Hospitality in mental health nursing

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Security guards in mental health settings: Starting the conversation

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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

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

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

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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

Multidisciplinary health professionals' assessments of risk: how are tools used to reach consensus about risk assessment and management?

Author accepted manuscript (Post-Print) made available in accordance with publisher copyright policy.Risk assessment and management are among the most important and complex tasks health professionals undertake in their practice to prevent harm to patients and ensure safe and effective treatment. The aim of this study was to examine how multidisciplinary team members use tools to assess and manage risk, through examination of how tools are used to gather, record and “score” risk information; and how this process impacts on the formulation of risk assessment and management plans, interaction with patients, and consensus with colleagues regarding patient care. Fourteen professionals completed an assessment for a hypothetical client using a risk assessment and management tool, and then discussed their assessment in semi-structured interviews. Professionals were in moderate agreement in their assessments of the client on the tool, and highlighted the complexity of their decision making. Clinical management decisions, such as the amelioration of particular risks, followed assessment of the patient in a consistent way. The tool was an important way to for clinicians to communicate their judgments to others and set plans to direct patient care. Implications for the use of clinical decision making tools and instruments in mental health care, and the need for a focus on multidisciplinary decision making, are highlighted

Understanding child mental health consultation from the perspective of primary health care professionals

Published version made available with permission from publisher. Version of record available here: im To explore the understanding of mental health consultation and its utilisation from the perspective of primary care workers working with children and young people who experience mental health issues. Background Recognition of mental health consultation is respected and advocated as a way forward to support those professionals who may not necessarily have the training or understanding of child mental health issues, yet come across them frequently as part of their daily practice. Little is known, however, about how primary care professionals understand or utilise mental health consultation. Design A qualitative research design informed by phenomenology. Methods: School nurses (n=6) were purposively sampled. Semi-structured interviews were undertaken, facilitated by the use of open-ended questions. All interviews were audio-recorded and transcribed, followed by vigorous thematic analysis. Results Five overarching themes were identified from the data. These included: communication; crisis identification; hindrances; resources; and expectations. Each main theme consisted of several sub-themes relating to issues of professional identity; blurring of professional boundaries; constraints such as time management and workload; and the participant’s own needs, including self-confidence and educational needs. Conclusions and implications for clinical practice When utilised, mental health consultation proved effective in supporting the participants to address the mental health needs of children and young people; however, there are several factors such as lack of resources, differing perceptions of mental health consultation and personal challenges that prevent full engagement. This research contributes to existing knowledge by advocating that all individuals participating in mental health consultation should be encouraged to embrace the practice and understand what it actually means within the context of their own discipline

Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia

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