvich¹, Natasha Marston¹, Kay McCauley²

¹Monash Alfred Psychiatry Research Centre, Melbourne, Australia, ²Monash University, Melbourne, Australia

Introduction: Current data on antipsychotic use in pregnancy is limited. Establishment of the National Register of Antipsychotic Medication in Pregnancy will provide evidence-based clinical guidelines for the best use of antipsychotic medication during pregnancy and for one year postpartum.

Method: Participation will include women with a history of mental illness, who are taking antipsychotic medication and who become pregnant. Participants will be sought Australia-wide. Following provision of informed consent, data will be gathered via telephone and/or face to face interviews during pregnancy, following delivery, and for the first year postpartum. Information will include demographics, medical, psychiatric, medication and obstetric history, and information on general health and wellbeing for mother and baby.

Results: This study is current and ongoing, with a proposed target of 100 participants. Several time point analyses are possible and include the antenatal period, immediately post-delivery and for the first year of the baby’s life. Results to date will be presented.

Discussion: The collection of ongoing data, and the resulting guidelines, have the potential to provide regular contemporary updates to clinical treating teams for evidence-based management of women in this vulnerable population group. We plan to fill a void in mental health services where currently there is a distinct lack of information available to treating clinicians with regard to providing safe and timely care of women who take antipsychotic medication and become pregnant.

Top of page

Suicide research and the ethics of engagement

Richard Lakeman

Dublin City University, Dublin, Ireland

Suicide is a pressing social concern but engaging with suicidal people in research is fraught with ethical difficulties. This paper presents the findings of a web based survey of experienced suicide researchers and human ethics committee members (from Ireland, the United Kingdom, Canada, Australia and New Zealand) on the ethical problems and ethical practice involved with working with people who may be suicidal. Ethical research involving suicidal people requires both procedures to protect participants, and consideration of ethics as an ongoing negotiated process. The findings provide salient pointers for researchers and practitioners to consider in their work with suicidal persons.

Top of page

Protected Engagement Time the Art of Therapeutic Interaction

Fiona Lamont¹, Jane Stein-Parbury²

¹SESIAHS, NSW, Australia, ²UTS, NSW, Australia

Mental health nursing has evolved into a profession that is both a science and an art. The science is the use of theories of human growth and development to observe and understand human behaviour. The art is the purposeful application of this scientific knowledge and we apply this through our interactions with patients.

This presentation discusses a proposed research project that’s aim is to determine how much time mental health nurses spend in therapeutic engagement with patients. Following an observational period, a protected engagement program will be implemented in identified units. With the introduction of Protected Therapeutic Engagement (PET) time we hope to see a decrease in the number of incidents on the ward.

An audit of files and incident reports will be carried out to ascertain types of patient behaviours. Staff will be given the Maslach burnout inventory to fill out pre and post PET intervention. Patients will be given a patient satisfaction survey. An adapted version of the observation scale entitled “nurses daily activity recording system” developed by Whittington and McLaughlin (2000) will be used to determine how nurses are spending their time whilst on shift.

Once we have established the amount of time staff are spending with patients in therapeutic interactions we will implement PET. Nursing staff will be given weekly workshops on improving counselling skills and information on what can be done during PET. All other staff and patients will be informed via posters around the ward and what their responsibilities will be at this time.

Top of page

Registered Nurses’ Experience of Managing delirium in the acute care setting: Implication for Mental Health Liaison

Ian Landsborough

Curtin university of Technology, Perth, WA, Australia

Introduction

Recent research into Registered General Nurses’ perception of caring for the delirious patient has demonstrated they experience frustration and dissatisfaction with the assessment and management of these patients. This paper will outline the experiences of nurses caring for the delirious patient, their perceived difficulties and frustrations and discuss the implications of this for the Mental Health Liaison role.

Methods

Qualitative descriptive research methodology was employed for this pilot study and data were collected using semi-structured interviews, memos and observation. Eight participants were recruited from a convenient sample of nurses working at two major metropolitan hospitals in Western Australia. The interviews were conducted during 2007. Interviews

lasted between 45-60 minutes. The final sample size was determined by saturation or where no new data was being collected which occurred after the eighth interview. Interviews were audio tape-recorded. Demographic information on participants was also obtained at the beginning of each interview.

Results

Analysis of the data identified two major themes: ‘Inability to differentiate confusion from delirium’, and ‘Managing confused patients’. The perceived inability to differentiate confusion from delirium had three main components: caring for so many confused patients, feeling helpless and lack of education and training to assess confused delirious patients. Managing confused patients also had three main components: safety issues, attitudes of staff and the environment.

Discussion

The results of this study will be discussed in the context of the Mental Health Liaison role. This will focus on the development and use of assessment tools, management strategies and implications for improved care and reduced cost of caring for the delirious patient.

Top of page

Do the concept of resilience and the experience of schizophrenia go together?

Sue Liersch, Janette Curtis, Peter Caputi

University of Wollongong, Wollongong, Australia

Resilience as a psychological concept is currently receiving prominence in both professional and contemporary literature and also in health service policy and planning documents. Can a concept that is largely based on a psychological construct be applied to an experience like schizophrenia for which biological challenges are so powerfully entwined? What research has been done to support the use of resilience as a mental health strategy in general and for schizophrenia in particular?

What originally started as an investigation of resilience research in the context mental illness has out of necessity evolved into research to ‘begin at the beginning’ by asking people who have experienced schizophrenia what they believe resilience to be about and how they see resilience in the context of their experiences and future challenges. Findings of this qualitative study are compared with existing resilience theory to determine strength of correlation with known resilience factors and also to highlight differences for resilience in the context of mental illness experience.

Implications and plans for future development of an instrument to measure resilience in the context of schizophrenia will also be discussed.

Top of page

Findings from travels under a Winston Churchill Memorial Fellowship to investigate

Less restrictive practices in acute mental health care

Sue Liersch

¹University of Wollongong, Wollongong, Australia, ²Greater Southern Area Health Service, Goulburn, Australia

The presenter will discuss;

A collaborative community based program between Police and Mental Health for non-stigmatising intervention for people experiencing mental health crisis in the community.
How programs eliminating seclusion and restraint in acute inpatient facilities are really managing.
Adopting a workplace philosophy of non-violent crisis intervention.
Pathways for nutritional assessment and treatment for people diagnosed with mental illness and how this intervention is greatly improving long term outcomes.
The ‘Courage to Come Back’ awards.

Top of page

The art and science of clinical supervision

Lisa Lynch¹, Kerie Hancox¹, Brenda Happell²

¹Southern Health, Victoria, Australia, ²Central Queensland University, Queensland, Australia

Clinical supervision has been a priority on the nursing agenda for many years. However, there is little evidence of systematic implementation. In this presentation it will be argued that that a significant reason for the lack of access to clinical supervision for all nurses is the paucity of attention paid to clinical supervision implementation strategies. A considered and structured plan, for the implementation of clinical supervision and strong nursing leadership is crucial to the success of implementation strategies. Indeed ad hoc, disorganised and uncoordinated approaches to introducing clinical supervision could actually reinforce the surrounding common myths and misconceptions, and significantly reduce the potential positive benefits. The authors present a model of clinical supervision, developed directly from clinically-based research. The model provides an easy to use step by step guide to implementation that would be of benefit to the individual nurse seeking to implement clinical supervision in his or her own work area or Nurse Managers, Directors of Nursing and even Chief Executive Officers wishing to exploring how to implement clinical supervision throughout an organization.

Top of page

Interpersonal Aspects Of Patient Satisfaction And The Culture Of Mental Health Nursing Practice

Belinda Mackie

Monash University, Melbourne, Australia

Today in the field of public mental health and its treatment of patients we see the priority psychiatry has come to place on the sciences. Influencing this are the processes behind power in the mental hospital that correlate with a capitalist structure that, rather than a material or economic result, produces health. The introduction of the economic rules of the marketplace to the field has increased the pressure to maintain preferred provider status with private insurance carriers and the escalating costs for mental health services have resulted in a climate of cost containment, strict standards of accountability and intense competition. As a result significance has been placed on the evaluation of health services and in particular patient satisfaction is now being targeted as a measure of the outcome of psychiatric care. Patient satisfaction is strongly correlated to interpersonal aspects of psychiatric nursing care. This relationship is revealed in the therapeutic approach of engaging with the patient and the creative application of theoretical and experiential knowledge in the practice setting. This presentation will explore nurse’s resistance to patient feedback, the nursing crisis and the nature of the therapeutic relationship in the context of patient satisfaction.

Top of page

Mental Health Nursing Research: An Investigation on Psychiatric

Referrals from the Police

Reshin Maharaj¹, Louise O'Brien², Sharon Andrew², Donna Gillies¹

¹Sydney West Area Mental Health Service, NSW, Australia, ²University of Western Sydney, NSW, Australia

INTRODUCTION: Police are a major source of referral to psychiatric services but few studies have systematically addressed police referrals to psychiatric services. By utilising the art and science of mental health nursing research, this study investigated the characteristics of patients referred by the police by comparing police referred patients to patients referred from other sources. METHOD: Data was collected from the records of 101 police referred patients and 99 patients referred from other sources. Multivariate analyses were used to test for differences between referral groups on a range of demographic, diagnostic and admission outcomes. RESULTS: Of the 200 patients admitted 85% were referred by involuntary legal commitment (100% police referrals and 69% from other sources). Referral groups were significantly different on a number of diagnostic and admission outcome variables. Police referrals were 3 times more likely to be diagnosed with a mental disorder due to substance misuse. The most important predictor for a police referral was drug or alcohol problems. DISCUSSION: Clearly, there are advantages for persons with drug and alcohol problems who are admitted to mental health services as it provides a safe place for recovery from the acute effects of substance misuse. The concern however, is whether admission to mental health facilities is beneficial, that is, whether it reduces danger to others or produces favourable changes in health. This discussion will focus on the art of adapting nursing practice so that better outcomes for those whose lives we seek to enhance can be achieved.

Top of page

Evaluation Of An Innovative Workshop For Nursing Students On Person Centred Care In Mental Health

Elizabeth Martin, Annette Rushforth, Donna Harvey, Steven O'Reilly

University of Sydney Department if Rural Health, Broken Hill NSW, Australia

Involvement of consumers as presenters is an accepted strategy in mental health promotion and is increasingly becoming evident in health worker education in the area of mental health.

A collaborative education project, supported by the local University Department of Rural Health, resulted in the development of a workshop aimed at improving delivery of mental health care by health professionals. This innovative workshop combines theoretical perspectives of mental health care with the lived experience of the consumer. The goal is to teach health workers, not only about mental health care, but also the impact of mental health care delivery models on the person experiencing mental health problems.

The program, originally targeted at existing health workers, has now been successfully incorporated into the student nurse rural placement program run by the University Department of Rural Health.

Claims to success are based on student/participant evaluation as scored on an adaptation of the University of Sydney, Unit of Study Evaluation form. The qualitative and quantitative results of feedback from the first four cohorts to attend are presented.

Top of page

Building Community Across Geographic Boundaries: New Brushstrokes On A Broad Canvas

Elizabeth Martin¹, Denise McGarry³, Andrew Cashin⁴

¹Broken Hill University Department of Rural health, NSW, Australia, ²Greater Western Area Health service, NSW, Australia, ³Northern Sydney Central Coast Area Health service, NSW, Australia, ⁴University of Technology, NSW, Australia

Mental health nurses in remote areas are relatively disadvantaged in terms of access to ongoing professional development forums. Nursing praxis-input in face to face mode is rendered, at the least inconvenient, related to geographic isolation. Attempts to remedy this have been made by linking a remote site of Greater Western Health Service in NSW to the Northern Sydney Central Coast Area Health Service bi monthly mental health nurse speaker symposium. This paper explores the enablers and barriers experienced by remote mental health nurses in adopting this innovative approach to professional development. The participant responses to an email survey, based on Salmon’s hierarchy of aspects of involvement in communities of professional practice, are presented. These are compared to those factors identified by the same survey instrument administered to metropolitan mental health nurses. Similarities and contrasts are explored and hypotheses are suggested to explain the unique features of remote area mental health nursing in relation to participation in this approach to professional development and community building.

Top of page

Can a computers replace a Mental Health Lecturer?

Jem Masters

University of Sydney, Sydney, Australia

In an era of electronic based technology mental health education has to support students in the use alternatives to the traditional methods of developing skills. There is an expectation that electronic resources are available to students outside of the clinical and academic environments which enables them to learn more than the basic nursing skills. The majority of post-graduate or pre-registration nursing students have an extensive knowledge of technology and computer based programs which they have used in their previous professions or academic careers.

