ORCID Profile
0000-0002-5045-0558
Current Organisation
University of Sydney
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Publisher: Wiley
Date: 14-07-2021
DOI: 10.1111/INM.12907
Abstract: The aim of this ethnographic study was to explore how a group of nine Danish people with schizophrenia managed physical health issues as they naturally occurred in everyday life. Qualitative methods were used to generate of data. Thematic analysis led to the description of two typical strategies used by participants to manage debilitating physical health issues in everyday life. Modifying everyday life to manage discomfort was a strategy employed to manage potential or actual discomfort associated with ongoing poor physical health, while retreating from everyday life to recover was a strategy used by participants who experienced recurring discrete episodes of poor physical health characterized by fast deterioration. Both management strategies were inexpedient as they failed to produce any positive progress in terms of the participants regaining health. The social context of participants’ everyday life was characterized by a lack of interactions with others about their prevailing and ongoing physical health issues. Repeated use of these inexpedient strategies to manage physical health caused potential worsening rather than improvements to physical health. There is a need for future research that explores aspects of beneficial management of physical health issues among people with severe mental illness. Relevant foci of such research include enhancing self‐management of physical health, active help‐seeking behaviours, and opportunities to engage in interactions with others about physical health issues.
Publisher: Informa UK Limited
Date: 29-09-2020
Publisher: Wiley
Date: 04-01-2011
DOI: 10.1111/J.1447-0349.2010.00708.X
Abstract: Adopting a collaborative approach within clinical relationships is illustrative of consumers' and nurses' positive beliefs, values, and attitudes towards each other and their partnership. However, for collaboration to be successful, how roles are determined, how each partner relates to the other, and how decisions are to be made need to be clearly defined and agreed upon. The research study described here utilized a mixed-method approach comprising focus groups and surveys to explore the subjective understandings, attitudes, and experiences of consumer-nurse collaboration within a mental health rehabilitation context in order to more clearly determine the conditions for successful nurse-consumer collaboration. The study found that although consumers and nurses conceptualized collaboration in similar ways, their lived experiences were disparate. A key finding of the study was that mutual recognition of each others' knowledge and expertise is needed for successful collaboration. The study reinforced the need for consumers and nurses to establish common ground on which to collaborate and to articulate the behaviours and expectations of working collaboratively. While collaboration was acknowledged as a significant and desirable basis for therapeutic relationships, it was challenged by determinants of power, such as knowledge, information, and expertise.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.INJURY.2018.01.009
Abstract: Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001. The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence.
Publisher: SAGE Publications
Date: 03-09-2020
Abstract: Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma. A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists. Three themes were identified: a power struggle between people, trauma, and psychiatry trauma is not a medical condition and serving the profession to protect society. Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.
Publisher: Wiley
Date: 18-02-2011
DOI: 10.1111/J.1447-0349.2010.00721.X
Abstract: People with serious mental illness have higher morbidity and mortality rates than general populations, and overweight/obesity-related conditions are prevalent. Psychotropic medications are a primary factor in significant weight gain. Adolescents and young adults, particularly those with first-episode psychoses taking atypical antipsychotics, are susceptible to weight gain. This paper reports findings from an integrative review of research investigating the impact and treatment of psychotropic-induced weight gain. Four databases were searched, yielding 522 papers. From these and hand-searched papers, 36 research reports were systematically classified and analysed. The review revealed people experiencing psychotropic-induced weight gain perceive it as distressing. It impacts on quality of life and contributes to treatment non-adherence. Weight management and prevention strategies have primarily targeted adults with existing/chronic illness rather than those with first-episode psychoses and/or drug naiveté. Single and multimodal interventions to prevent or manage weight gain produced comparable, modest results. This review highlights that the effectiveness of weight management interventions is not fully known, and there is a lack of information regarding weight gain prevention for young people taking psychotropics. Future research directions include exploring the needs of young people regarding psychotropic-related weight gain and long-term, follow-up studies of lifestyle interventions to prevent psychotropic-related weight gain.
Publisher: Wiley
Date: 10-07-2023
DOI: 10.1111/AJO.13733
Abstract: Women present to the emergency department (ED) with pregnancy complications including bleeding. They seek investigations, treatment and clear discharge and referral pathways. The aim was to identify trends, characteristics, ED care and discharge pathways for women who present to the ED with early pregnancy bleeding. Retrospective data (from 2011 to 2020) were extracted from a regional health district‘s databank. Data were processed, and deterministic linking was used to produce a final data set. Descriptive statistics were used to identify trends and characteristics. Linear and logistic regression models were used to identify factors that influence health service use, outcomes and discharge pathways. Over the 10 years, there have been almost 15 000 presentations to the ED for early pregnancy bleeding, from approximately 10 000 women, 0.97% of all ED presentations. The frequency of presentations increased by 19.6% over the study period. The average age of women who presented to the ED was 29.1 years, which increased from 28.5 years (2011) to 29.3 (2020). The median length of stay was less than 4 h, and most women were treated and discharged from the ED. One‐third of presentations received neither ultrasound nor pathology, but health service costs increased by 330% from 2014 to 2020. Maternal age is increasing, as is the frequency of ED presentations for early pregnancy bleeding, and both factors increase demands on the ED. Findings from this study may inform strategies to improve current care models and improve quality and safety practices within the ED.
Publisher: Wiley
Date: 13-04-2021
DOI: 10.1111/INM.12866
Publisher: Wiley
Date: 27-10-2022
DOI: 10.1111/FAMP.12832
Abstract: Open Dialogue is a collaborative approach to mental health care emphasizing integrated services and a dialogical psychotherapy approach. Open Dialogue training programs eschew traditional didactic teaching of technical therapeutic skills in favor of more experiential learning processes. It is unclear how these training programs affect trainees and shape their perspectives on Open Dialogue. Our aim was to follow up a group of Australian Open Dialogue trainees and explore their perspectives on learning processes and psychotherapeutic practice. We utilized a prospective focus group design with data from audio‐recorded focus groups convened before ( n = 2) and after ( n = 3) participants completing an advanced Open Dialogue training program. Data were subjected to reflective thematic analysis. We identified the theme “Extending possibilities by holding ideas lightly,” which represented a universal principle that participants applied to multiple aspects of their practice, for ex le, favoring multiple perspectives and approaches to therapy, including those other than Open Dialogue. This theme had two sub‐themes: (1) “Allowing intimacy by being aware of personal biographies” and (2) “Learning by joining others,” which reflected an increased willingness by participants to reflect on and share their inner experiences and an emphasis on joint experiential exercises in the training program. “Extending possibilities by holding ideas lightly” facilitated a means of incorporating a dialogical perspective into existing practices thus avoiding the potential barriers to a wholesale implementation of Open Dialogue. Findings indicated that the participants were not learning how to practice a therapeutic technique or propositional knowledge, but were socialized into a dialogical way of being.
