ORCID Profile
0000-0001-7457-3221
Current Organisation
Deakin University
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Publisher: Informa UK Limited
Date: 29-10-2020
DOI: 10.1080/01612840.2019.1648618
Abstract: Older adults with dual diagnosis remain an under-diagnosed population in mental health services, with complex needs and high rates of medical comorbidity. Dual diagnosis is a significant challenge to contemporary mental health services, with recognition of the increased rate of relapse and costs of care of poorly managed dual diagnosis identified through comprehensive research. Unfortunately, the research attention paid to those with dual diagnosis in younger age groups has not been replicated in the older adult cohort, with few studies specifically exploring the treatment needs of these in iduals. Of the studies that do exist, many identify poor screening and assessment, clinician frustration and a lack of cohesive treatment for co-occurring alcohol and other drug use disorders for older adults. We draw from a mixed methods exploratory study conducted in an inner Melbourne community older adult mental health service providing care to consumers with dual diagnosis to formulate recommendations to improve the care provision to this cohort. We discuss changes to the way older adult mental health services operate that are essential to improve the care and response to consumers presenting with dual diagnosis. Ultimately, we aim to discuss how older adult mental health services can improve to provide timely, responsive care to those with dual diagnosis.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Informa UK Limited
Date: 09-12-2017
DOI: 10.1080/01612840.2016.1256456
Abstract: Alcohol use disorder in older adults is associated with a number of substantial medical complications, including cognitive decline. Due to limited success and application of screening approaches in this cohort, older adults are more likely to present to general hospital settings with undiagnosed problematic alcohol use. Consultation-liaison psychiatry services operating in general hospital settings are likely to be referred older adults with alcohol use disorders for assessment and management. A 77-year-old female presented to a metropolitan hospital with symptoms including frequent falls, slurred speech, difficulty judging distance, hypersomnia, poor reasoning, and odd behaviours. She also presented with severe anxiety and bruxism. Several diagnostic tests were inconclusive, and a consultation-liaison psychiatry assessment revealed a prominent heavy drinking pattern and concurrent abuse of oxycodone and benzodiazepines. This report adds further support to the case for uniform screening of all older adults for alcohol and other drug (AOD) use. A number of weeks had passed before the patient's drinking pattern was established, with no withdrawal management in place. A multifaceted treatment approach, including antidepressant therapy, anticraving medication, benzodiazepine as well as opiate rationalisation, and AOD counselling support was commenced prior to discharge from the general hospital.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 07-08-2021
DOI: 10.1111/INM.12923
Abstract: Problematic alcohol and other drug use has a significant societal, personal, and financial burden. Nurses are key in responding to problematic alcohol and other drug use however, research indicates many nurses hold negative attitudes towards people with substance and alcohol use disorders. Further, little content exists in most undergraduate degrees to address stigma held by new nurses. The objective of this scoping review, structured using Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8 (1), 19–32, 2005) framework, is to examine studies that either explore or attempt to improve the knowledge and attitudes of undergraduate nurses caring for people who use alcohol and other drugs. Our initial search located 610 articles, and after screening, 14 articles were appraised using the Mixed Methods Appraisal Tool (MMAT) and included in this review. Most of the papers appraised were small, localized studies using evaluation methods considered low quality, but showed promising results in addressing stigma and confidence in providing care to people who use alcohol and other drugs. This review indicates that a consistent direction for improving knowledge and attitudes among undergraduate nursing students working with people who use alcohol and other drugs is urgently needed. Further studies of interventions, tested with more rigorous evaluation methodologies, are required to extend existing work in this area.
Publisher: Informa UK Limited
Date: 19-07-2019
DOI: 10.1080/01612840.2019.1630531
Abstract: Nurses remain at the forefront of direct patient care due to the nature of their role they are in a position to provide assessment, response and referral of in iduals in healthcare settings with problematic alcohol and other drug (AOD) use. We aim to determine the AOD knowledge of nurses in a regional health district in Australia and the awareness of an AOD service operating in the clinical environment. We employed a cross-sectional online survey, with descriptive and correlational analysis performed to explore relations between knowledge and both assessment and referral practices for in iduals with problematic AOD use. Results indicate good knowledge of the AOD service, with confidence to refer to the service associated with recent contact. Lower satisfaction levels with the AOD service were found in nurses who had no recent contact with the service. Awareness of the service was also positively associated with completion of the electronic AOD assessment. These results indicate that the presence of experienced AOD clinicians may increase familiarity with AOD services and increase screening. Given the link between familiarity and comfort with the AOD service and referral, establishing specialised AOD nursing positions remains an important strategy. We argue that the presence of specialised AOD nurses has a flow on effect in maintaining continuing screening and encouraging nurses to refer in iduals with problematic AOD use for ongoing care and treatment.
