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