Cost-Effective Prevention of Coronary Heart Disease

Healthcare designed to prevent future illness and minimize progression of current illness is a powerful means to improve quality of life, minimize mortality, and decrease health care costs. Coronary heart disease (CHD) is the #1 killer of both men and women in the United States. Prevention of CHD involves early identification and management of risk factors through assessment and treatment. The goal in CHD prevention is to produce the largest relative risk reduction, the smallest number needed to treat, and the lowest cost per quality-adjusted life year saved. Evidence-based treatment strategies have been shown to cost-effectively minimize CHD risk and reduce morbidity and mortality. Approaches that encompass the lifespan, solidify assessment and treatment strategies in the primary care setting, and reach into the workplace, schools, churches, and homes to make small changes in risk factors across an entire population are important areas for improving CHD preventive care. Public health policies are also necessary to support implementation of preventive programs.     

Towards a healthier lifestyle for staff of a psychiatric hospital: description of a pilot programme

Various lifestyle factors contribute to morbidity and mortality. Health promotion programs have the potential to increase awareness about, and possibly modify, some of these factors. In the workplace, these programs can be accessed by large groups of people. A healthy lifestyles programme was piloted for non-clinical staff in Central Sydney Area Mental Health Service, Australia. The aim of the programme was to provide non-clinical staff working in a mental health setting with education and information on a range of health conditions and topics. A needs analysis survey, along with formal and informal liaison and discussion, informed the programme's development and implementation. A total of 28 sessions were held; attendance ranged from 1 to 51 with a mean of 13.57 and a median of 12.5. Feedback regarding the programme has generally been positive. This pilot demonstrates that nurses, with their colleagues from other disciplines, are well positioned to deliver health promotion and education initiatives that may contribute to increasing awareness, and possibly modification, of lifestyle factors.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

HIV prevention for people with serious mental illness: a survey of mental health workers’ attitudes,knowledge and practice

Aim. The aim of this survey was to investigate the attitudes, knowledge and reported practice (capabilities) of mental health workers concerning humanimmunodeficiency virus (HIV) and other sexually transmitted diseases in people with serious mental illness. Background. People with serious mental illness are at increased risk of HIV and other sexually transmitted infections. Mental health workers have a key role to play in promoting sexual health in this population, but it is unclear how they perceive their role in this work and whether they have the capabilities to deliver sexual health promotion. Design. Cross sectional survey. Methods. A questionnaire was devised and distributed to 650 mental health workers working in a London (UK) NHS mental health service. Results. A response rate of 44% was achieved. Overall, workers reported positive attitudes to sexual health promotion and were knowledgeable about risk behaviours and risk factors for HIV infection. Adherence to glove wearing was good. However, participants’ knowledge about HIV/AIDS in people with schizophrenia was poor and most reported they were not engaged in sexual health promotion activities with people with serious mental illness. Glove wearing was predicted by those who had drug and alcohol training and clinical experience and knowledge of risk factors was predicted by previous health promotion training. No other demographic factors predicted any of the other subscales. Conclusion. Mental health workers require training to provide skills for health promotion regarding sexual health and HIV in people with serious mental health problems. In addition, there needs to be more research on risk behaviours. Relevance to clinical practice. The development of effective interventions to reduce this behaviour.     

Workplace health promotion programs. An overview

The development of workplace health promotion programs is a popular trend in corporate America. The workplace is considered to have great potential for health promotion and education because workers spend more than 30% of their waking hours at work. Corporate managers are attracted by the broad claims of benefits made for workplace health promotion programs, which include improving employees' health and fitness; decreasing medical and disability costs; reducing absenteeism; improving job satisfaction; increasing productivity; and enhancing the corporate image. Although these claims are not proven through scientific research, current evidence suggests the workplace health promotion programs can have a positive impact on employees. The trend of increasing numbers of corporations establishing health promotion programs should continue in the future.     

Interwoven histories: Mental health nurses with experience of mental illness,qualitative findings from a mixed methods study

The effects of mental health nurses’ own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses’ lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six‐phase approach. The analysis revealed the broad context of nurses’ experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses’ lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses’ mental illness could be much broader than the effect of workplace stress.     

Mental health issues within the general health care system: the challenge for nursing education in Australia

The mental health content of undergraduate nursing programs has consistently been identified as inadequate in preparing graduate nurses with the knowledge and skills for, and interest in, a career in mental health nursing. Since the introduction of generic nursing education, undergraduate programs have become primarily focused on the development of generalist skills, with specialisation occurring at postgraduate level. The integration of mental health services within the broader health care system in Australia has led to a significant increase in the prevalence of mental health problems within the general health care setting. The relevant literature suggests that nurses are not well prepared to meet the mental health care needs of this population. The aim of this paper is to briefly outline the incidence of mental health problems within the general health care system, the implications for nursing, and the potential role which nursing could play in recognising, and providing appropriate care for the treatment of mental health problems. The implications for nursing education, and the need for mental health nursing skills to be considered essential for all nurses will be discussed.     