Publisher: Wiley
Date: 07-08-2015
DOI: 10.1111/INM.12143
Abstract: In 1962, Charles Winick proposed that addiction was a self-limiting process, whereby in iduals stopped using substances once the stresses of life transitions ceased. The notion of maturing out, as labelled by Winick, often forms the basis of the natural recovery movement in alcohol and other drug (AOD) research, aiding the notion that older in iduals either cease their substance use or fall victim to the higher mortality rates prevalent in substance-using populations. As more consumers present to adult mental health treatment settings with co-occurring substance use disorders, the idea that in iduals will simply cease using AOD is outdated. Given the future challenges of an ageing population, it is prudent to explore those who fail to mature out of substance use, as well as challenge the notion that older adult mental health services rarely encounter substance-using in iduals. The present study explores Winick's research in the context of an ageing population and older adult mental health services. It also ponders the proposition put forth in subsequent research that older in iduals with lifelong substance use switch to substances that are easier to obtain and better tolerated by their ageing bodies.
Publisher: Wiley
Date: 18-04-2023
DOI: 10.1111/INM.13154
Abstract: The introduction of long‐acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long‐acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and in iduals treated with long‐acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each in idual with opioid dependence treated with long‐acting injectable buprenorphine was associated with 90 fewer needles dispensed each month ( p 0.001). The nurse practitioner led model of care for in iduals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and in iduals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating in iduals with opioid use disorder influenced needle and syringe dispensing in the study setting.
Publisher: Wiley
Date: 21-03-2023
DOI: 10.1111/JOCN.16694
Abstract: To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness. Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. A five‐step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist. The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework. MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020. Studies eligible for inclusion ( N = 40) represented research from 15 countries most (67.5%, n = 27) used a qualitative design, 22.5% ( n = 9) were quantitative and 10% ( n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning. The review identified a lack of robust evidence about the effectiveness of specific nurse manager‐led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness. Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce. What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers. No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).
Publisher: Wiley
Date: 02-12-2023
DOI: 10.1111/JOCN.16596
Publisher: Informa UK Limited
Date: 25-01-2018
DOI: 10.1080/01612840.2017.1413458
Abstract: Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview in iduals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use. Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.
Publisher: Informa UK Limited
Date: 02-11-2015
DOI: 10.3109/01612840.2015.1081655
Abstract: Oral administration of methadone has been used as a treatment strategy for opiate addiction for many years. The state of Victoria, Australia, has a long-running methadone program with a large number of participants. Accordingly, a growing number of adults have utilised methadone maintenance treatment for a number of years and are now moving into older age due to advances in medical treatment and harm reduction initiatives. The objective of this review is to examine the literature pertaining to co-occurring mental illness in older methadone treatment participants and to explore the future challenges this growing cohort of ageing adults pose to aged persons’ psychiatry services. As part of a broader study into dual diagnosis in older adults, a search of the Scopus, ProQuest, and CINAHL journal databases was performed. Twenty abstracts from literature published within the previous 15 years (1999–2014) were identified that explored methadone maintenance programs and the older adults maintained on them. A number of researchers have identified the ageing methadone population to have a high degree of comorbid mental illness and psychological distress. Studies also indicate that in iduals enrolled in methadone maintenance programs may engage in a degree of continual substance use, potentially leading to deleterious effects on their psychosocial function. An ageing methadone population experiencing a high degree of comorbid mental illness is likely to challenge aged persons’ psychiatry services. These services are likely to be increasingly called on to manage these in iduals, particularly within Victoria where few substance use services exist for those over the age of 65. It is essential that aged persons’ psychiatry services prepare to provide care for these in iduals in a responsive manner that is inclusive of both their mental health and substitution pharmacotherapy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: Informa UK Limited
Date: 02-08-2017
