bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of health promotion practice within a UK hospital: results of a pilot study
Authors: Haynes Charlotte L. , Cook Gary A.
Published: September 2010

Introduction and aim  There is clear evidence that modifiable risk factors – smoking, alcohol misuse, poor diet, lack of exercise and obesity – are detrimental to health. UK public health policy now requires hospitals to have in‐place health promotion programmes to empower patients to swap risky for healthy behaviours. This audit aimed to determine a baseline level of health promotion practice for modifiable risk factors in a UK hospital.

Method  Case notes from two hundred and fifty hospitalized adult patients (excluding all terminally ill patients), discharged alive between January and June 2004, were audited for evidence of screening for risk factors (smoking, alcohol, diet, exercise and obesity) and the provision of health promotion to change these risk behaviours.

Results  The majority of inpatients were asked about smoking (88%) and alcohol consumption (74%), but few were screened for obesity (18%) or asked about their normal diet (5%) and physical activity (3%). Health promotion was delivered to a third of smokers and over half of inpatients reporting misuse of alcohol. Healthy diets, exercise and weight management were rarely discussed. Only three inpatients were screened for all risk factors.

Conclusion  This study indicates that the majority of hospital inpatients were screened for smoking and alcohol use, but improvements need to be made in the delivery of health promotion for smoking cessation and sensible drinking. It is clear that inpatients’ are not routinely screened for diet, exercise and weight status, nor delivered health promotion for the management of these risk behaviours.
Accuracy assessment of prediction in patient outcomes
Authors: Bartfay Emma , Bartfay Wally J.
Published: September 2010

In order to provide effective health care to patients, clinicians must rely on their ability to accurately diagnose disease and to prognosticate the outcomes. Prognostic studies have received considerable attention in health science and medicine in relation to patient outcomes. However, little effort has been spent on evaluating prognostic accuracy. The purpose of this paper is to present a comprehensive review of the methods for assessing prognostic accuracy in patient outcome prediction. The strengths and limitations of these approaches are critically appraised. We argue that we need to consider incorporating accuracy assessment for predicting patient outcomes both in clinical practice and in research.
Measuring patient assessments of the quality of outpatient care: a systematic review
Authors: Säilä Tiina , Mattila Elina , Kaila Minna , Aalto Pirjo , Kaunonen Marja
Published: September 2010

Rationale, aims and objectives  The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care?

Methods  Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients’ assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases.

Results  Thirty‐five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design.

Conclusion  Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.
The case‐mix of chronic illness hospitalization rates in a managed care population: implications for health management programmes
Authors: Linden Ariel , Goldberg Steven
Published: September 2010

Objective  This paper reports on the case‐mix of hospitalized patients based on their health plan enrolment and utilization experience, absent a health management (HM) programme. The implications for achieving targeted reductions in admissions within the context of implementing a population HM programme are discussed.

Study design  Descriptive.

Methods  Members were identified with asthma, coronary artery disease, congestive heart failure and diabetes. These cohorts were then mapped to disease‐specific hospitalizations across a 2‐year period (2004–2005). Four distinct case‐mix categories were developed. Group 1 comprised members hospitalized for the specific condition in both years. Group 2 comprised all identified members of a disease cohort in 2004 that were not hospitalized in that year but were admitted for the condition in 2005. Members were assigned to Group 3 if they were hospitalized in 2005, did not appear in the 2004 identified cohort but were, in fact, enrolled in the health plan. Group 4 comprised new health plan enrollees in 2005 and were subsequently hospitalized during that year.

Results  Of the total admissions in 2005, on average 6.4% came from Group 1, 62.4% came from group 2, 10% from group 3 and 21.2% from Group 4.

Conclusions  If an HM programme was to be implemented in this population, the typical identification methods currently used by the industry would have resulted in most hospitalized patients either being initially classified as low risk or going undetected. Improving identification and stratification methods will allow HM programmes to better tailor interventions to impact hospitalization rates for the chronically ill.
Evidence‐based medicine beyond the bedside: keeping an eye on context
Authors: Tilburt Jon C.
Published: September 2010

Rationale  Evidence‐based medicine is being applied to decisions in a range of contexts beyond one‐to‐one patient care. Yet considerable disagreement persists regarding the defining components of evidence‐based decision‐making, particularly in institutional and public health contexts.