To your health: implementation of a wellness program for treatment staff and persons with mental illness

Persons with mental illness often have poor access to both health promotion and primary care services. Consequently, they are at greater risk for earlier mortality, and comorbid health problems that ultimately impact their community rehabilitation. The "To Your Health" program is a health promotion program, based on the states of change model that was implemented as part of a clubhouse rehabilitation program. The program used personal wellness profiles, health assessments, and personal goal setting to assess the relative wellness of clients and staff in order to increase their awareness of health-promoting behaviors. Additionally opportunities were provided to engage individuals in making changes through participation in activities that provided opportunities to try out new behaviors and to set goals that integrated changes into their lives. The initial findings are reported along with the rationale for the involvement of clients and staff, and the role of health promotion in community rehabilitation of persons with mental illness.     

Incentivizing healthy lifestyle behaviors to reduce cardiovascular risk in people with serious mental illness: An equipoise randomized controlled trial of the wellness incentives program

BackgroundMedicaid recipients with serious mental illness die 25–30 years earlier than people in the general population due to health conditions that are modifiable through lifestyle changes. Cardiovascular diseases from excess weight, smoking, and sedentary lifestyle contribute substantially to this life expectancy disparity. The current study evaluated the impact of incentives on participation in weight management programming (for overweight and obese adults) and smoking cessation treatment (for regular smokers).MethodsParticipants were Medicaid recipients with disabling mental illness receiving services at any one of 10 community mental health centers across New Hampshire. Using an equipoise stratified randomized design, n = 1348 were enrolled and assigned to one of four weight management programs (Healthy Choices Healthy Changes: HCHC) and n = 661 were enrolled and assigned to one of three smoking cessation interventions (Breathe Well Live Well: BWLW). Following assignment to an intervention, participants were randomized to receive financial incentives (to attend weight management programs, or to achieve abstinence from smoking) or not. Data were collected at baseline and every 3 months for 12 months.DiscussionNew Hampshire's HCHC and BWLW programs were designed to address serious and preventable health disparities by providing incentivized health promotion programs to overweight/obese and/or tobacco-smoking Medicaid beneficiaries with mental illness. This study was an unprecedented opportunity to evaluate an innovative statewide implementation of incentivized health promotion targeting the most at-risk and costly beneficiaries. If proven effective, this program has the potential to serve as a national model for widespread implementation.     

Psychiatric/Mental health nursing education in Victoria, Australia: barriers to specialization

The introduction of undergraduate comprehensive nursing education in Victoria, Australia, during the 1990s has resulted in significant changes in undergraduate preparation for psychiatric/mental health nursing. Comprehensive programs became charged with the responsibility of preparing graduates to provide care for people experiencing a mental illness across a broad range of health-care settings, as well as providing a pathway for graduates with an interest in specialist practice in this field. The aim of this article is to clearly articulate the issues associated with psychiatric/mental health nursing education at the undergraduate level, including prevalence of mental illness, the inadequacy of psychiatric/mental health nursing theory and practice at undergraduate level, the negative attitudes of students toward this field of practice, and the subsequent failure of nursing education and practice initiatives to provide a clear mechanism for specialization in this important area of nursing practice. Throughout the article, the distinction between generalist and specialist preparation is argued and accompanied by a call for nursing education to recognize and address the issues associated with both domains.     

Identifying health and safety risks for childcare workers.

Childcare workers are exposed to several health and safety risks in their work environment, the most common being infectious diseases, musculoskeletal injuries, accidents, and occupational stress. Pregnant childcare workers have an additional risk of potential harm to the fetus. Occupational health nurses can work collaboratively with childcare workers to reduce these risks and provide workplace health promotion programs. This article explores the occupational health and safety issues for childcare workers and suggests health promotion strategies that could be implemented by occupational health nurses working in this arena.     

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the ‘cardiometabolic mental health nurse’ is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness.     

Psychiatric nurses and undergraduate nursing students' perceptions of preceptorship in the mental health setting

The importance of clinical education for nursing is widely acknowledged and considerable effort has been invested into identifying the most effective models. Psychiatric nursing has the additional imperative of increasing recruitment into the field. While clinical experience has been found to influence nursing students' attitudes towards psychiatric nursing and people experiencing a mental illness, little attention has been paid towards the factors that influence these outcomes. This study addresses the question, what is the experience of preceptorship for mental health nurses and undergraduate nursing students' in the mental health setting? An examination of the interactions within this model and the development of a substantive theory are facilitated by utilising the qualitative methodological approach, grounded theory. Findings indicate that psychiatric nurse preceptors seek to accomplish connectedness in the preceptorship relationship, through overcoming fear and other misconceptions. In addition, a number of factors emerged where commonality exists between the experiences of mental health nurse preceptors andthe nursing students. These included the need to manage the reconciling of difference between general acute health and mental health settings, the challenge for both groups to address student fear and preconceived ideas of mental illness and the need of preceptors to 'protect' the students.     

