An exploration of mental health nursing models of care in a Queensland psychiatric hospital

This qualitative study that took place in 2006 in a publicly funded Queensland psychiatric hospital explored nursing models of care from multiple points of view. Eleven participants were interviewed. Two were post-acute consumers, three were nurse unit managers, one was an enrolled nurse, and the remaining five were registered nurses. Even though participants valued an approach that was different to a medical model, in the absence of an explicit nursing approach, the predominantly illness-care culture led nurses to resort to problem-focused care. Relying on implicit models of care created inconsistencies and precluded the nursing strategies from being systematically evaluated, revised, or extended. Various changes were identified and included the desire for further consultation and staff development so that an explicit model of care could be introduced and evaluated

Development of an mHealth application for family carers of people with dementia: A study protocol

Background: The progressive and complex nature of dementia demands carers have specific knowledge and training. However, often carers do not have adequate knowledge and skills, particularly for functional disability care. Aim: This study aims to develop and test the feasibility of an educational and supportive mHealth/smartphone application that addresses the needs of family carers of people with dementia related to functional disability of care recipients. Methods: This mixed method study consists of three phases. In phase one, an online survey and individual interviews with carers will be conducted to assess their needs related to management of functional disability and the development of an mHealth application. Additionally, experts will be consulted to identify their opinions on application development. In phase two, using information from phase one, an mHealth application will be designed and developed. In phase three, a feasibility study will be conducted with carers to identify usability, user adherence, acceptance and experiences with the application. Discussion: This study will generate new knowledge about the needs of carers related to the management of functional disability of people with dementia and the use of smartphones for health-seeking behaviours, and will develop an mHealth application for carers to address the needs related to functional disability care. Conclusion: A mixed method study was designed to develop a user-centred educational and supportive mHealth app for family carers to address needs related to the functional disability of people with dementia consisting of three phases: needs assessment, the designing of the app and a feasibility study. © 2018 Australian College of Nursing Lt

Family carers' perspectives of managing activities of daily living and use of mHealth applications in dementia care: A qualitative study

Aim: To examine the needs, barriers and challenges experienced by family carers of people with dementia concerning the management of their care recipients' functional disabilities, and their experiences and opinions of using mobile health (mHealth) applications in health information seeking. Background: Functional disability is a significant problem among people with dementia and management can be challenging for family carers. Evidence suggests that mHealth applications can support knowledge needs of patients and families. Design: A qualitative descriptive exploratory study. Methodology: In-depth interviews were conducted with a purposive sample of family carers using a semi-structured interview guide. An inductive thematic analysis method was used. The COREQ reporting guideline was followed. Results: Five spousal and five child carers participated in this study. Four key themes were identified: (a) Challenges faced that contribute to psychological distress and burden; (b) Essential role of support systems in dementia care; (c) Information and educational needs of family carers, and (d) Experiences and attitudes of mHealth applications as an educational and supportive resource. Conclusion: Providing functional care is demanding, challenging and stressful, and leads to carer burden. The complexity of dementia is a barrier in the organisation of functional care and access to a support network is vital to care provision. The information needs of family carers can potentially be addressed through an mHealth application. Relevance to clinical practice: This study provides important information on family carers' needs, and the barriers and challenges related to functional care for people with dementia. Findings from this study can assist nurses and other health professionals in the planning of educational and supportive programs for family carers. Furthermore, the use of mHealth applications could positively contribute to the delivery of these programs. © 2019 John Wiley & Sons Lt

Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey

Background: Family carers of people with dementia face different challenges in providing care for daily living activities of their care recipients. Today, mHealth applications are widely used in healthcare. Aim: To examine the needs of family carers of people with dementia concerning the management of functional disability of their care recipients, carer burden and use of mHealth applications when seeking health information. Methods: A total of 166 family carers, who were recruited through leading dementia support organisations in Australia, research institutes, and social media, completed an online survey. In data analysis, descriptive statistics, Pearson's Chi-square test, Mann-Whitney U test and Kruskal-Wallis H test were used. Findings: People with dementia were dependent on family carers for complex activities (e.g. taking medication) (99.4%), domestic activities (e.g. washing clothes) (97%), and self-care (e.g. bathing) (79.5%). Family carers reported a moderate-to-high need for education in functional disability care (62.6%). Bathing was reported as the most difficult activity to perform (30.1%). Three-quarters of carers reported carer burden (74.1%). Most carers (98.8%) owned a smart-device, and 51.2% of family carers reported having an mHealth application. Educational needs for functional disability care were associated with age (highest among those between 36–65 years) and eHealth literacy of carers (greater among carers with adequate eHealth literacy). Carer burden was associated with stage of dementia (highest in advanced dementia) and experiencing chronic medical problems of care recipients. Possession of an mHealth application was associated with employment status (currently employed), adequate eHealth literacy and higher educational needs. Conclusion: Providing functional disability care is one of the priority needs for education. These educational needs can potentially be provided via mHealth applications. Health professionals can use these findings to plan educational interventions to address family carers’ needs. © 2019 Australian College of Nursing Lt

mHealth applications as an educational and supportive resource for family carers of people with dementia: An integrative review

