Rachel Rossiter

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.

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.

Predatory publishing: Take care that you are not caught in the Open Access net

A relatively recent innovation intended to remove restrictions to online access to peer-reviewed scholarly research (Conn, 2015), open access publishing may have created the conditions in which new predatory practices are flourishing; it is not in itself the problem. Many highly rigorous, scholarly, and professional journals are exclusively open access; others, such as Nursing and Health Sciences, offer a range of traditional and open access options. Most open access options are fee-based. Many research granting bodies have strongly advocated unrestricted access to studies they fund, and some are funding publication costs in order to make results widely and rapidly available. Beyond the open access options being adopted by mainstream publishers, the ease of digital publishing has led to a myriad of new journals competing for authors and revenue. Some of these apply the same rigorous peer review practices and standards of scholarly excellence we rely on as consistent with advances in professional disciplines such as nursing, but across every academic field, professional discipline, and geographic jurisdiction, we see the emergence of a new species of publishers whose practices reveal little evidence of editorial and publishing quality. With profit as the driving force, these predatory publishers engage in a range of disturbingly unethical and unscholarly practices and even fabricate impact factors.

The experiences of head and neck cancer patients requiring major surgery.

Background: The prevalence of head and neck cancers is lower (3.5% of total cancers in Australia) than for a number of other cancers. Treatment for head and neck cancer is often drastic and debilitating and patient outcomes are poorer. Objective: This qualitative study explored the experiences of cancer patients who underwent surgery for head and neck cancer. Methods: In-depth face-to-face interviews were conducted with 12 patients 7 to 26 months after surgery. Interviews were thematically analyzed to produce a rich description of patients’ experiences from diagnosis through surgery and beyond. Results: Critical aspects of patients’ experiences are described through the following themes: only having half the story, shocks and aftershocks, living with the aftermath, and being supported. Participants identified difficulties arising from receiving insufficient, confusing, and often untimely information. The persistent and traumatic nature of what patients endure challenges their physical, mental, and emotional coping capacity and, in some cases, their motivation to live. Conclusions: There is a need to address gaps in support and education of patients and carers. Of particular concern is the problem related to information provision and comprehension. Critical examination of current practices, together with efforts toward coordinated care tailored to individual needs, is required, along with outreach services for patients in rural areas. Implications for Practice: The development and evaluation of targeted resources in a variety of forms such as DVD, Internet, and pamphlets are needed. Robust assessment strategies are required to inform supportive interventions matched to stages and significant events in patients’ journeys.

Unstructured play for anxiety in pediatric inpatient care

PURPOSE The purpose of this study was to examine the effects of unstructured play activities on the anxiety levels of hospitalized children. METHODS A nonequivalent control group pretest posttest design was employed for this study. The sample included children (N = 165) ages 4-7 years admitted to a large pediatric referral center in the United Arab Emirates. The control group (n = 84) received usual care, while the experimental group (n = 81) engaged in age-appropriate unstructured play activities using disposable games and toys. Parents and siblings, if present, were encouraged to participate. Research assistants conducted the play activities twice a day, with 30-min morning and evening sessions. Anxiety was measured at baseline and at the end of days 2 and 3 with a translated form of the Short-State-Trait Anxiety Inventory for Children. RESULTS Anxiety scores in both groups were similar at baseline and decreased significantly over the 3 days. Compared with the control group, anxiety scores in the intervention group were significantly lower on day 2 (12.7 ± 2.3 vs. 10.7 ± 2.5, p = .003) and day 3 (10.6 ± 2.2 vs. 9.47 ± 2.4, p < .001). The greatest decrease occurred in the percentage of children in the experimental group with medium-level anxiety scores: baseline (n = 61, 75%), day 2 (n = 24, 30%), and day 3 (n = 0, 0%). CONCLUSIONS This simple, low-cost play intervention implemented by nurses resulted in statistically and clinically significant decreases in the anxiety levels of children in an acute inpatient setting.

Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study.

UNLABELLED Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations. OBJECTIVES To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves. METHODOLOGY A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants. RESULTS The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.

Childhood Stress in Healthcare Settings: Awareness and Suggested Interventions

Pivotal to healthy adulthood is a supportive and nurturing environment that enables successful progression through the developmental tasks of childhood and adolescence. For many children there are events that disrupt this development. Illness, injury, painful medical interventions, and hospitalization have been reported by children and families as causing medical trauma and psychological stress. Frequently pediatric health professionals focus primarily on achieving positive physical treatment outcomes. Creating an environment that will support the developmental tasks of childhood and limit the trauma and distress associated with illness and treatment is also required. Strategies and practices to deliver holistic and comprehensive pediatric care are well established in many Western settings. Opportunity exists to broaden the focus of pediatric care in developing healthcare systems such as the United Arab Emirates (UAE) to encompass psychological well-being. The study focused on two key objectives, firstly to assess healthcare professionals’ awareness of the stressful and potentially traumatic nature of healthcare settings and treatment for children. Second the study explored the views of healthcare participants regarding possible strategies to minimize medically induced stress and trauma for children and adolescents in UAE healthcare settings. The study utilized a mixed methods design in which participants views were examined through administration of a survey comprised of close-ended questions that were analyzed quantitatively and open-ended questions analyzed qualitatively. One hundred and seventeen healthcare professionals from a range of disciplines in two government hospitals completed the survey. Data revealed that one third of the participating healthcare professionals were unaware of or did not think that their healthcare settings could provoke stress for pediatric patients. Respondents suggested three main strategies to minimize stress for children and parents while receiving treatments, specifically; providing focused information for both children and healthcare providers, adapting the environment and systems to fit children’s needs, and, improving the interpersonal skills and attitudes of healthcare professionals. The findings from this study could inform the development of standards for pediatric services and policy directions in regard to post-graduate training for health professionals working in pediatric healthcare settings.

