What are the experiences of Emergency Department nurses in caring for clients with a mental illness in the Emergency Department?

Background

Australian Emergency Departments are experiencing increased numbers of clients with a mental illness and Emergency Departments are becoming increasingly utilised as the first point of contact and portal into the mental health care system. Therefore nurses working within the Emergency Departments find themselves having to care for clients with a mental illness as part of their daily work. The aim of this study was to gain an understanding of the experiences of Emergency Department nurses caring for clients with a mental illness in the Emergency Department.

Methods

An interpretive phenomenological study was undertaken using semi structured interviews to enable the lived experiences of Emergency Department nurses to be discovered and articulated. Six Registered Nurses working within an Emergency Department were interviewed, and these participants were asked to tell the story of their experiences in their own words.

Results

Results are based on data collected from six participant interviews. Three major themes emerged related to caring for clients with a mental illness in the Emergency Department: (i) Time as a causative factor, (ii) environment and the influence of surroundings and (iii) understanding the client's personal journey.

Conclusions

Data obtained from participants in this study confirm what has been reported in the literature, that is, that there has been an increase in presentations of clients with a mental illness to the Emergency Department, and the results of this study highlight that time constraints specific to the Emergency Department impact both the client with the mental illness and the Emergency Department nurse caring for these clients. In addition, narratives from Emergency Department nurses purport that the environment within the Emergency Department is not conducive to the provision of optimal care to this client group who have unique care needs and require a specialised management focus. Furthermore, the participants expressed that they had difficulty conceptualising the role of the Emergency Department in the client's personal journey. The concept of recovery in mental health comes into conflict with the culture within the Emergency Department that views recovery as a restoration or return to health rather than the unique journey of the client living with a mental illness.     

Effectiveness of psychiatric mental health nurses: can we save the core of the profession in an economically constrained world?

Mental and behavioral disorders are common, affecting more than 25% of all people at some time during their lives. Mental disorders and their burden on society have increased dramatically. This scenario can be an opportunity for psychiatric/mental health (P/MH) nurses. Some literature shows gratifying experiences of care delivered by P/MH nurses, but that can also be a threat if, in a world with an economic dominance such as ours, we are not able to clarify our identity and effectiveness. One implication of this is that we need to identify the contribution of nursing to patient outcomes through nurses' independent, dependent, and interdependent roles. The authors stressed the importance of improving our accountability and fighting against invisibility to policy makers to prioritize the nurse-client relationship and identify our effectiveness. Based on some literature, the authors argue that clinical nurse specialists are in a better position than nurse practitioners to produce nursing-sensitive outcomes.     

What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

Objectives

The purpose of this review was to determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia. The aim was to identify approaches that could be delivered within community practice to reduce burden and increase knowledge, mental health and coping.

Questions addressed

What effect did support have on carer burden and other needs? What were the key elements of effective support? What effective supports could mental health nurses deliver within practice?

Design

This review covers the international scientific literature published between 1980 and 2008.

Data sources

Searches were made of electronic databases relevant to nursing. All papers, published in English, were assessed. Hand searches of review papers and references were also carried out. Sixty-eight studies were included.

Study appraisal and synthesis

Only comparative studies providing a quantitative assessment of carer outcomes were included. Findings were synthesised in narrative format and grouped by intervention type.

Results

Of the 68 emerging studies, 12 (18%) directly included nurses in delivering the intervention and 16 (24%) included nurses as part of a multidisciplinary team. There is fairly robust evidence that education improves carer knowledge of schizophrenia. There is, however, little evidence that it addresses more substantive areas such as burden, coping or mental health. Supportive family education moves beyond information giving by developing coping. As might be expected these approaches can reduce burden. More intensive programmes such as behavioural family therapy aim to address stressful relationships which commonly occur in families of people diagnosed with schizophrenia. These programmes are particularly effective in reducing burden and can also improve mental health. Community support such as intensive outreach is also effective in reducing burden. Finally, there is some evidence that mutual support groups reduce burden and improve coping.

Conclusions

Research on effective support for carers of people diagnosed with schizophrenia is emerging. Although findings were mixed, there was some evidence supporting a range of approaches that mental health nurses could offer to carers. There is, however, still a need for pragmatic studies to determine the extent that these approaches can be delivered within nursing practice.     

