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Australian prisons are overpopulated with people suffering from numerous health problems. COVID-19 presents a significant threat to prisoner health. This article examines the current regulatory responses from Australian state and territory governments to COVID-19 and a recent case which tested the human rights of prisoners during a pandemic.

The doctrine of consent (or informed consent, as it is called in North America) is built upon presumptions of mental capacity. Those presumptions must be tested according to legal rules that may be difficult to apply to COVID-19 patients during emergency presentations. We examine the principles of mental capacity and make recommendations on how to assess the capacity of COVID-19 patients to consent to emergency medical treatment. We term this the CARD approach (Comprehend, Appreciate, Reason, and Decide).

Objective This study aimed to examine the quality of mental health certificate (MHC) completion in rural and remote New South Wales, to include the determination of those identified as mentally ill or mentally disordered, and subsequent processes thereafter. Methods MHCs were collected from April 2016 to March 2017. A de-identified review was undertaken and audited for completion of mandatory criteria. Data were separated by three groups of completing health practitioners, and descriptive and inferential statistics calculated to assess for differences between groups. Results A total of 277 MHCs were included. Local medical officers were significantly more likely to: have longer assessment periods, indicate mentally disordered rather than mentally ill, and to have the mental health certificate revoked upon reassessment at a declared mental health facility, than their psychiatry or accredited person peers. They were also significantly less likely to complete documentation relating to behaviour personally assessed or observed by others. Conclusion This study identified inconsistencies in documentation completion between groups, highlighting training opportunities for non-mental health specialists, particularly mental health assessment and lawful detention requirements. Attention to this is warranted within medical training syllabuses, post-graduate training and support programs.

Aims and objectives To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. Background Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. Design This study used an exploratory descriptive qualitative approach guided by self-determination theory. Method A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. Results Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. Conclusions This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. Relevance to clinical practice Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Aim and objectives:\ud To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals.\ud \ud Background:\ud Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate.\ud \ud Design: \ud A cross‐sectional survey using the STARD guidelines was used.\ud \ud Methods:\ud The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open‐ended question on violence prevention management strategies was also conducted.\ud \ud Results:\ud Comprising of 14 items with two factors (patients and staff), the study revealed a 9‐item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies.\ud \ud Conclusions:\ud The use of the 9‐item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting.\ud \ud Relevance to clinical practice:\ud The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence.

This study reviews the outcomes of programmes teaching empathy to post-graduate nurses.Nurses who are able to empathise with their patients, place themselves within a preferred position to deliver better patient outcomes. There have been substantial efforts to improve the empathy skill level of undergraduate nursing students, with success but understanding this skill level at the post graduate level is limited.An integrated literature review of the qualitative and quantitative literature on nurse post graduate education programmes over the last 10 years was conducted.CINAHL, Medline, Psych-Info, Google Scholar and hand searching of reference lists of relevant papers were used.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.The review includes nine quantitative non randomised studies and one qualitative study. The findings suggest that empathy skills in post graduate nurses can be improved, but given the variation in the operational definition of empathy used, range in frequency and length of training and speciality specific requirements further work is needed to understand the use of 'empathy' in the post graduate nurse.Future non university based or 'in house' empathy education in nursing should focus on the post graduate nurse and the needs of their clinical specialties.

The COVID‐19 pandemic has created a heightened state of anxiety and fear in many communities (Usher, Durkin, & Bhullar, 2020), particularly within vulnerable populations (such as the elderly, people with disability and people with mental illness; prisoners and asylum seekers). These vulnerable populations are already sensitive to the use of restrictive practices, namely, the use of interventions that restrict the rights or freedom of movement of patients via restraint (chemical, mechanical, social or physical) and seclusion. These concerns are exacerbated in a time of pandemic (World Health Organization, 2020). The laws in all Australian jurisdictions require consideration of the principle that the freedom of people in care is restricted as little as possible. It is therefore essential that restrictive practices are undertaken lawfully and with careful consideration (Chandler, White, & Wilmott, 2016). Two recent decisions of tribunals illustrate these concerns (See Box 1).

