Improving exchange with consumers within mental health organizations: Recognizing mental ill health experience as a ‘sneaky,special degree’

Stigmatizing views towards consumers may be held even by those working within mental health organizations. Contemporary mental health policies require organizations to work collaboratively with consumers in producing and delivering services. Using social exchange theory, which emphasises mutual exchange to maximise benefits in partnership, the current study explores the perspectives of those working within organizations that have some level of consumer leadership. Interviews were conducted with 14 participants from a range of mental health organizations. Data were transcribed, and analyzed using thematic analytic and discursive psychological techniques. Findings suggest stigma is still prevalent even in organizations that have consumers in leadership positions, and consumers are often perceived as less able to work in mental health organizations than non‐consumers. Several discourses challenged such a view – showing how consumers bring value to mental health organizations through their expertise in the mental health system, and their ability to provide safety and support to other consumers. Through a social exchange theory lens, the authors call for organizations to challenge stigma and promote the value that consumers can bring to maximize mutual benefits.     

The value of local registry data for describing cervical cancer management and outcomes over three decades in Australia

Registry data on invasive cervical cancers (n = 1,274) from four major hospitals (1984‐2012) were analysed to determine their value for informing local service delivery in Australia. The methodology comprised disease‐specific survival analyses using Kaplan‐Meier product‐limit estimates and Cox proportional hazards models and treatment analyses using logistic regression. Five‐ and 10‐year survivals were 72% and 68%, respectively, equating with relative survival estimates for Australia and the USA. Most common treatments were surgery and radiotherapy. Systemic therapies increased in recent years, generally with radiotherapy, but were less common for residents from less accessible areas. Surgery was more common for younger women and early‐stage disease, and radiotherapy for older women and regional and more advanced disease. The proportion of glandular cancers increased in‐step with national trends. Little evidence of variation in risk‐adjusted survival presented over time or by Local Health District. The study illustrates the value of local registry data for describing local treatment and outcomes. They show the lower use of systemic therapies among residents of less accessible areas which warrants further investigation. Risk‐adjusted treatment and outcomes did not vary by socio‐economic status, suggesting equity in service delivery. These data are important for local evaluation and were not available from other sources.     

Assessment of the elderly: it’s worth covering the risks

Background Comprehensive assessments provide an invaluable opportunity to identify those at risk of adverse health events, enabling timely access to appropriate health care. Aims This study aimed to evaluate the effectiveness of a comprehensive assessment tool, the Adult Patient Assessment Tool (APAT), particularly in relation to early identification of older people at risk of falls, pressure areas, cognitive impairment or delirium, or patients with mental illness or substance abuse. Methods Concurrent mixed methods including an initial retrospective medical record audit and focus groups were used. Results With the introduction of the APAT, assessment of falls risk and mental illness increased. The number of nursing actions relating to pressure areas and falls also increased, indicating a greater awareness of patients’ individual needs. Non-clinical information gathered through the APAT enabled a more holistic approach to patient care. Conclusion The use of electronic medical records would alleviate pressures on nurses’ time, providing an opportunity to store and retrieve comprehensive nursing assessment and benefit patient health care. Implications for nursing management Early assessment results in an increased number of nursing activities related to patient care. Further education relating to mental health and substance abuse screening and cognitive assessment may enhance the completion of these tools.     

Service to the poor: The foundations of community nursing in England, Ireland and New South Wales

This paper describes the foundations of community nursing in England, Ireland and New South Wales. It is guided by Foucault's work on power, discourse and knowledge, and argues that the common discourse of poverty coupled with the influence of socially advantaged women in the nineteenth century was the impetus for the development of community nursing in England, Ireland and New South Wales. Throughout the nineteenth century in Great Britain, economic and industrial development, coupled with an unprecedented growth in the population (particularly among the poor) inspired socially advantaged women to extend traditional gender-specific roles to address the needs of the poor. Protestant women in England advanced professional nursing as a career for women and in Ireland and New South Wales; Catholic women pioneered professional nursing, targeting the poor as the focus of their practice. These women used prevailing social conditions to enhance their life options within the limits prescribed by social norms.     

Health promotion in local churches in Victoria: an exploratory study

Church‐based health promotion has increasingly gained attention in strategies to address health disparities. In Australia, we have limited understanding of the role of local churches in health promotion and without this, how they might be involved in meaningful partnerships to tackle public health challenges. The objective of this qualitative study was to explore how churches are involved in health promotion in the state of Victoria. The research involved in‐depth interviews with ministers from 30 churches in urban and rural Victoria, and case studies with 10 of these churches to enable further exploration. These case studies, conducted in 2010, included interviews with church staff, focus groups with volunteers, participant observation and document analysis. Analysis was iterative, utilising open, axial and thematic coding. Three different expressions of church – traditional, new modern and emerging – were identified and found to differentiate the levels and types of health promotion activity. Case studies illustrate the different expressions of how church mission influences health promotion activity. The traditional churches were involved particularly in disease screening and health education activities with their own, predominantly older congregation members. The new modern churches tended to have the material and human resources to be harnessed in health promotion activities involving congregation members and others. Emerging churches, in contrast, engaged in broad health‐promoting activities, including disease prevention, lifestyle activities and socio‐ecological approaches at a community level. These research findings highlight the opportunities and challenges of engaging with local churches in health promotion efforts and public health programmes to address health inequities.