Family carers encounter several challenges related to caring for people with dementia, and they need support in managing care recipients’ health needs. This study aims to identify, appraise and synthesise the existing evidence on the use of mHealth/smartphone applications as an educational and supportive resource for family carers of people with dementia. An integrative literature review approach was used. Seven databases were searched. The search generated 117 articles, with seven meeting the inclusion criteria. Three categories and their attendant sub-categories emerged from the literature. The categories are ‘carer support’, ‘evaluation strategies’ and ‘barriers and challenges’. mHealth applications appear to be a feasible intervention for family carers of people with dementia despite the limited available research and barriers for their development and implementation. Further research on mHealth applications with strong methodological rigour and more research on mHealth applications as an educational and supportive resource for carers of people with dementia are needed. © The Author(s) 2018

Working effectively with clients who self-injure using a solution focused approach

In Australia, the most common service used by self-injurers is the emergency department. Even though nurses are the key clinician available to such patients, nurses have usually received no special training to identify and address the needs of these clients. Building on the knowledge that emergency nurses feel ill-prepared, lack clear frameworks for practice and are thus vulnerable to subtle discourse tensions such as managing versus caring, and diagnosing versus understanding, an intervention was conducted and evaluated to enhance understandingand build proactive nursing skills. It was centred on a nursing philosophy known as solution focused nursing (SFN) – a model of care developed by author to orient care away from a deficit model. Deficit models tend to be reactive and centred on presenting problems. SFN is designed to move nurses’ perspective towards a proactive,strengths orientation, the aim of which is to assist them to instill hope in the client and motivate him/her to take the next steps needed for change and recovery. Nurses in two Australian emergency departments completed questionnaires before and after participating in SFN training focused on working with complex clients who self-harm. A comparison group of nurses also completed questionnaires. Results indicated some benefits of the intervention; there were improvements in participants’ perception that nursing is strengths oriented and in nurses’ satisfaction with their skills. Yet, there were no significant improvement in nurses’ reports of theirprofessional self-concept. There is merit in: broadening access to the intervention, so that more nurses in other contexts can learn a strengths model of care and apply it to their practice; and extending the research to measure sustained learning outcomes and improvements to practice

‘I can actually talk to them now’ : qualitative results of an educational intervention for emergency nurses caring for clients who self-injure

Aim and objectives. This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury.Background. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies.Design. A mixed method pretest–posttest group design was used.Methods. Nurses (n ¼ 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning.Results. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses’ capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented.Conclusions. The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting.Relevance to clinical practice. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care

Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nurses

Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses’ clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses’ ability to consider the patients’ psychosocial needs following the intervention. Thus this study has shown that interactive education not onlyimproves attitude and confidence but enlarges nurses’ rea- soning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change –acknowledgment and respect

Life stories and biography : a means of connecting family and staff to people with dementia

Aims. This article assesses the Family Biography Workshop (FBW) designed to support family and staff to co-construct the history of the person with dementia in residential care.Background. Family–staff conflict in residential dementia care is a major stressor that disturbs effective relationships and contributes to stress. Biographical research has been found to improve communication and promote family–staff relations. Few studies focus on family biography as an approach that promotes positive relations that translate into inclusive care interactions. Design. A qualitative descriptive approach was used to assess the influence of participation in the FBW and the impact of developing biographical knowledge on family–staff caregiver attitudes, perceptions of roles, conflict and the subsequent management of stress using participatory care practices. Methods. The FBW process involved seven family caregivers, seven staff and one researcher working collaboratively through a series of six weekly two-hour sessions, designed to help them build a biography of the person with dementia.Results. For family caregivers, reviving memories of their relatives as ‘whole’ persons enabled some to ‘stand outside’ and see beyond the disease-saturated context. For staff, ‘opening possibilities’ of ‘seeing’ the resident within the family context empowered them to engage in genuine participatory practices. Residents benefited from being connected as staffs’ ‘know how’ in initiating and engaging developed.Conclusion. Future research will examine the effects of the FBW on the dynamics of family–staff roles and relationships. This research aims to reduce stress from role inadequacy, task burden, poor relationships and improve staff attitudes towards family participation.Relevance to clinical practice. This study substantiated the FBW by revealing understanding of the meaning of biography work for family and relatives in care; providing effective support that empowered staff to confidently relate; and fostering engagement in inclusive care practices that encouraged residents’ initiatives

Supporting autonomy of nursing home residents with dementia in the informed consent process

Background: In studies involving people with dementia, researchers have historically defaulted to seeking consent from a proxy, the assumption being that people with dementia are unable to provide their own informed consent. This choice denies people with dementia a voice in the consent process, thus disregarding their autonomy and agency. Recently, other options for improving the consent process have been explored. Objective: This study aimed to determine whether nursing home residents with dementia could demonstrate an ability to provide their own informed consent as determined by the Evaluation to Sign Consent instrument. Methods: As part of a larger study on the quality of life of nursing home residents, the Evaluation to Sign Consent was administered to 392 people diagnosed with dementia. Data on demographic variables, such as gender and age, as well as level of cognitive impairment, were also collected. Results: Just over one-fifth (22%) of the residents with dementia were judged as having the capacity to provide their own informed consent to participate in this specific research project. Consistent with existing literature, capacity to consent was significantly, and negatively, associated with cognitive impairment. Conclusion: This study demonstrates that assuming all people diagnosed with dementia are unable to provide informed consent for research on the basis of cognitive test scores, or on clinical assessment alone, potentially denies them the autonomy to make a decision that they may be capable of making. Research involving people with mild-to-moderate dementia needs to consider evaluating whether potential participants have the capacity to provide their own consent