Russell Ashmore

Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

The practice of locking acute ward doors in the UK to manage patient care has been reported with increasing frequency in a number of recent official documents; however, there is little research examining the practice. This study explores the perceptions and experiences of mental health nurses working on acute wards where the doors are locked for all or part of a shift. Audio-taped, semi-structured interviews were undertaken with 11 qualified mental health nurses and analysed using content analysis. Six broad categories were identified: policies and documentation, locking and unlocking the doors, communicating the decision, reasons for locking the doors, benefits and concerns. The findings suggest that there is a need for mental health nurses to reflect on the reasons for, and wider implications of locking ward doors before their wholesale implementation is considered in the UK.

Student nurses perceptions of their interpersonal skills : A re-examination of Burnard and Morrison's findings

Herons six category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. The popularity of this framework has generated a number of studies which have attempted to offer empirical support for the theory. The aim of this study was to re-evaluate some of these findings. Utilising an earlier research instrument, a set of findings are offered and comparisons made with previous work. Our findings suggest that student nurses perceive themselves to be most skilled in the use of supportive, prescriptive and cathartic interventions and least skilled in the use of informative, catalytic and confronting interventions. A discussion of the new findings and their implications is offered.

The Delphi Method: methodological issues arising from a study examining factors influencing the publication or non-Publication of mental health nursing research

Purpose – The paper describes how the classic Delphi method can be adapted and structured to ensure that specific research questions are clearly addressed. Design/methodology/approach – As part of a larger mixed method project, a modified Delphi study was undertaken to explore factors influencing publication and non-publication of mental health nursing research. Findings - This paper reports brief findings from the Delphi study. However, its main focus is the methodological issues arising from the Delphi method. Implications - The paper argues that the classic Delphi method can be adapted and structured to ensure that specific research questions are able to be clearly answered. The adaptations are pragmatic in approach and in keeping with the general principles underpinning the Delphi method, while successfully addressing the problems of attrition and previous criticism of homogenous panels. Originality/value - This paper offers some practical solutions to issue arising from undertaking research using the Delphi method.

The impact on relationships following disclosure of transgenderism: a wife's tale

Accessible summary: What is known on the subject?The experiences of transgender people are becoming increasingly more visible in popular culture, biographical literature and the media.The topic has received little attention within the psychiatric and mental health nursing literature.There is a paucity of literature exploring the impact on relationships following a disclosure of transgenderism. What does this paper add to existing knowledge?A narrative account of the consequences for the wife of one transwoman and their relationships with friends and family following the disclosure of transgenderism.The article identifies a range of issues that require further attention in relation to healthcare provision. These include the mental health needs of partners and spouses; attitudes of healthcare professionals towards transgender issues; and the adequacy of the formal support offered to partners and spouses of transgender people. &NA; What are the implications for practice?There is a need for healthcare practitioners to explore their understanding of transgender issues and how these may impact on the mental health of partners and spouses.It is important that healthcare professionals provide a hopeful and supportive environment to enable couples to explore their relationships following disclosure of transgenderism.

Medical response time to section 5(4) (nurses' holding power) of the Mental Health Act 1983 over a 24-year period.

This study examines the trends associated with medical response time (MRT) for all section 5(4)s of the Mental Health Act 1983 applied in one mental health trust over a 24-year period. Eight hundred and three section 5(4)s were applied during the study period of which 786 had a recorded medical response time. The mean MRT was 140 minutes and 647 (82.3%) patients were seen by a doctor within the four-hour period specified in the Mental Health Act Code of Practice (DoH, 1999). Analysis of MRT showed no significant difference with the day of the week or when the weekday mean MRT was compared to that for the weekend. A significant difference was observed for the mean MRT prior to, and following, the introduction of the four-hour period noted in the MHA Code of Practice. Significant differences were also observed for the MRT over the 24-hour period. The mean MRT for the “working hours” period was significantly higher than that for the combined period Monday-Friday, 5pm-9am, and Saturday and Sunday. The findings suggest the need for mental health trusts to review their practices to ensure that patients receive a medical assessment in the shortest period of time following the application of section 5(4).