Publisher: Wiley
Date: 17-04-2012
DOI: 10.1111/J.1466-7657.2012.00993.X
Abstract: To summarize and synthesize research that explored the experience of surviving life-threatening injury in adolescents, young persons and adults. Informed by systematic literature review strategies, a description of the experience of in iduals who survived life-threatening injury was sought by reviewing 13 studies with qualitative data on the phenomena. Data were managed using NVivo software and synthesized using thematic analysis to elicit meaning. The review synthesized a substantial number (n=273) of participant experiences of traumatic surviving life-threatening injury and revealed that during the initial 3 years following life-threatening injury, the in idual goes through a shifting, iterative process in order to reconstruct various aspects of their injury and themselves, including mental, emotional, spiritual, physical and relational facets. Three major themes were illuminated: a time of chaos, negotiating injury and reconciling injury. In order to navigate through the experience of injury, family members were key sources of affirmation and support in anchoring the person to their life, in reconstructing themselves in the aftermath of injury and in coming to terms with the impacts of injury. This qualitative synthesis describes the iterative process in iduals go through following life-threatening injury and the overwhelming need to reconstruct aspects of self as a way to create meaning. It demonstrates the need to gain further understanding of the influence of the family in recovery from injury and indicates that education is required to provide practical strategies to assist clinicians to develop appropriate and relevant patient goals and expectations.
Publisher: Wiley
Date: 24-01-2014
DOI: 10.1111/ANS.12524
Abstract: To determine the incidence and characteristics of major traumatic injury treated in the Australian Capital Territory (ACT) over a 5-year period. A retrospective analysis of ACT Level 1 Trauma Centre registry data from July 2007 to June 2012 was conducted. Inclusion criteria were: major trauma (Injury Severity Score (ISS) >15), intensive care unit admission, hospital stay >3 days or penetrating injury. There were 931 patients with an ISS >15, a 12.5% increase over the 5-year period (P = 0.003). Unadjusted mortality rates in the ISS >15 group remained stable at 9.9%. About half of all injuries occurred outside the ACT. The largest age group represented was 16-24 years. Road trauma was the most prevalent injury mechanism, but its incidence reduced over the 5-year period (52.2-40.3% [P = 0.005]). There was a 3.1% increase in admissions following violence. The largest demographic affected by major trauma in the ACT and surrounds is young people. Injury prevention should remain focused on road trauma but also target violence and high-risk recreation activities. Further investigation around the circumstances of major traumatic injury in young people is required. Funding and cross-border agreements should be reviewed to minimize financial disadvantage to the ACT.
Publisher: Wiley
Date: 12-2019
DOI: 10.1002/ANZF.1387
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.INJURY.2020.01.017
Abstract: To provide effective care and promote wellbeing and positive outcomes for parents and families following paediatric critical injury there is a need to understand parent experiences and psychosocial support needs. This study explores parent experiences two years following their child's critical injury. This multi-centre study used an interpretive qualitative design. Parent participants were recruited from four paediatric hospitals in Australia. Semi-structured interviews were audio recorded and transcribed verbatim. Qualitative data were thematically analysed and managed using NVivo 11. Twenty-two parents participated. Three themes were identified through analysis: Recovering from child injury Managing the emotional impact of child injury Being resilient and finding ways to adapt. A long-term dedicated trauma family support role is required to ensure continuity of care, integration of support and early targeted intervention to prevent long-term adverse outcomes for critically injured children and their families. Early and ongoing psychosocial intervention would help strengthen parental adaptation and address families' psychosocial support needs following child injury.
Publisher: Wiley
Date: 26-04-2012
DOI: 10.1111/J.1447-0349.2011.00796.X
Abstract: Physical health in people with mental illness is often compromised. Chronic physical conditions and disease risk factors occur at higher rates than in the general population. Although substantial research exists regarding mental-physical comorbidities in middle to older-aged adults and mental illness consequential to childhood physical illness, research addressing physical health in young people/emerging adults of 16-24 years with primary mental illnesses is minimal. Health problems often track from youth to adulthood, indicating a need to better recognize and understand the overall health of young people with mental illness. This paper reports findings from an integrative review of published research investigating physical health of emerging/young adults with mental illness. A total of 18 research papers were systematically analysed. The review found that comorbid mental-physical illness/conditions were evident across a wide age span. Specific physical health problems, including pain, gastrointestinal, and respiratory disorders, were apparent in those 16 years to those in their mid-late 20s, and/or with first episode psychosis. Lifestyle risk factors for cardiometabolic disorders occurred with some frequency and originated prior to adulthood. These findings highlight the need for targeted health screening and illness prevention strategies for emerging/young adults with mental health problems and draws attention to the need for young people to be supported in their health-care behaviours.
Publisher: Wiley
Date: 09-02-2016
DOI: 10.1111/INM.12189
Abstract: Compromised physical health and raised levels of morbidity and mortality are experienced by young people (16-24 years) with mental illness, and are compounded by psychotropic medication. How this group conceives and experiences physical health is not well understood. We investigated the meanings, beliefs, and endeavours of young people that impact their physical health understandings and behaviours. The present study formed the qualitative phase of a sequential mixed-methods study, and incorporated semistructured interviews with 12 hospitalized young people. Qualitative content analysis was used to analyse data. Participants held a holistic ideal of physical health that they did not meet. Weight change, poor sleep, and limited exercise adversely impacted their lives and self-image. Sedentary behaviour, reduced energy, and limited health literacy compromised effective management of physical health. Young people needed structure and support to assist them in addressing their physical health needs when amotivation overwhelmed their internal resources. Nurses are well placed to help young people increase their competency for health management. In idualized information and methods to promote good physical health are required for this group in jeopardy from physical morbidity and mortality.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.AUEC.2021.04.003
Abstract: To determine the incidence, characteristics (including timeframe) and predictors of patients discharged from the Emergency Department (ED) that later return and require admission. A retrospective cross-sectional study examining all return visits to three EDs in Sydney, Australia, over a 12-month period. Patients returning within 28 days from ED discharge with the same or similar complaint were classified as a return visit to ensure capture of all return visits. Descriptive and inferential statistics were used to analyse the data and logistic regression was performed to predict factors associated with return visits with general admission, and return visits admitted to critical care. There were 1,798 (30%) return visits which resulted in admission, mostly to a non-critical care area (1,679, 93%). The current NSW 48 -h time frame used to define a return visit in NSW captured half of all admitted returns (49.5%) and just over half (59.2%) of critical care admissions. Variables associated with an admission to critical care were age (OR 1.02, 95% CI 1.01, 1.03), initial presentation (index visit) made to a lower level ED (OR 3.76 95% CI 2.06, 6.86), Triage Category 2 (OR 3.67 95% CI 2.04, 6.60) and a cardiac diagnosis (OR 5.76, 95% CI 3.01, 11.01). This model had adequate discriminant ability with AUROC = 0.825. A small number of return visits result in admission, especially to critical care. These patients are at risk of poor outcomes. As such, clinicians should have increased index of suspicion for patients who return that are older, present with cardiac problems, or have previously presented to a lower level ED. Revision of the current timeframe that defines a return visit ought to be considered by policy makers to improve the accuracy of this widely used key performance indicator.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.NEDT.2018.04.001
Abstract: Healthcare students can experience high levels of stress. Emotional intelligence can moderate stress and increase wellbeing however there has been no prior research on the relationship between emotional intelligence and stress in Australian healthcare students. To measure emotional intelligence (EI) and perceived stress (PS) in final year healthcare students (nursing, pharmacy and dentistry), and to explore the relationships between EI, PS and discipline. A cross sectional survey of pre-registration healthcare students at a metropolitan university in Australia. 203 pre-registration final year healthcare students (n = 58 nursing n = 112 pharmacy n = 34 dentistry). Emotional Intelligence was measured using the GENOS Emotional Intelligence Inventory (Concise Version) and stress was measured using the Perceived Stress Scale (PSS). A significant negative correlation was found between EI and PS in nursing and pharmacy students. No difference was found in EI across disciplines. Mean EI scores were lower than normative means. PS was significantly higher than the normative mean for pharmacy and dentistry students and higher than nursing students. Emotional intelligence can have a protective effect against stress for healthcare students and can be increased via targeted educational interventions. To support student wellbeing there is a clear need for pre-registration healthcare curricula to include educational components on strengthening EI.