DOI: 10.1080/01612840.2017.1349847
Abstract: Dual diagnosis has been identified as a significant challenge to mental health services, resulting in higher rates of psychiatric relapse and greater illness severity. Much research explores dual diagnosis in the adult mental health cohort, however little research attention has been paid to older adults with dual diagnosis. Far from being a trivial issue, preliminary studies have shown that dual diagnosis in older adults is under diagnosed and poorly identified by clinicians with few specific treatment options available. In addition, studies of the ageing baby boomer cohort demonstrate a potential for dual diagnosis presentations to increase in the coming years. This article explores the experiences of a clinical team providing care to older adults with dual diagnosis in Melbourne, Australia, through a semi-structured interview process. The participants described a number of systemic barriers to providing care to the older adults with dual diagnosis presenting to the mental health service, in addition to feeling poorly prepared and expressing a degree of clinical helplessness. Additionally, the participants described service improvement, which included a strong dual diagnosis culture in the leadership team of the mental health service and role modelling dual diagnosis competent practice among clinicians.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Wiley
Date: 08-10-2022
DOI: 10.1111/INM.12939
Abstract: Advance statements, advance directives, or psychiatric wills are a key component of a shift to mental healthcare that promotes autonomy and choice and aims to reduce restrictive and coercive care practices in mental health treatment settings. The use of advance statements has gained momentum to provide a means for in iduals to detail clear preferences for mental health treatment. This paper uses a qualitative descriptive design to explore the experiences of clinicians (n = 15) implementing advance statements in the state of Victoria, Australia, a region that introduced advance statements as part of an overhaul of mental health legislation in 2014. The study, reported using the COREQ framework, found two key themes after analysis: experiences of advance statement training, with the availability and quality of training and training as a driver of change emerging as sub-themes, and experiences of advance statements in practice, with participants providing narratives of the barriers and facilitators to successful advance statement implementation. We recommend that clinician and service user experiences of advance statement implementation are further explored to identify existing and emerging barriers to implementation of these tools, which are crucial to achieve autonomy and choice for in iduals receiving mental healthcare.
Publisher: Wiley
Date: 24-07-2022
DOI: 10.1111/JOCN.16467
Abstract: To explore the long‐term impact of the COVID‐19 pandemic on nurse alcohol consumption. The COVID‐19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre‐existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well‐being and sustainability. Qualitative descriptive study design. Secondary analysis of in idual, semi‐structured interviews with nurses ( N = 42) from erse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE‐Q guidelines. Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward). Several participants described increased alcohol consumption because of the COVID‐19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption. Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS‐CoV‐2 virus, and increased alcohol consumption is a significant threat to personal and workforce well‐being, workforce sustainability and quality nursing care.
Publisher: Wiley
Date: 23-12-2023
DOI: 10.1111/INM.13108
Abstract: Emergency departments are often the first point of contact for in iduals presenting to healthcare services for assistance and treatment for mental ill health. Emergency departments, particularly those in regional areas, can experience high staff turnover and rely on novice nurses for workforce sustainability. The aim of this paper is to explore the experiences of novice nurses (nurses with years of experience) in providing care to in iduals presenting with mental ill health in the emergency department. Semi‐structured interviews were conducted with novice nurses ( N = 13) in a regional emergency department, using qualitative description as the guiding framework. The following three main themes were identified: (i) confidence in providing quality and safe nursing care, (ii) perceived barriers to providing quality and safe nursing care, and (iii) factors that increase confidence. Our findings indicate that proving safe and appropriate nursing care is affected in novice nurses by factors that lead to a perceived lack of confidence, such as how in iduals present to the emergency department (e.g. intoxicated or violent), an inability to conduct conversations to assess accurately and perceived shortfalls in the emergency department environment itself. Future research should examine the curriculum for relevance of undergraduate education regarding acute mental health presentations and develop training strategies that enhance communication with in iduals who present to the emergency department with mental ill health.
