Health risk behaviours and health care needs among people with psychiatric illness

This paper presents findings from two studies. Study 1 explored differences between people with psychiatric illness (PPI) (N=144) and the general population (N=151) in levels of low-fat diet, exercise and smoking. Study 2 investigated barriers and health care needs of PPI (N=60). The prevalence of overweight, cigarette smoking and sedentary lifestyle were significantly greater among PPI than the general population. Major predictors were limited social support, knowledge of correct dietary principles, lower self-efficacy, psychiatric symptomatology and various psychotropic drugs. The findings demonstrated that PPI over-used medical services but under-used preventive services due to inaccessibility, lower satisfaction and knowledge of services.

Patient safety, ethics and whistleblowing : a nursing response to the events at the Campbelltown and Camden Hospitals

In November 2002, in what stands as one of the most significant whistleblowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned.

Measurement for improvement: a survey of current practice in Australian public hospitals

Objective:
To identify patient safety measurement tools in use in Australian public hospitals and to determine barriers to their use.

Design:
Structured survey, conducted between 4 March and 19 May 2005, designed to identify tools, and to assess current use of, levels of satisfaction with, and barriers to use of tools for measuring the domains and subdomains of: organisational capacity to provide safe health care; patient safety incidents; and clinical performance.

Participants and setting:
Hospital executives, managers and clinicians from a nationwide random sample of Australian public hospitals stratified by state and hospital peer grouping.

Main outcome measures:
Tools used by hospitals within the three domains and their subdomains; patient safety tools and processes identified by individuals at these hospitals; satisfaction with the tools; and barriers to their use.

Results:
Eighty-two of 167 invited hospitals (49%) responded. The survey ascertained a comprehensive list of patient safety measurement tools that are in current use for measuring all patient safety domains. Overall, there was a focus on use of processes rather than quantitative measurement tools. Approximately half the 182 individual respondents from participating hospitals reported satisfaction with existing tools. The main reported barriers were lack of integrated supportive systems, resource constraints and inadequate access to robust measurement tools validated in the Australian context. Measurement of organisational capacity was reported by 50 (61%), of patient safety incidents by 81 (99%) and of clinical performance by 81 (99%).

Conclusion:
Australian public hospitals are measuring the safety of their health care, with some variation in measurement of patient safety domains and their subdomains. Improved access to robust tools may support future standardisation of measurement for improvement.

Developing a process model for deployment of radion frequency identification technology (RFID) in hospitals : an action research framework

Radio Frequency Identification (RFlD) technology is increasingly being explored for deployment in hospitals to improve their existing processes. In recent years, RPID pilots has lead to full scale implementation in hospitals, especially for tracking of expensive equipment as well as movable assets that are critical in surgeries. However, academic research is yet to emerge with a generic process model that can be adapted contextually for deployment of RPID in particular hospital settings. In this paper, we propose an action research framework for a pilot implementation of RPID in a large Indian hospital, the experiences of which will contribute to and result, in the development of such a process model.

Interventions for reducing the use of seclusion in psychiatric facilities : a review of the literature

Background The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

Aims To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

Method We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Results Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Conclusions Reducing seclusion rates is challenging andgenerally requires staff to implement several interventions.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for consumers of mental health services. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.

The aim is to review the research on seclusion-reduction initiatives in psychiatric facilities. We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and postseclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review. Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion. Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Intervention designed to reduce the use of summary execution in acute psychiatric inpatient settings

Context: Although it may seem preposterous to consider the need to reduce the use of summary executions in acute psychiatric inpatient settings because practitioners simply would not consider using such inhumane treatment, it is sobering that many mental health professionals do not hesitate to use seclusion.

Objectives: We draw attention to the assumption that underlies the thinking of many mental health professionals that seclusion is acceptable simply because it is available.