Aims and Objectives  This article reviews the key elements of evidence‐based decision‐making for clinical medicine, and adapts those key elements and argues for their broad applicability to a variety of decision‐making contexts including institutional, public health, and self‐care decision‐making contexts.

Methods  Conceptual Analysis.

Results  Evidence based decision‐making involves research evidence, “social and institutional circumstances”, and “values” of stakeholders. Furthermore, evidence‐based decision‐making includes “judgment” exercised by experts to appropriately weigh and integrate the various decision‐making elements.

Conclusion  Asking critical questions about the purposes and context of a specific decision, basic principles of evidence‐based reasoning can be appropriately applied beyond the bedside.
Translating psoriasis treatment guidelines into clinical practice – the need for educational interventions and strategies for broad dissemination
Authors: Nast Alexander , Erdmann Ricardo , Pathirana Delano , Rzany Berthold
Published: September 2010

Rationale  Evidence‐based guidelines can make a substantial contribution to improving medical care. However, it is important to ensure that guidelines are: (1) developed in areas in which they are needed the most; and (2) translated effectively into everyday clinical practice.

Objectives  To evaluate the need for guidelines in the treatment of psoriasis vulgaris, the success of the dissemination activities undertaken to date, and the potential benefits of educational interventions in encouraging guideline compliance.

Methods  All dermatologists working in the Berlin‐Brandenburg region of Germany were invited to attend a workshop on the psoriasis treatment guidelines. Participants could take part in a survey examining the general need for psoriasis guidelines and the success of previous dissemination activities.

Results  A total of 42% of survey participants had not received a copy of the guidelines prior to the workshop. Of those who had received a copy, only 15% had studied the guidelines in detail. In total, 76% of survey participants felt that physicians' low levels of confidence in administering systemic treatments had resulted in these treatment options being used less frequently than they should. Seventy‐nine per cent of survey participants believed that the guidelines would be helpful in improving physicians' confidence and ultimately lead to an increased use of systemic treatments.

Conclusion  The results of the present study indicate that there is a great need for guidelines on the treatment of psoriasis vulgaris in Germany, especially in light of dermatologists' low levels of confidence administering systemic treatments. Strategies for broad dissemination are essential for proper guideline implementation.
Interpretation of tests of heterogeneity and bias in meta‐analysis
Authors: Ioannidis John P. A.
Published: September 2010

Statistical tests of heterogeneity and bias, in particular publication bias, are very popular in meta‐analyses. These tests use statistical approaches whose limitations are often not recognized. Moreover, it is often implied with inappropriate confidence that these tests can provide reliable answers to questions that in essence are not of statistical nature. Statistical heterogeneity is only a correlate of clinical and pragmatic heterogeneity and the correlation may sometimes be weak. Similarly, statistical signals may hint to bias, but seen in isolation they cannot fully prove or disprove bias in general, let alone specific causes of bias, such as publication bias in particular. Both false‐positive and false‐negative signals of heterogeneity and bias can be common and their prevalence may be anticipated based on some rational considerations. Here I discuss the major common challenges and flaws that emerge in using and interpreting statistical tests of heterogeneity and bias in meta‐analyses. I discuss misinterpretations that can occur at the level of statistical inference, clinical/pragmatic inference and specific cause attribution. Suggestions are made on how to avoid these flaws, use these tests properly and learn from them.
User‐driven health care: answering multidimensional information needs in individual patients utilizing post–EBM approaches: an operational model
Authors: Biswas Rakesh , Maniam Jayanthy , Lee Edwin Wen Huo , Gopal Premalatha , Umakanth Shashikiran , Dahiya Sumit , Ahmed Sayeed
Published: September 2010

The hypothesis in the conceptual model was that a user‐driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world.

It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.
Meta‐analysis of repeated measures study designs
Authors: Peters Jaime L. , Mengersen Kerrie L.
Published: September 2010

Rationale, aims and objectives  Repeated measures studies are found in many areas of research, particularly in areas of healthcare. There is currently little information available to inform the method of meta‐analysis of repeated measures studies so that the structural dependence of the data is appropriately accommodated and the findings are meaningful.

