Psychiatric-Mental Health Nurses\u27 Confidence and Preparedness for Integrated Care

Individuals suffering from serious mental illness (SMI) often suffer concurrent with chronic medical illnesses such as cardiovascular disease, hypertension, diabetes, and obesity. Those individuals with SMI have higher morbidity and mortality rates and require more healthcare services than individuals without SMI (Rao, Raney, & Xiong, 2015). Medical illnesses are often overlooked in the behavioral health setting because mental health care providers’ lack training and knowledge about medical illnesses. Lack of confidence also plays a role in treating concurrent medical illnesses. Psychiatric mental health nurses in behavioral health settings mainly focus their attention on the aspects pertinent tomental illness and often neglect the medical illnesses that are also present. Because of trends towards provision of care more holistic integrated care, psychiatric mental health nurses will need essential knowledge and skills in recognizing, assessing, treating, and referring to those with medical related problems. The purpose of this project was to determine whether psychiatric mental health nurses are prepared and have the confidence to provide integrated care in a behavioral setting. Four registered nurses completed the confidence survey and pre and posttest. Pretest results revealed that nurses could benefit from continuing education interventions. Posttest results revealed that educational interventions can help prepare nurses to work in an integrated setting. The confidence survey revealed that nurses felt more confident working in an integrated setting. Findings from the project indicated that evidence-based educational interventions can increase nurses’ confidence and prepare them to work in an integrated setting

Theatrical criticism of Addison and Steele

The purpose of this paper in to bring together in one body all, or as many as possible, of the references made by Addison and Steele to the theater in The Tatler, The Spectator, and Tho Guardian. In order to do this, it has been necessary to scan all of the papers included in these three periodicals to find those which contained a mention of the theater, for only rarely did Addison or Steele devote an entire paper to any one subject. It is hoped, therefore, that in going through these essays no significant comments on the theater have been overlooked

Optimising self-managed funding for people with a long-term disability: dialogue summary

A day-long stakeholder dialogue was held on 5 March, 2015 to consider the factors which influence the uptake of self-managed funding by people with a long-term disability, and identify barriers and facilitators to the implementation and uptake of self-managed funding. Sixteen people participated. Discussions noted the following key considerations: The term ‘self-managed’ funding is more appropriate for people with long-term disability, particularly those who experience cognitive impairment. It should be assumed that all people with a long-term disability have the right to take up self-managed funding. Every person with a long-term disability has some capacity to self-manage their funding, and efforts should focus on building this capacity through education and training. Although people with a long-term disability may not want to take up self-managed funding the first time it is offered to them, every effort should be made to allow them ample time to consider it and opportunities provided to enable consumers and carers to ask for more information about what is required to participate. The approach to self-managed funding needs to be different for people with catastrophic injury compared with other conditions. Self-managed funding should be offered early for maximal uptake. To date, in the early implementation stages of current models, more people with spinal cord injury (SCI) than people with traumatic brain injury (TBI) have taken up self-managed funding; this is assumed to be a reflection of the additional complexities in the needs of people with TBI. To have greater success in the uptake of self-managed funding for people with a traumatic brain injury (TBI), there needs to be considerable thought about making the processes involved appropriate, particularly for those with cognitive and behavioural impairments. The capacity of people with a TBI to undertake the tasks associated with self-managed funding needs to be assessed by staff who have trained skills and also reasonable expectations of what can be accomplished. The relationship of the Carers and Family members with a person with a TBI needs to be supported through a range of offerings for self-managed funding. Funding agencies and service providers need to build trust and be willing to work collaboratively with people with long-term disabilities to ensure that they can consider self-managed funding as a means of empowerment and control. Encouraging and actively supporting people in peer support networks to talk to others about what the experience of self-managed funding is like and/or having consumer organisations conduct forums that present real-life experiences were considered next steps to increasing the uptake of self-managed funding

Reflections on Centaur Upper Stage Integration by the NASA Lewis (Glenn) Research Center

The NASA Glenn (then Lewis) Research Center (GRC) led several expendable launch vehicle (ELV) projects from 1963 to 1998, most notably the Centaur upper stage. These major, comprehensive projects included system management, system development, integration (both payload and stage), and launch operations. The integration role that GRC pioneered was truly unique and highly successful. Its philosophy, scope, and content were not just invaluable to the missions and vehicles it supported, but also had significant Agencywide benefits. An overview of the NASA Lewis Research Center (now the NASA Glenn Research Center) philosophy on ELV integration is provided, focusing on Atlas/Centaur, Titan/Centaur, and Shuttle/Centaur vehicles and programs. The necessity of having a stable, highly technically competent in-house staff is discussed. Significant depth of technical penetration of contractor work is another critical component. Functioning as a cohesive team was more than a concept: GRC senior management, NASA Headquarters, contractors, payload users, and all staff worked together. The scope, content, and history of launch vehicle integration at GRC are broadly discussed. Payload integration is compared to stage development integration in terms of engineering and organization. Finally, the transition from buying launch vehicles to buying launch services is discussed, and thoughts on future possibilities of employing the successful GRC experience in integrating ELV systems like Centaur are explored

