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Social workers and other professionals providing mental health services are regularly required to make high-stakes decisions in situations characterised by conflicting demands. To better understand the factors that drive clinical decision making in situations of risk and uncertainty, we used a design-based research framework to pilot a new approach for improving professional decision making. The programme, which combined simulated interviews, a master class series and personal monitoring of real-time decisions, was designed to focus explicit attention on biological, emotional, cognitive and contextual influences on decision making. Preliminary results from a pilot study suggest that during and immediately following the intervention, clinicians demonstrated new insights into their decision making processes. In addition, they reported benefitting both from the opportunity to reflect individually and share reflections with others. Physiological data demonstrated an association between stressful decisions in real-world clinical practice, elevated heart rate and emotional responses. Qualitative data suggested that client risk represented only one aspect of decision making that resulted in emotional and physical responses, and others included team dynamics, socio-evaluative stressors and organisational and societal factors. This innovative decision making programme creates new opportunities for integrating research, practice and education and shows promise of improving social work practice.

In an effort to improve safety in psychiatric settings, health professionals need to be aware of patients at risk for aggression and violent behaviour. To do so, a risk-flagging functionality can be built into an electronic health record system to alert health professionals of potentially aggressive or violent patients. This paper describes a risk-flagging system at Canada's largest psychiatric hospital and presents initial findings and lessons learned. Risk flags embedded in an electronic health record system are one way of communicating patient risks to health professionals but should be complemented with other forms of risk communication.

Suicide risk assessment is a critical component of mental health practice for which the stakes are high and the outcomes uncertain. This research examines the consistency with which clinicians make determinations of suicide risk and factors influencing clinical confidence. Seventy-one social workers interviewed two standardized patients performing in scenarios depicting suicidal ideation, judged whether the patient required hospitalization, and completed standardized suicide risk assessment measures. Self-ratings and qualitative interviews explored participants’ confidence in their judgment of risk. Participants had highly divergent views regarding whether or not the risk of suicide was sufficiently high to require hospitalization. However, regardless of the ultimate decision reached, participants were equally confident when recommending either clinical course of action. The variation in risk assessment appraisals in this study, despite at times high rates of confidence in risk appraisals, speaks ...

Professional judgment in complex clinical situations such as the assessment of suicide risk encompasses a multifaceted cognitive understanding of the substantive issues, technical expertise, and emotional awareness. This experimental design study investigated the degree to which the previous work-related experiences of clinicians and their preexisting emotional state influence professional judgment regarding acute risk in patients presenting with suicidal ideation. Experienced social workers and social work students conducted suicide risk assessments on 2 standardized patients performing in scenarios constructed to depict individuals presenting with suicidal ideation. This study revealed significant variations in clinical judgments of practitioners assessing suicide risk. While scores on standardized risk assessment measures were the strongest predictor of judgments regarding the need for hospitalization to ensure the safety of the patient, other influences included clinician age and levels of posttraumatic stress symptoms. Mental health clinicians and organizations that employ them should be aware of possible individual influences on professional judgments related to suicide risk.

To identify the key factors that are necessary to account for in planning and developing rehabilitation and community services for stroke based on users' perspectives.A meta-synthesis of qualitative research comprising three stages: (i) systematic searching and identification of relevant reports; (ii) critical appraisal of selected reports; (iii) analysis and synthesis of included reports.A total of 138 reports were identified, 101 were rejected after applying the inclusion criteria. Following critical appraisal, 18 papers were included. The main interconnecting themes relate to how the impact of stroke is influenced by: (i) the person; (ii) close social relationships; (iii) the social environment; (iv) interactions between all three. The lines-of-argument synthesis relates to the social world a person inhabits and its effect on how a person will perceive and deal with their stroke. Support will be most effective when delivered in the context of this social world.How stroke is perceived is highly dependent on a person's identity. Support can be effective if delivered within the existing structures of a stroke survivor's unique social world.

This study explores the experiences and perceptions of clinicians from a range of professions to articulate general principles for clinical supervision in mental health. Seventy-seven volunteer clinicians participated in 14 focus groups in 2008–2009. They discussed their perceptions about clinical supervision, facilitators, and barriers. Discussions were digitally recorded and transcribed verbatim, and qualitative analytic methods were used to identify themes and exceptions. The study found frontline clinicians identified interacting factors they associated with quality clinical supervision. Themes related to the structure, content, and process of supervision and contained common elements across professions and those that were specific to nursing. Considerable agreement exists regarding principles for interprofessional supervision in mental health; that it is available on a regular and crisis-responsive basis, and that supervisors are expert in clinical interventions for specific populations and have the ...

Background: The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia. Methodology: A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records. Results: Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis. Conclusions: In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change.

This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts.A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended.The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction.Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

Substantial organizational change in many health institutions has eliminated profession-based departments and replaced them with program management structures. This article aims to explore practitioners' perceptions of their professional work in a large urban centre for addiction and mental health that has undergone such change. Seventy-six practitioners from six professions participated in focus groups that were transcribed and analyzed. Practitioners' perceptions about their professional competence, performance, development, and job satisfaction were affected by three interrelated factors: available supervision from experts who validate practitioners' subjective work experiences and provide population-specific knowledge for effective interventions; teams that provide a home base and support through positive interpersonal relations, collaboration and informal feedback; and organizations and managers who provide assistance and training while expecting quality performance and productivity. Effective clinical and organizational leaders manage tensions between providing supportive environments and expecting accountability throughout the workplace.

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

In a recent survey the Learning and Teaching Support Network (LTSN) Generic Centre asked all subject centres to articulate the three most important issues on assessment in their subject. The LTSN Mathematics, Statistics and Operational Research Network at the University of Birmingham responded as follows:1. Issues in computer-aided assessment, which include reliability, robustness and ease of use. It should also apply to both formative and summative assessment in the forms of diagnostic, continuous and formal testing. There are at least two special issues for mathematics, which are applicable to other numerate disciplines such as science and engineering:– display and input of mathematical expressions; for example, with powers and fractions that typically display over several lines; and– equivalently right answers; for example, in mathematical terms x+y is the same as y+x and this would cause some difficulty if standard character matching techniques were employed as the only method for comparing answers.

Differentiation of osteomyelitis from cellulitis or septic arthritis can be difficult. The radiological examination often does not have the characteristic features. Seventy of 71 children with osteomyelitis had focal areas of increased radioactivity at the site of the infection. The addition of “blood pool” images aids in the interpretation of the study as they permit evaluation of the effect of hyperemia. The 13 children with cellulitis had diffuse increase in radioactivity involving both the bones and soft tissues. Bone imaging as the initial screening procedure for osteomyelitis is recommended.