Method  Using a published meta‐analysis on the impact of diet advice on weight reduction of obese or overweight individuals, we demonstrate possible approaches for repeated measures meta‐analysis. These approaches differ in terms of the type of result obtained (e.g. effect at a particular time‐point, trend over time, change between time‐points) and the data needed for the analysis (e.g. means, regression slope estimates). Some approaches involve violating assumptions of independence in the data structure and so to investigate the impact of this violation a simulation study is carried out.

Results  The different approaches described for the meta‐analyses of repeated measures studies can all provide useful effect estimates depending on the question to be addressed by the meta‐analysis. However, violation of the independence assumption in some approaches can lead to biased estimates.

Conclusions  In practice, the methods available to carry out meta‐analyses of repeated measures studies will not only depend upon the question of interest, but also on the data available from the primary studies.
The effectiveness of clinical guideline implementation strategies – a synthesis of systematic review findings
Authors: Prior Mathew , Guerin Michelle , Grimmer‐Somers Karen
Published: September 2010

Objective  To establish the effectiveness of clinical guideline implementation strategies.

Data sources/study setting  Systematic reviews in full text, English language, 1987–2007, reporting any measure of clinical process change or cost–benefit analysis.

Study design  Overview of secondary evidence

Data collection/extraction methods  Independent critical appraisal using AMSTAR, primary author undertaking all data extraction using a purpose‐built form.

Principal findings  We identified 144 potential papers, from which 33 systematic reviews were included. These reflected 714 primary studies involving 22 512 clinicians, in a range of health care settings. Implementation strategies were varied, rarely comparable, with variable outcomes. Effective implementation strategies included multifaceted interventions, interactive education and clinical reminder systems. Didactic education and passive dissemination strategies were ineffective. Cost‐effectiveness studies were rare.

Conclusions  Successful guideline implementation strategies should be multifaceted, and actively engage clinicians throughout the process.
Perspectives on evidence‐based practice from consumers in the US public mental health system
Authors: Tanenbaum Sandra J.
Published: September 2010

Rationale, aims and objectives  Evidence‐based practice (EBP) is a matter of mental health policy in USA. Supporters find it useful in two forms, as generating a list of approved practices and as providing information to practitioners and consumers engaged in shared decision making. Almost nothing has been written about consumer perspectives on EBP. Given that they play an important role in the second form of EBP, this study explores the range and logic of these perspectives and of related views about the role of information in decision making.

Methods  Four focus groups (n = 38) were held in two settings in a Midwestern state in 2005. Thirty‐nine face‐to‐face semi‐structured interviews were conducted at three settings in 2006. Focus group members and interviewees were seriously mentally ill consumers in the public mental health system. Focus group sessions and interviews were audiotaped and transcribed. Thematic categories and subcategories were analysed.

Results  Focus group members and interviewees varied among themselves and between groups in their responses, but three major thematic categories emerged in both groups – consumers have positive and negative attitudes towards evidence; consumers seek and receive information from multiple sources; and consumers have competing and complementary principles for decision making. Interviews revealed that although real shared decision making is rare, consumers want to and may be involved in decisions about their care.

Conclusions  EBP per se has mostly by‐passed consumers in the public mental health system, but at least some want to be better informed about and more involved in their care. Their misgivings about evidence are reasonable and resonate with the principles of the recovery movement.
Can ‘Cascades’ make guidelines global?
Authors: Fried Michael , Krabshuis Justus
Published: September 2010

Why are guidelines in medicine so important today? What role do they have? Why and how did the World Gastroenterology Organization (WGO) choose a global focus? What does this mean for guidelines? These are the underlying questions addressed by our article. We argue that the addition of ‘Cascades’ to guidelines will increase their impact in large parts of the world. By so doing, we hope to add a new dimension to the ‘knowledge into action’ debate. A number of illustrations shows how raised expectations and resource restrictions pose – or should pose – an enormous challenge for guideline makers. Furthermore, the emphasis on evidence also creates problems for guideline making. If resources are limited it is unlikely gold‐standard technologies are available. We believe Cascades can help.

A Cascade is a selection of two or more hierarchical diagnostic or therapeutic options, based on proven medical procedures, methods, tools or products for the same disease, condition or diagnosis, aiming to achieve the same outcome and ranked by available resources.

