Consumers’ Perceptions of Nurses Using Recovery-focused Care to Reduce Aggression in All Acute Mental Health Including Forensic Mental Health Services

Recovery-focused care is now the preferred model of care that health professionals can utilize to support people with a mental illness to achieve their personal and clinical recovery. However, there remains a lack of practice guidelines and educational opportunities to support nurses to use recovery-focused care with consumers who may become aggressive. Objective: This paper reports the findings of research conducted with consumers to obtain their perception of how nurses can use recovery-focused care to reduce aggression in all acute mental health including forensic mental health services. Research Design and Methods: Thirty-one people diagnosed with a mental illness participated in this study. The constructivist grounded theory method guided data collection, coding, and analysis to generate categories that described the consumer perspective. Results: Five categories emerged, and these were: 1) see the person as an individual with a unique lived experience, 2) dialogue to explore the reason for the behaviour, 3) use positive communication to encourage self-management, 4) promote personal comfort to de-escalate the risk for aggression, and 5) travel alongside the person to co-produce strategies for reducing aggression. Conclusion: The findings may be tested in future research to translate recovery principles into acute mental health settings. They can also be incorporated into nursing education and professional development training to increase understanding of consumer perspective of recovery-focused care in all acute mental health including forensic mental health services

Development of a falls risk assessment and management tool for older adult mental health units

Fall prevention in Western Australian hospitals is monitored with a monthly generic falls assessment/management tool. Whilst this practice is suitable for bed ridden patients, it fails to capture the falls risk for older adult mental health patients who are predominantly ambulant and frequently confused. This paper describes the development of a specific mental health falls risk management tool (MHFRMT) for use in older adult mental health units. The development of this tool evolved from formative focus group research which successfully identified relevant predictors of risks for falls in this population. Corresponding management strategies were then developed for each criterion to the assessed levels of risk. Fall prevention management strategies included referral to physiotherapists for gait and balance testing, referral to occupational therapists for functional ability status and to podiatry for foot care. The new tool was initially piloted across three older adult mental health units in Western Australia with staff feedback resulting in some formatting revisions. The tool was then piloted at a fourth older adult mental unit with no further revisions required. The result was a new tool encompassing a weekly assessment rather monthly like the current generic falls form. Staff feedback was mainly about the format of the new tool rather than the content, suggesting that future studies need to focus on investigating the reliability and validity of the MHFRMT. Finally, although some staff were not happy with the increased work load associated with a weekly assessment, the weekly reporting highlighted two key issues in this patient group over three weeks: (1) fluctuating cognition and (2) mental state and behaviour changes. Additionally, the medication alert system identified the number of medications that increase falls risk and also indicated the risk alert level associated with each medication

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

Aims: To compare falls sustained in two groups of patients (one with mental disorders and the other neurocognitive disorders), in two acute inpatient older adult mental health services in Western Australia (WA). Background: Falls are the most common adverse event experienced during inpatient care. Older people with mental disorders and neurocognitive disorders constitute a high-risk group for accidental falls in hospitals. Methods: Data relating to 207 fall events from 2010-2011 reported in medical records and incident reports were collected. Individuals who sustained a fall were grouped as having a mental disorder (n=73) or neurocognitive disorder (n=134) according to their primary ICD10 diagnosis. Results: Significant differences in the factors that contributed to the fall between the two groups were highlighted. Falls sustained by those with a neurocognitive disorder were due to confusion and disorientation, and psychotropic medication effects. Their falls were more likely to be unwitnessed and injuries were generally less severe. Falls sustained by older adults with mental disorders were attributed to symptoms of their illness or medication side effects and tended to result in more severe injuries requiring medical treatment or further investigation. Conclusions: Older adults with neurocognitive disorders and behavioural and psychological symptoms associated to dementia have different falls risk factors related to their specific illness and cognitive functioning. There is a need for health professionals to receive training to assess, manage and provide appropriate interventions to reduce the specific falls risks in patients with both mental disorders and neurocognitive disorders

A systems approach to the perception of the integration of public health into pharmacy practice: A qualitative study

Background: Pharmacists, as health professionals, are ideally positioned to support the health and wellbeing of populations, in addition to their role of providing individualised health care. Objective: The aim of this study was to explore current opinion on the contribution of pharmacists to public health and how this may be enhanced to positively impact public health indicators. Methods: A total of 24 pharmacists from Australia, United Kingdom, Canada and the United States of America, and Australian public health professionals and consumers participated in semi-structured interviews between January and October 2021. Interpretive thematic analysis was applied with coding of transcripts using the constant comparison method. Themes were developed and named in accordance with Bronfenbrenner’s ecological theory of development. Results: Pharmacists contribute to public health and have important roles in health education and illness prevention services. Strong enablers in community pharmacy include trust by consumers and ease of accessibility to pharmacists. Pharmacists are viewed as leaders in communities and contribute to the health system broadly in areas such as medication policy and public health organisations. Participants suggested that pharmacist contributions to public health are often unrecognized by the pharmacy profession, health professionals and consumers, and could be developed to allow effective contributions. Strategies to improve pharmacist contributions included clarifying public health-related terminology, increased development of pharmacy roles and reform for community pharmacies to participate in health prevention and promotion services. Integration of public health in pharmacy education, professional development, and recognition of pharmacy roles across all system levels were also identified as important. Conclusions: The study indicated that pharmacists currently contribute to the improvement of public health. However, development strategies are required for this to be more effective in integrating public health approaches into their professional practice to be recognized for their public health-related roles