Background Workplace violence prevalence has attracted significant attention within the international nursing literature. Little attention to non-mental health settings and a lack of evaluation rigor have been identified within review literature. Objectives To examine the effects of a workplace violence training program in relation to risk assessment and management practices, de-escalation skills, breakaway techniques, and confidence levels, within an acute hospital setting. Design A quasi-experimental study of nurses using pretest-posttest measurements of educational objectives and confidence levels, with two week follow-up. Setting A 440 bed metropolitan tertiary referral hospital in Sydney, Australia. Participants Nurses working in specialties identified as a ‘high risk’ for violence. Method A pre-post-test design was used with participants attending a one day workshop. The workshop evaluation comprised the use of two validated questionnaires: the Continuing Professional Development Reaction questionnaire, and the Confidence in Coping with Patient Aggression Instrument. Descriptive and inferential statistics were calculated. The paired t-test was used to assess the statistical significance of changes in the clinical behaviour intention and confidence scores from pre- to post-intervention. Cohen's d effect sizes were calculated to determine the extent of the significant results. Results Seventy-eight participants completed both pre- and post-workshop evaluation questionnaires. Statistically significant increases in behaviour intention scores were found in fourteen of the fifteen constructs relating to the three broad workshop objectives, and confidence ratings, with medium to large effect sizes observed in some constructs. A significant increase in overall confidence in coping with patient aggression was also found post-test with large effect size. Conclusions Positive results were observed from the workplace violence training. Training needs to be complimented by a multi-faceted organisational approach which includes governance, quality and review processes.

Generalist health professionals (GHPs) or those healthcare professionals working in nonmental health facilities are increasingly being required to provide care to consumers with a mental illness. The review aimed to synthesize the qualitative research evidence on the meanings and interpretations made by GHPs (nonmental health professional) who interact with consumers with mental illness in nonmental health settings. A systematic review of the qualitative literature was undertaken for the years 1994-2016. The following electronic databases were searched: CINAHL, MEDLINE, PsycINFO, and Sociological Abstracts. Using narrative synthesis methods, the following themes were identified: mental health knowledge (the GHPs' knowledge level about mental illness and how this impacts their experiences and perceptions); GHPs perceive mental illness as a safety risk (GHPs concern over harm to the consumer and themselves); organizational support (the system response from the environmental design, and expert support and care); and emotional consequences of care (the feelings expressed by GHPs based on their experiences and perceptions of consumers). The results suggest that GHPs provide care in a setting which consists of multiple understandings of what care means. Efforts beyond educational initiatives such as organizational and system-level changes will need to be implemented if we are to progress care for this consumer group.

Background Workplace violence in healthcare remains a significant issue for healthcare professional, in terms of risk to patients and staff. One part of a workplace violence prevention and management programme is to educate staff in their response to critical events. Drawn from the disaster management literature, tabletop exercises were used in this study to simulate workplace violence and educate staff on the appropriate emergency response during a violent event. The use of tabletop exercise in this context is a novel approach to workplace violence prevention management. Aim and objective This study describes the development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention and management emergency response systems. Methods Using a sequential explanatory mixed method design. The study comprised of two phases 1) quasi–experimental (quantitative) and 2) focus group (qualitative) to evaluate the effectiveness of the violence prevention management tabletop exercises. COREQ guidelines were followed the qualitative arm of the study and the TREND statement for the quantitative part of the study. Results Statistically significant improvements in healthcare professional confidence levels were found two weeks post the tabletop exercises. A post focus group revealed three categories concerning the participant’s experiences of the tabletop exercises, (role clarity, adult learning and organisational support). Conclusion Tabletop exercise may provide a, low cost, context specific novel approach to educating staff in emergency violence response systems at a tertiary referral hospital. Educators and policy makers may consider the use of tabletop exercises in the ongoing work in preparing health care staff for workplace violence. Relevance to clinical practice Successful tabletop exercises should consider a local ward level context, the use of adult learning principles, have high level organisational support and cover role clarity as a key learning area.

The process of handover has received recent attention within Australian health care, as evidence linking patient safety with the quality of handover emerges. Such links between clinical handover and patient safety have been reported elsewhere in the literature, where it is posited that the safe care of patients relies not only on the expertise and judgment of individual clinicians, teamwork, and effective management, but hinges to a large extent on the quality of information transferred from team to team. The present qualitative, descriptive study used participant observations, focus groups, and interviews to investigate the nursing handover in two acute mental health inpatient units in New South Wales, Australia. Data collected as part of that investigation contributed to the development of a handover guideline that incorporates the key components of structure, content, and leadership. The research indicated a link between these components, and further revealed the necessity to have other forums, such as supervision and clinical review, to ensure that handover serves its intended purpose in an efficient manner.