Publisher: Wiley
Date: 24-03-2021
DOI: 10.1111/JOCN.15732
Abstract: To explore the impact of the COVID‐19 pandemic on alcohol and other drug nurses providing treatment for in iduals presenting with problematic alcohol and other drug use. COVID‐19 has caused disruption to contemporary health service delivery, including alcohol and other drug treatment. Provisional research on drug and alcohol consumption patterns shows changes attributable to the pandemic, with implications for service delivery. Research also indicates the impact of the pandemic on healthcare staff is significant, leading to workforce challenges that threaten care provision. Qualitative descriptive study design. Data were collected using semi‐structured, in idual telephone interviews with practising alcohol and other drug nurses from Australia and New Zealand ( n = 19). COREQ reporting guidelines were used. After thematic analysis, three key themes emerged: ‘No room at the inn: Changes to service delivery due to COVID‐19’, ‘We are providing care to a very vulnerable group of people: Consumer factors during COVID‐19’ and ‘Personally, we were very, very stressed: Workforce factors due to COVID‐19’. The findings from this study indicate that the impact of the pandemic was felt by alcohol and other drug nurses, services and healthcare consumers alike. The experiences of alcohol and other drug nurses through the COVID‐19 pandemic need further exploration both to ensure workforce sustainability and that disruptions to alcohol and other drug services do not occur in future outbreaks of communicable disease. COVID‐19 has had a profound effect on nurses in all settings, and these effects are likely to be felt for some time after the pandemic: nursing specialties require support to ensure ongoing workforce sustainability and well‐being of nursing staff. All nurses need to be aware of changes to alcohol and other drug use during the pandemic and screen healthcare consumers accordingly.
Publisher: Wiley
Date: 25-03-2022
DOI: 10.1111/INM.12998
Abstract: The recently released Victorian Mental Health Royal Commission report has recommended a shift to integrated treatment, defined as treatment for alcohol and substance use disorders and mental ill health occurring in parallel, rather than distinct systems catering to each need. However, little work has sought to determine the perceptions of nurses working in alcohol and other drug (AOD) treatment towards integrating with mental health services. In this study, we explore the perspectives of specialist AOD nurses towards the integration of mental health and AOD treatment services. Secondary analysis of semi-structured interviews with Australian specialist AOD nurses (n = 46) conducted as part of a wider workforce study in 2019. Data were analysed using thematic analysis and reported using the COREQ guidelines. Of the interviews analysed, six were AOD nurses working in an Australian state that had recently undergone service integration however, many participants expressed perceptions of service integration. Two key themes are reported in this paper: (i) perceptions of service integration, where AOD nurses participating in our study were concerned that integration would result in the model of care they worked under being replaced by a mental health-based model that was felt to be highly risk averse, and (ii) experiences of service integration. Concerns about the focus of care as well as the complexity of care differing between the two services demonstrated a contrast in both philosophical approaches to work with consumers and legislative difference in voluntary versus compulsory care provision.
Publisher: Informa UK Limited
Date: 08-04-2019
DOI: 10.1080/01612840.2019.1565874
Abstract: Recent events and media coverage have put aggression and violence toward healthcare workers on the agenda of many governments and healthcare providers. Shown to cause poor job satisfaction, attrition and higher rates of turnover, aggression and violence toward healthcare workers is a substantial problem in the provision of quality care. We aim to determine the feasibility of providing aggression management training to undergraduate nursing students to better prepare them for the workforce. This review found seven studies utilizing various methods of providing aggression management training to students. Delivery was erse in terms of format, content and duration, and the efficacy of training was typically determined in a pre- and post-test fashion. The findings in reviewed studies indicate significant improvements in competence and attitudes, however some methodological caveats exist. We conclude that aggression management training for undergraduate nursing students is indeed feasible within certain constraints: methodological approaches to demonstrating efficacy need to evolve beyond pre- and post-test designs and changes in content delivery incorporating new and novel methods, such as simulation, need to be considered and incorporated. Aggression management training should be considered as essential in the nursing curriculum in order to provide neophyte nurses with the skills and capabilities to manage aggression and violence in their future workplaces.