The C/C Genotype of the C957T Polymorphism of the Dopamine D2 Receptor is Associated with Schizophrenia

The T allele of the human dopamine D2 receptor (DRD2) gene C957T polymorphism is associated with reduced mRNA translation and stability. This results in decreased dopamine induced DRD2 upregulation and decreased in-vivo D2 dopamine binding. Conversely, the C allele of the C957T polymorphism is not associated with such changes in mRNA leading to increased DRD2 expression. PET and post-mortem binding studies show that schizophrenia is often associated with increased DRD2 availability. We report that on the basis of comparing the frequencies of the C/C and T/T genotypes of 153 patients with schizophrenia and 148 controls that schizophrenia is associated with the C/C genotype. The C957T shows a population attributable risk for schizophrenia of 24% and an attributable risk in those with schizophrenia of 42%. Increased expression of D2 receptors associated with the C allele is likely to be important in the underlying pathophysiology of at least some forms of schizophrenia. Enhanced understanding of schizophrenia afforded by this finding may lead to advances in treatment and prevention

Parents’ Perceptions of the Physical Health Outcomes of Young People Diagnosed with First Episode Psychosis

This study explores parents’ perceptions of their son/daughter’s physical health needs following a first episode psychosis diagnosis and commencement on antipsychotic medication. The research process was guided by grounded theory methodology and data were collected using semi-structure interviews with 16 parents. Four categories were identified. Participants described the importance, challenges and strategies for their son/daughter to maintain their physical health, and the need to improve young people’s health literacy, particularly in areas of physical health, diet and lifestyle. These findings will assist health professionals to provide parents with information to better support their son/daughter to maintain their physical health

What Accounts for the Factors of Psychopathology? An Investigation of the Neurocognitive Correlates of Internalising, Externalising, and the p-Factor

Neurocognitive deficits have been consistently associated with a wide range of psy-chopathology and are proposed to not only be a consequence of the development of psychopathology but also directly involved in its aetiology. However, there is no clear understanding of what neurocog-nitive processes are particularly important to mental health. In this paper, we explored the association between neurocognitive abilities and the factors derived from structural models of psychopathol-ogy. Four hundred participants from a representative community sample completed measures of symptomology and substance use, as well as 8 neurocognitive tasks. We found a correlated-factors model, with internalising and externalising as the higher-order factors, and a single-factor model with only the p-factor, to be good fits for the data. Tasks that measured the speed of processing were significantly associated with internalising, externalising, and the p-factor, and accounted for significant amounts of unique variance in the factors after accounting for the common variance of the other tasks. Tasks that measured working memory, shifting, and inhibition were not significantly associated with psychopathology factors. Our findings suggest that neurocognitive abilities may not be differentially associated with psychopathology factors, but that speed of processing is a common correlate of the factors. We emphasise the importance of examining neurocognitive abilities and psychopathology on the individual level

Nurse-led cognitive behavioural therapy for respiratory patients

Anxiety and depression are common comorbidities of chronic obstructive pulmonary disease and have a negative impact on patients’ physical functioning, use of healthcare resources and mortality. Risk factors for and rates of psychological difficulties are currently higher due to the coronavirus pandemic. A recent trial demonstrated the clinical effectiveness of a cognitive behavioural therapy intervention delivered by respiratory nurses, and surveys have shown they feel psychological support is an important part of their role. Barriers remain to patients receiving mental health support; however, this intervention could provide an important step towards improving access

Self-management in chronic lung disease: what is missing?

Self-management, as a strategy to support those living with chronic respiratory conditions such as asthma and COPD, has been widely advocated in guidelines and adopted in practice. However, there can be a disconnect between the goals of patients and healthcare professionals. Goals and barriers to self-management are often compounded by the complex social, emotional and medical needs of patients. People living with chronic respiratory conditions also often have symptoms of anxiety and depression, which can impact on self-management. Self-management therefore requires patients and healthcare professionals to work together and it is essential to involve patients when designing, implementing and evaluating self-management interventions.Patient preferences are clearly important and goal setting needs an individual, flexible and responsive approach from healthcare professionals, which aligns to a more personalised approach to management of treatable traits and the burden of disease. To achieve these goals, healthcare professionals need education to support patients in self-management and behaviour change. This approach should lead to shared decision-making and partnership working that puts the patient right at the centre of their care