Charlotte de Crespigny

Increasing confidence of emergency department staff in responding to mental health issues: An educational initiative

Abstract Introduction This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.

Alcohol and other drug problems in Australia: the urgent need for nurse education

The economic, social and health costs associated with alcohol and other drug use, including medicines, impact on the Australian community profoundly. Many Australians use alcohol and other drugs (AODs) on a regular basis and a significant number experience problems at some time. There are about 25,000 drug-related deaths annually, the majority of which are related to alcohol and tobacco use. Many young people die or are injured as a direct result of alcohol intoxication, accidental overdose and related problems, and significant numbers of elderly people are hospitalised, permanently incapacitated or suffer avoidable trauma through adverse drug reactions and side-effects of medications. It is estimated that at least 25 per cent of acute hospital beds hold patients with alcohol-related problems directly associated with the medical diagnosis, and there are comparable numbers of people needing social and other forms of assistance at some time. Despite the preventative nature of many AOD problems and the call for harm reduction, timely intervention and support for the thousands of Australians attending hospitals, community health and mental health services, nurses are yet to effectively assist the community in preventing and responding to the range of AOD problems. Nursing policy, guidelines and clinical expertise are required to assist the community in addressing this issue. Undergraduate, postgraduate and continuing education have a vital role to play in providing the profession with the knowledge, skills and research base to meet this challenge.

Better medication management for Indigenous Australians: findings from the field

This paper reports findings from interviews and focus groups conducted within a multidimensional action research project concerning medication management among Indigenous Australians. Participants were Aboriginal people with mental health problems, carers and family members, and health and social service workers from different regions in South Australia. A meta-analysis of findings from each regional project component was conducted, and major themes conceptualised and developed into a coherent summary. The findings revealed problems of a magnitude not previously realised—mental health problems (including alcohol and drug problems) and medication management among Aboriginal people clearly are major issues requiring immediate and sustained attention if the health and welfare of the Australian Indigenous population are to be improved. Findings concerned eight major areas: social and emotional wellbeing issues; stressors on Aboriginal health services and providers; training for the Aboriginal health workforce; mainstream health services for Aboriginal people; trust and confidentiality within Aboriginal health services; English language literacy and numeracy skills of Aboriginal clients; remote living arrangements for many Aboriginal people; problems with alcohol use; and institutionalised and individual racism in the community at large.

Improving Indigenous health through better medication management: an overview

This paper provides an overview of a major South Australian research project with implications for the health of all Indigenous Australians. The researchers set out to explore the medication needs of Aboriginal people with mental health problems and found that most Aboriginal people have to deal with profound challenges to social and emotional wellbeing with significant medication implications. No previous research had investigated the problem of medication use by Aboriginal people in metropolitan, rural and remote locations to the depth and extent of this project. The research therefore is of widespread relevance and holds interest for many Indigenous and non-Indigenous individuals and groups, consumers, service providers and policy-makers. As a research team comprising Indigenous and non-Indigenous members, we were committed to implementing strategies in the course of the project with immediate benefit to project participants as well as longer-term impact on improved use of medications. The design of the project enabled these strategic interventions and we are pleased to promote this model to other researchers. Recommendations from the project concern services, coordination of care, carers and family members, workforce education, and community development. Readers are advised where the project report and other published papers can be accessed. The project was funded by the Commonwealth Department of Health and Ageing.

Alcohol and other drug use issues in Australia: no place to hide

Alcohol and other drug (AOD) use is common worldwide. There is a wide spectrum of AOD issues that pose a major threat to public health, safety and the wellbeing of communities, families and individuals. There is no doubt that nurses have primary roles in identifying, preventing and addressing AOD use issues in emergency departments and general hospital units, clinics, specialist mental health and drug and alcohol services, sexual health services, youth services and community settings where people seek health care and other assistance. Nurses have credibility and are trusted by communities for their ability to address many health issues, including AOD health problems. Despite the enormous economic burden associated with AOD use across the world, the nursing profession has yet to fully acknowledge and embrace this serious issue for nurses.