Publisher: Informa UK Limited
Date: 25-04-2019
DOI: 10.1080/01612840.2019.1565875
Abstract: Research indicates that homeless women are reported to experience more mental health issues than women who are not homeless and are an increasing proportion of the overall homeless population. In addition, homeless women are more likely to have alcohol and/or other drug use disorders. We provide a comprehensive review of the contemporary literature that revealed homeless women experience a range of mental health problems including depression, anxiety, post-traumatic stress disorder and alcohol and other drug use disorders. Studies in this literature review indicate that some women have pre-existing mental health issues which precipitate homelessness while others develop mental illness because of their homelessness domestic violence was also recognised as an antecedent to homelessness, although further research is needed in this area. The results of this study indicate that the homeless cohort is a complex one with distinct needs. We provide information that can help refine assessment processes and plan appropriate services to address the mental health needs of homeless women. Finally, recommendations for mental health nursing practice in regard to caring for homeless women are made.
Publisher: Wiley
Date: 06-02-2023
DOI: 10.1111/INM.13125
Abstract: Alcohol and other drug (AOD) nurse practitioners have an advanced scope of practice that allows them to diagnose, prescribe pharmacological treatments for alcohol and other substance use disorders, and monitor physical and mental health. The Behaviour Change Wheel (BCW) is used to understand barriers and facilitators to implementation by applying three conditions of behaviour change (capability, opportunity, and motivation—the COM‐B framework). The aim of this paper is to describe the current AOD nurse practitioner workforce, and to explore barriers and facilitators to AOD nurse practitioner uptake in Australia. A mixed method approach was used in this study: a survey to determine the current state of the AOD nurse practitioner workforce ( n = 41) and qualitative interviews with 14 participants to determine barriers to endorsement and ongoing work as a nurse practitioner. Interview transcripts were analysed using thematic analysis and mapped to the COM‐B framework. The AOD nurse practitioner is a highly specialized provider of holistic care to people who use alcohol and other drugs, with AOD nurse practitioners performing advanced roles such as prescribing and medication management. However, there are several barriers to the further uptake of AOD nurse practitioners in Australia, including varied organizational support, a lack of support for the higher study required to become a nurse practitioner and a lack of available positions. Arguably, nurse practitioners are key to addressing prescriber shortages inherent in AOD treatment settings. In addition, they are equipped to provide true holistic care. We recommend that barriers are addressed to expand the AOD nurse practitioner workforce in Australia.
Publisher: Wiley
Date: 02-02-2023
DOI: 10.1111/JPM.12901
Abstract: Australia is a commonwealth of federated states and territories with each having unique mental health legislation. Victoria implemented advance statements based on legislation from overseas jurisdictions such as Scotland. The aim of this Victorian legislation was to underpin an in idual's autonomy and decision‐making in relation to treatment, particularly compulsory treatment. Advance statements allow in iduals within the healthcare setting to document preferences for care and treatment during times of decompensated mental health, including informing nominated persons and preferences for recovery‐oriented care however, advance statements continue to attract barriers in their implementation and use. This paper focuses on legislation within one jurisdiction, Victoria, highlighting that several barriers to uptake exist, including uncertainty around the legal status of advance statements, the ideal setting to implement advance statements and concern around perceived consumer capacity to contribute to developing advance statements. There are substantial differences of opinion regarding adherence to treatment and recovery preferences contained within the advance statement, especially when decisions are made in the context of decompensated mental health. The Theoretical Domains Framework (TDF) model has been used to formulate recommendations in several other health studies, but to date has not been used to provide recommendations for greater implementation of advance statements. Implementation science is a contemporary research translation movement that seeks to identify factors and strategies that influence the adoption and integration of interventions like advance statements in real world settings. For this study it has been useful to identify barriers, consider implementation strategies and link this with policy frameworks to support practice change. Our study revealed that real challenges exist for mental health clinicians in adopting advance statements despite them having a strong held intention to empower service users to play a greater role in their own treatment and care decisions. The facilitators identified in this study highlight the notion that advance statements, and the concept of supported decision‐making are needed in contemporary mental health care. Implementation science can assist in identifying barriers and suggesting facilitators including enhanced training, incentivization of advance statement creation, and greater awareness of the overarching purpose and principle of advance statement creation. Continued support and training in implementing and maintaining advance statements is required if mental health clinicians are to drive the uptake of this important reform to mental health legislation. Training needs to be provided that will address attitudes, and strongly held beliefs that pose barriers to the use of advance statements. Advance statements, also known as advance directives or psychiatric wills, provide in iduals the opportunity to document care and recovery preferences during a period of mental ill health. Although the use of advance statements has gained momentum, little research has explored the factors that promote or hinder further uptake. To determine the factors that promote or hinder the uptake of advance statements. Cross‐sectional online survey of healthcare workers ( n = 190). Promoting factors include high perceived value of advance statements, particularly their role in recovery focussed care, while hindering factors include disagreement or responsibility for advance statement creation and legal status. This study indicates that several hindering factors or barriers to advance statement uptake remain, and until these factors are addressed future implementation is arguably hindered. In this paper, we have used the Theoretical Domains Framework (TDF) model to outline suggestions to address hindering factors to implementation and guide future implementation strategies for advance statement uptake and practice change. The ongoing uptake of advance statements requires tailored implementation strategies address hindering factors. Strong promoting factors, such as the shared belief in the advance statement model and its role in recovery focused care, should be considered a strong foundation for implementation strategies.