The Faculty of Nursing and Midwifery in collaboration with the E-Learning Centre at Sydney University has been developing web based programs for student to learn assessment skills and formulate clinical diagnosis using a progressive reasoning program. Mental Health Nursing has taken the lead in developing an online Mental State Examination assessment for student to work through and submit an MSE, Clinical Diagnosis and Develop Management strategies.

This paper demonstrates how the students use progressive reasoning to formulate of clinical diagnosis using a web based program which focuses on MSE. The paper highlights the benefits of technology as addendum to face to face teaching. Similarly, how online technology can be used to support the learning of mental health nursing skills away from the clinical environment or classroom.

Top of page

Obscuring the landscape: hidden nature of child sex abuse

Sue McAndrew¹, Tony Warne²

¹University of Leeds, Leeds, United Kingdom, ²University of Salford, Greater Manchester, United Kingdom

There is growing international recognition of the prevalence of mental health problems manifesting from emotional, physical and sexual abuse in childhood. In the UK, initiatives are being piloted to ensure that all qualified mental health nurses receive mandatory training aimed at raising the awareness of the issues involved in order theses can more effectively addressed in clinical practice. Concurrent to this strategy is an emergent drive to ensure nurses receive such education within their pre-registration training. A content analysis undertaken on 30% sample of the Mental Health Nurse curriculum documents for England revealed that sexual abuse per se was a hidden topic.

This paper explores the difficulties involved in developing a new curriculum capable of facilitating a better awareness and understanding of emotional, physical and sexual abuse in childhood and its relationship to mental health and well being in adulthood. These difficulties include the reluctance of many teachers and practitioners to address these and other taboo issues as a consequence of their own history and culture. Providing a curriculum whereby the unspeakable can be safely explored requires an organisational approach that is able to provide containment and a safe space to explore self and self in relation to others. In this paper, consideration is given to how as educationalists, we could use more creative approaches to nurse education and in doing so, mirror how we want nurses to be with their patients in clinical practice.

Top of page

Risk Assessment For Future Violence- A Fusion Of Technology, Tools And Clinical Judgment

John McCallum

NSW Institute of Psychiatry, Sydney, Australia

“Risk assessment” in mental health nursing, in the narrowest sense, implies employment of skills in judging the probability of a client being “a danger to themselves or others”. It can be argued that the assessment of risk to self has become well entrenched in mental health nursing as evidence based practice, but what of the assessment of risk for future violence?

There is a compelling body of literature suggesting that clinical judgment alone is less reliable in assessing risk for future violence than the employment of actuarial and “Structured Professional Judgment” tools. In forensic mental health these tools have been embraced as almost essential in the conduct of comprehensive risk assessments. It is argued that the principles underpinning these tools can be successfully applied to mental health assessments more broadly, by mental health nurses combining greater awareness of empirically based risk factors with clinical judgment. A hypothetical case scenario will be shown in video format with the audience asked to judge, based on the clinical interview alone, whether the client should be admitted involuntarily? A discussion of tools for assessing risk for future violence follows, referenced by the literature, with a particular focus on how the HCR-20 tool, developed in British Columbia, can be applied to the hypothetical case scenario. It is submitted that the use of video technology as a teaching aid prompts mental health nurses to reflect on the practise of risk assessment for future violence, fusing clinical expertise with the use of specific tools.

Top of page

Primary caregiver access to early psychosis services: Overcoming the obstacles; learning for the future

Terence McCann¹, Dan Lubman², Sai Lu¹

¹Victoria University, Melbourne, Australia, ²Melbourne University, Melbourne, Australia

Introduction. Primary caregivers play an important role in the recovery of family members from early onset psychosis, but often encounter considerable difficulties in accessing mental health services. These difficulties undermine their burden of care and physical and mental wellbeing.

The aims of this paper are to (i) understand the experiences of primary caregivers in accessing specialist mental health services for a family member with early onset psychosis, (ii) explore why they experience difficulties in accessing services, and (iii) examine how they overcome these difficulties on the initial and subsequent occasions.

Method. Twenty primary caregivers were recruited through ORYGEN Youth Health early psychosis centre in Melbourne. Participants took part in in-depth, audio-recorded interviews. A thematic analysis of the data was undertaken, informed by Colaizzi’s (1978) methodology.

Findings. Primary caregivers frequently encountered difficulties in accessing specialist mental health services. Access was affected by a range of caregiver and organisational related factors, such as prior knowledge and understanding of early onset psychosis, level of assertiveness, social and cultural influences, and organisational issues. The caregivers used a range of strategies to improve their access to services.

Conclusions. The findings reinforce the need for specialist mental health services to be more accessible to primary caregivers when they first seek help for a family member with early onset psychosis, particularly individuals with limited understanding of mental illness and those from culturally and linguistically diverse backgrounds. The implications for caregivers and for further research are also considered.

Top of page

Antipsychotic medication side-effects and adherence in people with schizophrenia

Terence McCann¹, Eileen Clark², Sai Lu¹

¹Victoria University, Melbourne, Australia, ²La Trobe University, Wodonga, Victoria, Australia

Introduction. Many individuals with schizophrenia are hesitant to take their antipsychotic medications. A wide range of factors affect adherence, but the relationship between side-effects and non-adherence is inconclusive.

This paper examines the prevalence of antipsychotic medication side-effects in individuals with schizophrenia, and assesses if there is any relationship between side-effects and medication taking.

Method. The Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS) was used with a convenience sample of 81 mental health consumers with schizophrenia from the western region of Melbourne and the Grampians region of rural Victoria. The LUNSERS is a 51-item, closed response, self-rating instrument which requires respondents to signify how often they have experienced each of the side-effects in the preceding month.

Results. The results showed that approximately 20% omitted taking their medication at least once in the week before data collection. Around half reported they had experienced more than 45% of the LUNSER side-effects in the month prior to data collection. The cumulative influence of side-effects was not associated with medication omission. Older participants were more likely to experience anticholinergic and allergic side-effects than their younger counterparts. Younger females were more likely to experience hormonal related side-effects than older females. Overall, medication omission was not significantly correlated with any of the seven LUNSERS sub-scales.

Conclusions. The findings indicate that side-effects are common, and highlight the need for greater attention to be given to age and gender specific side-effects. The implications of the findings for consumer and case manager education and management, and further research are examined.

Top of page

‘KYA’ WEAVE – Introducing women sensitive practice

Kay McCauley-Elsom¹, Jakqui Barnfield², Fiona Reed²

¹Monash University, Frankston, Victoria, Australia, ²Peninsula Health Psychitric Service, Frankston, Victoria, Australia

INTRODUCTION:

The introduction of gender sensitive practices with a focus on the needs of women specifically, in the acute inpatient and community settings has been advised by both the literature and government documents for more than a decade. However the implementation of such policies is not evident in clinical practice. This presentation introduces Kya WEAVE. Kya is an indigenous term for wise women; WEAVE is an acronym which explains the concepts relating to the wellbeing, empowerment, advocacy, value and enlightenment of women. Kya WEAVE is a pilot program in one mental health service in Victoria, which aims to address the issue of implementing women sensitive practice and to develop and deliver educational opportunities for staff.

METHOD:

Literature review was performed. Workshops were run to identify the key issues. Educational activities have included the development of an educational package for staff relating to women sensitive practices within mental health services and a one day conference was held to promote aspects of the needs of women and staff.

RESULTS:

A literature review was performed which identified key areas for consideration when implementing women sensitive practice including issues of physical wellbeing, reproductive health, sexual and physical abuse issues, pregnancy and the use of antipsychotics and parenting issues. An overview of the educational package will be presented, along with feedback from staff and women regarding the implementation of women sensitive practices within the mental health service.

DISCUSSION:

The launch of KYA WEAVE was timed to coincide with International Women’s Day which introduced staff to the concept and objectives of the pilot program. Current practices in the acute inpatient units in particular are noted in the literature as not providing women sensitive practices, with a lack of consideration for women specific needs. This presentation will outline the literature and progress of the program to date.

Top of page

Psychosis, Pregnancy and Motherhood: A case study of ten women

Kay McCauley-Elsom, Wendy Cross

School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia

Introduction

Women with serious mental illness are becoming pregnant. They may experienced many stressors in their lives which cause distress not the least includes their experience of psychosis, of the treatment, and of the ongoing need for medication to keep them well. It is reported in the literature, and is a popular belief in the community and among clinicians, that this vulnerable group of women will encounter many difficulties with pregnancy and motherhood.

Method

Yin’s (2003) case study methodology has been used to explore and explain the experiences of ten women enrolled on NRAMP. Their perspectives of psychosis, pregnancy and motherhood are presented using logic charts and diagrams to identify patterns and themes. The women’s stories reflect the voices of the women.

Results

During pregnancy they express concern that the medications may harm their baby. Motherhood for some is an event which makes them happy and proud, their baby gives them hope and a reason to stay well. For others however, their experiences are not so positive with a high risk of relapse, of separation from their baby and their baby being placed in the care of others. Two clearly defined themes identified include the ‘Desired outcomes’ and the ‘unwanted outcomes’, these themes are presented in more detail in this presentation.

Conclusion

Using Yin’s case study methodology has enabled the pathways of these ten women to be identified. This first study of the experiences of women with psychosis provides evidence of both the experiences and outcomes for the mothers and their babies.

Top of page

The art of collaboration – the skilled coming together of consumers and nurses.

Andrea McCloughen, Louise O'Brien, Caroline McSherry, Donna Gillies, Malcolm Horsfall, Subba Singh

¹SWAHS Mental Health Network, NSW, Australia, ²University of Western Sydney, NSW, Australia

Mental health nurses are directed to establish collaborative relationships with consumers and consumers are encouraged to take an active role in their treatment and engage with nurses collaboratively. Currently there is inconsistent definition about what collaboration means, processes contributing to nurse-consumer collaboration are poorly articulated and the attitudes and values of nurses and consumers are unclear.

This presentation will outline preliminary findings from a research study exploring whether consumers and nurses share common understandings, attitudes, values and experiences of consumer-nurse collaboration in a mental health rehabilitation setting. Separate focus groups were used to gain an understanding of the perceptions and experiences of consumer-nurse collaboration. A survey was used to more broadly determine significant areas of agreement and disagreement about consumer-nurse collaboration.

Shared understanding about consumer-nurse collaboration and conditions that contribute to favourable collaboration emerged from the study. Collaboration was experienced as a dynamic process governed by mutual and active participation between individuals who value and trust each other. The way those individuals engaged and worked together positioned collaboration as art encompassing person and skill.

It is anticipated that findings from the study will inform mental health nursing practice and contribute to the development of effective strategies and behaviours for nurses to engage consumers collaboratively. Furthermore consumers’ understanding of collaboration may be enhanced and their attitudes and expectations strengthened so that they feel better equipped to work with nurses in a collaborative way.

The study was awarded an ACMHN research grant in 2007.

Top of page

Developing the next generation of mental health leaders: The art of mentoring.

Andrea McCloughen, Louise O'Brien, Debra Jackson

¹University of Western Sydney, NSW, Australia, ²Sydney West Area Health Service - Mental Health Network, NSW, Australia

Introduction: This presentation outlines findings from a PhD study that explored Australian nurse leaders conceptualisation and experiences of mentoring relationships for nurse leadership. Specifically, mentoring is positioned as a progressive connection that looks to the future and is highlighted as a skilled human activity with its own principles and methods - an art, which develops human potential.

Methods: A phenomenological approach was used to collect narrative from thirteen Australian nurse leaders who were interviewed about their understanding and experiences of mentoring relationships for nurse leadership.

Findings: The participants believed that mentoring had influenced and contributed to their own and others’ leadership development and career success. Participants experienced mentoring relationships as transformative and evolutionary, where the possibilities of being human were nurtured. They understood mentoring relationships as progressive connections with the dynamic purpose of developing personal capacity and specific focus on the facility of leadership to progress both individuals and the nursing profession.

Discussion: The mentoring relationship is a specialised relationship based on a unique human connection that transcends technology and science. It transports nurses toward positions of leadership as a means of safeguarding the future of nursing. Mentoring for leadership should be understood as a supportive professional relationship and considered by mental health nurses who are aspiring to leadership positions. In its broadest sense mentoring for leadership should be viewed as an astute investment in the future of the mental health nursing profession because it supports those nurses who have the capacity to lead, to do so in a confident, wise and visionary way.

Top of page

Duly Authorised Officer’s practices under mental health law in New Zealand: Are nurses meeting the requirements of the law?

