Children with Behavioral/Mental Health Disorders and School Mental Health Nurses in Australia

TOPIC: This review of the literature addresses Australian school mental health nursing is an emergent field of practice. PURPOSE: Children with behavioral/mental health disorders present challenges to schools, teachers, and their families. They can be disruptive in class, inappropriate with their peers, and perform poorly academically. Often this group of children do not respond to the school's usual strategies to support appropriate behavior. When children with behavioral/mental health disorders do not receive specialized support based on their problems and needs, their problems can escalate over time and in adolescence their behavior may become more challenging, with increased aggression, substance use, contact with the criminal justice system, and school failure with or without dropout. CONCLUSION: Mental health nurses, working as case managers, could be effective in the support of children with behavioral/mental health disorders in schools. Mental health nurses, because of their professional education and clinical practice, work not only with the individual child but also with family members. They are well prepared to case manage in schools and support individual teachers and health and welfare services in their management of their clients with behavioral/mental health disorders.     

住院慢性精神病患者开展物业服务队模式研究

目的：探讨住院慢性精神病患者开展院内物业服务队的康复模式,寻找恢复期慢性精神病患者职业康复的新途径。方法：101例恢复期慢性精神病患者分为物业组50例和对照组51例,均用精神病药物维持治疗。物业组开展理发、洗衣、商店、保洁及维修等类似物业的岗位训练,采用全开放和半开放管理方法。于入组前、治疗后3、6、12个月末时对2组患者进行阳性和阴性症状量表（PANSS）和住院精神病患者康复疗效评定量表（IPROS）评定。结果：物业组在治疗3个月末时,PANSS中阴性症状及精神病理单因子评分均明显低于对照组;6及12个月末时下降更显著,PANSS总分也出现明显下降（P〈0.05,0.01）。IPROS中生活能力及关心和兴趣单因子评分在3个月末、工疗情况及社会能力评分在6个月末时均明显低于对照组（P〈0.05,0.01）。上岗后患者出勤率〉92%,劳动态度和劳动质量均随时间的推移而提高。结论：院内物业服务队可成为恢复期慢性精神病患者新的职业康复途径,但让其回归社会还需要多渠道合作。     

全程专业化个案管理模式在乳腺癌患者护理中的作用

目的探索乳腺癌患者全程专业化个案管理模式的实施方法及效果,为有效利用医疗资源、促进专科护理发展提供参考。方法2011年1—6月,在完善宣教材料和准备工作的基础上,由接受过专业培训的乳腺专科护士对在瑞金医院住院的乳腺癌患者379例,实施为期6个月的个案化管理,内容涉及为患者及家属提供专业的信息、心理支持、直接护理以及多学科间协调等高级护理服务。结果2011年1—6月共接收乳腺癌个案379例,完成专业咨询近800例次,接受电话咨询4186min,短信咨询1236次,网络联系52例次。与2010年同期相比,乳腺癌患者平均住院天数减少27％,选择保乳及重建手术的患者数、PICC置管人数、门诊换药例次等指标均明显增加,患者的满意率从95．6％提高至97．8％。结论乳腺癌患者的个案管理模式是适应肿瘤多学科综合治疗的护理工作模式,能充分体现对乳腺癌患者的全程、个体化和专业化的护理内涵。     

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes,practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post‐registration physical health‐care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post‐registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.     

Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia

People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse‐based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health‐care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health‐care settings in Australia.     

Nurse Practitioner Management of Uninsured,Rural Adults With Chronic Illness

Nurse practitioners are an accepted part of the primary care provider pool in the United States. Their positive effect on process measures and health services use has been shown to be at least equal to physicians, but the effects on specific patient outcomes among specific patient populations are still unclear. The purpose of this cohort study was to evaluate the effect of nurse practitioner management of rural, uninsured patients with chronic illnesses in regard to blood pressure, lipid, and blood sugar control. Health services use was also examined. Significant improvements in physiologic measures and health services use over time were documented.     

Identifying Older Adults With Serious Illness: Transitioning From ICD-9 to ICD-10

ContextIdentifying the seriously ill population is integral to improving the value of health care. Efforts to identify this population using existing data are anchored to a list of severe medical conditions (SMCs) using diagnostic codes. Published approaches have used International Classification of Diseases, Ninth Revision (ICD-9) codes, which has since been replaced by ICD-10.ObjectivesWe translated SMCs from ICD-9 to ICD-10 using a refined code list. We aimed to test the hypothesis that people identified by ICD-9 or ICD-10 codes would have similar Medicare costs, health care utilization, and mortality.MethodsUsing data from the National Health and Aging Trends Study linked to Medicare claims, we compared samples from periods using ICD-9 (2014) and ICD-10 (2016). We included participants with six-month fee-for-service Medicare data before their interview date who had an SMC identified within that period. We compared the groups' demographic, functional, and medical characteristics and followed up them for six months to compare outcomes.ResultsAmong subjects in the 2016 (ICD-10) sample, 19.9% were hospitalized, 24.6% used the emergency department, 7.2% died, and average Medicare spending totaled $9902.04 over six months of follow-up. We observed no significant differences between the 2014 and 2016 samples (P > 0.05); both samples represent 18% of Medicare fee-for-service beneficiaries.ConclusionIdentifying the seriously ill population using currently available data requires using ICD-10 to define SMCs. Routine measurement of function, quality of life, and caregiver strain will further enhance the identification process and efficiently target palliative care services and appropriate quality measures.     

