Michael Hazelton

Patient‐related violence against emergency department nurses

In a finding that reflects international experiences, nurses in Australia have been identified as the occupation at most risk of patient-related violence in the health-care sector. A search of the literature was undertaken to explore this concept, with a focus on the emergency department and triage nurses. Significant findings included the fact that nurses are subjected to verbal and physical abuse so frequently that, in many instances, it has become an accepted part of the job. This attitude, combined with the chronic under-reporting of violent incidents, perpetuates the normalization of violence, which then becomes embedded in the workplace culture and inhibits the development of preventative strategies and the provision of a safe working environment. Nurses are entitled to a safe workplace that is free from violence under both the occupational health and safety legislation and the zero-tolerance policies that have been adopted in many countries including Australia, the UK, Europe, and the USA. Therefore, policy-makers and administrators should recognize this issue as a priority for preventative action.In a finding that reflects international experiences, nurses in Australia have been identified as the occupation at most risk of patient-related violence in the health-care sector. A search of the literature was undertaken to explore this concept, with a focus on the emergency department and triage nurses. Significant findings included the fact that nurses are subjected to verbal and physical abuse so frequently that, in many instances, it has become an accepted part of the job. This attitude, combined with the chronic under-reporting of violent incidents, perpetuates the normalization of violence, which then becomes embedded in the workplace culture and inhibits the development of preventative strategies and the provision of a safe working environment. Nurses are entitled to a safe workplace that is free from violence under both the occupational health and safety legislation and the zero-tolerance policies that have been adopted in many countries including Australia, the UK, Europe, and the USA. Therefore, policy-makers and administrators should recognize this issue as a priority for preventative action.

Patient-related violence at triage: A qualitative descriptive study

AIM The aim of the study was to describe the experiences of a group of triage nurses with patient-related workplace violence during the previous month. BACKGROUND Globally and within the Australian health industry, nurses have been reported to be the occupation at most risk of patient-related violence, with triage nurses identified as a high risk group for both verbal and physical violence. METHOD The study took place in the Emergency Department of a tertiary referral and teaching hospital in regional New South Wales, Australia. Data were collected from August to September 2008, and a qualitative descriptive methodology was employed. FINDINGS The participants all reported experiencing episodes of patient related violence that were perceived as inevitable and increasing in intensity and frequency. Themes included identification of precipitating factors such as long waiting times and alcohol and substance misuse. Organisational issues included lack of aggression minimisation training; lack of formal debriefing following episodes of violence and frustration at lengthy reporting processes. CONCLUSION In the context of the Emergency Department where patients present with a range of diagnoses and behaviours, it is unlikely that the issue of patient-related violence can be totally eliminated. However it can be prevented or managed more effectively on many occasions. Strategies to support staff and prevent and manage violence effectively should be a priority to provide a safe working environment and occupational health and safety for staff.

Bibliometrics, citation indexing, and the journals of nursing.

Bibliometric research has risen in popularity during recent years and an increasing number of investigations now have examined the nursing literature. Our article provides a comprehensive overview of citation-based research in the nursing profession, as well as a discussion of bibliometrics, journal impact factors, and international publishing trends. The debate on evidence-based practice and its potential influence and relevance for nursing scholars is also covered. Although journal performance indicators are, no doubt, important for the contemporary nursing academic, it is the core research skills and attributes that nursing scholars, academics, and educators will need to consider more carefully in future if the next generation of professional nurse researchers is to truly flourish.

Managing the ‘unmanageable’: Training staff in the use of dialectical behaviour therapy for borderline personality disorder

Abstract Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants’ demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectial behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article proCvides a brief overview of the findings of the survey, the main purpose is to reporNt the findings of the focus group interviews.

The workplace and nurses with a mental illness

A qualitative approach was used to explore workplace experiences of nurses who have a mental illness. Interview transcripts from 29 nurses in New South Wales, Australia were subjected to discourse analysis. One significant finding was a theme depicting the need for support and trust. This superordinate theme encompassed four subelements: declaring mental illnesses, collegial support, managerial support, and enhancing support. Most of the participants portrayed their workplace as an unsupportive and negative environment. A number of colleagues were depicted as having little regard for the codes for professional nursing practice. This paper shows how nurses in the study dealt with the workplace support associated with mental illness.