Brian McKenna, Anthony O'Brien, Katey Thom

University of Auckland, Auckland, New Zealand

Introduction

In New Zealand, mental health legislation in 1992 introduced statutory roles now undertaken by mental health nurses. One such role is the Duly Authorised Officer (DAO) who is responsible for the procedural requirements necessary to facilitate compulsory assessment. The DAO must ensure that the purpose of the assessment is explained to the person in the presence of a family member, or someone concerned with their welfare. Three recent High Court decisions have challenged DAO practices in arranging the presence of a third party. The aims of this study are to describe the circumstances in which these requirements prove problematic and the decision- making processes which take place.

Methods.

A retrospective audit of clinical documentation was undertaken of all compulsory assessments from three District Health Boards (DHB) over a month (n = 60). Focus groups were undertaken in each DHB with mental health nurses who were DAOs (participants =14).

Results

There was a commitment by the DAOs to ensure the presence of a concerned third party but the use of the police for such purposes was questionable. There were examples of tension between the statutory requirement and art of nursing practice. Ethical decision-making frameworks were used to justify modifying statutory requirements. Considerable angst was associated with making such decisions and the possible consequences.

Discussion

DAOs must document decision-making thoroughly and be able to justify their actions under legal scrutiny. National guidelines for practice need to be developed for DAOs to assist mental health nurses in meeting statutory requirements.

Top of page

Using multimedia to assist treatment planning and outcomes measures compliance

Brett Mckinnon², Wendy Cross¹

¹Monash University, Melbourne, Victoria, Australia, ²Mildura Mental Health Service, Mildura, Victoria, Australia

The Victorian Mental health Act (1986) was amended in 2004 to include section 19A that relates to treatment planning. Each patient who is receiving mental health care should have a detailed treatment plan that outlines their particular issues and how services in partnership with them, and their significant others, will assist them to manage their individual issues to improve their state of health and well being.

Since the inception of Section 19A services have struggled to implement consistent strategies to adhere to the Act. Further, outcome measures documentation was found to be a time consuming process that also has poor compliance. Outcome measurements evaluate patient progress and perception and are valuable in tracking effectiveness of planned care. Hence completion is desirable.

This paper outlines research-in-progress of the development of a programmed software application that aims to assist with the adherence to Section 19A, as well as assisting clinicians to complete Outcome measures documentation in a timely and efficient manner. The software application will allow for traceable evidence based data to be collated that will assist with implementing, maintaining and updating managed mental health care. The program satisfies all the elements the act asks of service providers and facilitates collaborative partnerships between consumers and carers.

The study will include pre and post implementation file audits, clinician and consumer consultant focus group meetings and consumer and carer interviews. Clinician training and support will be provided throughout the trial period, following which, the quantitative evaluations will occur.

Top of page

Pushing The Boundaries: Relationships With Adolescents

Julia McLean

Taranaki District Health Board, New Zealand

Preparing the mental health nursing workforce for working with patients experiencing mental illness is essential. Mental health nurses have a responsibility to provide safe and effective care. The need for the mental health nurse to maintain professional, yet therapeutic boundaries with this client group when forming the therapeutic relationship is significant. This paper discusses four adolescent mental health nurses’ experiences of assessing, understanding and maintaining therapeutic boundaries with adolescents in a mental health setting in New Zealand.

Therapeutic relationships are central to mental health nursing. The nurse’s role in maintaining boundaries within this relationship can be challenging. When therapeutic boundaries are breeched within the nurse adolescent relationship the adolescent’s safety within this relationship is compromised

The three key themes that emerged from this narrative inquiry include: the importance of the nurse clarifying his/her role; the learning that occurs throughout the nurse’s practice journey; and the role of the nurse in keeping the adolescent and the nurse safe.

These findings highlight the importance of the nurse knowing her/himself and having an ability to identify the learning that occurs in the nurse’s own life journey. Clinical supervision and open communication with senior nurses and mentors assist the nurse in monitoring practice. When nurses do not have sufficient knowledge of the fundamental principles of adolescent mental health nursing; such as knowledge and skills in both adolescent development and psychodynamic nursing, they are at risk of boundary crossings. Recommendations are made from this small study for nursing practice, nursing education and further research.

Top of page

Mental Health Nurse Practitioners: The Way To The Future.

Rene Michael, Dianne Wynaden

Curtin University, Western Australia, Australia

Nurse practitioners (NP) are a vitally needed workforce development, particularly as the indicators of demand outstripping available labour supply have become urgent. However the current organisation of health care and the service structure of health work force have remained mostly unaltered for more than 100 years. Specialties, such as mental health nursing, have developed within disciplines but the dominant focus on staffing for health service is still nurses, doctors and a varying range of allied health professional croups. The relationship between these disciplines has not evolved beyond a hierarchical one with medicine at the peak of this hierarchic. Nursing has responded to the crisis in health care through a range of innovative roles and service models, one of which is the emergence of NP service. Within the area of Mental Health, NPs are especially important to delivering on the goals of increasing wellness levels through effective care, which is proactive and planned rather than episodic and reactive. As a NP there is a new level of health care provider which will achieve positive outputs and outcomes, which are set for further enhancement to their practice. This paper provides a snapshot of the NP programs offered through the School of Nursing and Midwifery at Curtin University of Technology, Western Australia as they relate to Mental Health nursing practice. The NP in Australia and globally is educated and authorised to practise with autonomy and discretion. Mental Health Nurses who are qualified NPs can enhance practice in response to patient/consumer needs informed by their own clinical judgement.

Top of page

Leadership through Reflective Practice

Sallyanne Miller, Lisa Soares

Institute of Reflective Practice, Gloucestershire, United Kingdom

We can be honestly unaware of how our behaviour impacts on those around us, and our organisations. This means that we can be unaware of both the positive and negative affects of the work habits we build up over the years and how they impact on getting the work done. Reflective Practice Groups are a powerful tool for developing this insight into personal and team dynamics and then converting these discoveries into action to improve their immediate workplace.

This is achieved through exploration of the context in which group members’ work using specific situations. By exploring workplace stories and issues, the reflective practice process builds understanding of each group members’ ‘part’ in the situations they find themselves in, the impacts of behaviour on others and the team’s dynamics. With this knowledge, solutions and strategies are more easily identified to address issues and changes.

By working with Reflective Practice - in groups – the team gains insight into each other that is difficult to achieve in the everyday doing of the work. By creating a space specifically for reflection the team has the opportunity to learn and solve problems together and share in the accountability for the way the team gets their work done.

This paper explores the process and outcomes of a team who have made meeting in a reflective practice group a regular part of their meeting schedule.

One in - all in: Promoting safer medication administration through on-line competency assessment for all nurses.

Greg Miller, Sharon Sherwood, Semon Wain

NorthWestern Mental Health, Melbourne, Victoria, Australia

In 2006, NorthWestern Mental Health introduced a medication quality and safety initiative inclusive of the development of a Medication Administration Learning Package – described previously at this conference. This paper examines how the medication safety initiative has progressed, building upon its evaluation and recommendations from Clinical Risk Committee and evidence of medication errors in context wider than the original entry level practitioner.

The orientation to Safe Medication Administration is the final revision of the original hard copy package and is in use as a an initial credentialing tool for Registered Division 1, 2 (endorsed) and 3 Nurses, and as providing a supportive formative ‘refresher’ learning package applicable to nurses returning to clinical practice, those who are moving from one clinical setting to another and importantly nurses identified as at risk of medication error incidents.

The strategy also called for the implementation of a mandatory annual learning and competency assessment for all nurses working in NorthWestern Mental Health clinical services. Anticipated benefits of the initiative include safe outcomes for patients through competent nursing practice and decreased incidence of medication errors. This paper describes the policy changes, systems implemented and in particular the development implementation and evaluation of the on-line learning and assessment tool to facilitate this goal.

Top of page

Leadership through Reflective Practice – A Workshop

Sallyanne Miller, Lisa Soares, Steve Wiggins

Institute of Reflective Practice, Gloucester, United Kingdom

This workshop explores the process of reflective practice by providing an opportunity to experience it, understand the role of the group member, and the role of the consultation in crating a safe yet challenging environment for reflection, learning and designing action.

Top of page

Mental Health Intervention Project - “Preventing and resolving mental health crisis situations by working collaboratively”

Michael Mitchell, Helen Turner

Queensland Police, Queensland, Australia

Police, ambulance and mental health services often provide services to the same people with a mental illness. The Mental Health Intervention Project (MHIP) is a tri-agency partnership between the Queensland Police Service (QPS), the Queensland Ambulance Service (QAS) and Queensland Health (QH) aimed at the prevention and safe resolution of mental health crisis situations. The MHIP is a state-wide program with an implementation schedule which is staged over three years from 2006-2009 and will roll out across 17 Queensland Health Service Districts. The project relies heavily on the three services committing to work together to build upon existing relationships and collaborative protocols, with particular emphasis on agency specific training, information sharing and improved pathways of referral for individuals who are experiencing a mental health crisis. The MHIP provides Mental Health Intervention Coordinators within each agency to enable police, ambulance and health staff to work together at district level, to seek local solutions to local mental health issues. To date, each service has developed and delivered training programs that provide staff with enhanced knowledge and skills to de-escalate situations involving people with a mental illness. These programs include opportunities for cross agency and joint agency training involving all three services.

Top of page

Mood Is To Day As Affect Is To Season: A Photojournal

David Miu

Sydney South West Area Health Service, Sydney, Australia

Background and Purpose: As a novice Mental Health Nurse I have observed that often the mental state of mental health clients can impact upon the nurses’ subconscious. To better understand this impact I subjectively explored my own mental health state and tracked changes and fluctuations in my mood.

Methods-: Within this subjective experience it is critical for the subject to have a keen and open mind to allow their current thoughts and feelings to be channelled through a camera lens. As photographs can contain raw emotion that is unfiltered and unedited, a collaboration of photographs may reveal a picture that is usually unknown and hidden from others and from themselves. Various photographs were taken over a 12-month period, emotionally analysed and described in a photojournal.

Results-: By better understanding my own emotions and feelings, I have successfully found a method of articulating myself when verbal expressions are difficult. I have been able to identify the overly prevalent emotion of sadness in relation to my workload throughout the year. By being able to find a way to share my problems, it has allowed me to find a way to keep my mental state in check.

Conclusions-: This subjective personal experience has provided me with an increased awareness of my own thoughts and feelings, a means to vent and explore my own emotions, and a technique that can be used by my colleagues and clients.

Top of page

“The switching Atypical antipsychotic to Abilify study”

Norman Moore, Ah-Nya On, Pasan Manawadu

Mid west AMHS, Sunshine, Victoria, Australia

A high percentage of clients with schizophrenia and related disorders in community mental health clinics often would have experience with taking some form of atypical antipsychotic medications. There are times when clients needed to have an antipsychotic changeover to another agent due to efficacy or tolerability issues or both.

What is the best way to introduce the new agent?

“The switching Atypical antipsychotic to Abilify study” is a 12-week randomised clinical trial conducted on 26 clients in Mid West CCT. The study placed subjects onto a rapid titration and a slow titration group, to study which group has the best outcome.

Following an initial medical review, baseline measurements of the following were obtained: blood for fasting lipid profile and blood sugars; PANNS; CGI; Weight; BMI; Drug/alcohol abuse and dependence; QOL; CSFQ and IntegNeuro. Some of these parameters were remeasured at four and eight weeks, and all were repeated at 12 weeks.

The preliminary findings suggest that there is no clinical significance in the effectiveness of the drug between the two groups. It also shows all the subjects have benefited from the drug in that there were positive gains in all the parameters measured.

Top of page

A Review Of Jung’s Psychology Of Schizophrenia And Its Relevance In Contemporary Psychiatric Nursing Practice

Alan Moore

Monash Medical Centre, Melbourne Victoria, Australia

This paper review’s C G Jung’s writings on schizophrenia and argues that they have a contemporary relevance. The psychiatrist Carl Gustav Jung (1875-1961) has posthumously gained a reputation as a leader of ‘New-Age’ thought. Despite the fact that Jung spent the first 10 years of his psychiatric career working with the chronically mentally ill in the Burgholzli Asylum in Zurich Jung’s ideas have little influence on modern, mainstream, psychiatry. Jung conducted research and wrote a number of papers on schizophrenia whilst at the Burgholzli Asylum. Based on word association experiments, conducted with patients who suffered from schizophrenia, Jung became convinced that they had essentially the same internal conflicts as those effecting ordinary individuals. He also became convinced of the symbolic meaning in delusions and hallucinations. From his researches he developed a psychology of schizophrenia, whilst also proposing that the illness had an organic component. This paper argues that despite being written 100 years ago Jung’s writings on schizophrenia still have a contemporary relevance and remain of value to the clinician who would develop the art of psychiatric nursing, as well as understanding its science. Drawing on Jung’s writings from his Collected Works Volume 3 and his autobiography, Jung’s psychology of schizophrenia is summarized. In conclusion and noting the recent revival of interest in the unconscious in psychiatric nursing literature, the paper proposes that Jung’s psychology of schizophrenia can help contemporary psychiatric nursing address the imbalance created when there is a dominant biological model for the illness.