Liability Risks for Psychiatric Mental Health Nurse Practitioners

Psychiatric/mental health nurse practitioners play a key role in providing care to patients with mental illness. This role is increasing caused in part by a nationwide shortage of psychiatrists, as well as a lack of primary care physicians trained in basic psychiatric services. However, with increased clinical responsibilities come important legal considerations. Psychiatric nurse practitioners should become familiar with legal issues surrounding this practice area in order to ensure best practices for patients and to avoid malpractice litigation and licensing issues.     

The Effectiveness of the Mental Health Nursing Inverventions in a General Hospital

The purpose of the study was to investigate: a) how mental health nursing interventions were provided to general hospital patients, who during their hospitalization presented psychological/pyschiatric problems and b) how the patients actually evaluate the effectiveness of the care given to them. We interviewed 95 medical-surgical patients, who were referred to the psychiatric consultation-liaison service of a general hospital. During the interview, a nursing evaluation of the patients' psychological problems took place, followed by appropriate mental health nursing interventions which were taken from the NOSIE scale and the standards of the Psychiatric Mental Health Nursing Practice. Anxiety was the most common problem 41.1% in the referrals. The comparison of the mean value of the patients' problems before and those after the mental health nursing interventions, showed statistically significant reduction of the problems. Also, the comparison of the mean value in the fourth assessment of the patients' problems with the mean value of the patients' opinion, showed an achievement in facilitating the verbal expression and comforting the physical and psychological symptoms to a point statistically significant.     

Effectiveness of a community‐based nurse‐led lifestyle‐modification intervention for people with serious mental illness and metabolic syndrome

The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24‐week randomized trial evaluated the effects of a community‐based nurse‐led lifestyle‐modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health‐related quality of life and physical activity. Sixty‐one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse‐led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants’ cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health‐related quality of life, and physical activity.     

The Impact of Mental Health Nursing Module,Clinical Practice and an Anti-Stigma Program on Nursing Students' Attitudes toward Mental Illness: A Quasi-Experimental Study

BackgroundIt is important to support nursing students during their education in developing positive attitudes toward people with mental illness.ObjectivesTo examine the impact of mental health nursing module, clinical practice, and anti-stigma program on the attitudes of nursing students toward mental illness.DesignThe study was a single group pretest and posttest quasi-experimental design.SettingsThis study was conducted in a nursing school in the west of Turkey.ParticipantsThe sample of the study consisted of 64 undergraduate nursing students.MethodsThe data were collected through the Beliefs Toward Mental Illness Scale and Social Distance Scale.ResultsThe mean scores of the dangerousness subscale significantly decreased after mental health nursing module, clinical practice and anti-stigma program. The results revealed significant positive differences in the mean scores of the social distance scale after the theory, clinical practice, and anti-stigma program were completed.ConclusionsThe mental health nursing curriculum should be focused on replacing stereotypes with accurate information. Anti-stigma programs should be included in standard mental health nursing courses.     

精神科护理学教学对护理本科生就精神疾病患者歧视态度影响的研究

目的了解护理本科生在接受精神科护理学课程教学前后对精神疾病患者歧视态度的状况,为精神科护理学教学方式的改进与完善提供依据。方法 2012年3月-6月运用歧视精神疾病患者评估量表对某高校接受精神科护理学课程学习的护理本科生进行问卷调查,比较课程学习前后学生对精神疾病患者歧视态度的变化及原因。结果教学前后,学生在隔离因子及能力因子方面对精神疾病患者的歧视态度改变不大,前后相比差异无统计学意义（P〉0.05）,在危险因子方面的则有所改观,对精神疾病患者的危险趋向评价降低,前后比较差异有统计学意义（P〈0.05）。结论精神科护理教学应当打破常规模式,增加学生与患者的接触,以减轻其对精神疾病患者的歧视。     

Affiliate Stigma Among Caregivers of People with Intellectual Disability or Mental Illness

Background Affiliate stigma refers to the extent of self‐stigmatization among associates of the targeted minorities. Given previous studies on caregiver stigma were mostly qualitative in nature, a conceptually based, unified, quantitative instrument to measure affiliate stigma is still lacking. Materials and Methods Two hundred and ten caregivers of people with intellectual disability (CPID) and 108 caregivers of people with mental illness (CPMI) were recruited to validate the 22‐item Affiliate Stigma Scale with caregiving stress, subjective burden and positive perceptions. Results Exploratory factor analysis suggested that the scale was unidimensional, with excellent internal consistencies for both CPID and CPMI. It showed good predictive validity on subjective burden, after the extent of caregiving involvement and caregiving stress were controlled for. Conclusion Implications on psychoeducation and stigma reduction were discussed. The newly developed scale provided a quantitative instrument with which affiliate stigma can be compared across different conditions.     

某校护理本科生对精神病患者受贬低/歧视的感知状况调查

目的 了解护理本科生对精神病患者受贬低、歧视的感知状况。方法 运用贬低-歧视感知量表对北京某医科大学护理本科1～4年级的277名学生进行对精神病患者受贬低、歧视情况感知的调查。结果 144名护理本科生认同人们会看不起精神病患者,216名护生认同大部分人不愿意和患过精神病的人做好朋友,194名护生认同很少有人会雇用精神病患者为他们服务,158名护生认同人们对待精神病患者和普通人是不同的。不同年级、有无精神科临床见习经历和有无学习过精神科护理专业课程的护理本科生,其对精神病患者贬低/歧视态度的感知状况不同（P〈0.001）。结论 具备一定精神科专业知识、与精神病患者有过直接接触的护理本科生对患者存在消极认识,因此有必要对此开展相应的干预,针对性的反歧视项目值得探讨和研究。