Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardou... more Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 25 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.
International Journal of Mental Health Nursing, Jun 1, 2005
Positive and effective consumer outcomes hinge on having in place optimal models of nursing care ... more Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.
Social Psychiatry and Psychiatric Epidemiology, Jan 24, 2006
To identify patients&... more To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.
Considerable research documents the health consequences of psychosis and co-occurring substance u... more Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.
Objective: To provide some direction for those interested in obtaining funding with the purpose o... more Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published –and getting started in writing –does not hinge on conducting formal research or receiving research funding.
Résumé/Abstract For this quantitative study, a cross-sectional design was used to assess patients... more Résumé/Abstract For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients ...
Social Psychiatry and Psychiatric Epidemiology, 2006
To identify patients&... more To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.
Purpose To descriptively assess medical students' concerns for their mental and emotional sta... more Purpose To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. Study design From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. Results 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. Conclusions Despite widespread awareness of appropriate support se...
Journal of Psychosocial Nursing and Mental Health Services, 2008
Working with and treating individuals with co-occurring substance misuse presents unique challeng... more Working with and treating individuals with co-occurring substance misuse presents unique challenges for mental health nurses. Substance misuse is common in mental health settings, and its clinical challenges with system barriers impede positive treatment outcomes. To work effectively in everyday clinical practice with dual diagnosis clients, nurses need to consider potential guiding principles. These principles pertain to treatment aims, engagement, assessment, symptoms, care plans, cycle of change, motivational interviewing, traps to avoid, active treatment, relapse prevention, agency collaboration, and treatment diversity. Clinical tools are easily accessible resources that can provide a framework for contemporary practice in a range of settings. Such resources are helpful in practice and as a foundation for orientation, education, self-reflection, and peer review. Setting expectations for everyday practice and ensuring that clients with a dual diagnosis receive the best care poss...
Journal of Psychosocial Nursing and Mental Health Services, 2010
In this study, we surveyed clinical staff to ascertain their views regarding the delivery of diff... more In this study, we surveyed clinical staff to ascertain their views regarding the delivery of difficult news (DDN), such as the need for lifelong medication with possible side effects, in inpatient mental health settings. Nearly all staff agreed patients had a right to information about their diagnosis, two thirds thought the doctor was the best person to inform patients of their diagnosis, and approximately half believed full diagnosis and treatment disclosure may have negative consequences. Providing hope when delivering difficult news was endorsed by almost all staff, and most took special precautions (e.g., greater monitoring) after DDN. Two thirds had never received specific training for DDN, yet most considered themselves competent in DDN. In DDN, staff usually or always considered patients' level of insight/awareness, likely distress, diagnosis, and whether they would understand the consequences of the diagnosis.
Journal of Psychosocial Nursing and Mental Health Services, 2010
For this quantitative study, a cross-sectional design was used to assess patients&amp... more For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than be ing told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients' questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.
Journal of Psychosocial Nursing and Mental Health Services, 2009
Recent reports indicate an absence of respect in workplace culture. Every person has the right to... more Recent reports indicate an absence of respect in workplace culture. Every person has the right to a workplace that is fair and equitable and in which he or she is treated with respect and dignity. Working in a collegial manner is challenging when environments have staff who engage in unprofessional or disruptive behaviors. A number of steps can be taken to support a healthy workplace and prevent bullying. Healthy workplaces are ones in which leaders and managers lead by example, champion respect, and set the tone and expectation for behaviors essential for fostering a harmonious and collaborative environment. The role of the leader/manager is crucial in developing a positive workplace culture that supports a high level of professionalism and a culture of zero tolerance toward bullying.