Top of page

Research for Science and Art: The impact of a Participatory Action Research Project on the care of children with mental health problems receiving care in a general paediatric unit

Lorna Moxham¹, Brenda Happell¹, Kerry Reid-Searl¹, Trudy Dwyer¹, Julie Kahl², Jodie Morris², Narelle Wheatland²

¹Central Queensland University, Queensland, Australia, ²Rockhampton Base Hospital, Queensland, Australia

This presentation will describe the benefits of action research as an approach that promotes change and improvement. The process and outcomes of a participatory research project (PAR) will be outlined. The aim of the project was to enhance the skill and confidence of general nurses in providing care and treatment for children and adolescents admitted to the general unit with a primary psychiatric diagnosis. Focus groups conducted at the commencement of the project highlighted the following concerns of the paediatric nurses: lack of skill and knowledge; fear of saying or doing the wrong thing; lack of communication with child and youth mental health services (CYMHS); and the invisibility of mental health work. These findings led to the implementation of a number of new initiatives including: the development of policies and procedures; education sessions; a resource folder; strategies to improve communication with CYMHS; strategies to promote the importance of mental health work throughout the hospital. A second series of focus groups conducted approximately eight months later indicate significant improvements including: more confidence in what they know and don’t know about mental health; overcoming the fear; improved communication; standing up for the importance of mental health work. The participants expressed the view that they still do not feel confident in communicating with families. Further strategies to assist in overcoming this fear are currently being developed.

Top of page

Absconding: Patients Running Away From Hospital

Eimear Muir-Cochrane, Krista Mosel

Flinders University, SA, Australia

Absconding by psychiatric patients is a high risk event with potential risk of harm to self or the general public.

The aim of this study was to to determine the rate of absconding by detained patients from inpatient psychiatric wards in one psychiatric hospital in South Australia and to provide a comprehensive socio-demographic and clinical profile of absconding patients including age, gender, diagnosis, legal status, time, day and month of absconding. A retrospective audit of 115 cases of absconding was carried out in a South Australian psychiatric hospital over a period of twelve months.

Data was collected from patient information systems and anonymised for researchers to scrutinise. Descriptive statistics were employed to analyse the data, identifying a comprehensive profile of absconding patients. A broad absconding profile of patients was found to be young, male and schizophrenic (average age 33). The average time spent away from the unit during the period AWOL is 2.5 days. However 63% of absconders return to the ward within 24 hours. Most absconds occur on the 1^st 21 day detention order. Abscond times strongly correlate with handover, morning tea and afternoon tea and there were also seasonal influences.

Implications for practice include scrutiny or risk assessment prior and post absconding events, a need to explore the reasons why patients leave hospital without permission and the need to examine the specific characteristics of repeat absconders. This research has implications for nursing practices to reduce the risk of absconding and improve patients’ experiences of hospitalisation.

Top of page

Working with Peer Support Workers In Postgraduate Mental Health Education

Eimear Muir-Cochrane, Kevin Rouse, Gardner Andrew

Flinders University, SA, Australia

This poster will explore theoretical and practical issues of involving consumers (people with a mental illness) in the delivery of mental health education in the higher education sector.

Globally, government policies and guidelines recommend increased involvement of consumers in all aspects of health and social care education, with the inclusion of ‘experts through experience’ underpinning mental health policy. Involvement of consumers in mental health education has a number of aims, as outlined by Repper et al. (2001) including to;

draw on consumer first hand experiences of mental health problems, treatments and services as a basis for learning how to provide acceptable and useful support and care;
explore the impact of mental health problems on the lives of real people so that education is broadened to incorporate ideas about recovery, status, socially valued roles and relationships; and enable qualified mental health professionals to challenge cultures within their own workplace.

Such aims underpin the shift towards a 'recovery’ model of mental health care and support the drive to instil in mental health staff essential capabilities that include respecting diversity, challenging inequality, identifying people’s needs and strengths and providing consumer-centred care. This chapter will examine the philosophical underpinnings of the recovery movement and discuss how this philosophy has been integrated into curricula within interdisciplinary mental health postgraduate programs. Further the chapter will explore the operationalisation of these curricula through computer based synchronous and asynchronous learning, face to face classroom teaching and distance education models of learning.

Top of page

Care: Seeking And Maintaining Employment For People With Depression And Other Mental Illnesses

Ian Munro, Karen-leigh Edward

Deakin University, Melbourne, Australia

Aim: The study undertaken in 2007-8 aimed to evaluate the Disability Open Employment Services (DOES), now termed the Disability Employment Network (DEN), developed by the Australian Federal Government to assist clients with health disabilities to seek and maintain employment. Currently there are 69 DEN programs in Victoria and approximately 236 DEN programs Australia-wide. This is the first time this type of program has been evaluated in a service delivery setting in Australia.

Method: This study employed a quantitative and qualitative design for inquiry.

Findings: Key findings relate to the fragmented status of current services and the inadequate preparation of employment counsellors.

Implications and Conclusions: Implications for practice relate to the enhancement of the provision of employment services to people with a mental illness. Further research is required into the factors which clients perceive as enabling or inhibiting their participation in employment support services. Key issues for exploration include: service cultures, service resourcing and systemic barriers. Further knowledge is also required of ways by which employment support services and mental health organisations can work together as interlocked services. Additionally, investigation is required into the mental health educational needs of employment counsellors and of models for the provision of education to staff. This knowledge could assist in maintaining a contemporary and effective vocational support workforce, potentially improving client outcomes.

Top of page

You Can’t Take The Person Out Of The Communication Process

Martin Musco, Deb Spurgeon

Top End Mental Health Service, Darwin N.T, Australia

The Northern Territory is geographically isolated, climatically challenged, and a culturally complex environment. Initiating and maintaining relationships across this dramatic landscape of people and geography is the key to innovative clinical practice. The combined skills of individual practitioners and the diverse use of technology enables this network to deliver “better care” to consumers and provide professional learning exchanges to isolated colleagues.

A number of factors come into play that enhances the quality of service for consumers, such as technology (computers, telephones, fax machines, video conferencing equipment and mobile phones). While technology is present and ever growing in the role of bringing our communities together it is the art of human communication entwined with this technology that provides “better care” for consumers.

The essential communication networks include, Aboriginal interpreters, Aboriginal Mental Health Workers, remote area nurses, inpatient clinicians, non-government organisations and patient travel.

Human relationships combined with “modern” technology overcome the challenges and obstacles that exist within our very unique environment. This provides enhanced outcomes for consumers and communities.

Top of page

The Resettlement Experience Of Elderly Immigrants Of Indian Origin Living In Western Australia. What Psychological Distress Do They Experience?

Pauline Nathan, Anne Bartu

Curtin University of Technology of Nursing, Perth, Western Australia, Australia

Increases in the aging population and global migration are major challenges faced by countries such as Australia. It is estimated that Australia’s aging population will make up 24–26% of the total population by 2051.

Thirty two percent of Australia’s population aged 65 years and over were born overseas, most commonly in the United Kingdom and Europe. However, recent figures have shown that there is a steady stream of older people (6-15%) who have come from China, India and Vietnam.

Despite, their significant presence there is limited research done on smaller migrant groups living in Australia. A study on older Vietnamese migrants showed that they had a higher risk of developing mental illness, as they faced problems of simultaneously adjusting to a new culture and to changes experienced with aging. Another reported that Chinese and other newer arrivals were inclined not to use government mental health services. To avoid social stigma, women, especially the elderly tend to avoid treatment for mental illness. Several overseas studies also highlighted how symptoms of mental illness can often be presented as somatic symptoms such as headaches, tiredness, nausea, insomnia, weight loss, etc.

Preliminary findings of this research in progress suggested that although many elderly Indians continued to live with their extended family, yet, they continued to report feelings of disconnection, loneliness and hopelessness, with many seeking help from their GPs for various somatic symptoms.

Top of page

An Exploration Of The Experiences Of Nurses Performing Constant Observation In A Mental Health Setting

Malcolm NEILSON

Toowoomba and Darling Downs District Division of Mental Health, Toowoomba, Queensland, Australia

Introduction: This paper reports on an exploratory study on the personal impact on mental health nurses of performing constant observation duty on patients who are acutely unwell in a mental health context.

Method: A qualitative research study, using a broadly phenomenological in-depth interview method was undertaken with a purposive sample of ten (10 )experienced registered nurse participants from an acute mental health unit.

Findings: Three key themes were identified in the participant experiences. These were: Workload, Tension and Support. Constant observation was found to increase both workload and tension, although these effects were found to be moderated by the availability of support.

Implications for nursing: Ensuring the availability and the use of routine support mechanisms may positively reduce the impact of constant observation on the nurse performing it.

Conclusion: The experience of performing constant observation varies considerably, depending on the nature of the patient’s presenting condition. The negative effects of workload and tension on nurses associated with constant observation may be reduced through attention to routine support mechanisms.

Top of page

Post-Seclusion Counselling: A therapeutic intervention for psychiatric inpatients

Lillian Nejad, Gerda Wesseling

¹Southern Health, Dandenong, VIC, Australia, ²Monash University, Caulfield, VIC, Australia

Currently, there is a worldwide trend toward the reduction, and even elimination, of seclusion practices in psychiatric inpatient units; however, it continues to be a common practice in Australia. The use of seclusion in psychiatric inpatient units is often associated with problems such as loss of therapeutic rapport between patients and nurses and potential negative psychological consequences for the patient. Despite these inherent problems, there is a dearth of specific programs that assist patients after a seclusion experience. In an attempt to address this gap in mental health services, two psychologists developed a therapeutic intervention, “Post-seclusion counselling (PSC)” that aims to reduce the chance of negative psychosocial problems for patients. As part of a pilot project commenced in 2002, mental health nurses from two inpatient units volunteered to attend half-day workshops that aim to raise awareness of the problems associated with seclusion practices, to allow the participants to discuss their difficulties associated with seclusion, and to introduce PSC and the benefits associated with ensuring that all inpatients who have experienced seclusion are given the opportunity to talk about how they felt, to clarify aspects of the seclusion episode, and to discuss how to prevent further seclusion episodes. The results of the evaluation of the workshop and the data collected from inpatients will be presented. Implications of the results will be discussed including indicators that support formalising this intervention in inpatient units as part of a larger programmatic effort to reduce seclusion practices.

Top of page

Positive Reinforcement: Developing Practice Indicators and Benchmarking Tools for Mental Health Nursing

Christine Neville¹, Catherine Hangan²

¹University of Queensland, Ipswich, Queensland, Australia, ²University of Southern Queensland, Toowoomba, Queensland, Australia

This workshop is designed to act as a brainstorming activity to assist in the development of practice indicators and benchmarking tools to accompany the newly revised ‘Standards of Practice for Mental Health Nurses’. The workshop will be run by members of the research team involved in the recent revision of the ‘Standards of Practice’ (ANZCMHN, 1995). It is considered that desirable outcomes for the workshop would include, amongst others, the generation of appropriate practice indicators for further development by the research team. Participants are expected to actively engage in the workshop and would have the opportunity to be involved in the creation of practice indicators and benchmarking tools to support the revised ‘Standards’ and mental health nursing practice. It is envisioned that the ‘Standards’ and practice indicators will be utilised by mental health nurses, and nurses working in mental health services, across Australia.

Top of page

Mental Health Nursing Care for Older People in Developing Countries

Christine Neville

The University of Queensland, Ipswich, Queensland, Australia

In low and middle income countries and for pockets of marginalised, indigenous people in other countries, the role of a specialist mental health nurse for older people is a new concept. The mental health status of older people in these societies is a matter of increasing interest and concern for the nursing profession. This concern stems from the population trend of a dramatic increase in the proportion of older people due to success in fertility control and decline in general mortality. Accompanying the greater numbers of older people will be an inevitable increase in mental health disorders such as depression, anxiety and substance abuse as well as age-related disorders such as dementia. Some of these societies have great ethnic and socioeconomic diversity, some are experiencing war, displacement and family disruption. All will have increased levels of mental health disorders as a consequence. These phenomena have highlighted the issue that nurses need to develop processes of care for the mental health of older people living in such situations.