Eating and substance use disorders frequently co-occur in clinical samples. This comorbidity presents a particular challenge due to increased medical complications, higher relapse rates, psychiatric comorbidity, and poorer overall outcomes for both disorders, and is associated with specific medical and psychiatric difficulties that contribute to complexity in diagnosis and treatment. However, patients with co-occurring substance use and eating disorders do not widely receive structured standardized assessment or treatment for eating disorders in substance use treatment settings. Focus groups were conducted to seek clinician's knowledge and perceptions of screening and care planning for eating disorder presentations in a rural substance use treatment setting. The study adheres to COREQ guidelines. To analyse the focus group data, the authors utilized thematic analysis and three major themes emerged as follows: beliefs about clients (stereotypical views, complexity of comorbidity, client expectations), understanding of self (lack of knowledge/skills, professional role), and organizational barriers and enablers. Whilst identifying a significant number of clinician and organizational barriers to providing screening and treatment of eating disorders in a substance use treatment setting, focus group discussions also highlighted a number of potential enablers. Most notably clinicians identified a willingness to provide screening and care planning if they were provided with education, a clinical pathway and access to screening tools. A consensus conferencing approach facilitated construction of a clinical pathway to enable the service to provide screening, assessment, and treatment planning for clients with comorbid eating disorder.

Aims and Objectives: The aim of this paper was to evaluate the impact of phone support on sick day management of young people with type 1 diabetes.Method: Qualitative exploratory study to understan...

Aims and objective To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance.

Generalist health professionals, often without formal mental health training, provide treatment and care to people with serious mental illness who present with physical health problems in general hospital settings. This article will present findings from a constructivist grounded theory study of the work delivered by generalist health staff to consumers with mental illness on the general medical/surgical wards of two metropolitan hospitals in Sydney, Australia. The results analysed included three participant observations, two focus groups, and 21 interviews and hospital policy and protocol documents. A substantive theory of mental health work in general hospital settings is illustrated which conceptualizes the following categories: (i) the experience: conflicting realities and ideals; (ii) The Context: facilitating social distancing; and (iii) the social processes: invisibility affecting confidence. The categories are understood through the theoretical lens of symbolic interactionism with the theory providing insights into how the generalist health professionals understand their sense of self or identity.

This paper discusses the development of a mental health nurse clinician to a mental health nurse researcher. Understanding the theoretical and professional drives that shape mental health nurses clinical practice and how that links to becoming a researcher is discussed. Mental health nurses who conduct research have to often move between their clinical roles and that of the researcher, doing this safely using a reflective supervision approach enables the nurse to conduct the research from a stronger professional and ethical standpoint. The intention of the paper is to encourage mental health nurses to engage in research and development. Shifting between the positions of a mental health nurse clinician and a qualitative researcher has some parallels to the processes in the nurse-service user relationship. This paper addresses this development from practitioner to researcher in one mental health nurse's journey through a PhD study using constructivist grounded theory. The paper examines theoretical and professional drives that have shaped my clinical practice and the role of the researcher in constructivist grounded theory, the notion of the researcher shifting between insider and outsider status, and the importance of reflexivity in conducting research. These influences will be discussed in the context of the development of a constructivist grounded theory study of the delivery of health care to service users with a mental illness in general hospital wards.

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource.

This paper describes a modified Delphi approach to developing a set of direct care activities for assistants in nursing (AIN) working in mental health settings within a metropolitan local health district (LHD). Although AIN have been employed in a range of health care settings in recent years, they have not routinely been placed in the mental health context. A modified Delphi method was utilised as it has a proven history of application in the health sector, particularly in circumstances where new guidelines, policies or practice frameworks were required. A set of direct care activities for working in mental health settings was developed from an initial set of baseline descriptors and then two rounds of consensus conferencing with a panel of experts. This paper will detail that process and discuss the resulting implications for the consensus reached on the set of direct care activities.

AIM To gain insight into medical surgical nurses' process(es) of categorising mental illness in general hospitals. BACKGROUND Categorising patients is a daily social practice that helps medical surgical nurses understand their work and actions. Medical surgical nurses' categorising of mentally ill patients in general hospitals is a means in which they articulate their understanding of mental illness and perform their clinical practice. How medical surgical nurses categorise, and the impact that categorising can have on their work practices is poorly understood. DESIGN A focus group study. METHOD Focus group discussions (n = 2) of medical surgical nurses' understanding and experience of delivering care to patients with mental illness in a general tertiary referral hospital were conducted in November 2014. Discourse analysis was used to analyse the transcribed data to uncover how participants made discursive evaluations and how this related to their daily clinical practice. RESULTS The analysis uncovered participant's use of four categories of mentally ill patients: the managed, the unpredictable, the emotional and the dangerous. For participants these categories explained and justified their clinical practice as linked to the challenges and barriers they experienced in providing effective care within the larger healthcare organisation. CONCLUSION The language used by medical/surgical reflects the wider discourse of managerialism in healthcare organisations. The recognition of these categories can be used by educators, liaison mental health services and policy makers to reconsider service design and learning opportunities for medical surgical nurses to reduce stigmatisation of patients with mental illness.

Generalist health care professionals are increasingly challenged to provide mental health care within their own clinical specialties. Educators are challenged with providing innovative, engaging and accessible education programs to increase the mental health knowledge and skills of generalist health care professionals. Simulation is increasingly being used within learning curricula to optimise learning and the use of information and communication technology has emerged as a novel way of providing simulated learning. This paper describes the development process of an interactive, multimedia 'eSimulation' mental health education program for generalist health care professionals. The resulting eSimulation education program incorporated the following five key attributes of simulation: (1) Creating a hypothetical opportunity; (2) Authentic representation; (3) Active participation; (4) Integration; and (5) Repetition, evaluation and reflection. This process can be used to guide nursing educators in the development of tailored eSimulation education programs. An evaluation of the eSimulation will be reported elsewhere, in Part 2 of this paper.

Aim To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’. Background The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a ‘mental health day’ as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. Design Online cross-sectional survey. Methods Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of ‘mental health day’ reportage were determined using logistic regression. Results Fifty-four percentage of the n = 5041 nurse and midwife respondents took ‘mental health days’. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. Conclusion Specific characteristics of nurses and midwives who report taking ‘mental health day’ sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.

Background:There are high rates of cognitive problems and organic and functional psychiatric disorders in patients admitted to general hospital wards, which may necessitate the use of psychotropic medications. There is evidence of over-prescription of medications such as antipsychotics and antidepressants in community settings such as residential care. However, the prevalence of psychotropic use in general hospitals is unknown.Methods:A point prevalence study of the use of psychotropic medications in an acute general hospital was conducted by auditing medication charts for type, dose, indication, and other clinical processes associated with their use.Results:The files of 197 patients were audited, 139 (70%) were aged 65 years and over. Eighty-nine (45%) of patients were prescribed a psychotropic, with 35 (17.7%) antidepressants; 21 (11%) antipsychotics; 19 (10%) benzodiazepines; six (3%) mood stabilizer; five (2%) cholinesterase inhibitors; one (0.5%) anti-parkinsonian medication, and one (1%) patient on zolpidem and another patient melatonin (1%). Most prescriptions (72%) were in people 65 years and over and 27 (20%) of indications were found to be off label prescribing. There were deficits in the documentation of indications for the use of psychotropic medications and follow up arrangements.Conclusions:Rates of benzodiazepines use were less than that reported incomparable settings. Concerns regarding off label prescribing, under-dosing, and lack of adequate documentation of indications and follow-up instructions were raised. Given the potential adverse effects of psychotropic medication, improved governance, and education regarding their use is required.

Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. The lack of adequate mental health educational preparation of general health professionals (GHP) has been identified as a major barrier to meeting the health-care needs of mental health patients. This study aimed to review and synthesize research evidence on mental health education programmes (MHEP) that have been designed to develop the knowledge, skills, and attitudes of GHP. An integrative literature review was conducted following a search of key electronic databases and hand searching of references of relevant papers, and 25 papers met the study inclusion criteria. Knowledge, skill, and attitudinal improvements in GHP post MHEP were shown in most studies. MHEP that included supervised clinical experience, role play, and case scenarios were reported as being more effective. Issues such as patient participation in education, interprofessional education models, and the willingness, interest and, motivation for GHP to be involved in MHEP warrant further research.

Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses.

There has been much recent literature on the technical parameters of electroconvulsive therapy (ECT) with regard to improving efficacy and minimizing adverse effects, but relatively little on ECT service delivery. This paper will discuss the development and characteristics of an ECT service at a teaching hospital in metropolitan Sydney, New South Wales, Australia. A mixture of qualitative and quantitative methods, including a selective literature review and audit of ECT use were used. The results of the audit were compared with the 2007 revision of the Royal Australian and New Zealand College of Psychiatrists' clinical memorandum on ECT. We discuss issues, such as the optimal site for ECT delivery, ECT mental health nurse coordinator role, credentialing of psychiatrists, registrar supervision, and the development of an ECT committee. A significant finding of the audit was that the majority of patients were treated under the New South Wales Mental Health Act, and voluntary patients were more likely to have a diagnosis of a depressive disorder, whereas involuntary patients were more likely to have a non-mood disorder diagnosis. This study has shown that auditing of ECT practices and services by mental health nurses is essential for quality improvement processes. The audit highlighted areas of service delivery that should be subject to review and evaluation against professional standards.

PURPOSE. This paper explores the use of capacity building practice as an approach for the mental health liaison nurse (MHLN). CONCLUSIONS. The role of the MHLN has established itself within nursing, with various approaches to the role documented in the nursing literature. Most descriptions of the role are limited by simply explaining what the MHLN does, rather than explaining the underlying approach and evaluation of the model suggested. Capacity building practice is explored in the context of the liaison role, and its use is demonstrated in a clinical example of suicide risk in a general hospital setting. PRACTICAL IMPLICATIONS. The future scope of MHLN and their use of capacity building approaches may lead to the improvement of consumer health outcomes and also develop the skill of the non-mental health nurse in generalist settings.

Background Consumers with a mental illness have a significantly higher risk of physical health problems than the general population. The role of health behaviour beliefs and their part in the health of consumers with a mental illness has been poorly explored in the literature. Objectives To understand the relationship between physical health risk factors and health behaviour beliefs in consumers with schizophrenia. Design A cross-sectional survey study design using the European Health and Behaviour Survey and assessing ( n =99) consumer's blood pressure, waist circumference, body mass index, smoking history, exercise levels, demographics, family history of diabetes and cardiovascular disease was used. Settings The study was conducted in a 76-bed psychiatric facility located within a 550-bed metropolitan generalist hospital in Sydney, Australia. Participants Patients attending an outpatient clozapine clinic at the mental health service were asked to participate in the survey by a nurse working in the clinic during the study period. Results Of the 163 consumers asked to be involved in the study, n =99 agreed to participate. Mean waist circumference and body mass index for both males and females were significantly above normal population limits. Overall, consumer's beliefs toward their health on the European Health and Behaviour Survey were positive, having statistically significantly more positive attitudes to the statements ‘avoiding too much sugar', ‘drinking no alcohol' and ‘yearly blood pressure checks' than a previously published non-mental health consumer sample. Whilst having positive attitude toward their healthcare, consumers' physical health risk parameters were higher than general population norms. Conclusions Consumers with a mental illness have a significantly higher risk for serious physical health problems, yet possess high positive attitudes toward their physical health care. Models of care need to explore this contradiction within mental health services to improve patient outcomes.

Background: The philosophy of occupational therapy and that of recovery are markedly similar; however, there is limited research linking occupation to recovery in mental health. Aim: This study aimed to explore the relationship between recovery and occupation in consumers with mental health problems. Method: A qualitative method in the form of narratives was chosen in exploring the uniquely subjective experiences of mental health, occupation and recovery. Five members of a mental health support group (GROW) were engaged in semi-structured interviews, whereby individual narratives were analysed through comparative methods to identify categories and themes. Findings: Five categories emerged: (1) The recovery map, (2) GROW has just given me the platform, (3) You have to become active, (4) The great barriers and (5) Where am I now … I couldn't bear it if I was any better. The participants' experiences of recovery highlighted the necessity for occupational engagement in a supported environment. The benefits of occupation included feelings of social cohesion, meaning, purpose, normalisation, routine, competence, productivity, skill acquisition, routine and pleasure. These factors enabled the participants to re-establish self-concepts and subsequently promoted mental health. Implications: The findings may have implications for occupational therapy practice, whereby occupational therapy could facilitate a leadership role in recovery-orientated mental health services.

Aim This study reports on a locally organized model of succession planning in a 550-bed general hospital. Background Within healthcare, succession planning has traditionally been considered for people at the executive director level and little research has been published with nurses working at the clinical level. Method A succession planning model was developed from the literature and through a process of consultation with senior staff. The model was then evaluated from a customer satisfaction, programme progress, effective placement and organizational results perspectives. Nurses who were successful in obtaining a new role were surveyed after 6 weeks in the position. Descriptive statistics, including numbers of placements and types of positions filled, were recorded. A checklist for conducting a programme evaluation of succession planning was also used. Results Twenty-five nurses participated, with 31 positions succeeded to. Nurses reported positively that the programme was beneficial, increased their sense of career planning and gave them a greater understanding of their career pathway. Conclusions The succession planning programme provided an opportunity for the organization to identify new leaders. The study outcomes have identified potential improvements to the way succession planning is conducted at the hospital. Implications for nursing management Nurse Managers are in key positions to develop effective succession planning models. This study offers a process for managers to develop effective succession planning programmes within their organization.