The construction of such a cascade is a hazardous intellectual journey that goes, to some extent, against established practice. But lives can be saved by matching options for diagnosis and treatment to available resources. While the optimal strategy, defined through an evidence‐based approach, should always be the goal, one must be aware of the resource limitations that confront our colleagues in certain parts of the world and we should endeavour to work with them in the guideline development process to develop strategies that are clinically sound yet economically feasible and dacceptable to their populace.
Optimizing clinical practice with case‐based reasoning approach
Authors: Dussart Claude , Pommier Pascal , Siranyan Valérie , Grelaud Gilles , Dussart Sophie
Published: September 2010

Rationale and aims  Learning through experience is an important approach that humans employ to comprehend new problems. The knowledge of physicians does not only consist of rules, but of a mixture of textbook knowledge and experience. Medical treatment is facing a challenge of knowledge discovery from the growing volume of information.

Method  Case‐based reasoning (CBR) matches the natural reasoning model of human. This approach is similar to that used by physicians when they are thinking: ‘I have seen a patient like this’, and provides instant recollection of past cases that may be relevant to the present case. In fact, CBR is an approach for solving problems based on solutions of similar past cases. Unlike other forms of reasoning such as rule‐based reasoning, CBR does not draw conclusions by chaining together generalized rules.

Conclusion  The application of CBR to medical databases can be powerful techniques to aid physicians in making decisions about the management of their patients, in various types of medical units. CBR is an effective reasoning strategy for optimizing clinical practice.
Reason, reality and objectivity – shared dogmas and distortions in the way both ‘scientistic’ and ‘postmodern’ commentators frame the EBM debate
Authors: Loughlin Michael
Published: September 2010

Both defenders and certain critics of evidence‐based medicine (EBM) share philosophical commitments – assumptions about the meaning of and relationship between such fundamental concepts as ‘objectivity’, ‘subjectivity’ and ‘rationality’– that frame the debate between them. Critics need to be particularly careful in analysing their own philosophical commitments. Ironically, failure to do so has led some to ground their rejection of EBM in philosophical theses that are less clear and/or more contentious than the reasonable conclusions they wish to defend. There is no need to label ‘objectivity’ a ‘myth’ or ‘scientific method’ an ‘illusion’ in order to identify what is wrong in EBM. Such strategies play into the hands of EBM dogmatists, allowing them to continue to position themselves as the defenders of ‘science’ and ‘reason’.
Systematic review: indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery
Authors: Lemmens Lidwien , Van Zelm Ruben , Vanhaecht Kris , Kerkkamp Hans
Published: September 2010

Background  A systematic review on clinical pathways for gastrointestinal surgery was performed. The aim was to study indicators that are used to evaluate these clinical pathways and to study which effects of clinical pathways are reported.

Methods  A search was performed for the period from January 2000 to November 2006 in MEDLINE, EMBASE and CINAHL. The Leuven Clinical Pathway Compass was used to categorize the indicators reported in literature.

Results  Twenty‐three studies were selected, of which 16 were controlled studies. The studies assessed most frequently complication rates, re‐admissions, mortality and length of stay. More specific indicators like time to start defecation and time to return to enteral feeding were reported as well. None of the studies reported adverse effects in any of the domains of the Clinical Pathway Compass.

Conclusion  Clinical pathways for gastrointestinal surgery can enhance efficiency of care without adverse effects on outcome. Specific indicators to evaluate these clinical pathways are time to return to enteral feeding and time to defecate. Furthermore, additional to complication rates, number of re‐admissions, mortality and length of stay, indicators such as the number of re‐operations, pain scores and intensive care unit admission can be assessed to monitor effectiveness and patient safety of the clinical pathways.
The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part one
Authors: Cutcliffe J. R. , Black C. , Hanson E. , Goward P.
Published: September 2010