Can nurses, working in the emergency department, independently clear cervical spines?: a review of the literature

The prompt clearance of a patient's cervical spine is extremely beneficial both to the patients and the department however correct guidelines and education must be established before this can be undertaken safely. This paper examines whether nurses given the appropriate training and education using appropriate diagnostic and clinical criteria can safely, effectively clear cervical spines without consulting a medical practitioner. The paper explores the use of the Nexus Guidelines [J.R. Hoffman, W.R. Mower, A.B. Wolfson, New England Journal of Medicine 343 (2) (2000) 94-99] as a clinical prediction tool and presents evidence for its use.     

Which resources moderate the effects of demanding work schedules on nurses working in residential elder care? A longitudinal study

BackgroundShiftwork is a major job demand for nurses and has been related to various negative consequences. Research suggests that personal and job resources moderate the impact of work schedules on stress, health and well-being.ObjectivesThis longitudinal study examined whether the interactions of personal and job resources with work schedule demands predicted work engagement and emotional exhaustion in nursing.DesignThis longitudinal study included two waves of data collection with a one year follow-up using self-report questionnaires among 247 nurses working shifts or irregular working hours in residential care for the elderly in the Netherlands.MethodsModerated structural equation modelling was conducted to examine the interactions between personal and job resources and work schedule demands. Two work schedule demands were assessed: type of work schedule (demanding vs. less demanding) and average weekly working hours. Two personal resources, active coping and healthy lifestyle, and two job resources, work schedule control and the work schedule fit with nurses’ private life, were assessed.ResultsResults showed that the work schedule fit with nurses’ private life buffered the relationship between work schedule demands and emotional exhaustion one year later. Furthermore, the work schedule fit with nurses’ private life increased work engagement one year later when work schedule demands were high. Work schedule control strengthened the positive relationship between work schedule demands and emotional exhaustion one year later. The personal resources, active coping and healthy lifestyle were no moderators in this model.ConclusionNurses suffer less from decreasing work engagement and emotional exhaustion due to work schedule demands when their work schedules fit with their private lives. Work schedule control did not buffer, but strengthened the positive relationship between weekly working hours and emotional exhaustion one year later. Job resources appeared to be more important for nurses’ well-being than personal resources. These findings highlight the importance of the fit of a work schedule with nurse's private life, if the work schedule is demanding.     

Does sex influence the allocation of life support level by dispatchers in acute chest pain?

Aim

The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL.

Patients

All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study.

Methods

Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL.

Results

The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level.

Conclusion

This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.     

An extra pair of hands? A case study of the introduction of support workers in community mental health teams for older adults

Background Despite the expanding deployment of support workers in mental health services, little evidence exists on what managers and professional practitioners should expect of such staff in community settings. Aims This case study evaluated the introduction of support workers in community mental health teams for older adults. Method A multiple method design engaged support workers and professional colleagues in individual interviews, a focus group and a work satisfaction survey. Results While the new resource boosted service provision, disparity between the intended role and the assumptions of professional practitioners caused confusion and dissatisfaction. Conclusions The study highlights the need for managers to ensure role clarity when non‐professional workers are introduced into multidisciplinary community teams. Implications for nursing management Promoting diversity of skills in the mental health workforce is a progressive move in tuning services to the heterogenous needs of clients in the community. However, introducing unqualified workers into multi‐disciplinary teams necessitates clear guidance to prevent their activity being confined within existing professional models. Support workers offer much potential in innovative service delivery.     

Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support?

BACKGROUND: Healthcare professionals have a duty to maintain basic life support (BLS) skills. This study aims to evaluate medical students’ factual knowledge of BLS and the training they receive. METHODS: A cross-sectional, closed-response questionnaire was distributed to the first- and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent’s previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions (MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identified answer to the 5 MCQ’s. RESULTS: A total of 3,732 complete responses were received from 21 medical schools. Eighty percent (n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a significant difference (P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ’s compared to the first-year students except in identifying the correct depth of compressions required during CPR (P=0.095). Overall 10.3% (95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ’s on BLS: 9% of the first-year students (n=194) and 12% of the fourth-year students (n=190). On an institutional level the proportion of students answering all MCQ’s correctly ranged from 2% to 54% at different universities. Eighty-one percent of students (n=3,031) wished for more BLS training in their curriculum. CONCLUSION: Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.     

