Dianne Wynaden

The power of vivid experience in hand hygiene compliance

In recent years, explicit behavioural theories have been used in some research into hand hygiene behaviour. One of the most prominent of these has been the theory of planned behaviour (TPB). In this qualitative study aimed at increasing understanding of infection prevention practice in the acute care setting, TPB was identified as a suitable framework for the emergence of new insights that have the potential to improve the power of existing education and training. The theory emerging from the research was based on a finding that individual experience is of greater import than formal education in explaining hand hygiene behaviour. This indicated that exposure to vivid vicarious experience is a potential means to improving the power of existing training methods and increasing the propensity for instilling sustainable adequate hand hygiene habits.

A questionnaire to determine nurses' knowledge of delirium and its risk factors

Abstract Delirium is a frequent complication of hospital admission, especially among the elderly. It can have serious consequences in terms of morbidity, mortality and decreased quality of life. Nevertheless, an extensive literature review found that it is poorly recognised and poorly managed by medical and nursing staff. Although some researchers have found that education programs for nurses can improve outcomes for patients with delirium, no research assessing nurses’ knowledge was found. The objective of this research was to determine nurses’ level of knowledge regarding delirium and its risk factors. A questionnaire survey sent to nurses at a teaching hospital found that nurses’ knowledge of delirium was generally inadequate, although one ward which had had inservice education attained better results. It is recommended that cognitive assessment in general and delirium in particular be incorporated into nursing education. Improved education could potentially lead to improved health outcomes and considerable cost savings.

There is no health without mental health: are we educating Australian nurses to care for the health consumer of the 21st century?

One in five Australians has a diagnosable mental illness and the impact of the illness on the individual, their family, and the community is significant. Since comprehensive nursing was introduced in the 1980s there have been repeated concerns raised regarding the preparedness of graduates from Australian undergraduate nursing programs to care for people who have a mental illness. In 2009, despite a recent comprehensive national review of the mental health/illness content in pre-registration curricula, these concerns remain. The nursing profession must have a responsibility to the global community to ensure that registered nurses are educated to meet evolving health challenges and the needs of the health consumer in the 21st Century. The purpose of this paper is to highlight the prevalence and impact of mental illness on health care outcomes in all settings and to challenge the profession to acknowledge that mental health nursing content must be a core area of all undergraduate curricula. A nationally coordinated response to address the long standing identified deficits in the educational preparation of comprehensive nurses is now a priority to ensure that nurses remain a major stakeholder group in the delivery of health care and key health informants and decision makers within the global health care arena.

Types of Patients in a Psychiatric Intensive Care Unit

Objective: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients’ diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management. Method: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained. Results: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients. Conclusion: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.

Lived experience in teaching mental health nursing: Issues of fear and power

Australian mental health policy clearly articulates recovery focus as the underpinning of mental health services. Barriers to achieving a recovery focus are identified in the literature, with negative attitudes of health professionals receiving particular attention. The involvement of people with lived experience of significant mental health challenges and mental health service use is essential to enhancing more positive attitudes. Lived-experience involvement in the education of nurses is evident; however, it is generally limited and implemented on an ad hoc basis. Overall, there is a paucity of literature on this topic. A qualitative exploratory study was undertaken to elicit the views and perceptions of nurse academics and lived-experience educators about the inclusion of lived experience in mental health nursing education. One major theme to emerge from the research was issues of fear and power, which included three subthemes: facing fear, demystifying mental illness, and issues of power. Lived-experience involvement has an important role to play in the education of nurses in addressing fear and demystifying the experience of mental illness. The power that lived-experience educators exercised in their roles varied considerably, and for many, was limited. Therefore, the effectiveness of lived-experience involvement requires a more equitable distribution of power.

The caregiving experience: How much do health professionals understand?

Legal, social and economic factors have changed the delivery of care to people who have a mental disorder. Many of these people are now treated in the community and they live with or in close proximity to their family. The aim of this paper is to provide health professionals with an insight into the experience of being a caregiver to a person with a person with a mental disorder. For these families caregiving becomes an integral part of everyday life. Positive outcomes for both the caregiver and the ill family member are more likely to occur when effective levels of collaboration exist between health professionals and caregivers. Collaboration is enhanced when caregivers and health professionals value each others contribution to the ill family members care. Often the burden, stress, and socio-economic effects on the family caring for a person with mental illness is not sufficiently appreciated and further increases this burden. A review of the literature from the caregivers perception is presented. An increased understanding of the caregiving experience will enable health professionals to develop and implement strategies that facilitate positive outcomes for the caregiver and the ill family member.

Assessing cognition in elderly patients presenting to the emergency department

INTRODUCTION AND BACKGROUND Delirium occurs frequently among elderly patients in the Emergency Department (ED), and accurate assessment is difficult without knowledge of the patients usual cognitive functioning. This audit was designed to determine whether routine cognitive screening of elderly patients in ED could lead to early identification of delirium. METHODOLOGY An audit using the abbreviate mental test (AMT) and Confusion Assessment Method (CAM) tools assessed 28 elderly ED patients for the presence of delirium. RESULTS Fourteen (50%) of the 28 patients had no cognitive deficit on admission. Eleven (39.3%) displayed a cognitive deficit other than delirium and three (10.7%) had delirium, but only one had been diagnosed prior to the audit. DISCUSSION The prevalence rate of delirium in elderly ED patients was similar to those reported in the literature. The audit demonstrated the importance of cognitive assessment, as cognitive changes can be an early and sensitive indicator of physiological dysfunction. However, the AMT had limitations which inhibited its use in ED. A four question version known as the AMT4 may be more suitable. RECOMMENDATIONS ED nurses should routinely establish baseline cognitive functioning and assess for delirium. The AMT4 may be more suitable because of its brevity, but requires further research.

Establishing best practice guidelines for administration of intra muscular injections in the adult: A systematic review of the literature

Abstract This article describes best practice guidelines for the administration of intramuscular injections developed after the identification of 300 abstracts and a review of 150 articles on the subject area. While the administration of medication via the intramuscular route is a daily occurrence for nurses working in both hospitals and community settings, several concerns and complications have been identified with the procedure. Routinely, nurses are required to make numerous decisions regarding factors such as needle size, length and the site to be used during the administration of medication into muscle tissue. Therefore, it is important that relevant up-to-date guidelines are available to assist nurses to make informed decisions about the technique to use. Techniques delivering medication to the correct site will facilitate efficacious outcomes for the client and ensure the delivery of quality nursing care in all health care settings.

Mental health lived experience academics in tertiary education: The views of nurse academics

BACKGROUND Australian national mental health strategy emphasises inclusion of people diagnosed with mental illness in all areas of mental health care, policy development and education of health professionals. However, the way this inclusion has translated to Australian universities is relatively unexplored. OBJECTIVES Explore views of nurse academics regarding service user involvement in nursing education programmes. DESIGN Qualitative exploratory. SETTINGS Australian universities offering educational programmes in nursing at postgraduate and undergraduate levels. PARTICIPANTS Thirty four participants from 27 Australian universities participated. METHODS Data were collected using semi-structured telephone interviews with academics involved in teaching and/or coordinating undergraduate and/or postgraduate mental health nursing contents. Data were analysed using content analysis based on four cognitive processes: comprehending, synthesising, theorising and re-contextualising data. RESULTS Four major themes emerged: good idea? long way to go; conceptualising the service user academic role; strengths of lived experience led student learning; and barriers to implementation. CONCLUSIONS Findings indicated strong support for including mental health service users in teaching nursing students. However, at most universities service user engagement was often an informal arrangement, lacking clear guidelines and limited by financial barriers and the positioning of mental health nursing within curricula.

Consumer participation in nurse education: a national survey of Australian universities.

Consumers of mental health services have an important role to play in the higher education of nursing students, by facilitating understanding of the experience of mental illness and instilling a culture of consumer participation. Yet the level of consumer participation in mental health nursing programmes in Australia is not known. The aim of the present study was to scope the level and nature of involvement of consumers in mental health nursing higher education in Australia. A cross-sectional study was undertaken involving an internet survey of nurse academics who coordinate mental health nursing programmes in universities across Australia, representing 32 universities. Seventy-eight percent of preregistration and 75% of post-registration programmes report involving consumers. Programmes most commonly had one consumer (25%) and up to five. Face-to-face teaching, curriculum development, and membership-to-programme committees were the most regular types of involvement. The content was generally codeveloped by consumers and nurse academics (67.5%). The frequency of consumer involvement in the education of nursing students in Australia is surprisingly high. However, involvement is noticeably variable across types of activity (e.g. curriculum development, assessment), and tends to be minimal and ad hoc. Future research is required into the drivers of increased consumer involvement.