Carmela Salomon

Intellectual disability health content within nursing curriculum: An audit of what our future nurses are taught.

BACKGROUND Individuals with intellectual disability experience chronic and complex health issues, but face considerable barriers to healthcare. One such barrier is inadequate education of healthcare professionals. OBJECTIVE To establish the quantity and nature of intellectual disability content offered within Australian nursing degree curricula. DESIGN A two-phase national audit of nursing curriculum content was conducted using an interview and online survey. SETTING Australian nursing schools offering pre-registration courses. PARTICIPANTS Pre-registration course coordinators from 31 universities completed the Phase 1 interview on course structure. Unit coordinators and teaching staff from 15 universities in which intellectual disability content was identified completed the Phase 2 online survey. METHODS Quantity of compulsory and elective intellectual disability content offered (units and teaching time) and the nature of the content (broad categories, specific topics, and inclusive teaching) were audited using an online survey. RESULTS Over half (52%) of the schools offered no intellectual disability content. For units of study that contained some auditable intellectual disability content, the area was taught on average for 3.6h per unit of study. Units were evenly distributed across the three years of study. Just three participating schools offered 50% of all units audited. Clinical assessment skills, and ethics and legal issues were most frequently taught, while human rights issues and preventative health were poorly represented. Only one nursing school involved a person with intellectual disability in content development or delivery. CONCLUSION Despite significant unmet health needs of people with intellectual disability, there is considerable variability in the teaching of key intellectual disability content, with many gaps evident. Equipping nursing students with skills in this area is vital to building workforce capacity.

All roads lead to medication? Qualitative responses from an Australian first-person survey of antipsychotic discontinuation.

OBJECTIVE The purpose of the survey was to better understand the experiences of people who attempt antipsychotic discontinuation. METHOD A multiple-choice and short-answer survey was distributed in 2011-2012 to potential participants involved in participating organizations. Respondents were asked about past discontinuation events, including decision negotiation and withdrawal experience. This article thematically analyses their free-text responses. RESULTS There were 98 valid surveys returned. Respondents highlighted the roles of the therapeutic alliance and health and illness explanatory models in understanding the context of discontinuation. Reported impacts of discontinuation were mixed and complex. Withdrawal syndromes were described by over half of the participants. Of the 98 respondents, 21 reported remaining antipsychotic-free at the time of survey completion. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Participant accounts highlight the importance of context and relationships in their thinking about antipsychotic discontinuation. Although results cannot necessarily be generalized, participant descriptions of withdrawal syndromes suggest there may be a need to improve education, monitoring, and support strategies for some people during discontinuation. Shifting toward a more collaborative, transparent, and service-user-driven approach to discontinuation may help to mitigate some of the negative discontinuation impacts identified. The polarized discontinuation outcomes described highlight the individuality of every participants recovery journey and the need to avoid generalizing about the role of antipsychotics in care.

Experiencing antipsychotic discontinuation: results from a survey of Australian consumers