The role of the palliative care nurse emphasizes the need for holistic care, and as this role has developed it has become evident that palliative care nurses require skills which, arguably, not all registered general nurses possess; particularly, skills pertaining to the psychological, social and spiritual domains of the person. In order to identify the skills that such nurses may require, there may be merit in considering other specialities of nursing which pay particular attention to the psychological, social and spiritual domains of the person. Consequently, this two‐part paper explores the areas of commonality and synchronicity between palliative care nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non‐physical care, the nurse–client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation, and the focus on physical care. Part one of this paper therefore focuses on the first three areas of alleged commonality, with part two focusing on the fourth commonality, the key differences and the implications of such similarity. Given these areas of similarity the authors argue there is a case for reconsidering if the RGN qualification is an essential requirement for working within palliative care or if those with other skills – skills based on ‘being with’ rather than ‘doing for’– such as RMNs, should be thought of for such roles.
The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part two
Authors: Cutcliffe J. R. , Black C. , Hanson E. , Goward P.
Published: September 2010

This is the second of a two‐part paper which explores the areas of commonality and synchronicity between palliative care (PC) nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non‐physical care, the nurse–client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation and the focus on physical care. Part one focused on the first three areas of commonality, whereas this paper focuses on the fourth commonality, the locus of control. It also focuses on key differences and the implications of such similarity. The paper highlights the practice, education and research implications of this alleged commonality. It suggests, given the evidence that clients perceive the therapeutic relationship as the vital and unique aspect of PC nursing, that those working within palliative care need to question whether or not RGN registration is an essential requirement, or whether those with other skills, such as psychiatric/mental health (P/MH) nurses, should be considered for such roles. It highlights the need for the provision of post‐basic counselling courses and the potential value for PC nurses of receiving clinical supervision from P/MH nurses or mental health liaison nurses. Lastly, it posits that the research issues arising out of this alleged commonality centre on the potential impact such transitions in care delivery may have on the care delivered, on the nurses themselves and on the clients.
Constraints and blocks to change and improvement on acute psychiatric wards – lessons from the City Nurses project
Authors: BRENNAN G. , FLOOD C. , BOWERS L.
Published: September 2010

Recent years have seen sustained criticism and inspection of acute inpatient psychiatric wards, with the publication of reports and research leading to policy developments and a variety of efforts to improve perceived deficits. The City Nurses project seeks to reduce levels of conflict and containment on acute wards through the placement of expert nurses on wards to assist with the implementation of changes according to a working model of conflict and containment generation, based on previous research. Evaluation has shown significant decreases in aggression, absconding and self‐harm by patients. However, in the course of working with the wards, various constraints and blocks to change have been identified and we describe these in detail in this paper. Analysis of the fieldwork diaries of the two City Nurses identified that change was hindered by limited staffing resources, problems with the physical environment and other resources, insufficient beds and the process of bed management, hierarchical ambiguity and multidisciplinary issues, the overdemanding role of the ward manager, and pervasive anxiety about the potential for serious untoward incidents and their implications for staff. We argue that sustained positive change in acute inpatient psychiatry requires these underlying structural issues to be both acknowledged and, if possible, resolved.
Parents’ experiences of collaboration with community healthcare professionals
Authors: JAKOBSEN E. S. , SEVERINSSON E.
Published: September 2010

Over the last decades there has been a reduction in the number of institutional beds in psychiatric care in Norway. This has led to more psychiatric patients being dependent on community care and consequently an increased need for collaboration with the parents of these patients. In most cases parents are an important source of support in helping patients manage their everyday life. The aim of this study was to explore how parents of adult psychiatric patients experience collaboration with health professionals in the community healthcare services. The data collection in this study is based on 12 interviews with six parents, and a qualitative analysis method was employed. Four themes emerged: (1) communication and relationship between parents and health professionals; (2) lack of information; (3) parents’ participation in the treatment of their son or daughter; and (4) the need for guidance and support. It was reported that health professionals are suspicious of parental involvement and often refuse to allow them to participate in the care. Further research on parents’ experiences of collaboration is necessary. The value of parents as an important source of support can be enhanced by means of increased collaboration.
Managing aggression in a psychiatric hospital using a behaviour plan: a case study
Authors: BISCONER S. W. , GREEN M. , MALLON‐CZAJKA J. , JOHNSON J. S.
Published: September 2010

