Risk analysis : an integrated approach to the assessment and management of aggression/violence in mental health

Assessing a patient's risk of violent behaviour, predicting dangerousness and the development of a subsequent management plan have become integral and important aspects of contemporary mental health practices. What is less clear, and much discussed within the literature, is how we should best implement risk assessment and risk management practices within mental health care. The aim of this paper is to critically discuss risk assessment practices in order to propose a systematic approach to the effective assessment and management of aggression and violence in mental health settings. A critical review of the risk literature in mental health was undertaken. The literature search highlighted different generations or approaches to risk assessment methodology, which were critically reviewed. From this critical review a proposed model entitled ‘risk analysis’ is argued from the appraisal and critique of the literature as a more encompassing and collaborative approach to the assessment and management of risk

Personality disorder prevalence and treatment outcomes : a literature review

Personality disorder is argued to be the most prevalent psychiatric disorder and is considered to be a significant public health burden, yet there is little evidence that the disorder occupies a commensurate place in public health service planning, appropriate to such a burden. This paper reviews the prevalence and treatment outcome studies of individuals with personality disorder. The literature search highlighted prevalence studies and evidence based pharmacological, psychosocial, and alliance based interventions within this area. From this review, the place of mental health nurses within health service models is discussed

'eSimulation' part 1 : development of an interactive multimedia mental health education program for generalist nurses

Generalist health care professionals are increasingly challenged to provide mental health care within their own clinical specialties. Educators are challenged with providing innovative, engaging and accessible education programs to increase the mental health knowledge and skills of generalist health care professionals. Simulation is increasingly being used within learning curricula to optimise learning and the use of information and communication technology has emerged as a novel way of providing simulated learning. This paper describes the development process of an interactive, multimedia 'eSimulation' mental health education program for generalist health care professionals. The resulting eSimulation education program incorporated the following five key attributes of simulation: (1) Creating a hypothetical opportunity; (2) Authentic representation; (3) Active participation; (4) Integration; and (5) Repetition, evaluation and reflection. This process can be used to guide nursing educators in the development of tailored eSimulation education programs. An evaluation of the eSimulation will be reported elsewhere, in Part 2 of this paper

Mental health liaison nursing, taking a capacity building approach

Purpose: This paper explores the use of capacity building practice as an approach for the mental health liaison nurse (MHLN). Conclusions: The role of the MHLN has established itself within nursing, with various approaches to the role documented in the nursing literature. Most descriptions of the role are limited by simply explaining what the MHLN does, rather than explaining the underlying approach and evaluation of the model suggested. Capacity building practice is explored in the context of the liaison role, and its use is demonstrated in a clinical example of suicide risk in a general hospital setting. Practical Implications: The future scope of MHLN and their use of capacity building approaches may lead to the improvement of consumer health outcomes and also develop the skill of the non-mental health nurse in generalist settings

The 'difficult' nurse-patient relationship : development and evaluation of an e-learning package

Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care. This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed. Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations

'eSimulation' part 2 : evaluation of an interactive multimedia mental health education program for generalist nurses

This paper reports on an evaluation of an eSimulation mental health education program for generalist nurses; developed using the following five key attributes of simulation: (1) creating a hypothetical opportunity; (2) authentic representation; (3) active participation; (4) integration; (5) repetition, evaluation and reflection. Four themes emerged from a qualitative thematic analysis of semi-structured interview data involving fourteen generalist nurses. The following four themes: (1) authenticity; (2) participation; (3) clinical reasoning; (4) control of learning provide supporting evidence that these attributes are positioned within the learning resource. Participants found the scenarios within the resource realistic, engaging and relevant to their scope of practice. This type of learning resource may help in developing the knowledge, skills and confidence of generalist nurses in delivering safe and competent mental health care in the generalist setting, when access to specialist services and appropriate means of training are unavailable

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the 'cardiometabolic mental health nurse' is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness

Challenging behaviour, risks and responses

It has been argued that the nurse–consumer relationship is central to nursing care. Nurses in general are in continuous and direct contact with consumers and, as such, spend extended periods of time with them. Continuous contact places nurses in a unique position to develop therapeutic relationships with consumers through processes of collaboration, inclusiveness, mutuality and respect. However, there may be times when the relationship nurses have with consumers is tested, placing nurses in a difficult position and facing challenging behaviour (Stein-Parbury 2014). ‘Challenging behaviour’ is a term used by nurses to describe behaviour that disrupts relationships with others and complicates healthcare delivery—for example, aggression, manipulation, self-harm, suicide and psychosis-related behaviour. The terms ‘difficult behaviour’, ‘problem behaviour’, ‘difficult patient’ and ‘behaviours of concern’ have all been used to describe challenging behaviour (Farrell et al. 2010). Challenging behaviour occurs in inpatient units, community settings, emergency departments, general hospitals and primary care settings

Health behaviour beliefs and physical health risk factors for cardiovascular disease in an outpatient sample of consumers with a severe mental illness : a cross-sectional survey

Background: Consumers with a mental illness have a significantly higher risk of physical health problems than the general population. The role of health behaviour beliefs and their part in the health of consumers with a mental illness has been poorly explored in the literature. Objectives: To understand the relationship between physical health risk factors and health behaviour beliefs in consumers with schizophrenia. Design: A cross-sectional survey study design using the European Health and Behaviour Survey and assessing (n = 99) consumer's blood pressure, waist circumference, body mass index, smoking history, exercise levels, demographics, family history of diabetes and cardiovascular disease was used. Settings: The study was conducted in a 76-bed psychiatric facility located within a 550-bed metropolitan generalist hospital in Sydney, Australia. Participants: Patients attending an outpatient clozapine clinic at the mental health service were asked to participate in the survey by a nurse working in the clinic during the study period. Results: Of the 163 consumers asked to be involved in the study, n = 99 agreed to participate. Mean waist circumference and body mass index for both males and females were significantly above normal population limits. Overall, consumer's beliefs toward their health on the European Health and Behaviour Survey were positive, having statistically significantly more positive attitudes to the statements 'avoiding too much sugar', 'drinking no alcohol' and 'yearly blood pressure checks' than a previously published non-mental health consumer sample. Whilst having positive attitude toward their healthcare, consumers' physical health risk parameters were higher than general population norms. Conclusions: Consumers with a mental illness have a significantly higher risk for serious physical health problems, yet possess high positive attitudes toward their physical health care. Models of care need to explore this contradiction within mental health services to improve patient outcomes

The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital

Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses