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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions.

Chronic non-communicable diseases such as heart disease, cancer and diabetes are the biggest killers worldwide. Chronic conditions include heart disease, stroke, diabetes, cancer, chronic respiratory disease and are often comorbid with mental illness. Over 60 years ago, the British Medical Journal reported an association between mental illness and poor physical health ( Philips, 1934 ). Comorbid mental illness and physical illness incrementally worsens health compared with mental illness alone or any of the chronic non-communicable diseases such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes alone. This paper aims to open the dialogue related to optimising, through nursing intervention, a patient's self-righting and self-management factors in the context of comorbid chronic conditions such as heart disease, stroke, diabetes, cancer, chronic respiratory disease, with mental illness. Self-managementand self-righting capabilities are now being considered integral to reducing the negative impact of chronic conditions such as mental illness. Personal characteristics associated with resilience comprise optimism, an active or adaptable coping style and the ability toelicit social support. Existing resilience factors can be assessed forby nurses and optimised through interventions when patients with chronic conditions are in care. Representing over 70% of the global health workforce, nurses are well positioned to enact such practice enhancements to facilitate better outcomes for patients.

The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery.

Oral health care is an essential aspect of nursing care. There are many variances in the quality and frequency of the oral care that is delivered to patients by nursing staff, such as oral care being given a low priority when compared to other nursing care elements, oral care being neglected, and oral care delivery being dependent on the nurse’s knowledge of oral hygiene. Additionally, there are some particular patient groups known to be at risk of oral health problems or who have existing oral diseases and conditions. As people age their susceptibility increases to chronic and life-threatening diseases, and they can be at increased risk of acute infections increases compromised by ageing immune systems. The aim of this literature review was to ignite the discussion related to the oral care practices of nurses for older acute medical hospitalised patients. The review revealed that nursing staff know that good nursing includes oral health care, but this knowledge does not always mean that oral health care is administered. Oral health care seems to be separated from other nursing activities and is not discussed when nursing care plans are written, only when oral problems are obvious.

Bariatric surgery is now a common weight loss solution for morbidly obese men where meaningful weight reduction and improvements in quality of life have been identified postsurgery. As the majority of surgical candidates are female, there exists a paucity of literature relating to the experience of males undergoing bariatric surgery. In this study, a qualitative descriptive–exploratory design was used to explore body image descriptions, adaptation of a new lifestyle, new boundaries postsurgery, and any barriers seeking consultation for surgery. Six males who had undergone bariatric surgery were recruited in Australia. Data were collected and analyzed using NVivo between May and October 2014. The themes emerging from the data included living in an obese body, life before surgery, decision making for surgery, and life after surgery. The participants collectively reported that life before surgery was challenging. They described the changes the surgery had made in their lives including positive changes to their health, body image, social lives, and self-esteem. Some participants preferred not to tell others their intentions for surgery due to perceived stigma. The men in this study also described a lack of information available to them depicting male perspectives, a possible barrier for men seeking weight loss surgery options. Implications for practice highlighted in these results relate to a greater need for accessible information specific to men based on real-life experiences.

Background\ud Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure.\ud \ud Methods\ud A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated.\ud \ud Results\ud All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p

Despite the substantial risks posed in the surgical environment, compliance in wearing appropriate personal protective equipment (PPE) in the operating room (OR) and the post-anaesthetic care unit (PACU) amongst health care workers is considered poor globally. Lack of awareness and limited access to information about the appropriate precautions to prevent exposure contribute to continued high-risk behaviours amongst the team in the perioperative setting.The aim of this project was to assess current compliance rates of staff in the use of PPE and to develop and implement an educational program to increase staff compliance in the perioperative setting of a large, private hospital (450 beds).A convenience sample of perioperative nurses were invited to complete a questionnaire.Eighty (80) registered nurses RNs) were invited to participate response rate of 69%), giving a sample size of n = 55. Questionnaires not completed in full were not included in the final analysis, leaving n = 31 fully completed questionnaires. There was an education group (n = 14) and a control group (n = 17). Between the groups, educational background, type of work and patient contact were very similar. Of those that did respond regarding exposure, only 20% reported the incident. Both groups identified their manager and team as frequently discussing safer work practices and being supportive. PPE was identified as essential; however, participants reported not enough time to always follow standard precautions (education 15%; control 25%).Team and good leadership was identified as essential to ongoing professional knowledge and support with regard to risk minimisation in the perioperative setting.

Aims and objectives- The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse, or physical abuse/assault) perpetrated against the nurse or other health professional by patients/relatives or staff. In light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers.\ud Background – Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings.\ud Design- Systematic review with meta-analysis\ud Data Sources- The databases of Medline (1966 to 2015), CINAHL (1982 to 2015) and PsychInfo (1920 to 2015).\ud Methods- Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or non-mental health/psychiatric).\ud Results - A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to non-mental health nurses.\ud Conclusions – The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had 3 times higher odds of physical assault than other nurses.\ud Relevance to clinical practice- In light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programs.

The complexity of providing treatment for people with dual diagnosis is well recognized. For the purpose of this paper, the World Health Organization definition of dual diagnosis was used; that is, a person diagnosed with an alcohol or drug use problem in addition to mental illness. This research explored the personal narratives of those who experience dual diagnosis using the Internet as a data source. An important consideration in using the Internet as a data source was that Web forums can offer a sense of anonymity, allowing people to share very detailed and personal information, and providing a rich source of qualitative data. The results produced five emergent themes: spiralling out of control - again!, getting help and giving support, treating both the addiction and mental illness, having meaning and being active, and being honest with self and others. The results indicate that individuals who experience dual diagnosis are often left to navigate their personal treatment requirements across two diverse systems, and were generally not satisfied with the conflictual advice received across these two systems (i.e. alcohol and other drug and mental health services). This study has produced valuable insights related to consumer-perceived service barriers and enablers.

Summary Background Cardiovascular disease is the most common cause of death in Australian women. The genesis and progression of cardiovascular disease is modulated by a complex interplay of genetic, physiological, social and economic circumstances. Increasingly the impact of racial, ethic, social and economic inequalities is identified as predictors of cardiovascular disease outcome. Despite important advances over the last 30 years in reducing age adjusted mortality from cardiovascular disease, it continues to represent a major social and economic burden nationally and internationally. Aim This paper provides a critical review of the social issues impacting upon women in Australia. It also identifies areas for future interventions with a view to improving outcomes in women with cardiovascular disease. Method The bibliographic databases; CINAHL, MEDLINE, PsycARTICLES, were searched for relevant studies using the search terms ‘women', ‘cardiovascular disease', and ‘socio-economic status'. Findings While some gains have been made in reducing the risk factor profile and rates of death from cardiovascular disease, it is clear that gender, race and socioeconomic disparities persist. Conclusions New approaches are required to improve health differentials for CVD, and reduce the impact of gender, racial, ethic, social and economic factors on health disparities.

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.

Objective: The pilot study aimed to evaluate the Disability Open Employment Services (DOES), now called the Disability Employment Network (DEN), developed by the Australian Federal Government to assist clients with health disabilities to seek and maintain employment. This is the first time this type of programme has been evaluated in a service delivery setting in Australia.\ud Method: This study employed a mixed method design for inquiry.\ud Findings: Male participants reported less symptom interference with work duties than females. There was also an association of gender on mental health with males reporting lower levels of mental health than females. There was an association of employment goal on the degree to which symptoms interfered with work duties where those whose goal was full time work experienced significantly more interference from their symptoms than other individuals. Key findings relate to the fragmentation of current services and the variability in the educational preparation of employment counsellors.\ud Implications and Conclusions: Implications for practice relate to the enhancement of the provision of employment services to people with a mental illness. Further research is required into the factors which clients perceive as enabling or inhibiting their participation in employment support services and further knowledge is also required about how employment support services and mental health organisations can work together as interlocked services.

It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.

Aim. This paper is a report of a study to explore the phenomenon of resilience in the lives of adult patients of mental health services who have experienced mental illness. Background. Mental illness is a major health concern worldwide, and the majority experiencing it will continue to battle with relapses throughout their lives. However, in many instances people go on to overcome their illness to lead productive and socially engaged lives. Contemporary mental health nursing practice primarily focuses on symptom reduction, and working with resilience has not generally been a consideration. Method. A descriptive phenomenological study was carried out in 2006. One participant was recruited through advertisements in community newspapers and newsletters and the others using the snowballing method. Information was gathered through in-depth individual interviews which were tape-recorded and subsequently transcribed. Colaizzi’s original seven-step approach was used for data analysis, with the inclusion of two additional steps. Findings. The following themes were identified: Universality, Acceptance, Naming and knowing, Faith, Hope, Being the fool and Striking a balance, Having meaning and meaningful relationships, and ‘Just doing it’. The conceptualization identified as encapsulating the themes was ‘Viewing life from the ridge with eyes wide open’, which involved knowing the risks and dangers ahead and making a decision for life amid ever-present hardships. Conclusion. Knowledge about resilience should be included in the theoretical and practical education of nursing students and experienced nurses. Early intervention, based on resilience factors identified through screening processes, is needed for people with mental illness.

This paper presents a review of the literature of service trends and practice recommendations for management of those with the dual diagnosis of mental illness and substance abuse. The method for the review was to search bibliographical data bases and hand held literature published in English between 1990 and 2007. Using the search terms dual diagnosis, and co-morbidity and mental illness, 93 abstracts were selected and reviewed. The authors concluded that a collaborative approach to care with better integration of drug and alcohol services within mental health would benefit clients with a dual diagnosis. Improved education to enhance the assessment and diagnosis of this client group is also considered essential for clinicians in both mental health and alcohol and drugs services.

Comorbidities related to diabetes such as chronic wounds can increase the need for surgical procedures, with at least 10% of all patients undergoing surgery having diabetes. Being diagnosed with diabetes can be seen as a risk factor for developing wound healing problems. Discussion: This short report highlights the potential positive influences gained from providing resilience education and self- management education to people with type 2 diabetes, potentially enhancing self-managing abilities and reducing poor wound healing. Summary: Modern wound care practice is centred on symptom reduction and working with pathology; however, working with people to enhance their personal resilience and promoting positive psychological adaptation can impact positively on their mental health.

Background: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. Results: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. Conclusions: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

Background An estimated 30–50% of patients admitted to acute medical care settings experience co-morbid physical and mental illness. Research suggests that health professionals in these settings find managing this patient group challenging. A number of studies have investigated health professional’s attitudes and perceptions however there is limited research that investigates the lived experience in a current Australian healthcare context. The aim of this study was to explicate an in-depth description of the health professional’s experience when caring for patients experiencing co-morbid physical and mental illness in Australian acute medical care settings. Methods A phenomenological design was undertaken with six participants representing nursing and medical disciplines. In 2013–2014 one-on-one semi-structured interviews were used and the data collected underwent thematic analysis using an extended version of Colaizzi’s phenomenological inquiry. Results Six themes emerged including—challenging behaviours, environmental and organisational factors, lack of skills, knowledge and experience, hyper-vigilance and anxiety, duty of care and negative attitudes with an overarching theme of fear of the unknown. Conclusions Staff in acute medical care settings were unsure of patients with mental illness and described them as unpredictable, identifying that they lacked requisite mental health literacy. Regular training is advocated. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1264-z) contains supplementary material, which is available to authorized users.

Table S2. Symbolic representation of phenomenon.

Table S1. Extended version of Colaizziâ s phenomenological method.

Introduction: Surgery can be a stressful and anxiety-provoking event for children and their parents. Preparing a child for surgery may help reduce the anxiety children experience, potentially impacting on the experience of pain since pain experienced can be exacerbated by anxiety. Post-surgical pain in children is associated with problematic behaviours, which can lead to ward disruptions, increased length of stay and anxiety in the child and parent/guardian. The mock admission process was intended to simulate a real admission. Mock admissions involve meeting the surgical team, seeing the theatre environment and a visit to the paediatric ward to meet the staff there. Aim: The aim of this retrospective audit was to compare length of stay and pain in two cohorts of paediatric patients: those who received a mock admission compared to those who did not. Method: A retrospective chart audit was undertaken. Results: A variation in length of stay between the groups was observed, with 96% of the children who received a mock admission having a 24-hour length of stay. By comparison, 20% of those who did not receive a mock admission had a longer length of stay of 48 hours or more. Pain scores were also higher in children who did not receive a mock admission. Conclusions: The mock admission process provided surgical preparation for paediatric patients and has indicated a potential positive impact by reducing length of stay and assisting in the reduction of pain experienced post surgery.

This article develops a theoretical discussion related to the value of a phenomenological framework in contributing to contemporary nursing knowledge. Nursing is based on the understanding of patients' personal experiences and their responses to their illness. Phenomenological methodology utilizes the patient's own language to reflect meanings embedded in their health experience.

Background\ud Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction.\ud \ud Methodology\ud An online survey was distributed to breast cancer patients from Breast Cancer Network Australia. Results were tabulated, described qualitatively and analyzed for significance using a multiple logistic regression model.\ud \ud Results\ud 501 mastectomy patients completed surveys, of which 62% had undergone breast reconstruction. Factors that positively influenced likelihood of reconstruction included lower age, bilateral mastectomy, access to private hospitals, decreased home/work responsibilities, increased level of home support and early discussion of reconstructive options. Most common reasons for avoiding reconstruction included “I don't feel the need” and “I don't want more surgery”. The most commonly sited sources of reconstruction information came from the breast surgeon followed by the plastic surgeon then the breast cancer nurse and the most influential of these was the plastic surgeon.\ud \ud Conclusions\ud A model using factors easily obtained on clinical history can be used to understand likelihood of reconstruction. This knowledge may help identify barriers to reconstruction, ultimately improving the clinicians' ability to appropriately educate mastectomy patients and ensure effective decision making around breast reconstruction.

The aim of this project was to review current research regarding postnatal depression in fathers and to present potential screening and referral options. The search was limited to scholarly (peer reviewed) journals and all articles were retrieved with date limits. Initial search parameters were the following: antenatal depression OR pregnancy depression OR postnatal depression OR perinatal depression AND father* OR men OR paternal. The search yielded 311 abstracts returned. With reference to the inclusion criteria and primary and secondary outcomes intended for the focus of this review, N = 63 articles were retrieved and read in full by the researchers. These articles were included in the final integrative review. Depression in fathers following the birth of their child was associated with a personal history of depression and with the existence of depression in their partner during pregnancy and soon after delivery. Based on the review the authors suggest routine screening and assessment of both parents should occur across the pregnancy and postnatal period. The use of the Edinburgh Postnatal Depression Scale for screening of depression in men needs to be linked to referral guidelines for those individuals who require further investigation and care.

Background: People with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases. Methods: A retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 – August 2013). Results: A total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options. Conclusions: The results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.

Aim\ud The aim of this project was to develop and deliver an evidence-based educational package with a physical and mental health focus to clinicians and other health care workers in mental health settings.\ud \ud Background\ud For individuals who experience mental disorders, pharmacotherapy is often considered as a first line of treatment. However, owing to adverse drug reactions and pre-existing physical conditions, outcomes for clients/service users may be compromised. Mortality and morbidity rates of people diagnosed with a serious mental illness caused by physical health conditions do not compare favourably with the general population. This paper reports on a physical skills project that was developed in collaboration between the University of Huddersfield and South West Yorkshire Partnership Foundation Trust.\ud \ud Method\ud Pre–post study design: five workshops were conducted in the fields of intramuscular injections, diabetes, health improvement, oral health and wound care. A total of 180 pairs of questionnaires to assess practitioner and student skills and knowledge were administered to participants before and after workshops. All workshops resulted in a statistically significant improvement in subject skills and knowledge scores (P < 0.001 in all cases). Questionnaires also elicited participant satisfaction with the workshops: over 99% of participants reported being ‘satisfied’ or ‘very satisfied’ with the workshops.\ud \ud Implications for nursing management\ud Mental health nurses are the largest group of registered practitioners working in the mental health setting and thus need to be harnessed to make a positive contribution to the improvement of the physical health status of service users with a serious mental illness.

Personal experiences of aggression or violence in the workplace lead to serious consequences for nurses, their patients, patient care and the organisation as a whole. While there is a plethora of research on this topic, no review is available that identifies types of aggression encountered, individuals perceived to be most at risk and coping strategies for victims. The aim of this systematic review was to examine occupational anxiety related to actual aggression in the workplace for nurses. Databases (MEDLINE, CINAHL and PsycINFO) were searched, resulting in 1543 titles and abstracts. After removal of duplicates and non-relevant titles, 137 papers were read in full. Physical aggression was found to be most frequent in mental health, nursing homes and emergency departments while verbal aggression was more commonly experienced by general nurses. Nurses exposed to verbal or physical abuse often experienced a negative psychological impact post incident.

Oral health care seems to be separated from other nursing activities and does not appear to be acknowledged when nursing care plans are written, only when oral problems are obvious. This study examined the state of oral health of patients presenting to a variety of healthcare specialties in a major metropolitan hospital

Evidence-based practice is fundamental to nursing, yet there are many reports in the literature of the difficulty associated with incorporating research activity that leads to evidence-based practice into daily practice. This study used a hospital-based research enhancement model (HREM) to plan, develop, and implement a research outreach ward-based seminar (ROWS) program and evaluate its effectiveness as a means for nurses to increase their knowledge and capacity in research and evidence-based practice. A survey was used to collect both quantitative and qualitative data for evaluation of the program. A total of 78 evaluations were returned after ROWS attendance. Three main themes from the survey were explored. These include accessibility of research, appreciation and application of research, and training in research. The results suggested that nurses are interested in participating in research activities, including projects, best practice forums, journal clubs, and seminars. The HREM can address some common barriers to an evidence-based practice culture and the application of evidence-based practice within nursing. J Contin Educ Nurs 2013;44(10):447–454.

BACKGROUND: Interplast Australia and New Zealand was established to provide voluntary teams of expertly qualified surgeons, nurses, anesthetists, and allied health care professionals to provide free plastic and reconstructive surgery to the people of neighboring developing countries. Nepal is a developing country that has received overseas assistance for plastic and reconstructive surgery with Interplast since 2007. AIM: The aim of this article was to present three (3) case examples derived from Nepal to illuminate the enhanced capacity of Nepalese plastics and reconstructive health care professionals who have received education facilitated by Interplast METHOD: Case presentations. DISCUSSION: The work performed by Interplast demonstrates that such barriers can be overcome by providing safe, effective, and life-changing plastic surgery to the people of Nepal. Through a collaborative education engagement (described in this article as provided to nursing and other health care workers) volunteers who work with Interplast were able to enable and empower plastics nursing and allied health staff located at the participating site to continue to facilitate complex surgery to the local Nepalese community. Participatory education is an educational approach used by the volunteers working with Interplast CONCLUSION: This collaborative approach offered a means to transfer knowledge into practice for better patient outcomes for nurses and allied health staff in a developing country such as Nepal.

The complexity of providing treatment for people with dual diagnosis is well recognized. For the purpose of this paper, the World Health Organization definition of dual diagnosis was used; that is, a person diagnosed with an alcohol or drug use problem in addition to mental illness. This research explored the personal narratives of those who experience dual diagnosis using the Internet as a data source. An important consideration in using the Internet as a data source was that Web forums can offer a sense of anonymity, allowing people to share very detailed and personal information, and providing a rich source of qualitative data. The results produced five emergent themes: spiralling out of control - again!, getting help and giving support, treating both the addiction and mental illness, having meaning and being active, and being honest with self and others. The results indicate that individuals who experience dual diagnosis are often left to navigate their personal treatment requirements across two diverse systems, and were generally not satisfied with the conflictual advice received across these two systems (i.e. alcohol and other drug and mental health services). This study has produced valuable insights related to consumer-perceived service barriers and enablers.

Aim: Originating from unfunded research undertaken in 2007, this paper offers an overview of Colaizzi’s method of phenomenological analysis and proposes an extension to the original seven step approach enhancing rigour and, expanding information sources to enhance in-depth descriptions of phenomena for study. Background: The focus on human experience emanates from the human sciences in which the everyday lived world of humans constitutes the ontological and epistemological focus of enquiry – understanding of human experiences. Since the emergence of phenomenology as a method of enquiry, advances in phenomenological thought and research methods have emerged. Method: Colaizzi’s phenomenological method of enquiry was used as the basis of enquiry in this study. Findings: The extension to Colaizzi’s method of analysis emanated from recent research conducted by the authors to allow participants to express their experiences through everyday language. These ‘expressions of life’ included – art, music, poetry, metaphor as symbolic representations – as a vehicle for participants’ to explicate their experiences. Conclusion: The additional step proposed as an extension to Colaizzi’s seven step analysis offers researchers using Colaizzi’s method greater access to implicit and explicit meanings embedded in participant descriptions by utilising ‘expressions of life’ – art, music, poetry, metaphor as symbolic representations – as articulated by the participants in explicating their experience of the phenomenon.

The needs of dually diagnosed clients in mental health services have been and remain a focus for service development and improvement in Australia. The Council of Australian Governments committed to a five-year National Action Plan on Mental Health with a $1.8 billion injection into mental health services. In Australia there have been great advances in the service initiatives and service deliverables to those clients who experience a dual diagnosis. These advances include that dual diagnosis is systematically identified and responded to in a timely, evidence-based manner as a core business in mental health and alcohol and other drug services. These advances are brought to life by specialist mental health and alcohol and other drug services that establish effective partnerships and agreed mechanisms to support integrated care and collaborative practice. Here, four case studies are offered as a means of illustrating the ways in which projects undertaken in local community health services have approached dual diagnosis treatment for clients. These case studies reflect how cooperation and cross-referral between services, as well as effective management of dual diagnosis clients by suitably qualified staff can produce benefits to clients who use the service.

Breast cancer is the most common cancer for women in both the developed and the developing world, comprising nearly one quarter of all female cancers. The most advanced forms of treatment, including mastectomy, may produce a five-year survival rate of 75% or more for certain types of cancer. For women experiencing breast cancer, breast reconstruction is often a positive option that can enhance quality of life and plays a significant role in a woman's recovery from breast cancer.The aim of this article is to present some different cases of women who have undergone autologous breast reconstruction free flaps and discuss advanced and intensive nursing care practice.Nurses need to not only be proficient in the postoperative physical care of patients who undergo mastectomy but also demonstrate advanced skills related to the educational needs of patients and their families and to ensure care is delivered in a manner that is patient centred and individualised. Nurses require advanced skills to meet the social and psychological care needs of the patient and their family during this major life event.

Aims:This study sought to measure the rates and trajectory of depression over six months following admission for an acute cardiac event and describe the relationship between depression and life satisfaction.Background:Co-morbid depression has an impact on cardiac mortality and is associated with the significant impairment of quality of life and well-being, impairments in psychosocial function, decreased medication adherence and increased morbidity.Design:This was a descriptive, correlational study.Method: The study was undertaken at a large public hospital in Melbourne. Participants were asked to complete a survey containing the cardiac depression scale (CDS) and the Personal Well-being Index.Results: This study mapped the course of depression over six months of a cohort of patients admitted for an acute cardiac event. Significant levels of depressive symptoms were found, at a level consistent with the literature. A significant correlation betweendepressive symptoms as measured by the CDS and the Personal Well-being Index was found.Conclusions: Depression remains a significant problem following admission for an acute coronary event. The Personal Wellbeing Index may be a simple, effective and non-confrontational initial screening tool for those at risk of depressive symptoms inthis population.Relevance to clinical practice: Despite the known impact of depression on coronary heart disease (CHD), there is limited research describing its trajectory. This study makes a compelling case for the systematic screening for depression in patients with CHD and the importance of the nursing role in identifying at risk individuals.Copyright © 1999–2011 John Wiley & Sons, Inc. All Rights Reserved.

Objective The aim of this article is to present a current discussion related to the nursing care of clients treated with atypical antipsychotic medicines and who have a risk of developing metabolic instability and/or Type 2 diabetes. The importance of such a discussion is to provide both the novice and the experienced nurse with additional knowledge of this current health issue with which to inform their nursing practice. Discussion The potential for psychosis to be a chronic condition is very high, and often people require antipsychotic medicine for lengthy periods throughout their lives. Sometimes, treatment is for life. The second generation of antipsychotic medicines was greeted with much enthusiasm since it was better tolerated than the first generation. However, each medication has desired and adverse effects and, when taken for lengthy periods, these effects may produce physical illness. Studies show that the prevalence of Type 2 diabetes and the metabolic syndrome was significantly higher in clients with a chronic psychiatric disorder, particularly schizophrenia. Conclusions Metabolic instability, especially weight gain, is associated with some psychotropic medicines. Nursing interventions need to include care assessment, planning, intervention, and evaluation for clients treated with antipsychotic medicines in terms of risk minimization strategies in routine nursing care.

Objective: The notion of caregiver ‘burden’ has been used as a term that refers to the financial, physical and emotional effects of caring. This Australian 2002 research investigated the caregiver burden of HIV/AIDS on the gay male carers of gay men with the disease. Methods: This study was a phenomenological inquiry and employed van Manen’s approach to content analysis. Data saturation occurred at twelve participants. Results: The findings produced carer themes relating to coping with the burden of care of a person living with HIV/AIDS (PLWHA) in the context of living day-to-day with HIV/AIDS, coping with the last phase of AIDS toward death, saying goodbye and remembrance. Conclusion: Allocating resources to gay male carers such as; education, respite care, family therapy and cognitive-behavioral therapy (CBT) to address grief and stigma issues, has implications for how health services might reduce the burden of care for these carers.

Debate about nursing curricula has been on the forefront of industry and academia in Australia particularly since the shift from the ‘apprenticeship style’ of training for nurses to a university-based, comprehensive, bachelor's degree. There is the suggestion that university-based courses are rather inflexible and take for granted that the provision of mental health nursing across what is an essentially general course will ultimately attract the numbers of quality staff members required to fill speciality positions in mental health. Recent literature advocates for a direct entry undergraduate mental health programme in Australia, similar to that in the UK. This is suggested as one of many strategies to address the growing disparity between the demand and the supply for effective mental health treatment and care. The support of preceptor staff in the clinical field in terms of workloads, supervision and professional development are also identified as areas for attention. Another strategy that this paper addresses is the increased support of student preceptors in the areas of workload, supervision and professional development, whereas they forge organizational links between the tertiary sector and industry to facilitate enhanced communication channels between the theoretical curriculum (the theory) and the clinical sites (the practice). Additionally, increasing the mental health content in current curricula to a level that reflects hospital-based and community mental health needs is also required.