Publisher: Wiley
Date: 04-08-2006
DOI: 10.1111/J.1447-0349.2006.00416.X
Abstract: Collaborative research activities are increasingly being used across health-care settings and are viewed as a positive way to achieve mutual outcomes. However, interagency or intersectoral research programmes are not without problems. They are, at best, challenging and complex activities that require enormous commitment of resources, expertise and insight from all stakeholders. This paper uses the ex le of an actual collaborative research project to illustrate factors that can impair collaboration and in turn negatively impact on intersectoral research outcomes. It is anticipated that an honest description of those events and issues that adversely affected the programme presented here, and examination of the associated literature, will serve as a guide to others embarking on similar collaborative endeavours. This paper does not attempt to provide a full review of the comprehensive range of literature about collaboration and collaborative research rather, it presents some key themes identified as having the potential to impact on the success of collaborative research projects. Key themes acknowledged by the authors as influencing the progress of the research project highlighted here are communication, environment, politics and power, and organizational culture.
Publisher: Informa UK Limited
Date: 12-2001
Abstract: Although contemporary nursing literature urges clinicians to embrace the principles of evidence-based practice and utilise research to guide professional activity, this challenge has frequently gone unheeded by mental health nurses. Indeed the reality of merging research and practice is a complex process impeded by significant barriers. Examination of these barriers provides credible reasonfor mental health nurses' slow progress toward evidence-based nursing practice to date. However, exploration of these barriers also leads to the identification of strategies to overcome them, inevitably rendering the current situation untenable.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.IENJ.2021.101125
Abstract: Unplanned return visits to the emergency department (ED) have been associated with adverse outcomes and may reflect the quality of care delivered. Several studies speculate the reasons for return and suggest clinician behaviour as potentially influencing a patient's decision to return to the ED. There is little research about this issue from the clinician's perspective, which is necessary to inform future practice improvement. A descriptive cross sectional design was employed to ascertain perspectives on identification and management of return visits occurring within 48 hours of discharge. An electronic survey was distributed to all medical, nursing, and clerical staff at one ED. Descriptive statistics were used for quantitative data and content analysis was performed on textual data. Results were categorised as barriers or facilitators, then mapped to the Theoretical Domains Framework. A response rate of 59.7% (n=86/144) was achieved. Staff reported increased levels of concern for this patient group but not all staff were aware of the policy for managing return patients (40.7%). Five barriers and three facilitators were identified that mapped to eight influencers of behaviour including knowledge, memory and environmental factors. Overall, staff were aware of return patients but lacked familiarity with policy and processes to identify and commence relevant protocols. Further review of current practice as well as the patient perspective is required before any intervention to improve practice is developed.
Publisher: Wiley
Date: 11-11-2009
DOI: 10.1111/J.1440-1800.2009.00451.X
Abstract: Mentoring relationships occur across a range of nursing contexts and are shown to have multiple, favourable personal and professional outcomes. Specifically, mentoring has been associated with the development of nurse leaders. This study describes features that are integral to initiating mentoring relationships that focus on nursing leader development. These significant features are addressed in relation to the nursing literature. Thirteen nurse leaders from eastern states of Australia were interviewed during 2005 and 2006 about their understanding and experiences of mentoring for leadership. Their narratives were analysed using a hermeneutic phenomenological methodology. Mentoring relationships for nurse leadership were revealed as developing from esteemed connections between two people. Mentors were shown to unconditionally ch ion their mentee's careers, and mentees were shown to possess a leadership vision for nursing. The findings of this study have implications for establishing mentoring relationships for nurse leader development. Consideration should be given to the specific focus and context of these relationships to ensure that the full potential of the mentoring process is realised. It is also important to better understand the key aspects that contribute to the phases of mentoring relationships for nurse leader development because they are shown to influence the dynamic and function of these relationships over time.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.NEDT.2014.11.009
Abstract: To investigate the state of knowledge on emotional intelligence (EI) education in pre-registration nursing programmes. Integrative literature review. CINAHL, Medline, Scopus, ERIC, and Web of Knowledge electronic databases were searched for abstracts published in English between 1992-2014. Data extraction and constant comparative analysis of 17 articles. Three categories were identified: Constructs of emotional intelligence emotional intelligence curricula components and strategies for emotional intelligence education. A wide range of emotional intelligence constructs were found, with a predominance of trait-based constructs. A variety of strategies to enhance students' emotional intelligence skills were identified, but limited curricula components and frameworks reported in the literature. An ability-based model for curricula and learning and teaching approaches is recommended.