Publisher: Informa UK Limited
Date: 27-01-2015
DOI: 10.3109/01612840.2014.951135
Abstract: Dual diagnosis is associated with frequent relapse, poor treatment engagement and overall unsatisfactory treatment outcomes. A comprehensive review of the contemporary literature examining this issue was conducted, finding a paucity of literature concerning dual diagnosis in older adults. Of the literature appraised for this review, a number of studies examined US Veteran's Affairs populations, which were largely male. Studies concerning older mental health populations were scarce. During the literature search, a number of background studies that influenced contemporary research regarding dual diagnosis in older adults were found these studies were examined regarding their contribution to contemporary paradigms concerning older adults with co-occurring mental illness and substance use disorders. This review presents the results of the contemporary literature concerning dual diagnosis in older adults. Several recurring themes emerge from the literature, including the notion of a statistically small population that, in absolute terms, represents a sizeable number of in iduals coming to the attention of aged mental health services in the future. Additionally, the potential for under-diagnosis in this cohort is highlighted, potentially creating a hidden population of older adults with dual diagnosis.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/INM.12215
Abstract: Co-occurring mental illness and substance use disorder, known as dual diagnosis, is a significant challenge to mental health services. Few older adult specific alcohol and other drug treatment services exist, meaning older adult mental health services may become the default treatment option for many. Evidence suggests that dual diagnosis leads to substandard treatment outcomes, including higher rates of psychiatric relapse, higher costs of care and poorer treatment engagement. This paper explores the prevalence of co-occurring alcohol and other drug (AOD) use in an older adult community mental health service in inner Melbourne, Australia. This aim was accomplished by using a retrospective file audit of clinical intake assessments (n = 593) performed on consumers presenting to the service over a two-year period, June 2012-2014. Of consumers presenting to the service, 15.5% (n = 92) were assessed by clinicians as having co-occurring AOD use. Depression predominated in the dual diagnosis group as the primary mental health disorder. Dual diagnosis consumers in this s le were statistically more likely to be male and younger than their non-dual diagnosis counterparts. A limitation of this audit was the lack of implementation of screening tools, leaving assessment to clinical judgement or the interest of the clinician. This may also explain the discrepancy between the results of this study and previous work. Although appearing to be a relatively small percentage of assessments, the results accounted for 92 in iduals with complex mental health, AOD and medical issues. Poor screening procedures in a population that is traditionally difficult to assess need to be rectified to meet the future challenges inherent in the ageing baby boomer generation, changing drug use trends and extended lifespans through harm reduction initiatives and medical advancements.