This paper focuses on the critical role of nursing in implementing a behaviour plan in a psychiatric hospital. The plan was implemented with a 40‐year‐old man with a long history of aggression towards others and self. The study used a single‐subject research design with baseline and intervention phases (AB Design). Data were collected on (1) frequency of incidents of aggression towards others and self; (2) use of restrictive interventions to manage aggression (i.e. restraints, pro re nata medication, 1:1 special observation); and (3) frequency of staff injury. The data show a decrease in frequency of aggression towards others and self, a concurrent reduction in the use of restrictive interventions to manage aggression, and a decrease in incidents of staff injury. The behaviour plan helped staff maintain a safe and therapeutic milieu. The behaviour plan has given the patient an opportunity to learn positive replacement behaviours and skills, and the opportunity eventually to leave the hospital to live in a less restrictive community home.
Integrating science, practice and reflexivity – cognitive therapy with driving phobia
Authors: TOWNEND M. , GRANT A.
Published: September 2010

The scientist–practitioner model has long been espoused within cognitive behavioural psychotherapy. The study includes an evaluation of the efficacy of cognitive therapy for driving phobia. Assessment, formulation and practical treatment of this common problem are also reported. Self‐report measures evaluated results. Eight of the 10 consecutive cases improved significantly and reported that the intervention was acceptable. A reflexive analysis of the research findings and the influences on the first author’s practice as a researcher and practitioner are also explored. Recommendations for future research are also made.
A survey of mental health nurses’ experiences of stalking
Authors: ASHMORE R. , JONES J. , JACKSON A. , SMOYAK S.
Published: September 2010

Although an increasing amount of literature has appeared in recent years on the subject of stalking, little is known about mental health nurses’ (MHNs) experiences of this phenomenon. The aims of the study were to investigate: (1) the incidence of stalking among a sample of MHNs in the UK; (2) who the perpetrators were; (3) the impact of stalking on MHNs; and (4) how MHNs manage their experiences. Employing a survey design, the British version of the Rutgers‐Penn clinicians and stalking questionnaire was distributed to a convenience sample of 400 MHNs in the UK. Data were analysed by means of descriptive statistics and McNemar test. The findings reveal that: (1) 50% (n = 56) of MHNs who completed the questionnaire had been stalked; (2) on the whole, victims were female (78.6%) and stalkers males (82.1%); (3) stalkers were from a variety of social groups including mental health service users and MHNs; (4) victims were threatened, followed, physically assaulted and received unwanted communication; (5) MHNs reported a variety of stress‐related (psychological and behavioural) responses to their experiences; and (6) employed a range of coping strategies. This study serves to raise awareness of a number of issues surrounding an under‐reported phenomenon in mental health nursing and points to the need for further research to explore the reliability and consequences of the findings.
Should service user involvement be consigned to history? A critical realist perspective
Authors: STICKLEY T.
Published: September 2010

Service user involvement in the UK healthcare agenda is now widely expected. Historically, service user groups have been increasingly successful in their demands for greater involvement. Hierarchies of involvement exist that include consultation and partnership working. Psychiatry is an archetypal arena in terms of power and control. The traditional view of interpreting the place of service users within this arena is that the service user is at the bottom of this hierarchy; involvement allows transcendence of the power hierarchy. Critical realist theory is offered as an alternative approach to understanding these complex relationships. It is argued that contemporary models of involvement perpetuate and sustain the power positions of the dominant discourse within psychiatry. It is suggested that a critical realism perspective, offers a model that does not kowtow to the dominant discourse but rather recognizes that service users now possess power, especially in terms of being able to provide services that statutory services providers now require. Is it time for service users to call the tune, and, in doing so, establish a power position outside the traditional hierarchy of power?
The principles and processes of inspiring hope in bereavement counselling: a modified grounded theory study – part two
Authors: CUTCLIFFE J. R.
Published: September 2010

This second part of a two‐part paper attempts to answer the question: do bereavement counsellors inspire hope in their clients and if so, how? Using a modified grounded theory method data were collected by means of semi‐structured interviews; undertaken with a theoretical sample of bereavement counsellors and ex‐clients who had received bereavement counselling. In keeping with the tenets of grounded theory, the data were coded and analysed using the constant comparison method, and this produced an emerging, substantive theory of the principles and processes of hope inspiration for this client group. This theory is comprised of a core variable: the implicit projection of hope and hopefulness, and three sub‐core variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a healthy (good) ending. Part one of this paper included a review of the literature and focused on stage one. Part two on the other hand, focuses on stages two and three, and highlights the categories therein. The paper concludes by highlighting implications arising from the findings (other discussion points have been published elsewhere).
The Thorn Course: rhetoric and reality
Authors: COULDWELL A. , STICKLEY T.
Published: September 2010