Publisher: Wiley
Date: 03-07-2017
DOI: 10.1111/JOCN.13792
Abstract: To identify barriers to adherence with prescribed analgesic regimens in recently discharged trauma patients. Trauma pain severely interferes with the life of healthy and often working in iduals with intense and enduring pain experienced at home following discharge. The reasons for this are unclear considering discharge information (including discharge referral letters and nursing discharge checklists) and analgesics (scripts and/or medication) are routinely provided to patients at hospital discharge. A prospective exploratory study. Between July-December 2014, 82 recently discharged adult trauma patients completed a questionnaire about their injury-related pain and pain management experiences posthospital discharge from a level one trauma centre. For 77 of these participants, medical records were reviewed for documentation regarding pain, analgesic consumption and hospital discharge processes. Sixty-five participants (84%) consumed opioids prior to discharge, with two-thirds (65%) of these participants given a script for and/or opioid medication at hospital discharge. Of the 77 participants who took analgesics following discharge, 26 (34%) indicated they had experienced side effects and 16 (21%) used pain medication not prescribed by a doctor. Whilst it was documented that discharge letters were given to 25 participants (32%) at discharge and 13 participants (17%) had completed nursing discharge checklists, these participants reported the lowest pain severity and interference scores postdischarge. Insufficient information and analgesics given to trauma patients at hospital discharge and inconsistent and incomplete discharge processes fail to equip trauma patients to effectively manage their pain at home. It is crucial that nurses and other healthcare professionals are aware of and actively contribute to correct and complete discharge processes. Effective patient and hospital facilitators can contribute to good pain management practices amongst recently discharged trauma patients, which will thereby improve the functional outcomes of this patient population.
Publisher: Wiley
Date: 17-08-2022
Abstract: Open Dialogue is an alternative approach to service provision for people experiencing mental health problems. Training and implementation of dialogical ways of working require that professionals disposition themselves as experts and ‘unlearn’ traditional therapeutic relations. This study explored trainees’ discussions of their expectations of Open Dialogue as they commence their training. Four focus groups, two in Australia and two in Denmark, were analysed thematically. We generated the theme ‘shared concern’ with four sub‐themes: (1) ‘A democratising alternative’, (2) ‘Waiting and listening’, (3) ‘Acknowledging many kinds of expertise’ and (4) ‘Personal participation’. Rather than learning a therapeutic technique, ‘shared concern’ in dialogical practices emphasised a collaborative approach to manage ubiquitous uncertainty and a political commitment to addressing inequities in service delivery. This variance from usual reasons to undertake training has implications for course design and delivery that have yet to be considered. The theme ‘shared concern’ was generated from across the focus groups, which was well aligned with the doxa of Open Dialogue Trainees emphasised their experience of Open Dialogue as a moral counterapproach to traditional healthcare with less emphasis on the actual psychotherapeutic practices
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Publisher: SAGE Publications
Date: 27-11-2021
Abstract: This article explores the implementation of an innovative approach to mental health care in a private health setting. Open Dialogue is a recovery-oriented approach to mental health that emerged in Finland, which emphasises family involvement, interdisciplinary collaboration and a flexible, needs-adapted approach. Early research is promising however, little research has explored Open Dialogue outside Finland. This study aimed to explore the introduction of this approach at a private, inpatient young-adult mental health unit in Australia. Drawing on data from a long-term ethnographic field study that included 190 hours of observation and qualitative interviews, the findings show that despite staff members being inspired by and supportive of Open Dialogue, the existing ideology and organisational structures of the unit conflicted with the integration of Open Dialogue principles. Dialogical ways of working were challenged by medical dominance and emphasis on economic efficiencies. This study emphasises the importance of a ‘good’ fit between organisational cultures and innovations. It also highlights the challenges of moving towards recovery-oriented and family-focused models of care in the Australian neoliberal health care context. There is a need for organisational and ideological change in health services that is receptive to, and meaningfully supports, efforts to implement recovery-oriented care.
Publisher: Wiley
Date: 29-09-2021
DOI: 10.1111/JMFT.12457
Publisher: Wiley
Date: 25-03-2018
DOI: 10.1111/INM.12457
Abstract: Open Dialogue is a resource-oriented approach to mental health care that originated in Finland. As Open Dialogue has been adopted across erse international healthcare settings, it has been adapted according to contextual factors. One important development in Open Dialogue has been the incorporation of paid, formal peer work. Peer work draws on the knowledge and wisdom gained through lived experience of distress and hardship to establish mutual, reciprocal, and supportive relationships with service users. As Open Dialogue is now being implemented across mental health services in Australia, stakeholders are beginning to consider the role that peer workers might have in this model of care. Open Dialogue was not, initially, conceived to include a specific role for peers, and there is little available literature, and even less empirical research, in this area. This discussion paper aims to surface some of the current debates and ideas about peer work in Open Dialogue. Ex les and models of peer work in Open Dialogue are examined, and the potential benefits and challenges of adopting this approach in health services are discussed. Peer work in Open Dialogue could potentially foster democracy and disrupt clinical hierarchies, but could also move peer work from reciprocal to a less symmetrical relationship of 'giver' and 'receiver' of care. Other models of care, such as lived experience practitioners in Open Dialogue, can be conceived. However, it remains uncertain whether the hierarchical structures in healthcare and current models of funding would support any such models.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.INJURY.2015.05.036
Abstract: The aim of this qualitative study was to explore how young people aged 16-24 years' experience, perceive and manage the effects of major traumatic injury during the initial six months following major traumatic injury. Specifically: (1) how do young people manage the physical and emotional effects of major injury within the trauma system of care? (2) What are young peoples' perceived needs for healthcare and how are these met within the trauma system of care? (3) What do young people perceive as the role of family in supporting them? This study forms part of the qualitative follow-up phase of an explanatory sequential mixed methods study investigating the characteristics and experience of major traumatic injury for young people 16-24 years, and the role of family in supporting them, in the initial six months following injury. The paper reports on young peoples' (aged 16-24 years) experiences of being admitted with major traumatic injury to two Australian Level 1 Trauma Centres. Twelve injured young people aged 17-23 years (mean=19 years) participated in the study. Two semi-structured in-depth interviews with young people were conducted and transcribed verbatim the first prior to hospital discharge (n=12), and the second (n=7) within 3 months of hospital discharge. Data were managed using NVivo software, and thematically analysed. During the initial 6 months following injury, young people experienced a complex process of adaptation involving feelings of vulnerability and loss of control over their physicality, environment and life-course. Self-management strategies included use of Information technology as a form of distraction family and friends to create a sense of familiarity and normality and information and validation-seeking from health care professionals as a means of understanding and regaining a sense of self. Key elements of resilience theory applicable to the findings such as problem-based coping, self-efficacy and strong social support offer a useful framework for anticipatory guidance that is responsive to the psychosocial needs of injured young people and facilitates a strength-based patient-centred approach to managing major traumatic injury.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Informa UK Limited
Date: 03-10-2015
DOI: 10.3109/01612840.2015.1036480
Abstract: Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16-25 years) Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples' well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.