Racism and Injustice: Urban Aboriginal Women's Experiences when Patronising Licensed Premises in South Australia

This paper presents the findings regarding urban, predominantly young, Aboriginal womens experiences of patronising licensed premises in South Australia. This research aimed to tap new information directly from the experiences of participants who lived in the southern metropolitan region of South Australia. It focused on their experiences of socialising at licensed premises such as pubs and clubs, locally, and in the city of Adelaide. A qualitative research design within the critical social Scientific paradigm was applied using semi-structured interviews and thematic analysis. The recommendations developed from the findings, and the final community report, were developed collaboratively with participants and other Aboriginal women from their local community. Consistent with the experiences of other young non-Aboriginal women in South Australia, as reported by the chief investigator of this study, the findings of this research show that Aboriginal women try to enjoy socialising with friends and family in licensed premises such as pubs and clubs. However, the Aboriginal women were constrained by frequently experiencing racism and injustices when they tried to enter, or when inside, pubs and clubs. Being accused of stealing, prevented from entering or being expelled from venues, racist comments and being subjected to physical violence, conflict with bar and security staff and non-Aboriginal patrons, as well as lack of safety, were some of the issues these Aboriginal women have experienced in licensed premises in urban and suburban South Australia. This research now offers recommendations from the women that call for important changes in policy and service provision that can improve the conditions of Aboriginal women when they are visiting licensed premises.

Our interest is swelling: a collaborative venture to establish the world's first free public screening for lymphoedema.

This article describes the collaborative processes involved in the implementation of a free public health screening program for people at risk of lymphoedema following the removal of lymph nodes during surgery to control breast, prostate and other cancers, or injury. The planning phase of the program is described with emphasis on the need to secure a well situated venue, the commitment of a cohort of key health professionals, service club and lay volunteers, and the need to carefully target and publicise the event widely. The implementation phase requires careful consideration of the physical layout of the event, the direction and management of the flow of human traffic, information and equipment requirements, and recognition that screening programs place people in vulnerable positions. Effective communication skills are essential, as is a knowledge of where people can be referred should the need arise. A budget is provided together with discussion regarding the success of the program and recommendations for future consideration such as the need to target men to attend screening and for long term follow up of the outcomes.

A global public health problem: a role for all multidisciplinary professionals

2 The last issue of The Drug and Alcohol Professional featured a number of the papers from the first conference held by The International Network of Nurses (TINN) interested in Alcohol, Tobacco and Drug Misuse in Copenhagen, Denmark, in June 2001. In this issue, two papers that were presented at the conference but were too lengthy for the last publication are now included. Clancy et al focus on the practices of methadone in Mapping the role of nuses in Methadone Substitution Therapy (MST) Programmes across Europe: Core competencies, and de Crespigny’s article gives insight into some of the specifics in the ‘land down under’ in the paper Alcohol and other drug use issues in Australia: no place to hide. A huge thanks to David Cooper, Editor of TDAP, for allowing the conversation on global alcohol, tobacco and other drug (ATOD) issues to continue. And thank you to the multidisciplinary readership of TDAP. Collaboration between key professionals in all disciplines committed to addressing these issues is necessary if we are to reduce this global public health problem. This journal offers all stakeholders in the field a forum in which to engage in international dialogue; exchange views and expertise; and critically examine the issues that require effective prevention, early intervention, harm reduction and treatment. It is also an arena in which we can discuss the necessary training, education, workplace development and policy strategies that are required across health, social and related fields. Why is collaboration important? A simple answer is that there is greater knowledge and power in numbers. A common difficulty in addressing ATOD misuse is the institutional, political, geographical, economic and, at times, professional barriers that people with ATOD problems face when trying to access services. We need dedicated professionals to break down these barriers, both locally and globally. It is only through working together that we can effectively identify and respond to ATOD problems, Guest Editorial A global public health problem: a role for all multidisciplinary professionals