Nurses' perceptions of a mental health education programme for Australian nurses

In the present study, we present qualitative findings of study of nurses' perceptions of a mental health education programme for Australian nurses. Many nurses avoid disclosing their mental health problem/illness because of the stigmatization by health workers. Mental health education is a successful means to address workplace stigma; thus, it can be anticipated that such education can address workplace difficulties experienced by nurses with mental health problems. During 2008, a qualitative study was conducted to obtain nurses' perceptions of a short mental health education programme for nurses. The workshop purpose was to improve mental health literacy in order to improve support to colleagues with mental health problems. Semistructured, audio-taped interviews were conducted with 13 nurses and then transcribed. A framework analysis approach guided interpretation of the data. The education programme had limited effect on the participants' attitudes towards colleagues with mental health problems. This was likely due to their high level of mental health literacy and experiences prior to the workshop. Participants felt that a more focused nurse-specific programme might have been more efficacious. Implementing a nurse-specific education session is potentially an effective means to improve support to nurses who experience mental health problems.     

Health diaries for self-monitoring and self-regulation: applications to individuals with serious mental illness

Various health promotion interventions have been developed for individuals with serious mental illness that address such problems as medication nonadherence and physical inactivity. The beneficial outcomes of these interventions may be enhanced or extended if patients used a tool to monitor their own health habits. A systematic review of studies on health diaries was conducted to inform the development of the Monthly Medication Journal. A self-regulation model is discussed in using health diaries as self-monitoring and self-regulation tools for individuals with various mental health disorders.     

Beyond the physical examination: the nurse practitioner's role in adolescent risk reduction and resiliency building in a school-based health center

School-based health centers in high schools provide a unique setting in which to deliver risk-reduction and resilience-building services to adolescents. The traditional health care system operating in the United States focuses on the treatment of illness and disease rather than on preventing problems originating from health risk behaviors. Nurse practitioners can promote healthy behavior in adolescents through linkages to parents, schools, and community organizations; by conducting individual risk assessments; and by providing health education and access to creative health programs that build resilience and promote protective factors. With a focus on wellness, nurse practitioners as advanced practice nurses and specialists in disease prevention and health promotion can establish students' health priorities in the context of the primary health care they deliver on a daily basis.     

Improving the quality of students' dietary intake in the school setting.

The dramatic increase in our understanding of the brain's development throughout childhood has increased our knowledge of the significance of micronutrients, such as iron and vitamin B-12, for this development. Deficiencies of these micronutrients have been shown to have an impact on students' cognitive development. Regardless of this knowledge, students continue to make unhealthy food choices and develop poor dietary habits. School environments are places where there is an opportunity to practice healthy eating habits. Yet many school policies fail to address the sale of foods of minimal nutritional value in the school setting. School nurses can play a vital role in planning policies at the local and national level that support and encourage healthy food environments, performing assessments of the nutritional status of students, and spearheading the implementation of evidence-based health promotion programs. It is time for school nurses to take the lead in efforts aimed at improving the quality of students' dietary intake in the school setting.     

Infectious hazards in the clinical laboratory: a program to protect laboratory personnel

The increasing risk of exposure to blood-borne pathogens in the health care setting makes the development of effective infection control programs in the laboratory workplace critical. Central to such programs is the concept of universal precautions. The program described here relates the level of protection or precaution to the potential danger for infection, given the laboratory workstation and task which is to be performed. Four Levels of Protection are described. Implementation of this program requires that each workstation and procedure in each laboratory section be reviewed by the laboratory director and supervisory personnel for risk of exposure. Implementation additionally requires that provisions be made for both the initial and continuing education of laboratory employees. Laboratory directors and supervisors should also monitor the program to ensure compliance. There will certainly be situations unique to individual institutions or laboratory settings that may require precautions or policies over and above those described by universal precautions. Laboratory policies will not gain acceptance if they are developed and implemented without the advice and cooperation of the hospital medical staff. Employee acceptance of infection control policies will be greater if actual development and implementation actively involves the laboratory personnel who will practice them. The program described here is but one approach to the problem. Employers and laboratory directors must understand that it is their responsibility to develop a program that provides appropriate safeguards for workers who may be exposed to infectious agents in the laboratory workplace and to ensure that employees are properly trained and educated in the proper use and application of those safeguards.     

Physical Health Risk Behaviours in Young People with Mental Illness

Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16–25 years) Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples’ well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.