Jenny Tohotoa

Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the hospital anxiety and depression scale

BackgroundPerinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding.MethodsA repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results.ResultsThe mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean =1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean =1.07) with no significant changes.ConclusionsBoth intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety.Trial registration(Australian New Zealand Clinical Trials Registry ACTRN12609000667213)

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.

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 involvement in mental health education for health professionals: feasibility and support for the role

AIMS AND OBJECTIVES To explore factors impacting on the feasibility of academic and educator roles for consumers of mental health services. The supports required to facilitate these roles from the perspectives of mental health nurse academics and consumer educators/academics will also be explored. BACKGROUND Involving consumers in the education of health professionals is becoming more common. Frequently this strategy is viewed as important to influence the attitudes of health professionals towards consumer participation in mental health services. There remains a paucity of research about these roles and the factors which promote and support their feasibility. DESIGN Qualitative exploratory. METHOD In-depth telephone interviews were undertaken with 34 nurse academics and 12 consumer educators or academics. Participants included nurse academics coordinating undergraduate and postgraduate mental health subjects, and consumer academics and educators involved in teaching mental health nursing components. Interviews were 20-45 minutes in duration. Data were analysed thematically. RESULTS Four subthemes were identified under the broad theme of feasibility and support: Reliability, support, vulnerability and seen to be griping. CONCLUSIONS Significant barriers were identified by nurses and consumers to effective consumer involvement, largely reflecting the impact of mental health challenges. Despite this, there was little evidence of structured support being available to enhance the viability of these positions. RELEVANCE TO CLINICAL PRACTICE Involving consumers in the education of health professionals through teaching, curriculum development, assessment and evaluation, is likely to enhance consumer participation in mental health services and ultimately improve service delivery. This involvement needs to be genuine to be effective. Consumers are often viewed as unreliable, vulnerable and using education to voice their own negative experiences. These issues and lack of support provided pose major barriers to successful roles, strategies to overcome barriers and maximise the effectiveness of roles require investigation and implementation.

Exploring the Scope of Consumer Participation in Mental Health Nursing Education: Perspectives From Nurses and Consumers

PURPOSE Exploration of the views and experiences of nurse academics and consumer academics and educators regarding the scope of consumer participation in mental health nursing education. DESIGN AND METHODS A qualitative, exploratory inquiry into the description and views of mental health nurse academics and consumer educators about these roles FINDINGS A significant variation in roles from guest speaker to substantive academic positions was evident, with most involvement brief and specifically teaching focused. Consumer participation in education was generally valued but noted to be limited in breadth and scope. Some concern was raised about the relevance of consumer academic roles, with a clear conceptualization of the consumer academic role necessary to facilitate their contribution to the education of health professionals. PRACTICE IMPLICATIONS Mental health consumer involvement in the education of nurses has been shown to impact positively on the attitudes of health professionals to people with mental illness. Advocacy for increased, meaningful input from consumers into nursing education is therefore necessary to improve practice.

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

Aims: To compare falls sustained in two groups of patients (one with mental disorders and the other neurocognitive disorders), in two acute inpatient older adult mental health services in Western Australia (WA). Background: Falls are the most common adverse event experienced during inpatient care. Older people with mental disorders and neurocognitive disorders constitute a high-risk group for accidental falls in hospitals. Methods: Data relating to 207 fall events from 2010-2011 reported in medical records and incident reports were collected. Individuals who sustained a fall were grouped as having a mental disorder (n=73) or neurocognitive disorder (n=134) according to their primary ICD10 diagnosis. Results: Significant differences in the factors that contributed to the fall between the two groups were highlighted. Falls sustained by those with a neurocognitive disorder were due to confusion and disorientation, and psychotropic medication effects. Their falls were more likely to be unwitnessed and injuries were generally less severe. Falls sustained by older adults with mental disorders were attributed to symptoms of their illness or medication side effects and tended to result in more severe injuries requiring medical treatment or further investigation. Conclusions: Older adults with neurocognitive disorders and behavioural and psychological symptoms associated to dementia have different falls risk factors related to their specific illness and cognitive functioning. There is a need for health professionals to receive training to assess, manage and provide appropriate interventions to reduce the specific falls risks in patients with both mental disorders and neurocognitive disorders.

Promoting recovery-oriented mental health nursing practice through consumer participation in mental health nursing education

Abstract Background: Developing recovery-oriented services, and ensuring genuine consumer participation in all aspects of services are central components of contemporary Australian mental health policy. However, attitudes of mental health professionals present a significant barrier. Given the positive impact of education on health professionals’ attitudes, particularly when consumers are involved, further exploration of consumer involvement in education is required. Aims: To enhance understanding of the role consumers can play within mental health nursing education. Method: A qualitative exploratory project was undertaken involving individual interviews with mental health nurse academics and consumer educators. Results: Two main themes emerged from nurse participants: Recovery in action, consumer educators were able to demonstrate and describe their own recovery journey; and not representative, some participants believed consumer educators did not necessary reflect views and opinions of consumers more broadly. Two main themes for consumers were: the truth about recovery, consumer educators demonstrated recovery as an achievable goal; and not a real consumer, where health professionals to dismiss the consumer experience as unrepresentative and therefore not credible. Conclusions: Consumer participation can contribute positively to nurse education, however representativeness presents a major barrier, potentially enabling nurses to dismiss experiences of consumer academics and educators as exceptional rather than typical.