Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

The practice of locking acute ward doors in the UK to manage patient care has been reported with increasing frequency in a number of recent official documents; however, there is little research examining the practice. This study explores the perceptions and experiences of mental health nurses working on acute wards where the doors are locked for all or part of a shift. Audio-taped, semi-structured interviews were undertaken with 11 qualified mental health nurses and analysed using content analysis. Six broad categories were identified: policies and documentation, locking and unlocking the doors, communicating the decision, reasons for locking the doors, benefits and concerns. The findings suggest that there is a need for mental health nurses to reflect on the reasons for, and wider implications of locking ward doors before their wholesale implementation is considered in the UK.     

Computer-assisted therapy: harbinger of the 21st century?

Research findings suggest that computer-assisted therapy (CAT) has the potential to play a significant role in mental health care. Psychoeducation, cognitive-behavioral, and systematic desensitization strategies appear most amendable to CAT approaches. Potential advantages of CAT include an increased number of treatment options, low cost, privacy, consistency and individualization of care, and ease of data collection. Although CAT appears promising, clinician resistance and failure to adequately monitor clients may hamper its use. Moreover, precautions will need to be taken to insure that CAT programs have been well-designed and tested. Nurses should become involved in the development, testing, and implementation of CAT software.     

There is no health without mental health: Are we educating Australian nurses to care for the health consumer of the 21st century?

One in five Australians has a diagnosable mental illness and the impact of the illness on the individual, their family, and the community is significant. Since comprehensive nursing was introduced in the 1980s there have been repeated concerns raised regarding the preparedness of graduates from Australian undergraduate nursing programs to care for people who have a mental illness. In 2009, despite a recent comprehensive national review of the mental health/illness content in pre‐registration curricula, these concerns remain. The nursing profession must have a responsibility to the global community to ensure that registered nurses are educated to meet evolving health challenges and the needs of the health consumer in the 21^st Century. The purpose of this paper is to highlight the prevalence and impact of mental illness on health care outcomes in all settings and to challenge the profession to acknowledge that mental health nursing content must be a core area of all undergraduate curricula. A nationally coordinated response to address the long standing identified deficits in the educational preparation of comprehensive nurses is now a priority to ensure that nurses remain a major stakeholder group in the delivery of health care and key health informants and decision makers within the global health care arena.     

The development of mental health care pathways: friend or foe?

Greater emphasis is being placed on mental health services to be more responsive to clinical variation. Care pathways can standardize clinician response to established diagnostic groups such as schizophrenia. This article discusses care pathways using the findings of a research study carried out in London to explore the development and implementation of a care pathway. Respondents encountered many difficulties such as the principles behind individualized care and generic roles and responsibilities in preformulating their work into a care pathway sequence. This article concludes with areas for further application and research.     

Being and doing politics: an outdated model or 21st century reality?

Title. Being and doing politics: an outdated model or 21st century reality?. Aim. This paper presents a discussion of how critical social theory can be used as a tool for research, reflection and exploration of the political role of the nurse. Background. Sociological theory can be used to examine ideologies within nursing systems in order to contribute to the future development of the profession. The importance of critical social theory has been identified in the literature as being directly relevant to holism which is central to the nature of nursing. Data sources. Texts published in English were identified from 1990 to 2008 using the keywords critical social theory, community nursing, political advocacy, social justice, sociological theory, health inequalities, health democracy, equity and inequality. Discussion. Critical social theory can be used as a tool to highlight ethical ways to practise nursing. One reason for examination of the community nurse’s political role is a shift in focus from the individual as patient to communities experiencing health inequalities. Nursing needs to decide whether the profession will work at the political level, and where advocacy and citizenship are located within a community role. Conclusion. Nurse educators must prepare nurses for political participation, and nurse managers need to focus on national and local contexts in order to encourage policy analysis and community engagement within nursing practice. An understanding of critical social theory can aid decision‐making in relation to global and local policy, enable the nursing profession to respond to social injustice, and permit nurses to work with communities in the pursuit of community health.     

The user perspective: respected or rejected in mental health care?

The purpose of this study was to examine the extent to which patient views influence treatment planning by measuring the level of agreement between patients and health workers regarding patient needs as well as the impact of patient wishes on decision making when viewpoints conflict. Data on patient characteristics and needs were collected for a sample of 1080 patients within Norwegian mental health care using patient interviews and health worker ratings. Results of the assessment were then reviewed by multidisciplinary treatment teams responsible for making decisions regarding patient needs for services. On average, patients, health workers, and teams identified 4.3 (SD = 4.2), 9.3 (SD = 5.5), and 10.3 (SD = 5.7), respectively, of 40 possible needs per patient. In cases where patient and health workers disagreed on the presence of a need, the teams tended to concur with the health worker. Interestingly, health care workers and teams were far more inclined than their patients to identify needs related to professional monitoring and follow-up. Results may indicate that contemporary tenets in mental health care regarding user involvement and autonomy are not sufficiently emphasized in practice.     