Despite high reported rates of antipsychotic non-adherence, little is known about consumer experiences during discontinuation. This study was designed to increase understanding of antipsychotic discontinuation from consumer perspectives. In 2011-2012, 98 Australian consumers involved with participating organizations completed an anonymous survey detailing past antipsychotic discontinuation attempts. Of the 88 participants who reported at least one discontinuation attempt, over half (n = 47, 54.7%) reported stopping without clinician knowledge or support. This group was 35% (confidence interval 15.4-54.6%) more likely to stop abruptly than those (n = 41, 45.3%) stopping with clinician support (P = 0.002). Only 10 participants (23.3%) recalled being given information about discontinuation symptoms other than relapse; however, 68 participants (78.2%) reported experiencing a range of discontinuation symptoms including physical, cognitive, emotional, psychotic or sleep-related disturbances. Findings cannot be readily generalized because of sampling constraints. However, the significant number of participants who reported discontinuation symptoms, in addition to psychosis, is consistent with previous research. This study provides new insight into consumer motivations for discontinuation and possible problems in clinical communication that may contribute to frequent non-collaborative discontinuation attempts. Mental health nurses, who play a pivotal role in medication communication events, may benefit from increased awareness of consumer perspectives on this topic.Accessible summary The aim of the survey was to gain an understanding of consumer experiences of antipsychotic discontinuation. Incorporating consumer perspectives into practice may help clinicians to better understand discontinuation decisions and experiences. This topic may be of particular interest to mental health nurses who play an important role in supporting consumers with medication related decisions. The survey highlighted that consumers often try to discontinue antipsychotic medication, frequently without the knowledge or against the advice of clinicians. Consumers who discontinued in such unsupported ways appeared more likely to stop abruptly. Abrupt cessation has been associated with a number of increased risks in the literature. Negative discontinuation symptoms such as difficulty sleeping, mood changes, problems concentrating, increased psychotic experiences and physical problems were reported by more than half of the survey participants. Many consumers reported that they did not feel adequately informed about how to most safely stop or what to expect when stopping. These findings add new knowledge to our understanding of why consumers discontinue antipsychotics. The problems participants reported in their relationship with clinicians, in particular, helps to explain why so many consumers may stop in secret. The need to improve communication between consumers and clinicians around the common experience of antipsychotic discontinuation is highlighted. Findings also highlight the need to conduct further research into discontinuation symptoms and how clinicians might better educate and support consumers who are experiencing them. Abstract Despite high reported rates of antipsychotic non-adherence, little is known about consumer experiences during discontinuation. This study was designed to increase understanding of antipsychotic discontinuation from consumer perspectives. In 2011–2012, 98 Australian consumers involved with participating organizations completed an anonymous survey detailing past antipsychotic discontinuation attempts. Of the 88 participants who reported at least one discontinuation attempt, over half (n = 47, 54.7%) reported stopping without clinician knowledge or support. This group was 35% (confidence interval 15.4–54.6%) more likely to stop abruptly than those (n = 41, 45.3%) stopping with clinician support (P = 0.002). Only 10 participants (23.3%) recalled being given information about discontinuation symptoms other than relapse; however, 68 participants (78.2%) reported experiencing a range of discontinuation symptoms including physical, cognitive, emotional, psychotic or sleep-related disturbances. Findings cannot be readily generalized because of sampling constraints. However, the significant number of participants who reported discontinuation symptoms, in addition to psychosis, is consistent with previous research. This study provides new insight into consumer motivations for discontinuation and possible problems in clinical communication that may contribute to frequent non-collaborative discontinuation attempts. Mental health nurses, who play a pivotal role in medication communication events, may benefit from increased awareness of consumer perspectives on this topic.

Antipsychotic discontinuation syndromes: a narrative review of the evidence and its integration into Australian mental health nursing textbooks.

In light of the high number of people discontinuing antipsychotics each year, it is essential that nurses develop a robust understanding of all aspects of the discontinuation experience. While there is a large body of published work documenting post-discontinuation relapse rates, less is known about other aspects of the discontinuation experience. This paper presents the results of a narrative review of international studies of antipsychotic discontinuation syndromes and their relevance to nursing practice. Four key mental health nursing textbooks used in student nurse education in Australia are examined to assess how this evidence has been incorporated into clinical recommendations. This review finds that the evidence for discontinuation syndromes could be more widely disseminated and applied than it is at present. Strikingly, this evidence has not been incorporated into key mental health nursing textbooks in Australia at all. Slow integration into nursing published work may be influenced by a number of clinical and research uncertainties. We consider the impact of this silence on key nursing roles of psycho-education and adverse event monitoring during antipsychotic discontinuation periods. Further robust research should be conducted into discontinuation syndromes as a matter of urgency. Given the high number of consumers potentially impacted upon by discontinuation syndromes, nurse authors and educators should consider revising key nursing textbooks to include the currently available information about discontinuation syndromes.

