Eileen Clark

Bachelor of Nursing students career choices: A three-year longitudinal study

This paper presents the findings of a survey which explored the career preferences of Australian Bachelor of Nursing students for certain clinical specialities. A convenience sample was recruited, with data collected three times between 2005 and 2007. With first-year students, acute care nursing of the adult and child and midwifery were the most popular career choices, whereas considerably less were interested in mental health or aged care nursing, and nearly two-fifths were undecided. By third-year, there was a shift in career preferences, with acute care of the adult and mental health being the most popular choices. In contrast, midwifery and aged care were the least preferred careers. The study provides some evidence students commence their course with a predominantly lay-informed image of nursing, but this may be tempered by favourable curricular influences towards the mental health field. However, the curriculum discourages students from pursuing a career in aged care and midwifery.

Risk Profiles for Non-Adherence to Antipsychotic Medications

Poor adherence to medications is common in individuals with schizophrenia, and can lead to relapse and re-hospitalization. This paper presents the findings of an Australian study of the factors affecting antipsychotic medication taking in individuals with schizophrenia. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability sample of mental health service users. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss version 15. Most participants had insight into their illness and were aware of the stigma of mental illness. Around 70% experienced annoying side effects, while nearly half admitted alcohol consumption. About one-fifth admitted they had missed taking medications during the previous week. Significant others played a variable role in medication taking. Over 80% were satisfied with their relationships with health professionals, but were less satisfied with access to these professionals, especially psychiatrists. Logistic regression analysis showed that age, impact of medication side effects, and access to psychiatrists were independent predictors of medication omission. It is argued that medication taking is a complex issue, which needs to be taken into consideration in health professional training and measures to promote adherence.

Subjective side effects of antipsychotics and medication adherence in people with schizophrenia.

AIM This paper is a report of a study conducted to describe the prevalence of antipsychotic medication side effects in individuals with schizophrenia, and to assess if a relationship existed between side effects and medication-taking. BACKGROUND Non-adherence to antipsychotics is common in people with schizophrenia. There is a direct relationship between non-adherence and relapse, but it is unclear if an association exists between side effects and non-adherence. METHOD The Liverpool University Neuroleptic Side-effect Rating Scale was used with a convenience sample of 81 mental health service users with schizophrenia. Participants were recruited from one urban and one rural area in Australia in 2004. Data were analysed using Statistical Package for Social Science and nonparametric statistical methods based on the nature of data. FINDINGS Around 20% of participants had missed taking their medication at least once in the week before data collection. About half experienced one or more side effects, but the level of accumulated side effects was not associated with medication omission. Older participants were more likely to experience anticholinergic and allergic side effects than their younger counterparts. Younger women were more likely to experience hormone-related side effects than older women. Overall, medication omission was not statistically significantly correlated with any of the seven Liverpool University Neuroleptic Side-effect Rating Scale subscales. CONCLUSION Greater attention needs to be paid to age- and gender-specific side effects and to monitoring side effects in people prescribed atypical medication antipsychotics. Service users, case managers and prescribers may need additional training to assist them to identify side effects and to take steps to ameliorate or at least minimize their effects.

Attitudes of patients towards mental health nurse prescribing of antipsychotic agents.

We examined the attitudes of patients with schizophrenia towards unrestricted independent non-medical prescribing of antipsychotic agents by mental health nurses. Data were collected using the Factors Influencing Neuroleptic Medication Taking Scale with a sample of 81 patients with schizophrenia who lived in the community. The results showed that a small majority supported mental health nurses having prescriptive authority. Younger participants were more likely than older participants to favour these clinicians being permitted to discontinue prescribed medication. Most considered their relationships with mental health nurses as satisfactory, and were satisfied with the way these clinicians responded to their concerns regarding antipsychotic agents. Beliefs about prescribing were positively associated with perceived knowledge of medications. The findings draw attention to patient support for non-medical prescribing by these nurses. They highlight the need for mental health nurses to be properly educated to assume this important role, and the requirement for further research.

First-time primary caregivers' experience accessing first-episode psychosis services

Aim: Easy access to first‐episode psychosis (FEP) services is critical in reducing the duration of untreated illness. However, primary caregivers can encounter difficulties accessing services on behalf of young people with FEP. This qualitative study describes the lived experience of first‐time primary caregivers of young adults with FEP, with a focus on examining how they access specialist FEP services.