Journal of Psychiatric and Mental Health Nursing, 2006
This cross‐sectional study was conducted across inpatient facilities of a metropolitan mental hea... more This cross‐sectional study was conducted across inpatient facilities of a metropolitan mental health service in Sydney, Australia. Given shorter lengths of stay in acute inpatient facilities, it is important to ascertain differences between patients’ and carers’ perceptions of need and support in order to guide delivery of care in the community. The objectives were to: (1) assess the needs of patients recently admitted to hospital and ascertain the level of carer involvement while in hospital; (2) compare the degree of agreement between patients’ and carers’ perceptions of need and caregiver burden; and (3) determine the relationship between levels of need and carer burden prior to hospitalization. Over a 2‐month period, consecutive patients (n = 200) were interviewed using the Camberwell Assessment of Need Short Appraisal Schedule and a modified version of the Involvement Evaluation Questionnaire to assess basic needs and patient perceptions of caregiver burden, respectively. Of th...
Aims and objectives. In this article, we identify key aspects for enhancing real-world research i... more Aims and objectives. In this article, we identify key aspects for enhancing real-world research in mental health care clinical settings and broadly discuss some practicalities and issues that must be considered beforehand. Background. Practice which is evidence-based uses interventions or treatment methods that are supported by research findings for their quality and efficacy. Modern mental health settings endorse evidence-based practice and welcome the development of innovative, evidence-based approaches to care. Often, however, research findings are inaccessible, inconclusive, inconsistent, contradictory and overwhelming in sheer volume. Further, where there is no evidence, the absence of evidence is frequently mistaken for evidence of absence of the effectiveness of services. Design. Discursive paper. Method. The main themes expressed in the literature were collated by the authors into themes, and their relevance to the development of real-world clinical mental health research is summarised with the aid of a vignette. Conclusions. Ideally, research should be part of mainstream activities and as such constitute core business. Staff in mental health services should be encouraged to be research productive, and prospective clinical researchers should consider linking their studies to higher research degree programmes so that they can access resources, support and expertise to sustain motivation and morale. Relevance to clinical practice. For research findings to make the leap to evidence-based practice, the research needs to include real-world consumers and families typical of clinical practice supported by clinically relevant outcomes. Clinical and research leaders should create opportunities for academic and clinical nurses to collaborate in research, and researchers should ensure that clinically relevant outcomes are presented in ways that are meaningful and accessible to clinicians.
‘Reputations’ are an ever-present aspect of human groupings and society. How often might we hear ... more ‘Reputations’ are an ever-present aspect of human groupings and society. How often might we hear that a certain individual has an excellent reputation in a certain field, while another’s reputation is less favourable, or that a particular institution’s high reputation is a reason to seek entry there, and contrasts with another institution’s poor reputation, which is a deterrent? Despite the ubiquitous nature of reputations, and their myriad potential consequences, the subject has attracted limited attention in the academic and health literature. In this editorial, we flesh out some of the dimensions of reputation, with a view to encouraging further debate and discussion, and suggest a way to achieve and maintain a positive reputation if working in an academic setting. The importance of the topic was recently underscored by the Ethics Resource Center, which suggested that ‘Among all of an organization’s assets, a good reputation may be the most important. It is also the easiest to lose and the most challenging to maintain’ (Ethics Resource Center 2011, p. 3). What is meant by a reputation? According to the Free Dictionary (http://www.thefreedictionary.com/reputation), reputation may be defined as ‘the general estimation in which a person is held by the public or the state, or situation of being held in high esteem, or a specific characteristic or trait ascribed to a person or thing’. It follows from definitions like this that a key aspect of reputation is its subjective quality. While reputation traditionally bypasses a measure of objective performance to encompass what the ‘person in the street’ thinks and says about somebody or an institution, it is noteworthy that there have been some recent attempts to quantify reputation, at least at the institutional level. For example, there is now a formal ranking of universities according to reputation (http://www.timeshighereducation. co.uk/world-university-rankings/2011-2012/reputation-rankings.html). In this ranking system, reputation draws on opinions about research and, to a lesser extent, teaching. This information may then be used by prospective students to make judgements about institutions where they may choose to study. Similarly, academic staff will be understandably keen to work at facilities that are