The Thorn Course that provides psychosocial interventions and family work training for UK mental health professionals was founded in 1992. Since this time policy, service provision and needs have changed. The aim of this study was to examine the Thorn Course through relevant literature, in order to establish whether research and policy have been integrated into practice within training and services. A search of professional journal databases was conducted. Keywords used were ‘Thorn Course’ and ‘psychosocial intervention training’. The resulting body of literature was reviewed. Five main themes emerged which were examined: needs identified, delivering the Thorn Course, training outcomes, implementing interventions and user and carer involvement. There is a distinct lack of research studies evaluating any aspect of the Thorn Course. There is little evidence that user and carer involvement has moved beyond rhetoric and community mental health nurses continue to lack opportunities and support to implement psychosocial skills acquired in training.
Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self‐harming women showing borderline personality symptoms
Authors: PERSEIUS K‐I. , KÅVER A. , EKDAHL S. , ÅSBERG M. , SAMUELSSON M.
Published: September 2010

The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self‐harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18‐month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory‐General Survey (MBI‐GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self‐harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI‐GS, showed no significant changes over the 18‐month period, although there was a tendency for increased burnout levels at the 6‐month assessment, which had returned to baseline levels at 18 months.
Progression of the mental health nurse practitioner role in Australia
Authors: WAND T. , WHITE K.
Published: September 2010

The guiding principle of health care is to serve the needs of the public. Healthcare services are therefore required to be increasingly flexible and open to new approaches to meet changing demands. They must also adjust and expand as new challenges are presented. Public awareness of mental health issues and the current demands placed on health services for access to affordable and appropriate mental health care have never been so great. The introduction of nurse practitioners (NPs) in Australia is a proud and long‐anticipated moment for the discipline of nursing. However, a major challenge for the introduction of NPs in Australia will be to reassure medical colleagues, allied health professionals and the public that NPs are able to deliver high‐quality primary care. This paper elaborates on the progress of the mental health NP role in Australia. Attention is centred on the characteristics the mental health NP role, the maintenance of professional competency to practise at an advanced clinical level, and the prospects and potential significance of NPs for mental health nursing practice. The nurse‐led clinic, implemented through the process of consultation and systematic evaluation, is identified as an avenue for the extension of mental health NP practice in the delivery of autonomous primary care.
Violence and aggression: a literature review
Authors: WOODS P. , ASHLEY C.
Published: September 2010

This paper reports the results of a literature review that was undertaken to provide background for a small pilot study that introduced violence measurement instruments that was to assist the development of nursing practice on an acute psychiatric unit. Multiple databases were searched, focusing on publications since 1994: CINAHL, Ovid Healthstar, Ovid MEDLINE (R), EMBASE, and PsycINFO. The search used the following four groups of key word alternatives (used in truncated form to allow for ending permutations) in combination with each other: violence, aggression, dangerous; prediction, assessment, factor, risk, issue, cause, reason; mental, psychiatric; inpatient, short‐term, acute, admission. Searching was supplemented with footnote chasing of those papers retrieved and existing resources of the first author. Consequently, the synthesis of the results discussed cannot be considered a systematic review of the literature and is a reflection of some of the key issues found in the literature.
Choice as an intervention to promote well‐being: the role of the nurse prescriber
Authors: JONES M. , JONES A.
Published: September 2010

Case studies are a popular way to explore clinical experiences that occur with patients and nursing staff. We describe a case study with a patient diagnosed with schizophrenia and who required pharmacological interventions to bring about mental health well‐being. The role of the nurse prescriber is discussed alongside the process of engendering choice within the prescribing encounter. This paper discusses the process of switching medication to one chosen by the patient.
Burden, coping and needs for support of caregivers for patients with a bipolar disorder: a systematic review
Authors: VAN DER VOORT T. Y. G. , GOOSSENS P. J. J. , VAN DER BIJL J. J.
Published: September 2010

