Hospitality in mental health nursing

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Studies on the Treatment of Thyrotoxicosis With Radioactive Iodine (131I) and Antithyroid Drugs

Radioactive iodine (131I) is widely used in the treatment of thyrotoxicosis: an estimated 500,000 patients have been given this form of therapy since its widespread availability in the late 1940s. Despite this experience there is still uncertainty about the response of patients to 131I, particularly in the first year after treatment; the lag between administration and biochemical response can cause problems in patient management. There are also surprisingly few data on the effects of 131I on thyroid physiological processes: much of what is known was published before the availability of accurate measurement of thyroid hormone levels and thyroid stimulating hormone. This thesis attempts to address these points. The effects of antithyroid drug treatment on response to 131I are also examined, and the possible reasons for interactions between antithyroid drugs and 131I treatment explored. In the first part of the experimental section of the thesis the early effects of radioiodine (131I) treatment in patients with thyrotoxicosis were examined. In 50% of patients serum concentrations of thyroxine (T4) and tri-iodothyronine (T3) rose 48 hours after 131I administration, although in none was this associated with clinical deterioration. A similar finding was noted in patients who had been given carbimazole treatment for a minimum of three months before 131I administration. There were no major changes in serum thyroglobulin or TRAb levels following 131I treatment, and no relationship between changes in these variables and thyroid hormone concentrations was observed. The effect of 131I therapy on early (20 minute) uptake of following intravenous injection of radioisotope was examined serially in 55 patients with thyrotoxicosis: 24 of these had been treated before 131I with carbimazole. In all subjects 20 minute uptake of 123I which was taken to represent iodide trapping by the thyroid, fell by four weeks after 131I administration. In those patients who subsequently developed permanent hypothyroidism within the next few months uptake values remained low. In contrast, a small rise in uptake measurements following the initial fall occurred in those patients who were biochemically euthyroid one year after 131I administration. Patients who were still thyrotoxic one year after 131I administration had a higher 20 minute uptake of 123I before 131I administration (p 2% in a patient with hypothyroidism, an iodide organification defect may be partially responsible for the hypothyroidism. Iodide organification was formally studied in 24 patients given 131I treatment using an intravenous perchlorate discharge test. Nine had evidence of an organification defect within three months after treatment. In all patients there was a tendency for these defects to improve with time, and there was no evidence that iodide organification impairment had a major influence on thyroid biochemical function. A major theme of the thesis is the interaction between carbimazole and 131I treatment. Of 79 patients studied, 36 were made euthyroid with carbimazole before 131I administration. Carbimazole pretreatment (drug stopped at least 72 hours before 131I) caused a reduction in the incidence of hypothyroidism during the first twelve months after 131I treatment (19% v 42%, p <0.05). (Abstract shortened by ProQuest.)

Being safe practitioners and safe mothers: a critical ethnography of continuity of care midwifery in Australia

© . This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective To examine how midwives and women within a continuity of care midwifery program in Australia conceptualised childbirth risk and the influences of these conceptualisations on women’s choices and midwives’ practice. Design and setting A critical ethnography within a community-based continuity of midwifery care program, including semi-structured interviews and the observation of sequential antenatal appointments. Participants Eight (8) midwives, an obstetrician and seventeen (17) women. Findings The midwives assumed a risk-negotiator role in order to mediate relationships between women and hospital-based maternity staff. The role of risk-negotiator relied profoundly on the trust engendered in their relationships with women. Trust within the mother-midwife relationship furthermore acted as a catalyst for complex processes of identity work which, in turn, allowed midwives to manipulate existing obstetric risk hierarchies and effectively re-order risk conceptualisations. In establishing and maintaining identities of ‘safe practitioner’ and ‘safe mother’, greater scope for the negotiation of normal within a context of obstetric risk was achieved. Key Conclusions and Implications for practice The effects of obstetric risk practices can be mitigated when trust within the mother-midwife relationship acts as a catalyst for identity work and supports the midwife’s role as a risk-negotiator. The achievement of mutual identity-work through the midwives’ role as risk-negotiator can contribute to improved outcomes for women receiving continuity of care. However, midwives needed to perform the role of risk-negotiator while simultaneously negotiating their professional credibility in a setting that construed their practice as risky

People hospitalised on acute psychiatric wards report mixed feelings of safety and vulnerability

Author accepted manuscript (Post Print) made available in accordance with publisher copyright policy.Commentary on: Stenhouse RC. ‘Safe enough in here?’: patients’ expectations and experiences of feeling safe in an acute psychiatric inpatient ward. J Clin Nurs 2013;22:3109–18. Implications for practice and research - Patients expect to be cared for and kept safe by nurses. They feel physically safer when male nurses are present and feel vulnerable among fellow patients. - Nurses need to be sensitive to the experience of hospitalisation and need to provide physical and emotional safety for all inpatients through close engagement with them. - Further research is needed to explore the factors that promote feelings of being safe and recovery in acute inpatient units

Security guards in mental health settings: Starting the conversation

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Nurses' experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study

"This is the peer reviewed version of the following article: [Muir-Cochrane, E. C., Baird, J. and McCann, T. V. (2015), Nurses' experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study. Journal of Psychiatric and Mental Health Nursing, 22: 109–115. doi: 10.1111/jpm.12189], which has been published in final form at [http://dx.doi.org/10.1111/jpm.12189I]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."Accessible summary While the decision to use restraint and seclusion was not taken lightly, nurse participants felt that there were no effective alternatives to the use of these measures. Adverse interpersonal, physical and practice environments contributed to the onset of aggression in old age psychiatry inpatient settings. Policies to reduce or eliminate the use of restraint and seclusion need to take account of wide-ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices. Abstract Restraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

© . This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/There are significant issues associated with the use of restrictive measures, such as seclusion and restraint, in child and adolescent mental health care. Greater understanding of how restrictive measures are used is important for informing strategies to reduce their use. In this brief report we present a 12-month audit (1/1/2010-31/12/2011) of the use of restrictive measures (seclusion, physical restraint) in one child and adolescent acute inpatient mental health unit in Australia. The study highlights the need for continued efforts to reduce the use of restrictive measures in child and adolescent mental health services

Hold my hand and walk with me: Empathy on the mental health inpatient unit

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