Objective This study aimed to determine the prevalence and predictors of metabolic syndrome in an outpatient clozapine clinic in Australia. Methods Metabolic syndrome is a cluster of some of the most dangerous cardiovascular risk factors, and its high prevalence in people with mental illness has been demonstrated. Patients attending a clozapine clinic were screened for the following: age, gender, ethnicity, waist circumference, blood pressure, high-density lipoprotein level, low-density lipoprotein level, blood sugar levels, total cholesterol level, triglycerides level, weight, body mass index, insulin resistance level, length of time on clozapine, clozapine dose, smoking status, family history of diabetes and cardiovascular disease, and personal history of polycystic ovarian syndrome. All the variables that were found to be significantly associated with metabolic syndrome were entered into a multivariate logistic regression analysis. Results Seventy-three patients were screened for metabolic syndrome using the International Diabetes Federation's (2007) definition. Forty-five (61.6%) patients met the criteria for the syndrome. Increased blood sugar level, high diastolic blood pressure, older age, increased waist circumference, raised triglycerides level, and higher body mass index emerged as significant predictors of metabolic syndrome in the sample. Conclusions This study adds further support for the systematic screening for metabolic syndrome in patients receiving clozapine. The need for intervention programs which screen for and address the modifiable risk factors of metabolic syndrome is discussed.

Practice development is widely described as: ‘ways in which knowledge and skills development is used to provide better patient care’. This article will outline a mental health units approach and experience of implementing collaborative practice development processes which identify values and beliefs and enable the development of a framework of action to effect positive change. A qualitative participatory action research design was used to engage participants in exploring and critiquing relevant workplace culture issues. The project was divided into four chronological stages: values clarification; claims, concerns and issues; barriers, enablers and actions; and action planning. The results of this project highlight a number of issues for practice development approaches. We believe that these processes are easily transferable to other organizations within health care. Copyright © 2009 John Wiley & Sons, Ltd.

Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.

Introduction: Workplace stress among nurses has been associated with high absenteeism, low work satisfaction, and poor retention rates. Aim: This pilot study evaluated the effectiveness of a 1 day stress management program on nurses' stress levels. Methods: The nurse participants attended an 8 h face-to-face interactive workshop based on cognitive behavioral therapy. The subjects also were given a self-directed manual with reading and exercises to use after the workshop. The nurses were assessed at baseline and at 6 weeks postworkshop attendance using the Nurse Stress Scale (NSS). They were asked to rate their level of stress at work, outside of work, and their overall stress. The participants also were asked to evaluate the perceived usefulness of the workshop at follow-up. Results: The sample consisted of 18 new graduate nurses halfway through their first year. The NSS subscales “nurse–doctor conflict”, “death and dying”, and “nurse–nurse conflict” showed statistically significant improvement at follow-up. The ratings of stress at work, outside of work, and the overall stress also showed statistically significant improvement. Conclusions: The workshop was well-received by the new graduate nurses. The pre/post findings suggest a beneficial effect of the intervention. The authors are encouraged by the results and now plan to conduct a multisite, randomized controlled trial to seek to establish a wider evidence base for the intervention.

Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.

Preventing suicide can depend upon the ability of a range of different health professionals to make accurate suicide risk assessments and treatment plans. The attitudes that clinicians hold towards suicide prevention initiatives may influence their suicide risk assessment and management skills. This study measures a group of non-mental health professionals' attitude towards suicide prevention initiatives. Health professionals that had attended suicide prevention education showed significantly more positive attitudes towards suicide prevention initiatives. The findings in this study further support the effectiveness of educating non-mental health professionals in suicide risk awareness and management.