Publisher: Wiley
Date: 28-06-2017
DOI: 10.1111/JOCN.13865
Abstract: To identify challenging interpersonal interactions experienced by nursing and pharmacy students during clinical placement, and strategies used to manage those situations. Healthcare students and staff experience elevated stress when exposed to dynamic clinical environments, complex care and challenging professional relationships. Emotionally intelligent behaviours are associated with appropriate recognition and management of emotions evoked by stressful experiences and development of effective relationships. Nursing and pharmacy students' use of emotionally intelligent behaviours to manage challenging interpersonal situations is not well known. A qualitative design, using semi-structured interviews to explore experiences of challenging interpersonal situations during clinical placement (Phase two of a larger mixed-methods study). Final-year Australian university nursing and pharmacy students (n = 20) were purposefully recruited using a range of Emotional Intelligence scores (derived in Phase one), measured using the GENOS Emotional intelligence Inventory (concise version). Challenging interpersonal situations involving student-staff and intrastaff conflict, discourteous behaviour and criticism occurred during clinical placement. Students used personal and relational strategies, incorporating emotionally intelligent behaviours, to manage these encounters. Strategies included reflecting and reframing, being calm, controlling discomfort and expressing emotions appropriately. Emotionally intelligent behaviours are effective to manage stressful interpersonal interactions. Methods for strengthening these behaviours should be integrated into education of nursing and pharmacy students and qualified professionals. Education within the clinical/workplace environment can incorporate key interpersonal skills of collaboration, social interaction and reflection, while also attending to sociocultural contexts of the healthcare setting. Students and staff are frequently exposed to stressful clinical environments and challenging interpersonal encounters within healthcare settings. Use of emotionally intelligent behaviours to recognise and effectively manage these encounters may contribute to greater stress tolerance and enhanced professional relationships. Nursing and pharmacy students, and their qualified counterparts, need to be educated to strengthen their emotional intelligence skills.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.INJURY.2019.01.026
Abstract: Efforts to improve teamwork in trauma include simulation-based team training with a non-technical skills (NTS) focus. However, there is a lack of evidence to inform the development of team training programs for maximum uptake of NTS in clinical practice. This descriptive paper aims to evaluate the extent NTS were practiced by the trauma team in a Level 1 trauma hospital after NTS training and to identify facilitators and barriers to use of NTS in clinical practice. A 38-item questionnaire targeting clinicians who attended a simulation based multidisciplinary Trauma Team Training program was developed. The questionnaire was developed using the Theoretical Domains Framework, a validated tool to identify what practices need to change. It included questions on the current practice of NTS in real life trauma resuscitation. Eighty six of 235 eligible participants (rate 37%) responded to the questionnaire. All relevant professions and clinical services were represented. There were 15 facilitators and 12 barriers identified. Barriers and facilitators were allocated to categories of factors known to influence trauma team practices. These were: (1) organisational factors that influence the trauma team, (2) team factors that influence teamwork and (3) cognitive factors that influence team decision making. NTS were being used by frontline clinicians in real world trauma resuscitations to varying degrees, depending on organisational, team and cognitive facilitators and barriers. Facilitators to the implementation of NTS skills during trauma emergencies included team composition, roles and responsibilities, procedural compliance and leadership. Barriers included decision making and communication. This study described team members experience of using NTS in 'real world trauma resuscitation' to inform future team training interventions.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.INJURY.2016.04.037
Abstract: Adolescents and young people are the population at greatest risk of injury and therefore injury-related mortality and morbidity. Inquiry into the injury trajectory of young people is needed to identify this group's specific needs for healthcare. This paper reports the integration of quantitative and qualitative findings from a sequential explanatory mixed methods study examining young people aged 16-24 years' experience and trajectory of traumatic physical injury in the initial six months. The aim of integration was to address the question: In what ways are injured young peoples' experiences and self-management during the initial six months of the injury trajectory impacted by their injury, family support, and provision of healthcare? Key findings from epidemiological datasets on young person injuries from hospital and coronial databases (Phase 1) were combined with key findings from qualitative interviews with 12 injured young people and 10 family members (Phase 2). The integration of findings from Phase 1 and Phase 2 resulted in three new findings [1] (Alfred Health, 2014). A young person's perception of the severity of their injury, as well as the amount of time spent in hospital, impacts substantially on the way in which they experience injury, and this is managed differently between genders [2] (Newnam et al., 2014). Admission to an Intensive care unit, including the intensity and duration of care, is the primary influence on how a family will provide support to the young person in the inpatient period and [3] (Lyons et al., 2010). Young people's perception and understanding of their recovery from injury is in contrast with how healthcare systems are structured to provide rehabilitation and recovery care. The injury trajectory and recovery process of young people in the six months following injury have been have conceptualised. These trajectories of recovery can inform the development of anticipatory guidance frameworks for clinicians and guide the provision of and planning for clinical services for injured young people.
Publisher: Informa UK Limited
Date: 10-2006
DOI: 10.5172/CONU.2006.23.1.120
Abstract: There are a variety of structured and unstructured supportive relationships available to nurses. Internationally, nurses commonly use preceptorship, clinical supervision, and mentorship to meet distinct needs and provide differing levels of commitment, intensity, and enabling functions. Of particular interest to the nursing profession is the use of mentoring relationships to support nurses in achieving leadership positions. In Australia, preceptorship and clinical supervision are freely used and understood by nurses however, mentoring relationships are less readily applied, and agreed meanings and understanding are lacking. This paper will explore the range of supportive relationships available to nurses. The terms used to define and describe these relationships, and how these relationships are contextualised, will be explored in order to better understand the position of mentorship for nurses in Australia. The potential value of mentorship in developing nursing leadership in Australia will also be identified.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2019
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.INJURY.2015.03.030
Abstract: The aim of this study was to explore how family members perceive and support young people with traumatic physical injury during the acute phase of hospital care. This study forms part of the qualitative explanatory follow-up phase of a mixed methods study. The paper reports on family members' experiences of providing support to young people 16-24 years admitted with major traumatic injury to an Australian Level 1 Trauma Centre. Semi-structured in-depth interviews with family members were conducted and transcribed verbatim. Data were managed using NVivo software, and thematically analysed. Family support was determined by how family members perceived the injury. Driven by a need to protect the injured young person, family members sought to control potential emotional impacts of injury, creating a buffer between the young person and other people including healthcare professionals. Family members safeguarded the psychological well-being of the young person, in an attempt to facilitate their transition back to independence. This study identifies iterative changes in family relationships and emotional and practical support provided by family members during the initial injury trajectory, extending understandings of the broader burden of injury. Key elements of family stress theory offer a useful framework for the development of anticipatory guidance for clinicians that are responsive to the emotional needs of patients and families, supporting the need for a family-centred care approach to managing major traumatic injury in young people.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Wiley
Date: 28-07-2021
DOI: 10.1111/FAMP.12695
Abstract: Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health‐care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members’ experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille’s (Professions and professionalisation, 1970, Cambridge University Press, 109‐152) concepts of “indeterminacy” and “technicality,” and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.INJURY.2019.05.003
Abstract: The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child's injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months and distressed trajectory where parents experienced significant psychosocial disruption due to their child's injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families' psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child's admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
DOI: 10.1097/JTN.0000000000000273
Abstract: The long-term implications of pain following injury are well known however, the immediate posthospitalization incidence and impact of pain is less understood. Inadequate pain relief during this time can delay return to work, leading to psychological stress and chronic pain. This exploratory study aimed to identify the incidence, intensity, and impact of injury-related pain in recently discharged adult trauma patients. During July to December 2014, 82 recently discharged adult trauma patients completed a questionnaire about their injury-related pain experience approximately 2 weeks posthospital discharge from a Level 1 trauma center. The questionnaire was developed using the Brief Pain Inventory, assessing severity, and impact of pain through a score from 0 to 10. The average age of participants was 52 years, the median Injury Severity Score was 6, and almost all ( n = 80, 98%) experienced a blunt injury. The majority of participants reported pain since discharge ( n = 80, 98%), with 65 (81%) still experiencing pain on the day of data collection. Normal work was most affected by pain, with an average score of 6.6 of 10, closely followed by effect on general activity (6.1 of 10) and enjoyment of life (5.7 of 10). The highest pain severity was reported by those with injuries from road trauma, with low Injury Severity Scores, who were female, and did not speak English at home. Pain in the recently discharged adult trauma patient is common, intense and interferes with quality of life. Identification of barriers to effective pain management and interventions to address these barriers are required.