highly ranked in terms of measurable reputation. So, what are the elements of a reputation? We would suggest that, in general, the two critical components of reputation are work performance itself (by an individual or institution) and, as importantly, dissemination of news about such performance to others. At the heart of a ‘positive’ reputation, then, is performing one’s duties to a reasonably high standard – as a bare minimum, performing according to the position requirements is required. A positive reputation also has an element of others learning about one’s work – the ‘hearsay’ aspect, if you will – so not being shy about tactfully promoting one’s work, without being ‘excessively’ selfpromoting, is essential. Many ‘quiet achievers’ who might otherwise have a positive reputation, regrettably go unnoticed. It follows that reputations may be enhanced, or sullied, by various means. First, as mentioned, it is essential for a person or institution to perform their expected tasks. A range of factors – inertia, unsuitability, poor organizational skills, lack of training, inadequate supervision, etc. – may mitigate against this occurring. It is worth digressing to note here the potential influence of mental illness on reputation: certain mental illnesses, e.g. manic episodes of bipolar disorder, are notorious for damaging a person’s reputation, but the active phase of any psychiatric illness can tarnish a reputation and warrants due attention for this, among other reasons. Second, various factors may have an impact on one’s work being detected by others. The situation of the ‘quiet achiever’ has been noted. Not actively seeking or having opportunity for disseminating information about one’s work (e.g. through conference and other presentations and journal article submissions) will not add to a positive reputation. Establishing a strong professional reputation requires not only strong personal characteristics, including credibility, competence, and trustworthiness, but also purposeful action, political
Increasingly, consumers and carers are involving themselves in many aspects and levels of mental ... more Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted
International Journal of Mental Health Nursing, 2003
The oral and written presentation of work arising from clinical practice, service development, qu... more The oral and written presentation of work arising from clinical practice, service development, quality improvement projects and research is presently encouraged and supported. Because this work may involve consumers, staff and the organization, it is important that proper consideration is given to how the work is disseminated, including any ethical implications. There is a need to ensure that consumers, staff, facilities, the organization and intellectual property are protected from any potential concerns that may arise. This research note provides protocols and a checklist that may be of interest and may be relevant for clinicians and researchers to review and appraise their work before oral or written presentation.
International Journal of Mental Health Nursing, 2005
Positive and effective consumer outcomes hinge on having in place optimal models of nursing care ... more Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.
Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardou... more Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 25 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.
International Journal of Mental Health Nursing, Jun 1, 2005
Positive and effective consumer outcomes hinge on having in place optimal models of nursing care ... more Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.
Social Psychiatry and Psychiatric Epidemiology, Jan 24, 2006
To identify patients&... more To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.
Considerable research documents the health consequences of psychosis and co-occurring substance u... more Considerable research documents the health consequences of psychosis and co-occurring substance use disorders. Results of randomized controlled trials assessing the effectiveness of psychosocial interventions for persons with dual diagnoses are equivocal but encouraging. Many studies are hampered by small, heterogeneous samples, high attrition rates, short follow-up periods, and unclear description of treatment components. The treatments available for this group of patients (which can be tailored to individual needs) include motivational interviewing, cognitive-behavioral therapy, contingency management, relapse prevention, case management, and skills training. Regardless of whether services follow integrated or parallel models, they should be well coordinated, take a team approach, be multidisciplinary, have specialist-trained personnel (including 24-hour access), include a range of program types, and provide for long-term follow-up. Interventions for substance reduction may need to be further developed and adapted for people with serious mental illnesses. Further quality trials in this area will contribute to the growing body of data of effective interventions.
Objective: To provide some direction for those interested in obtaining funding with the purpose o... more Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published –and getting started in writing –does not hinge on conducting formal research or receiving research funding.
Résumé/Abstract For this quantitative study, a cross-sectional design was used to assess patients... more Résumé/Abstract For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients ...