The overseas qualified nurse (OQN) has become an important part of the Australian nursing workforce. Efforts to enhance their adjustment to work and life in Australia have been recommended in the literature. This study examines the experiences and needs of a group of OQNs at a major metropolitan tertiary referral hospital in Australia. Using a descriptive survey, 56 nurses reported their experiences with three major themes emerging, career and lifestyle opportunities, differences in practice and homesickness. Nurses from culturally and linguistically diverse backgrounds reported not being employed in their chosen speciality and rating the utility of ward and hospital orientations more positively when compared to English speaking background nurses. From the study results an organisational and a personal approach has been undertaken to aid in the adjustment of OQNs into the nursing workforce. (author abstract)

Projected nursing shortfalls in Australia have identified the need for organisational planning and strategies around recruitment and retention in healthcare facilities. Strategies include but are not limited to alliances with university faculty and the quality of undergraduate clinical placement experience. This cross-sectional study explored undergraduate nursing students' satisfaction with clinical placement experience from the perspective of multiple university faculties, and the relationship this has with future employment intention at a metropolitan hospital in Sydney, New South Wales. Findings from respondents demonstrated satisfaction with the clinical placement on the following criteria: expectations being met; welcoming of unit staff and attitudes of thereafter; clinical and university facilitator support; and participation in patient care. Three quarters of respondents also indicated that they would consider the hospital as a future employer. Satisfaction with clinical placement experience may aid organisational recruitment strategies.

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource.

& Sons Ltd. Aim: To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. Background: Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context. Methods: A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings. Results: The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance. Conclusion: These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders. Implications for nursing management: To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention. © 2015 John Wiley

This paper reports on an evaluation of an eSimulation mental health education program for generalist nurses; developed using the following five key attributes of simulation: (1) creating a hypothetical opportunity; (2) authentic representation; (3) active participation; (4) integration; (5) repetition, evaluation and reflection. Four themes emerged from a qualitative thematic analysis of semi-structured interview data involving fourteen generalist nurses. The following four themes: (1) authenticity; (2) participation; (3) clinical reasoning; (4) control of learning provide supporting evidence that these attributes are positioned within the learning resource. Participants found the scenarios within the resource realistic, engaging and relevant to their scope of practice. This type of learning resource may help in developing the knowledge, skills and confidence of generalist nurses in delivering safe and competent mental health care in the generalist setting, when access to specialist services and appropriate means of training are unavailable.

The need for Australian health care organisations to deliver culturally competent and safe care to its increasingly diverse population provided the impetus for the development of an interactive eSimulation module “Communicating with Patients from Culturally and Linguistically Diverse Backgrounds, Case Study: Ms Shu Fen Chen”. This article discusses the rationale, development and implementation of the module. Feedback from sixty nurses and allied health professionals indicated the module was highly engaging and had a positive impact on learners' confidence, knowledge and clinical practice. It is concluded that eSimulation modules can contribute to the uptake of cultural competency training and create a foundation for further initiatives to enhance the provision of culturally competent health care.

Objective This retrospective study aimed to explore the appropriate application and implications of Mental Health Act 2007 (NSW) (MHA) certificate use in a metropolitan generalist hospital in New South Wales. Methods A de-identified MHA certificate review was undertaken within acute generalist medical and surgical specialties between June 2012 and May 2013. To assess differences, data were separated into two categories according to whether certificates were completed by psychiatry trainees or generalist medical officers. Analysis of indications for detention was also undertaken and qualitatively matched against legislative criteria. Results A total of 43 MHA certificates were included in the review, which highlighted missing elements in most certificates. Differences were found when professional consensus by the researchers was used to match documentation to legislative criteria. The researchers disagreed with nine of the 16 indications (mental illness/mental disorder) by the generalist medical officers and only one indication by a psychiatry trainee. Six of the certificates appeared to be related to lack of capacity and need for treatment of medical conditions, thus more related to Guardianship Act 1987 (NSW) applications. Conclusion This study highlights inconsistencies in legislative knowledge and requirements between professional groups. Education and training opportunities have been identified to ensure greater consistency in application of the MHA, preservation of patient rights and avoidance of stigma. MHA use in this setting should be exercised with caution and by appropriately trained individuals. What is known about the topic? The MHA and its state and territory counterparts provide for the treatment, care and support of people who have a mental illness and the protection of a person’s rights therein. Despite not being intended for application in generalist facilities, mental health legislation is widely used in generalist facilities and certificates are completed by generalist health professionals with limited training in this area of practice. What does this paper add? This study adds to the limited body of knowledge in relation to MHA detention in acute generalist facilities. Disparate preparation of medical officers in the use of this legislation has been identified, which has potential wider implications for patients beyond immediate care. What are the implications for practitioners? Inadequate attention to correct completion of MHA certificates and associated documentation could potentially invalidate detention, leaving healthcare professionals and institutions open to litigious claims that restrictive or coercive practices subsequent to the certificate’s completion were technically unlawful. Further, detention under the MHA, albeit temporarily, has potential human rights issues attached and wrongful detention could lead to longstanding issues relating to stigma.

Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. The lack of adequate mental health educational preparation of general health professionals (GHP) has been identified as a major barrier to meeting the health-care needs of mental health patients. This study aimed to review and synthesize research evidence on mental health education programmes (MHEP) that have been designed to develop the knowledge, skills, and attitudes of GHP. An integrative literature review was conducted following a search of key electronic databases and hand searching of references of relevant papers, and 25 papers met the study inclusion criteria. Knowledge, skill, and attitudinal improvements in GHP post MHEP were shown in most studies. MHEP that included supervised clinical experience, role play, and case scenarios were reported as being more effective. Issues such as patient participation in education, interprofessional education models, and the willingness, interest and, motivation for GHP to be involved in MHEP warrant further research.

Difficult nurse-patient relationships are an area where general nurses can improve their knowledge, confidence and skill. This chapter describes a user-centred approach used to create a low-cost e-simulation of a commonly occurring case of manipulative patient behaviour. This e-simulation required nurses to focus on specific problems, gain understanding about the possible causes, and use empathetic understanding of what was needed to improve patient care. Specific examples from our experience of including nurses from the very beginning of the design process illustrate how everyday technology can provide an authentic experience of difficult nurse-patient behaviours to prepare general nursing staff who are facing a higher incidence of mental illness in patients that are now in the general hospital setting.

Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses.

There has been much recent literature on the technical parameters of electroconvulsive therapy (ECT) with regard to improving efficacy and minimizing adverse effects, but relatively little on ECT service delivery. This paper will discuss the development and characteristics of an ECT service at a teaching hospital in metropolitan Sydney, New South Wales, Australia. A mixture of qualitative and quantitative methods, including a selective literature review and audit of ECT use were used. The results of the audit were compared with the 2007 revision of the Royal Australian and New Zealand College of Psychiatrists' clinical memorandum on ECT. We discuss issues, such as the optimal site for ECT delivery, ECT mental health nurse coordinator role, credentialing of psychiatrists, registrar supervision, and the development of an ECT committee. A significant finding of the audit was that the majority of patients were treated under the New South Wales Mental Health Act, and voluntary patients were more likely to have a diagnosis of a depressive disorder, whereas involuntary patients were more likely to have a non-mood disorder diagnosis. This study has shown that auditing of ECT practices and services by mental health nurses is essential for quality improvement processes. The audit highlighted areas of service delivery that should be subject to review and evaluation against professional standards.

Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care. This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed. Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations.

This paper explores the use of capacity building practice as an approach for the mental health liaison nurse (MHLN).The role of the MHLN has established itself within nursing, with various approaches to the role documented in the nursing literature. Most descriptions of the role are limited by simply explaining what the MHLN does, rather than explaining the underlying approach and evaluation of the model suggested. Capacity building practice is explored in the context of the liaison role, and its use is demonstrated in a clinical example of suicide risk in a general hospital setting.The future scope of MHLN and their use of capacity building approaches may lead to the improvement of consumer health outcomes and also develop the skill of the non-mental health nurse in generalist settings.

BRUNERO S, LAMONT S and COATES M. Nursing Inquiry 2010; 17: 65–74 A review of empathy education in nursing The ability for nurse educators to improve the empathy skill set of nurses has been the subject of several studies with varied outcomes. The aim of this paper is to review the evidence for empathy education programmes in nursing and make recommendations for future nurse education. A review of CINAHL, Medline, Psych Info and Google Scholar was undertaken using the keywords empathy, person centredness, patient centredness, client centredness, education and nursing. The studies included were required to have measured the effectiveness of empathy training in postgraduate and or undergraduate nurses. The included studies incorporated both qualitative and quantitative methods and were published in peer-reviewed journals. Studies were ranked for level of evidence according to The Joanna Briggs Institute criteria. Seventeen studies from the literature review were found that met the inclusion criteria. Of the 17 studies, 11 reported statistically significant improvements in empathy scores versus six studies that did not. Several variables may affect empathy education that need to be accounted in future studies such as; gender, cultural values and clinical speciality experience. Models of education that show most promise are those that use experiential styles of learning. The studies reviewed demonstrated that it is possible to increase nurses’ empathic ability.