Community nursing in the 21st century: who, where, what, how?

Change is a given in the health service, but the changes currently under way are particularly important in the opportunities they offer district nurses to expand and develop their roles. In this article, the director of the Queen's Nursing Institute, which pioneered the training and development of district nurses, examines what can be learned from the past and present, in an attempt to inform the future direction of district nursing.     

Re-engineering of health care: opportunity or threat for occupational therapists?

The health care system is responding to a paradigm shift from the industrial era to the knowledge society. The rapidly changing administrative structures of some hospitals and increasing numbers of proposals for new models of care are disconcerting for therapists who are used to working in traditional organizational structures and models of care. However, with a broader understanding of the shift that is occurring, it becomes apparent that this paradigm shift is pushing the system toward care practices that are more consistent with occupational therapy practices than those of the traditional medical model. This paper describes the factors influencing the direction of the paradigm shift, the major emerging models of care and organizational structures associated with the paradigm shift, and then discusses the issue of whether the paradigm shift presents a threat or a challenge to occupational therapists.     

Universities preparing health professionals for the 21st century: can something new come out of the traditional establishment?

To address clinical education in chronic disease management, the University of Alberta partnered with the local health authority to develop interprofessional team placements in diabetes chronic disease management. The objectives were to determine a meaningful and sustainable approach to interprofessional team placements. Pre-licensure students from medicine, nursing, nutrition and pharmacy participated in a project-based team experience designed to increase their discipline-specific knowledge of diabetes while enhancing their team process skills. Quantitative and qualitative research methods were used to evaluate project implementation and student outcomes. The majority of students reported learning "a great deal" about the roles of other health professionals and knowledge regarding the management of diabetes from the perspective of other health disciplines. However, several key learning outcomes were not fully accomplished; to enhance student's interprofessional team skills, increase their knowledge of interprofessional team functions and learn how to modify team function in a clinical setting. Creativity concerning relevant projects, varying settings, and differing models of service delivery should be encouraged, and flexibility within the project and process is essential for self-directed learning of student teams. New models of interprofessional clinical education, such as the chronic disease management model used in this study, have potential, if supported by the shift in health science programs culture.     

Cultural health care or child abuse? The Southeast Asian practice of cao gio

Although the immigration of Southeast Asians more than doubled over the past 20 years, much misunderstanding still persists regarding traditional, culture-bound health practices used by Vietnamese, Cambodian and Laotian families. The research presented in this paper explains one such traditional practice, that of cao gio. Cao gio, a dermabrasion therapy, is used extensively by many Southeast Asian women to treat a variety of illnesses. Health care providers do not appreciate this practice, however, to the extent that it is claimed to be a form of child abuse in some of the literature reviewed. A better understanding of the practice by those involved in the primary care of Southeast Asian families is not only necessary, but essential to avoid the mislabeling and misinterpretation of cultural, traditional health practices as child abuse. Lack of awareness of Southeast Asian cultural practices is quite significant, even though the United States experienced three major waves of Southeast Asian immigration during the past 20 years (Takeuchi, & Young, 1994). Over the past decade, the number of Southeast Asian immigrants and refugees to the United States has increased 108% or by more than 1 million individuals (Fong, & Mokuau, 1994; Frank-Stromborg, 1991; Ja, & Aoki, 1993; Tran, 1991; U.S. Census Bureau, 1998). Yet, despite this, Southeast Asian individuals are poorly understood, and the literature reveals little about what health, illness and treatment constitute for these different cultures (Boston, 1992; Buchwald, Panwala, & Hooton, 1992). The ethnic groups that comprise Southeast Asians, formerly known as the Indochinese, include individuals from Vietnam, Cambodia and Laos (Catanzaro, & Moser, 1982; Chung, & Kagawa-Singer, 1993). The majority of these individuals are refugees who fled their countries due to political persecution (Toole, & Waldman, 1993). This paper describes the findings of a phenomenological research study completed among 19 Southeast Asian women regarding beliefs about health and health practices. The women discussed the practice of cao gio (phonetically pronounced as gow yaw) and its importance, effectiveness and significance to their cultures. The discussion relates the study findings to the debate and issues surrounding child abuse, the consequences of misreporting, as well as the consequences of cultural ignorance in the provision of health care to those of different cultural practices and beliefs, particularly those of Southeast Asian ethnicity.