Social Psychiatry and Psychiatric Epidemiology, 2006
To identify patients&... more To identify patients' and carers' perceptions of need in inpatient and community settings and investigate the relationship between need and caregiver burden. The study was conducted across a metropolitan mental health service in Sydney, Australia. Patients (n = 407) and carers (n = 50) completed the Camberwell Assessment of Need Short Appraisal Schedule. Carers also completed a shortened version of the Involvement Evaluation Questionnaire to assess caregiver burden. When completing the assessment tools, patients and carers in hospital settings were asked to consider the 4 weeks preceding hospitalisation; in the community, patients and carers were asked to consider the previous 4 weeks. These data show a high percentage of patients in hospital and community settings have unmet needs for company, daytime activities and intimate relationships. Inpatients had more unmet needs than community based patients. Agreement between patients' and carers ratings' of need ranged from 'poor' to 'moderate'. There was a strong relationship between unmet need and burden from the carer's perspective. Patients with and without carers had similar numbers of needs. Carers of patients recently admitted to hospital reported a significantly higher burden. Carers of inpatients experienced significantly more burden than carers of outpatients. Opportunities to access support, information and education should be readily available and not contingent upon demonstrating a close familial relationship to the patient. We found that unmet need was significantly related to burden, suggesting that meeting patient needs could reduce carer burden.
Purpose To descriptively assess medical students' concerns for their mental and emotional sta... more Purpose To descriptively assess medical students' concerns for their mental and emotional state, perceived need to conceal mental problems, perceived level of support at university, knowledge and use of student support services, and experience of stresses of daily life. Study design From March to September 2011, medical students at an Australian university were invited to complete an anonymous online survey. Results 475 responses were received. Students rated study and examinations (48.9%), financial concerns (38.1%), isolation (19.4%) and relationship concerns (19.2%) as very or extremely stressful issues. Knowledge of available support services was high, with 90.8% indicating they were aware of the university's medical centre. Treatment rates were modest (31.7%). Students' concerns about their mental state were generally low, but one in five strongly felt they needed to conceal their emotional problems. Conclusions Despite widespread awareness of appropriate support se...
Journal of Psychosocial Nursing and Mental Health Services, 2008
Working with and treating individuals with co-occurring substance misuse presents unique challeng... more Working with and treating individuals with co-occurring substance misuse presents unique challenges for mental health nurses. Substance misuse is common in mental health settings, and its clinical challenges with system barriers impede positive treatment outcomes. To work effectively in everyday clinical practice with dual diagnosis clients, nurses need to consider potential guiding principles. These principles pertain to treatment aims, engagement, assessment, symptoms, care plans, cycle of change, motivational interviewing, traps to avoid, active treatment, relapse prevention, agency collaboration, and treatment diversity. Clinical tools are easily accessible resources that can provide a framework for contemporary practice in a range of settings. Such resources are helpful in practice and as a foundation for orientation, education, self-reflection, and peer review. Setting expectations for everyday practice and ensuring that clients with a dual diagnosis receive the best care poss...
Journal of Psychosocial Nursing and Mental Health Services, 2010
In this study, we surveyed clinical staff to ascertain their views regarding the delivery of diff... more In this study, we surveyed clinical staff to ascertain their views regarding the delivery of difficult news (DDN), such as the need for lifelong medication with possible side effects, in inpatient mental health settings. Nearly all staff agreed patients had a right to information about their diagnosis, two thirds thought the doctor was the best person to inform patients of their diagnosis, and approximately half believed full diagnosis and treatment disclosure may have negative consequences. Providing hope when delivering difficult news was endorsed by almost all staff, and most took special precautions (e.g., greater monitoring) after DDN. Two thirds had never received specific training for DDN, yet most considered themselves competent in DDN. In DDN, staff usually or always considered patients' level of insight/awareness, likely distress, diagnosis, and whether they would understand the consequences of the diagnosis.
Journal of Psychosocial Nursing and Mental Health Services, 2010
For this quantitative study, a cross-sectional design was used to assess patients&amp... more For this quantitative study, a cross-sectional design was used to assess patients' ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than be ing told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients' questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.