Informal mental health patients: what are they told of their legal rights?

Purpose The purpose of this paper is to determine what written information is given to informally admitted patients in England and Wales regarding their legal rights in relation to freedom of movement and treatment. Design/methodology/approach Information leaflets were obtained by a search of all National Health Service mental health trust websites in England and health boards in Wales and via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings Of the 61 organisations providing inpatient care, 27 provided written information in the form of a leaflet. Six provided public access to the information leaflets via their website prior to admission. Although the majority of leaflets were accurate the breadth and depth of the information varied considerably. Despite a common legal background there was confusion and inconsistency in the use of the terms informal and voluntary as well as inconsistency regarding freedom of movement, the right to refuse treatment and discharge against medical advice. Research limitations/implications The research has demonstrated the value of Freedom of Information Act 2000 requests in obtaining data. Further research should explore the effectiveness of informing patients of their rights from their perspective. Practical implications Work should be undertaken to establish a consensus of good practice in this area. Information should be consistent, accurate and understandable. Originality/value This is the only research reporting on the availability and content of written information given to informal patients about their legal rights.

Section 5(4) of the Mental Health Act 1983: a review of local policy and guidance in England and Wales

Purpose – The purpose of this paper is to review policy or guidance on the implementation of Section 5(4) written by NHS mental health trusts in England and health boards in Wales. Design/methodology/approach – A Freedom of Information request was submitted to all trusts in England (n=57) and health boards in Wales (n=7) asking them to provide a copy of any policy or guidance on the implementation of Section 5(4). Documents were analysed using content analysis. Specific attention was given to any deviations from the national Mental Health Act Codes of Practice. Findings – In total, 41 (67.2 per cent) organisations had a policy on the implementation of Section 5(4). There was a high level of consistency between local guidance and the Mental Health Act Codes of Practice. There were however; different interpretations of the guidance and errors that could lead to misuse of the section. Some policies contained useful guidance that could be adopted by future versions of the national Codes of Practice. Research ...

Visa refusal following compulsory hospital admission under the Mental Health Act 1983 (England and Wales): fact or fiction?

ACCESSIBLE SUMMARY Historically, compulsory hospital admission led to discrimination for service users. For example, until recently detention under the Mental Health Act 1983 (England and Wales) would disqualify a person from being a Member of Parliament. There is a belief among mental health professionals that compulsory hospital admission will result in service users being refused a tourist visa. However, there is a paucity of literature on this topic, particularly from an international perspective. Based on the information reviewed in this study, there is no evidence to support this belief. Of 262 travel destinations, 96 (36.6%) require British citizens to obtain a tourist visa. Six (2.3%) destinations require applicants to declare a mental health condition in order to obtain a tourist visa. None of these destinations ask applicants to declare a history of compulsory hospital admission. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health nurses require education to ensure that their knowledge of mental health legislation is up to date. This education should include information on the potential consequences of compulsory hospital admission for the service users social life following discharge. Service users and their families should be provided with written information on the potential social impact of detention along with a list of organizations that can provide advice on specific issues. ABSTRACT This study sought to establish whether a history of compulsory hospital admission prevented a person from obtaining a tourist visa. A visa application form and/or other relevant information were obtained for 262 travel destinations visited by British citizens. Ninety-six (36.6%) destinations require British citizens to obtain a tourist visa. All visas are issued subject to travellers meeting a number of conditions, for example being in possession of travel insurance. Six (2.3%) destinations (Australia, China, Guam, Puerto Rico, Russia and the USA) ask applicants to declare a mental health condition. None of these destinations require applicants to disclose whether they have been admitted to hospital, either informal or under a section of the Mental Health Act 1983. However, the possibility exists that anyone declaring a mental health problem may be asked to provide further information about their condition before a visa is granted. Mental health professionals need to acquire accurate knowledge of the potential consequences of compulsory hospital admission. This will enable them to support service users more effectively. Similarly, service users need to be aware of the implications of detention for their social life following discharge from hospital. Further research is required in this area, particularly from an international perspective.