Brenda Happell

EXPLORING THE BENEFITS OF AN EXERCISE PROGRAM FOR PEOPLE WITH SCHIZOPHRENIA: A QUALITATIVE STUDY

The relationship between regular exercise and physical health and well-being is extensively documented in the literature. However, considerably less attention is devoted to the impact of exercise on health outcomes for people experiencing a mental illness. In response to the recognized paucity, a structured exercise program was developed and implemented for residents of a Community Care Unit in metropolitan Melbourne, Australia. Six residents participated in the program over a period of three months. This paper reports the findings of a qualitative study. A focus group interview was conducted with the resident participants (n = 6), the exercise physiologists who developed and implemented the program (n = 2), and nursing staff involved in implementing and supporting the program (n =4). Analysis of the data collected revealed that four main themes had emerged: the individual nature of the program, physical improvement, group dynamics, and future plans. The findings of this study suggest that involvement in the program produced very positive outcomes, most notably in the physical fitness of residents. The individual nature of the program which enabled gradual participation, and the cohesive approach of the group as a whole were considered very important factors contributing to the overall success. Furthermore, the participants planned to continue with some form of physical activity in the future. The potential value of regular exercise for patients experiencing a mental illness has significant implications for nursing and requiresfurther research exploration.

MENTAL HEALTH REFORMS AND THEIR IMPACT ON CONSUMER AND CARER PARTICIPATION: A PERSPECTIVE FROM VICTORIA, AUSTRALIA

Victoria, Australia has experienced significant changes in the structure and delivery of mental health services over the past three decades. As a result of these changes, there is now an expectation that consumers of services and their carers have increased opportunities to participate in the design and delivery of services. There currently exists a paucity of research that examines the degree to which this goal has been realized in practice. This article presents findings from a qualitative research study investigating the perceptions of consumers and carers regarding the degree to which the contemporary service system allows for their increased participation. Data were collected through in-depth interviews with consumers and carers. The findings suggest that consumers have identified an increased scope for their participation, although this varies considerably from service to service. Carers on the other hand described very little opportunity for participation at any level. The responses of carers suggest there may be some inherent difficulty in facilitating increased participation for both groups. Strategies to support carer participation are urgently required if the goals of state and national mental health policy in Australia are to be realized.

Changing Attitudes: The Role of a Consumer Academic in the Education of Postgraduate Psychiatric Nursing Students.

Consumer participation in health care is increasingly becoming an expectation within mental health services. Consumer involvement in the education of mental health professionals, including nurses is considered crucial to achieving this aim. This article describes the impact of a mental health consumer academic on the attitudes of postgraduate psychiatric nursing students towards consumer participation. A questionnaire was administered to students before (n = 25) and following (n = 19) exposure to the teaching of the consumer academic. Comparison of results suggests that support for consumer participation increases after exposure to the consumer academic reinforcing the value of mental health consumers in psychiatric nursing education.

SUICIDE AND SCHIZOPHRENIA: A REVIEW OF LITERATURE FOR THE DECADE (1990-1999) AND IMPLICATIONS FOR MENTAL HEALTH NURSING

This paper presents an overview of recent evidence on general and specific risk factors for suicide in patients with schizophrenia. The authors highlight the significant factors contributing to the likelihood of suicide in patients diagnosed with schizophrenia. This information will enhance the delivery of nursing care to these patients in all health care settings. A review of literature was conducted by two methods of investigation: Medline and CINAHL search and a manual search through articles from 1990 to 1999. The lifetime risk of committing suicide is estimated at about 9-13% of persons with schizophrenia, and it is 20 to 50 times higher than that in the general population. Young white males diagnosed with schizophrenia who are depressed, unmarried, unemployed, socially isolated, and functionally impaired and who lack external support are the most vulnerable in the early stages of schizophrenic illness. Findings can be instrumental in identifying and treating patients who are most vulnerable and in making psychiatric nurses aware of the scenarios and critical stages of the disease process when suicide is most likely to occur.

The Benefits of an Exercise Program for People with Schizophrenia: A Pilot Study.

While the benefits of physical fitness have been extensively documented, there is a paucity of literature examining the impact of an exercise program on people experiencing a mental illness. An exploratory study was conducted with six patients diagnosed with schizophrenia who participated in a 3-month physical conditioning program. The findings suggest that most participants increased their physical strength and endurance and exhibited improvements in weight control and flexibility. The majority of patients reported increased fitness levels, exercise tolerance, reduced blood pressure levels, perceived energy levels and upper body and hand grip strength levels.