This study was aimed to highlight the factors which influence experienced burden, coping and needs for support of caregivers for patients with a bipolar disorder. Research articles meeting content and methodological quality criteria from January 1995 through October 2005 were reviewed. High objective and subjective burden is experienced by these caregivers. Subjective burden is extremely influenced by illness beliefs. High burden is associated more with severity of symptoms (than diagnosis), difficulties in the relationship with patient, lack of support and stigma. Coping is influenced by appraisal and burden. Different phases in the process of caregiving require different coping mechanisms. Little research is available on effectiveness of coping mechanisms and needs for support. Suggestions are nevertheless found in the literature for professional support. Caregivers of patients with a bipolar disorder experience high burden and try to cope in different ways. Little research is available on coping styles and needs for support. However, recommendations can be made to increase support for these caregivers.
Fostering a culture of engagement: a pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution‐focused therapy techniques
Authors: HOSANY Z. , WELLMAN N. , LOWE T.
Published: September 2010

It is widely acknowledged that there are major concerns about quality of care, ward atmosphere, the nature of nurse–patient interactions and patient outcomes in UK psychiatric acute admission units. Brief solution‐focused therapy (SFT) is an approach which aims to shift the focus of interactions in professional care away from the traditional concentration on an individual's problems and weaknesses towards a more proactive identification of their strengths and positive coping mechanisms. This approach relies on a collaborative engagement with patients, in which the nurse or therapist using simple language aims to help the patient construct a plan to ensure their immediate safety while working to identify, focus on and reinforce their strengths and coping mechanisms in the achievement of identified future goals. This paper reports on a pilot study whose principal objective was to determine whether a short training in brief SFT for psychiatric nurses can produce measurable improvements in nurse–patient interactions in two psychiatric acute admission wards. In this study, 36 nurses undertook a 2‐day training course in SFT and were followed up 3 months after training. Positive results were obtained on a number of measures indicating that nurses had acquired knowledge and skills and were applying SFT techniques in their clinical work.
Forensic psychiatric nursing: skills and competencies: I role dimensions
Authors: MASON T. , LOVELL A. , COYLE D.
Published: September 2010

This paper reports on an investigation into the skills and competencies of forensic psychiatric nurses from the perspective of three groups: (A) forensic psychiatric nurses; (B) non‐forensic psychiatric nurses; and (C) other disciplines. A national survey of forensic psychiatric services in the UK was conducted, and information gathered on the perceived skills and competencies in this growing field of psychiatric practice. From 3360 questionnaires, 1172 were returned, making a response rate of 35%. The results indicate a small discrepancy between forensic nurses' and non‐forensic nurses' perceptions of the role constructs of forensic practice. However, a larger difference was noted between nurses' perceptions and other disciplines' perceptions of the constituent parts to forensic psychiatric nursing. Nurses tended to focus on personal qualities both in relation to themselves and the patients, while the other disciplines focused on organizational structures both in defining the role and in the resolution of perceived deficits. The findings have implications for multidisciplinary working, as well as policy formulation and curriculum development in terms of the skills and competencies of forensic nurse training.
Forensic psychiatric nursing: skills and competencies: II clinical aspects
Authors: MASON T. , COYLE D. , LOVELL A.
Published: September 2010

This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non‐forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty; (2) the skills best suited to overcome those problems; and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non‐forensic psychiatric nurses and 43 other disciplines. The results highlighted a ‘top ten’ list of main problems with possible solutions and main areas for development. The conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.
Providing care to the elderly with depression: the views of aged care staff
Authors: HASSALL S. , GILL T.
Published: September 2010

The purpose of this paper was to scope the views of care staff working in an aged care setting in an effort to understand the issues these staff face in the delivery of care to the elderly with depression. Seventeen care staff working in metropolitan, regional and rural areas of Queensland participated in one‐on‐one interviews in order to elicit their views on the identification of depression in the elderly and the care processes staff employed to manage depression. Interview notes were taken, reviewed, transcribed and analysed using content analysis. Discussion with participants revealed five themes regarding the management of depression in both community and residential aged care settings. These included: the extent to which depression is an issue for clients and residents; staff understanding of depression and the ability to recognize when a client or resident is depressed; discussing depression with general practitioner's and other healthcare professionals; processes and procedures for treating and addressing depression; and education and training on depression for staff. The findings revealed that care staff need greater education and training about depression and targeted strategies for its identification and management.