Top of page

Mental health crises at home: service user perspectives on what helps and what hinders when they receive home based treatment as an alternative to admission to an acute inpatient unit

Stephen Niemiec

University of Sunshine Coast, Queensland, Australia

Traditional methods of gaining service user views is often through the use of `satisfaction surveys`. Because such surveys are often devised by service providers there are concerns that their use as evaluation tools may be flawed due to issues of power and passivity, and that they do not represent active involvement by service users in the feedback loop. This session presents a description of a participatory research study conducted to identify the perspectives of previous service users of a crisis resolution and home treatment service established in Newcastle-upon-Tyne in the north east if England and to present the data gained over several years.

Feedback was initially sought in order to establish the criteria for the development of a service evaluation questionnaire. Seven themes emerged from the data which were then used as a framework for the evaluation questionnaire. These themes have also been used within this paper to present what our participants told us was important to them when they received a service at home as an alternative to being admitted to an inpatient unit and the results of the surveys produced to date.

The participatory research methods included a two-stage modified Delphi study and semi-structured interviews conducted by service user interviewers to gather rich data to inform the construction of a service evaluation questionnaire.

What is different about this study is that service users have an opportunity to let service providers know what was/is important to them when they receive care and what is perceived as not being helpful allowing clinicians to shape their service delivery if necessary.

Top of page

‘Thriving not just Surviving’

Carolyn Noel, Sharon Sherwood

NWMHS, Victoria, Australia

This paper describes and visually showcases the creative arts therapy program at AMHRU. It delineates a creative process that promotes active involvement by clients to, express them-selves, learn new skills and create art for self, the unit and the community.

By engaging the consumers in the creative process we reawaken their hope.... the first step to recovery. We start where the client is and gently coax them to bigger and more ambitious outcomes. As they learn these new skills their self-confidence and interest in the world around them grows.

The creation of major art pieces not only provides meaningful endeavour, some much needed pocket money and the opportunity to learn money management skills, it raises the participants self esteem when these pieces are purchased to be permanently displayed in public places. The clients of AMHRU have created some stunning art which is mounted on the garden fence leading up to the unit they are also involved in creating art for a major infrastructure project within the community. These works showcase people with mental health issues in a positive light showing what they can achieve when given the opportunity.

Learning Objectives:

· The audience will gain practical knowledge of the creative arts therapy process and gain an insight into why this process works in positive ways for mental health consumers, at all stages of their recovery.

· Throughout history, people have used the creative arts to express themselves and find meaning in their world. Now these creative arts expressions have found a way to show mental health consumers in a very positive light.

Top of page

From Seclusion to Inclusion

Sharon Olsson

Central Northern Adelaide Mental Health Directorate, South Australia, Australia

This paper reports on findings of a scholarship tour in 2007 to study nursing practice in New Zealand, the USA and Italy, where the use of restraint and seclusion practices have been eliminated, or markedly reduced, in the management of acutely disturbed behaviour; and to identify best practice which will inform and reform mental health nursing practice to reduce and eliminate, where possible, the use of restraint and seclusion. Restraint and seclusion have increasingly been recognised as controversial and contradictory to the recovery framework of care, which is provided within the least restrictive environment, and the Federal and State Governments have made reduction, and elimination where possible, a priority for mental health service reform.

Top of page

Non-participant observation was undertaken in intensive and acute care units as well as community based mental health services to identify world standard management of acutely disturbed consumers and to gain insights into cultural factors which foster a least restrictive approach to acute mental health nursing.

Common cultural and practice themes emerged from observations across all services visited and included values, leadership, measurement, training, treatment=program, staff attitude, responses to disturbed behaviour, staff and consumer debrief, client-centred policies and recovery.

These themes are currently being used in collaboration with other State and Territory services to develop action plans which will reform nursing practice and improve the ability of consumers to work with dignity and in partnership with their care team, resulting in reduction of psychological distress, increased consumer satisfaction and improved outcomes.

Top of page

Music Therapy In Acute Psychiatric Facilities: An Undergraduate’s Perspective

Tamsyn Opie

LaTrobe University, Bundoora, VIC, Australia

Music is fast becoming a growing part of everyday life. Saturday morning cartoons have been largely replaced with music videos, and popular television shows are using music more frequently in their advertising. Music has long been known to effect people’s emotions: major chords instil happiness, whilst minor chords invoke a sadder feeling.

Whilst on clinical placement for my undergraduate nursing course majoring in mental health, I was able to see the effects that music therapy had on the clients in an acute adolescent psychiatric facility. The satisfaction of having recorded a music track by themselves was amazing. Several of them had their own musical instruments such as keyboards and guitars with them, which they were able to use at nearly any time. I have also seen people, who may not necessarily participate in music therapy sessions, become involved through writing their own lyrics, getting their feelings out on a piece of paper in a way they can’t always do when talking.

Being an undergraduate student gives me the opportunity to see things from a slightly different perspective to the mental health clinicians I have been on placement with. I have more of an opportunity to participate in therapy groups and view it from the client’s perspective, getting a greater understanding on what they gain from music therapy sessions.

But should music therapy stop at the level of the trained music therapist? What is it that I think nurses can do to enhance patients’ experiences?

Top of page

Developing a culturally secure environment and reducing seclusion

Frances Pagdin, Patricia Bradley, Kerry Sims

NT Mental Health Services, Darwin, Australia

Mental health nursing has developed over the years with both a focus in the art and science of caring for people experiencing a mental illness. One practice however, has been based on pseudo science or science misinterpreted and over used. That practice is the one of seclusion. In a culturally mixed environment the misconstruing of culturally derived behaviour also compounds the problems associated with the use of seclusion. The inpatient units in the NT are re-creating culturally secure environments in order to reduce the use of seclusion associated with aboriginal people and in so doing developing inpatient units that are culturally secure for all clients. This work is underpinned by information gained from a study tour funded by the Federal government and has its genesis in the Units becoming a federally funded beacon site for seclusion reduction. This paper describes the culturally appropriate strategies used within the Units and also those associated with effecting positive change within the NT mental health services.

Top of page

Managing Mental Health Units whilst changing practice and context.

Frances Pagdin, Margaret McAlavey, Patricia Bradley

NT Mental Health Services, Darwin, NT, Australia

Mental Health Inpatient Units have over time changed as a result of the devolution of mental health services and their mainstreaming into the broader health arena. Within the NT this process was implemented as with all other Australian mental health services however, the process was complicated by several factors such as significant levels of transient staff, limited practice models, professional remoteness and sub optimal responses to the cultural mix of clients. The Clinical Nurse Managers of the units, with the Nursing Director, sought to identify ways in which the limiting factors could be ameliorated and positive progress made so as to achieve better outcomes for clients and a workplace that was safe and valuing of the nursing staff. This paper describes the strategies used, providing a before and after snapshot, as well as discusses the outcomes for all the stakeholders.

Top of page

The Relationship is Central

Christine Palmer

Private Practitioner, Brisbane, Australia

Despite the dominant biomedical approach to the treatment of mental disorder in acute psychiatric inpatient units today, working with people in the context of a relationship is central to the practice of mental health nurses working in this environment. In this Age of Technology and Science, it is the relationship that is the enduring art of mental health nursing. The relationship extends beyond the person in care to include family/significant others so that the historical notion of ‘the client’ is no longer relevant. Mental health nurses also work with each other and with their colleagues from other disciplines inside a similar relationship. Interestingly, mental health nurses view essential relationship building skills as largely intrinsic and that they are enhanced through practise. It is the work itself that makes a good mental health nurse better.

This presentation reports on the findings of a critical ethnographic study designed to describe the culture of mental health nursing within an acute psychiatric inpatient unit. Three other themes linked to The Relationship as the central finding are Negotiating Power within the Team, Managing Risk, and Office Work as Clinical Work. Mental health nurses working within the acute psychiatric inpatient setting negotiate their practice within the context of a biomedically oriented service that dictates what legitimate mental illness is and how treatment is approached. Managing these conflicting forces is essential to continuing the art of mental health nursing.

Top of page

Service User Views and Expectations of UK Mental Health Nurses: A Systematic Review of Empirical Research

John Playle, Penny Bee

University of Manchester, Manchester, United Kingdom

Mental health nurses (MHNs) comprise the largest proportion of the mental health workforce in the UK. Systematically reviewing studies of user expectations and views of MHNs is vital to advance understanding of the contribution they can make to user-centred service modernisation and delivery. This paper reports the process and findings of a systematic review of UK published studies (1995–2005) of service users’ views and expectations of MHNs. The review was commissioned by the English and Scottish Departments of Health as part of National reviews of Mental Health Nursing (DH 2006). The search strategy included comprehensive computerised searches of electronic databases; hand searching of academic journals and grey literature together with searches of key policy and user organisation websites. 143 studies eventually met the inclusion criteria, the majority being small-scale academic led studies biased towards white, adult service user views. Service users expect MHNs to play a multi-faceted role combining practical and social support with more formal psychological therapies. Many studies report inadequate information provision, poor inter-professional communication, a perceived lack of caring, and lack of opportunities for collaborative care. Inpatient MHNs are seen as particularly inaccessible. MHNs should be equipped with both therapeutic clinical skills and more generic interpersonal skills associated with relationship building, engagement and communication. Future research should be undertaken collaboratively with service users and include effective mechanisms for dissemination, implementation and evaluation of findings. In particular, views of children, adolescents, the elderly and minority ethnic groups, currently under-represented in research, should be examined.

Top of page

Is there a need for a specialist mental health service for people with an intellectual disability

Andrew Pridding

St Vincents, Melbourne, Australia

Since deinstitutionalisation people with intellectual disability have been expected to access the generic mental health service system. This is in line with the underpinning philosophy of normalisation adopted by disability services throughout the western world. However there is increasing evidence that people with intellectual disability do not get their needs met in the generic system. The reasons for this include the atypical presentation of mental disorders and communication difficulties often complicated by service delivery issues. The management of chronic and persistent problem behaviours and autistic spectrum disorders also requires specialist skills and drug therapy may be complicated by a high frequency of side-effects and atypical responses and the presence of co-existing epilepsy and other medical conditions that need to be taken into consideration. Ethical issues arise in relation to capacity and consent. This paper explores these issues and considers if there is a need for specialist disability professionals and service structure that could lead to better service delivery to this group.

Top of page

The BETTER Model: A Guide To Assist Mental Health Nurses In Discussing Sexuality With Consumers

Chris Quinn, Graeme Browne

Gold Coast Mental Health Service, Ashmore, Australia

This paper reports on the initial; stages of a study exploring the nurses’ role in discussing sexuality as part of assessment in mental health nursing.

The available literature informs us that although there is wide acceptance of sexuality as a legitimate focus for mental health nurses, lack of knowledge about sexuality, conservative attitudes, and anxiety when discussing sexual issues are wide spread. There remains a hesitancy among nurses to discuss sexual issues and to include sexual histories in their day to day practices.

The nurse consumer relationship places mental health nurses in a unique position to make sexual health enquiries. A significant portion of consumers suffer sex related problems as a result of their illness, and treatment difficulties. There is evidence that some consumers stop taking their medication because of the effect it has on their sexual responsiveness and ability to form intimate relationships.

The initial stage of this project explores nurses’ experience of using the BETTER model. The BETTER model can assist nurses to include sexuality in their assessments to ensure practice standards are met to provide holistic care. Integrating information about sexuality into clinical practice can validate clients’ experiences and enhance their quality of life. By avoiding the topic, nurses are missing a valuable opportunity to educate clients and provide comprehensive, holistic care.

Top of page

Teaching Granny to Suck Eggs: Education and Skills Training for Authorised Mental Health Practitioners in Western Australia

Tim Rolfe

¹Office of the Chief Psychiatrist, Perth, Western Australia, Australia, ²Curtin University, Perth, Western Australia, Australia

The 1996 Mental Health Act in Western Australia (MHA) legislated for Authorised Mental Health Practitioners (AMHPs) whose role, similar to doctors, is referring a person for a compulsory examination by a psychiatrist. It is the first step in ensuring that a person who is suspected of having a mental illness and who may meet the criteria of involuntary status is examined by a psychiatrist. AMHPs may also authorise police transportation of that person to hospital. It is an independent decision making role in the use of legal authority. There are approximately 400 AMHPs in WA, mostly community mental health nurses.