Mental health reform, citizenship and human rights in four countries

Abstract Mental health is now seen as a major global problem. In recent decades acknowledgement of the global cost of mental illness has prompted mental health reforms in many countries. While there have been national differences in how the reforms have been played out, in virtually every case there has been an intensification of governmental interest in mental health, resulting in the adoption of deinstitutionalisation and community care as the officially sanctioned options for providing mental health services. At the same time, the new policy directions have been characterised by concern for the citizenship participation and human rights protection of mental health service users. This paper compares recent mental health reforms in four countries – Australia, the UK, Italy and Brazil – with particular emphasis on the relationship between deinstitutionalisation, citizenship and human rights. The paper concludes by arguing that the question of whether deinstitutionalisation has worked is best addressed using an international comparative approach.

Encounters with the 'Dark Side': New Graduate Nurses' Experiences in a Mental Health Service

Abstract Despite almost two decades of reform under Australia’s National Mental Health Strategy, the life circumstances of many people with mental illness seem little improved. While lack of rehabilitation, housing and community support services have been blamed for policy shortfalls, there is also concern that mental health services may impede rather than facilitate recovery from mental illness. To explore this particular concern, this paper reports data from a project which evaluated a group mentorship programme for new graduate nurses working in an Australian public mental health service. Prominent among the problems raised in mentorship group discussions were: the arduous nature of mental health work; the uncaring attitudes and practices of many veteran nursing staff; and the maltreatment and neglect of service users. These participants characterised mental health facilities as tough security-minded places, where staff act more as risk-managers rather than therapists, and all service users are treated as if they might be dangerous. They also perceived a connection between the dismissive ways in which they were often treated by veteran colleagues and the widespread mistreatment of service users.

An overview of swearing and its impact on mental health nursing practice

Swearing is a subject largely ignored in academic circles but impossible to ignore in the workplace. Nurses encounter swearing from patients and their carers, staff and managers and use swearwords in communication with each other. Language is the major tool of the mental health nurse and swearing an aspect of language frequently used in situations of intense emotion. This paper provides an overview of the historical, legal and cultural aspects of swearing in an Australian context in order to assist nurses in their practice.

Occupational therapy and obesity: An integrative literature review

BACKGROUND/AIM Obesity is a significant public health concern globally. It is associated with poor physical health, mental health and subjective well-being and limitations on occupational participation. With its focus on the relationship between occupation, health and well-being, occupational therapy would appear to be well placed to address both the causes and consequences of obesity. The aim of this review was to explore the scope of the role of occupational therapy practice in this field and the supporting evidence base. METHODS Searches were conducted in four online databases and nine occupational therapy journals. Articles were included if they were theoretical, quantitative or qualitative research, explicitly related to occupational therapy and obesity, published in peer-reviewed journals, in English between 2002 and 2012. All research articles were critically reviewed and thematic analysis was conducted across all of the articles in the review. RESULTS Eight theoretical articles, 12 quantitative and two qualitative research studies were included. Only three were outcome studies. Thematic analysis identified four categories of focus of occupational therapy intervention: health promotion and prevention, increasing physical activity participation, modifying dietary intake and reducing the impact of obesity. Four categories of intervention strategies were also identified; assessment, modifying the environment, education and introducing and adapting occupations. CONCLUSION AND SIGNIFICANCE The findings of this review suggest a comprehensive role for occupational therapy in addressing obesity. However, the paucity of outcome studies mean that significantly more research is required to further define and provide a strong evidence base for occupational therapy practice in this emerging field.

A Comparison of Patient Clinical and Social Outcomes Before and After the Introduction of an Extended-Hours Community Mental Health Team

Objective: The aim of this study was to assess the effectiveness of the addition of standard community treatment to a hospital-based service in a regional district of Australia. Method: The study was a naturalistic investigation of a routine clinical service and utilized a longitudinal panel design. Two matched groups of seriously mentally ill patients were recruited, one before the addition of the community mental health team (CMHT) and one after. Each sample was followed up for one year using a semistructured questionnaire and instruments including the Brief Psychiatric Rating Scale, the Global Assessment Scale, the Life Skills Profile and the Rosenberg Self-Esteem Scale as well as hospital records. Results: Patients in both groups showed similar patterns of improvements. Although the aims of the new service included reducing in-patient utilization and improving social functioning, there were few significant differences between the two groups. While the number of admissions and length of stay were lower in the post-CMHT sample most were admitted rather than treated in their homes by the CMHT. Conclusion: The study concludes that better outcomes might have been achieved if the aims of the CMHT had been limited to either crisis or rehabilitation interventions, but not both. More attention needs to be paid to the service context in which model programmes are introduced so that new developments can be more closely tailored to the realities of what is likely to be achievable.