The aim of this study was to explore the experience of mental health nurses undertaking doctoral studies. The study was conducted in Victoria, Australia. A descriptive-exploratory approach to inquiry was used for this study. Participants were mental health nurses who had successfully completed a doctoral qualification. Eligibility for inclusion required participants to be residing in Victoria (irrespective of where their doctoral studies were undertaken) and to have conducted their research within the domain of mental health and/or currently employed in the field of mental health nursing. Of the 20 potential participants invited, 16 accepted the invitation. Five emergent themes were explicated from narrative analyses. These themes were "being a trail blazer," "positioning for professional advancement," "achieving a balance between competing priorities," "maintaining a commitment to the development of the profession," and "a point of affirmation." An understanding of the experience of undertaking doctoral studies can be used to influence the development of strategies to encourage more mental health nurses to consider undertaking a doctoral degree.

The last decade has seen a substantial increase in the number of psychiatric or mental health nurses in Victoria, Australia who hold doctoral qualifications. The literature refers to the importance of scholarship for the professional development and recognition of nursing as a discipline. However, there is a paucity of literature addressing the contribution of nursing doctoral graduates to scholarship in mental health nursing or indeed the broader nursing profession. This paper presents the findings from a survey of psychiatric nurse doctoral graduates currently residing in the State of Victoria. A questionnaire was developed by the authors and distributed to the known doctoral graduates. The main findings demonstrate considerable variation in the discipline and topic of inquiry and in the extent to which doctoral studies had led to dissemination of research findings and engagement in further scholarly activity. The strengthening of mental health nursing knowledge requires scholarship and doctoral graduates are expected to make a major contribution, through research and the dissemination of findings. This paper presents a descriptive overview of doctoral graduates in one State of Australia with a particular focus on research and scholarship.

Caring is neither simply a set of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb). The purpose of this article is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practiced in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs. Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered, underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse-patient relationship. We believe that caring theory has much to offer nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Nurses need to be able to actually practice caring rather than just theorize about it-using caring theories to inform their practice.

There is a dearth of research conducted on the relationship aspect of gay men caring for gay men. This Australian research conducted in 2002 investigated the emotional effects of HIV/AIDS on the gay male carers of gay men with the disease. This study was phenomenological inquiry and employed van Manen's approach to content analysis. Twelve participants for the study were recruited. The results produced emergent themes relating to coping with HIV/AIDS, living day-to-day with HIV/AIDS, coping with the last phase of AIDS towards death, saying goodbye and remembrance. This research highlights the resilient coping style of carers of persons living with HIV/AIDS. The research also gives rise to recommendations for practice and educational contexts in terms of the support and care considerations for persons living with HIV/AIDS and their carers.

This paper will develop a discussion about caring as a modern mental health nurse. We argue that the demands of mental health nursing today extend beyond the more traditional skills of care and caring. We believe that in order to meet mental health needs in the 21st century that caring should be extended to encompass the additional expertise of emotional intelligence and resilience. Emotional intelligence, resilience, and resilient behaviours have the potential to assist individuals to transcend negative experiences and transform these experiences into positive self-enhancing ones. This has implications for improved consumer outcomes through role-modelling and educational processes, but also may hold implications in supporting a strong workforce in mental health.

The potential for resilient behaviors and emotional intelligence involves an interplay between the individual and his or her broader environment. Studies that have examined resilience explore factors or characteristics that assist individuals to thrive from and in adversity. These protective factors are part of an individual’s general makeup. Some of these factors are considered genetic, such as a personality that is outgoing and social; however, many protective behaviors can be learned. Coping in the face of adversity involves emotional intelligence and resilience, both of which can be developed through support and education. In this context, fostering resilience and emotional intelligence has the potential to improve clinical outcomes for mental health consumers.

Personality type and resilient behaviors provide protection from the experience of depression, and resilience can increase the risk of not being depressed. Psychiatric–mental health nurses are well positioned to facilitate the development of resilience qualities in people who are depressed. Clinical strategies, which could be undertaken by the psychiatric–mental health nurse, include early intervention, promoting a positive social and familial climate, promoting self-esteem and support building, social and life skills/vocational education, and linking and brokering clients into extracurricular activities.