The experience of young people with depression: a qualitative study

People who develop depression experience a maelstrom of emotions as they struggle to understand what is happening to them. While the experience has been comparatively well documented in older adults, much less is known about the depression experience and responses of young people. In this study, we aimed to explore the experience of young people diagnosed with depression. Twenty-six young people were recruited from a youth mental health service. A qualitative interpretative design was used, incorporating semi-structured, audio-recorded interviews. Results provided four overlapping themes, reflecting the young peoples difficulties in coming to terms with, and responding in self-protective, harmful and at times life-threatening ways to their depression: (1) struggling to make sense of their situation; (2) spiralling down; (3) withdrawing; and (4) contemplating self-harm or suicide. Study conclusions are that young people faced considerable difficulties coming to terms with, and responding to, depression. Improving young peoples understanding of depression and its treatment, reducing community stigma and providing accessible and youth-focused services remain important targets for intervention. It is also important to improve mental health literacy in the community to increase awareness of depression and how mental health professionals, including nurses, respond effectively to the young person.

Responding to Stigma: First-Time Caregivers of Young People With First-Episode Psychosis

OBJECTIVE This study explored how caregivers of young adults who had experienced a first episode of psychosis coped with stigma while maintaining their caregiving role. METHODS Qualitative interviews were undertaken with 20 caregivers in Melbourne, Australia. RESULTS Some caregivers adopted an open approach about disclosing their young persons illness. Alternatively, some were secretive about the illness, because of fears of and experiences with stigmatization if others found out. Caregivers also suggested ways to minimize the stigma that intensified their burden of care. CONCLUSIONS The findings showed the kinds of roles that family members and others have in supporting caregivers. Caregivers who were secretive about their situation were particularly vulnerable to feeling burdened and needed additional support from clinicians. Caregivers need increased support to enable them to better cope with and respond to stigma.

The self-efficacy model of medication adherence in chronic mental illness.

AIM In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. BACKGROUND Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. METHOD This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. RESULTS The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences - personal issues, medication side-effects and complexity, and social stigma - which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. CONCLUSION The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. RELEVANCE TO CLINICAL PRACTICE For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence.

Acute (adult clinical inpatient) care nurses' attitudes towards and knowledge of nationally endorsed 5As smoking cessation guidelines.

Nurses are expected to be involved in health promotion, including smoking cessation. This study aimed to assess nurses’ knowledge, sense of responsibility and willingness to provide smoking cessation interventions as described in the national 5As guideline. Data were collected by a survey distributed to a convenience sample of nursing staff (n = 162) from thirteen different adult acute care wards at a major metropolitan Melbourne hospital. Nearly all respondents (87%) agreed that they had a responsibility to counsel patients, and 22% were already doing so, but only 22% (n = 36) of respondents demonstrated an adequate level of knowledge of smoking cessation. Nurses were more likely to counsel patients on health conditions related to their area of practice than those that were not. The findings indicate that greater emphasis is needed in undergraduate courses and in-service programs to increase nurses’ awareness, and implementation of the 5As guideline for smoking cessation.

The influence of friends on smoking commencement and cessation in undergraduate nursing students: a survey

Background: Smoking is one of the leading causes of morbidity and mortality in most countries. Despite the fact that nurses have an important role in health promotion, and are in a good position to see and reflect on the detrimental effects of tobacco smoking, research has shown that the rate of smoking among nurses is similar to the rest of the population. Objective: The objective of this study was to examine the attitudes and experiences of undergraduate nursing students in relation to smoking commencement and cessation. It was part of a larger study that explored students’ smoking behaviours, knowledge and attitudes. Method: A non-probability sample of 366 undergraduate nursing students from a large Australian school of nursing and midwifery took part in the study. The participants completed the Smoking and Health Promotion instrument. Ethics approval was obtained prior to the commencement of the study. Results: Peers and friends were an important influence on the decision to commence smoking. The wish to comply with peer norms was especially prominent in mid-adolescence. Most smokers wanted to cease smoking, and many had tried unsuccessfully to stop on one or more occasions. They conceded that the pleasure they obtained from smoking and the effects of stress acted as barriers to stopping. The participants acknowledged the adverse health effects of smoking and some had already experienced these effects, but neither of these was enough to prompt them to cease. Conclusions: Undergraduate nursing curricula need to place greater emphasis on examining smoking related illnesses, as well as health promotion and role modelling in particular. Health promotion strategies that target peers are needed as an alternative to programmes that use fear or appeals to moral authority to prevent individuals from commencing smoking or encouraging cessation.