Journal of Psychosocial Nursing and Mental Health Services, 2009
Recent reports indicate an absence of respect in workplace culture. Every person has the right to... more Recent reports indicate an absence of respect in workplace culture. Every person has the right to a workplace that is fair and equitable and in which he or she is treated with respect and dignity. Working in a collegial manner is challenging when environments have staff who engage in unprofessional or disruptive behaviors. A number of steps can be taken to support a healthy workplace and prevent bullying. Healthy workplaces are ones in which leaders and managers lead by example, champion respect, and set the tone and expectation for behaviors essential for fostering a harmonious and collaborative environment. The role of the leader/manager is crucial in developing a positive workplace culture that supports a high level of professionalism and a culture of zero tolerance toward bullying.
Journal of Psychiatric and Mental Health Nursing, 2006
This cross‐sectional study was conducted across inpatient facilities of a metropolitan mental hea... more This cross‐sectional study was conducted across inpatient facilities of a metropolitan mental health service in Sydney, Australia. Given shorter lengths of stay in acute inpatient facilities, it is important to ascertain differences between patients’ and carers’ perceptions of need and support in order to guide delivery of care in the community. The objectives were to: (1) assess the needs of patients recently admitted to hospital and ascertain the level of carer involvement while in hospital; (2) compare the degree of agreement between patients’ and carers’ perceptions of need and caregiver burden; and (3) determine the relationship between levels of need and carer burden prior to hospitalization. Over a 2‐month period, consecutive patients (n = 200) were interviewed using the Camberwell Assessment of Need Short Appraisal Schedule and a modified version of the Involvement Evaluation Questionnaire to assess basic needs and patient perceptions of caregiver burden, respectively. Of th...
Aims and objectives. In this article, we identify key aspects for enhancing real-world research i... more Aims and objectives. In this article, we identify key aspects for enhancing real-world research in mental health care clinical settings and broadly discuss some practicalities and issues that must be considered beforehand. Background. Practice which is evidence-based uses interventions or treatment methods that are supported by research findings for their quality and efficacy. Modern mental health settings endorse evidence-based practice and welcome the development of innovative, evidence-based approaches to care. Often, however, research findings are inaccessible, inconclusive, inconsistent, contradictory and overwhelming in sheer volume. Further, where there is no evidence, the absence of evidence is frequently mistaken for evidence of absence of the effectiveness of services. Design. Discursive paper. Method. The main themes expressed in the literature were collated by the authors into themes, and their relevance to the development of real-world clinical mental health research is summarised with the aid of a vignette. Conclusions. Ideally, research should be part of mainstream activities and as such constitute core business. Staff in mental health services should be encouraged to be research productive, and prospective clinical researchers should consider linking their studies to higher research degree programmes so that they can access resources, support and expertise to sustain motivation and morale. Relevance to clinical practice. For research findings to make the leap to evidence-based practice, the research needs to include real-world consumers and families typical of clinical practice supported by clinically relevant outcomes. Clinical and research leaders should create opportunities for academic and clinical nurses to collaborate in research, and researchers should ensure that clinically relevant outcomes are presented in ways that are meaningful and accessible to clinicians.