Publisher: Wiley
Date: 20-05-2022
DOI: 10.1111/INM.13022
Abstract: Embedded into Victoria's mental health legislation as part of the 2014 Mental Health Act suite of reforms, advance statements are designed to convey an in iduals' preferences for treatment during times when the ability to communicate or make decisions may be impaired. This study investigated Victorian mental health clinicians' knowledge and attitudes of advance statements as well as their experience with training and implementation. We used an online Qualtrics survey of Victorian mental health clinicians ( n = 190) to achieve this aim. Instrument validity was determined using the Content Validity Index (CVI) with field experts rating each item for relevance. A value of 80% or higher was sought and computed for each in idual item on the scale, as well as for the overall scale. The Cronbach's Alpha coefficient was conducted to determine internal consistency reliability with a value of α = 0.721 for the survey, suggesting that the scale had acceptable internal consistency and reliability. Despite widespread support and positive attitudes towards advance statements existing among mental health clinician participants, the level of knowledge and perception of barriers continues to significantly affect the wide‐spread uptake of advance statements. The quality and extent of training in legal and clinical aspects of advance statement varied widely among the study participants, with the quality and benefits of the training affecting participant reported confidence level as well as their practical experience with advance statements. Three recommendations can be made: that advance statements are embed into routine mental health practice to identify in iduals who have existing advance statements and support those who do not to prepare one that regular co‐produced and facilitated training be provided to increase understanding, promotion, and overall use and uptake of advance statements and finally, for local mental health service to develop a culture for positive engagement and promotion of autonomy through inclusive practices around decision‐making.
Publisher: Wiley
Date: 06-07-2023
DOI: 10.1111/INM.13189
Abstract: The principles of least restrictive care and recovery‐focused practice are promoted as contemporary practice in the care of in iduals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery‐focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. ( Journal of Psychiatric and Mental Health Nursing , 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's ( International Journal of Social Research Methodology: Theory and Practice , 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least‐restrictive, therapeutic environments.
Publisher: Wiley
Date: 16-06-2021
DOI: 10.1111/JAN.14939
Abstract: This study aimed to explore the experiences of alcohol and other drug nurses transitioning to telehealth due to the COVID‐19 pandemic. COVID‐19 has caused immense disruption to healthcare services, and to reduce viral transmission, many services moved to off‐site care delivery modalities such as telehealth. We used a qualitative descriptive design for this study. Secondary analysis of semistructured interviews with alcohol and other drug nurses from Australia and New Zealand ( n = 19) was conducted in July and August 2020. Data were analysed using thematic analysis and reported using COREQ guidelines. Three were identified: ‘“All our face‐to‐face contact ceased with clients”: Changing service delivery’, ‘“How do I do my job when I can't see you?”: An anxious shift in service delivery’ and ‘“A lot of Indigenous people don't like the FaceTiming and all that”: Challenges to delivery of services through telehealth’. Participants in our study reported challenges in transitioning to telehealth modalities. The perceived loss of therapeutic communication, difficulties in assessing risks to healthcare consumers such as domestic violence and challenges delivering telehealth care to a marginalized consumer cohort need to be overcome before telehealth is considered successful in alcohol and other drug treatment. However, telehealth was a successful adjunct to existing practices for nurses working with consumers in regional or remote areas or where consumers preferred this method of service delivery. Nurses in this study described substantial issues with the delivery of alcohol and other drug treatment via telehealth, including a perception that telehealth was a barrier to addressing risks to consumers who use alcohol and other drugs, and difficulties working in a therapeutically beneficial way via telehealth. Telehealth is a means to reduce viral transmission through a reduction in face‐to‐face contact, and although it may be useful for some service functions, it may be detrimental to the clinical services nurses provide.
Publisher: Wiley
Date: 06-06-2023
DOI: 10.1111/INM.13180
Abstract: The 2021 release of the report from the Royal Commission into Victoria's Mental Health System suggested 65 recommendations to improve a mental healthcare system that was described as “broken”. Several of these recommendations relate to the use of restrictive interventions, such as restraint (both physical and mechanical) and seclusion. These interventions continue to be used in Victorian inpatient mental health facilities today, often in response to aggression and violence towards staff, visitors, family and other consumers. Several health services have committed to the substantial reduction or elimination of the use of restrictive interventions. In this perspective paper, we argue that significant investment is required to achieve this goal. Pressure on mental health nursing staff to cease using restrictive interventions without viable alternatives to de‐escalation, restrictions in the built environment, workforce constraints and a lack of education provided early in nursing careers need to be addressed before we can achieve the elimination of restrictive interventions. We recommend that substantial investment in mental health inpatient units, the mental health nursing workforce, and a systemic shift in the role of the mental health nurse are required to attain sustained reduction and potential elimination of restrictive interventions.
No related grants have been discovered for Adam Searby.