This presentation details how the Clinical Consultant at the Office of the Chief Psychiatrist devised and delivers the clinical training for these experienced nurses. AMHPs must have a firm understanding of mental health legislation, be able to conduct excellent Mental State Examinations and be familiar with crisis and risk management. From the perspective of managers we are training experienced mental health nurses in what should be their every day skills. One manager said ‘it may be like teaching granny to suck eggs’.

The presentation will outline how an innovative, interactive training course was devised using video, role-plays, case studies and humour to keep experienced nurses engaged with learning resulting in excellent evaluations and a sought after professional development experience.

This short course can be a model for delivery of specialist nurse training in statutory responsibility in other jurisdictions who have already or are introducing similar roles.

Top of page

The Hidden Art: The use of Intuition in Mental Health Nurse Risk Assessments within the Emergency Department.

Alistair Ross

RMIT University, Melbourne, Vic, Australia

Changes in the provision of mental health care over the last 20 years through deinstitutionalisation to a community focus of care have lead to a dramatic increase in the volume of mental health clients presenting to the emergency department. According to a large study undertaken by the Department of Human Services in 2005 more than 40% of clients presenting to the Victorian Emergency Departments presented exhibiting either suicidal or self harm ideation. Often the person will have been directed to the ED by a family member or healthcare professional [i.e. GP] out of desperation or to secure their situation.

Mental Health nurses working in the ECATT (Emergency Crisis Assessment & Treatment Team) setting are generally made up of experienced mental health nurses with a substantial level of clinical experience, and are generally required to conduct a risk assessment as part of the complete mental health assessment on large number clients. ECATT nurses are faced with the challenges of completing a thorough risk assessment and formulating a plan for care whilst meeting the demands of various stakeholders; particularly with regards to the rigid time constraints for patients in the emergency department.

In this sort of environment to what degree must the ECATT nurse rely on their sense of intuition in decision making with suicidal patients?

This paper will explore the ideas surrounding the use of intuition in the assessment of suicidal or self harming patients who present to emergency departments, examine the philosophical underpinnings of intuition in nursing and reflect on how this resides within an essential empiric data.

Top of page

Challenging Therapeutic Pessimism: Creatively Implementing Evidence Based Practice

Rachel Rossiter, Toni Schofield, Michael Hazelton

¹North Coast Area Health Service, Kempsey, NSW, Australia, ²University of Sydney, Sydney, NSW, Australia, ³University of Newcastle, Newcastle, NSW, Australia

Delivering effective mental health care in an environment where under-resourcing, stigmatising behaviours, therapeutic pessimism and clinician burnout are frequently the norm demands both creativity and the implementation of evidence-based practices.

This paper describes a section of the results of a qualitative research project exploring the experience of mental health professionals learning and delivering an evidence-based treatment for borderline personality disorder (BPD). Participants worked in a public mental health service in either a specialist psychotherapy unit or in a regional community mental health team. While a growing evidence base describes positive outcomes from treatments such as Dialectical Behaviour therapy (DBT), recent literature continues to describe pervasive therapeutic pessimism exhibited by clinicians in public mental health services. Concurrently, descriptions of a workforce that is struggling to meet the demands for delivery of effective mental health services continue to emerge.

Data analysis revealed a marked shift from a dialogue of pessimism to one of therapeutic practice and optimism. This change was marked by shifts in personal and professional identity and an enhanced ability to respond empathically to people who had previously been seen as untreatable. Participants identified factors specific to the practice of DBT that they experienced as contributing to their change in practice. The discourse was marked by passion and enthusiasm describing the impact of practising DBT upon the clinicians’ well-being.

The clinicians’ perspective described in this research provides an opportunity to reflect upon the potential benefits of an evidence-based treatment on clinician well-being and creative means of addressing therapeutic pessimism and burnout.

Top of page

Accessing a technology focused environment reduces mental health stigma.

Paul Rungen

St Vincents Hospital, Sydney, Australia

Main streaming of mental health services and the development of Psychiatric Emergency Care Centres (PECC) has been seen to stigmatise people with mental health issues. It can be suggested that people with mental health issues require the same level of access to modern facilities and technology as those people with medical conditions. Therefore PECCs provide more than just a “holding area” away from the main emergency department prior to transfer to traditional mental health units or discharging a person into the community.

This paper explores the impact of assessment and treatment of people within an environment which is technology focused who have mental health issues within a framework of crisis intervention. By including these people within a busy Sydney metropolitan hospital, working collaboratively with the emergency department. A therapeutic environment is created where the specialist nursing skills can help reduce the stigma that is historically and traditionally associated with people with complex mental health issues. This paper highlights the availability of technology and advance medical support, which also reduces the stigma of mental illness by ensuring a comprehensive nursing and medical assessment is conducted in collaboration with mental health professionals.

Finally this paper discusses the supportive role that specialist mental health nurses have in the development of a cooperative environment within the emergency department and the advancement of technical skills required across the environment.

Top of page

Mental Health Nurse Incentive Program – Enhancing Mental Health Services.

Kim Ryan

Australian College of Mental Health Nurses, Australia, Australia

As a part of the COAG reform agenda in 2006 the then Prime Minster announced a significant boost to support mental health care in Australia. $1.9 billion over 5 years was committed. Part of this reform was the allocation of $191.6 million of new funding for providing services by mental health nurses in collaboration with general practitioners and psychiatrists. An incentive payment was established so that general practices, private psychiatrists, and other appropriate organizations would be able to engage or retain mental health nurses to assist in the provision of coordinated care for people with severe mental disorders.

The Mental Health Nurse Incentive Program (MHNIP) was implemented 1 July 2007. It has provided scope for a variety of models to be established for psychiatrists to work with mental health nurses. A joint presentation by a psychiatrist and will address navigating the process of setting up MHNIP and showcase how the MHNIP allows for the integration of the program within a private practice framework.

Top of page

Phase 1 of a practice development project to explore mental state identification by clinicians in an Alcohol and Drug Service

Corriann Schafer

¹Queensland University of Technology, Brisbane, Australia, ²Queensland Health, Brisbane, Australia

It was the purpose of this study to engage clinicians within an Alcohol and Drug Service in phase 1 of a clinical practice development project to explore attitudes and practice around mental state identification of clients. A recent chart audit revealed that the identification of mental health problems was well below rates identified in the literature. Subsequently less mental health screens were used and there was marked variation between teams in identification of mental health problems and use of screens. Based on a practice development model, focus groups were conducted and findings revealed that a high percentage of clinicians claim to assess a clients mental state informally with every contact, however due to a number of factors this information is not always documented and screens not used. Such factors include level of clinical knowledge and skill, client factors, clinician’s assumptions, time constraints, location of screens and mental health referral experiences. These same factors also contribute to the discrepancy between teams in the identification of mental health problems and use of mental health screens.

Top of page

Increasing Integration of Mental Health and Alcohol Tobacco & Other Drug Services

Corriann Schafer, Bernadette Klopp

Queensland Health, Brisbane, Australia

A State-wide project to address the complexities and gaps in the provision of service to clients/consumers with co-occurring mental disorders and alcohol and other drug problems. The objectives of the project addressed policy and guidelines, organisational integration initiatives, partnerships and workforce development. An integrated model of care was promoted to guide service sector responsibility and the development of localised district protocols. Various methods were used to gather data reflective of each Districts ‘Dual Diagnosis Capability’ pre and post project including; service mapping; district executive focus groups; and clinician based surveys. Results will be compiled and recommendations made via a report by 30 June 2008.

Top of page

The Art And Science Of Creating Therapeutic Environments: Mental Health Buildings Of The 21^st century

Kath Schelling, David McLeod

Hunter New England Mental Health Service, NSW, Australia

The 21^st century brings the continuing tension between building new facilities that are both therapeutic and safe for consumers, staff and visitors. Reports such as Tracking Tragedy (Dec 2003) and the resultant facility checklists strive to eliminate risk in building design. Recent work cover prosecutions and safety legislation continue to add pressure for organisations to provide safe environments for staff that are often counter intuitive to building rapport and therapeutic relationships with consumers. Facility guidelines prescribe the size and type of rooms that is allowed and the purpose and complexity of technology has repercussions on nursing practice and consumer and staff movement.

This presentation seeks to explore the process and outcomes of the design and development of a new mental health facility including its technology and the perceived impact on practice. User groups with clinicians, consultation with consumers and carers occurred to develop the building design and detail. Evidence was drawn from the literature and site visits to other facilities bore witness to lessons learned in relation to design and technology interface issues. This process is supported by a comprehensive change management process to relocate the service and staff within it to maximise the potential positive clinical outcomes associated with changing nursing practice and moving mental health nursing and care firmly into the 21^st century.

The design and development of a purpose built acute mental health facility provides an opportune time to create an environment that strives to balance aesthetics, safety, privacy, dignity within a technological context.

Top of page

Mental Health Nurses’ Reflections On Their Role

Wendy Scott

Country Health SA, Clare Office, Australia

“ Mental Health Nurses’ Reflections on their Role” focuses on three core aspects.

1.The core role of a Mental Health Nurse that sets them apart from other professions working within the mental health care setting.

2.To provide a commonality in the understanding of what it is that makes the field of mental health nursing unique.

3. To offer a direction for improvement of the profession as perceived by the profession.

The impetus for this project evolved from the Department of Health, Mental Health Nurse Advisory Group recognising the need for clarification of the professional role of Mental Health Nurses within the workplace.

The results indicated that Mental Health Nursing is one of the only professions in the field of Mental Health that when working within their full scope of practice have the capacity to provide care inclusive of Mental Illness/Health, Physical Illness/Health, Spiritual Health, Pharmacological interventions, Therapeutic interventions and Social interventions.

The findings within this discussion paper have also indicated that Registered Mental Health Nurses recognise the need to ensure that they develop, maintain and improve their knowledge and skills. The areas identified by Mental Health Nurses that require ongoing attention include

Addressing Physical and Spiritual care of consumers
Care of young people under the age of 18 when their parent is the identified client.
Identification and development of future leaders at all levels within the workforce and providing support and encouragement for current leaders.
Access to and participation in Clinical Supervision/Reflective Practice

Top of page

Natural Born Mental Health Nurses - A Multimedia Representation of Peer Group Clinical Supervision in Action.

Wendy Scott², George Farquharson¹, Stephen Harding³, Bernie Stefan-Rasmus¹

¹Central Northern Adelaide Health Service, Mental Health Directorate, Adelaide, Australia, ²Country Health, Clare, Australia, ³Royal District Nursing Society, Adelaide, Australia

Four Peer Mental Health Nurses, four clinical issues – four varying conversations.

INTRO:

Come and see the art of peer group supervision in practice utilising a multimedia approach. Four senior Mental Health Nurses meet monthly for group supervision. The location, a café in a lower socio economic area (close to a busy shopping mall in a in the western suburbs of a burgeoning metropolitan sprawl), makes for numerous distractions and changes in focus during a session which does however ultimately finish with resolving issues raised by group members in a black humorous fashion.

METHODS:

This particular multimedia representation (including dramatic re-enactment, narration and audio/sound projections) of a group clinical supervision session in action presents an overview, and perhaps a voyeuristic entree into the private world of clinical supervision.

RESULTS:

The dramatic reconstruction of a typical peer group clinical supervision session,along with its occasional narration will draw the audience along a brief exploration of clinical issues. By journey's end the audience will have seen/heard evidence of the positive aspects of professional support and consultation inherent in the clinical supervision process.

DISCUSSION:

The enthusiasm of the presentation will demonstrate the enhanced self-awareness of the clinicians, all from varied mental health environments, and their willingness to continue to strive towards improved consumer outcomes in their own individual practices.

Was the session a success? – You be the judge!

Top of page

The Value Of Group Therapy For Women With Perinatal Depression

Tracy Semmler-Booth, Belinda Edwards, Dianne Simmons

Lyell McEwin Health Service, Elizabeth Vale, Australia

Objective: To illustrate the successfulness of a Cognitive Behavioural Therapy (CBT) group for women with perinatal depression.

Main Ideas: The perinatal mental health team has been involved in running a support group since 2001. The group is facilitated by a mental health nurse practitioner and a mental health midwife. One - two closed 10 week groups are offered each term as well as a follow on open group. 1 group is based at the hospital and 1 within a non-government organisation community Hub.

Method: Since 2003 yearly satisfaction surveys have been completed by women and these indicate the usefulness of the group to the women who have participated. The group has been changed to meet the needs of women using comments from the questionnaires.

Since January 2006 evaluation data has included a pre and post Edinburgh Postnatal Depression Scale (EPDS), women’s goals and a satisfaction questionnaire.

We have just commenced collecting EPDS scores 6 months post group to evaluate the long term benefits of the group.