‘Reputations’ are an ever-present aspect of human groupings and society. How often might we hear ... more ‘Reputations’ are an ever-present aspect of human groupings and society. How often might we hear that a certain individual has an excellent reputation in a certain field, while another’s reputation is less favourable, or that a particular institution’s high reputation is a reason to seek entry there, and contrasts with another institution’s poor reputation, which is a deterrent? Despite the ubiquitous nature of reputations, and their myriad potential consequences, the subject has attracted limited attention in the academic and health literature. In this editorial, we flesh out some of the dimensions of reputation, with a view to encouraging further debate and discussion, and suggest a way to achieve and maintain a positive reputation if working in an academic setting. The importance of the topic was recently underscored by the Ethics Resource Center, which suggested that ‘Among all of an organization’s assets, a good reputation may be the most important. It is also the easiest to lose and the most challenging to maintain’ (Ethics Resource Center 2011, p. 3). What is meant by a reputation? According to the Free Dictionary (http://www.thefreedictionary.com/reputation), reputation may be defined as ‘the general estimation in which a person is held by the public or the state, or situation of being held in high esteem, or a specific characteristic or trait ascribed to a person or thing’. It follows from definitions like this that a key aspect of reputation is its subjective quality. While reputation traditionally bypasses a measure of objective performance to encompass what the ‘person in the street’ thinks and says about somebody or an institution, it is noteworthy that there have been some recent attempts to quantify reputation, at least at the institutional level. For example, there is now a formal ranking of universities according to reputation (http://www.timeshighereducation. co.uk/world-university-rankings/2011-2012/reputation-rankings.html). In this ranking system, reputation draws on opinions about research and, to a lesser extent, teaching. This information may then be used by prospective students to make judgements about institutions where they may choose to study. Similarly, academic staff will be understandably keen to work at facilities that are highly ranked in terms of measurable reputation. So, what are the elements of a reputation? We would suggest that, in general, the two critical components of reputation are work performance itself (by an individual or institution) and, as importantly, dissemination of news about such performance to others. At the heart of a ‘positive’ reputation, then, is performing one’s duties to a reasonably high standard – as a bare minimum, performing according to the position requirements is required. A positive reputation also has an element of others learning about one’s work – the ‘hearsay’ aspect, if you will – so not being shy about tactfully promoting one’s work, without being ‘excessively’ selfpromoting, is essential. Many ‘quiet achievers’ who might otherwise have a positive reputation, regrettably go unnoticed. It follows that reputations may be enhanced, or sullied, by various means. First, as mentioned, it is essential for a person or institution to perform their expected tasks. A range of factors – inertia, unsuitability, poor organizational skills, lack of training, inadequate supervision, etc. – may mitigate against this occurring. It is worth digressing to note here the potential influence of mental illness on reputation: certain mental illnesses, e.g. manic episodes of bipolar disorder, are notorious for damaging a person’s reputation, but the active phase of any psychiatric illness can tarnish a reputation and warrants due attention for this, among other reasons. Second, various factors may have an impact on one’s work being detected by others. The situation of the ‘quiet achiever’ has been noted. Not actively seeking or having opportunity for disseminating information about one’s work (e.g. through conference and other presentations and journal article submissions) will not add to a positive reputation. Establishing a strong professional reputation requires not only strong personal characteristics, including credibility, competence, and trustworthiness, but also purposeful action, political
Increasingly, consumers and carers are involving themselves in many aspects and levels of mental ... more Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted
International Journal of Mental Health Nursing, 2003
The oral and written presentation of work arising from clinical practice, service development, qu... more The oral and written presentation of work arising from clinical practice, service development, quality improvement projects and research is presently encouraged and supported. Because this work may involve consumers, staff and the organization, it is important that proper consideration is given to how the work is disseminated, including any ethical implications. There is a need to ensure that consumers, staff, facilities, the organization and intellectual property are protected from any potential concerns that may arise. This research note provides protocols and a checklist that may be of interest and may be relevant for clinicians and researchers to review and appraise their work before oral or written presentation.
International Journal of Mental Health Nursing, 2005
Positive and effective consumer outcomes hinge on having in place optimal models of nursing care ... more Positive and effective consumer outcomes hinge on having in place optimal models of nursing care delivery. The aim of this study was to ascertain the experience and views of mental health nurses, working in hospitals in an area mental health service, regarding nursing care delivery in those settings. Surveys (n = 250) were sent to all mental health nurses working in inpatient settings and 118 (47%) were returned. Results showed that the quality of nursing care achieved high ratings (by 87%), and that two-thirds of respondents were proud to be a mental health nurse and would choose to be a mental health nurse again. Similarly, the majority (71%) would recommend mental health nursing to others. Concern was, however, expressed about the continuity and consistency of nursing work and information technology resources. Nurses with community experiences rated the importance of the following items, or their confidence, higher than those without previous community placements: the importance of interdisciplinary teamwork; the importance of participating in case review; the importance of collaborating with community staff; confidence in performing mental state examinations; and confidence in collaborating with community staff, suggesting that this placement had positive effects on acute care nursing.
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Papers by Glenn Hunt