Optimising self-directed funding for the long-term disabled: briefing document

People with long-term disabilities have become increasingly frustrated with the inadequate support services provided by the disability sector. In particular, people with long-term disabilities want to have support services which met their needs as well as greater choice and control in the decisions around them. Over the last five years the popularity of self-directed funding has increased significantly. In 2011/12 the Australian Government made a commitment to implement a National Disability Insurance Scheme (NDIS) as advised through an inquiry by the Productivity Commission to have full rollout country wide by 2018. Self-directed funding is used as a mechanism to promote self-determination and empowerment in people with long-term disabilities and to facilitate their living in the community independently. Self-directed funding can be provided by an individual package held by a provider, by an individual budget held by the person to spend through providers or by direct payments to spend on the open market. The implementation of self-directed funding models has been implemented in various forms over the past couple of decades, including the piloting of small scale programs and the introduction of larger scale programs by government bodies or departments in specific disability groups.  Self-directed funding models are strongly established in the UK, USA and Western Australia. The inclusion of infrastructure supports such as independent brokers, financial intermediaries and ongoing support for clients are beneficial features of established models, particularly for people with complex needs. Despite their popularity, there is a lack of evidence about the effectiveness of self-directed funding models in practice, and no evidence comparing different models.  No single model has been demonstrated to be superior to another, likely in part because the cultural and political context in which a scheme is introduced has a strong influence on its design, implementation and outcomes. Despite this, there are consistent indications that offering flexible and creative options within models is the best approach for ensuring people with more complex and potentially unmet needs, have an opportunity to take up self-directed funding successfully. There are limited studies of the feasibility and impact of self-directed funding for people in the compensable sector with catastrophic injuries. Qualitative studies using interviews or questionnaires reveal that, generally, people with long-term disabilities recognise that self-directed funding should be one option among the range of options for receiving necessary support services; however, there is variability in the stated willingness to take on self-directed funding themselves. A lack of awareness of what is involved in self-directed funding and how it can be managed has been reported. In addition, it has been suggested that not all people have the skills, education or experience to manage self-directed funding, hence training and information sessions that are understandable and comprehensive are likely to be necessary in order to encourage uptake.  This NTRI Forum aims to consider the factors which influence the uptake of self-directed funding by the long-term disabled. Two questions were identified for deliberation in a Stakeholder Dialogue: 1. What are the barriers and facilitators to optimal implementation and uptake of self- directed funding in Australia and New Zealand? 2. How can knowledge of barriers and facilitators be used to address these challenges

Optimising return to work practices following catastrophic injury

This paper aims to enhance understanding of the features of optimal return to work practices following traumatic brain and spinal cord injury and identify barriers and facilitators to their implementation. Executive summary People with catastrophic injuries face many long-term challenges in the community as a result of their injury: one of the most problematic can be in returning to work (RTW). It may not only be a significant issue for the person with a catastrophic injury but also for their family, friends, the employment industry, and society. Worldwide mean RTW rates for people with catastrophic injury are approximately 30-40%; however, in Australia the overall mean rate is unknown. Internationally, the best RTW rates reported for moderate to severe traumatic brain injury (TBI) come from the UK, Sweden and USA, whilst for spinal cord injury (SCI) they are in Switzerland and Sweden. There are several differences in the way rates reported are calculated such as the time post-injury, making it difficult to definitively identify whether one country achieves better RTW rates than another. Several studies have been conducted to determine the factors which facilitate and limit RTW for people with catastrophic injury. These include having pre-injury employment, age, education, severity of injury, level of cognitive impairment, being functionally independent, fatigue, psychological adjustment to the change, social support and the work environment to name a few. There is a general lack of understanding of the experience of people with catastrophic injury who return to work and, therefore, little known about how job retention can be successful in the long-term. Four types of VR interventions have been identified to facilitate RTW – 1) program based rehabilitation, 2) supported employment, 3) case co-ordination and 4) hybrid or mixed. An evidence review identified 15 relevant articles and it was found that there was limited high quality evidence to support any type of intervention more effective than the other. There was however moderate evidence identified for the effectiveness of case co-ordination for achieving successful RTW for people with moderate to severe TBI and high level evidence for a specialist TBI-VR combination intervention. A reduction in the claiming of benefits after 1 year was also observed. The most promising RTW intervention for people with SCI appears to be supported employment; however, as only one RCT has provided this evidence, further studies are required. Several factors that affect the likely success of RTW interventions were also identified in exploring the research evidence and implications for future research were identified. Substantial research has been conducted on RTW interventions in people with TBI since the late 1980s, however this is not the same for SCI. High quality evidence and transparent reporting of study details are still lacking. This NTRI Forum aims to enhance understanding of the features of optimal return to work practices following traumatic brain and spinal cord injury and identify barriers and facilitators to their implementation. Two questions were identified for deliberation in a Stakeholder Dialogue: 1. In the Australian context, what are the barriers to, and facilitators of, application of strategies to optimise RTW outcomes for people with catastrophic injury? 2. How could identified barriers and facilitators be addressed to ensure successful RTW and better retention of people with catastrophic injury? An accompanying document (Dialogue Summary) will present the results of the deliberation upon these question