Key messages: The letter of the law (seclusion is legal) is frequently given precedence over the spirit of the law (seclusion should used as a method of last resort, if at all). The availability of seclusion as an intervention makes its use inevitable. Although sufficient checks and balances exist in society to prevent psychiatric staff from adding summary executions to their ‘‘treatment’’ paradigms, legislators need to set the bar much higher. Outside intervention, in the form of legislation, is needed because the mental health professions seem incapable of discontinuing the use seclusion despite evidence of the trauma it causes to both patients and staff and despite the lack of evidence that it achieves any desirable outcomes.

Conclusion: The use of seclusion is unacceptable and should be as impossible and unthinkable as summarily executing our patients. By the use of what would seem, at first glance, an absurd analogy between seclusion and summary execution we highlight the need for a shift in policy and legislation regarding the use of traumatising interventions.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Background: Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for psychiatric consumers. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.
Aims: To review the research on seclusion-reduction initiatives in psychiatric facilities.
Methods: We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and post-seclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review.
Results: Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion.
Conclusion: Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Reducing seclusion in acute psychiatric inpatient settings : a need for strong leadership

Background: Seclusion is of limited therapeutic value and can be a harmful and traumatic experience for psychiatric consumers. Many psychiatric facilities have made substantial efforts to eliminate seclusion or reduce this practice to negligible levels.

Aims: To review the research on seclusion-reduction initiatives in psychiatric facilities.

Methods: We reviewed the peer-reviewed, English-language literature on seclusion reduction initiatives. We sourced 16 papers that focused on seclusion reduction initiatives and in which pre- and post-seclusion data were reported. Opinion-based papers and research that focused solely on pharmaceutical methods to reduce seclusion were excluded from our review.

Results: Successful seclusion reduction initiatives typically involved senior management implementing multiple changes within the facilities. Although commonalities exist with regard to the interventions used in these facilities to reduce seclusion (e.g., treatment plan improvement, monitoring seclusion episodes, changing the therapeutic environment), the ways in which these initiatives were combined tended to be unique to each organisation. State-level organisations sometimes provided the impetus for such changes to be made. There is strong evidence that changes made to psychiatric facilities were effective in reducing or eliminating seclusion.

Conclusion: Seclusion reduction in psychiatric facilities requires strong leadership from senior management. Sometimes leadership from state-level organisations accelerates a seclusion reduction agenda.

Cardiovascular health behaviours and health needs among people with psychiatric disabilities

Recent research in Australia has found that people with a mental illness experience higher mortality rates from preventable illnesses, such as cardiovascular disease, respiratory disease and diabetes compared to the general population. Lifestyle and other behavioural factors contribute significantly to these illnesses. Lifestyle behaviours that affect these illnesses include lack of physical activity, consumption of a poor diet and cigarette smoking. Research on the influence of these factors has been mainly directed towards the mainstream population in Australia. Consequently, there remains limited understanding of health behaviours among individuals with psychiatric disabilities, their health needs, or factors influencing their participation in protective health behaviours. This thesis presents findings from two studies. Study 1 evaluated the utility of the main components of Roger’s (1983) Protection Motivation Theory (PMT) to explain health behaviours among people with a mental illness. A clinical population of individuals with schizophrenia (N=83), Major Depressive Disorder (MDD) (N=70) and individuals without a mental illness (N=147) participated in the study. Respondents provided information on intentions and self-reported behaviour of engaging in physical activity, following a low-fat diet, and stopping smoking. Study 2 investigated the health care service needs of people with psychiatric disabilities (N=20). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were significantly greater among people with a mental illness compared to that reported for individuals without a mental illness. Major predictors of the lack of intentions to adopt health behaviours among individuals with schizophrenia and MDD were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, a limited social support network and a high level of psychiatric symptoms. In addition, findings demonstrated that psychiatric patients are disproportionately higher users of medical services, but they are under-users of preventive medical care services. These differences are primarily due to a lack of focus on preventive health, feelings of disempowerment and lower satisfaction of patient-doctor relationships. Implications of these results are discussed in terms of designing education and preventive programs for individuals with schizophrenia and MDD.