Results: Women are satisfied with the format of the group, their goals are being met within the group and the EPDS scores for all women have decreased significantly post group and continue to decrease when measured at the 6 month interval.

Discussion: These results affirm the usefulness of group therapy in this group of women and show sustained benefit.

Recommendations: We are working with University of South Australia to undertake more formal research on the benefits of these groups.

Top of page

‘Integrated Rehabilitation and Recovery Care Service (IRRCS): Working collaboratively towards better outcomes for consumers in Secure Extended Care Units.

Sharon Sherwood¹, Barbara Hill², Lisa Soares¹

¹NWMHS, Victoria, Australia, ²WRHC, Victoria, Australia

IRRCS West is a new service designed to assist people to move from Secure Extended Care Units (SECU) to living in the community. The aims of IRRCS are;

(1) for PDRSS and Clinical Mental Health Services to work collaboratively in providing high levels of community support for SECU consumers

(2) SECU consumers, who historically have experienced difficulties finding enough community support and secure long-term housing, will gain skills and community linkages to enable them to live in their community at an optimum level.

IRRCS West has been a unique collaboration between all the clinical and community based mental health services in the western metropolitan region of Melbourne. Partners agreed to work together to achieve the following outcomes:

§ Improved health outcomes and continuity of care in the community for selected consumers within the target group.

§ More multi-disciplinary and integrated recovery, rehabilitation and care approaches

§ Optimisation of investment in public mental health services

§ Enhanced capacity for shared care

§ Improved trust, cooperation and understanding between services within each sector.

Our shared goal is the development of a sustainable, responsive and cohesive recovery and rehabilitation service system that achieves better outcomes for consumers.

Top of page

Clinical judgement... is it art?

Using routine outcome measurement to strengthen the art of clinical judgement

Emma Smith, Lucy Horgan

Department of Human Services, Victoria, Australia

Routine outcome measurement has been part of the Australian public sector mental health system since 2003 when it was introduced as a key strategy to strengthen evidence based culture and practice. Five years on, many nurses and other clinicians perceive outcome measurement (OM) as a ‘data collection’ exercise rather than an integral part of clinical practice. In 2007, the Victorian Department of Human Services secured further Commonwealth funding to establish a team of clinicians to provide additional support, and strengthen the clinical use and application of OM in day to day practice. This team, QUATRO VIC was established in early 2008.

Over the past 10 years there has been major growth in published research on OM in mental health with a number of papers investigating attitudinal and other factors that assist or deter the use of Outcome Measurement in clinical practice. Through extensive fieldwork with services, QUATRO VIC set out to discover more about these factors and to establish more practice examples of OM supporting clinical judgement and decision making. QUATRO VIC then worked collaboratively with mental health teams, and assisted them to increase understanding and clinical application of OM information. This paper reports on the reflections and findings of this process to date.

Top of page

Bridging The Gap Between Health Sciences And Social Sciences: The Mental Health Workforce In Humanitarian Work

Rochelle Stewart-Withers

University of Queensland, Brisbane, Australia

More than one million people in Sri Lanka were directly affected by the December 2004 tsunami, and it was considered that many of these people would require treatment for shock and the various stress related disorders that may follow. Given the enormity of what was experienced and the severe shortage of practising mental health professionals in the country, numerous organisations and countries sent mental health professionals to assist. While undoubtedly a well meaning humanitarian approach to this large scale natural disaster it has been suggested that in some instances clinical interventions such as PTSD-focused psychotherapy were being introduced outside the health sector in an ‘uncoordinated and vertical, stand-alone manner’ (WHO 2005). Thus the approach to mental health care was often adhoc, culturally unsafe and showed little understanding for the socio-political complexities in which the disaster occurred. Without a proper understanding of the culture and the socio-political context, and without the integration of interventions into existing systems more harm than good can occur (WHO 2005).

Drawing on data from the field, this paper considers the role of Western mental health professionals in large scale humanitarian events, be they natural disasters or post-conflict situations, and argues the importance of mental health professionals intersecting with wider social sciences, such as development studies, so that the approach to care is grounded in local knowledge systems, local systems of governance and cultural frameworks and a wider understanding of macro and micro socio-political processes.

Top of page

“Delete as appropriate”: Language and conduct in mental health nursing practice

Teresa Stone¹, Michael Hazelton²

¹Hunter New England Mental Health, Newcastle, Australia, ²University of Newcastle, Newcastle, Australia

Phrases such as “that is not appropriate” or “her behaviour has been inappropriate” are often used by mental health nurses when discussing the thoughts and actions of clients, and the management decisions of colleagues. What constitutes ‘appropriate’ and ‘inappropriate’ behaviour is at the heart of both the art and science of mental health nursing practice.

The word “appropriate” encompasses notions of what is “fit and proper”, pointing to considerations of suitability, acceptability, aptness and the “right” thing to do. It is frequently used to modify a noun as an expression of universal reproach, for example, “that is inappropriate behaviour” or “he is an inappropriate admission”. Nursing texts refer to “appropriate nursing interventions” and “appropriate communication skills” and nursing itself is an “appropriate” mix of art and science. This appropriate/inappropriate binary is a powerful rhetorical device that features heavily in mental nursing discourse.

What is appropriate/inappropriate and how is this defined? Inherent in the idea of “appropriate” and “inappropriate” are sets of beliefs, values and culturally-determined notions of what constitutes acceptable and unacceptable behaviour and encompasses theories of politeness, taboo and Foucault’s ideas on inclusion and exclusion, normality and abnormality.

This paper examines the concept of appropriateness/inappropriateness in mental health nursing practice and explores the basis for making decisions based on this powerful binary. Included will be a presentation of research into the forms of language nurses deem to be “appropriate” and “inappropriate” and how nurses respond when the norms for polite behaviour and language are violated, and the impact this may have on the therapeutic relationship.

Key words: language, therapeutic relationship, politeness and nursing

Top of page

“Speak For Yourself”: Stories From Adolescent Mental Health Media Groups

Bronwyn Tarrant

¹Australasian Society for Traumatic Stress Studies, Victoria, Australia, ²CBT Australia, Australia, Australia, ³Monash University, Gippsland, Australia

This paper presents a decade of inpatient and outpatient media activities within an adolescent mental health service. Beginning in 1995 with a single hour live-to-air weekly radio program, nearly 100 adolescent mental health consumers have created 410 hours of broadcast media through three television series, three radio programs and one short film. The activities evolved from the CBT group therapy program and a need to engage with adolescents and in a meaningful way to facilitate a sense of agency. Enlisting the communication media of adolescents, who are technologically and television literate, the participants have learned: social skills, stress management, anger management, self-acceptance, mindfulness, empathy development and organizational skills – whilst, fully creating, writing, performing, designing, editing, and distributing high quality media projects. Each project has been broadcast at a local community, national or Asia-pacific level – without ever disclosing the mental health status of the participants. The paper will demonstrate that media projects can successfully encompass: skills acquisition, peer-based learning, health promotion, and consumer participation. The project now enters its own teenage years with a feature documentary film in production and exploring the realm of 3D animation.

Top of page

Seeking safety amid judgement and labelling: A consumer perspective

Jenny Tohotoa

Curtin University of Technology, Perth W.A., Australia

Introduction:

The escalating rate of self-harming behaviour presentations to Emergency departments increases the levels of stress for both staff and consumers; borderline personality disorder represents the most frequent diagnostic category for deliberate self-harm. Identified inadequate training and education for staff in suicide/parasuicide management techniques often creates a perceived unsafe space for the self-harming consumer.

Aim:

To identify the facilitators and the barriers to empathic care for people diagnosed with borderline personality disorder who present at Emergency Departments with deliberate self-harm.

Methodology:

A total of nine consumers and two nursing staff were interviewed for this study, and the findings were placed within the context of relevant scientific literature. A grounded theory approach was used and semi –structured interviews were conducted. The constant comparative method of analysis was used to identify core categories and themes.

Results:

The findings of this study emphasised the importance of management plans developed in conjunction with the consumer. In addition, adequate risk assessment and increased empathy skills can decrease the revolving door presentations of people with borderline personality disorder who self-harm.

Recommendations:

To augment the current training programs for nurses, doctors and allied health staff to include a greater understanding of borderline personality disorder and the skills needed for a therapeutic alliance. This would enable more staff to work effectively with this complex disorder. Finally, the findings have implications on how healthcare services and healthcare workers address the issues for people diagnosed with a borderline personality disorder.

Top of page

Iatrogenic Abuse: on the wrong side of mental health care!

Robert Tummey

Coventry University, Coventry, United Kingdom

Abuse occurs in mental health care against the people served, through the staff, the systems, the care, the emphasis and the power. It may not be the purpose and may be ‘dressed’ in ways that can be justified, but it does occur. The nature of such a discussion can be disturbing to the caring professional, but it is also a stark reminder that care does not always afford people the protection or asylum required. Instead, misuse of power and abusive relationships can be formed that harm and deprive.

This paper will discuss the topic in more detail and take a deeper look at possible influences. These include, mental health environments (use of CCTV), psychiatric treatment (evidence based practice, medication) and staff attitude (detachment, othering). Ways to guard against such processes will be determined and the championing of innovative teams and areas of good practice will be cited.

Top of page

Definition and Diagnostic Criteria of Internet Addiction

Kesaraporn Wanajak, Cobie Rudd, Anne Wilkinson

School of Nursing, Midwifery, and Postgraduate Medicine, Edith Cowan University, Perth, WA, Australia

Empirical studies suggest that some computer users are becoming addicted to the Internet, causing academic, social and relationship problems. Symptoms of Internet overuse appear to be occurring worldwide, including Thailand, where Internet use has increased dramatically. As well, literature is emerging surrounding the outcomes of Internet overuse. However, there is debate in the literature pertaining to what constitutes IA and the consistent diagnosis criteria and/or precise clinical definitions of IA have not yet been established.

This study employs three rounds of a modified Delphi technique method to obtain a consensus definition and diagnostic criteria of IA and to identify salient therapeutic strategies for minimising the harm of IA. Thirty experts in Thai society were recruited to participate in this study. Responses to the questions on each round were summarised, analysed, and salient themes identified.

The consensus definition and diagnostic criteria of IA derived from the Delphi methods will be used to classify a sample of students reported Internet use as addicted or normal in a survey of 1,200 secondary school students in Chiang Mai, Thailand as a subsequent part of this research. The completed project should result in a more precise, consensus definition and diagnostic criteria of IA that will assist clinicians and educators identify Internet overuse. Additionally the identification of potential strategies is proposed for minimising the harm which might be caused by IA among secondary students in Chiang Mai, Thailand, and subsequently to a broader audience.

Top of page

Care: What Mental Health Nurses Say And What Mental Health Nurses Do

Philip Warelow, Karen-leigh Edward

Deakin University, Geelong and Burwood, Australia

Aim: The purpose of this paper is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practised in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs.

Implications and Conclusions: Caring is not simply a set of attitudes or theories, nor does it comprise all that mental health nurses do. Mental health nursing care is determined by the way a nurse uses knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb).Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered; underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse – patient relationship. We believe that caring theory has much to offer mental health nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Mental health nurses need to be able to actually practice caring rather than just theorise about it –using caring theories to inform their practice.

Top of page

A Bricolage Quilt: Squaring the art and science of mental health nursing research.

Tony Warne¹, Sue McAndrew²

¹University of Salford, Greater Manchester, United Kingdom, ²University of Leeds, Leeds, United Kingdom

This paper challenges the prevailing current empirically orientated approaches underpinning evidence based mental health nursing practice. Whilst many evangelical nurses have continued to embrace purism in their search for the definitive scientific evidential approach to underpin practice, others have embraced multiple methods and perspectives in their research, teaching and practice development.

This paper explores the use of bricolage as a way of better understanding the inter-related connections between theory, practice and the felt experiences of service users. The origins of bricolage can be traced back to the work of Levi Strauss, and Denzin and Lincoln’s contribution to qualitative methodologies. The development of their work in this area, can likewise be traced back to the work of Simmel, Goffman, Garfinkel and Schutz who as sociologists were interested in better understanding ‘everyday life’ and the meanings individuals attribute to that life. For the bricoleur the object of inquiry, be it social, cultural, psychological or educational is inseparable from its context, the language used to describe it, its historical situatedness and the socially and culturally constructed interpretations of its meaning as an entity in the world.

Examples, drawn from three service user conference evaluations, are used to demonstrate the importance of being able to move beyond the notion of the research method being merely a procedure, to one that respects the complexities of the lived world and works towards connecting the research act to the emotion and the heart of lived human experience.