Diabetes in the United Arab Emirates: the need for valid datasets for health service planning

In 2013, the age-standardised comparative prevalence of diabetes in the United Arab Emirates (UAE) was 18·98%, amongst the highest in the world; the global comparative prevalence in 2013 was 8·3%. Recent research and anecdotal reports from clinicians point out that Abu Dhabi, in particular, is burdened by high and rising rates of diabetes, obesity, and non-communicable diseases (NCDs) related to diabetes. Abu Dhabi and the UAE generally have unusual subpopulation distributions, with a known population imbalance resulting from a large, young, male immigrant labour force. Although these expatriate workers tend to return home before age-related health issues, such as diabetes, become evident, their dietary preferences contribute substantially to the changing dietary patterns in the UAE. In the absence of a fully developed public-health workforce and services and community support infrastructure, primary clinicians struggle to eff ect health-care improvements in the UAE. Reliable baseline and comparative data are essential for the development of eff ective health programmes and services, and for review and evaluation of the eff ectiveness of interventions. Systematic collection and initial analysis of data have been important priorities associated with the development of a research programme focused on the prevention and management of diabetes and associated NCDs. In Abu Dhabi and the rest of the UAE, however, the sourcing of reliable data has proved particularly challenging, as substantial gaps exist in published demographic and health status data. To address this gap, the support and collaboration of key UAE-based health service agencies is crucial to enhance access to unpublished data and grey literature. Access to such data has the potential to improve knowledge and understanding of the true nature and extent of the problem of diabetes in the UAE, and inform achievable, robust, and sustainable recommendations that are appropriately aligned to conditions, context, and values of the UAE population. Among other solutions to address this gap, we present an argument for use of existing national alliances (other than the commonly used Middle East and Northern Africa region [MENA]) for the collection and improvement of access to valid data, and for benchmarking diabetes metrics for the UAE. The UAE benefi ts little from existing regional aggregation of data on diabetes. For example, the WHO aggregates data regionally to its Eastern Mediterranean Regional Offi ce (EMRO). The International Diabetes Federation (IDF) aggregates and summarises the global burden and prevalence of diabetes with World Bank geographic and income classifi cations: data for the UAE are aggregated within the MENA grouping, which is made up of heterogeneous populations (table). Indeed, data for the UAE is commonly compared with other MENA countries, yet vast diff erences in wealth, health, and lifespan exist between the UAE (and other Gulf nations) and the low-income nations in the MENA grouping. Unlike the UAE, many countries in this grouping also struggle with war, famine, and infectious disease. Unlike the rest of MENA, the UAE and other GCC countries fall into both the World Bank highincome category, and the International Monetary Fund emerging and developing economy category. Thus, there is a need for a grouping made up of more homogeneous comparators for benchmarking. Aggregating data is convenient for administrative handling, but risks important diff erences being disguised and distorted. Aggregated data needs to be qualifi ed by the rationale for aggregation. Given the rapid wealth acquisition, modernisation, major nutritional transitions, and changes in physical activity in Gulf nations, the reported escalation of diabetes in these countries demands culturally and contextually specifi c attention. Benchmarking the UAE and Abu Dhabi against aggregated data from apparently dissimilar countries would need a strong justifi cation. In searching for benchmarks relevant to the burden of diabetes and other NCDs in the UAE, we identifi ed three groupings with which the UAE has established member affi liation. These include the Gulf Cooperation Council (GCC), the Arab League, and the Organisation of Islamic Cooperation (OIC; table). All three groupings share (to some extent) common faith, culture, and language. Each grouping has a charter to cooperate on shared For more on MENA see http:// web.worldbank.org/WBSITE/ EXTERNAL/COUNTRIES/MENAE XT/0,,menuPK:247619~pagePK: 146748~piPK:146812~theSite PK:256299,00.html

Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.

Making the most of conference attendance

International conferences are an excellent way to get an up-to-date perspective of what is happening in your field and engage with decision makers and influential researchers across the globe. Conferences have been described as being “holiday, hot air and hubris” (Holstein, 2013), but are also an important part of an academic career (Houston, 2013). Conference-going experiences range from the spine-tingling excitement of hearing something, or meeting someone who will make a huge difference to your professional practice, or the cringe of seeing someone ruin their international reputation perhaps forever by ill-advised behavior.