Publisher: Wiley
Date: 15-11-2005
DOI: 10.1111/J.1440-0979.2005.00394.X
Abstract: A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper.
Publisher: Wiley
Date: 20-03-2014
DOI: 10.1111/CFS.12143
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.AUEC.2018.12.003
Abstract: Unplanned return visits account for up to 5% of Emergency Department presentations in Australia and have been associated with adverse events and increased costs. A large number of studies examine the incidence, characteristics and outcomes of unplanned return visits but few studies examine the reasons for return from a patient perspective. The objective of this integrative review was to determine the incidence, characteristics, outcomes and reasons for unplanned return visits to Emergency Departments. An integrative literature review design was employed to conduct a structured search of the literature using the databases CINAHL, MEDLINE, PubMed, ProQuest and EMBASE (inception to June 2018). Results were screened using predefined criteria and final studies collated and appraised using a quality assessment tool. Fifty-two primary research articles were included in the review. The timeframe used to capture unplanned return visits varied and the incidence ranged between 0.07% and 33%. The majority of patients who return unplanned to the Emergency Department are subsequently discharged (51% and 90%) without an adverse event. There is no consensus on the timeframe employed to classify unplanned return visits to the Emergency Department and the commonly used 72h lacks evidence. Routine statewide data linkage to capture return visits to other facilities is needed to ensure accurate data about this vulnerable patient group. Further research that focuses on patient and clinician perspectives is required to facilitate the development of local strategies to reduce the incidence of avoidable unplanned return visits.
Publisher: Springer Science and Business Media LLC
Date: 27-01-2012
DOI: 10.1038/NG.1054
Publisher: Springer Science and Business Media LLC
Date: 18-05-2023
DOI: 10.1007/S10597-022-00984-0
Abstract: Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine in idual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles.
Publisher: Informa UK Limited
Date: 19-10-2021
DOI: 10.1080/01612840.2021.1986758
Abstract: The aim of this prospective case study was to explore clients' and social network members' responses to participating in a newly implemented Open Dialogue approach in an Australian early intervention in psychosis treatment context. We followed four clients' trajectories through treatment by drawing on data from electronic medical record entries, observed or audio-recorded network meetings, and client and family interviews. Data were analysed thematically. Clients and families generally appreciated the Open Dialogue approach, even though it created hard practical and psychosocial work for them before, during and in between meetings. We discuss the increased workload as responsibilization of families.
Publisher: Wiley
Date: 20-02-2019
DOI: 10.1111/JOCN.14230
Abstract: To explore the pain management experiences of recently discharged adult trauma patients and the discharge practices of the treating hospital. Adult trauma patients are not always able to manage their pain effectively and as a result often experience intense and enduring injury pain at home. They describe their pain experience as unique and debilitating, and report feeling uninformed at hospital discharge. There is a need to understand what is fundamentally required for this population at hospital discharge, to facilitate competent pain management and promote best possible outcomes. A mixed methods convergent study design. The quantitative results (incidence, intensity and impact of injury pain and the barriers to effective pain management) were merged with the qualitative results (patient experiences and beliefs) to produce greater understanding about the reasons behind the pain management practices of participants. Integration of the quantitative and qualitative data produced four new themes. These themes demonstrate that recently discharged adult trauma patients do not have the knowledge or experience to understand or manage their injury pain effectively at home. Inadequate information and education by clinicians, at hospital discharge, contribute to this insufficiency. Clinicians need to understand the trauma patient pain experience to appreciate the importance of their discharge practices. Increased understanding and implementation of evidence-informed discharge processes would improve current discharge practices and ultimately support and improve the trauma patient's injury pain management practices at home. By understanding the patient perspective in the pain management of injuries, clinicians are better able to appreciate what hospital discharge practices and information are genuinely required by the trauma patient to manage their pain effectively at home, potentially preventing the long-term consequences of injury pain.
Publisher: Wiley
Date: 15-05-2003
DOI: 10.1046/J.1440-0979.2003.00278.X
Abstract: Despite a fall in smoking activity among the general population, in iduals with schizophrenia continue to smoke at alarming rates and suffer poor health as a consequence. It would appear that limited and conflicting knowledge, outdated perceptions, and ineffective interventions have hindered efforts to promote healthy behaviours among this group. This paper reviews the literature on the association between nicotine dependence and schizophrenia and explores explanations for the phenomenon. Complex psychopathological, biochemical, and neuropharmacological interactions between smoking and schizophrenia are revealed. The interface of schizophrenia and smoking behaviour, particularly among those hospitalized in mental health facilities, and rationales for the management of this manifestation are examined. In addition, inferences regarding the role of mental health nurses in the care of this population are reached, and implications for nursing practice are discussed.
