Team based vs patient allocation systems in nursing: a comparative evaluation and socio-cultural discussion

This thesis reports on an effort to promote, implement and experimentally evaluate the ‘team nursing’ model of nursing care in comparison with an ‘individual patient allocation’ model of care at a large Sydney teaching hospital, as an ameliorating response to a workplace experiencing low job satisfaction and lack of adequate skilled manpower. A systematic review of available research (1980-2004) in relation to models of nursing care, leading up to the project’s development and implementation between 2002-4, is reported as background to the workplace change project described. This review indicated a need for more experimental evaluations of models of care initiatives. In the active arm of the experimental study subsequently conducted, an action research approach was taken to pursue the change to the team nursing model of nursing care. Experimental and focus group-based qualitative evaluation methods were employed to assess the merits of making this change in approach to daily nursing work organization in inpatient acute care settings. Both experimental and qualitative evaluation findings indicated that multiple benefits were accrued by making a shift away from an individual practice-focused model of care towards a collective practice-focused model. A novel 14-item tool for the measurement of job satisfaction in nursing was employed as a key measure of outcome of the model of care change. The results of validation studies in relation to this tool are presented. In an effort to contextualize the results of the project within the wider nursing socio-historical frame, the disposition of nurse executives and senior academics towards teaming and the models of care agenda is explored via thematic and post-structuralist analyses of an interview-based study. The thesis draws from multiple research paradigms in order to bring the results of the project work and its evaluation and the qualitative study among nursing leaders, together. Clinical autonomy is isolated and discussed as a central concern of both practicing and academic nurses. Post-structurally defined models of both the contemporary challenge for acute care nursing and a unifying model for the future are presented and discussed

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers

Prevalence and predictors of metabolic syndrome among patients attending an outpatient clozapine clinic in Australia

Objective: This study aimed to determine the prevalence and predictors of metabolic syndrome in an outpatient clozapine clinic in Australia. Methods: Metabolic syndrome is a cluster of some of the most dangerous cardiovascular risk factors, and its high prevalence in people with mental illness has been demonstrated. Patients attending a clozapine clinic were screened for the following: age, gender, ethnicity, waist circumference, blood pressure, high-density lipoprotein level, low-density lipoprotein level, blood sugar levels, total cholesterol level, triglycerides level, weight, body mass index, insulin resistance level, length of time on clozapine, clozapine dose, smoking status, family history of diabetes and cardiovascular disease, and personal history of polycystic ovarian syndrome. All the variables that were found to be significantly associated with metabolic syndrome were entered into a multivariate logistic regression analysis. Results: Seventy-three patients were screened for metabolic syndrome using the International Diabetes Federation's (2007) definition. Forty-five (61.6%) patients met the criteria for the syndrome. Increased blood sugar level, high diastolic blood pressure, older age, increased waist circumference, raised triglycerides level, and higher body mass index emerged as significant predictors of metabolic syndrome in the sample. Conclusions: This study adds further support for the systematic screening for metabolic syndrome in patients receiving clozapine. The need for intervention programs which screen for and address the modifiable risk factors of metabolic syndrome is discussed

Reducing emotional distress in nurses using cognitive behavioral therapy : a preliminary program evaluation

Introduction: Workplace stress among nurses has been associated with high absenteeism, low work satisfaction, and poor retention rates. Aim: This pilot study evaluated the effectiveness of a 1 day stress management program on nurses' stress levels. Methods: The nurse participants attended an 8 h face-to-face interactive workshop based on cognitive behavioral therapy. The subjects also were given a self-directed manual with reading and exercises to use after the workshop. The nurses were assessed at baseline and at 6 weeks postworkshop attendance using the Nurse Stress Scale (NSS). They were asked to rate their level of stress at work, outside of work, and their overall stress. The participants also were asked to evaluate the perceived usefulness of the workshop at follow-up. Results: The sample consisted of 18 new graduate nurses halfway through their first year. The NSS subscales "nurse-doctor conflict", "death and dying", and "nurse-nurse conflict" showed statistically significant improvement at follow-up. The ratings of stress at work, outside of work, and the overall stress also showed statistically significant improvement. Conclusions: The workshop was well-received by the new graduate nurses. The pre/post findings suggest a beneficial effect of the intervention. The authors are encouraged by the results and now plan to conduct a multisite, randomized controlled trial to seek to establish a wider evidence base for the intervention

The Blue Card : a hand-held health record card for mental health consumers with comorbid physical health risk

Objective: We aimed to determine the effectiveness of a hand-held record (the 'Blue Card') for seriously mentally ill consumers by investigating effects on consumer knowledge of physical health risk factors, consumer involvement in care and communication with healthcare professionals. Method: Consumers were given and educated in the use of the Blue Card, which contained information regarding their physical health. Consumers completed a pre- and post-knowledge questionnaire and commented on the effectiveness of the Blue Card with respect to their knowledge of physical health risks. Results: Statistically significant improvements in consumer knowledge were shown at the 3-month follow-up, with high retention of the Blue Card being demonstrated. Consumers that used the card described their use of the card positively. Conclusions: The results are very encouraging. Further studies of this low-cost intervention are warranted to establish its effectiveness and utility

Health professionals' attitudes towards suicide prevention initiatives

Preventing suicide can depend upon the ability of a range of different health professionals to make accurate suicide risk assessments and treatment plans. The attitudes that clinicians hold towards suicide prevention initiatives may influence their suicide risk assessment and management skills. This study measures a group of non-mental health professionals' attitude towards suicide prevention initiatives. Health professionals that had attended suicide prevention education showed significantly more positive attitudes towards suicide prevention initiatives. The findings in this study further support the effectiveness of educating non-mental health professionals in suicide risk awareness and management

Profiling police presentations of mental health consumers to an emergency department

Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services

Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department

The objective of this study is to determine the clinical characteristics of people with mental health problems who frequently attend an Australian emergency department (ED). A retrospective clinical audit of presenter characteristics was conducted in a 550-bed tertiary referral metropolitan hospital with data reflecting 12 months of consecutive ED presentations between September 2002 and August 2003. A sample of 868 individuals accounted for 1076 presentations. Patients attending more than once accounted for 12.5% of the total sample. Significant variables associated with frequent attendance included: younger age; English speaking background; and mood and anxiety disorders. Lone arrival of a patient to the ED showed marginal significance. The significant associates of frequent attendance found in this study may be used to identify patients earlier to a multidisciplinary case review process and individual management planning involving clinicians, carers and patients