Can models of post‐traumatic stress disorder contribute to the application of cognitive therapy by nurse therapists when dealing with individuals affected by the Omagh bombing? An overview

As mental health professionals practising in an evolving multidisciplinary trauma and recovery team in Omagh, Northern Ireland, the by now infamous Omagh bombing of 15 August 1998 brought abruptly to attention the potential for adverse psychological consequences resulting from exposure to such trauma. As nurse therapists, this event provoked interest in the entity of post-traumatic stress disorder (PTSD) as being one of the possible negative psychological consequences, and the relevance and application of cognitive theory and practice in its treatment. Whilst recognizing that there is no single cognitive theory or model of anxiety disorder, this paper focuses on the approach of Beck and allied approaches when referring to cognitive theory and practice. It is intended to proffer a broad overview of areas the authors consider relevant in order to develop an appreciation of the entity of PTSD, and its evolution, having given a synopsis of the event that provoked interest. Finally, acknowledgement and a brief explication of some of the theoretical models of PTSD to date will be made, and the relevance and application of cognitive theory and principals in the treatment of the disorder will be considered.     

Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health?

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a ‘common sense’ blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.     

Does additional support by nurses enhance the effect of a brief smoking cessation intervention in people with moderate to severe chronic obstructive pulmonary disease? A randomised controlled trial

BACKGROUND: Smoking cessation is the primary disease modifying intervention for chronic obstructive pulmonary disease (COPD). SETTING: A Regional Respiratory Centre (RRC) out-patient department in Northern Ireland. METHODS: A randomised controlled trial (RCT) evaluated the effectiveness of brief advice alone or accompanied by individual nurse support or group support facilitated by nurses. Smoking status was biochemically validated and stage of change, nicotine addiction and dyspnoea were recorded at 2, 3, 6, 9 and 12 months. PARTICIPANTS: Ninety-one cigarette smokers with COPD were enrolled in the study (mean age 61 years, 47 female). RESULTS: After 12 months cessation rates were not significantly different between groups (p=0.7), but all groups had a significant reduction in their nicotine addiction (p=0.03-0.006). No changes in subjects' motivation or dyspnoea were detected over the 12 months. CONCLUSION: Patients with COPD were unable to stop smoking regardless of the type of support they received. Harm reduction may be a more appropriate goal than complete cessation for intractable smokers and nurses must evaluate their role in this arena.     

Change in perspective. One's profession from the viewpoint of others: how do nurses feel they are being perceived by physicians in professional interactions?

Collaboration between nursing personnel and physicians (and vice versa) on a medical ward is a fragile issue. There seems to be a need to rebuild this collaboration whenever there is a change of staff on the ward. This act can consume valuable resources and is basically influenced by the image of nursing personnel, and physicians among the other profession, respectively. This article presents the findings based on 18 interviews with physicians (eleven males/seven females), and 25 interviews with nursing personnel (five males/20 females) from two units of internal medicine of two confessional academic hospitals each with ca. 350 beds in a big city in Northern Germany. Both occupational groups experienced the reflection of their own professional image in a different way. Physicians seemed to be rather ignorant where their image among the nursing staff is concerned. In their answers they talked about qualifications of nurses in general and did not reflect upon their own image among nursing personnel. Nursing personnel often expected a social and a professional feedback from the physicians in spite of the fact that physicians are not experts in nursing. This may be due to the lack of a professional (not organizational) hierarchical context for the nursing personnel. The deficit of an own organizational structure of supervision, incentives and disincentives weakens the position of nurses in the context of a hospital.     

Meeting the needs? Perceived support of a nurse‐led lifestyle programme for young adults with mental illness in a primary health‐care setting

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle‐related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse‐led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse‐led programme provides health information‐management strategies that could easily be integrated in a primary health‐care setting.     

Comparing the frequency of physical examination techniques performed by associate and baccalaureate degree prepared nurses in clinical practice: does education make a difference?

Rapid changes in health care have underscored the need for reform in health professions education, including nursing education. One of many problems cited in the nursing and other health sciences education literature is overcrowded curricula; therefore, an evaluation of content is necessary. The purpose of this study was to determine whether differences exist in the frequency that physical examination techniques are performed by associate and baccalaureate degree prepared nurses. Participants completed a survey on performance of various physical examination techniques. A Mann-Whitney test showed no differences between the two groups in terms of frequency of techniques performed. A small negative correlation was found between frequency and years of experience with the nutrition assessment category. A comparison of physical examination content covered in baccalaureate and associate degree nursing programs is needed to further understand these findings.