Andrea McCloughen

Weight gain associated with taking psychotropic medication: an integrative review.

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.

Physical health and wellbeing of emerging and young adults with mental illness: An integrative review of international literature

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.

Esteemed connection: creating a mentoring relationship for nurse leadership.

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 champion their mentees 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.

Nursing handover within mental health rehabilitation: An exploratory study of practice and perception

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.

Positioning mentorship within Australian nursing contexts: a literature review.

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.

What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

The experience of surviving life-threatening injury: a qualitative synthesis

BACKGROUND To summarize and synthesize research that explored the experience of surviving life-threatening injury in adolescents, young persons and adults. METHODS Informed by systematic literature review strategies, a description of the experience of individuals 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. RESULTS 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 individual 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. CONCLUSION This qualitative synthesis describes the iterative process individuals 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.

The burden of youth: major traumatic injury in adolescents and young adults managed in the Australian capital territory

To determine the incidence, characteristics, and factors associated with mortality after major traumatic injury in adolescent and young people in the Australian Capital Territory (ACT). A combined retrospective analysis of the National Coroners Information System and ACT Level 1 Trauma Centre registry data from July 2007 to June 2012 was conducted. Inclusion criteria were age 16 to 24 years, injury occurring within the ACT or surrounding region of responsibility, Injury Severity Score of more than 15, intensive care unit admission, hospital stay of more than 3 days, penetrating injury, or death. There were 714 adolescent and young adults recorded in the TCH trauma registry and National Coroners Information System. Injury rates remained consistent over the 5-year study period. Over half the injuries occurred in the districts surrounding the ACT. The largest subset represented was 18 to 21 years (47.8%). Road trauma was the most prevalent injury mechanism overall (58.4%), reaching statistical significance within the 18- to 21-year subset (39.9%). Other dominant injury mechanisms overall were recreation (15.4%) and violence (15.3%); self-inflicted violence constituted 45.8% within the larger violence group. Variables associated with mortality included those injured within the ACT (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.23-0.76) and the injury categories of severe (OR, 52.27; 95% CI, 24.71-110.58) and critically injured (OR, 770.73; 95% CI, 267.37-2221.73). The largest demographic affected by major trauma in the ACT and surrounds is young people aged 16 to 24 years. The focus of injury prevention may benefit from targeting young people involved in multiple risk behaviors that contribute to road trauma, interpersonal and self-inflicted violence, as well as high-risk recreation activities. Further research examining the complexity and relationship between these risk factors is required, as well as the long-term burden associated with caring for injured patients in this age group.

Physical health and well-being: Experiences and perspectives of young adult mental health consumers

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. Individualized information and methods to promote good physical health are required for this group in jeopardy from physical morbidity and mortality.

Physical Health Risk Behaviours in Young People with Mental Illness

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