Publisher: Wiley
Date: 26-12-2014
DOI: 10.1111/NIN.12053
Abstract: Mentorship, often viewed as a central capacity of leadership, is acknowledged as influential in growing nurse leaders. Mentoring relationships are perceived as empowering connections offering a dynamic guided experience to promote growth and development in personal and professional life. A hermeneutic phenomenological approach informed by H eidegger and G adamer was used to explore understandings and experiences of mentorship for nurse leadership by 13 Australian nurse leaders. We found that learning and transformation associated with becoming a nurse leader mentor was experienced as an enduring evolutionary process. Participants' life journeys provided experiences that developed their understandings and established their personal identity as a leader and mentor. We considered the journey motif in terms of its inextricable connection with lived time and used H eidegger's ecstasies of temporality as a lens to understand how the temporal dimensions of past, present and future influenced and shaped the development of nurse leader mentors. We found that our temporal existence influences interpretation of ourselves and the world. In iduals can benefit from multiple separate mentoring interludes, with different mentors, over a lifetime. For some nurses, becoming a leader and mentor is a lifelong transformative process that grows from erse experience and influential role modelling rather than formal instruction.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.INJURY.2017.09.027
Abstract: Pain following injury is often intense, prolonged and debilitating. If poorly managed, this acute pain has the potential to delay rehabilitation and lead to chronic pain. Recent quantitative Australian research recommends implementing further information and interventions to improve trauma patient outcomes, however, to ensure effectiveness, exploration of the patient perspective is imperative to ensure the success of future pain management strategies. This study aimed to gain understanding about the experience of pain management using prescribed analgesic regimens of recently discharged adult trauma patients. Semi-structured interviews were used to explore the experiences and understandings of trauma patients in managing pain using prescribed analgesic regimens during the initial post-hospital discharge period. Twelve participants were purposively selected over a 6-month period at a level one trauma outpatient clinic based on questionnaire responses indicating pain related concerns. Qualitative data were thematically analysed. The overarching finding was that injuries and inadequate pain management incapacitate the patient at home. Four main themes were developed: injury pain is unique and debilitating patients are uninformed at hospital discharge patients have low confidence with pain management at home and patients make independent decisions about pain management. Patients felt they were not given adequate information at hospital discharge to support them to make effective decisions about their pain management practices at home. There is a need for more inclusive and improved hospital discharge processes that includes patient and family education around pain management following injury. To achieve this, clinician education, support and training is essential.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.AUEC.2018.11.003
Abstract: Effective teamwork is imperative in the emergency trauma setting as trauma teams work in the uncertain and complex context of resuscitating critically injured patients. Poorly performing teams have the potential to contribute to adverse events. Efforts to improve teamwork in trauma include simulation-based multidisciplinary team training with a non-technical skills (NTS) focus. However, there is a lack of evidence linking teamwork training programs with the uptake of NTS in real life trauma resuscitations. The aim of this study was to understand trauma team members' perspectives and experiences of teamwork in real world trauma resuscitations at a Level 1 Trauma Hospital, following completion of a simulated multidisciplinary Trauma Team Training (TTT) program. Semi-structured interviews were used to explore trauma team members' experiences and perspectives of the impact of TTT on the team's performance. Trauma team members who had completed TTT were invited to participate in the study. Fifteen participants from various disciplines (nursing, medical, allied health) and specialities (emergency, intensive care, trauma, anaesthetics, allied health) were interviewed. Qualitative data were thematically analysed. The overarching finding was that teamwork was the essential component to facilitate a group of skilled experts to collectively perform at an optimum level in emergency trauma care. Four main themes were developed: Leader-follower synergy promotes trauma teamwork Instability and inconsistency threaten trauma teamwork Clear communication enhances trauma team decision-making and Team training improves trauma team performance. A quickly constructed specialty team with unstable membership, will not transform naturally into an expert trauma team. The creation and maintenance of effective trauma teams requires training strategies such as multidisciplinary simulation that target team training and team interaction. Specifically, training should focus on developing non-technical skills for resuscitation trauma teams that have to form quickly and function effectively, often having never met before. As participants were overwhelmingly female, the data generated by this study are not necessarily generalisable to male members of trauma teams.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.PMN.2015.12.001
Abstract: Trauma is defined as injuries to tissue and organs resulting from mechanical, thermal, chemical, or electrical mechanisms. There is evidence to suggest that patients admitted to hospital for their injuries do not adhere to prescribed analgesic regimens once discharged however, the causes and potential solutions of this have not been fully explored. Patients who have inadequate pain relief also experience delayed return to work, psychological stress, disability, and chronic pain. To identify causes of and solutions to analgesic regimen nonadherence in recently discharged trauma patients. Integrative literature review. A systematic search using electronic databases (PsycINFO Embase CINAHL Medline) and hand-searching methods, using the terms "analgesics," "pain," "trauma," and "discharge," was conducted for the period 1990 to 2014. Review/Analysis Methods: Following a systematic screening process, the included articles were analyzed and synthesized to identify patterns, variations, and relationships. Twenty-four primary research articles were examined and three main categories were identified: pain is a common and enduring experience in recently discharged trauma patients, postdischarge analgesics are inadequately prescribed and poorly used, and inadequate discharge information inhibits adequate analgesic use. Reasons for poor analgesic adherence in the trauma outpatient population are not well understood and there is a paucity of solutions to address this problem. Research to inform the design of an evidence-based patient discharge process and patient information tools would address this evidence-practice gap.
Publisher: Wiley
Date: 08-2008
DOI: 10.1111/J.1447-0349.2008.00545.X
Abstract: Nursing handover is an established practice that involves an interchange of information between nurses to inform of the condition of patients. It is essential to nursing practice in terms of continuity and quality of patient care. However, there is a lack of agreement about the quality, content, and process of handover and, in particular, a lack of information specific to mental health contexts. This paper reports the results of exploratory research of the practice and beliefs about verbal nursing handover within an inpatient mental health rehabilitation setting. Qualitative data were obtained from audiotaped handovers and interviews with nurses and analysed using content analysis. Handovers were found to lack structure and content, be retrospective, problem-focused and inconsistent. The findings were fairly consistent with the literature and would likely be applicable across nursing settings however, the need to appraise nursing handover in unique contexts was also revealed. The study raised questions about how nursing handover reflects the goals and philosophies of mental health rehabilitation and whether nursing handover is an activity fully integrated with the focus of mental health rehabilitation.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.AUEC.2021.04.006
Abstract: Bleeding in early pregnancy occurs in approximately a quarter of all pregnancies and is a common reason for presentation to the Emergency Department (ED). This review combined current knowledge about experiences, interventions, outcomes and frequency of women presenting to the ED with per vaginal (PV) bleeding in the first 20 weeks of pregnancy. This integrative literature review was conducted using electronic database and hand searching methods for primary research published from 2000 followed by screening and appraisal. Articles were compared and grouped to identify characteristics and patterns that guided the synthesis of categories. Forty-two primary research articles met inclusion criteria. Four main categories related to experiences and outcomes of women with bleeding in early pregnancy presenting to the ED were identified: presentation frequency and characteristics women and their partners' experiences in the ED interventions and treatments patient and health service outcomes. Negative and often frustrating experiences are reported by women experiencing PV bleeding, their partners and ED healthcare providers. While strategies such as early pregnancy assessment services contribute to improved outcomes, the availability of these services vary. Further research is needed to identify specific needs of this group of women and their partners, and the staff providing their care in the ED, to inform strategies for improved quality of care.