Top of page

Poster Pride and Prejudice: A classical tale of the art of conference dissemination

Tony Warne¹, Sue McAndrew²

¹University of Salford, Greater Manchester, United Kingdom, ²University of Leeds, Leeds, United Kingdom

It has been argued that the dissemination of effective clinical innovations and research findings is key to the growth and development of the nursing profession. A number of options are available to researchers and practitioners to disseminate their scholarly work. Whilst peer reviewed, single authored empirical papers, published in international journals with high impact factors are still valued by many as the gold standard of dissemination; conferences have been identified as being a more influential opportunity than print media in disseminating research. Presenting at conferences is usually through paper or poster presentations. Arguably papers presented at concurrent sessions are to passive participants who seldom have the opportunity to challenge the content and implications of these presentations. This lack of interaction is a limitation to effective dissemination. Poster presentations might offer a less threatening environment within which challenging interactions can occur. We argue that they present an opportunity for educators, practitioners and researchers to come together to explore knowledge and ideas that is often displayed in very creative ways. This paper explores the continuing prejudices still found in the dissemination of research and other scholarly activities using poster presentations. The apparent hierarchy of value attached to the various ways of presenting outcomes continues to impact upon the effective processes of dissemination, assimilation and utilisation of best evidence today within practice. Using several award wining conference posters, this paper explores how this situation can be challenged. Concerns over polarised positions including style versus substance, attractiveness versus authenticity are discussed.

Top of page

Consumer Outcomes Resulting From Participation In A Healthy Lifestyle Program Addressing The Effects Of Medication-Related Weight Gain And Mental Illness

Rose Waterhouse, Jan Paterson, Inge Kowanko

Flinders University, Bedford Park, SA, Australia

Introduction: With the advent of atypical psychiatric medication consumers of mental health services asked that its’ concerning effects on weight gain and health be addressed. A healthy lifestyle program was developed, implemented and evaluated. This paper will discuss participant outcomes from the Intervention Program.

Methods: Data analysis using paired t-tests, and Wilcoxon Matched Pairs Signed-Ranks Tests were applied to body, and fitness measurements, psychological scales and Living Skills Profile (LSP) scores. Two semi-structured questionnaires recorded subjective changes noticed by participants. Thematic and inductive analyses were applied to the researcher’s journal and participants’ stories.

Results: 1) Statistical analysis of physical data revealed no significant changes resulting from participants’ involvement in the program. Microanalysis of this data indicated that for some participants’ the program made a difference. 2) Statistical analysis of psychological data revealed some small but significant changes to participants’ psychological states.

3) LSP functional subscales identified significant changes in self-care, social contact and total score, revealing that changes in functional abilities were attributable to the Intervention Program. Microanalysis of all these scores verified these results. 4) Thematic analysis demonstrated participants’ requirements for health, lifestyle, resilience and success. 5) Inductive analysis revealed other outcomes or explanations of outcomes hidden by statistical analysis.

Discussion: Clinical and participant findings raise questions about statistical results showing no change and provide explanation using observations from these findings. From this the notion of what is a successful outcome is examined.

Top of page

Motivational Interviewing Workshop – 1 day

Julianne Watson¹, Helen Duffy²

¹Centre for Anxiety and Related Disorders, Adelaide, South Australia, Australia, ²Flinders University, Adelaide, South Australia, Australia

Change can sometimes be difficult for most of us, let alone someone who has a mental health problem affecting their life. Do you want to learn some skills to assist you in helping your clients move in the direction of change?

Motivational Interviewing is a brief psychotherapeutic, evidence-based intervention for helping people change behaviour. However it is not a stand-alone treatment, it is easily integrated into any one individual’s current practice. It is not just applicable in the clinical setting, but also useful in management, education etc.

It aims to facilitate and enhance a person’s intrinsic motivation to change behaviours in a highly empathetically supportive but strategically directed conversation about the person’s problem and related life events.

This workshop will provide an interactive and practical approach to developing skills in basic motivational interviewing techniques. There will be an opportunity for practical experience in application of these techniques.

Top of page

Improving consumer outcomes through the incorporation of family sensitive practice in a rural mental health service.

Jennifer Watterson¹, Justine Anderson²

¹Latrobe Regional Hospital Mental Health Service, East Gippsland, Australia, ²Latrobe Regional Hospital Mental Health Service, East Gippsland, Australia

It has been long acknowledged that mental health care which includes the whole family, produces better outcomes for mental health clients. The recent government initiative for Families where a Parent has a Mental Illness (FaPMI) acknowledges this need and aims to address this in area mental health services. The newly created Prevention and Recovery Care Service (PARCS) in rural East Gippsland, has provided the opportunity to implement family sensitive practice from the point of referral, through assessment, implementation of treatment and to discharge.

The aim of the current presentation is to present an innovative care process developed through the collaboration of the PARCS senior clinician and FaPMI coordinator. The presenters will discuss the development, implementation and evaluation of family sensitive practice within the PARCS. The process of identifying areas of need and developing policies, processes and documentation to meet such need, will be highlighted along with evaluation of the effectiveness of family sensitive practice. Presenters will also discuss obstacles and challenges that were faced during the development process as well as how they were overcome.

Top of page

Poetry As Therapy: Hope, Healing And Self Expression

Maureen Wilde

SSWAHS, NSW, Australia

Mental health nursing has often been referred to as both a science and an art. Various forms of the creative arts, such as drama, music and poetry have been utilized as therapeutic interventions by nurses and other professionals as a component of care for the mentally ill person.

The connection between creativity and healing is well researched and validated. The use of creative therapies employs a humanistic approach involving the sharing of the essence of human existence and daily life experiences.

This sharing of life experiences assists people in their attempt to make sense of their world and to realize that they are not alone. The mentally ill person is confronted by many challenges and there is a need to confront their own personal sense of identity concomitant with the meaning of their experiences in relation to life itself.

Poetry as therapy has the capacity to enhance recovery through the exploration of ‘self’ and the nurturing of self expression. The written word often has the power to make sense of things which are difficult to understand. Through the creation of poetry, people have the capacity to recall deep memories and feelings and through this medium have the ability to evolve.

The nurse-patient relationship has the potential to reach a deeper level of understanding and awareness because of the degree of trust involved in patient self-disclosure. This paper will explore the nurse-patient relationship in the context of poetry as therapy in an inpatient mental health setting.

Top of page

At the end of my string: the experience of parents caring for a young person with emergent psychosis.

Rhonda Wilson

¹University of New England, Armidale NSW, Australia, ²NSW Institute of Rural Clinical Services and Teaching NSW Health, Dubbo NSW, Australia

Introduction. Rural parents struggle to find appropriate pathways to help a son with emergent psychosis. An early presentation of psychosis is often described as ‘something not quite right’, and may be interpreted by parents, as a difficult phase in adolescent developmental. As such, it may be thought of as if to pass with time. It is not always an obvious conclusion to seek mental health care. The findings of this study reveal some factors which impact access to early treatment for young rural men.

Methods. A qualitative study using interpretive phenomenological methods was conducted in rural northern NSW. Young men and parents participated in in-depth interviews which were transcribed and thematically analysed.

Results. One theme, which emerged, was that parents struggle to indentify sources of help. Parents did not always see health professionals as a first line of help provision. Another theme developed around the unpredictability and social discomforts that occur in family life as mental illness emerges. A burden of care was felt by parents who had hoped that their son would have achieved their own independence by this time. This type of family stressor was a significant trigger in developing new ad hoc coping strategies within the family and for the family to commence some in-house strategies in their quest for getting past this disruptive phase in family life.

Discussion. The findings suggest that the participants had difficulty identifying appropriate pathways to access help, and that they have developed their own ways of helping within the internal structure of family. This may explain why some rural young men experience a lengthy duration of untreated psychosis. Further, that the burden of care which parents experience during their son’s emergent phase of illness, creates a substantial burden on the emotional and social integrity of the family, and that this burden causes some parents to question how long they can cope, before they reach ‘the end of their strings’.

Top of page

Beautiful Minds, Creative Hands.

An Annual Mental Health Week Art Exhibition

Annette Woodhouse, Mario Christou (no affiliation)

Monash University, Dept Rural & Indigenous Health, Victoria,, Australia

Art has been used as a medium for both those currently suffering and recovering from mental illness, to express themselves and their experiences. This means of expression has been gaining increasing recognition for its importance in lessening social exclusion and the destigmatising of mental illness (Barraket 2005; Jermyn 2001; Vic Health 2003; Vic Health 2006a, 2006b; Hamilton, Hinks, and Petticrew 2003). Art allows the general public access to a different means of communicating with the notions of mental health, wellbeing, illness and recovery.

State level organisations support the promotion of mental health using the arts, such as, Vic Health funding of mental health arts projects (Vic Health, 2005) and Victorian Mental Health Foundation’s annual creative writing school activities at a state-wide level for mental health week. (Mental Health Foundation, 2007).

To support local artists, with a mental illness, in presenting their works a local X partnership of health, local government and community agencies was formed to coordinate an annual art exhibition. This collaboration fits with the current Victorian mental health promotion framework (Vic Health, 2005) and the World Health Organisation’s call for an intersectoral approach in promoting mental health (WHO, 2004).

The two presenters , a mental health nurse in the role of a regional mental health promotion officer and a consumer artist will discuss their reflections on the experiences and learning’s from the past two years exhibitions and the value of art for those involved, including consumers, carers, local government , health agencies and the general community who attended.

Top of page

Promoting the physical health of psychiatric patients

Dianne Wynaden

Curtin University of Technology, Perth WA, Australia

Introduction:

Lifestyle is an important factor in co-morbidity and mortality and psychiatric patients are at a high risk of developing significant disease due to lifestyle factors such as a poor diet, cigarette smoking, physical inactivity and substance abuse and misuse. It is also well recognised that antipsychotic medication used to treat mental disorders contributes to excessive weight gain further predisposing patients to obesity, a risk factor for diabetes mellitus and heart disease.

Methodology

A three month study with a group of consenting outpatients was conducted to evaluate a best practice technique for the administration of antipsychotic medications via intra muscular injections. One nurse trained in the technique administered all injections while being observed by a member of the research team.

Results

The consumers’ ages ranged from 20 to 70 years and their weight ranged from 51 to 126kgs. Sixty (62.5%) of the 96 consumers recorded a Body Mass Index of 25 or greater placing them in the overweight or obese category. None of the 60 obese patients received any health promotion information or counselling about their high Body Mass Index readings from the nurse while receiving their injection.

Discussion

Mental health nurses must engage in health promotion work. While obesity is a precursor for the development of many chronic health problems in all populations this risk is greatly increased in mental health consumers. All mental health nurses working in hospital and community setting need to develop health promotion strategies to assist consumers to manage this increasing problem.

Top of page

Mental Status Assessment: The current focus of this vital sign in nursing curricula

Dianne Wynaden¹, Malcolm Hare², McGowan Sunita², Speed Gaye², Landsborough Ian²

¹Curtin University of Technology, Perth WA, Australia, ²Fremantle Hospital, Fremantle WA, Australia

Vital signs are clinical measurements that indicate the state of a patient’s essential body functions, specifically pulse rate, temperature, respiratory rate, blood pressure and more recently pain. There is growing support to make mental status assessment the sixth vital sign due to the increasing numbers of elderly hospitalised patients and health professionals’ ongoing inability to accurately evaluate these patients’ mental state. This would facilitate early recognition of disorders such as delirium and reduce the level of associated burden, for example, increased length of stay and ward acuity levels. The elevation of mental status assessment and care to a quality measure would also be facilitated.

While elevation of mental status assessment to routine practice is identified by the researchers as best practice this presentation will detail the outcomes of three studies that demonstrate that current undergraduate curricula do not adequately prepare nurses to accurately assess a patient’s baseline levels and changes in mental status caused by conditions such as delirium:

Study 1: A quantitative study of 300 registered nurses’ level of knowledge of causes and risk factors for delirium

Study 2: The use of Abbreviated Mental Test 4 as a screening tool for identifying potential delirium in elderly patients presenting to the Emergency Department

Study 3: A qualitative study to describe how registered nurses care for confused patients in the acute care setting

While the educational preparation of nurses to work with people who have a mental illness is being addressed at a national level deficits remain in the nurses’ ability to provide optimum care to elderly hospitalised patients. With an ever increasing ageing population these identified deficits need to be urgently addressed in order to promote best practice outcomes for elderly hospitalised patients.

[1] Newell, W. H. 2001. A Theory of Interdisciplinary Studies.

[2] Graham & Van Biene . 2007. Hierargy of Engagement.

[3] Meares, R. 2005. The Metaphor of Play.

Top of page