The Implications of Legislative Change on the Future of Psychiatric Nursing in Victoria

Objective: The aim of this paper is to explore the potential implications of the Nurses Act introduced in 1993 upon psychiatric nursing in Victoria. Essentially this Act abolished the existing separate undergraduate education for psychiatric nursing. The focus of this paper is to explore the potential implications of this legislative change to the psychiatric nursing profession, particularly in light of relevant research findings. Method: In order to ascertain the impact of legislative change, a survey of psychiatric nursing content was conducted in Schools of Nursing throughout Victoria. Results: A 100% response rate was achieved. The responses indicated that little alteration had been made to existing general nursing courses to incorporate the change in legislation. The compulsory psychiatric nursing content varies from nil to 17.4% of the total curriculum. Conclusions: The theory and practice of psychiatric nursing constitute only a small proportion of undergraduate curricula. In view of the comparative unpopularity of psychiatric nursing as a career option for undergraduate students, the implications of this situation for the future psychiatric nursing workforce are serious.

EXPLORING THE COMPLEXITY OF COMPLIANCE IN SCHIZOPHRENIA

A large body of literature indicates that people diagnosed with schizophrenia are highly likely to not comply with their prescribed treatment regime at some stage during the illness process. Factors that indicate the risk of noncompliance have been the subject of considerable research over a number of years. This paper presents an extensive review of the research literature on the subject of compliance in schizophrenia. A number of factors have constituted the focus of research into this area. These include: socio-demographic characteristics, including age, gender and socioeconomic status; illness factors including insight, psychiatric symptomatology, duration of illness, substance abuse, and adverse side-effects of medication; psychosocial factors such as health beliefs and social supports; and treatment factors including the nature of the therapeutic relationship between patients and health care professionals. While the results of relevant research do not provide a clear and conclusive picture of compliance, they provide important information to guide the pivotal role of the mental health nurse in facilitating patient compliance.

Undergraduate nursing students attitude to mental health nursing: a cluster analysis approach

AIMS The use of cluster analysis to determine if specific groups of students could be identified based on their attitudes towards mental health nursing following the completion of a clinical experience in a mental health setting. BACKGROUND Research suggests that nursing students generally have a negative image of mental health nursing. This can be improved following clinical exposure in mental health settings, however, specific aspects of clinical experience that might facilitate attitudinal change have been under-researched. DESIGN Survey. METHODS A survey was administered to students (n = 703) immediately after completion of their clinical experience. Cluster analysis was used to identify natural groupings within the study cohort. RESULTS Three distinct clusters were identified. Cluster 1 demonstrated more positive attitudes, greater confidence and viewed mental health more positively than students in the other two Clusters. They were more likely to be male, have spent at least 30 minutes per shift with a preceptor and have completed shifts of eight hours rather than seven hours. CONCLUSIONS Attitudes to mental health nursing may be influenced by specific demographic characteristics of students and by specific aspects of their clinical experience. RELEVANCE TO CLINICAL PRACTICE The nursing workforce is an essential element of quality mental health service delivery. Knowledge about factors influencing more positive attitudes is important for structuring clinical experience and designing effective recruitment strategies to attract more students into this field of practice.

TALKING ABOUT HOPE: THE USE OF PARTICIPANT PHOTOGRAPHY

Hope as a concept is commonly described in everyday life and is generally regarded as an important component of health and fulfillment. The importance of hope in relation to people who are marginalised due to illness or other social circumstances has been examined in the research literature. There is, however, a paucity of research addressing the importance of hope for people living with schizophrenia. The authors, in attempting to redress this paucity, identified that participants have difficulty articulating the concept of hope and its meaning to them as individuals. Participant photography was introduced as a research method during the course of the study. This paper presents an overview of the use of participant photography as a method to assist participants to describe their view of hope and its importance. A brief overview of findings are presented and compared with findings derived from traditional interview techniques. Participant photography proved beneficial in facilitating a discussion of hope at a very personal level. The potential ethical implications of this approach are discussed.

Psychiatric nursing education: Doing the impossible?

Historically, psychiatric nursing has struggled to attract sufficient numbers of graduates of comprehensive nursing programs. Limited available research suggests that psychiatric-nursing education can produce more positive attitudes towards psychiatric-nursing practice and the care of the mentally ill. This article describes the results of a research project undertaken in Victoria, Australia, to extend existing knowledge by determining the impact of education in augmenting interest in psychiatric nursing as a future career option. The results of this quasi-experimental study suggest education can significantly increase the popularity of psychiatric nursing as a profession.