Publisher: Wiley
Date: 27-01-2023
Abstract: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. The aims of this study are to describe the co‐design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co‐develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery‐Oriented Practice Questionnaire (CROP‐Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP‐Q prior to using the educational resource ( n = 33) were 68 (median) and post scores ( n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability ( P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education (ii) personal benefits of participating (iii) co‐design experience and (iv) creating the resource. Co‐design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP‐Q in teaching and practice is needed.
Publisher: Wiley
Date: 11-2020
Abstract: There is little understanding of how recovery-oriented approaches fit within contemporary mental healthcare systems, which emphasise biomedical approaches to care, increased efficiency and cost-cutting. This article examines the established models of service delivery in a private, youth, mental health service and the impacts of the current system on staff. It explores whether the service is prepared or capable of adopting recovery-oriented approaches to care. Qualitative interviews were undertaken with staff and thematically analysed to understand the everyday practices on the unit. Data suggest that economic efficiencies and biomedical dominance largely shaped how health care was organised and delivered, which was perceived by staff as inflexible to change. Additionally, findings suggest that market-oriented principles associated with neoliberalism restricted the capacity of in iduals to transform services in line with alternative models of care and lowered staff morale. These finding suggest that, while neoliberal ideologies and biomedical approaches remain dominant in organisations, there will be challenges to adopting alternative recovery-oriented models of care and promoting healthcare systems that understand mental health issues in broader socio-political contexts and can flexibly respond to the needs of service users.
Publisher: MDPI AG
Date: 15-06-2023
Abstract: People with schizophrenia have shortened life expectancy partly due to physical ill health. Management of coexisting mental and physical health issues is complex, and knowledge in the field is lacking. This study investigated how physical health was managed among people with schizophrenia, by integrating findings from three separate analyses conducted in an ethnographic study. Qualitative data generation methods were used 505 h of field work were undertaken among nine participants with schizophrenia and 27 mental healthcare professionals were interviewed using a semi-structured interview approach. Three separate analyses were conducted using thematic and discourse analysis. Progressive focusing was used to integrate findings. Across the mental health care contexts that were part of this research, managing physical health was characterised by a lack of recognition of the seriousness of physical health issues as part of everyday life among people with schizophrenia. Poor physical health was accounted for as being “not of importance” by both mental health care professionals and the participants experiencing physical health issues. The integrated findings offer new insights about the social co-construction of poor physical health as something normal. At the in idual level, this shared understanding by people with schizophrenia and healthcare professionals contributed to sustaining inexpedient management strategies of “modifying” behaviour or “retreating” from everyday life when physical health issues were experienced.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.AENJ.2015.10.001
Abstract: In hospital emergencies require a structured team approach to facilitate simultaneous input into immediate resuscitation, stabilisation and prioritisation of care. Efforts to improve teamwork in the health care context include multidisciplinary simulation-based resuscitation team training, yet there is limited evidence demonstrating the value of these programmes.(1) We aimed to determine the current state of knowledge about the key components and impacts of multidisciplinary simulation-based resuscitation team training by conducting an integrative review of the literature. A systematic search using electronic (three databases) and hand searching methods for primary research published between 1980 and 2014 was undertaken followed by a rigorous screening and quality appraisal process. The included articles were assessed for similarities and differences the content was grouped and synthesised to form three main categories of findings. Eleven primary research articles representing a variety of simulation-based resuscitation team training were included. Five studies involved trauma teams two described resuscitation teams in the context of intensive care and operating theatres and one focused on the anaesthetic team. Simulation is an effective method to train resuscitation teams in the management of crisis scenarios and has the potential to improve team performance in the areas of communication, teamwork and leadership. Team training improves the performance of the resuscitation team in simulated emergency scenarios. However, the transferability of educational outcomes to the clinical setting needs to be more clearly demonstrated.
Publisher: Wiley
Date: 21-03-2014
DOI: 10.1111/JCAP.12072
Abstract: There is minimal published literature on experiences of peer support programs for children/adolescents in families affected by mental illness. This study aimed to explore children's and adolescents' perspectives of the ON FIRE peer support program. An exploratory qualitative study with 14 children/adolescents 9-17 years of age who participated in semi-structured interviews. Thematic analysis resulted in three themes of experience. Participants made connections with others in the program, developed personal strengths, and learned how to contribute to others' well-being. Participants derived substantial personal benefit from peer support. Use of social media and the Internet may facilitate future program delivery.
Publisher: Wiley
Date: 04-01-2011
DOI: 10.1111/J.1547-5069.2010.01377.X
Abstract: To develop an interpretation of Australian nurse leaders' understandings and experiences of mentorship for nurse leadership. The study aimed to explore experiential meanings and understandings that Australian nurse leaders apply to their mentoring relationships determine whether mentoring relationships contribute to nurse leader development in Australia and identify how Australian nurse leaders conceptualize mentorship. Hermeneutic phenomenology provided the methodological framework for the study. A purposive s le of 13 Australian nurse leaders was interviewed so they could share subjective experiences of mentorship through conversational narrative. Interview transcripts were analyzed to uncover and isolate key aspects of the phenomenon in text. An adaptation of Radnitzky's hermeneutic circle was used to develop a hermeneutic meaning interpretation of the text. The lived experience of mentorship for nurse leadership was understood and described through three existential motifs: imagination, journey, and mode of being. This article specifically addresses the finding that mentorship for leadership was sustained by the mentor's mode of being. These nurse leaders were not formally prepared to be mentors rather, they grew into being mentors as a result of their life journeys. The nurse leaders possessed a life attitude of mentorship that impacted how they perceived and interacted with their world. Mentorship was not formally learned, nor was it enacted as an adjunct role. Being a mentor was a fully integrated aspect of their person. Nurse-leaders use mentorship to grow and develop leadership potential in other nurses. Formal preparation to be a mentor is not fundamental to all mentorship. Some nurse leaders who mentor others for leadership grow into being mentors as a result of lifelong subjective experiences.
Publisher: Wiley
Date: 13-04-2020
DOI: 10.1111/JOCN.15270
Publisher: Springer Science and Business Media LLC
Date: 17-08-2020
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.AUEC.2018.10.002
Abstract: To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams. Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team. Final integration phase of a mixed methods embedded experimental study. Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members' experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes. Four main themes were developed: communication needs to be specific to the emergency context collaborative decision-making influences resuscitation situations standardisation promotes efficient trauma care proficient leadership empowers multidisciplinary teamwork. Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.
No related grants have been discovered for Andrea McCloughen.