Positive cardiometabolic health for adults with intellectual disability: an early intervention framework

Cardiometabolic morbidity is a significant contributor to the poorer health outcomes experienced by people with intellectual disability (ID). Tailoring cardiometabolic monitoring tools developed for the general population to better fit the altered risk profiles and extra needs of people with ID may help to improve health outcomes. This paper describes a new cardiometabolic monitoring framework designed to address the extra needs of people with ID. The framework was adapted from a generalist guideline after a process of extensive consultation with the original authors and over 30 ID and cardiometabolic experts. In addition to standard cardiometabolic monitoring practice, the framework encourages clinicians to: anticipate and address barriers to care such as communication difficulties and fear of blood tests; account for socioeconomic and genetic factors altering baseline cardiometabolic risk; and carefully rationalize psychotropic prescription. Together with this framework, a toolkit of free cardiometabolic resources tailored for people with ID and formal and informal carers is included. The monitoring framework promotes a multidisciplinary and holistic approach to cardiometabolic care for people with ID.

Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis

Abstract Background: The average age of onset of psychosis coincides with the age of college enrollment. Little is known about the impact of educational engagement on DUP in a college-aged population. Aims: To determine DUP, and the impact of educational engagement, for college-aged participants of the RAISE study (n = 404). Method: We conducted secondary data analyses on the publicly available RAISE dataset. Subsamples were analyzed to determine the impact of age and educational engagement on DUP. Results: DUP was significantly shorter (p < 0.02) for participants who were college-aged (18–22 years, n = 44) and engaged in post-secondary education (median = 12 weeks, mean = 29 weeks) compared with participants who were college-aged and not engaged in higher education (n = 92, median = 29 weeks, mean = 44 weeks). Conclusions: Educational engagement appears to be associated with a shorter DUP. This may be partially explained by the presence of on-site wellness centers in college settings. However, even among young people who engaged in post-secondary education DUP was still at, or beyond, the upper limit of WHO recommendations in this group. Future research exploring how colleges could improve their capacity to detect and refer at risk students for treatment at an earlier stage is recommended.

Unnecessary psychotropic drug prescription in primary care for people with intellectual disability

ABSTRACT FROM: Sheehan R, Hassiotis A, Walters K, et al . Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015;351:h4326. People with intellectual disability experience high rates of mental disorders and challenging behaviour, but representative data are hard to obtain for this population. Concerns have previously been raised about the difficulty this group experience in accessing quality mental health services1 and the morbidity associated with high rates of psychotropic drug prescription.2 General practitioners (GPs) are pivotal in provision of mental healthcare and representative data from this setting has the capacity to inform the epidemiology of mental disorders and the psychotropic drug burden for people with intellectual disability. Sheehan and colleagues conducted a longitudinal (1999–2003) cohort study of the prevalence of mental disorders and psychotropic drug prescription in adults with intellectual disability using data from a large, …

Intellectual disability content within pre-registration nursing curriculum: How is it taught?

BACKGROUND Despite experiencing higher rates of physical and mental health conditions compared with the general population, people with intellectual disability face inequitable access to healthcare services. Improving education of healthcare professionals is one way to reduce these inequalities. OBJECTIVE To determine how intellectual disability content is taught within Australian nursing schools. DESIGN A two-phase audit of Australian nursing curricula content was conducted using an interview and online survey. SETTING Nursing schools Australia-wide providing pre-registration courses. PARTICIPANTS For Phase 1, course coordinators from 31 nursing schools completed an interview on course structure. Teaching staff from 15 schools in which intellectual disability content was identified completed an online survey for Phase 2. METHODS Methods used to teach intellectual disability content and who taught the content were audited using an online survey. RESULTS Across the 15 schools offering intellectual disability content, lectures were the most common teaching method (82% of units), followed by tutorials (59%), workshops (26%), then other methods (e.g. e-learning; 12%). Approximately three-quarters of intellectual disability teaching used some problem-and/or enquiry-based learning. Only one nursing school involved a person with intellectual disability in delivering teaching content. Six (19%) participating schools identified staff who specialise in intellectual disability, and seven (23%) identified staff with a declared interest in the area. CONCLUSION While some nursing schools are using diverse methods to teach intellectual disability content, many are not; as a result, nursing students may miss out on acquiring the attributes which enable them to address the significant health inequalities faced by this group. A specific deficit was identified relating to inclusive teaching and clinical contact with people with intellectual disability.

Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

Background People with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID. Aim To compare medications recommended by GPs at encounters where ID is recorded versus other encounters. Design & setting Analysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive. Method Medication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs). Results Antipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters. Conclusion Higher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.